© 2011 Pearson Education, Inc. 17 Nutrition Through the Life Cycle: Childhood and Adolescence.

© 2011 Pearson Education, Inc.

17Nutrition Through the Life Cycle: Childhood and Adolescence

© 2011 Pearson Education, Inc.

Toddlers

• Age 12 to 36 months• Rapid growth rate of infancy begins to slow• Gain 5.5 to 7.5 inches, average 9 to 11 pounds• Higher energy expended for increased activity

levels• Increased nutrient needs are based on their larger

body size

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Toddlers

• Macronutrients:• Estimated Energy Requirement (EER) varies

according to the toddler’s age, body weight, and level of activity

• 30−40% of total kcal from fat• 1.1 grams of protein per kg body weight• 130 grams carbohydrates per day (most of the

carbohydrates should be complex)• 14 grams fiber per 1,000 kcal/day

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Toddlers

• Micronutrients:• Ensure adequate intake of the micronutrients

obtained from fruits and vegetables, including: vitamins A, C, E, calcium, iron, zinc, potassium

• Until age 2, drink whole milk for calcium• Iron-deficiency anemia is the most common

nutrient deficiency in young children

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Toddlers

• Fluid needs: active toddler may need more• Physicians may recommend supplements: • Toddlers with erratic eating habits • Fluoride supplement, if the community water

supply is not fluoridated • Vegan families• Medical conditions or dietary restrictions • Supplement should not exceed 100% Daily Value

for any nutrient per dose

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© 2011 Pearson Education, Inc.

Nutritious Food Choices

• Most are able to match intake with needs• Healthful variety of food available• Food should not be forced on a child• Frequent small meals for small stomach• Developmentally appropriate foods• Small portions, limited healthful alternatives • Role modeling is important

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© 2011 Pearson Education, Inc.

© 2011 Pearson Education, Inc.

© 2011 Pearson Education, Inc.

Allergy Watch

• Continue to watch for common food allergies: wheat, peanuts, cow’s milk, soy, citrus, egg whites, seafood

• Introduce one new food at a time

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Vegetarian Families

• Eggs and dairy: part of a healthful diet• Vegan diet may be low in protein, minerals

(calcium, iron, zinc), vitamins (D and B12)

• High fiber may impair iron and zinc absorption and promote a premature sense of “fullness” at mealtimes

• Fortified foods and supplement use to ensure adequate nutrition

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Children

• Growth slows: average gain 2–4 in./year• Values for most nutrients increase• For children ages 6−11 years: USDA

developed a MyPyramid for Kids • Sexual maturation begins ages of 8 and 9:

DRI values are separately defined for boys and girls beginning at age 9

© 2011 Pearson Education, Inc.

© 2011 Pearson Education, Inc.

Macronutrients

• Total fat intake should gradually drop to a level closer to adult fat intake

• 25−35% of total energy from fat• 130 grams carbohydrate per day• 14 grams fiber per 1,000 kcal • 0.95 grams protein per kg body weight

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Micronutrients

• Consuming adequate fruits and vegetables in the diet continues to be a concern (vitamins A, C, and E, fiber and potassium)

• “Milk displacement”—low-calcium diets also tend to be low in other nutrients

• RDAs for iron and zinc also increase

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Nutritious Food Choices

• Peer pressure encourages unhealthful food choices

• Families who plan, prepare, and eat meals together are more successful at promoting good food choices

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© 2011 Pearson Education, Inc.

School

• School breakfasts: optimize nutrient intake and avoid behavioral and learning problems from hunger in the classroom

• No monitoring for adequacy of food eaten • Soft drinks and snack foods in school • School lunches: what’s actually eaten (not

planned/served) tends to be higher in fat • Options to entice healthful selections

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Nutrition-Related Concerns

• Iron-deficiency anemia • Dental caries• Body image• Food insecurity

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© 2011 Pearson Education, Inc.

Adolescents

• Adolescence continues to 18 years• Puberty: secondary sexual characteristics

develop; capacity for reproduction• Emotions and behaviors unpredictable and

confusing

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Adolescents

• Growth spurts begin at age 10−11 for girls, 12−13 for boys

• Average 20−25% increase in height• Skeletal growth ceases closure of the

epiphyseal plates • Weight and body composition also change

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© 2011 Pearson Education, Inc.

Macronutrients

• EER for adolescents is based on gender, age, activity level, height, and weight

• 25−35% of total energy from fat• <10% of total energy from saturated fat • 45−65% of kcal from carbohydrates• 0.85 grams protein per kg body weight• 26−38 grams of fiber per day

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Micronutrients

• Calcium intakes must be sufficient for achieving peak bone density: 1,300 mg/day

• Iron needs are relatively high: 11 mg/day for boys, 15 mg/day for girls

• Vitamin A is critical for supporting rapid growth and development

• Supplement should not be considered a substitute for a balanced, healthful diet

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Fluid Recommendations

• The need to maintain fluid intake is increased with higher activity levels

• Boys: 11 cups/day• Girls: 10 cups/day• Importance of including water

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Nutritious Food Choices

• Parents can act as role models • Strong influence of peers, mass media,

personal preferences• Encourage whole grains, fruits, vegetables,

and milk or calcium-rich beverages

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Nutrition-Related Concerns

• Adequate calcium maximizes bone calcium uptake and bone mineral density

• Disordered eating and eating disorders can begin in these years

• Acne and diet• Cigarette smoking, alcohol, and illegal drugs

can have an impact on nutrition

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Pediatric Obesity

• Overweight: BMI above the 85th percentile of the same age and gender

• Obese: BMI above the 95th percentile• Higher risk of health problems: • Exacerbates asthma• Causes sleep apnea• Impairs the child’s mobility• Leads to intense teasing• Low self-esteem• Social isolation

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Pediatric Obesity

• Greater risk for type 2 diabetes, high blood lipids, high blood pressure, gallstones, depression, and other medical problems

• Higher risk of becoming overweight adults• Reversal of pediatric obesity can be

accomplished through an aggressive, comprehensive nationwide health campaign

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Pediatric Obesity

• Early tendency during toddler years• Monitor if >80th percentile for weight• Encourage physical activity• Limit foods with low nutrient density• Early intervention is often the most effective

measure against lifelong obesity

ABC Video Obesity in Children

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Role of the Family

• Provide nutritious food choices• Encourage a healthful breakfast • Sit down to a shared family meal each

evening or as often as possible• No television at mealtimes: encourage

attentive eating, enjoyment of the food• Parents should retain control over the

purchasing and preparation of food

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Role of the School

• Federal school lunch program: limit the amount of fat, sugar, and sodium served

• Many schools sell foods and beverages that exceed federal guidelines

• Nutrition education programs: health departments, Dairy Councils

• Consistent and repeated school-based messages on good nutrition

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© 2011 Pearson Education, Inc.

Physical Activity

• Recommendation: daily physical activity and exercise for at least an hour each day

• Bone- and muscle-strengthening activities at least 3 days each week

• Encourage noncompetitive, fun, and structured activities in ways that allow self-pacing

• Fitness Pyramid for Kids: guide children toward a physically active lifestyle

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© 2011 Pearson Education, Inc.

© 2011 Pearson Education, Inc.

Physical Activity

• Parental and adult role models • Shared activities: ball games, bicycle rides• Television/electronic games: < 2 hours/day • Electronic games: virtual tennis, step

aerobics, dancing, other active simulations

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Physical Activity

• Overweight children can “catch up” to their weight as they grow taller without restricting food (nutrient) intake

• Acquire motor skills and muscle strength• Establish good sleep patterns• Develop self-esteem; lower stress • Optimize bone mass• Enhance cardiovascular and respiratory

function

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Physical Activity

• Physically fit children: • Have improved behavior• Are more attentive• Are more focused• Have higher levels of academic achievement

• Parents, healthcare providers, and community members can work with school boards to optimize opportunities for physical activity