Transcript 18. Nutrition through the Life Cycle: Childhood and Adolescence

Chapter 18 Lecture
Chapter 18:
Nutrition Through
the Life Cycle:
Childhood and
Adolescence
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Toddlers
• Age 12 months to 36 months
• Rapid growth rate of infancy begins to slow
• Gain 5.5 to 7.5 inches, average 9 to 11
pounds
• Higher energy expended for increased
activity levels
• Increased nutrient needs are based on their
larger body size
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Toddlers (cont.)
• Macronutrients:
• Estimated Energy Requirement (EER) varies
according to the toddler's age, body weight,
and level of activity
• 30−40% of total kcal from fat
• 1.1 grams of protein per kg body weight
• 130 grams carbohydrates per day (most of
the carbohydrates should be complex)
• 14 grams fiber per 1,000 kcal/day
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Toddlers (cont.)
• Micronutrients:
• Ensure adequate intake of the micronutrients
obtained from fruits and vegetables,
including: vitamins A, C, E, calcium, iron,
zinc, potassium
• Vitamin D supplements recommended for
some children
• Until age 2, drink whole milk for calcium
• Iron-deficiency anemia is the most common
nutrient deficiency in young children
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Toddlers (cont.)
• As toddlers become more active, they lose more
fluids through sweat
• An active toddler may need more fluids
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Nutritious Food Choices
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Most are able to match intake with needs
Healthful variety of food available
Food should not be forced on a child
Frequent, small meals for small stomach
Developmentally appropriate foods
Small portions, limited healthful alternatives
Role modeling is important
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Allergy Watch
• Continue to watch for common food allergies:
wheat, peanuts, cow's milk, soy, citrus, egg
whites, seafood
• Introduce one new food at a time and monitor for
allergic reactions
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Vegetarian Families
• Eggs and dairy: part of a healthful diet
• Vegan diet may be low in protein, minerals
(calcium, iron, zinc), vitamins (D and B12)
• High fiber may impair iron and zinc absorption
and promote a premature sense of "fullness" at
mealtimes
• Fortified foods and supplement use to ensure
adequate nutrition
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Preschool and School-Age Children
• Growth slows: average gain 2–4 in./year
• Encourage physical activity
• EER varies according to age, body weight, and
level of activity.
• From age 4 through 8, values for most nutrients
increase
• Sexual maturation begins ages of 8 and 9: DRI
values are separately defined for boys and girls
beginning at age 9
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Macronutrients
• Total fat intake should gradually drop to a level
closer to adult fat intake
• 25−35% of total energy from fat
• 130 grams carbohydrate per day
• 14 grams fiber per 1,000 kcal
• 0.95 grams protein per kg body weight
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Micronutrients
• Consuming adequate fruits and vegetables in
the diet continues to be a concern (vitamins A,
C, and E, fiber and potassium)
• "Milk displacement"—low-calcium diets also tend
to be low in other nutrients
• RDAs for iron and zinc also increase
• If fluoride is not available in municipal water
supply, fluoride supplements may be needed
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Fluid
• Children: about 5 to 8 cups of beverages each
day, including water
• Exact amount depends on activity and weather
• Beverages should be free of caffeine and added
sugars
• USDA Daily Food Plan meets the nutrient
requirements for preschoolers
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© 2017 Pearson Education, Inc.
Nutrition-Related Concerns
• Nutritious food choices
• Iron-deficiency anemia
• Food insecurity and hunger
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Nutritious Food Choices
• Peer pressure encourages unhealthful food
choices
• Body image plays an important role
• Families who plan, prepare, and eat meals
together are more successful at promoting good
food choices
• Frequent family meals reduce the risk for
disordered eating, substance abuse, and
depression
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© 2017 Pearson Education, Inc.
Iron-Deficiency Anemia
• Higher among children from Mexican-American
and low-income families
• Children with very poor appetites or erratic
eating behaviors may need iron supplements
• If left untreated, iron-deficiency anemia can lead
to behavioral, cognitive, motor delays, and
impaired immunity
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Food Insecurity and Hunger
• 16 million children faced with food hunger and
insecurity
• Without adequate breakfast, children can't
concentrate or pay attention
• Impaired nutrient status can blunt children's
immune responses.
• Psychosocial health associated with food
insecurity
• Government and private programs can provide
nutrition benefits
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Role of School Attendance
• School breakfasts: optimize nutrient intake and
avoid behavioral and learning problems from
hunger in the classroom
• No monitoring for adequacy of food eaten
• Soft drinks and snack foods in school
• School lunches: what's actually eaten (not
planned/served) tends to be higher in fat
• Options to entice healthful selections
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Adolescents
• Adolescence continues to 18 years
• Puberty: secondary sexual characteristics
develop; capacity for reproduction
• During this developmental phase, they may be
less responsive to parental guidance
• Most adolescents navigate the challenges into
mature and healthy adults
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Adolescents (cont.)
• Growth spurts begin at age 10−11 for girls,
12−13 for boys
• Average 20−25% increase in height
• Average girl reaches almost full height by the
onset of menstruation (menarche); boys can
continue to grow during early adulthood
• Skeletal growth ceases closure of the
epiphyseal plates
• Weight and body composition also change
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© 2017 Pearson Education, Inc.
Macronutrients
• EER for adolescents is based on gender, age,
activity level, height, and weight
• 25−35% of total energy from fat
• ≤10% of total energy from saturated fat
• 45−65% of kcal from carbohydrates
• 0.85 grams protein per kg body weight
• 26−38 grams of fiber per day
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Micronutrients
• Calcium intakes must be sufficient for achieving
peak bone density: 1,300 mg/day
• Iron needs are relatively high: 11 mg/day for
boys, 15 mg/day for girls
• Vitamin A is critical for supporting rapid growth
and development
• Supplement should not be considered a
substitute for a balanced, healthful diet
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Fluid Recommendations
• The need to maintain fluid intake is increased
with higher activity levels
• Boys: 11 cups/day
• Girls: 10 cups/day
• Importance of including water
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Nutritious Food Choices
• Parents can act as role models
• Strong influence of peers, mass media, personal
preferences
• Encourage whole grains, fruits, vegetables, and
milk or calcium-rich beverages
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Nutrition-Related Concerns
• Adequate calcium intake maximizes bone
calcium uptake and bone mineral density
• Disordered eating and eating disorders can
begin in these years
• Acne is not caused by diet, but a healthy diet
can optimize skin health
• Cigarette smoking, alcohol, and illegal drugs can
have an impact on nutrition
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Pediatric Obesity
• Overweight: BMI above the 85th percentile of
the same age and gender
• Obese: BMI above the 95th percentile
• Higher risk of health problems:
• Exacerbates asthma
• Causes sleep apnea
• Impairs the child's mobility
• Leads to intense teasing
• Low self-esteem
• Social isolation
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Pediatric Obesity
• Greater risk for type 2 diabetes, high blood
lipids, high blood pressure, gallstones,
depression, and other medical problems
• Higher risk of becoming overweight adults
• Reversal of pediatric obesity can be
accomplished through an aggressive,
comprehensive nationwide health campaign
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Pediatric Obesity (cont.)
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Early tendency during toddler years
Monitor if >80th percentile for weight
Encourage physical activity
Limit foods with low nutrient density
Early intervention is often the most effective
measure against lifelong obesity
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Role of the Family
• Provide nutritious food choices
• Encourage a healthful breakfast
• Sit down to a shared family meal each evening,
or as often as possible
• No television at mealtimes: encourage attentive
eating, enjoyment of the food
• Parents should retain control over the
purchasing and preparation of food
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Role of the School
• Federal school lunch program: limit the amount
of fat, sugar, and sodium served
• Many schools sell foods and beverages that
exceed federal guidelines
• Nutrition education programs: health
departments, Dairy Councils
• Consistent and repeated school-based
messages on good nutrition
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Physical Activity
• Institute for Medicine recommends aerobic
physical activity for at least an hour each day
• Physical Activity Guidelines for Americans:
bone- and muscle-strengthening activities at
least 3 days each week
• Encourage noncompetitive, fun, and structured
activities in ways that allow self-pacing
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© 2017 Pearson Education, Inc.
Physical Activity (cont.)
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Parental and adult role models
Shared activities: ball games, bicycle rides
Television/electronic games: ≤ 2 hours/day
Electronic games: virtual tennis, step aerobics,
dancing, other active simulations
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Physical Activity (cont.)
• Overweight children can "catch up" to their
weight as they grow taller without restricting food
(nutrient) intake
• Acquire motor skills and muscle strength
• Establish good sleep patterns
• Develop self-esteem; lower stress
• Optimize bone mass
• Enhance cardiovascular and respiratory function
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Physical Activity (cont.)
• Physically fit children:
• Have improved behavior
• Are more attentive
• Are more focused
• Have higher levels of academic achievement
• Parents, healthcare providers, and community
members can work with school boards to
optimize opportunities for physical activity
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Pediatric Obesity Treatment
• Stage 1: lifestyle modifications to improve
dietary intake while decreasing energy intake,
and to increase physical activity
• Stage 2: consultations with a Registered
Dietitian Nutritionist, self monitoring, and
monthly visits with healthcare provider
• Stage 3: care team expands to include
behavioral health an exercise specialist, and
weekly visits with healthcare provider
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