Childhood Nutrition Flashcards
1
Q
Childhood
A
- Slower growth than infancy
- Food preferences established
- Gross motor skills refined
- Independent eating and feeding skills refined
- Primary recommendation: eat wide variety of foods
- Toddlers and preschoolers retain ability to **self-regulate food intake **
- Wide range of nutrient reuqirements **based on body growth and weight rates **
2
Q
Toddlers
A
Age 1-3
- Behavior parallels adolescent behavior
- Seeking more independence
- Temper tantrums, easily frustrated, negative attitude
3
Q
Preschool Age
A
Age 3-5
- Learn to control body functions
- Behave in socially acceptable manner
- Interact with others
4
Q
Middle School / Preadolescence
A
Middle School: Age 5-10
Preadolescence: Girls 9-11, Boys 10-12
- More responsive to external cues of appetite
- Develop personal independence
- Establish scale of values
- Individual variations become more noticeable with regards to:
- GR
- Activity patterns
- Nutrient reqs
- Personality
- Food Intake
5
Q
Food Acceptance
A
Influenced by:
- Parental food selection
- Mealtime environment → scolding vs. happy
- Peer pressure, advertising
- Previous experiences with that food
6
Q
Physical Growth
A
- GR slows
- Average yearly weight gain: 4-7 lbs/year (for all ages)
- Average yearly length gain:
- Toddler: 4-5 inches
- Preschool: 2-3 inches
- School age: 2-3 inches
- From 6→puberty, gender differences start to be noticed
7
Q
Body Composition
A
- Changes significantly
- Muscle Mass increase
- Skinfold decreases
- Subcutaneous fat→ females > males
- Head size proportion decreases (relative to body)
-
Brain growth
- 75% by 2nd year
- 100% by ages 6-10
-
Body Fluid
- Similar to adult by 2-3 years
- Extracellular fluid decreases
- Intracellular fluid increases
- Less vulnerable to dehydration than during infancy
- Decreased ratio of body surface area to body mass
- Elongation of leg bones and constant bone remodeling
8
Q
Growth Assessment
A
Growth charts
- Birth-36 months → recumbent measure
- 2-20 years → standing measure
- Growth Channels
- Progressive regular growth patterns of children
- Guided along individual genetically controlled channels
- influenced by nutritional and health status
- Should be maintained once established
- Maintaining weight-height % is more important than ht-for-age
9
Q
Growth Charts
A
- Based on NHANES III Data
- Measuring weight
- Stocking feet
- Standard exam clothing
- Beam balance scale
- Measuring weight
- Using Charts
- Detection of excess or inadequacies in nutrients
- 10-25th and 75-90th percentile → close observation
- Extremes → risk of overgrowth or failure → closer evaluation
- NHANES III
- more minorities
- New percentiles: 3rd and 97th
- Age increased to 20
- Data shows increased weight for children 6-20
- This increase not reflected in charts
- Charts no longer describe American population
- First time for making reasonable judgments about growth channels
10
Q
BMI for Age
A
- Main concern → overweight
- Don’t want to set growth standards on obese data
- Replaced weight for height
- More reliable index for overweight
- In kids, BMI is age and gender specific
- Reference points change with age
- 85% added to help identify risk for obesity
-
BMI decreases during preschool
- Lowest point at 4-6 years
- Followed by “BMI Rebound”
- Early BMI rebound → more at risk for being overweight or obese as an adult
- Advantages
- Compares well with:
- **weight for stature **
- measures of body fat
- Reference for adolescents was not previously available
- Consistent with adult index
- Can be used continuously to adulthood
- Compares well with:
11
Q
BMI for Age Cut Offs
A
>95th% → obese
85-94th% → overweight
5th-84th% → acceptable
<5th% → underweight
12
Q
Feeding Skills
A
- With increased age and strength, feeding skills are mastered
- Physical growth reflected in development of self-feeding
- Children learn to feed independently during 2nd year of life
- Ulnar deviation (articulation of wrist joint) enables spoon feeding
- Develop coordinated movement of wrist and hand
- Handedness is not established at 1 year
- Refined pincer grasp makes finger feeding preferable → children often place food in spoon
- By 18-24 months, children can tilt cup effectively
- Ability to chew hard, fibrous foods increases through school years
- Avoid foods with high choking risk
- Dried, sticky fruits
- Small fruits with skins and peels
- Graps, hot dogs and nuts cut in half
- Popcorn and chips
- Peanut butter
13
Q
Energy Requirements
A
- Based on
- REE
- GR
- Physical Activity
- Small gender difs until age 10
- Growth charts show adequacy of intake
- Catch up growth increases needs
- Age 1-3
- 102 kcal/kg/day
- EER = (89 x wt(kg) - 100) + 20
- Catch up growth → 150-250 kcal/kg
- Age 4-6
- 90 kcal/kg/day
- > 3 years Table 10.4, p. 283
- Ages 7-10
- 70 kcal/kg/day
- RDA’s provide guidelines for studying groups, but not evaluating diets of individual children
14
Q
Protein Requirements
A
- Based on:
- Maintenance of tissue
- Changes in body composition
- Synthesis of new tissue
- As child grows, protein intake relative to body size decreases
- Adequate intake determined by:
- Adequacy of growth
- Quality of protein in diet
- Age 1-3 →** 1.1 g/kg**
- Age 4-13 → .95 g/kg
15
Q
Minerals
A
- Inadequate intake may →
- Slow GR
- Inadequate bone mineralization
- Anemia
- Minerals of Concern
- Ca
- Fe
- Zn
16
Q
Calcium
A
- Required for bones
- >98% of Ca in body is bone
-
Absorption range from 30-60%
- Lactose increases absorption
- Phytic (wheat grains) and oxalic acid (green leafies, corn, soy, tofu, wheat germ) decrease absorption
- Age **1-3 **→ 700 mg/day
- Age 4-8 → 1,000 mg/day
- Age **9-18 **→ 1300 mg/day
- As protein increases → urinary calcium increases
- Recommended intake is high, relative to body size
- More Ca needed during rapid growth
- Milk and dairy products primary source
17
Q
Zinc
A
- Necessary for protein synthesis and growth
- Deficiency results in:
- Growth retardation
- Hypogeusia (low taste threshold) and diarrhea
- Impaired wound healing
- Impaired cell-mediated immunity
- Children don’t consume enough
- Increase Zn intake in deficient children → increased linear growth
- Meats are good source
- Absorption decreased by:
- Fiber
- Phytates
18
Q
Iron Requirements
A
- Increases with periods of rapid growth
- larger, more rapidly growing children have greatest requirement because they are increasing blood vol
- Age 1-2
- 15.9% deficient
- 2020 → 14.3%
- Age 3-4
- 5.3% deficient
- 2020 → 4.3%
- Deficiency most often in:
- 9-18 months
- Mexican (17%) > African (10%) > White (8%)
- Low income
- Causes:
- Inadequate intake/absorption
- repeated small blood loss
- Consequences:
- Delayed mental and physical development (impossible to pinpoint)
- Behavioral disturbances
- Decreased resistance to infection
- Prevention
- Use ground meat
- Include Vit C and Fe intake to increase absorption
- Limit milk to 24 oz/day
- Fe absorption decreased by antacids, bran and tea
- RDA for Fe assumes 10% absorption
- Supplementation
- 10 mg/day for “at risk”
- 3 mg/kg/day for treatment
- May improve weight gain, appetite, psychomotor and mental development
19
Q
Lead Poisoning
A
- Screening
- 9-10 months
- Again at 2 years
- Homes built before 1950
- Toxicity
- Decreased IQ
- Behavioral Problems
- Decreased growth
- Damage to brain, kidneys
20
Q
Vitamins
A
- Many vitamins function in energy metabolism
- Requirements based on CHO, protein and fat intake
- For kids, RDA are interpolated and calculated from infant and adult references
- At risk groups:
- Poverty and adverse family circumstances
- Vegetarian children
- Fe and B12
- mexican american children
- inadequate intake
- high prevalence of obesit and overweight
- Native american children
- Foster children
- Often high incidence of heat problems
- Chaotic social situation
- Homeless
- Growth stunting without wasting
- Not deficient in total kcals but in some nutrients
- Hungry children may have many negative behaviors that interfere with learning
21
Q
Supplementation
A
- Debated in healthy kids
- Recommended for at risk:
- Deprived or neglected
- Anorexia/poor appetite
- Chronic disease / frequent illness
- Obese on diets for weight management
- Vegans
- Food allergies requiring special diet
- Limited food acceptance, decreased variety
- Over 1/2 preschool and school aged kids receive MVI/min
- Children more likely to receive vitamins are at low nutrition risk
- Young kids > older kids
22
Q
Food Acceptance
A
- Taste
- Previous experiences
- Beliefs about specific foods
- Degree of satiation
- Size of pieces of food
- Ease of handling food
23
Q
Parental Influence
A
- Guides Preferences
- Establishes “style”
- Where and how foods are eaten
- Whome its eaten with
- How much is eaten
- Nutrition knowledge of parents
- Ordinal position of child
- Models have strong influence on food patterns
24
Q
Parent-Child Interactions
A
- Expectations
- Positive, neutral, or critical verbal mealtime interaction makes a big difference
- Establishment of pattern for meals/snacks
- Food jags are normal
- Bribery / Rewards with food should be avoided
25
Influence of Television
* Great impact on food attitude and requrests
* Children watch average of 28 hours TV/wk
* 33% watch \> 5 hrs/day
* 66% of homes have at least 3 TV's
* 2020 Goal \<2 hour/day
* Factors associated with TV viewing
* Low income
* Obesity
* Snacking (More calories, less nutrients)
* Lower vigorous physical activity
26
AAP Recommendations for TV
* No TV in child's bedroom
* 0-2 years: no screen time
* 2+ years: \<2hr screen-time/day
* Wants parents, not children, to determine what is bought/eaten for child
* Wants commercials aimed at parents, not kids
27
Influence of Advertising
* Large percentage of commercials focus on food
* Many commercials ignore nutrients and promote sweet flavor
* Preschool children often not able to recognize commercial as separate from the program
* Age 5-10 watch commercials more closely than older kids
* Older kids recognize and distrust commercials
* TV influences eating habits and nutritional status of kids
* Increases attempts to influence supermarket purchases of parents
* Mothers more likely to yield to requests for food than for other products
* Highly "child-centered" moms less likely to buy favorite cereal
28
Marketing Towards Kids
* Kids have a significant influence on purchasing habits of family
* Marketing to kids can affect buying patterns long-term
* Today's parents more willing to buy for kids
* More disposable income d/t dual incomes
* Smaller family sizes
* Stressed, over-committed parents feel guilty about not spending enough quality time
29
Preschool
Ages 3-5
* Clinical signs of malnutrition rare
* Large individual variations
* Decreased intake of Ca, P, Riboflavin, Fe, Vit A vs. Infancy b/c:
* Discontinuation of Fe-fortified infant cereals
* Reduction in milk intakes
* Disinterest in veggies
* Increased intake of carbs and fat compared to infancy
30
Preschooler Food Behaviors
* Food Rituals
* Only eat certain foods
* Mandate certain arrangements of foods
* One food can't touch another
* Sandwiches must be cut in a certain way
* Food must be prepared in a particular way
* Presentation is often an issue
* Disinterest in food, decreased appetite
* Strong Preferences
* Changes in likes and dislikes
* Erratic, unpredictable appetites
* Evening meal often least well received compared to breakfast and lunch
31
Preschool Food Prefs
* Carb rich foods easy to chew
* Dairy products, cereal, cookies, crackers, fruit juice
* Dry fortified cereals increasing as a primary source for many nutrients
* Yogurt and cheese increasing in popularity
32
Preschool Freq of Eating
* Most eat \> 3 times/day
* Average is 5-7x/day
* Frequency not related to nutrient intake unless freq. very low or very high
* Kids \<6, one Tbsp/day of veg/fruit/meat per year of life
* Ex: 4 y.o. kid → 4 Tbsp/day
33
Foods for Preschool Kids
* Simply prepared, plain, familiar
* Attractively served
* Presented in relaxing setting
* Indiscriminant snacking should be discouraged
* Prefer unmixed dishes \> casseroles
* Room temperature preferred over hot or cold temperatures
* Readily eat familiar foods
* Serve small portion of new foods with familiar and popular foods to expand variety
* Allow kids to look at, feel, play with and smell food first
* Appropraite size portions and pieces of food
34
Preschool Food Characteristics
* Balance Texture
* Hard/Chewy & Soft
* Dry & Moist
* Flavor
* Reject strong flavors in general
* Mildly salted foods vs. very salty foods
* Portion size
* Discouraged by large portions
* Offer less than child normally eats and offer 2nd serving
35
Preschool - Parental Concerns
* Limited intake of...
* Liquid milk
* meat
* Veggies
* Food in general
* Decreased appetite is normal, so prevent by...
* Frequent meal/snack times
* Serve small portions
* Encouraging physical activity
* Focus attention on what's eaten, not on what was refused
* Keep distractions to a minimum
* Excessive sweets → set limits on the availability of these foods
36
Preschool - Group Feeding
* Day care **8 hrs/day** → **1/3 RDA**
* Day care **\>8 hrs**/day → **1/2 - 2/3** of RDA
* Interval for meals: 2-3 hours
* Teachers/caretakers should eat with children without imposing their attitudes about food
* Day care/preschool are sites for nutrition education
37
School Aged Children
* Consistent, slow rate of growth
* Significant gains in cognitive, social and emotional skills
* Food choices increasingly affected by peers and less so by parents/family
* Critical period for developign activity patterns that will be maintained throughout adolescence
* Patterns of intake
* Most kids are adequately nourished
* Fat in diet = adult
* School lunch and breakfast contribute nutrients
38
Cognitive and Social Development (SA)
* Greater independence
* Credibility of parents questioned
* Develop sense of self
* Develop self-efficacy
* Greater access to money and vending machines and grocery stores
* Often responsible for meal prep
39
SA - Food Patterns
* Natural increase in appetite → increased food intake
* Amount and variety of food increase
* Dislikes may continue
* Sweetness and familiarity still important
* Still reject veggies and mixed dishes
* Time constraints
40
SA - Meal Patterns
* Breakfast
* Most eat, but lower % than preschool
* Girls \> boys in eating at home
* Usually contributes 1/4 RDA
* Yields better school attitude and record
* Lunch
* School lunches may be better than bag lunch
* Low income receive reduced price or free
* Dinner
* Opportunity for family interaction and socialization
* Offer children the family menu
* Do not cater to child's food idiosyncrasies
* Avoid conflicts during meal times
41
SA - School Meals
* School Programs
* Contributes significantly to nutrient intake
* Administered by USDA
* Wellness plan required
* Specific nutrition guidelines required
* Nutrition Integrity
* Ensuring that all foods available to kids in schools are consistent with the US DGA and DRI
42
School Breakfast Program, 1966
* 1/4 DRI
* Must comply with US-DGA
* 1 cup _milk_ → FF or LF
* 1 cup _fruit_
* **1 oz** _grain_
* at least half whole grain rich
* **7-10 oz/wk **
* **1 oz** _meat/meat alternate_ → **7-10 oz/wk**
43
National School Lunch Program, 1946
* Funded by Federal Gov
* Five Requirements
1. Based on nutritional standards (1/3 DRI)
* Same requirements as breakfast, plus:
* **3/4 - 1 cup** _veggies_
* Veg variety (dark green, red-orange, beans, starch)
* _Meat/meat alternative & grains_ → increase to **2 oz/day (9-12 grade)**
2. Non-profit operation
3. Accountable
4. Paid, free or reduced-price options
* Cash reimbursement based on number of meals served
5. Must participate in commodity program
44
National School Lunch Program
* Improve dietary intake and nutritional health
* Promote nutrition education
* Teach children to make appropriate food choices for a lifetime
* For low income kids, school meals may motivate them to go to school
