Infancy, Childhood, and Adolescence Chapter 11: Infancy, Childhood, and Adolescence Infancy, Childhood, and Adolescence J Pistack MS/Ed J Pistack MS/Ed

Growth Infants usually double their weight by 4-6 months They triple their weight by 1 year

Development Development - changing from a simple to more complex organism A psychological development is trust – need consistent handling Failure to thrive (FTT) term of inadequate growth

Nutritional Needs of the Term Infant The American Academy of Pediatrics recommends exclusive breastfeeding the first 6 months of life ◦ Prevents against infectious disease ◦ Decreases allergic responses ◦ May decrease chances for later obesity ◦ Infants are often developmentally ready for complementary foods at 4 to 6 months of age

Nutritional Advantages of Breast Milk Infection-fighting agents— immunoglobulin A (IgA) and leukocytes Allergy prevention—correct proteins, which are hydrolyzed that are less likely cause allergic response ◦ An infant can absorb whole proteins but that is what causes the allergic reaction Obesity—evidence suggest decreased obesity later in breastfed infants

Formula-Fed Infants Breastfeeding may not be possible for all mothers Formulas are regulated in the United States Do contain more protein than breast milk Come in many concentrations—powder, mix, ready to feed

Formula Preparations Directions for preparing the formula ◦ Cleanliness/sterility of equipment ◦ Water to use for dilution  Sterility  Fluoride content  Possible lead contamination  Safe storage  Use of correct strength formula  Safe heating of the formula before feeding the infant Discard prepared bottles of formula that are unrefrigerated for 1 hour or partially consumed

Soy Protein Formulas Free of cow’s milk protein and lactose and iron-fortified The American Academy of Pediatrics recommends using soy protein–based formulas in term infants for: ◦ Galactosemia and hereditary lactase deficiency - disease in which the transformation of galactose to glucose is blocked, allowing galactose to increase to toxic levels in the body. ◦ Those whose parents desire a vegetarian diet ◦ Secondary lactose intolerance following acute gastroenteritis

Soy Formulas (Continued) The Academy does not recommend soy protein–based formula under the following circumstances: ◦ Preterm infants ◦ Cow’s milk allergy ◦ Routine treatment of colic ◦ Healthy or high-risk infants to prevent atopic disease

Providing Nutrition to Preterm Infants Human milk from the infant’s mother is the gold standard Special formulas for premature infants May need calcium, phosphorus, and sodium supplements Greater risk for iron deficient anemia due to smaller iron stores—may need iron supplementation

Necrotizing Enterocolitis (NEC) The most serious gastrointestinal disorder of neonates Acquired injury to the bowel Inflammatory bowel disease results in inflammation and bacterial colonization of the bowel wall Causes significant morbidity and mortality in preterm infants

Nutritional Problems in Infancy Colic: cause unknown, spasms of colon, “Rule of 3”—crying 3 hours/day, 3 days/week, 3 weeks Diarrhea: rotavirus, enteritis, or food intolerance—more than three watery stools per day; hydration is key; monitor signs and symptoms of dehydration Allergies: hypersensitivity to a food; some severe; treatment is avoidance of allergen

Food Allergies in Infancy Most common protein foods: milk, eggs, peanuts, tree nuts, fish, crustacean shellfish, soy, wheat Diagnosis: allow time between food introduction to locate source Anaphylactic reactions to food (e.g., peanuts)— emergency!

Nutrition of the Toddler (1–3 Years Old) Foods not recommended until after age 1; gradually introduce if allergies are not a concern Foods include: ◦ Unmodified cow’s milk ◦ Egg white ◦ Wheat ◦ Citrus fruits ◦ Seafood ◦ Chocolate ◦ Nut butters

Nutrition of Preschool Child (3–6 Years Old) Adequate dentition and good nutrition are mutually supportive The American Dietetic Association has addressed meeting children’s nutrition and nutrition education needs while in child care

Child Care Recommendations Eight hours or less: should be offered one meal and two snacks or two snacks and one meal Eight or more hours: offer two meals and two snacks or three snacks and one meal Serve fruits and vegetables high in vitamin C daily High in vitamin A at least three times a week

Child Care Recommendations (Continued) Caregivers should not add extra salt or sugar to food Good institutional food management practices should be implemented ◦ Good hand washing ◦ Adequate refrigeration ◦ Proper storage of supplies

Nutrition of School-Age Child (6–12 Years Old) A balanced diet suitable for healthy adults will also be good for a school-age child Exercise can help growth and development by stimulating osteoblasts and expending energy to control weight

Nutrition in Adolescence Do not meet the daily recommendation for fruits, vegetables, and whole grains Exceed the daily recommended amount of sodium Drink more full-calorie soda per day than milk (Centers for Disease Control and Prevention, 2013) Peak growth spurt is known to take place between ages 10 ~14 for girls and 12~16 for boys During the peak growth spurt, the mineral and protein content of the body is increased so healthy nutrition intake is important

Concerns Regarding Adolescent Nutrition Diet lacks calcium and iron—some correlation to fractures in this age-group Skipping breakfast Overemphasis on weight Acne—linked or not to food

The Growing Concern About Overweight Children Pediatricians treating diseases of aging ◦ Hypertension ◦ High blood cholesterol ◦ Non–insulin-dependent diabetes mellitus Contributing factors ◦ Genetics ◦ Food environment ◦ Sedentary lifestyle ◦ Internal cues of hunger and satiety extinguished ◦ Lack of recognition of problem by adults

Prevention and Early Diagnosis Plot yearly body mass index on CDC growth charts Encourage healthy diets Low-fat dairy after age 2 Fruit and vegetable intake Promote physical activity Limit screen time to 2 hours per day