diet and nutrition in childhood

Question 1

What is the ideal food for babies?

Answer 1

Mammalian milk for 6 months
Infant formula is the alternative
Electronic care records- 34% at 6 months and <1% at 12 months
Reduces chances of obesity, diabetes and infections
Reduces chances of breast cancer in mothers
Even 3 months go a long way

Question 2

What should the maternal diet be?

Answer 2

Fat deposits- energy store for feeding
400-600kcal, 11g protein, fluid extra
Breast milk contains- carbs, fats, protein, vitamins, minerals, anti-infective agents (eg. Immunoglobulins and lysozymes)

Question 3

What are contraindications to breastfeeding?

Answer 3

Cleft palate (indirect feeding)
Inborn errors of metabolism (eg. Galactosaemia)
HIV (antiretrovirals)

Question 4

Why is formula used in lieu of other milks?

Answer 4

The babies rent kidneys, liver enzyme systems aren’t mature enough to digest
It’s a modified cows milk/substitute
Formula fed babies gain weight differently to breast fed babies

Question 5

What should a 4-6 month infant be intaking?

Answer 5

Breast milk or mixture of BM+FM
Due to depleting iron stores from before birth
Rapid growth and development at this age

Question 6

What should a 6-12 month infant be intaking?

Answer 6

Weaning process- iron needs to be included

Increased protein/vitamins/mineral uptake required

Question 7

What is the healthy start scheme?

Answer 7

Free milk, plain fresh and frozen fruit and veg, infant formula and vitamins
For (0-4yrs) and pregnant mothers
Monthly, flexible pre-loaded card scheme
Early and close liaison w health professionals
Started in WWII

Question 8

What is weaning?

Answer 8

Expanding diet from 6 months
Prior to this GIT too immature to digest
Kidneys couldn’t regulate high solute load
Poor neuromuscular coordination to move food back in mouth and swallow
Helps w chewing ability

Question 9

How to toddlers and pre-school children interact with food?

Answer 9

Eating- social occasion
Enjoy copying elders
Food refusal- attention
Milk from 1 year (500ml-1l) contains Ca, riboflavin, 1/2 protein and 1/4 energy of day
Vit D- added to cereals and milk
Should have variety and avoid unhealthy snacks
Should consider potential tooth decay
Water encouraged
Shouldn’t drink excessive tea due to tannins which affect iron absorption or added sugar

Question 10

What should 1-4 year olds have?

Answer 10

Energy dense diet needed as active and rapidly growing
Increased protein/vitamin/minerals intake
Make sure not too much fibre

Question 11

What should 5+ year olds have?

Answer 11

Can switch to semi-skimmed instead of full fat milk
Must have regular meals esp. breakfast
No unhealthy snacking
Low fat and sugar content but sufficient energy balance to avoid weight loss

Question 12

Is there child hunger in the UK?

Answer 12

Decline in family meals
500000 kids go to school hungry
8 million families have food poverty

Question 13

What are the nutrient needs for school children?

Answer 13

4-18 year old
Energy and protein requirement- increases
Vit D required from sun now
11-14- protein by 50%
11-18- higher Fe for girls
15-18- Ca in boys due to rapid skeletal development
5+ 35% of energy intake from fat

Question 14

How are school meals considering nutrition?

Answer 14

Free hot dinner
Set price meal for primary
Cafeteria for secondary
SFVS 2004- free fruit/veg a day
Lunches should provide at least one portion of fruit/veg
Menus should highlight in season fruit/veg
School food outlets provide fruit/veg (tuck shops, clubs, vending machines)
Healthy schools rating scheme- education and physical health promotion (BNF involved)
Jamie Oliver food foundation

Question 15

How might adolescence affect nutrition?

Answer 15

Transition to adulthood
Own choices- exert independence (diets)
Weight and shape influences may lead to eating disorders
Teenage growth spurt (insatiable appetite)
~encourage carb intake esp. if v physically active
~avoid fatty/sugary snacks

Question 16

Can vegetarian and vegan diets be okay for children?

Answer 16

Food stuffs can be bulky (not nutrient dense)
Plants- non-haem only Fe
Phytate inhibitor in nuts/legumes/whole grain cereals can reduce uptake Fe, Zn, Mg, Ca
Tannins and Ca can bind non-haem Fe
~Vit C can counter this by promoting absorption
Vit D in many animal-based sources so should be considered
Risks- growth spurts, unconventional eating habits, family isolation

Question 17

What is the dietary intake required for children?

Answer 17

Baby- 515-920 kCal, 40% lactose sugar, 12-15g protein

Preschool- 1200-1700 kCal, 25-30% sugar, 15-19g protein, 30-35% fat

Older children- 1800-2750 kCal, 17-25% sugar, 28-55g protein, 25-35% fat

Fe needed from milk to create stores, Ca due to rickets emergence, vit D dietary til 4yrs, should supplement Vit D, Vit C for Fe absorption, wound healing and preventing scurvy
VIT A for ENAMEL, VIT D for DENTINE
Salt <1-6g per day, free sugars <5-10%

Question 18

What is the diet, nutrition and the prevention of chronic diseases report?

Answer 18

SACN published information on children’s nutrition

Observational/experimental studies

Compromised/excessive nutrition during early life can cause long term health effects
Risk of chronic disease

Question 19

What are some food policies and campaigns?

Answer 19

NHS 5 a day

Change4life 2009 now known as Better Health- healthier families 2021 (contains Start4Life)

PHE- action on childhood obesity 2016/2018
PHE- 2 snack limit 2018

Sugar tax 2018
PHE- 20% less calorie content by 2024

London Transport 2019- ban junk food ads
Academy of Med Royal Colleges- less TV ads after 9pm and less fast food near schools

Question 20

How much sugar a day?

Answer 20

<2- 13g
<3- 15g
4-6yrs- 19g
7-10yrs- 24g
11+yrs- 30g

Too much sugar- harmful fat, heart disease, type 2 diabetes, cancer, tooth decay

Question 21

What are some nutritional organisations?

Answer 21

FSA- eat well guide
DHSC/DfE- surveillance of nutritional status
BNF- promote well-being and advice
Nutrition Society- publishes in journals and CPD
BDA- advice and fact sheets
NHS live well- advice and tips

Question 22

What are UK children eating?

Answer 22

1986/87- survey for adults
1993/93- NDNS repeated every 3 yrs, until 2000/01 (stand alone data)
2007- health service for England

National Diet and Nutrition Survey, started 2008- rolling programme, happens every year
~food consumption, nutrient intakes and nutritional status
~1.5+ years
~commissioned by FSA
~socio-demographics, physical measurements, age and gender
~1000 individuals (500 adults, 500 kids)
~compares w recommendations and trends

Question 23

How is data collected for the NDNS?

Answer 23

Interviews, diet diaries, blood, urine
Up to 3 years genders combined then separated
2011/12- now collect blood induced and 24hr urine Na
2015/16- free sugars and fibre now monitored
2016- physical activity from 16+
2019/20- intake 24, online 24hr diet diary (over 4 non-consecutive days)
COVID-19 affected data collection
BNF reported a summary

Question 24

What results have been collected from the NDNS?

Answer 24

In children-
Sugar sweetened soft drinks have reduced but still too high and main contributor to free sugar intake
Fruit/veg are consistently below 5 a day (only 12% meet, 2.9 f/g for 11-18yrs)
Saturated fat too high
Vitamins and minerals are less than recomm however now meet
Fibre intake and oily fish below recomm
Red and processed meat decreased

Indications of trends towards healthy recommendations

Question 25

What is the DNSIYC?

Answer 25

DNS of infants and young children, 2011
For 4-18 months

Results show-
Varied diet
More than before breast fed but not for long
Fruit/veg lower in low socioeconomic classes
Energy exceeded in 75% boy and 76% girls
Protein above RNI
Na 181% of RNI for 12-18 months

Question 26

How can habits be changed?

Answer 26

Slowly
Advertising
Knowledge, attitude, behaviour
Environment, access
Diet diaries
The whole family