Child and Preadolescent Nutrition PDF

Child and Preadolescent Nutrition Maymona Al-Hinai, PhD, RDN Definitions of the life-cycle stage Middle childhood: ages 5-10 years Preadolescence (school-age): 9-11 years for girls 10-12 years for boys Importance of nutrition Nutrition problems during this period:...

Child and Preadolescent Nutrition Maymona Al-Hinai, PhD, RDN Definitions of the life-cycle stage Middle childhood: ages 5-10 years Preadolescence (school-age): 9-11 years for girls 10-12 years for boys Importance of nutrition Nutrition problems during this period: Undernutrition Dental caries Weight issues at both ends of spectrum Adequate nutrition and establishing healthful eating behaviors Prevent immediate health problems Reduce risk of developing a chronic condition Normal Growth and Development Growth considerations Growth velocity will slow down during the school-age years Annual growth 3-3.5 kg in weight and 6 cm in height Periodic monitoring of growth continues to be important Weight and height should be plotted on the appropriate growth chart Normal Growth and Development WHO growth references Growth references for older children Height-for-age, weight-for- age, and BMI-for-age 5-19 years Gender specific Growth reference different than growth standard for 0- 5 years Constructed using existing historical data Physiological Development of School-Age Children Physiological development Muscular strength, motor coordination, and stamina increase More complex pattern movements Body fat reaches a minimum then increases in preparation for adolescent growth spurt Adiposity rebound: increase in percent body fat, which usually occurs on average at six years of age Early: ↑ risk of obesity Cognitive Development of School-Age Children Cognitive development Self-efficacy: knowledge of what to do and ability to do it Changes from magical thinking and egocentrism to concrete operations Able to focus on several aspects of a situation at the same time More rational cause/effect reasoning Able to classify, reclassify and generalize Decrease in egocentrism Develops sense of self More independent and learning family roles Peer relationships become important Cognitive Development of School-Age Children Development of feeding skills and eating behaviors Masters use of utensils, can be involved in simple food preparation, and assigned chores related to mealtime Eating behaviors Preferences of parents will influence the child’s food likes and dislikes Family mealtime Eating together as a family should be encouraged Outside influences Peer influence becomes greater as the child’s world expands beyond the family Cognitive Development of School-Age Children Media influence Children want to try foods on television Fast-food establishments are also attractive Snacking Snacks contribute significantly to daily intake and are needed to meet nutritional needs Food preference development, appetite, and satiety Parents assuming responsibility for providing a healthy food environment, but not being overly controlling or restrictive of their child’s intake Cognitive Development of School-Age Children Body image and excessive dieting The mother’s concern of her own weight may influence feeding practices Young girls are preoccupied with weight and size at an early age Restrictive feeding practices contribute to onset of obesity and may contribute to beginnings of eating disorders Energy and Nutrient Needs of School-Age Children Energy needs Vary by activity level and body size Based on a gender, age, height, weight, and physical activity level Gender Age EER (years) Boys 3-8 88.5 − (61.9 × age [y]) + PA × (26.7 × weight [kg] + 903 × height [m]) + 20 kcal Boys 9-19 88.5 − (61.9 × age [y]) + PA × (26.7 × weight [kg] + 903 × height [m]) + 20 kcal Girls 3-8 135.3 − (30.8 × age [y]) + PA × (10.0 × weight [kg] + 934 × height [m]) + 20 kcal Girls 9-19 135.3 − (30.8 × age [y]) + PA × (10.0 × weight [kg] + 934 × height [m]) + 25 kcal PA = 1.00 if PAL is estimated to be ≥ 1.0 < 1.4 (sedentary) PA = 1.13 if PAL is estimated to be ≥ 1.4 < 1.6 (low active) PA = 1.26 if PAL is estimated to be ≥ 1.6 < 1.9 (active) PA = 1.42 if PAL is estimated to be ≥ 1.9 < 2.5 (very active) Energy and Nutrient Needs of School-Age Children Protein Recommended is 0.95 gram of protein per kg body weight per day Common Nutrition Problems Iron deficiency Less common in middle childhood than toddler age Treatment is oral iron trial for four weeks Dietary recommendations: eat iron-rich foods Meat, fish, poultry, and fortified cereals Vitamin C rich foods to help absorption Common Nutrition Problems Dental caries Seen in half of children aged 6-9 Influenced by time teeth are exposed to carbohydrate Complex carbohydrates such as fruits, vegetables, and grains are better choices than simple sugars Regular meal and snack times are beneficial Continued need for fluoride supplementation  Prevention of Nutrition-Related Disorders in School- Age Children Rate of childhood overweight and obesity is alarming! Prevention of Nutrition-Related Disorders in School-Age Children Rate of childhood overweight and obesity is alarming! Prevention of Nutrition-Related Disorders in School-Age Children Characteristics of overweight children Taller Advanced bone ages Earlier sexual maturity Look older Higher risk for health consequences of obesity Prevention of Nutrition-Related Disorders in School-Age Children Predictors of childhood obesity Age at onset of BMI rebound Normal increase in BMI after decline Early BMI rebound results in higher BMIs in children Home environment Parental obesity increases risk of obesity in childhood due to genetics and environmental factors  Prevention of Nutrition-Related Disorders in School-Age Children Television viewing and screen time AAP recommends no screen devices in bedrooms and development of Family Media plan Strong relationship between TV viewing and obesity Reduced energy expenditure Increased dietary intake Disruption of sleep patterns Prevention of Nutrition-Related Disorders in School-Age Children Assessment of overweight and obesity Body mass index-for-age percentile Prevention of overweight and obesity Healthy eating and increased physical activity Prevention of Nutrition-Related Disorders in School-Age Children Treatment goal to develop healthy eating and physical activity behaviors for a lifetime Prevention of Nutrition-Related Disorders in School-Age Children Nutrition and prevention of cardiovascular disease in school-age children Total fat intake 25-35 % of total calories Include sources of linoleic (omega-6) and alpha-linolenic (omega-3) fatty acids Limit fruit juice, sugar-sweetened beverages and foods, salt, saturated fats, cholesterol, and trans fats Prevention of Nutrition-Related Disorders in School-Age Children Dietary supplements Not needed for children who eat a varied diet and get ample physical activity If given, do not exceed the Tolerable Upper Intake levels designated in DRI tables Needed for high-risk children: With anorexia or an inadequate appetite or who follow fad diets With chronic disease From deprived families or who suffer from parental neglect or abuse Who consume a vegetarian diet without adequate intake of dairy products With failure to thrive Dietary Recommendations Iron Iron-rich foods: meats, fortified breakfast cereals, dry beans, and peas Fiber Fresh fruits and vegetables, whole grain breads, and cereals Fat Limit foods high in saturated fat and trans fatty acids Calcium Adequate intake at this time need for peak bone mass 1000 mg/day for 4–8-year, 1,300 mg/day for 9-13-year Vitamin D Adequate vitamin D needed for calcium absorption Vitamin D from exposure to sunlight and fortified foods Dietary Recommendations Lactose intolerance Commonly seen in older children than in younger children Caused by low availability of lactase Tolerance varies by individual Include dairy products to point of individual tolerance Dietary Recommendations Fluids Cold water is the best fluid for children Provide plain sports drinks or diluted juice for prolonged vigorous physical activity Limit soft drinks; they provide empty calories, displace milk consumption, and promote tooth decay Dietary Recommendations Dietary Recommendations Vegetarian diets Should be planned to provide adequate protein, essential fatty acids, calcium, iron, zinc, vitamin B12 and vitamin C Physical Activity Recommendations Children should engage in at least 60 minutes of moderate- and vigorous-intensity physical activity each day Parents should set a good example, encourage physical activity, and limit media and computer use Physical Activity Recommendations Determinants of physical activity Girls are less active than boys Physical activity decreases with age Obese children are less active than non-obese children Season and climate impact level of physical activity Physical education in school has decreased Health-Promoting Schools Initiative Nutrition education School-age: a prime time for learning about healthy lifestyles Schools can provide an appropriate environment for nutrition education and learning healthy lifestyle behaviors Health-Promoting Schools Initiative