Chapter 14: Nutrition from Infancy Through Adolescence

Child Health

More children are receiving vaccinations

Fewer teenage pregnancies

Lower poverty rate

Increase number of obesity

Increase number of Type 2 diabetes

Decrease physical activity

Increase in consumption of sodas

Infant Growth and Development

Rapid growth rate

Weight doubles by 4-6 month of age

Weight triples by 1 year

Length increases 50% by the end of the 1st year

Nutrients needed to support proper growth

Inadequate nutrition (including fat) can inhibit growth

Effects of Undernutrition

More prevalent in developing countries

Smaller in size

Growth is an indicator of nutritional status

Following an adequate diet later won’t compensate for lost growth

WIC program

Assessment of Growth

Growth charts

Height and weight correspond to a percentile

50th percentile is considered average

Brain growth (fastest in infancy)

Over-feeding may increase the number of adipose cells

Restriction may affect organ development

Failure to Thrive

Usually due to poor parent-infant interaction

Infants need physical contact & eye contact

Diet restriction not recommended

Infants are dependent on others for nutrition

Infant’s Nutritional Needs

Human milk or formula for the first yearSupplemented with solid food at 4-6 month of ageHigh energy needsHigh protein needsHigher fat needsVitamin K given at birthVitamin D or sunshineVitamin B-12 if mom is a vegan

All can be met by feeding infant with human milk or formula

Calorie Needs

45-50 kcal per pound of body weight

~700 kcal/day for a 6 month old child

Breast milk or formula is ideal

High energy needs due to rapid growth & metabolism rate

Lose more heat from the skin due to higher body surface area

Protein Needs

0.7 – 1.0 g protein / pound (1.6-2.2 g/kg)

Half should be from essential amino acids

Breast milk or formula is ideal

Total protein should not exceed 20% of total energy needs

Excess nitrogen and minerals exceed the infant’s immature kidney abilities

Fat Needs

Under the age of 2, fat can provide 40% of total energy needs

More than 50% may lead to poor fat digestion

Half of the energy supplied by breast milk & formula comes from fat

Vitamin K

Routinely given as an injection

Intestinal bacteria will begin to synthesize

Mineral Needs

Iron store depleted by 4-6 month of ageChange to iron-fortified formula for bottle fed infantsPossible iron supplementation for breastfed infantsIntroduction of iron-fortified solid foods Zinc and iodide supplied by breast milk or formulaFluoride supplement after 6 month of age for tooth development

Water for Babies?2 oz/pound of body weight/dayMost fluid needs are met via breast milk or formulaSupplemental water may be necessary in hot climateDiarrhea, vomiting will require additional fluidsBabies are easily dehydrated and can damage kidneysUnder normal condition, additional water is not necessary

Formula Feeding

Cow’s milk is not tolerated by infants

Formulas must follow strict guidelines

Soy base contains soy protein

Fortified with vitamins and minerals

Feeding Skills

Grasps & transfers objects by 6-7 months

Holds bottle, play with food by 7-8 months

Self-feeding & drink from a cup around 10 months

More independence

When Should Solids Be Introduced?

Reached 13 pounds

Drinks 32+ oz a day (or 8-10+ breastfeeding/day)

Introduce solids at ~6 month of age

First Foods

Iron-fortified cereals--rice cereal Introduce one food at a timeWait a week before introducing a new foodStrained foods & meatsIntroduce vegetable before fruitDo not introduce mixed foodOffer juice in a sippy cup (prevent early childhood caries)No cow’s milk until 1 year of age

What NOT To Feed An Infant

Allergenic foods

Honey or corn syrup (contains Clostridium botulinum)

Highly seasoned foods

Excessive formula or breast milk

Choking potential foods

Cow’s milk

Excessive apple or pear juice

Limit Highly Allergenic Foods

Egg whites

Chocolate

Nuts

Cow’s milk

Key to Feeding Infants

Patience

Patience

PatiencePatience

Patience

Guidelines For Infant Feeding

Build to a variety of foodsPay attention to infant’s appetite to avoid overfeedingInfant needs fatChoose fruits, vegetables, grains but limit high-fiber foodsSugar in moderationSodium in moderationChoose foods containing iron, zinc, and calcium

Common Infant Health Problem: Colic

Repeated crying spell lasted 3 or more hoursAffects 10%-30% of all infantsUsually goes away in a few monthsNo physical problem identified with the infantAssociated with digestive problemsChange formula, or avoid certain foods if breastfeeding

DiarrheaNumerous loose stools in a dayRisk for dehydrationInfant needs additional fluidsElectrolytes-replacement fluids may be recommendedMay switch to soy-based formula for a few daysContinue to breastfeed

Milk Allergy

Cow’s milk contains 40+ different proteins that can cause allergic reactionsCauses vomiting, diarrhea, blood in the stool, constipationSwitch to soy base, or pre-digested protein formulaMay want to limit cow’s milk from breastfeeding mom

Iron-Deficiency Anemia

Occurs in older infants consuming too few solid foods

Cow’s milk is a poor source of iron

Feed iron-fortified formula

Feed iron-fortified cereals/meats

May need iron supplement

Preschool Children (age 2 - 5)

Average weight gain 4.5 - 6.6 lb. per year

Average height gain is 3-4 inches per year

Tapering of growth rate*

Reduction in appetite*

Promote good eating habits

Encouraging Nutritious Foods

Serve new foods & repeat exposure

Preschooler has sensitive taste buds & avoid new foods

Prefers crisp texture and mild flavor

Parents/caregivers must teach by example

Make meal time a happy time

Food Guide Pyramid for Children

Feeding Problems

Tension between parents and/or children

High expectations from parents

Change in appetite

Six small meals vs. 3 bigger meals

Foster good eating habits with good food choices

Not Eating As Much

Drop in growth rate

Loss of appetite

Typical serving size =

1 tablespoon per year old

Built-in feeding mechanism in normal weight children

Avoid nagging, forcing, bribing

Always Snacking and Never Finishes a Meal

Six small meals vs. three large meals

Smaller stomach capacity

Offers nutritious snacks

Do not overreactMeans of getting attention

Children will never starve themselves

Never Eats Vegetables

Introduce one at a time & repeatedly

Raw or blanched may be better tolerated

Serve with nutritious dip

Is He Eating Healthfully?

Compare to Food Guide Pyramid

Vitamin and mineral supplements are not necessary

Focus on good food choices

Use of fortified cereals

Foods with iron and zinc

Nutritional Problems in Preschoolers

Iron-deficient anemiaPoor oxygen supply to cellsCompromised learning abilitiesLower resistance to disease Iron-fortified cereals, lean meatsWIC

School-Age Children

Breakfast More likely to meet their nutritional needs

School lunch programs Fat content to decrease to 30% of total energy

Overemphasis of low-fat diets is linked to eating disorder

Need for nutrition education to promote wise food choices

Type 2 Diabetes

Alarming increase in the frequency in childrenRise in obesity & drop in physical activityScreening for at-risk childrenFamily historyEthnicityEncourage intake of low glycemic index foods

Obesity

25-30% of school-age are overweight

~40% of obese children become obese adults

~80% of obese adolescents become obese adults

Health threat

Encourage physical activity daily (>60 min./day)

Obesity

~34 hours a week spent in front of a TV, video game, or computer

Moderate kcal intake

Limit high fat foods

Weight loss diet may not be necessary

Obesity and self esteem

The Teenager

Rapid growth spurt between age 10-13 in girls*Rapid growth spurt between age 12-15 in boys*Girls gain ~10 inches Boys gain ~12 inchesGirls gain fat & lean tissueIncrease in appetitePeer pressure

Nutritional Problems of Teens

Anorexia nervosa and bulimia nervosa

Poor food choices

High fat intake

High sodium intake

Lack of calcium rich foods

Iron-deficiency anemia

No link between food & acne

Diets of Teenage Girls

Adoption of fad dietsDesire social acceptance; fat phobiaIncrease meals away from homeMissed mealsLimited food choicesIncrease snacking44% are trying to lose weightDiet commonly low in iron, calcium, zinc, vitamins folate, A and C

Get Teens to Eat Right!

Teens are unaware of long-term affect on healthRecommend smaller portions of high fat/sugar foodsLarger servings of low-fat dairy, lean meats, vegetables, fruits, and grainsStress the importance of nutrition & physical fitness

Snacking and Teens

1/4-1/3 of energy needs met by snackingSnack mostly on chips, candies, cola, ice cream“Snacking for socialization reason, not hunger”Poor dietary habits will continue into adulthoodIncreased risk for chronic diseases