Chapter 10 - Exam 2 Flashcards
Toddlers
1-3 years old
characterized by rapid increase in gross/fine motor skills
Preschool-age children
3-5 years old
11.8 mil in US
characterized by increasing autonomy, broader social circumstances, increasing language skills, and expanding self control
Importance of nutrition status
during toddler and preschool years, adequate nutrition is required to achieve full growth and development
undernutrition impairs cognition and ability to explore environment
Toddler and Preschool health
Healthy People 2020 - objectives for nation for improvements in health status by 2020
(some ex; increase fruits and veggies in diet, increase in consumption of whole grains and calcium, and to reduce calories from fats, sugars, and sodium)
Normal growth and development
from birth to 1 year, average infant triples birth weight
toddlers gain 2.7 kg (6.1 lb) and 12 cm (4.7 in) per year
preschoolers gain 2 kg (4.4 lb) and 7 cm (2.8 in) per year
Monitoring Children’s Growth
use calibrated scales and height board
toddlers - under ager 2 weighed without clothing or diaper, determine recumbent length
preschoolers - over age 2 weighed with light clothing, measure stature with no shoes
2000 CDC Growth Charts
gender specific
age specific (birth to 36 months, and 2 to 20 years)
monitor for weight-for-age, length/stature-for-age, head circumference for age, BMI for age
WHO Growth Charts
growth standards for children from birth to 5 years
international growth standards regardless of ethnicity or socioeconomic status
Toddler: Walking Development
progress by month; 15 - crawl up stairs 18 - run stiffly 24 - walk up stairs one foot at a time 30 - alternate feet going up stairs 36 - ride a tricycle (fascinated with skills, with no sense of dangers, leading cause of death in toddlers due to unintentional injury)
Toddler: Cognitive Development
toddlers "orbit" around parents vocab expands; 10-15 words at 18 months 100 at 2 years 3-word sentences at 3 years (increased determination to express own will, temper tantrums common)
Toddler: Development of Feeding Skills
12-14 months - completely weaned
gross/fine motor development improved;
12 months - refined pincer
18-24 months - able to use tongue to clean lips/rotary chewing
Toddler: Feeding behaviors
rituals in feeding common
may have strong preferences and dislikes
imitate parents/siblings
involve child in meal selection and prep
Meal Prep activities for young children
2 years - tear lettuce, rinse veggies/fruit, snap green beans
3 years - mash potatoes, squeeze citrus fruits, stir pancake mix
4 years - peel eggs/fruit (bananas or oranges), crack eggs, help with sandwiches and tossed salads
5 years - measure liquids, cut soft fruits with dull knife, use egg beater
Toddler: Food Intake
toddler-sized portions ~ 1 tbsp per year of age
nutrient dense snacks
Preschool-Age: Cognitive Development
cooperative and organized group play
vocab expands to > 2,000 words (begin using complete sentences)
control is central issue (childs challenge is to separate)
Temperament
Behavior style of a child (3 main temperaments);
- 40% “easy” - adapts to regular schedules and accepts new foods
- 10% “difficult” - slow to adapt and may be negative to new foods
- 15% “slow-to-warm-up” - slow adaptability, negative to new foods but can learn to accept
- remaining styles are “intermediate low” to “intermediate high” with a mixture of behaviors
Preschool-Age: Feeding Behaviors
can use fork, spoon, and cup
spills occur less frequently
appetite related to growth, increases prior to “spurts” of growth
Preschool-Age: Energy Intake
children adjust caloric intake to match caloric needs, avoid encouraging to “clean plate”
healthful eating habits must be learned
Preschool-Age: Feeding Relationship
- parent or caretaker; “what” children are offered to eat, environment in which food is served including “where” and “when”
- Child; “how much” to eat
Energy Needs: Calories
estimated energy requirement (EER) for 1-3 year olds - (89 x weight (kg) - 100) + 20
*(ex:) 12 kg child = (89 x 12 - 100) + 20 = 988 kcal/d
Energy Needs: Protein
1-3 years - 1.1 g/kg/d or 13g/d
4-8 years - 0.5 g/kg/d or 19 g/d
Energy Needs: Vit/Min
1-3 years - Iron 7 mg/d, Zinc 3 mg/d, Ca 700 mg/d
4-8 years - Iron 10 mg/d, Zinc 5 mg/d, Ca 1,000 mg/d
varied diet provides all vit/min needed, AAP recommends no supplements unless;
from deprived families, poor appetites/diets, consume only a few types of food
1 in 2 three year olds take supplements when not rec. to
Actual Nutrient Intake
meet or exceed intake for energy, protein, fat, and most vit/min requirements
sodium intake at 2,600 mg/d when only 1,000-1,200 mg/d recommended
iron, zinc, Ca, and Vit D/E tend to be lower
25% children 4-8 years old consume fast food
Physical Activity Recommendations
60 mins of PA everyday
Common Nutrition Problems
Iron-deficiency dental caries constipation elevated blood lead food safety overweight/obesity
Iron Deficiency
-toddlers (1-2 yo) - 15.9% are iron-deficient (with little physiological problems)
-preschoolers (3-5 yo) - 5.3% iron deficient
may result in delays in cognitive development
reduction on number of RBC’s (insufficient intake/absorption of iron
Iron Deficiency: Prevention
limit milk consumption on 1-5 yo to 24 oz/d
increase meat consumption, iron supplements, repeat screening
Dental Caries
1 in 3 children ages 3-5
causes;
streptococcus mutans (bedtime bottle with juice or milk, stick carb foods)
prevention with fluoride
Constipation
hard, dry stools associated with painful bowel movements
prevention - adequate fiber
1-3 yo - 19 g/d total fiber
4-8 yo - 25 g/d total fiber
Elevated Blood Lead Levels
~ 0.9% children 1-5 yo
low levels of lead linked to lower IQ and behavioral problems
high levels may decrease growth
reduce lead poisoning by eliminating sources of lead
Food Safety
key foodborne pathogens;
-campylobactr: handling raw/uncooked poultry, infected feces, unpasteurized milk or unchlorinated water
-salmonella: raw/undercooked eggs
-E coli: undercooked meat, unpasteurized apple cider
-listeria monocytogens: undercooked meats, unpasteurized milk
Prevention - clean hands/surfaces, separate foods, cook properly, chill promptly
Overweight/Obesity
BMI for over 2 yo; - ≥95% = obese - 85-94% = overweight - < 5% = underweight 12.1% of children 2-5 yo are obese (no significant gender/ethnicity differences) Prevention is best treatment
Treatment of Overweight/Obesity
4 stage approach
1: Prevention Plus
2: structured weight management (SWM)
3: comprehensive multidisciplinary intervention (CMI)
4: tertiary care intervention (TCI) - not appropriate for toddlers/preschool age children
