Nutrition in Toddlers, Preschoolers, Early Childhood, & Preadolescents - Part 3 PDF

Nutrition in Toddler, Pre-schoolers, Early Childhood, & Preadolescents – Part 3 By Dr Chen Seong Ting Email: [email protected] Acknowledgement to Dr Ong Shu Hwa  Part 3 Discuss common nutrition problems Iron-defici...

Nutrition in Toddler, Pre-schoolers, Early Childhood, & Preadolescents – Part 3 By Dr Chen Seong Ting Email: [email protected] Acknowledgement to Dr Ong Shu Hwa  Part 3 Discuss common nutrition problems Iron-deficiency anaemia Dental caries Constipation Lead poisoning Discuss prevention of nutrition related disorders Prevention of overweight & obesity Discuss physical activity in relation to nutrition and each life stage  Iron-deficiency Anaemia Toddlers (esp. 9 – 18 months old) at highest risk because of rapid growth rate and inadequate iron intake Caused by decreased production of RBCs Other causes: Dietary factor: Deficiency of folate (vit B9- help to make RBC) Non-dietary factor: Chronic inflammation or recent infection − Malaria, TB, helminth infections, HIV/AIDs Iron-deficiency Anaemia  NHANES III diagnosis of iron-deficiency anemia (based on the 5th percentile of Hb & Ht for age) Years of age Hemoglobin concentration Hematocrit 1–2 < 11.0 g/dL < 32.9 % 2–5 < 11.1 g/dL < 33.0 % 5–8 < 11.5 g/dL < 34.5 % 8 – 12 < 11.9 g/dL < 35.4 % Hb: protein molecules that carries O2 in RBC Hematocrit: RBC volume per total blood volume  Signs & Symptoms Lethargy, pale skin, unable to pay attention, shortness of breath, palpitations or irritability Consequences in young children: 1. Long-term delays in cognitive development 2. Behavior disturbances  Identification & Prevention Children who are at risk: Increase intake of meat, poultry & 1. Have a low-iron diet fish 2. Consume more than 24 oz. of milk Children ages 1 -5 years should not per day drink milk > 24 oz per day (low 3. Have limited assess to food iron content). Larger intakes may because of poverty or neglect displace high iron foods 4. Have special health care needs (inborn error metabolism or Increase Vit C intake: can increase chronic illness) absorption of non-heme iron  Dental Caries Prevalence among Asian children 40% to 97% % in Eastern Asia 38%-73.7% in Southern Asia 26.5%-74.7% in Western Asian countries (Ref: Almoudi et al. 2019. Pediatrics International) Vitamin D deficiency? Oral hygiene? Poor dietary choices?  Causes of tooth decay 1. Baby-bottle tooth decay: Habitual use of a bottle with milk or fruit juice at bedtime or throughout the day Baby bottle tooth decay 2. Dental caries: – Frequent exposure to CHO foods. Conducive environment for Streptococcus mutans (use CHO for food, excrete acid → cause food decay) – Exposure to a strong caries promoter (food that stick to the teeth, eg: sticky candy) Dental caries in children  Prevention of dental caries Seek early pediatric dental care Begin oral hygiene when teeth appear Avoid use of a bottle (milk or Use fluoridated toothpaste juice) at bedtime Fluorosis (staining of the teeth) Avoid indiscriminately eat or can cause by: drink (graze) throughout the day ❑Excessive fluoride supplementation Avoid snacking indiscriminately on sticky CHO ❑Consumption of toothpaste with fluoride Drink fluoridated water (resistant ❑Natural water supply high in to acid attacks) fluoride  Constipation passage of hard stools & dry stools associated with painful bowel movement Contributing factors: 1. Painful experience 2. Preschool: lack of privacy or cleanliness 3. Avoidance of toilet: too involved in their play 4. Diet (sugar & desserts are prone to constipation) 5. Switching milk: breast milk have more stools per week (5 – 40 bowel movements) vs. 5 – 28 for formula fed 6. Intense changes: illness, bedridden, eating less, dehydration  Recommendation by Expert Committee of RNI Malaysian (2017) Adequate intake of fibre: 19 – 25 g/day for young children  Fluid intake Based on Malaysian Dietary Guidelines, children between two to six years should have 4 to 6 glasses of water everyday. Offer children healthier choices Plain water, iced water, infused water, plain milk Prepare a water bottle with plain water Make drinking plain water as a habit for children  Lead poisoning Prevalence  Consequences of lead poisoning High level in the blood: may affect brain, blood & kidney Elevated blood levels: may decrease growth in children Low level exposure: associated with decreases in IQ, behavioral problems, ability to pay attention & academic achievement Childhood obesity Increased prevalence rate Epidemic Affect both high & low income Prevention is the most cost- effective way  In Malaysia, myBreakfast study (2015) 8705 school children aged 6 – 17 years 2 in 3 of those children who are overweight are boys 1 in 3 of the children are low in PA Children who skip breakfast are 1.34 x more likely to be overweight/obese  Childhood Obesity National Health and Morbidity Survey 2019 -Almost 30% children aged 5-17 years are overweight and obese  Possible causes of childhood obesity Family history of obesity Prader-Willi syndrome Environmental & social Hypothyroidism factors (family mealtime, food Cushing’s syndrome availability) Hypothalamic lesions Lifestyle factors (screen time, physical activity) Growth hormone deficiency Adiposity rebound  Consequences of overweight/obesity Type 2 Diabetes Knee/hip joint pain Hypertension Acne & hirsutism Stroke Early puberty PCOS Asthma Abnormal lipid profiles Constipation Depression/low self-esteem Nonalcoholic fatty liver Sleep apnea Increased fracture risks ……. Prevention of childhood obesity by MASO - Toddlers & School age children Nutritional : Continue to broaden diet, emphasize vegetables and fruits Minimise intake of juice and other sweetened beverages To establish regular meal pattern Parents should serve appropriate portion size  Behavioural aspects - Toddlers Emphasise family-based meals, avoid cooking special meals for kids Provide parental modelling of healthy diet, physical activity, and minimal television viewing Do not encourage overeating Do not use food as a reward or punishment Offer positive reinforcement for healthy choices, avoid criticism  Behavioural aspects - School-age children Support healthy body image, emphasising strength and health rather than weight and appearance  Physical Activity For Toddlers: Establish habits of physical activity; encourage more physical playtime Establish healthy television habits (less than one hour a day; not at meals; minimise the number of television in a household) For school children: Investigate local opportunities for adding organised sports to lifestyle (community and school programmes) Offer options, including individual sports if team sports not practical or enjoyed by child (for example: martial arts, dance) Participate in physical activities with children: recreational sports, outdoor play, walking, or cycling  Recommendations for Children and Adolescents (ages 6-17 Years) 60 minutes or more of moderate-to-vigorous intensity physical activity each day Aerobic activity (makes hearts beat faster): Most of the daily 60 minutes should include activities like walking, running. At least 3 days a week should include vigorous-intensity activities. Muscle-strengthening: Includes activities like climbing or doing push-ups, at least 3 days per week Bone-strengthening: Includes activities such as jumping or running, at least 3 days per week Ref: Centre for Disease Control and Prevention  Moderate – intensity aerobic Adolescents School-Aged Children Brisk walking Bicycle riding (on flat surfaces) Brisk walking Active recreation (hiking, kayaking, Bicycle riding (on flat surfaces) swimming) Active recreation (hiking, riding a Playing games that require catching scooter without a motor, swimming) and throwing (baseball and softball) Playing games that require catching House and yard work (sweeping or and throwing (baseball and softball) pushing a lawn mower) Ref: Centre for Disease Control and Prevention  Vigorous – intensity aerobic School-Aged Children Adolescents Running Running Bicycle riding (may include hills) Bicycle riding (may include hills) Active games (running and chasing, Active games (running and chasing, such as football) such as football) Jumping rope Jumping rope Martial arts Martial arts Sports such as soccer, basketball, Sports such as soccer, basketball, swimming, and tennis swimming, and tennis Vigorous dancing Vigorous dancing Ref: Centre for Disease Control and Prevention  Muscle - strengthening School-Aged Children Adolescents Games such as tug of war Games such as tug of war Resistance exercises using body Resistance exercises using body weight or resistance bands weight, resistance bands, weight Rope or tree climbing machines, hand-held weights Climbing on playground equipment Some forms of yoga Children yoga Ref: Centre for Disease Control and Prevention  Bone - strengthening School-Aged Children Adolescents Hopping, skipping, jumping Jumping rope Jumping rope Running Running Sports that involve jumping or rapid Sports that involve jumping or rapid changes in direction changes in direction Ref: Centre for Disease Control and Prevention  Part 3 Discuss common nutrition problems Iron-deficiency anaemia Dental caries Constipation Lead poisoning Discuss prevention of nutrition related disorders Prevention of overweight & obesity Discuss physical activity in relation to nutrition and each life stage