NUTRITION IN CHILDHOOD

Nutrient requirementChildren growing & developing

need more nutritious foodMay be at risk for malnutrition if : - poor appetite for a long period - eat a limited number of food - dilute their diets significantly with nutrient poor foods

EnergyEnergy needs of healthy children determined on : - basis of basal metabolism - rate of growth - energy expenditureMust be sufficient to ensure growth & spare protein, but not so excessiveSuggested intake proportions : 50 60% carbohydrate, 25 35% fat, 10 15% protein

Daily dietary reference intakes for energy for childrenAge Males Females (yr) (kcal) (kcal)

1 21046 9923 81742 16429 132279 2071

IOM, Food and Nutrition Board, 2002

ProteinEarly childhood 1.1 g /kg BWLate childhood 0.95 g/kg BWAt risk for inadequate protein intake : - strict vegan diets - with multiple food allergies - who have limited food selection because of fad diets - behavioral problems - inadequate access to food

Daily dietary reference intakes for protein for childrenAge Grams Grams / kg (yr)

1 313 1.14 819 0.959 1334 0.95

IOM, Food and Nutrition Board, 2002

Minerals and vitaminsNecessary for normal growth & developmentInsufficient intake impaired growth

deficiency disease

IronChildren 1 3 years high risk for iron deficiency anemiaRapid growth period Hb & total iron

diet may not be rich in iron-containing food

CalciumNeeded for adequate mineralization & maintenance of growing bone DRI : 1300 mg/day 9 18 yrs 800 mg/day 4 8 yrs 500 mg/day 1 3 yrsPrimary sources : milk & dairy product children who consumed no or limited amount at risk for poor bone mineralization

ZincEssential for growth if deficiency : - growth failure - poor appetite - decreased taste acuity - poor wound healingRDA : 3 mg / day 1 3 yrs 5 mg / day 4 8 yrs 8 mg / day 9 13 yrs

Best sources : meats & seafoodMarginal zinc deficiency reported in children from middle & low-income families (Robert & Heyman, 2000)

Vitamin DNeeded for calcium absorption & deposition calcium in the bonesThe amount required from dietary sources is depend on nondietary factors (geographic location & time spent outside)Primary sources : vitamin D-fortified milk

Vitamin-Mineral supplementDo not necessarily fulfill specific nutrient needsChildren who take supplement do not exceed the RDAShould not take megadoses, particularly fat soluble vitamins toxicity

Children at risk who may benefit from supplementation : - from deprived families - with anorexia, poor appetites, poor eating habits - with chronic diseases (cystic fibrosis, liver dis) - enrolled in dietary programs from weight management - vegetarian diets with inadeq intake of dairy product or calcium containing foods

FEEDING PRESCHOOL CHILDREN (1 6 yrs)

Still gaining height & weightStart to walk & talk

Depend on brain development

Depend on genetic & environmental influences stimulation & nutrition

Marked by vast development and the acquisition of skillsDecreased interest in food a difficult time for parents Smaller stomach capacity & variable appetite small servingEat 4-6 x/day snacks is important should be chosen carefully

Should not be given any food or drink within 1 hours of mealExcessive intake of fruit juices chronic non specific diarrheaExcess juice intake may replace the consumption of higher energy foods childs appetite food intake & poor growthChildren usually eat well in group setting ideal environment for nutrition education program

FEEDING SCHOOL-AGE CHILDREN (6 - 12 yrs)May participate in the school lunch program or bring a lunch from home

NUTRITIONAL CONCERNSObesityIncreased prevalenceNot a benign conditionThe longer a child has been overweight the more likely the is to be overweight during adolescent & adulthoodFactors contributing : - food establishment - eating tied to leisure activities - larger portion size - inactivity

Underweight & Failure to ThriveEtiology : - chronic illness - restricted diet - poor appetite - feeding problems

Iron deficiencyOne of the most common nutrient disorders of childhood (9% of toddlers)Possible factors associated : dietary intake, parents educational level, access to medical care1-yr old child who consume large quantities of milk only milk anemiaDo not like meat iron consumed in the nonheme form

Prevention : - consuming good dietary sources of iron - the amount of ascorbic acid and MFP to absorption

Dental CariesDrink sweetened liquids from a bottle at bedtime susceptible to early childhood caries (Baby bottle tooth decay)Snacks choose that are least cariogenicChewing sugarless gum salivary pH beneficialToothbrush should be introduced

AllergiesUsually develop during infancy & childhood and more likely when family history (+)Allergic responses most often include respiratory or GI symptom & skin reaction

Autism Spectrum DisordersAffect the childrens nutrient intake & eating behaviorsTypically eat only specific foods

restricted diet

at risk for inadequate nutrient intakeUsually refuse fruit & vegetablesCommonly very resistant to taking supplement

Popular dietary intervention : gluten-free and casein-free dietNutrition assessment should include : - the possibility of medication and nutrient interaction - use of alternative therapies, herbal and supplementNutrition intervention may include a behavioral program types of food accepted

PREVENTING CHRONIC DISEASEDietary fat & cardiovascular healthNCEP recommendation ( 2 yrs) : - no more than 30% of calories from fat ( 10% SAFA, 10% PUFA, 10-15% MUFA) - no more than 300 mg/day of cholesterol> 2 yrs gradually adopt a lower fat diet 4 yrs meet the NCEP guidelines

Calcium & bone healthOsteoporosis prevention : - begins in childhood by maximizing calcium retention & bone density - most efficient during childhood & adolescent Education is needed to encourage young people to consume an appropriate amount

FiberNeeded for health & normal laxationEducation is needed to help increase fiber intake

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