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CHAPTER 14 CHAPTER 14
NUTRITIONAL REQUIREMENTS NUTRITIONAL REQUIREMENTS DURING GROWTH AND DURING GROWTH AND
DEVELOPMENT AND EATING DEVELOPMENT AND EATING HABITS AFFECTING ORAL HABITS AFFECTING ORAL
HEALTHHEALTH
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 2
Infants: OverviewFeeding patterns in first 2 years of life create
environment for optimal development of genetically determined factors contributing to orofacial development and swallowing patterns
GrowthBirth weight doubles in 4 months (from 7.5 to 15 lb)By 1 year it triples Length or height increases 50% by age 1
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 3
Infants: Nutritional RequirementsEnergy requirements are much higher per pound
or kilogram of weight than for an adult 95 to 83 kcal/kg/day between 3 and 12 months of age,
respectively, vs. 29 to 37 kcal/kg/day for adultsInfants have a higher resting metabolic rate
Protein recommendationsAI =1.52 g/kg daily from birth to 6 months of age AI =1.2 g/kg for infants over 6 months of age This translates to about 9.1 to 11 g/day Should not exceed 20% of daily caloric intake due to
immature renal function
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 4
Infants: Breast Milk
Living cellsHormonesActive enzymes (e.g.,
lipase to aid in fat digestion)
AntibodiesLow mineral content;
ideal for immature infant kidneys
Long-chain fatty acids needed for brain and retina development
High cholesterol countBy 6 months of age, need
addition of iron-rich foods or supplements
By 2 months, supplement with vitamin D
Optimal source of nutrition for infants;Optimal source of nutrition for infants;
incredibly complex and contains:incredibly complex and contains:
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 5
Infants: Artificial Baby MilkDespite strict standards for infant formula, it
cannot duplicate human breast milkNonfat cow’s milk is the basis for most infant formulas
Provides 20 kcal/ozMost have been modified to include DHA for
brain and retinal developmentAPA provides guidelines for electrolyte, mineral,
and vitamin contentADA recommends use of fluoride-free
water to reconstitute powder formulas
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 6
Infants: Artificial Baby MilkAlternative artificial baby milk
Soy-based formulas used for infants with cow’s milk allergy Most common reason for use is relief of perceived formula
intolerance (spitting, vomiting, fussiness) or symptoms of colic although clinical studies do not indicate a benefit
Formulas for infants with special nutritional requirements Preterm infants Metabolic problems (e.g., phenylketonuria)
Formulas discontinued at age 1; whole milk provided until age 2
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 7
Infants: Feeding PracticesInfants typically eat six times/day at 4-hour
intervalsOral and neuromuscular development
Suckling encourages maximum development of the genetically defined jaw and chin Breastfed infants less likely to develop malocclusion—high
premaxilla, abnormal alveolar ridges, and palate and posterior cross-bite
Infants breastfed for a year require 40% less orthodontia than bottle-fed infants
Sucking from a bottle or on a pacifier, thumb, or fingers may result in narrower upper and lower dental arches
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 8
Infants: Feeding PracticesSuckling is replaced with sucking by 4 months of age
Sucking motion becomes developed enough to eat and handle semisolid foods from a spoon at 4 to 6 months
At about 6 to 8 months of age, develop the ability to receive food and perform a chewing motion
When infant can chew, variety of texture is mandatory to prepare infant to accept unfamiliar foods later in life Unless textured foods are offered, development of oral
musculature may be slow or delayed and affect speech
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 9
Infants: Feeding PracticesIntroducing foods
4 to 6 months First foods introduced are usually cereals made of
rice, oat, or barley Should be presented to the infant with a spoon Formula intake should remain around 32 oz daily Fruit juice provides no nutritional benefit for infants
less than 6 months old
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 10
Infants: Feeding Practices
Introducing foods6 months
4 to 6 oz of fruit juice diluted with equal portions of water can be introduced in a cup
Because of possible food allergy, only one new food should be introduced at a time
Order of introduction: vegetables, meats, and fruits Sweet foods are preferred so offer other foods first
Junior-type foods with a few lumps are introduced to initiate some chewing
Fluoride supplements recommended for children in areas without fluoridated water
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 11
Oral Health Concerns of Early Childhood
Nutritional deficiency during tooth development affects:Tooth sizeTooth formationTime of tooth eruptionSusceptibility to caries
Mild to moderate malnutrition during first year of life associated with increased caries in primary and permanent teeth
From Bath-Balogh M, Fehrenbach MJ: Illustrated From Bath-Balogh M, Fehrenbach MJ: Illustrated Dental Embryology, Histology, and Anatomy, ed 3. St. Dental Embryology, Histology, and Anatomy, ed 3. St.
Louis: Saunders, 2011.Louis: Saunders, 2011.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 12
Infant Oral CareGeneral oral hygiene guidelines
Infant’s gingiva should be cleaned daily with gauze; soft infant toothbrush and water or infant tooth cleaner to remove plaque biofilm
When teeth begin to erupt, parents should continue brushing teeth with soft infant toothbrush using fluoride-free toothpaste
AAPD recommends first dental visit by age 1When child is able to expectorate (usually 2 to 3 years
old), pea-sized amount of fluoride toothpaste can be used
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 13
Infant Oral Care
Feeding issues affecting oral healthAt-will nighttime breastfeeding should be discontinued
once teeth eruptInfants and toddlers should not be given a bottle at
bedtimeToddlers should be weaned from the bottle by 14 monthsInfants and toddlers should begin drinking from a cup as
soon as they can sit up and hold it A sippy cup between meals with juice, soda, or other sweetened
liquid places the child at risk for caries
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 14
Early Childhood CariesEarly childhood caries (ECC)
Presence of one or more decayed, missing (due to caries), or filled tooth surfaces in any primary tooth in child less than age 6
Severe early childhood caries (SECC)Rampant decay usually associated with
inappropriate feeding practicesChildren with SECC weigh less than their
ideal weight for height, and their weight
for age is frequently below 10th percentile
From Swartz MH: Textbook of From Swartz MH: Textbook of Physical Diagnosis, ed 7. Physical Diagnosis, ed 7.
Philadelphia: Saunders, 2014.Philadelphia: Saunders, 2014.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 15
ECC: Contributing Factors
Infection with Streptococcus mutans from caregiver
Addition of frequent or prolonged exposure to a fermentable carbohydrate will inoculate S. mutansA bottle at bedtime and frequent daytime
bottles or habitual use of a no-spill training cup increase caries risk
Prevention starts before birth with guidance to parents
From Bath-Balogh M, Fehrenbach MJ: From Bath-Balogh M, Fehrenbach MJ: Illustrated Dental Embryology, Histology, Illustrated Dental Embryology, Histology, and Anatomy, ed 3. St. Louis: Saunders, and Anatomy, ed 3. St. Louis: Saunders,
2011.2011.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 16
Cleft Palate and LipMalformation in which parts of the upper lip or
palate fail to grow togetherApproximately 1 out of 1000 infants born with cleft lip
with or without cleft palateDrugs, heredity, or nutrient deficiencies (namely folic
acid) may cause this malformation
Infants born with cleft palates are at high risk of developmental delays, including motor skills
Increased rates of dental abnormalities, including supernumerary, missing, or malformed teeth
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 17
Cleft Palate and LipFeeding can be major issue since
presence of the cleft prevents negative pressure needed for sucking Extra feeding time is necessary to
ensure adequate nutritionSpecial feeding devices needed when
feeding time exceeds 1 hourOther feeding issues include nasal
regurgitation, excessive air intake, and frequent burping
Spoon feeding introduced as soon as possible
From Bath-Balogh M, Fehrenbach MJ: From Bath-Balogh M, Fehrenbach MJ: Illustrated Dental Embryology, Histology, Illustrated Dental Embryology, Histology, and Anatomy, ed 3. St. Louis: Saunders, and Anatomy, ed 3. St. Louis: Saunders,
2011.2011.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 18
MyPlate & MyPyramid MyPlate & MyPyramid for Kids emphasize for Kids emphasize variety, moderation, variety, moderation, and balance in food and balance in food choices choices
Focus on importance Focus on importance of making consistent of making consistent smart food choicessmart food choices
Dietary Recommendations and Guidelines for Growth: Children
Older Than 2 Years
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 19
MyPlate for Kids: Key Messages for Parents
Set a good example Offer a variety of foodsStart with small portionsHelp them know when
they’ve had enoughFollow a meal and snack
scheduleMake mealtime a family
time
Cope with a picky eaterHelp them try new foodsMake food funEncourage 60 minutes of physical
activity dailyDietary fiber
intake = age of child + 5 g/day
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 20
Toddlers and Preschool Children: Overview
GrowthGrow approximately 2 to 3 inches/year and gain
around 5 lb/year Half of adult height achieved by 2½ to 3 years of age
Nutrient requirementsMost often deficient: iron, zinc, calcium, and vitamin DCaloric needs: 1000 kcal + 100 kcal per year of ageChoose nutrient-dense foods to meet growth needs
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 21
Toddlers: 1 to 3 Years OldSome finger foods should be provided at every mealToddlers can manipulate a cup by age 18 monthsProvide regularity with meals and snacksOffer small amounts of food several times per dayServing size is dependent on appetiteFood jags are common; continue to offer
well-balanced meals; let children choose
from what is offeredPrevent choking by closely supervising
children while they’re eating
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 22
Preschool Children: 4 to 6 Years Old
Independent in feeding themselvesCutting fruits and vegetables into small
pieces increases acceptancePrefer foods separate rather than mixedParents need to model appropriate eating behaviorsSnacks important to ensure adequate nutrient intakeEasy-to-chew foods more readily acceptedMay need 8 to 15 exposures to new food before
acceptance
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
ADD/ADHA
Promote a nutritionally well-balanced, high-protein diet
Limit added sugarsAdd more complex carbohydratesRestriction of synthetic food color additives
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Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 24
Children with Special NeedsMastication and swallowing problems are commonBruxism is common in cerebral palsy and Down
syndromeChildren with cerebral palsy, Down syndrome, and
intellectual disabilities likely to have abnormal sensory input and muscle tone
Difficulties with sucking, swallowing, spoon-feeding skills with semisolid or solid foods, chewing, and independent feeding are common
Tongue thrust associated with many of these conditions jeopardizes nutritional status
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 25
School-Age Children: 7 to 12 Years Old
Only 22% of all children consume 3 servings of vegetables daily
Food habits and intake may suffer because children do not take time for meals
Although bakery products, soft drinks, candy, and chips are favorites, nutritious snacks are preferable
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 26
School-Age Children: 7 to 12 Years Old
Dental cariesPrevalence of caries in the permanent teeth
of youths ages 6 to 11 years decreased from 25% in 1988–1994 to 21% in 1999–2004
Some racial, ethnic, and lower socioeconomic groups have more treated and untreated caries
Caries rate is reduced 60% when 1 ppm fluoride in drinking water is present during tooth formation
Application of sealants aids in reducing caries riskFood selection and patterns of consumption affect
caries risk, so nutritious foods should be encouraged
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 27
AdolescentsGrowth and nutrient requirements
Because of major biological, social, psychological, and cognitive changes; 17% of teens at nutritional risk
Growth of long bones, secondary sexual maturation, and fat and muscle deposition lead to increased nutrient requirements Calcium, vitamin D, and iron especially important
Only 9% of girls and 31% of boys between ages 14 and 18 get the recommended daily amount of calcium
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 28
AdolescentsInfluential factors on eating habits
External factors Family Peer pressure Mass media Economic and sociocultural factors
Internal factors Physiological needs Body image and self-concept Food preferences Personal values/beliefs toward health and nutrition
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 29
Adolescents: Food Choices
Favorite food choices among adolescents:Carbonated beverages,
sports/energy drinks Soda consumption
increased from 16 oz/day to 28 oz/day between 1977 and 1999
Orange and apple juice From 1977 to 2001, fruit
drink consumption from 1.8% to 3.4%
Flavored milkSteak, hamburgers,
chicken Pizza and spaghettiChipsFrench friesIce creamCandy (sour,
hard, chewy)Snack cakes
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 30
Adolescents: Food ChoicesAdolescents have more access to food outside the
home and experiment more with food selectionsAbout 25% of kilocalories come from high-calorie,
low-nutrient foods, which results in:Excessive intake of sodium, sugar, and fatInadequate fiberFrequent snacking and skipping meals, especially
breakfastEating in a hurryReliance on convenience and fast foods
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 31
Adolescents: Oral HealthAcademy of General Dentistry notes increase in
soda consumption has boosted caries rate in teens, which is approaching levels before fluoridation
AAPD warns of the following potential health problems as a result of high intake of sweetened drinks: Overweight attributable to additional caloric intakeDisplacement of milk consumption, resulting in calcium
deficiency with an attendant risk of osteoporosis and fractures
Dental caries and potential enamel erosion
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 32
Adolescents: Nutritional Counseling
Adolescents can frequently be motivated by responsibility, collaboration, fear of failure, and respect for the counselorNegotiation and reflective listening can enhance
their critical thinking skillsPresent nutrition and oral health
information in terms relevant to teen
lifestyles and personal interests (athletic performance, appearance)
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
HEALTH APPLICATIONChildhood & Adolescent Obesity
Discuss factors impacting/causing the obesity epidemic
Consider physiological/psychosocial complications leading to negative health consequences
Discuss social discrimination related to obesityConsider strategies and rationales for WHY
prevention is so importantDiscuss goal setting for obese children for weight
maintenance or reduction
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