Childhood and Nutrition

7/28/2019 Childhood and Nutrition

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dr. Arien Himawan,M.Kes

PPDS Gizi Klinik

Th.2012

CHILDHOOD AND NUTRITION


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Nutritional Status of Children in The United

States


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Poverty and The Undernourished Socioeconomic status is an important

determinant of nutritional adequacy in children,

with children from families living below the

poverty line more likely to be undernourished Poverty is associated with impaired growth in

children, and the impact can be severe


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Homelessness

Homelessness appears to increase nutritional

risk beyond that of poverty alone

A study from New York City in 1991 found that

homeless children had higher rates of growthstunting,

ohomeless children tended to have lower

height for age with preservation of normal

weight for heighto a pattern consistent with exposure to mild to

moderate undernutrition

Greater stunting was found in children form

single-parent families and those with large


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Growth and Development During

Childhood

Individuals maximum potential size is genetically

determined, but nutrition during the growth years

has major influence on whether this potential is

achieved


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Triples the birthweight

Increases the infants

height by nearly 50%

Thefirst 12

months

The average heightincreasing only 12 13 cm

The average weightincreasing about 25%.

Thesecond

year

Height and Weight


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Preschool years

(age 2 5)

Average weight gain5 6 lb per year

Height increases 2,5 3 inches per year

Doubling of birth

length at about age 4

School years (age 510)

Average weight gain7 lb per year

Height increases 2,5 3 inches per year

Childhood is a period ofslow and steady growth between

the explosive growth of infancy and the acceleration of

the pubertal growth spurt


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In USA, Black infants have smallerbirthweights than White infants

from age 2 through adolescence Black childrenare tallerthan White children at the same age

Asian children are shorterand lighterthan theirWhite and Black counterparts

EthnicDifferences

Appear at around age 6, with males beingslightly taller and heavierthan females

Females begin pubertal growth earlierthanmales, so by age 9 females are as tall asmales and generally heavier

GenderDifferences


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Growth Charts

Growth is predictable characteristic of normalchildren, and the rate of growth is sensitive to

changes in nutrition growth patterns during

childhood can be used to evaluate nutritional

statusThe charts are used to separate normal form

abnormal growth patterns and to draw attention

to unusual body size useful information on

growth rates can be obtained by examining

serial measurements


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Three basic growth chart

( height for age, weight for age, weight for stature ) :

Height for age : good indicator ofchronic nutritionalstature ( steady linear growth is a good measure of

the long-term adequacy of a childs diet )

Weight for height : better indicator of recent nutrient

intake than of long-term changes (

factor slowing orincreasing growth affect weight earlier than stature )

Healthy children expected to maintain growth channels

when serial measurements over time are recorded

Weight for height is a standard criterion fordeterminingobesity, but in some children, this may not predict the

level of body fat

measurement of a triceps skinfold is the single most

accessible and useful measurement


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Wasting : a child who has very low weight for height

indicate recently being markedly undernourished

Stunted : a childe whose weight and height are both lowfor age, but whose weight is appropriate for height

long-term undernutrition during childhood

hypocaloric dwarfism : stunting due to chronic

inadequate intake of a generally well-balanced diet OR maybe genetically short, have insufficient growth

hormone, suffer form a number of other diseaseunrelated to nutrition

Characteristic of childhood growth : catch-up growth

The ability to return to the predetermined growthchannel after falling out of it because of undernutritionof disease

unless the undernutrition has been prolonged or


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Body Composition

Percentage of body fat is greatest at age 9 12months (25% of body mass )

12 months - 8 years children become leaner

half of all new tissue formed is skeletal muscle

at age 8 years fat percentage is 13 % of body

mass and then begins to increase again ( the

prepubertal fat spurt )


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Organ Systems

Different pattern : Neural tissue

during infancy and nearly complete before

adolescence

75 80% complete by age 2 95% of its adult weight by age 10

Genital tissues

do not begin rapid development until adolescence

Lymphoid tissue ( tonsils, thymus, spleen )

develop rapidly through preadolescence, begin to

involute during adolescence


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The Digestive System

Develop rapidly in early childhood

Salivary glands : fully functional by age 2 years Stomach capacity increase throughout childhood fro 250

300 cc at 1 year old 500 cc at 2 years 900 cc at 10

years

Small intestine : 3 m at birth doubles in length by thebeginning of adolescence

Pancreatic and intestinal enzyme systems : partially

developed at birth adult like function early in childhood

pepsin, trypsin, amylase secretion : fully developed by 2years old

Lipase secretion : slowly, but complete at 3 4 years old

Liver: continues to develop the ability to storage glycogen

and provide glucose between meals.


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The Dentition

Third semesterof pregnancy : calcification of theprimary teeth begins

5 6 months of age : eruption of primary teeth

3 years of age : 20 primary teeth have erupted Establishment of the primary dentition and growth

of jaws in early childhood enables preschooler

to masticate and swallow an increasing variety of

solid foods

Shortly after birth until late teens : calcification of

permanent teeth

6 7 years : eruption of permanent teeth


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The Urinary System

Matures in early childhood

2-3 years the developing kidney is fully able to

concentrate and dilute urine to maintain water

balance

Greater ability to control water exchange

dehydration occurs less readily in preschool

children than in infants


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Nutritional Requierements During Childhood

Recommended Dietary Allowances for

Children Divided into 3 age groups : age 1 3, age 4 6, age 7

10 Gender difference in size and body composition are

minimal before the onset of puberty growth below age

10, dietary allowances are identical for both sexes

Calculated to meet the needs of children of averageheight, weight, and activity can be a wide range of

adequate daily intake

Total need for most nutrients increases, but decline per

unit body weight because lean body mass of children

contains a greater proportion off metabolically active


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Energy NeedsAdequate energy is of prime importance during childhood

growth

Determined by REE, level of activity and needs for growth

REE : varies primarily with the amount of lean body mass

Activity levels : vary considerably among children and in

individual children form day to day if not constrained by

illness or the environment, children are very active energy expenditure of acitivity is typically 1.7 2 x REE

Energy cost of new tissue is about 5 kcal/gram energy for

growth is only a small component of the total energy

requirement ( 1 2 % )

RDA :

age 1 3 : 102 kcal/kg/day

Age 4 6 : 90 kcal/kg/day

Age 7 10 : 70 kcal/kg/day

Adequacy of intake should be based on satisfactory growth


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Protein Needs Characteristic : protein synthesis and deposition into

new tissue

Nitrogen retention: infancy ( first few months ) : 200mg/kg/day

age 4 years : 11 mg/kg/day 1 4 gr/ kg of newtissue

Calculated based on maintenance requirements,changes in body size and composition and growthrates.

There is a slow decrease in protein needs relative toweight during childhood :

RDA : Age 1 3 : 1.2 g/kg

Age 4 6 : 1.1 g/kg

Age 7 10 : 1 g/kg

Evaluation on protein intake during childhood should


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Fat Requirements

Major source of energy during childhood

Provides 36 38% of total energy in the dietAAP ( American Academy of Pediatrics ) : age > 2

years :

Fat : 30% of total calories

Saturated fat less than 10% 3% of total energy form essential fatty acids

linoleic acid and alpha- linolenic acid, dietary

cholesterol less than 300mg / day

Nutritional adequacy should be achieved by eating awide variety of foods

Adequate calories and other nutrients must be

provided to support growth and development


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Carbohydrate Requirements

40 60 % of total calories

Provide a readily available source of energy Should be provided ample complex carbohydrates from

varied selection of whole-grain cereals, legumes, fruit

and vegetables.

Children tend to eat slightly more added sugar thanadults ( 14% vs. 11% of dietary energy, respectively )

Families trying to reduce sugar consumption should set

moderate goals rigorous elimination of sugar

containing foods from a childs diet without adequateenergy substitution lead to a hypocaloric intake and

poor growth


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Fiber Requirements

Adequate dietary fiber in a childs diet may lessen

constipation and lower chances of becoming obese

Children have small stomachs and food high in fiber

are bulky and often low in calories children may be

unable to consume adequate calories for normal

growth

Increasing fiber intake in the school-age child may

produce abdominal pain, bloating and flatulence, also

may interfere with the absorption of nutrients such as

zinc and magnesium.

AAP recommendation : modest amount of fiberincludingwhole-grain cereals

and breads, fruit and vegetables

unbalance diet that emphasizes high-fiber

low calorie foods should be avoided during childhood


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Vitamin Requirements

Fat-Soluble Vitamins Vitamin A :

Central role in cellular growth and differentiation duringdevelopment particularly in epithelial tissue

Adequate intake is important

RDA : 400 RE at age 2 700 RE at age 10

Vitamin D :

Requires for normal skeletal growth

RDA : > 6 months age : 10 g ( 400 IU )

Vitamin E :

Requirements increased with increasing body weight

during childhood growth. RDA : 6 mg at age 2 7 mg at age 10

Vitamin K :

No specific data requirement

RDA : 1 g/kb body weight


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Water-Soluble Vitamins

Thiamin, riboflavin and niacin :

Important in energy metabolism.

Intakes based on energy intake are adequate during

childhood.

RDA :

Thiamin = 0,5 mg/1000kcal

Riboflavin = 0,6 mg/1000kcal

Niacin = 6,6 NE/ 1000kcal

rise proportionally with increasing energy intake

during childhood growth


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Pyridoxine (B6) :

Plays central role in protein utilization and synthesis

Required in increasing amounts during childhood growth

RDA : 0,02 mg/ g protein

1 mg at age 2 1,4 mg at age 10

Folate and B12 :

Required during synthesis of large amounts of new bloodcells in growing vascular system

No specific data requirement interpolated from adult RDA RDA based on body weight

Vitamin C

Central role in collagen synthesis necessary for optimalgrowth and development of supporting tissues including

cartilage, bone and the connective tissue in skin and bloodvessels

Little data on requirements in children 10mg / day protectinfants from scurvy, > 6 months of age gradually increasedto adult level

RDA : 1 3 years : 40 mg


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Mineral Requirements

Major Minerals

Calcium and Phosphorus Skeletal growth during childhood requires a strong

positive balance of calcium and phosphorus

Lack specific data

RDA calcium : age 1 10 : 800 mg/ day RDA phosphorus : age 1 10 : 800 mg/ day

Ratio phosphorus : calcium = 1 : 1

Milk supplies most of calcium and phosphorus bychildren in the US, however many Blacks, Asian

Americans and Americans Indians can drink little or nomilk because ofintestinal lactase deficiency othersource of calcium : dark green leafy vegetables andsesame seeds, or fermented milk product ( often are

better tolerated )


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Magnesium

RDA : 6 mg/ kg/ day; 80 mg at age 2 170 mg at age

10

Iron

Need for synthesize hemoglobin during steady growth

of the red cell mass and for myoglobin synthesis in

developing skeletal muscle. Target iron storage at 20 years = 300 mg

RDA age 2 10 : 10 mg/day

Iron deficiency is the most common deficiency in

children in US, particularly those under 3 years old,because childrens diets are often oflimited intake of

iron-rich food such as meat and eeg lower in iron.


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Zinc

Important in protein synthesis and normal

growthEven marginal deficiency during childhood may

slow growth

RDA : 10 mg/ day

Severe zinc deficiency during childhood and

adolescence cause marked stunting of growth

and delayed sexual development

Children oflow-income families are at anincreased risk for suboptimal zinc nutrition

because of low dietary intake of meat, fish and

whole grains


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Iodine

Few studies relative energy requirements are usedto set the iodine allowance for children

RDA :

70g at age 2

120 g at age 10

Iodine deficiency has adverse effects on the growth

and development Selenium

Little is known about selenium needs during childhood allowances have been extrapolated from adult

values on the basis of body weight, with additionalamount estimated for growth requirements.

RDA :

Age 1 6 = 20 g

Age 7 10 = 30 g


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Trace Minerals

Very little known about children requirements for manyof the trace minerals

RDA has estimated ranges of safe and adequate

dietary intakes for copper, manganese, fluoride,

chromium, and molybdenum in childhood

Since the toxic levels for many trace minerals,

particularly in children, may be only several times usual

intakes, the RDA committee has recommended that the

upper levels of intake for these trace elements not be

routinely exceeded


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Water and Electrolytes

During infancy, daily turnover of water is rapid(about 15 20% of total body water is taken in from food

and water and excreted each day)

As children grown this decreases steadily, and by early

adolescence water exchange is similar to adult rates(about 5 %)

Water requirements per kilogram of body weight fall

steadily, from 120 -140 ml/day at 1 year to 60 8- ml/kg

at age 12 Along with the increase in total water requirement,

electrolyte needs increasse steadily during childhood

growth


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Feeding Skills

By age 1 most infants have developed acoordinated pincer grasp, and finger-feeding

becomes common and easy

About midway through the second year, children

begin to scoop food into a spoon, losing much ofthe food because they lack wrist control

Later in the second year, the coordination of the

elbow and wrist allows smooth transfer of thespoon ( and its content) to the mouth

Although most 2- year-olds can move a cup

steadily without spilling the content and can

handle a spoon, food is generally transferred


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Around age 4, most children begin cutting their foods

By age 5, most can handle a knife and fork as well as the

spoon

Rotary chewing movements begin around 12 months, as

primary dentition is established

The ability to chew hard, brittle or fibrous food increasesas the permanent teeth develop during the school years

Food should be prepared with the aim of supporting the

development of self-feeding skills and until the child

develop the dexterity and motor skill to manage utensils,

food should be served in a way that enables them to

learn feeding skills without great anxiety or frustration

Most foods served to 2 3 year olds should be divided

into bite-sized pieces and prepared so they can be eaten

with the fingers

Childhood and Nutrition

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