Toddler and Preschool Nutrition PDF

Toddler and preschool nutrition Dr Wesam Alyahya 1  Growth expectation  Growth is measured and assessed basically using CDC growth charts. Assessment of weight, height, head circumference. After the age of 2 BMI is used.  Approximately 25% of normal inf...

Toddler and preschool nutrition Dr Wesam Alyahya 1  Growth expectation  Growth is measured and assessed basically using CDC growth charts. Assessment of weight, height, head circumference. After the age of 2 BMI is used.  Approximately 25% of normal infants and toddlers drop to a lower percentile and remain on that track. 3  Average weight and height growth Average weight Age Average daily growth (g/d) 1-3 4-10 4-6 5-8 7-10 5-12 Growth rate for age 1-3 and 7-10 is more rapid and necessitate greater energy needs. 4  Energy and nutrients needs  Not surprisingly, energy needs varies based on growth rate, activity level in children, age, developmental stage 6  Protein needs  Protein is the primary factor in many body tissues.  As a child grows and develops, protein is a crucial nutrient needed to provide optimal growth.  Current recommendations state that protein intake should comprise approximately 10% to 20% of the child's daily intake.  This recommendation is designed to ensure that enough energy is provided to the body from all nutrients so that protein is spared for growth and development of tissues. 7  Protein needs cont, 8  Fat needs Until age 3 dietary fat plays a role in brain development:  Fat comprises approximately 60% of the central and peripheral nervous systems that essentially control, regulate, and integrate everybody system; thus, it is essential to obtain in the diet.  Fat content of the diet is linked with the feeling of satiety. Therefore, low fat meals or snacks for children can lead to hunger and subsequent overeating between meals.  Most of the fat should come from monounsaturated and polyunsaturated fats such as fish, nuts and vegetable oils. 9  Vitamins and minerals Calcium  Meeting the dietary reference intake of calcium in children is very important, for its needed for the rapid bone and skeletal development.  It is observed that children from 4-8 years usually replace milk intake with juices and soft drinks. x 10  Easy ways to increase calcium in the diet 1. Drink milk. Two 8-ounce glasses of milk each day can provide over 600 mg of calcium. Lactose-reduced milk is a good source of calcium if regular milk is not tolerated. Use heated milk in place of hot water to make hot cereals, such as oatmeal or hot chocolate. 2. Add cheese to sandwiches, casseroles, meat loaf, salads, and snacks. 3. Add broccoli and cheese to a baked potato. 4. Choose desserts made with milk such as pudding, custard, frozen yogurt, and ice cream. Substitute milk and yogurt in recipes instead of cream or sour cream. 11  Easy ways to increase calcium in the diet 5. Add dried powdered milk or evaporated milk when preparing soups, mashed potatoes, sauces, and hot cereals. 6. Drink a glass of calcium-fortified juice, such as orange juice. 7. Add almonds to muffin and bread recipes. 8. Remember to read labels for percentage of calcium. If it has greater than 30% of your calcium requirement for the day, then it would be a high calcium choice. Many foods are fortified with calcium, such as orange juice, rice, cereals, waffles, and pasta. 9. Choosing one high calcium food at each meal will help you to meet your goal every day! 12  Vitamin D Vitamin D sources: 1- photochemical reaction of sunlight on 7-dehydrocholestrol in skin 2- dietary sources: fish oils, fatty fish, and food fortified with vitamin D. Factors related to vitamin D status  The amount of melanin in our skin decreases the amount of vitamin D synthesized from sun light. Therefore, children with darker skin deeds to spend more time exposed to sun to obtain sufficient vitamin D.  The more skin is exposed to the sun the more vitamin D is synthesized. 13  Iron  Daily requirements for iron intake are based on age and iron stores.  During periods of rapid growth, the body's need for iron increases.  Iron can be classified as being derived from heme or nonheme sources;  Heme sources include animal meats and products, such as beef and chicken  Nonheme sources include fortified grains, fruits, and vegetables.  Though iron can be obtained from either source, absorption of this essential nutrient is found to be higher from heme sources than from nonheme.  Consuming foods with vitamin C while eating an iron containing food can promote better absorption of iron into the body. 14  Iron deficiency anemia It is common nutritional deficiency in children. Causes: 1- Risk factors: low income, poor diet, poor medical care. 2- increased calcium intake. As calcium compete with iron on the receptor. 3- refusal of meats. 15  Progression of iron deficiency 16  Increasing iron in the diet  Include a protein source at meals, such as fish, beef, or poultry.  Look for iron enriched or fortified grains, such as cereals, breads, and pasta.  Offer oatmeal or cream of wheat at breakfast  Add foods high in vitamin C to the meal, including citrus fruit, melon, and dark green leafy vegetables, for improved iron absorption.  Add pureed meats to pasta sauce or casseroles for toddlers with difficulty advancing to chewing meats.  Encourage children with advanced chewing skills to eat the skin of the baked potato for added dietary iron. 17  Vitamin supplement  A general multivitamin is not routinely recommended for toddlers and young children unless the diet history demonstrates the child's intake to be inadequate.  Supplementation is recommended for children without the means to eat a balanced diet and for those with chronic medical conditions or treatments who may lose necessary vitamins, including dialysis, cystic fibrosis, gastrointestinal conditions, and food allergies. 18  Water Water helps the body to Therefore, water is a very Sources: water, as do high maintain homeostasis allows important component of the moisture foods, such as fruit, for the transport of nutrients daily diet. soups, and ice cream. into cells, and also help in the Water can be offered to the removal of the waste products growing child for hydration, but of metabolism. care should be taken not to replace adequate milk or formula intake to prevent displacing vital nutrients in the diet. 19  Feeding pattern of the toddler 20  Food at 1 year  After the age of one year old, the child eats like the caregiver.  The portion size should be kept appropriate to their age, and to the child desire.  It is suggested that the appropriate portion size for the toddlers is ¼ - ½ of the adult's portion size. Examples: Grains: bread, one-fourth to one-half slice; cereal, rice, or pasta, cooked, 4 tablespoons; dry cereal, ¼ cup Cooked vegetables: I tablespoon per year of age Fruit: cooked or canned, ½ cup Dairy: milk, ½ cup Protein: chicken, turkey, beef, or fish, 1 ounce; ground meat, 2 tablespoons 21  Mealtime With Toddlers  Healthy eating environment is important, Structure at meals can have a significant influence on a child's eating patterns Suggestions to provide such a structured environment include: 1. the complete absence of television and other distractions. 2. the family should sit at the dining room or kitchen table together and enjoy the meal as a unit. 22  Mealtime With Toddlers  As with most behaviors, the child's stage of development can influence food choices. A toddler may prefer finger foods that encourage them to demonstrate their new independence.  Children have relatively small stomach size and may feel satiety before they finish their meal.  Children should not be forced to finish their meals. They become less sensitive to their body signs of satiety. 23  Introducing new food  As the toddler and young child is learning new feeding skills , it is a potential for introducing wide variety of food items.  Children usually refuses any new food because it is unfamiliar. Studies suggest that more food exposure up to 10 times results in the child accepts the new food items and develop familiarity.  It is important to introduce each new food at a time to avoid confusion.  Generally, parents are not patient with trying !!! 24  Planning children meal  The high cost of fruits and vegetables is often reported as the main reason a parent or caregiver does not frequently purchase these foods.  However, for example, local farmers markets provides a more affordable opportunity.  Canned fruits and vegetables is an option.  Children tend to eat more of foods they are familiar with, so it is important for healthy foods to always be available in the home. 25  Hunger and behavior  Influenced by environmental cues more than the previous "deprivation-driven response" during infancy  However, regardless of behaviors developed the child should not control meal planning. 26  Hunger and behavior cont,  Food behaviors can also be related to the availability of certain foods and how easy they are to consume for the developing child.  Children tend to choose foods more often that are in an accessible location.  Fruits and vegetables that are cut into sticks or bite size pieces are more likely to be chosen than whole fruits and vegetables simply because the child can handle them independently. 27  Group Discussio G1 Talk about picky eating and grazing G2 Talk about failure tot thrive and lactose intolerance G3 Talk about learning through participation and nutrition at school G4 Talk about physical activity. 29  Picky eating  Picky eating can be common in toddlers and may continue throughout childhood.  Often, picky eating may represent an attempt at become independence rather than a declaration of actual likes and dislikes  Using rewards, or punishment to encourage eating may only enforce the "picky eater phenomenon”.  A caregiver may try to accommodate a picky eater or to develop techniques that may help increase amount and quality of foods eaten. 30  10 tips for picky eaters –from mayo clinic  No. 1: Respect your child's appetite — or lack of one don't bribe or force your child to eat certain foods or clean his or her plate. This might only reinforce a power struggle over food and bring anxiety and frustration.  No. 2: Stick to the routine Serve meals and snacks at about the same times every day. Provide juice or milk with the food, and water between meals.  No. 3: Be patient with new foods Your child might need repeated exposure to a new food before he or she takes the first bite. Encourage your child by talking about a food's color, shape, aroma and texture. Serve new foods along with your child's favorite foods.  No. 4: Make it fun Serve broccoli and other veggies with a favorite dip or sauce. Cut foods with cookie cutters. Offer breakfast foods for dinner.  No. 5: Recruit your child's help At the grocery store, ask your child to help you select fruits, vegetables and other healthy foods At home, encourage your child to help you rinse veggies, stir batter or set the table. 31 No. 6: Set a good example  10 tips for picky eaters –from mayo clinic  No. 7: Be creative  No. 8: Minimize distractions to help your child focus on eating. Keep in mind that television advertising might also encourage your child to desire sugary foods.  No. 9: Don't offer dessert as a reward Withholding dessert sends the message that dessert is the best food.  No. 10: Don't be a short-order cook Encourage your child to stay at the table for the designated mealtime even if he or she doesn't eat. Keep serving your child healthy choices until they become familiar and preferred.  If you're concerned that picky eating is compromising your child's growth and development, consult your child's doctor. 32  Grazing  The growing toddler and child may not be hungry on a schedule, and they often do not want to stop for a meal or snack that may interrupt their playtime. Effect of grazing on child eating behaviors:  Grazing may produce a constant feeling of fullness and cause the child to avoid eating an appropriate amount at mealtime, therefore not expanding the stomach size.  Constant snacking and early satiety may result in the child not receiving adequate calories each day, thereby ultimately leading to failure to thrive.  It is important understand the difference between mealtime and playtime. 33  Failure to thrive  Failure to thrive is defined by "inadequate physical growth diagnosed by observation of growth over time using a standard growth chart.  Causes of failure to thrive: 1- Organic : inability to meet the caloric requirements due to medical condition, malabsorption, or increased metabolism with specific disease state. 2- Inorganic: food shortage ,incorrect mixing of formula. 34  Lactose intolerance  It is incomplete digestion of lactose, result in gastrointestinal symptoms due to inefficient lactase activity.  Children with this condition can dink few amount of milk, low lactose cheese, yogurt can be better tolerated. 35  Learning through participation  Involving children in the preparation of the meal may help to increase variety in the diet.  Time spent in the kitchen can also be used to talk about the different colors of fruit and vegetables, to help the child understand the healthy reasons behind eating a wider variety of foods, and to promote family bonding.  Allowing children to serve themselves at meals may decrease the incidence of exposure to excessive portion sizes. 36  Nutrition at school  Peer influence also plays a roll in lunchtime nutrition. Food choices are often affected by what friends at school are eating. Children may be encouraged to try a new food if others around them are eating it. On the other hand, such influence may also contribute to requesting more "junk" foods that other children bring to school.  Parents and children may benefit from education on choosing healthier options at school. If available, reviewing the monthly menu with the child can prompt discussion on which foods are the healthier choice. 37  Physical activity  With age and increased independence, physical activity often decreases.  Sometimes only encouragement may be all some children need to become more active. Studies have shown that parents who are supportive of their children's participation in physical activities are more likely to have an active child (Sallis, Prochaska, &c Taylor, 2000). 38  Physical activity  Sedentary activities such as watching television and playing video games have become the preferred after- school pastime. Parents, caregivers, health educators, and teachers should promote enjoyable alternatives to sedentary behaviors to increase children's participation in physical activity and prevent unhealthy weight gain.  The bottom line is that physical activity should be a part of everyday life. If children are cared for outside of the home after school, parents may need to discuss with day-care providers or other caregivers the stated preference that their child be active and not spend the afternoon involved in sedentary activities. 39