Final Flashcards
1
Q
Toddler
A
Children Age 1-3
2
Q
Toddler Characteristics
A
- defined by rapid increase in gross and fine motor skills
- increase in dependence, exploration of environment, and language skills
3
Q
Preschool Aged Children
A
Children age 3-5
4
Q
Preschool characteristics
A
- increased autonomy
- experimenting with broader social circumstances (attending preschool, staying w friend/relatives)
- increased language skills
- increase ability to control behavior (self control)
5
Q
Toddler Growth & Development
A
- gain 3.5 lb/year
- 1 cm in heigh/month
6
Q
Preschoolers Growth & development
A
- gain 4.4 lb/year
- grow 2.75 in (7 cm)/year
7
Q
Measuring Toddlers <2 years old
A
- weighed w/o clothes or diapers
- recumbent length
8
Q
Measuring children >2 years old
A
- weighed w/ light clothing
- measure stature with no shoes
9
Q
Problems measuring & plotting growth data
A
- error in measuring may result in errors in health status assessment
- use of calibrated equipment & plotting accuracy are vital
10
Q
Toddlers Cognitive Development
A
–> a time of expanding physical and developmental skills
–> walking begins as a “Toddle” improving in balance & ability
–> progress by month
- 15: crawl upstairs
- 18: run stiffly
- 24: walk up stairs
- 30:alternate feet going up stairs
- 36: ride tricycle
–> toddlers orbit around parents
–> transition from self centered to more interactive –> Vocab Words
- 10-75 words: 18 months
- 100 words: 20 months
3 word sentences: 3 years
11
Q
Toddler Feeding Skills
A
- gross & fine motor development improved
- 9-10 months: weaning bottle begins
- 12-14: completely weaned
- refined pincer
- 18-24: able to use tongue to clean lips & developed rotary chewing
- adult supervision to prevent choking
12
Q
Feeding Behaviors of Toddlers
A
- rituals in feeding are common
- may have strong preferences + dislikes
- food jags common
- serve new foods w familiar foods + when child is hungry
- toddlers imitate parents + older siblings
- slowing growth results in decrease appetite
- toddler sized portions: 1 TBS/year of age
- nutrient- dense snacks needed but avoid grazing on sugary foods that limit appetite for basic foods at meals.
13
Q
Preschool Age: Cognitive Development
A
- egocentric: cannot accept anothers point of view
- learning to set limits for himself
- cooperate + organized group play
- vocab expands to >2000 words
- begins using complete sentences
14
Q
Preschool Age: Feeding Skills
A
- can use fork, spoon, and cup
- spills occur less frequently
- foods should be cut into bite sized pieces
- adult supervision still required
15
Q
Preschool Age: Feeding Behaviors
A
- Appetite related to growth
- appetite increased prior to “spurts” of growth
- include child in meal selection and preparation
16
Q
Ways to include child in meal prep
A
- take them to farmers markets
- have them decide what goes into salad
- let children select and help prepare wholegrain side dish
- help shop, clean, peel, cut up fruits and veg
- learning tower
- gardening & toddlers
17
Q
What tastes do children prefer
A
sweet and slightly salty tastes
- reject sour and bitter
- like energy dense foods w/ lots of sugar
(Eat familiar foods
May need 8–10 exposures to new foods before acceptance
Food intake related to parent’s preferences)
18
Q
Why do children like sweet food
A
preference may develop because kids associated eating energy dense foods w/ pleasant feelings + satiety, or because these types of foods associated w special occasions (birthday parties)
19
Q
Appetite & Food intake of Preschool-age Children
A
- may prefer familiar foods
- serve child-silzed portions
- make foods attrcative
- strong-flavored or spicy foods may not be accepted
- control amount eaten between meals to ensure appetite for basic foods
20
Q
Temperament Differences
A
“Easy”—adapts to regular schedules & accepts new foods
“Difficult”—slow to adapt and may be negative to new foods, may need to give more exposures, be patient
“Slow-to-warm-up”—slow adaptability, negative to new foods but can learn to accept new foods
“Intermediate low” to “intermediate high” – a mixture of behaviors
21
Q
Temperament Theory
A
Child’s temperaments affect feeding and mealtime behavior. The “goodness of fit” between the temperaments of the child and the parent or caretaker can influence feeding and eating experiences. A mismatch can result in conflict over eating and food. Parents need to be aware of child’s temp when attempting to feed. (difficult or slow to warm child may need to be gradually exposed to new foods, and not hurried for him to accept them)
22
Q
Appetite and Satiety
A
Consumption of foods high in sugar and/or fat before meals decreases intake of basic foods
Offering large portions increases food intake and may promote obesity
Restriction of palatable foods increases preference for the foods
23
Q
Parents Child Feeding Relationship
A
Parent or caretaker responsibilities:
“What” children are offered to eat
The environment in which food is served including “when” & “where” foods are offered
Child’s responsibilities:
“How much” they eat
“Whether” they eat a particular meal or snack
24
Q
Practical Applications of Child-Feeding Research
A
- Parents should respond appropriately to children’s hunger and satiety signals
- parents should focus on the long term goal of developing healthy self-controls of eating & look beyond concerns of composition & quantity of foods children consume of fears that children may eat too much and become overweight
- dont attach contingencies”no dessert until you finish your broccoli” and coercive practices “clean your plate, kids are starving”
- dont severely restrict Junk foods- only makes them more desirable.
25
Common Nutrition Problems (Toddlers and Preschool)
```
Iron-deficiency anemia
Dental caries
Constipation
Lead poisoning
Food security
Food safety
```
26
Middle Childhood definition
Middle childhood—between the ages of 5 and 10 years
| can be termed "school age"
27
Preadolescence definition
Preadolescence—ages 9 to 11 years for girls; ages 10 to 12 years for boys. can be termed "school age"
28
Iron Deficiency Anemia:
Seen in 7% of toddlers
May cause delays in cognitive development and behavioral disturbances
Diagnosed by hematocrit and/or hemoglobin concentration
29
Preventing Iron-def anemia
Preventing Iron Deficiency:
Nutrition-Limit milk consumption to 24 oz/d since milk is a poor source of iron
Infants at risk should be tested at 9 to 12 months, 6 months later, and annually from ages 2 to 5
30
Intervention for Iron Defi
Intervention for Iron Deficiency
Iron supplements
Counseling with parents
Repeat screening
31
Dental Caries
```
Prevalence:
1 in 5 children ages 2 to 4
Causes:
Bedtime bottle with juice or milk
Streptococcus mutans
Sticky carbohydrate foods
Prevention:
Fluoride—supplemental amounts vary by age & fluoride content of water supply
```
32
Constipation
Definition: Hard, dry stools associated with painful bowel movements
Causes: “Stool holding” and diet kids will poop in the corner and hide it.
Prevention: Adequate fiber
33
Adequate Intake of total fiber for children
1-3 yrs age --> 19g/day of total fiber
| 4-8 years of age --> 25 g/day of total fiber
34
Tanner Staging/ Sexual Maturation Rating
- girls get breastbuds & pubic hair
| - boys get testis and pubic hair
35
Tanner stuff?
fill in
36
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 6.2 years
Boys have more lean tissue than girls
37
Menarche
first menstrual cycle
38
Menses
process of menstration
39
Thelarche
Thelarche = Breast bud development
40
Psychosocial issues in school age kids
Caregiver/peer interactions
Body image
Media influence
Dieting behaviors (parents/peers)
41
Parenting Styles:
You can match up parenting style w the child. If u r permissive parent it leads to. This is diff from temperament
a. Authoritarian when u say do this before I said so → passive child
i. 5 fold increase for obesity ( the worst )
b. Authoritative= lowest risk of obesity
42
Authoritarian vs Authoritative
Authoritarian when u say do this before I said so → passive child --> 5 fold increase for obesity ( the worst )
Authoritative= do this for this reason. lowest risk of obesity
43
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
44
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
45
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
46
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
47
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
-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
48
Adrenarche
Adrenarche = onset of androgen dependent signs of puberty (pubic hair, axillary hair, pimples)
49
Menarche
Menarche = Onset of menses
50
Girls and Boys peak puberty
Girls peak ~ 12 boys peak around 14. Peak linear growth velocity
51
Determinants of when Puberty Occurs
Non-Modifiables Factors:
- Genetics
- Race/ethnicity
- SES
```
Modifiable Factors:
- Nutritional status
? nutritional quality (energy adjusted intake)
Physical activity level
Energy Balance
General Health
Geographic location
Adiposity
? Leptin
```
52
Bone Age
Left hand x-ray of a girl:
chronologic age = 9 years old
Bone age = 8 years old
It occurs according to your hormone balance. If your hormones are faster your bones will calcify faster.
Bone age can be used to predict:
- how much time a child will be growing
- when a child will enter puberty
- what the child's ultimate height will be
53
Anorexia Nervosa (AN)
Body weight < 85% of that expected (BMI <17.5 for older teens)
Fear of gaining weight or becoming fat
Disturbance in body image
Amenorrhea (at least 3 cycles) or lack of menarche in younger teens (*** deleted in DSM-V because of men and women on OCP)
54
AN Subtypes
Restricting Type: doesn't eat much
Binge/Purge type: (don’t want to gain weight but cant help it and eat. This is diff from bulimia cuz it’s a weight component)
Self-induced vomiting
Laxatives
Diuretics
Enemas
55
Bulimia Nervosa (BN)
Recurrent episodes of binging
Within 2 hours, eating amount that is larger than most people would eat in same situation
Lack of control
Recurrent inappropriate compensatory behavior
At least 2X/week for 3 months (** changed to 1X/week in DSM V)
Self-evaluation unduly influenced by body shape and weight
Not during episodes of AN
56
Binge-Eating Disorder
```
Recurrent episodes of binging
Associated with 3 of:
Eating faster than normal
Eating until uncomfortably full
Eating large amounts when not hungry
Eating alone because of embarrassment
Feeling disgusted/depressed/guilty
Experiencing marked distress
On average at least 2X/wekk for 6 months
No inappropriate compensatory behaviors
```
57
Osteopenia and Eating Disorders Contributing Factors
Contributing factors:
Inadequate nutrition (Ca and vit D)
Low body weight
Amenorrhea (low estrogen)
Elevated stress response (cortisol)
58
Osteopenia
Osteopenia refers to bone density that is lower than normal peak density but not low enough to be classified as osteoporosis. Bone density is a measurement of how dense and strong the bones are. If your bone density is low compared to normal peak density, you are said to have osteopenia. Having osteopenia means there is a greater risk that, as time passes, you may develop bone density that is very low compared to normal, known as osteoporosis
- happens in people with eating disorders because malnourished and might not have proper mineralization and calicifcation of bones cuz cal and vit d.
59
Morbidity of osteopenia in AN
Improvement in BMD with restoration of weight, but still lower than healthy controls
Fracture risk is 3X that of age matched peers
60
Etiology of Eating Disorders
1. Psychodevelopmental Factors:
- bodily cahnges
- life transitions
- sexuality issues
2. Sociocultural Factors
- peers
- media
- lifestyle
- fam values
- abuse (sexual abuse too)
3. Neurochemical or Genetic Factors:
- brain chemistries
- DNA
- Personality structure
61
Predisposing Factors for an Eating Disorder
- Dieting
- Genetics (fam history of eating disorder, substance abuse, depression)
- Individual (age, sex, personality, poor self-esteem, occupation)
- Familial (fam dynamics, conflict skills, boundaries)
- Societal (pursuit of thinness, role confusion, salvation, weight reduction, dieting as solution)
62
Precipitating Factors of Eating Disorder:
- Major life changes (adolescence, marriage)
- Physical illness (cystic fibrosis, DM)
- Trauma (loss, grief, bullying)
63
Perpetuating Factors of Eating Disorders
- reinforcing properties of weight loss
- binge/purge cycle
- eating disorder as identity
- starvation syndrome
64
Policies for Prevention of Eating Disorder
Treatment is difficult and costly
Is primary prevention (reducing incidence) a better strategy?
Media
School based health programs
65
Eating Disorders characterized by:
Dysfunctional eating habits
Disturbance in body image
Change in weight (extreme loss to fluctuation around normal)
66
Classifications of Eating Disorders
Anorexia Nervosa
Bulimia Nervosa
Binge-Eating Disorder
67
How do you classify kids as overweight or obese
Use a Reference population from optimal growth data from NHANES. Can't use BMI for children because they are growing.
Overweight: greater than equal to 85%tile zscore >1.44
Obese: greater than equal to 95%tile, score >1.96
68
Adiposity Rebound
At 5 to 6 years of age, body fatness normally declines to a minimum, a point called adiposity rebound (AR), before increasing again into adulthood. You don't want to have an early adiposity rebound
69
What are some causal theories of Adiposity Rebound
- normal/low BMI before rebound
- rapid infant growth
- high protein, low fat? --> Rapid infant growth for babies compensating for being lower than normal. When you go from mothers milk ususally go from low protein high fat to high fat low protein→ might cause them to grow even faster.
70
What are some possible outcomes of early adiposity rebound?
As a child..
- increased body fat
- central adiposity
- bone age
- early menarche
- increased risk for obesity
71
Social Ecological Model
- Society (food&bev industry, gov, agriculture, media/ads, culture/social norms)
- Community (built environment, restaurants, supermarkets, parks)
- Interpersonal (home and family, school, childcare, physicians)
- Individual (genetics, psychosocial, other factors)
--> food & beverage intake + physical activity = energy balance --> prevention of overweight & obesity among children, adolescents, & adults
72
how does individual affect obesity?
obese pregnancy (abnormal metabolic environment) --> fetal/neonatal obesity (diet/activity) --> childhood obesity (decreased insulin sensitivity) (diet activity) --> adult obesity (type ii DM) --> obese pregnancy
73
Authoritative Parenting Risk for obesity
lower risk
74
Permissive Parenting Risk for obesity
2-fold increase
75
Authoritarian Parenting Risk for obesity
5 fold increase
76
Neglectful parenting risk for obesity
2 fold increase
77
Interventions for childhood obesity
- individual:surgery
- interpersonal: family (talk w family and child--> the younger the child, the more effective))
- interpersonal: school (increased nutrition quality in school and increase PA)
- Society: policy (SNAP, school lunch) & industry (front of package labeling,advertising initiative)
78
What extra nutrients are required for elderly?
```
calcium
vitamin D
vitamin B12
vitamin B6
(protein)
```
79
What nutrients are at decreased requirements for elderly?
calories, and vitamin A
80
Why are nutrient recommendations different for elderly different?
need to answer later
