NANCY R. MEARS, MS, CHES, PAPHS

NS325Nutrition Across the Life Cycle

Unit 4 Seminar

Case Study #2

Tony is an 11-year-old male whose favorite activity is his Playstation system. He loves to come home from school and start playing right away. He will usually grab a large bag potato chips and a soda from the fridge and snack while he plays. He will take a break for dinner, but then he heads right back to the game. Tony has always plotted around the 50th percentile for weight and height for age, but lately he has been gaining weight and is now greater than the 95th percentile for weight. His father is not concerned, reporting that he was the same way at his age but “thinned out” as he got older.

Case Study #2

Should Tony’s weight gain be a concern, despite his family history?

What recommendations could be made to the family?

Develop a 2 day schedule and 2 days worth of menu’s to reflect a better balance in Tony’s lifestyle.

This project must be minimum of one page, not including title and reference page (APA format). Put your case study in a Word 97-2003 document. Save it in a location and with the proper naming convention: username-NS325-section-unit4 case study 2.doc (username is your Kaplan username, section is your course section). When you are ready to submit it, go to the Dropbox and complete the steps to submit.

Food Acceptance In Children

Food Development

The transition from dependent to independent self feeding occurs over the first two years of life;

Shifts from a single to multiple food sources;

There are increased opportunities for the self-regulation of food intake;

There are new social influences for eating with peers and adult caretakers.

Preferences & Aversions

Prefer to eat foods that are familiar.

Born with preference for sweet taste.

Adverse responses to sour and bitter tastes.

Flavor, texture, color, temperature are all important to a foods perceived palatability.

Shaping Food Acceptance Patterns

Factors with greatest impact on shaping food acceptance patterns:

Opportunities for repeated exposure to new food

Social context of meals

Associative learning

Repeated Exposure

Initial rejection of foods is normal, but parents believe child is a “picky eater”.

Increase the food’s familiarity to learn to accept new foods.

Offer new foods in positive, patient manner.

Repeat foods: At least 8-10 times

Social Context

By watching what others eat and don’t eat, children learn which foods are acceptable or not acceptable.

Routine mealtime experiences teach children which food combinations their culture finds acceptable and which are not.

Learn which foods are eaten at which meals.

Associative Learning

The pairing of something in the environment with something else, resulting in a new response. Example: Conditioned Aversion- eat something that

makes you sick

Common feeding practices can create conditioned dislikes for healthy foods. Example – the use of sweets as rewards to get kids to

eat veggies – actually increases the preference for the “reward” food

Passing Down Eating Patterns

How parents handle their own food intake has profound impact on their children’s food acceptance, preference and intake patterns.

Adult’s food preferences influence not only types of foods that children will consume, but the overall quality of the diet.

Appetite regulatory mechanism can be turned off by parental practices that focus attention away from internal satiety cues. Eating all food on plate; improper portion sizes

Parents Can Shape Healthy Eating

What strategies would you recommend to parents to develop healthy eating patterns in kids?

Practical Suggestions for Healthy Eating Patterns

Offer repeated exposure to variety of healthy foods.Be patient; repeat foods at least 8-10 times.Start early - Make tasting new foods a pleasant routine.Adults need to be positive role models.Don’t use food as a rewards.Respect children’s ability to regulate their energy (food)

intake.Do not severely restrict children’s access to

sweets/desserts/unhealthier items - restriction may make these “forbidden” foods even more attractive – make them a treat outside of the home, not a staple in your household.

Mealtime with Toddlers

Mealtime with Toddlers

As toddlers continue to advance their feeding skills, it is crucial to provide a healthy feeding and eating environment.

Structure at meals can have a significant influence on a child’s eating patterns.

Avoid the philosophy of “clean plate club”

Mealtime with Toddlers

Introduce one food at a time in order to avoid confusion or overwhelming the child.

At least 10 exposures to each new food is recommended

Develop positive healthy relationship with all foods.

Offer a variety of healthy foods

Promoting Vegetable & Fruit Intake

Add fruit purees to mixes (pancakes, waffles, muffins);

Add fruit purees to yogurt and puddings;Add dried fruits to cereal and trail mixes;Mix vegetable purees in soups and sauces;Take the child to the grocery store to select

new fruits and vegetables to try!

Choking Prevention

Some children may not develop the skill of chewing with a grinding motion until 4 years of age

Cut food into small pieces

Child needs to remain seated when eating

Encourage child to take small bites and avoid overfilling their mouth

Foods to Avoid to Prevent Choking

Hot dog slicesCarrot ringsWhole grapesNutsPopcornHard candiesLarge beans

Questions??

Common Food Issues

Picky Eating

Can be common in toddlers, and may continue throughout childhood

May be their attempt at independence

Avoid punishment or rewards for eating food

Avoid making “special meals” for the picky eater

Common Food Issues

Grazing

Growing children may not want to stop what they are doing for a meal and can end up grazing;

May produce a constant feeling of fullness and cause the child to never eat an appropriate amount at meal, therefore not expanding the stomach size;

If a child asks for food or liquids more frequently than 2 to 3 hours, encourage them to wait until the next meal or snack time.

Health Issues

Failure to Thrive

Inadequate physical growth diagnosed by observation of growth over time using a standard growth chart.

Factors inability to meet calorie needs due to medical

conditions Malabsorption increased metabolism with specific disease

states food shortage incorrect mixing of formula neglect

Health Issues

Lactose Intolerance

The inability or insufficient ability to digest lactose, a sugar found in milk and milk products

Uncommon in healthy infantsSymptoms: stomach pain, flatulence, and loose

stoolsMany are able to tolerate small amountsSolid cheese and yogurt are better toleratedMany lactose-free and low-lactose products

available

Health Issues

Excessive Weight Gain

10% children 2-5 years old are obese20% children 6 – 11 years old are obeseNot just one factor, but a combination of

physical inactivity, exaggerated portion sizes, sugar-sweetened beverages, lack of fruits and vegetables, and too much screen time

What can be done??

Questions?

Role of Parents in Promoting Healthy Nutrition in Early Childhood

Eating is a learned behavior of flavor and foodpreferences.

Parents are a child’s first teachersPositive Role Modeling – children develop

preferences for the foods they see others eating

Self Regulation – the ability to regulate volume of food intake is believed to be a normal human inborn error

Talking Points

Establish a Regular Feeding Routine – When and

where does your child eat?

Your child should have a regular feeding routine including a consistent time and location

Television should be off during meals

Talking Points

Dietary Variety – What kinds of foods does your child

like to eat?

Offer soft veggies, fruits, meats, pasta, etc… so your child can practice picking up and chewing

Limit juice to only 4 ounces per day of 100% – fruit is a healthier option than juice because of the fiber and high sugar content in juice

Talking Points

Create Pleasant Mealtimes – Does your child enjoy

mealtimes?

Mealtime should be a pleasant and a positive eating experience for the child and the parent/caregiver

Talking Points

Competing Foods – Does your child receive fatty or

sweetened foods and drinks?

If a young child is offered foods such as french fries, chips, donuts, desserts, and soft drinks, they will learn to like and expect these foods instead of healthier foods – remember the number of exposures!

References

Edelstein, S. & Sharlin, J. (2009). Life Cycle Nutrition: An Evidence Based Approach. Massachusetts: Jones and Bartlett Publishers.

Questions?