Transcript Chapter_14R

NUTRITIONAL REQUIREMENTS
DURING GROWTH AND
DEVELOPMENT AND EATING
HABITS AFFECTING ORAL
HEALTH
CHAPTER 14
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
Infants: Overview
 Feeding patterns in first 2 years of life create
environment for optimal development of
genetically determined factors contributing to
orofacial development and swallowing patterns
 Growth
 Birth weight doubles in 4 months (from 7.5 to 15 lb)
 By 1 year it triples
 Length or height increases 50% by age 1
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Infants: Nutritional Requirements
 Energy requirements are much higher per pound
or kilogram of weight than for an adult
 95 to 83 kcal/kg/day between 3 and 12 months of age,
respectively, vs. 29 to 37 kcal/kg/day for adults
 Infants have a higher resting metabolic rate
 Protein recommendations
 AI =1.52 g/kg daily from birth to 6 months of age
 AI =1.2 g/kg for infants over 6 months of age
 This translates to about 9.1 to 11 g/day
 Should not exceed 20% of daily caloric intake due to
immature renal function
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Infants: Breast Milk
 Optimal source of nutrition for infants;
incredibly complex and contains:
 Living cells
 Long-chain fatty acids
 Hormones
needed for brain and
retina development
 High cholesterol count
 By 6 months of age,
need addition of iron-rich
foods or supplements
 By 2 months, supplement
with vitamin D
 Active enzymes (e.g.,
lipase to aid in fat
digestion)
 Antibodies
 Low mineral content;
ideal for immature infant
kidneys
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Infants: Artificial Baby Milk
 Despite strict standards for infant formula, it
cannot duplicate human breast milk
 Nonfat cow’s milk is the basis for most infant formulas
 Provides 20 kcal/oz
 Most have been modified to include DHA for
brain and retinal development
 APA provides guidelines for electrolyte, mineral,
and vitamin content
 ADA recommends use of fluoride-free
water to reconstitute powder formulas
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Infants: Artificial Baby Milk
 Alternative artificial baby milk
 Soy-based formulas used for infants with cow’s milk
allergy

Most common reason for use is relief of perceived formula
intolerance (spitting, vomiting, fussiness) or symptoms of colic
although clinical studies do not indicate a benefit
 Formulas for infants with special nutritional
requirements


Preterm infants
Metabolic problems (e.g., phenylketonuria)
 Formulas discontinued at age 1; whole milk
provided until age 2
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Infants: Feeding Practices
 Infants typically eat six times/day at 4-hour
intervals
 Oral and neuromuscular development
 Suckling encourages maximum development of
the genetically defined jaw and chin



Breastfed infants less likely to develop malocclusion—high
premaxilla, abnormal alveolar ridges, and palate and
posterior cross-bite
Infants breastfed for a year require 40% less orthodontia
than bottle-fed infants
Sucking from a bottle or on a pacifier, thumb, or fingers
may result in narrower upper and lower dental arches
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Infants: Feeding Practices
 Suckling is replaced with sucking by 4 months of age
 Sucking motion becomes developed enough to eat and
handle semisolid foods from a spoon at 4 to 6 months
 At about 6 to 8 months of age, develop the ability to
receive food and perform a chewing motion
 When infant can chew, variety of texture is
mandatory to prepare infant to accept unfamiliar
foods later in life

Unless textured foods are offered, development of oral
musculature may be slow or delayed and affect speech
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Infants: Feeding Practices
 Introducing foods
 4 to 6 months
 First foods introduced are usually cereals made of
rice, oat, or barley
 Should be presented to the infant with a spoon
 Formula intake should remain around 32 oz daily
 Fruit juice provides no nutritional benefit for infants
less than 6 months old
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Infants: Feeding Practices
 Introducing foods
 6 months
 4 to 6 oz of fruit juice diluted with equal portions of water can
be introduced in a cup
 Because of possible food allergy, only one new food should be
introduced at a time
 Order of introduction: vegetables, meats, and fruits



Sweet foods are preferred so offer other foods first
Junior-type foods with a few lumps are introduced to initiate
some chewing
Fluoride supplements recommended for children in areas
without fluoridated water
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Oral Health Concerns of
Early Childhood
 Nutritional deficiency during
tooth development affects:
 Tooth size
 Tooth formation
 Time of tooth eruption
 Susceptibility to caries
 Mild to moderate malnutrition
during first year of life associated
with increased caries in primary
and permanent teeth
From Bath-Balogh M, Fehrenbach MJ: Illustrated
Dental Embryology, Histology, and Anatomy, ed 3. St.
Louis: Saunders, 2011.
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Infant Oral Care
 General oral hygiene guidelines
 Infant’s gingiva should be cleaned daily with gauze;
soft infant toothbrush and water or infant tooth cleaner
to remove plaque biofilm
 When teeth begin to erupt, parents should continue
brushing teeth with soft infant toothbrush using
fluoride-free toothpaste
 AAPD recommends first dental visit by age 1
 When child is able to expectorate (usually 2 to 3 years
old), pea-sized amount of fluoride toothpaste can be
used
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Infant Oral Care
 Feeding issues affecting oral health
 At-will nighttime breastfeeding should be discontinued
once teeth erupt
 Infants and toddlers should not be given a bottle at
bedtime
 Toddlers should be weaned from the bottle by 14 months
 Infants and toddlers should begin drinking from a cup as
soon as they can sit up and hold it

A sippy cup between meals with juice, soda, or other sweetened
liquid places the child at risk for caries
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Early Childhood Caries
 Early childhood caries (ECC)
 Presence of one or more decayed, missing (due
to caries), or filled tooth surfaces in any primary
tooth in child less than age 6
 Severe early childhood caries (SECC)
 Rampant decay usually associated with
inappropriate feeding practices
 Children with SECC weigh less than their
ideal weight for height, and their weight
for age is frequently below 10th percentile
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
From Swartz MH: Textbook of
Physical Diagnosis, ed 7.
Philadelphia: Saunders, 2014.
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ECC: Contributing Factors
 Infection with Streptococcus mutans
from caregiver
 Addition of frequent or prolonged
exposure to a fermentable
carbohydrate will inoculate S.
mutans
 A bottle at bedtime and frequent
daytime bottles or habitual use of a nospill training cup increase caries risk
From Bath-Balogh M, Fehrenbach MJ:
Illustrated Dental Embryology, Histology,
and Anatomy, ed 3. St. Louis: Saunders,
2011.
 Prevention starts before birth with
guidance to parents
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Cleft Palate and Lip
 Malformation in which parts of the upper lip or
palate fail to grow together
 Approximately 1 out of 1000 infants born with cleft lip
with or without cleft palate
 Drugs, heredity, or nutrient deficiencies (namely folic
acid) may cause this malformation
 Infants born with cleft palates are at high risk of
developmental delays, including motor skills
 Increased rates of dental abnormalities, including
supernumerary, missing, or malformed teeth
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Cleft Palate and Lip
 Feeding can be major issue since
presence of the cleft prevents
negative pressure needed for
sucking
 Extra feeding time is necessary to
ensure adequate nutrition
 Special feeding devices needed when
feeding time exceeds 1 hour
 Other feeding issues include nasal
regurgitation, excessive air intake, and
frequent burping
 Spoon feeding introduced as soon as
possible
From Bath-Balogh M, Fehrenbach MJ:
Illustrated Dental Embryology, Histology,
and Anatomy, ed 3. St. Louis: Saunders,
2011.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Dietary Recommendations and
Guidelines for Growth: Children
Older Than 2 Years
 MyPlate & MyPyramid
for Kids emphasize
variety, moderation,
and balance in food
choices
 Focus on importance of
making consistent
smart food choices
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MyPlate for Kids: Key Messages for
Parents




Set a good example
Offer a variety of foods
Start with small portions
Help them know when
they’ve had enough
 Follow a meal and snack
schedule
 Make mealtime a family
time




Cope with a picky eater
Help them try new foods
Make food fun
Encourage 60 minutes of
physical
activity daily
 Dietary fiber
intake = age
of child +
5 g/day
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Toddlers and Preschool Children:
Overview
 Growth
 Grow approximately 2 to 3 inches/year and gain
around 5 lb/year
 Half of adult height achieved by 2½ to 3 years of age
 Nutrient requirements
 Most often deficient: iron, zinc, calcium, and vitamin D
 Caloric needs: 1000 kcal + 100 kcal per year of age
 Choose nutrient-dense foods to meet growth needs
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Toddlers: 1 to 3 Years Old
 Some finger foods should be provided at every meal
 Toddlers can manipulate a cup by age 18 months
 Provide regularity with meals and snacks
 Offer small amounts of food several times per day
 Serving size is dependent on appetite
 Food jags are common; continue to offer
well-balanced meals; let children choose
from what is offered
 Prevent choking by closely supervising
children while they’re eating
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Preschool Children:
4 to 6 Years Old
 Independent in feeding themselves
 Cutting fruits and vegetables into small
pieces increases acceptance
 Prefer foods separate rather than mixed
 Parents need to model appropriate eating behaviors
 Snacks important to ensure adequate nutrient intake
 Easy-to-chew foods more readily accepted
 May need 8 to 15 exposures to new food before
acceptance
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ADD/ADHA
 Promote a nutritionally well-balanced, highprotein diet
 Limit added sugars
 Add more complex carbohydrates
 Restriction of synthetic food color additives
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Children with Special Needs
 Mastication and swallowing problems are common
 Bruxism is common in cerebral palsy and Down
syndrome
 Children with cerebral palsy, Down syndrome, and
intellectual disabilities likely to have abnormal
sensory input and muscle tone
 Difficulties with sucking, swallowing, spoon-feeding
skills with semisolid or solid foods, chewing, and
independent feeding are common
 Tongue thrust associated with many of these
conditions jeopardizes nutritional status
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School-Age Children:
7 to 12 Years Old
 Only 22% of all children
consume 3 servings of
vegetables daily
 Food habits and intake may
suffer because children do not
take time for meals
 Although bakery products, soft
drinks, candy, and chips are
favorites, nutritious snacks are
preferable
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School-Age Children:
7 to 12 Years Old
 Dental caries
 Prevalence of caries in the permanent teeth




of youths ages 6 to 11 years decreased from 25% in
1988–1994 to 21% in 1999–2004
Some racial, ethnic, and lower socioeconomic groups
have more treated and untreated caries
Caries rate is reduced 60% when 1 ppm fluoride in
drinking water is present during tooth formation
Application of sealants aids in reducing caries risk
Food selection and patterns of consumption affect
caries risk, so nutritious foods should be encouraged
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Adolescents
 Growth and nutrient requirements
 Because of major biological, social,
psychological, and cognitive changes; 17%
of teens at nutritional risk
 Growth of long bones, secondary sexual
maturation, and fat and muscle deposition
lead to increased nutrient requirements

Calcium, vitamin D, and iron especially important

Only 9% of girls and 31% of boys between ages 14
and 18 get the recommended daily amount of
calcium
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Adolescents
 Influential factors on eating habits
 External factors
 Family
 Peer pressure
 Mass media
 Economic and sociocultural factors
 Internal factors
 Physiological needs
 Body image and self-concept
 Food preferences
 Personal values/beliefs toward health and nutrition
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Adolescents: Food Choices
 Favorite food choices
among adolescents:
 Flavored milk
 Steak, hamburgers,
 Carbonated beverages,
sports/energy drinks

Soda consumption
increased from 16 oz/day
to 28 oz/day between
1977 and 1999
 Orange and apple juice
 From 1977 to 2001, fruit
drink consumption  from
1.8% to 3.4%






chicken
Pizza and spaghetti
Chips
French fries
Ice cream
Candy (sour,
hard, chewy)
Snack cakes
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Adolescents: Food Choices
 Adolescents have more access to food outside
the home and experiment more with food
selections
 About 25% of kilocalories come from high-
calorie, low-nutrient foods, which results in:
 Excessive intake of sodium, sugar, and fat
 Inadequate fiber
 Frequent snacking and skipping meals, especially
breakfast
 Eating in a hurry
 Reliance on convenience and fast foods
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Adolescents: Oral Health
 Academy of General Dentistry notes increase in
soda consumption has boosted caries rate in
teens, which is approaching levels before
fluoridation
 AAPD warns of the following potential health
problems as a result of high intake of sweetened
drinks:
 Overweight attributable to additional caloric intake
 Displacement of milk consumption, resulting in calcium
deficiency with an attendant risk of osteoporosis and
fractures
 Dental caries and potential enamel erosion
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Adolescents:
Nutritional Counseling
 Adolescents can frequently be motivated
by responsibility, collaboration, fear of
failure, and respect for the counselor
 Negotiation and reflective listening can
enhance their critical thinking skills
 Present nutrition and oral health
information in terms relevant to teen
lifestyles and personal interests (athletic
performance, appearance)
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HEALTH APPLICATION
Childhood & Adolescent Obesity
 Discuss factors impacting/causing the obesity
epidemic
 Consider physiological/psychosocial
complications leading to negative health
consequences
 Discuss social discrimination related to obesity
 Consider strategies and rationales for WHY
prevention is so important
 Discuss goal setting for obese children for weight
maintenance or reduction
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