Childhood Overweight & Obesity

Dietary Guidelines

• The Dietary Guidelines for Americans 2010 emphasizes maintaining appropriate calorie balance during each life stage to manage weight and support pediatric weight management.
• The Dietary Guidelines for Americans 2020 expands on life-stage-specific recommendations, nutrient-dense dietary patterns, and added sugar limits, reinforcing the role of caloric balance in weight management.

Overweight and Obesity

• Overweight and obesity in toddlers and preschoolers is a multifaceted problem that is difficult to treat, making prevention the preferred approach.
• Body mass index-for-age percentile is the recommended screening tool for assessing overweight and obesity.

Interpreting CDC Growth Charts

• Growth "tracks" within percentile range.
• BMI for age percentiles are: >95th is obese, >85th and <95th is overweight, and <5th is underweight.

Characteristics and Consequences of Overweight Children

• Overweight children tend to be taller, have advanced bone age, and experience earlier sexual maturity.
• Consequences of being overweight in children include high blood lipids, elevated liver enzymes, hypertension, and abnormal glucose tolerance & Type 2 diabetes.

Determinants of Pediatric Obesity

• Factors being identified in literature as determinants of pediatric obesity in the first 1000 days include prenatal period involving higher maternal pre-pregnancy BMI and excess gestational weight gain.
• Breast vs. formula feeding, breast milk is better than formula
• Complementary Feeding and Early Diet. Rapid weight gain, infant early solid feeding modalities, intake of nutrients, and infant gut microbiome

Prevention of Overweight and Obesity

• Limiting sugar-sweet beverages, encouraging fruits and vegetables, limiting television and screen time, eating a daily breakfast, limiting restaurants and fast foods, and limiting portions can help prevent it

Treatment of Overweight and Obesity Expert Committee Recommendations (6-11 years)

• Stage one is prevention plus
• Stage two is structured weight management
• Stage three is comprehensive multidisciplinary intervention
• Stage four is tertiary care intervention

Nutrition and Prevention of Cardiovascular Disease

• To prevent cardiovascular disease in toddlers and preschoolers it is important to limit dietary saturated fats, trans fat, and cholesterol.
• Acceptable macronutrient distribution ranges for fat for children one to three years old and for those four to 18 years old: 25 to 35 percent.

Children with Special Health Care Needs

• A child with a chronic condition or disability does not see, hear, or walk, or does not reach the appropriate developmental milestones.
• Estimates range from five to 31 percent of children have disabilities.
• Up to 90 percent of children with disabilities have a nutrition problem.

Eligibility for Early Intervention Services

• Eligibility includes those with developmental delays in cognitive, physical, language and speech, psychological, or self-helping skills.
• Also includes those with a physical or mental condition with a high probability of delay like Down syndrome.
• Those at risk medically or environmentally for substantial developmental delay if services are not provided are also included.

Nutrition Needs with Chronic Conditions

• DRIs are a starting point for setting protein, vitamin, and mineral needs for children with chronic conditions.
• Chronic conditions may cause poor appetite, increased caloric needs, or lead to overweight, obesity, or underweight.
• Nutrient interventions should be customized for children with chronic conditions.

Growth Assessment

• Nutrition assessment is the first step to determine if nutrition services are needed.
• Assessment answers questions about whether growth is on track, food and nutrient intake adequate, feeding or eating skills age appropriate, and if diagnosis affects nutritional needs.
• Nutrition screening tools exist, and specific growth charts developed for chronic conditions should be used if available.
• Conditions include low or very low birthweight, and special head growth chart.

Feeding Problems

• Special health care needs cause feeding problems in young children combined with typical feeding issues of the average toddler or preschooler.
• These include low interest in eating, long mealtimes, preferring liquids over solids, and food refusals.
• Behavioral feeding problems are common with toddlers and preschoolers with behavioral and attention disorders.
• Behavioral disorders affect nutritional status like in autism spectrum disorder (ASD), and attention deficit hyperactivity disorder (ADHD).
• Excessive fluid intake causes children to rather drink than eat.
• Mashed or blended foods may be contaminated or spoiled.
• Cerebral palsy or other neuromuscular and genetic disorders (e.g., Down syndrome) may result in feeding problems from disabilities involving neuro-muscular control.

Failure To Thrive

• Failure to thrive (FTT) is when a child’s growth declines more than two growth percentiles and can result from a complex interplay of factors.
• Factors include digestive, asthma, or breathing problems, neurological conditions, and pediatric AIDS.
• Recovery can include catch-up growth.

Toddler Diarrhea and Celiac Disease

• Toddler diarrhea is typically caused by sucrose and sorbitol content of fruit juices; limiting juice may be recommended.
• Celiac disease results in diarrhea
• It's caused by sensitivity to the protein gluten found in wheat and other grains.
• Complete restriction of any gluten-containing foods is important.

Autism Spectrum Disorders

• No specific diet is recommended for prevention or treatment.
• Gluten-free and casein-free diets have been used by parents but not endorsed by professional societies.

Muscle Coordination Problems and Cerebral Palsy

• Characterized by muscle coordination problems related to spastic quadriplegia which is severe cerebral palsy.
• Meal patterns may be changed to provide small, frequent meals, and snacks to prevent tiredness at meals.
• Foods recommended include foods that are easy to chew and soft.

Pulmonary Problems

• Examples of pulmonary problems include asthma and brochopulmonary dysplasia
• Pulmonary problems increase nutrient needs, lower interest in eating, and can slow growth
• Preterm infants are at high risk of breathing difficulties
• Recommend small, frequent meals with concentrated energy

Developmental Delay

• Developmental delay may be suspected when specific nutrients are inadequately or excessively consumed.
• May result from iron deficiency or lead toxicity.
• Changes in growth rate are typical, short stature is common.

Food Allergies and Intolerance

• True food allergies are seen in two to eight percent of children.
• Common allergens: cow’s milk, eggs, wheat, peanuts and tree nuts, soy, and crustacean shellfish.