School Age Children Flashcards
Age of school children
- Middle Childhood: 5 to 9 year olds
Preadolescence: 9 to 11 year old girls & 10 to 12 year old boys
Growth of school aged children
growth is lower than earlier stages and occurs in spurts
* gain average 3 to 3.5 kg and 6 cm per year
What is the gain in fat mass called and when does it occur?
rebound adiposity around ~6-7 years
* normal increase in BMI
* greater increase in fat mass for girls
* early rebound adiposity associated with obesity
How is growth monitored?
WHO growth charts
monitor using weight for age (until 10 years of age) and height for age; BMI for age
What factors would be considered optimal for growth in these age groups?
- physical activity/ movement
- Sleep
- Quality nutrition
Motor Skill Development
- improved motor coordination
- ability to perform more complex pattern movements
- increasing muscular strength
- physical activity contributing more to energy expenditur (highly variable)
Feeding and Food Skills
- mastered the use of utensils
- should be involved with food preparation and chores related to meals
- ready to learn about simple nutrition facts and relate to food they are eating
How should this aged learn about nutrition?
“this food helps make you strong”
* Not complex
* not related to chronic disease or body weight
* not “good” or “bad” foods
Cognitive and Social Development
- decreased engocentricism
- more rational cause/effect reasoning, but concrete thinking (Can relate consequences to action)
- development of sense of self and self- efficacy
- increasing importance of peer relationships
- greater independence
- promotion of autonomy
Eating Behaviours
- eat more away from home
- some independance on food choice
- influence of family vs. peers
- environmental influences (culture of school, activites, what is available)
- marketing of foods (beyond advertising too)
Diet Quality
Based on following recommendations in Eating Well with Canada’s Food Guide most require improvement or have a poor quality diet.
How are energy intakes determined?
Energy needs for maintenance, growth and activity
Estimated Energy Expenditure:
* separate formula boys and girls
* different formula for 3-8 years and 9-18 years
* weight, height, age, and physical activity level (variable)
Stats of obesity
Canadian Health Measures Survey (2009 to 2011):
* 5 to 11 year olds: 19.7% overweight
* 13.1% obese
* ~1.5% underweight
Canadian 24-hr movement guidelines for 5-17 years
SIT
* Limit sitting for extended period
* No more than 2 hours of recreational screen time
UNINTERRUPTED SLEEP
* 5 to 13 years: 9 to 11 hours
* Consistent bed and wake-up times
STEP (LIGHT ACTIVITY)
* Several hours, structured and unstructured
SWEAT (MODERATE TO VIGOROUS)
* At least 60 mins
* Vigorous activities, muscle and bone strengthening at least 3 days/week
Macronutrient Recommendations
fibre intake
Median intake fibre: below AI boys and girls 4-13yrs
Canadian Community Health Survey (CCHS) 2.2 (2011)
AMDRs
fat intake stats
- 9-13 years female: 6.5% fat intake below, 11% above
- 9-13 years male: 12% fat intake above
Micronutrients of Concern
Reflects intake of ultra-processed foods
Intake less than EAR 9 to 13 year olds:
* Iron: <3%
* Calcium: 44-67%
* Vitamin D: 84-93%%
* Vitamin A: 12-22%
* Magnesium and Zinc: 10-25% girls
- Sodium: 80-97% had intake above UL
- Potassium: median intake below AI
Lower range: males; Higher range: females
Goals for School-Age Children
- adequate, but not excessive, energy and nutrient intake
- support normal development (growth, motor, cognitive and social)
- encourage healthy eating patterns and behaviors (family strongest influence still)
- support self-regulation of energy intake
Division of Responsibility in Feeding
- Parents decide: What foods are offered & when and where to eat
- Children decide: Whether or not they eat & how much they eat
How to Feed a School-Age Child
- role modeling
- foods available and accessible (chopped up veg and fruit)
- food preparation
- consistent eating schedule (Need to know when they can expect to eat)
- meals at table without distractions
- selecting foods and serving size from what
is offered themselves (encourage internal cues)
What parental control practices that can have negative impact?
- pressure to eat
- restriction for weight
- threats and bribes
- intrusive control ⤄ permissive feeding
- prompt to eat
- rules and limits
- redirection and negotiation
Body Image
Children senstive to cues from parents and friends so rebound adopisty can be misconstrued and may start to trigger negative body images.
* severe restriction of ‘unhealthy’ foods and/or focus on weight can increase risk of disordered eating in children
Healthy Foods to feed school aged children
- variety (all food groups, different foods within groups)
- unprocessed or minimally processed emphasized
- processed in moderation; ultra-processed not needed
What regulates energy intake?
INTERNAL CUES: The hypothalamus is the control centre of hunger and satiety via signals from the nervous system, hormones, and blood nutrient levels
* hunger: low glucose, ghrelin, other hormones
* satiety: stretching in GI tract, CCK, leptin, other hormones
What are External Cues?
Anything that can influence consumption other than feelings of hunger and satiety and can interfere with internal cues
* sight, smell, taste of foods
* Advertising
* Habits, social situations
* Portion sizes
* Parental and peer modeling
* Pressure or incentives to eat more
* Using food as a reward
* Food often equates with love or acceptance
Regulation of Energy Intake in Toddlers and Pre-schoolers
6 day food records in 2 to 5 years reveal large
variability in energy from individual meals (33%),
lower variability in daily energy (10%)
* responsive to internal cues: energy intake variability, eat more if lower energy density
* but sensitive to external cues: praise, rewards, portion sizes, peers
Fat Substitution Study in 2-5 year olds
Ate more CHO to compensate for calories they weren’t getting in fat
* meals can be variable but children are good at regulating overall intake
Influence of internal vs. external cues
Children will rely on internal cues but can be overrun by external cues which can lead to more food consumption
* yogurt study - encouraging taste
* drink study - praise/ reward
* peer modelling
Yogurt study
external cues ate more high density
Based on study: Adjustments with different energy density and use of internal vs external cues (convo about fullness vs. food)
* yogurt – same amount with one high kcal and the other low kcal
* offered an ad lib snack (unlimited amount) after yogurt
* influence of internal vs external cues
Praise and reward (Drink study) on energy intake regulation
Reward does not always encourage to eat more food creates an inadvertent side effect it seems like
Children (3 to 5 years) offered novel drink
* Praise if drink +/- offered more and encouraged
* Movie ticket if drink +/- offered more and encouraged
* Controls – got drink and movie ticket
Offered drink again Consume less second time if praise or movie with or without encouragement to drink more the first time
How does modelling as an external cue effect regulation?
Food preferences determined – children who didn’t like vegetable (target) mixed with peers who did and saw that peers influenced each other in both ways, so will accept and try new foods with peers
* Evaluated frequency of choosing non-preferred food, and overall consumption of non-preferred food and children who did not like vegetables increased intake of that vegetables
Why is assessing appetite important?
assessment of appetite important in understanding regulation of food intake
* appetite: subjective sensations of hunger, satiety, motivation to eat
Appetite Assessment in Older Children and Adults
visual analog scales are most commonly used to assess appetite for these ages
Assessing appetite in young children
Developed a picture-based assessment for
use in young children where they can point to pictures where they feel most hungry (board games, video games, walking dog etc.)
* Before the age of ~8 years, not able to complete visual analog scales usually either starving or extremely hungry so hard to assess level of hunger and satiety.
Around peri-willer syndrome - part of this is ravenous hunger
Reccomendations around exposure to allergenic foods
Introduce “allergenic” food earlier
* Purposeful early feeding of peanut is a reversal from the 2000 AAP recommendations that suggested high-risk infants avoid peanut to age 3 years.
