Nutrition And Lifecycle: children

Question 1

Key components of breastmilk which make optimal for nutrition

Answer 1

• 3.5g fat per 100mL, including DHA and AA (essential for healthy brain development) provides 50% of energy. Easily digested due to glycoproteins surrounding lipid droplets
• 7g lactose per 100mL main CHO, source of energy. Oligosaccharides provide important protection against infection
• 0.9g protein per 100mL, with alpha-lactobumin which is easily digested, lower protein which is more accepted by developing kidneys
• vitamins and minerals: all except D and K in acceptable amounts. Fe and Zn low but highly bioavailable. Ca:P ratio is optimal. Na is low for kidneys
• anti-infective properties: immunoglobulins (IgA, IgG, IgE) lactoferrin (also promotes Fe absorption), lactobacillus bifidus promoting factors, WBC, oligosaccharides

Question 2

Why formula milk is not recommended

Answer 2

• does not have immunoglobulins
• not the same composition as breast milk
• DHA and AA may not be metabolised in the same way

Question 3

Recommendations for weaning

Answer 3

• 6 months exclusive breastmilk
• from 6 months can introduce complementary feeding, starting with pureed and then mashed, then finger foods from 7 months
• introduce variety, repeated exposure and eange of flavours from 6-12 months (this is sensitive period for solids)
• formula/breast milk can be given from 6-12 months along with other fluids (water)
• can have full fat cows milk from 1-2 years
• 2 years onwards can have semi-skimmed cows milk
• neophobia can onset from 12 months and peaks at 20 months. Can reduce this by setting good example (eating together), introducing variety and repeated exposure, having home cooked veg from 6 months
• offer variety of foods to ensure adequate Fe
• keep sodium intake low
• avoid sugar and high intake of citrus foods to avoid dental caries
• stop bottle at 1 year to prevent dental caries
• baby led weaning not recommended, may impact speech development

Question 4

Tracking infant growth

Answer 4

• growth charts used to track progress, if adequate nutrition will likely follow trajectory until 20 years old
• BMI used too for weight; 2-91st decile is healthy, 91-96 is overweight and >96 is obese
• having healthy weight in childhood is a good predictor of long term health and chronic disease

Question 5

Factors impacting food acceptance

Answer 5

• neophobia occurs due to cognitive development
• exposure to variety and multiple exposures in critical window (6-12 months)
• positive reinforcement
• lead by example: family mealtimes
• homecooked vegetables included from 6 months
• respond to hunger and satiety cues

Question 6

School children nutrition

Answer 6

• less of a worry due to guidelines on school dinners

- more concerned about excess nutrition and vitamin D deficiency

Question 7

Adolescent nutrition

Answer 7

• 45% of bone growth, 20% of weight and 50% of adult weight acquired during this time
• girls have 23% body fat and males 12%
• risk is Fe, Ca, D deficiencies during this time
• ensure eating bioavailable protein sources and still drinking milk (consumption usually declines during this period)
• obesity: 9% females and 7% males, encourage sensible dietary choices and exercise (60 mins PA per day)
• anorexia and bulimia nervosa: psychotherapy
• teen pregnancy: high risk of low birth weight and Ca, Fe, Zn, folic acid, C and A deficiencies as still developing themselves
• athletes often experience delayed puberty due yo low body fat and lack of sex hormone production