Child and Preadolescent Nutrition

Child and Preadolescent Nutrition

• Middle childhood spans ages five to ten years.
• Preadolescence (school-age) occurs from ages nine to 11 years for girls and ten to 12 years for boys.

Normal Growth

• Growth and development depend on genetics, hormones, and nutrition.
• Genetics primarily determines a child's height and body size.
• Hormones represent the biochemical aspect of growth, with the endocrine system, hypothalamus, and pituitary gland secreting hormones during growth periods.
• Genes instruct hormones to regulate growth and development.

Calculating Predicted Height

• The predicted height calculation for children considers parental heights with a slight adjustment for gender.
• For boys, add 5 inches (13 cm) to the sum of parental heights; for girls, subtract 5 inches (13 cm) before dividing by two.
• Example calculation:
  • Daughter’s predicted height (mother 160 cm, father 180 cm): (160 + 180 - 13 cm) / 2 = 163.5 cm
  • Son’s predicted height (mother 160 cm, father 180 cm): (160 + 180 + 13 cm) / 2 = 176.5 cm

Growth Considerations

• Growth velocity slows during school-age years.
• Monitoring growth is important.
• Adiposity rebound, a mild growth spurt, occurs around ages 6 to 7.
• A "midgrowth spurt" involves a small increase in growth velocity between ages 4 and 8.
• Weight and height should be plotted on appropriate growth charts.

Physiological Development

• Muscular strength, motor coordination, and stamina increase in school-age children.
• They demonstrate more complex movement patterns.
• Body fat reaches a minimum before increasing in preparation for the adolescent growth spurt.

Cognitive Development

• School-age children develop self-efficacy, recognizing what they can do.
• Thinking shifts from magical and egocentric to concrete operations.
• Children develop a sense of self.
• They become more independent and learn their family roles.
• Peer relationships gain importance.

Feeding Skills and Eating Behaviors

• Parental preferences influence a child's food likes and dislikes.
• Family mealtimes are encouraged to promote healthy eating habits.
• Snacking is necessary to meet nutritional needs.
• A responsive feeding style should be adopted.

Influences on Eating Behaviors

• Peer influence grows as children expand their world beyond the family.
• Media exposure prompts children to try foods seen on television.
• Fast-food establishments are attractive to children.
• A mother's concerns about her own weight can influence her child’s feeding practices.
• Young girls may become preoccupied with weight and size at an early age.

Nutrition

• Growth requires sufficient macro and micronutrients.
• Adequate calories ensure normal growth.
• Nutritional needs differ at each developmental stage.

Energy and Nutrient Needs

• Energy needs vary based on activity level and body size.
• Dietary Reference Intakes consider gender, age, height, weight, and physical activity level.
• Estimated energy expenditure (EER) includes total energy expenditure plus kilocalories for energy deposition.
• Protein intake: 0.95 gram per kg of body weight daily.
• Children generally meet or exceed recommended intakes of most vitamins and minerals.

Factors Affecting Dietary Intake in Preadolescence

• Parents and peers act as role models, but preadolescents make more independent food choices.
• Children might avoid new foods or experiment with them due to increasing independence.
• Factors impacting choices: culture, religion, school, media, parental monitoring.
• A responsive feeding style is advised.
• Parents should model healthy eating habits.

Food Rewards

• Using food as a reward or punishment makes it a privilege, not fuel.
• High-fat, sugary, and caloric foods are often used as rewards.
• Controlling behaviors negatively impact food habits.

Cultural Food Preferences

• Culture includes learned knowledge, beliefs, customs, and habits shared by a group.
• Different cultures have different core foods.
• Families often model cultural foods as healthy choices.

Peer Influence

• Peer influence is less influential than during adolescence due to the earlier stage of social network formation.
• 3- to 7-year-olds may eat a new food if they see a peer modeling consumption.
• Peers can impact opinions about foods.

Food Likes and Dislikes

• Picky eating and food neophobia are common.
• Picky eating can last for years; 47% of cases persist for over 2 years.
• Picky eating often develops between ages 2 and 6.
• Preadolescents may continue to exhibit food neophobia.

Advertising and Marketing

• Preadolescents are susceptible to marketing tactics.
• Nearly one-third of children and adolescents are overweight or obese.
• Health professionals consider food marketing of nutritionally poor foods a potential factor in obesity.

Advertising and Marketing Standards

• The Institute of Medicine (IOM) created marketing standards for foods, beverages, and meals to children and youth.
• The Children’s Food and Beverage Advertising Initiative (CFBAI) set voluntary category-specific nutrition standards in 2014.

Advertising Spending

• Food and beverage companies spend over $1.6 billion annually on advertising to young consumers.
• Tactics: catchy slogans, intimidation, and cartoons.
• Emotional connections through characters are used for both healthy and unhealthy foods.

School Environment

• Schools impact food choices through meals, vending machines, stores, bake sales, and parties.
• Public and private schools use federally funded breakfast and lunch programs.

Food Availability

• Environmental factors and obesogenic environments prevail.
• Fast food restaurants are often in close proximity.
• Child and adult obesity are lowest in neighborhoods promoting healthy eating and physical activity.

Nutrient Recommendations (Continued)

• Dietary Guidelines for Americans provides guidelines for energy, macronutrients, and micronutrients.
• Children typically need more calories per kilogram of body weight than adults over 19.
• Calorie guidelines for girls and boys ages 6 to 9 range from 1,400 to 2,000 depending on age, weight, and activity level.

Physical Activity Recommendations

• Physical activity enhances emotional state, musculoskeletal and cardiovascular systems, healthy weight, and neuromuscular awareness.
• It prevents disease and teaches good habits.
• 60 minutes or more of daily physical activity is recommended.
• "Let’s Move!" focuses on reducing and preventing childhood obesity.

Actual vs. Recommended Activity

• Children need at least 60 minutes of physical activity daily.
• Parents should set an example, promote physical activity, and limit media use.
• Only 7.9% of middle and junior high schools require daily physical education.

Organized Sports

• Participation in organized sports has been related to a lower incidence of overweight.
• AAP recommends participation in a variety of activities.
• Organized sports should not replace regular physical activity.
• Proper use of safety equipment should be emphasized.

Oral Health

• Primary teeth are replaced between ages 7 and 13.
• Diet affects tooth health, especially sugary beverages and snacking.
• Brushing twice a day is important.
• Healthy habits should be encouraged early.
• Fluoride, calcium, and vitamin D are essential for tooth mineralization.

Bone Health

• Calcium is crucial for bone health.
• The body can build calcium stores early to prevent future deficiency.
• DRI for calcium for ages 4–8 is 1,000 mg per day.
• Vitamin D deficiency is common in adolescents and is crucial to maintain serum calcium and enable bone mineralization.
• DRI for Vitamin D for ages 1–13 is 600 IU/day.
• Vitamin D needs can be met via diet, sunlight, and supplements.

Sugar

• Sugary drinks make up a large portion of the sugar-containing foods consumed by children.
• Sugar is linked to risks like overweight, obesity, diabetes, elevated triglycerides, cardiovascular disease, fatty liver disease, elevated uric acid levels, gout, and dental caries.
• Reducing sugar intake necessitates addressing numerous settings such as schools, homes, worksites, and communities.

Overweight and Obesity

• Overweight and obesity among children are increasing.
• Data suggests a link to inactivity.
• Obesity increases the risk of cardiovascular disease and type 2 diabetes mellitus.
• Approximately 17.7% of children ages 6–11 are obese.
• Obesity increased over the past 25 years but may have reached a plateau.

Traits of Overweight Children

• Overweight children are often taller.
• They often have advanced bone ages.
• They may exhibit earlier sexual maturity
• They appear older.
• They face higher risks of health consequences of obesity.

Childhood Obesity

• Onset age of BMI rebound is a predictor of childhood obesity.
  • BMI rebound is a normal increase in BMI after decline
  • Early BMI rebound results in higher BMIs in children
• Parental obesity is a predictor of childhood obesity.

Addressing Pediatric Overweight and Obesity

• Expert committees have provided recommendations.
• Assessment involves body mass index-for-age percentile.
• Prevention includes healthy eating and increased physical activity.

Obesity Treatment

• Treatment includes four stages:
  • Prevention Plus
  • Structured Weight Management (SWM)
  • Comprehensive Multidisciplinary Intervention (CMI)
  • Tertiary Care Intervention (reserved for severely obese adolescents)

Goals of Treatment

• For overweight individuals (85%-95% BMI), the goal is weight maintenance or a slow weight gain until achieving a BMI <85%.
• For obese individuals (BMI 95%-98%), the goal is weight maintenance or a weight loss less than 1 lb/month until BMI is <85%.
• For individuals with a BMI of 99%, the goal is weight loss <2 lb/week until BMI is <85%, or at least weight maintenance.

CVD Prevention

• Acceptable fat range of total energy is 25-35% for ages 4-18 years
  • Recommendations: 7% saturated fat, 300mg cholesterol, <1% trans fat
• Include sources of linoleic (omega-6) and alpha-linolenic (omega-3) fatty acids
• Limit fruit juice, sugar sweetened beverages, salt, saturated fats, cholesterol, and trans fats.

Children over 2 years of age with hyperlipidemia

• Recommendations are <7% saturated fat, <200 mg cholesterol