Child and Preadolescent Nutrition

Child and Preadolescent Nutrition

• Middle childhood is defined as ages five to ten years
• Preadolescence (school-age) spans ages nine to 11 years for girls, and ten to 12 years for boys

Normal Growth and Development

• Growth is influenced by genetics and hormones
• Growth and development results from the combined actions of genetics, hormones, and nutrition
• Genetics determine height and body size
• Hormones biochemically affect growth

Hormonal Influence

• The endocrine system, hypothalamus, and pituitary gland secrete and encourage hormones during growth periods
• Hormones use instructions from genes to regulate growth and development

Genetics and Height Prediction

• Mother's and father's heights determines child's potential height
• Add 5 inches (13 cm) if calculating for a boy, subtract if calculating for a girl
• Divide the result by two for the predicted height

Growth Considerations

• Growth velocity slows during school-age years
• Periodic monitoring of growth is important
• A mild growth spurt occurs around 6 to 7 years of age and associates with adiposity rebound
• "Midgrowth spurt" involves a small increase in growth velocity between ages 4 and 8 years
• Weight and height should be plotted on an appropriate growth chart

Physiological and Cognitive Development

• Muscular strength, motor coordination, and stamina increase with physiological development
• Increasing complex pattern movements occur
• Body fat reaches a minimum then increases preparing for adolescent growth spurt
• Self-efficacy, or an understanding of what and how to do something, appears during cognitive development
• Cognitive development marks changed from magical thinking/egocentrism to concrete operations
• As children develop cognitively, they develop sense of self
• Children become more independent and learn family roles
• Peer relationships become important

Feeding Skills and Eating Behaviors

• Parental preferences impact a child’s food likes/dislikes
• Family meals together are encouraged
• Snacks are needed to meet nutritional needs
• A responsive feeding style should be adopted, and food preference development as well as appetite and satiety should be accomodated

Influences on Food Choices

• Peer influence grows along with the child’s world/experience outside the family
• Children want to try foods on television
• Fast-food establishments are also attractive

Body Image and Dietary Intake

• Mother’s weight concerns may influence feeding practices
• Young girls become preoccupied with weight and size early on

Nutrition and Growth

• Sufficient macro and micronutrients are required for growth
• Adequate calories ensure growth occurs normally
• Nutrition needs vary at each developmental stage

Energy and Nutrient Needs

• Energy needs vary by activity level and body size
• Dietary Reference Intakes (DRIs) bases energy level on gender, age, height, weight, and physical activity
• Estimated energy expenditure (EER) is total energy expenditure plus kilocalories for energy deposition

Protein, Vitamins, and Minerals

• The protein recommendation is 0.95 gram per kg of body weight each day
• The mean intakes of most nutrients meets the recommendations

Establishing Food Behaviors

• Parents and peers are food role models
• Preadolescents exhibit more choice
• Children may avoid new foods because of increased independence
• Culture and religion may impact a childs food choices
• Responsive feeding is recommended
• Parents should model healthy habits

Food Rewards and Cultural Preferences

• Using food as a reward or punishment makes food a privilege, not fuel
• High-fat, high-sugar, and high-calorie foods used for rewards
• Controlling behaviors do not positively influence food habits, like pressuring healthy foods but not allowing sweets
• Culture is shared knowledge, beliefs, customs, and habits that are learned, not inherited
• Cultures have different core foods
• Family models cultural foods as a healthy choice

Social and Personal Influences on Food

• Peer influence not as strong as during adolescence because the social network is still forming
• 3- to 7-year-olds are likely to eat a new food if they see a peer modeling consumption
• Peers can impact opinions about foods
• Picky eaters and food neophobia are food likes and dislikes
• Picky eating habits can continue to be an issue for many years, lasting longer than 2 years in 47% of cases
• Picky eating develops between ages 2 and 6
• Common for preadolescent children to continue demonstrating food neophobia

External Influences and Advertising

• Preadolescents are susceptible to marketing
• Nearly 1/3 of children/adolescents are overweight/obese
• Increased obesity rates lead health professionals to see food marketing as a factor in obesity
• The Institute of Medicine (IOM) has created standards for marketing foods, beverages, and meals to children/youth
• Council of Better Business Bureaus’ Children’s Food and Beverage Advertising Initiative (CFBAI) established voluntary category nutrition standards

Marketing to Children

• Food/beverage companies spend more than $1.6 billion per year on advertising to young consumers
• Marketing tactics include using catchy slogans, intimation, and cartoons
• Characters with an emotional connection have been used for healthy and unhealthy foods

Schools and Food Choices

• School meals, vending machines, stores, bake sales, parties impact food choices
• Public and private schools have access to federally funded breakfast and lunch programs

Environmental Factors and Availability

• Environmental factors affect food availability
• Obesogenic environments are where many fast-food restaurants are closely situated
• Child and adult obesity are lowest in neighborhoods with environments most favorable to healthy eating and physical activity

Nutritional Recommendations

• Dietary Guidelines for Americans provide energy, macronutrient, and micronutrient needs
• Children need more calories per kilogram of body weight versus adults 19+
• Daily calorie guidelines for girls and boys ages 6–9 range between 1,400–2,000
  • Factors: age, weight status, and activity level

Physical Activity

• Physical activity helps improve emotional state, musculoskeletal/cardiovascular systems, and neuromuscular awareness
• Physical activity prevents disease, teaches good habits, recommends 60+ minutes per day
• "Let’s Move!" is a federal program reducing and preventing childhood obesity
• Children should engage in at least 60 minutes of physical activity each day
  • Parents should set examples, boost physical activity, and limit media/computer use
• Only 7.9% of middle and junior high schools require daily physical education

Organized Sports

• Organized sports participation links to lower overweight incidence
• The AAP recommends participation in a variety of activities, and sports should not replace regular physical activity
• Proper use of safety equipment should emphasized

MyPlate and Childhood Nutrition

• Focus on portion sizes of different foods, fruits, grains, vegetables, protein and dairy in a balanced diet

Common Considerations

• Primary teeth replaced by permanent teeth (ages 7-13)
• Diet impacts tooth health: Limit sugary beverages and snacking between meals
• Brush at least twice per day and encourage healthy habits
• Fluoride, calcium, and vitamin D are essential vitamins/minerals for tooth mineralization

Bone vs Sugar

• Calcium intake is important
• Body can build calcium stores in bones early on to prevent future deficiency
• Vitamin D deficiency is common in adolescents and maintains adequate serum calcium/phosphate to enable normal bone mineralization
• Drinks with sugar a large portion of children’s sugar consumption
• Associated health risks include: overweight, obesity, diabetes, elevated triglycerides, cardiovascular/nonalcoholic fatty liver diseases, elevated uric acid, gout, and dental caries
• Sugar-sweetened beverages should be curbed at schools, homes, worksites, and communities

Overweight and Obesity

• Overweight/obesity in children is increasing
• Data from NHANES links obesity to inactivity
• Elevated risk of cardiovascular disease and type 2 diabetes mellitus
• Approximately 17.7% of children ages six through 11 are obese
• Increased over past 25 years but may have reached a plateau
• Overweight children are taller and have advanced bone ages
• They experience earlier sexual maturity
• They look older and exhibit higher risk for health consequences of obesity

Predictions for Childhood Obesity

• Predictors of childhood obesity include age at onset of BMI rebound
• Normal increase in BMI after decline, such that early BMI rebound results in higher BMIs in kids
• Maternal/parental obesity may be a predictor

Body Mass Index

• Pediatric overweight and obesity must be addressed by expert committee evidence-based recommendations
• Obesity assessed via body mass index (BMI)-for-age percentile
• Prevention of overweight and obesity through healthy eating and increased physical activity
• Treatment of overweight/obesity occurs in stages: Prevention Plus, Structured Weight Management (SWM), Comprehensive Multidisciplinary Intervention (CMI), Tertiary Care Intervention (reserved for severely obese adolescents)
• Target overweight children (85%-95% BMI) to weight maintenance, or a slow weight gain until reaching below 85%
• Target obese children to weight maintenance, or weight loss of less than 1 lb/month until target achieved Weight loss should be less than 2 lb/week until target achieved

Nutrition and Cardiovascular Disease

• Encourage a proper diet in school-age children to prevent heart disease
• Recommend a fat range of 25–35% of energy for aged four through 18 is recommended (<7% Saturated, <300mg Cholesterol, and <1% trans fat)
• Include sources of linoleic (omega-6) and alpha-linolenic (omega-3) fatty acids
• Limit fruit juice, sugar-sweetened beverages/foods, salt, saturated fats, cholesterol, and trans fats
• Children over 2 year of age with hyperlipidemia should limit to <7% saturated fat and less than 200 mg cholesterol