Growth and Development Ages 5-12

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

Normal Growth and Development

• Growth and development depends on combined actions of genetics, hormones, and nutrition
• Genetics determine height and body size
• Hormones biochemical aspect of growth
• The endocrine system, hypothalamus, and pituitary gland secrete and stimulate hormones during periods of growth
• Hormones regulate growth and development, using instructions from genes
• To predict a child's height, add the mother's and father's height in inches or centimeters
• Add 5 inches (13 cm) for boys or subtract 5 inches (13 cm) for girls, then divide by two
• Growth velocity slows during school-age years
• "Midgrowth spurt" describes small increases in growth velocity between ages 4 and 8
• Weight and height should be plotted on growth charts
• Muscular strength, motor coordination, and stamina increase during physiological development
• Body fat reaches a minimum and rises in preparation for adolescent growth spurt

Cognitive Development

• Self-efficacy: the knowledge of what to do and ability to do it
• Thought processes shift from magical thinking and egocentrism to concrete operations
• A sense of self develops
• Children become more independent and learn family roles
• Peer relationships become important

Feeding Skills and Eating Behaviors

• Parental preferences influence a child’s food likes and dislikes
• Eating together as a family is beneficial
• Snacks are needed to meet nutritional needs
• Responsive feeding is a helpful style to adopt
• Peer influence grows as the child's world expands
• Children may want to try foods seen on television
• Fast-food restaurants are attractive
• Mother's weight concerns may impact her feeding practices
• Young girls are preoccupied with weight and size

Nutrition Needs

• Growth requires sufficient macro and micronutrients
• Adequate calories needed to ensure growth
• Nutrition needs vary during each developmental stage
• Energy needs rely on activity level and body size
• Dietary Reference Intakes are based on gender, age, height, weight, and physical activity level
• Estimated energy expenditure (EER) is total energy expenditure plus kilocalories for energy deposition
• The recommendation is 0.95 grams of protein per kg of body weight each day
• Children's mean intakes of most nutrients typically meet or exceed recommendations

Factors Affecting Dietary Intake during Preadolescence

• Parents and peers are role models, but preadolescents exercise more choice
• Children may continue to avoid new foods or begin to experiment because of independence
• Culture and religion, school, media, and parental monitoring all impact food choices
• Responsive feeding is a helpful style
• Parents should model good habits
• Food rewards can cause food to be viewed as a privilege instead of fuel
• Foods high in fat, sugar, and calories are often used as food rewards
• Controlling behaviors do not positively influence food habits
• Culture is defined learned knowledge, beliefs, customs, and habits shared by a group
• Cultures all have different core foods
• Families likely to model cultural foods as a healthy choice
• Peer influence isn't as strong as during adolescence; social network is still forming in preadolescence
• 3- to 7-year-olds are more likely to eat something if they see a peer modeling consumption
• Peers affect food opinions
• Picky eaters have food neophobia (avoidance of new foods)
• Picky eating can remain a problem for many years; 47% have it longer than 2 years
• Picky eating typically develops between 2 and 6 years old
• Advertising sways preadolescents
• Nearly a third of children and adolescents are overweight/obese
• Rapid obesity rates have led health professionals to see food marketing of nutritionally poor foods as a potential factor
• The Institute of Medicine (IOM) has made standards for marketing to children
• The Council of Better Business Bureaus’ Children’s Food and Beverage Advertising Initiative (CFBAI) set uniform, voluntary nutrition standards in 2014
• Food and beverage companies spend over $1.6 billion per year on advertising to this consumer group
• Tactics: catchy slogans, intimation, and cartoons, plus emotionally connecting characters
• Schools impact choices via meals, vending machines, stores, bake sales, and parties
• Public and private schools use federal school breakfast and lunch programs
• Environmental factors and obesogenic environments (close proximity of fast food) impact food availability
• Child and adult obesity are lowest where environments support healthy eating and physical activity

Nutritional Recommendations

• Dietary Guidelines for Americans give macronutrient and micronutrient needs
• Children need more calories per kilogram of body weight than adults 19+
• The daily calorie range for girls and boys ages 6–9 is 1,400–2,000, depending on age, weight status, and activity level
• Physical activity helps emotional health, musculoskeletal system, cardiovascular system, weight, and neuromuscular awareness
• Physical activity prevents disease, and teaches good habits
• The recommendation is 60 minutes or more of physical activity daily
• Let’s Move! is a federal program focused on reducing and preventing childhood obesity
• Children need 60 minutes of daily physical activity
• Parents should set a great example and encourage activity, plus limit media/computer use
• Only 7.9% of middle and junior high schools require daily physical education
• Organized sports involvement links to a lower rate of overweight
• AAP recommends a variety of activities, but organized sports should not replace regular physical activity
• Using safety equipment should be emphasized

Other Considerations

• Primary teeth fall out and are replaced by permanent teeth from ages 7 to 13
• Diet impacts tooth health
• Limit sugary drinks, snack between meals
• Brush at least twice per day; encourage healthy habits while young
• Fluoride, calcium, and vitamin D are essential minerals for teeth
• Calcium is important for bone health
• The body builds up calcium stores to protect against deficiency
• Vitamin D deficiency is common in adolescents
• Vitamin D maintains adequate serum calcium and phosphate to enable normal bone mineralization
• DRI is 600 IU/day for ages 1–13, via diet, sunlight, and supplements
• The bulk of sugar intake for children comes from sugar-sweetend beverages
• Sugar is associated with risks like overweight/obesity, diabetes, elevated triglycerides, cardiovascular disease, nonalcoholic fatty liver disease, elevated uric acid levels, gout, and dental cavities
• Any setting where sugar-sweetened beverages are found needs to be addressed

Disorders: Prevention

• Overweight and obesity is increasing among children
• NHANES data links it to inactivity
• Obesity increases risk of cardiovascular disease and type 2 diabetes mellitus
• Approximately 17.7% of children ages six through 11 are obese
• Obesity increased in the past 25 years but may have reached a plateau
• Overweight children are often taller, have advanced bone ages, and earlier sexual maturity
• Overweight children tend to look older
• Overweight children have a higher risk for health consequences of obesity
• The age at onset of BMI rebound predicts childhood obesity
• Normal increase in BMI after decline (rebound)
• Early BMI rebound results in higher BMIs in children
• Maternal/parental obesity predict childhood obesity
• Address the problem of pediatric overweight and obesity with the expert committee’s evidence-based recommendations
• Assess with body mass index-for-age percentile
• Prevent with healthy eating and increased physical activity

Treatment

• There are four stages to treating overweight and obesity: Prevention Plus; Structured Weight Management (SWM); Comprehensive Multidisciplinary Intervention (CMI); and Tertiary Care Intervention.
• Tertiary Care intervention is reserved for severely obese adolescents

The goal of treatment

• For overweight (85%-95% BMI): maintain weight, or slowly gain untilachieving
• For Obese (BMI 95%-98%): maintain weight, or lose 1 lb/month until
• For BMI 99%: lose 2 lb/week until
• Maintain at least.
• Acceptable fat range is 25 to 35 percent of energy for those ages 4 to 18 years, while limiting saturated fat, cholesterol and trans fats
• Sources of linoleic (omega-6) and alpha-linolenic (omega-3) fatty acids should be included
• Limit fruit juice, sugar-sweetened beverages and foods, salt, saturated fats, cholesterol, and trans fats
• Kids over 2 years old with hyperlipidemia need to get saturated fat down to 7% or less, and cholesterol below 200 mg