Monitoring Growth in Early Childhood

Growth rates:
- Second year of life: average weight gain of 1.361-2.268 kg and average growth of 7.72-12.7 cm per year
- Children 4-5 years old: average weight gain of 1.814-2.92 kg per year and average growth of 7.62 cm per year
BMI is used to assess appropriate weight for height after 2 years of age
WHO growth charts are derived from breastfed infants and intended for use on all children up to 2 years old
CDC growth charts are used for children ages 2-19 years and track weight, stature, and BMI
Accurate measurement techniques are important because medical and nutrition decisions are based on these measurements
Proper technique for measuring weight: children > 36 months should be weighed on a beam-balance or digital scale wearing light undergarments, and weight should be measured to the nearest 0.1 kg
Proper technique for measuring stature: use a wall-mounted vertical board with an attached metric ruler and horizontal headpiece, stand the child against the ruler without shoes, and measure to the nearest 0.1 cm

Growth Chart Interpretation

Measurements are plotted on growth charts to help interpret data
Measurements fall into percentiles, and a point plotted on the 95th percentile line means that 95% of children of the same age and sex have a lower weight for age
CDC growth charts are used starting at 2 years old, and plotted measurements correspond to nutrition indicators
5th and 95th percentiles are the outermost percentile cutoff values indicating abnormal growth
Interpreting plots over time can create a picture of a child's overall growth status compared to that of other children and provide data on the individual child
BMI does not differentiate between excess fat mass and excess lean mass to weight
Normal growth is indicated by growth points following the current percentile line or within one to two percentile line changes
Movement crossing two or more percentile lines is potentially a sign of growth disturbance and warrants further consideration, monitoring, and assessment

Factors That Affect Dietary Intake

Between 2-5 years: decreased nutrition needs and appetite, slowed growth, high activity levels, and relatively small stomach capacity
Foods with high nutrient density are important during this stage
Learning about, trying, and accepting new foods, mastering motor skills needed to feed oneself, and establishing healthy food preferences and eating habits are important aspects of this stage
Food jags, food aversions, and neophobia can affect dietary intake
Providing new or disliked nutritious foods along with accepted nutritious foods and ensuring adequate fluid intake, fiber, and limiting fatty foods can help prevent constipation
Young children can self-regulate food intake, but between 3-5 years, they are less responsive to internal cues and more responsive to external cues, which may lead to overeating
A child's personality can influence food intake, and parents and caregivers should help children recognize their hunger and fullness cues
Media influence can drive children's consumer behavior through advertising, and children may not recognize the persuasive nature of advertising
Parental influence can affect children's eating habits and weight status, and parents should model healthy eating habits, avoid restricting or forcing foods, and establish a positive feeding relationship
Cultural influences can affect how and what children eat, and may also play a role in how food is prepared, what foods are considered healthy, and utilization of health services
Obesogenic environments can promote weight gain and are not conducive to weight loss, and barriers to choosing healthful behaviors include lack of time, lack of neighborhood safety, and limited knowledge of portion size and cooking methods

Nutrition Recommendations and Requirements

Dietary Guidelines for Americans, 2020-2025 provide estimated calorie ranges for children 2-5 years old based on sex and activity level
Carbohydrate intake should be 45-65% of total daily calories, and fiber intake should be 19-25 grams per day
Protein intake should be 1.1-0.95 grams per kilogram of body weight, and high-quality protein sources include animal sources
Fat intake should not be restricted before age 2, and monounsaturated and polyunsaturated fats should be encouraged
Calcium and vitamin D intake are important for bone growth and development, and vitamin D also aids in immune function and inflammation reduction
Iron intake should be 7-10 milligrams per day, and serum ferritin is a good indicator of iron status
Sodium intake should be limited to 1,000-1,200 milligrams per day, and excessive intake can lead to high blood pressure and cardiovascular disease### Constipation
Fewer than two bowel movements a week or hard, dry, and small bowel movements that are difficult to pass
Common causes include ignoring the urge to have a bowel movement, low-fiber diets, medications, and GI issues
Prevention involves adequate fluid and fiber intake
Possible complications include fecal impaction, anal fissures, and rectal prolapse

Lead Exposure

Lead is a naturally occurring toxic metal that impacts the brain and nervous system
Effects of lead exposure are believed to be irreversible
Methods of exposure include occupational and environmental sources
Children absorb four to five times as much ingested lead as adults
Effects of exposure include distribution to organs and storage in teeth and bones
Undernourished children are more susceptible to lead exposure

Preventing Overweight and Obesity

Overweight is defined as a BMI at or above the 85th percentile and below the 95th percentile
Obesity is defined as a BMI at or above the 95th percentile
Prevalence of obesity in children ages 2-5 years is 13.9% from 2015-2016
Behavioral factors contributing to overweight and obesity include dietary patterns, physical activity level, medication use, education and skills, environment, and food marketing and promotion
Genetics also play a role in overweight and obesity

Consequences of Overweight and Obesity

Children who are obese have a greater risk of high blood pressure, high cholesterol, impaired glucose tolerance, insulin resistance, type 2 diabetes, breathing problems, joint problems, musculoskeletal discomfort, fatty liver disease, gallstones, gastroesophageal reflux, psychological stress, low self-esteem, and low self-reported quality of life
Obese children are likely to be obese as adults, which can have significant health consequences

Physical Activity Recommendations

Inactive children often become inactive adults, increasing the risk of many diseases
Physical activity should be enjoyable, age-appropriate, and offer variety
Recommendations include 15 minutes of light, moderate, or vigorous activity per hour, and 3 hours of daily activity of all intensities
Regular physical activity can result in less stress, better self-esteem, readiness to learn in school, healthy weight, healthy bones, muscles, and joints, and better sleep