Transcript chapter_12_child_and_preadolescent_nutrition

Chapter 12
Child and Preadolescent
Nutrition
Definitions of the Life Cycle Stage
• Middle childhood—between the ages of
5 and 10 years
• Preadolescence—ages 9 to 11 years for
girls; ages 10 to 12 years for boys
– may also be termed “school-age”
Introduction
• Focuses on growth and development of
school-age and pre-adolescent children
– Physical, cognitive, emotional, social
growth
– Growth spurts
– Modeling healthy eating and physical
activity behaviors
Importance of Nutrition
• Establishing healthy eating habits helps
prevent immediate & long-term health
problems
• Adequate nutrition associated with
improved academic performance
Tracking Child and Preadolescent Health
• Data on U.S. children in 2010
– Children under 18 were nearly 10% of
population
– 7.5 million had no health insurance
• Disparities in nutrition status exist
among different races & ethnic groups
Tracking Child and Preadolescent Health
• Disparities in nutrition status exist among
different races & ethnic groups.
– African American, American Indian, and
Hispanic children more likely to live in
poverty
– Odds of being obese significantly higher
for non-Hispanic Black children and
Mexican American children
Normal Growth and Development
• Measurement techniques
– Growth velocity will slow down during the
school-age years
– Should continue to monitor growth
periodically
– Weight and height should be plotted on the
appropriate growth chart
Normal Growth and Development
• 2000 CDC growth charts
– Tools to monitor the growth of a child for
the following parameters
• Weight-for-age
• Stature-for-age
• Body mass index (BMI)-for-age
– Can be downloaded from CDC website:
www.cdc.gov/growthcharts/cdc_charts.htm
Normal Growth and Development
• 2000 CDC growth charts
– Based on data from cycles 2 & 3 of the
National Health & Examination Survey
(NHES) & the National Health & Nutrition
Examination Surveys (NHANES) I, II, & III
• WHO Growth References
– Available at www.who.int/childgrowth
Normal Growth and Development
Physiological Development in School-Age
Children
• Muscular strength, motor coordination,
& stamina increase
• In early childhood, body fat reaches a
minimum then increases in preparation
for adolescent growth spurt
• Adiposity rebounds between ages 6 to
6.3 years
• Boys have more lean tissue than girls
Cognitive Development in School-Age
Children
• Self-efficacy…the knowledge of what to
do and the ability to do it
• Change from preoperational period to
concrete operations
• Develops sense of self
• More independent & learn family roles
• Peer relationships become important
Development of Feeding Skills
•  motor coordination & improved
feeding skills
• Masters use of eating utensils
• Involved in food preparation
• Complexities of skills  with age
• Learning about different foods, simple
food prep and basic nutrition facts
Eating Behaviors
• Parents & older siblings influence food
choices in early childhood with peer
influences increasing in preadolescence
• Parents should be positive role models
• Family meal-times should be
encouraged
• Media has strong influence on food
choices
Body Image and Excessive Dieting
• The mother’s concern of her own
weight issues may increase her
influence over her daughter’s food
intake
• Young girls are preoccupied with weight
& body size at an early age
Body Image and Excessive Dieting
• The normal increase in adiposity at this
age may be interpreted as the
beginning of obesity
• Imposing controls & restriction of
”forbidden foods” may increase desire
& intake of the foods
Energy and Nutrient Needs of SchoolAge Children
• Energy needs vary by activity level &
body size
• The protein DRI is 0.95 g/kg body wt
• Intakes of vitamins & minerals appear
adequate for most U.S. children
DRI for Iron, Zinc and Calcium for SchoolAge Children
Common Nutrition Problems
• Iron deficiency
– Less common in children than in toddlers
– Dietary recommendations to prevent:
encourage 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 to 9
– Reduce dental caries by limiting sugary
snacks & providing fluoride
– Choose fruits, vegetables, and grains
– Regular meal and snack times
– Rinse (or better yet, brush the teeth) after
eating
Prevention of Nutrition-Related Disorders
• Prevalence of overweight among
children is increasing
• Data from NHANES I, II, & III suggest
weight gain linked to inactivity rather
than increases in energy intake
• Excessive body weight increases risk of
cardiovascular disease & type 2
diabetes mellitus
Prevalence of Overweight and Obesity
• Definitions:
– Obese = BMI-for-age ≥95th%
– Overweight = BMI-for-age from 85th to
95th% (Discuss meaning of “to”)
• Obesity more common in Hispanic and
non-Hispanic black children and
adolescents
• Heaviest children are getting heavier
Characteristics of Overweight Children
• Compared to normal weight peers,
overweight children:
– Are taller
– Have advanced bone ages
– Experience earlier sexual maturity
– Look older
– Are at higher risk for obesity-related
chronic diseases
Predictors of Childhood Obesity
• Age at onset of BMI rebound
– Normal increase in BMI after decline
– Early BMI rebound, higher BMIs in children
later
• Home environment
– Maternal and/or Parental obesity most
significant predictor of childhood obesity
Effects of Television Viewing Time
• Obesity related to hours of television
viewing
• Resting energy expenditure decreases
while viewing TV
• Healthy People 2020 objective:
– Increase proportion of children who view 2
hours or less of TV per day from 78.9% to
86.8%
Television Viewing Time
Addressing the Problem of Pediatric
Overweight and Obesity
“An ounce of prevention is worth a
pound of cure”
Prevention and Treatment of Overweight
and Obesity
• Expert’s recommend a 4-stage approach:
• The four stages:
– Stage 1: Prevention Plus
– Stage 2: Structured Weigh Management (SWM)
– Stage 3: Comprehensive Multidisciplinary
Intervention (CMI)
– Stage 4: Tertiary Care Intervention (reserved for
severely obese adolescents)
Prevention and Treatment of Overweight
and Obesity
Prevention and Treatment of Overweight
and Obesity
• Treatment consists of a multicomponent, family-based program
consisting of:
– Parent training
– Dietary counseling/nutrition education
– Physical activity/addressing sedentary
behaviors
– Behavioral counseling
Nutrition and Prevention of CVD in
School-Age Children
• Acceptable range for fat is 25% to 35%
of energy for ages 4 to 18 year
• Include sources of linoleic (omega-6)
and alpha-linolenic (omega-3) fatty
acids
• Limit saturated fats, cholesterol & trans
fats
Nutrition and Prevention of CVD in
School-Age Children
• Increase soluble fibers, maintain weight,
& include ample physical activity
• Diet should emphasize:
– Fruits and vegetables
– Low-fat dairy products
– Whole-grain breads and cereals
– Seeds, nuts, fish, and lean meats
Dietary Supplements
• Supplements not needed for children
who eat a varied diet & get ample
physical activity
• If supplements are given, do not exceed
the Tolerable Upper Intake levels
Dietary Recommendations
• Iron
– Iron-rich foods: meats, fortified breakfast
cereals, dry beans, & peas
• Fiber
– Increase fresh fruits and vegetables, whole
grain breads, and cereals
• Fat
– Decrease saturated fat and trans fatty
acids
Dietary Recommendations
• Calcium & Vitamin D
– Bone formation occurs during puberty
– Include dairy products and calcium-fortified
foods
– Vitamin D from exposure to sunlight and
Vitamin D fortified foods
– If lactose intolerant:
• Do not completely eliminate dairy products but
decrease only to point of tolerance
Fluid and Soft Drinks
• Provide plain water or sports drinks to
prevent dehydration
• Cold water is the best fluid for children
• Limit soft drinks because they provide
empty calories, displace milk
consumption & promote tooth decay
• Energy drinks should not be consumed
by children
Recommended versus Actual Food
Intake
• Saturated fat—intake is 11% of calories
(recommend <7%)
• Total fat—intake excessive in Black &
Mexican-American girls and Black boys
• Caffeine—increasing because of soft drink
consumption
• Calcium intake falls short of RDA
• Fast food—33% of children consume fast
food each day
Other Considerations
• Cross-cultural Considerations
– Healthy People 2020-a major goaleliminate health disparities among different
segments of the population
– Health care professionals should learn
about cultural dietary practices
Other Considerations
• Vegetarian Diets
– Suggested daily food guides for
vegetarians are available
– Vegetarian diets should be planned to
provide adequate calories, protein,
calcium, zinc, iron, omega-3 fatty acids,
Vitamin B12, riboflavin and Vitamin D
Physical Activity Recommendations
• Recommendations:
– Children should engage in at least 60 minutes
of physical activity each day
– Parents should set a good example,
encourage physical activity, and limit media &
computer use
• Actual:
– Only 7.9% of middle & junior high schools
require daily physical activity
Determinants of Physical Activity
• Determinants may include:
– Girls are less active than boys
– Physical activity decreases with age
– Season & climate impact level of physical
activity
– Physical education classes are decreasing
Organized Sports
• Participation in organized sports linked
to lower incidence of overweight
• AAP recommends:
– Participation in a variety of activities
– Organized sports should not take the place
of regular physical activity
– Emphasis should be on having fun and on
family participation rather than being
competitive
Organized Sports
• Participation in organized sports linked
to lower incidence of overweight
• AAP recommends:
– Use of proper equipment such as mouth
guards, pads, helmets, etc.
– Should not include intensive, specialized
training
Nutrition Education
• School-age: a prime time for learning
about healthy lifestyles
• Schools can provide an appropriate
environment for nutrition education &
learning healthy lifestyles
• Education may be knowledge-based
nutrition education or behavior based on
reducing disease risk
Nutrition Education
Nutrition Integrity in Schools
• All foods available in schools should be
consistent with the U.S. Dietary Guidelines &
Dietary Reference Intakes
• Sound nutrition policies need community &
school environment support
• Community leaders should support the
school’s nutrition policy
• The School Health Index (SHI) should be
completed & implemented
Nutrition Integrity in Schools
• The SHI (School Health Index) helps:
– Identify strengths and weaknesses in
health promotion policies and strategies
– Develop an action plan
– Involve stakeholders (teachers, parents,
students, community) in improving school
policies and programs
School Health Index
Public Food and Nutrition Programs
• Child nutrition programs
– Began in 1946
– Provide nutritious meals to all children
– Reinforce nutrition education
– Require schools to develop a wellness
policy
Public Food and Nutrition Programs
• Financial assistance provided by the federal
gov’t to schools participating in the National
School Lunch Program
– Five requirements
• Lunches based on nutrition standards
• No discrimination between those who can and
cannot pay
• Operate on a non-profit basis
• Programs must be accountable
• Must participate in commodity program
Public Food and Nutrition Programs
• The National School Lunch Program (NSLP)
Standards:
1. Both fruits and vegetables every day;
increasing whole grains
2. Only fat-free or low fat milk
3. Limiting calories based on child’ age
4. Reduce saturated and trans fats, and sodium
School Breakfast Program
• Authorized in 1966
• States may require schools who serve
needy populations to provide school
breakfast
• The NSLP rules apply to the School
Breakfast Program
• Breakfast must provide ¼ the DRI
Other Nutrition Programs
• Summer Food Service Program
– Provides summer meals to areas with
>50% of students from low-income families
• Team Nutrition
– Provides training, technical assistance,
education, or support to promote nutrition
in schools