Chapter 18: Life Cycle Nutrition: Childhood through Adolescence

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Chapter 18: Life Cycle Nutrition: Childhood through Adolescence

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Toddlers versus Preschoolers

Toddlers

• 1–3 years old

• Growth rate is high, but slower than infancy

- Age 2: Gain 3–5 pounds, 3–5 inches Preschoolers

• 3–5 years old

• Need same nutrients as adults, but have

- Lower energy needs

- Smaller appetites

- Smaller stomachs

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Growth and Development

Growth charts

• Used by pediatricians

- Monitor height and weight

- Compare to national standards for age and gender

- Place child in a percentile

Quick Check

Jack is 24 months old, weighs 36 pounds and is 36 inches long. What are his percentiles?

Figure 18.1

Growth Chart

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Eating Patterns and Nutrient Needs

Young children need to eat frequent, small meals and nutrient-dense foods

• Energy needs: 1,000–1,600 kcal per day

• Appropriate portion sizes

- Child-sized plates and cups

- “Mini”-sized food items, such as bagels

- Rule of thumb is to serve 1 tablespoon of food per year of age at a meal

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Food Safety

Avoid choking hazards

• Offer bite-sized pieces of food

• Limit availability of

- Hot dogs

- Nuts or seeds

- Chunks of meat, cheese, or peanut butter

- Whole grapes or raisins

- Hard candy or gum

- Popcorn

- Raw vegetables

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Nutrient Needs

Carbohydrate

• At least half of grain intake should be from whole grains

• Fiber recommendations:

- Ages 1–3 years = 19 grams

- Ages 4–8 years = 25 grams

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Nutrient Needs

Protein

• RDA (toddlers) = 1.1 grams per kilogram of body weight

• RDA (school-age) = 0.95 grams per kilogram of body weight

Fat

• Ages 2–3 years old = 30–35% of kilocalories from fat

• Age 4 and over = 25–35% of kilocalories from fat

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Nutrient Needs: Calcium and Iron

Calcium

• Necessary for healthy bone development

• Ages 1–3 years need 500 milligrams per day

- 8 ounces of milk provides 300 milligrams Iron

• Necessary during periods of rapid growth

• Good sources of iron for children include lean meats, beans, and iron-fortified cereals

• Cow’s milk is a poor source of iron

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Iron: Deficiency versus Toxicity

Deficiency (Anemia)

• Most common nutrient deficiency in young children

• Can lead to developmental delays

• Exacerbates attention deficit hyperactivity disorder

• Associated with lead poisoning

Toxicity

• Leading cause of death in children under age 6

• Occurs because iron can build up in tissues and organs

- Ingesting 200 milligrams of iron can be fatal

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Nutrient Needs

Vitamin D

• American Academy of Pediatrics recommends

- Ages 1–8 years consume 10 micrograms (400 IU) of vitamin D per day

- Sources include fortified milk, egg yolk, and some fish

- Two 8-oz glasses of milk only provides half of the recommended intake

- Supplements or fortified cereals may be needed

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Nutrient Needs

Young children need nutrient-dense beverages

• Fluid recommendations are based on body weight

- Drinking too much fluid may reduce fiber or iron intake

• Preferred beverages include water and milk

• 100% fruit juice can be provided in moderation

• Soda and sugary drinks should be avoided

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Food Behaviors

Eating habits form early in life

• Children will adapt to foods offered to them A variety of food should be offered to young children

• A child may need to be exposed to a new food at least 10 times before accepting it

Division of responsibility

• Parents = What, when, and where food is offered

• Child = Whether or not to eat, and how much “Cleaning the plate” may encourage overeating

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Food Preferences

Parents have strong influence over children’s food preferences

• Children model after adult behaviors, both healthy and unhealthy

• Including young children in food shopping, menu planning, and meal preparation can encourage variety in their food consumption

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Food Preferences

Picky eating and “food jags” are common in young children

• Picky eating – not wanting to try new food

• Food jags – tendency to eat only a small selection of food

- Very common and normal, but also temporary- Can be identified through a food diary- Long-term jags increase risk of nutrient deficiency

- Solutions include- Offering a variety of food items within the

preferred food type- Gradually weaning the child from the food item

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Vegetarianism

Young children can grow and develop normally on a well-balanced vegetarian diet

• Vegetarian foods such as beans, nuts, seeds, and whole grains are high in fiber

- Multiple servings per day may exceed a young child’s fiber needs

• Good sources of calcium, iron, and zinc need to be included in the diet

• Supplementation of vitamin B12 may be necessary

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Quick Review

Toddlers grow at a slower rate than infants, and have smaller appetites

Frequent, small meals may be needed to provide adequate kilocalories, macronutrients, calcium, iron, and vitamin D

Appropriate beverages include water, milk, and 100% fruit juice

Small portion sizes should be encouraged, while “cleaning the plate” should be discouraged

A variety of foods should be offered, and parents should serve as role models for healthy eating

“Food jags” are normal and usually temporary

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School-Aged Children

Ages 6–12 years Are not fully grown

• Each year, gain about 7 pounds and 2.5 inches Compared to toddlers and preschoolers they

• Do not eat as many times per day

• Tend to be less hungry (maintain blood glucose longer)

• Can eat more food at each sitting Can impact healthy development through dietary choices Continue to develop habits based on modeling adult

behaviors

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Child Obesity

Body Mass Index (BMI) is the measurement tool used to determine weight status

• For children, the categories are

- Overweight = BMI ≥ 95th percentile

- At risk for overweight = BMI ≥ 85th percentile

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Child Obesity

What is considered child obesity?

• Condition of a child’s having too much body weight for his or her height.

• The use of the word “obese” to describe children is controversial

What causes child obesity?

• Genetics: Only a small percent of cases

• Environment: Excess kilocalories, inadequate exercise

• Obese parents

• Prenatal overnutrition

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Child Obesity: Excess Kilocalories

Sources include

• Regular soda, candy bars, potato chips

- Many of these products are sold within school buildings through vending machines or the cafeteria

- Also available in most convenience stores and shopping centers

- Typically replace healthy options such as milk, water, or fresh fruits and vegetables

• Increased portion sizes at meals and snacks

- Occurs both within and outside of the home

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Child Obesity: Food Preferences

High sugar and high-fat foods are often preferred by school-aged children

• This could lead to an excess kilocalorie intake These preferences are formed by

• Overexposure to television advertisements featuring appealing characters or famous spokespeople

• Modeling of parent or sibling eating behavior

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Debate: Does Sugar Cause ADHD?

Attention deficit/hyperactivity disorder (ADHD) occurs when children are inattentive, hyperactive, and impulsive

No cause has been identified, but a high sugar intake has been proposed to cause hyperactive behavior

• American Dietetic Association conclusion: Sugar intake does not have an effect on behavior or learning

• American Academy of Pediatrics conclusion: No evidence exists that ADHD is caused by eating too much sugar

What do you think?

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Child Obesity: Inadequate Physical Activity

Low levels of exercise occur in school-aged children due to

• Increased “screen time” – exposure to a television, computer, or video games

• Less access to physical education in schools

• Increased use of a car for transportation

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Child Obesity: Prevention

American Academy of Pediatrics recommendations

• Parents must ensure their children receive adequate nutrients without excess kilocalories

• A variety of healthy food must be offered to children

• “Screen time” must be limited to two hours or less per day

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Child Obesity: Treatment

Weight loss is not recommended for overweight children Weight maintenance allows for healthy growth Increased physical activity is encouraged

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Obesity-Diabetes Relationship

Type 2 diabetes – a disease typically diagnosed in adults

• Very likely to occur in obese children Prevention tips

• Identify high-risk individuals based on family history

• Reduce risk factors such as being overweight or sedentary

Treatment tips

• Educate all members of the family about diabetes

• Provide support by eating the same foods as the child

• Encourage physical activity

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School-Aged Children and Dental Hygiene

42% of children and adolescents (6–19 years) have at least one cavity or filling. Source: CDC, 2005

School-aged children are susceptible to dental caries, but sometimes do not practice good oral hygiene

American Dental Association recommends

• Regular brushing and flossing

• Consuming a balanced diet in accordance with the Dietary Guidelines for Americans

• Limiting consumption of high-sugar foods such as soda, fruit juice, or milk

Figure 18.3

MyPyramid for Kids

A visual tool for children and parents to understand healthy eating

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MyPyramid for Kids

Key messages

• Be physically active every day

• Choose healthier foods from each group

• Eat more of some food groups than others

• Eat foods from every food group every day

• Make the right choices for you

• Take it one step at a time

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National School Lunch Program (NSLP)

Serves nutritious, low-cost or free lunches to 30.5 million school-aged children each day

NSLP nutrient guidelines have specific recommendations establishing

• Minimum intakes

• Maximum intakes

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The Role of Breakfast

Eating breakfast may be associated with healthy body weight among children and adolescents

Many schools with the National School Lunch Program also offer a school breakfast

Eating breakfast may benefit

• Cognitive function, including memory

• Academic performance

• School attendance

• Psychosocial function

• Mood

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Quick Review

Rates of overweight and obesity are increasing among school-aged children

Risk of type 2 diabetes increases in obese individuals Limiting excess kilocalorie intake from high-sugar or high-

fat foods can help prevent obesity Engaging in physical activity and reducing “screen time” is

necessary to maintain a healthy body weight MyPyramid for Kids provides information about healthy

eating patterns Schools may provide nutritious breakfast and lunch meals Parents must continue to serve as role models for healthy

behavior

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Adolescence

Developmental period between childhood and adulthood

• Ages 9–19 years

• Physical changes occur, including a growth spurt

- Height increases

- Weight increases due to bone growth and gains in lean body mass and body fat stores

• Hormonal changes occur including the onset of menstruation for females

• A healthy diet is necessary at this time to ensure adequate nutrients, especially kilocalories, protein, calcium, and iron

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Nutrition-Related Behaviors

Desire for independence and individuality

• Making own food choices

• Having own transportation to access food

Influence of peers, media, and nonparent role models

• Exposure to unrealistic or unsafe eating practices

• May lead to adoption of damaging habits

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Nutrient Needs: Calcium

½ of peak bone mass accumulates in adolescence

AI for calcium = 1,300 mg for ages 9–18 years

• Inadequate calcium intake can lead to low peak bone mass and is a risk factor for osteoporosis

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Nutrient Needs: Iron

Additional iron supports muscle growth and increased blood volume

• Adolescent females need iron to support menstruation RDA for iron

• Females aged 14–18 years = 15 milligrams

• Males aged 14–18 years = 11 milligrams Iron deficiency is common in adolescence, especially

among individuals who limit intake of enriched grains, lean meats, and legumes

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Disordered Eating

Disordered eating patterns are more prevalent in adolescent females than males

• May be linked with poor body image or low self-esteem Teens often adopt unhealthy habits such as

• Skipping meals

• Using food substitutes

• Taking diet pills or nutritional supplements

• Purging through vomiting, laxatives, or diuretics Eating family meals promotes healthy eating patterns

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Quick Review

Height and weight increase during the growth spurt in adolescence

• This prompts an increased need for calcium and iron Adolescents have increased power over their food decisions

• Soda and sports drinks may replace water and milk Peers and the media exert a strong influence on teens

• As a result, unhealthy habits may be formed Disordered eating may exist in teens with poor body image

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Putting It All Together

Toddlers and preschoolers benefit from eating frequent, small meals consisting of nutrient-dense meals

Exposure to a variety of healthy foods is necessary to promote good nutrition

Picky eating and “food jags” are common, temporary behaviors

In childhood, obesity may result from overconsumption of kilocalories, especially in the form of soda or candy

Parents can serve as good role models by choosing healthy foods for themselves at family meals

Adolescence is characterized by a growth spurt which increases calcium and iron needs

A teenager’s eating habits may be influenced by peers or the media