Chapter 18: Life Cycle Nutrition: Childhood through Adolescence

Toddlers versus Preschoolers 1–3 years old Growth rate is high, but slower than infancy Age 2: Gain 3–5 pounds, 3–5 inches Preschoolers 3–5 years old Need same nutrients as adults, but have Lower energy needs Smaller appetites Smaller stomachs

Growth and Development Growth charts Used by pediatricians Monitor height and weight Compare to national standards for age and gender Place child in a percentile

Growth Chart Quick Check Jack is 24 months old, weighs 36 pounds and is 36 inches long. What are his percentiles? Figure 18.1

Eating Patterns and Nutrient Needs Young children need to eat frequent, small meals and nutrient-dense foods Energy needs: 1,000–1,600 kcal per day Appropriate portion sizes Child-sized plates and cups “Mini”-sized food items, such as bagels Rule of thumb is to serve 1 tablespoon of food per year of age at a meal

Food Safety Avoid choking hazards Offer bite-sized pieces of food Limit availability of Hot dogs Nuts or seeds Chunks of meat, cheese, or peanut butter Whole grapes or raisins Hard candy or gum Popcorn Raw vegetables

Nutrient Needs Carbohydrate At least half of grain intake should be from whole grains Fiber recommendations: Ages 1–3 years = 19 grams Ages 4–8 years = 25 grams

Nutrient Needs Protein RDA (toddlers) = 1.1 grams per kilogram of body weight RDA (school-age) = 0.95 grams per kilogram of body weight Fat Ages 2–3 years old = 30–35% of kilocalories from fat Age 4 and over = 25–35% of kilocalories from fat

Nutrient Needs: Calcium and Iron Necessary for healthy bone development Ages 1–3 years need 500 milligrams per day 8 ounces of milk provides 300 milligrams Iron Necessary during periods of rapid growth Good sources of iron for children include lean meats, beans, and iron-fortified cereals Cow’s milk is a poor source of iron

Iron: Deficiency versus Toxicity Deficiency (Anemia) Most common nutrient deficiency in young children Can lead to developmental delays Exacerbates attention deficit hyperactivity disorder Associated with lead poisoning Toxicity Leading cause of death in children under age 6 Occurs because iron can build up in tissues and organs Ingesting 200 milligrams of iron can be fatal

Nutrient Needs Vitamin D American Academy of Pediatrics recommends Ages 1–8 years consume 10 micrograms (400 IU) of vitamin D per day Sources include fortified milk, egg yolk, and some fish Two 8-oz glasses of milk only provides half of the recommended intake Supplements or fortified cereals may be needed

Nutrient Needs Young children need nutrient-dense beverages Fluid recommendations are based on body weight Drinking too much fluid may reduce fiber or iron intake Preferred beverages include water and milk 100% fruit juice can be provided in moderation Soda and sugary drinks should be avoided

Food Behaviors Eating habits form early in life Children will adapt to foods offered to them A variety of food should be offered to young children A child may need to be exposed to a new food at least 10 times before accepting it Division of responsibility Parents = What, when, and where food is offered Child = Whether or not to eat, and how much “Cleaning the plate” may encourage overeating

Food Preferences Parents have strong influence over children’s food preferences Children model after adult behaviors, both healthy and unhealthy Including young children in food shopping, menu planning, and meal preparation can encourage variety in their food consumption

Food Preferences Picky eating and “food jags” are common in young children Picky eating – not wanting to try new food Food jags – tendency to eat only a small selection of food Very common and normal, but also temporary Can be identified through a food diary Long-term jags increase risk of nutrient deficiency Solutions include Offering a variety of food items within the preferred food type Gradually weaning the child from the food item

Vegetarianism Young children can grow and develop normally on a well- balanced vegetarian diet Vegetarian foods such as beans, nuts, seeds, and whole grains are high in fiber Multiple servings per day may exceed a young child’s fiber needs Good sources of calcium, iron, and zinc need to be included in the diet Supplementation of vitamin B12 may be necessary

Quick Review Toddlers grow at a slower rate than infants, and have smaller appetites Frequent, small meals may be needed to provide adequate kilocalories, macronutrients, calcium, iron, and vitamin D Appropriate beverages include water, milk, and 100% fruit juice Small portion sizes should be encouraged, while “cleaning the plate” should be discouraged A variety of foods should be offered, and parents should serve as role models for healthy eating “Food jags” are normal and usually temporary

School-Aged Children Ages 6–12 years Are not fully grown Each year, gain about 7 pounds and 2.5 inches Compared to toddlers and preschoolers they Do not eat as many times per day Tend to be less hungry (maintain blood glucose longer) Can eat more food at each sitting Can impact healthy development through dietary choices Continue to develop habits based on modeling adult behaviors

Child Obesity Body Mass Index (BMI) is the measurement tool used to determine weight status For children, the categories are Overweight = BMI ≥ 95th percentile At risk for overweight = BMI ≥ 85th percentile

Child Obesity What is considered child obesity? Condition of a child’s having too much body weight for his or her height. The use of the word “obese” to describe children is controversial What causes child obesity? Genetics: Only a small percent of cases Environment: Excess kilocalories, inadequate exercise Obese parents Prenatal overnutrition

Child Obesity: Excess Kilocalories Sources include Regular soda, candy bars, potato chips Many of these products are sold within school buildings through vending machines or the cafeteria Also available in most convenience stores and shopping centers Typically replace healthy options such as milk, water, or fresh fruits and vegetables Increased portion sizes at meals and snacks Occurs both within and outside of the home

Child Obesity: Food Preferences High sugar and high-fat foods are often preferred by school-aged children This could lead to an excess kilocalorie intake These preferences are formed by Overexposure to television advertisements featuring appealing characters or famous spokespeople Modeling of parent or sibling eating behavior

Debate: Does Sugar Cause ADHD? Attention deficit/hyperactivity disorder (ADHD) occurs when children are inattentive, hyperactive, and impulsive No cause has been identified, but a high sugar intake has been proposed to cause hyperactive behavior American Dietetic Association conclusion: Sugar intake does not have an effect on behavior or learning American Academy of Pediatrics conclusion: No evidence exists that ADHD is caused by eating too much sugar What do you think?

Child Obesity: Inadequate Physical Activity Low levels of exercise occur in school-aged children due to Increased “screen time” – exposure to a television, computer, or video games Less access to physical education in schools Increased use of a car for transportation

Child Obesity: Prevention American Academy of Pediatrics recommendations Parents must ensure their children receive adequate nutrients without excess kilocalories A variety of healthy food must be offered to children “Screen time” must be limited to two hours or less per day

Child Obesity: Treatment Weight loss is not recommended for overweight children Weight maintenance allows for healthy growth Increased physical activity is encouraged

Obesity-Diabetes Relationship Type 2 diabetes – a disease typically diagnosed in adults Very likely to occur in obese children Prevention tips Identify high-risk individuals based on family history Reduce risk factors such as being overweight or sedentary Treatment tips Educate all members of the family about diabetes Provide support by eating the same foods as the child Encourage physical activity

School-Aged Children and Dental Hygiene 42% of children and adolescents (6–19 years) have at least one cavity or filling. Source: CDC, 2005 School-aged children are susceptible to dental caries, but sometimes do not practice good oral hygiene American Dental Association recommends Regular brushing and flossing Consuming a balanced diet in accordance with the Dietary Guidelines for Americans Limiting consumption of high-sugar foods such as soda, fruit juice, or milk

MyPyramid for Kids A visual tool for children and parents to understand healthy eating Figure 18.3

MyPyramid for Kids Key messages Be physically active every day Choose healthier foods from each group Eat more of some food groups than others Eat foods from every food group every day Make the right choices for you Take it one step at a time

National School Lunch Program (NSLP) Serves nutritious, low-cost or free lunches to 30.5 million school-aged children each day NSLP nutrient guidelines have specific recommendations establishing Minimum intakes Maximum intakes

The Role of Breakfast Eating breakfast may be associated with healthy body weight among children and adolescents Many schools with the National School Lunch Program also offer a school breakfast Eating breakfast may benefit Cognitive function, including memory Academic performance School attendance Psychosocial function Mood

Quick Review Rates of overweight and obesity are increasing among school-aged children Risk of type 2 diabetes increases in obese individuals Limiting excess kilocalorie intake from high-sugar or high- fat foods can help prevent obesity Engaging in physical activity and reducing “screen time” is necessary to maintain a healthy body weight MyPyramid for Kids provides information about healthy eating patterns Schools may provide nutritious breakfast and lunch meals Parents must continue to serve as role models for healthy behavior

Adolescence Developmental period between childhood and adulthood Ages 9–19 years Physical changes occur, including a growth spurt Height increases Weight increases due to bone growth and gains in lean body mass and body fat stores Hormonal changes occur including the onset of menstruation for females A healthy diet is necessary at this time to ensure adequate nutrients, especially kilocalories, protein, calcium, and iron

Nutrition-Related Behaviors Desire for independence and individuality Making own food choices Having own transportation to access food Influence of peers, media, and nonparent role models Exposure to unrealistic or unsafe eating practices May lead to adoption of damaging habits

Nutrient Needs: Calcium ½ of peak bone mass accumulates in adolescence AI for calcium = 1,300 mg for ages 9–18 years Inadequate calcium intake can lead to low peak bone mass and is a risk factor for osteoporosis Figure 18.4

Nutrient Needs: Iron Additional iron supports muscle growth and increased blood volume Adolescent females need iron to support menstruation RDA for iron Females aged 14–18 years = 15 milligrams Males aged 14–18 years = 11 milligrams Iron deficiency is common in adolescence, especially among individuals who limit intake of enriched grains, lean meats, and legumes

Disordered Eating Disordered eating patterns are more prevalent in adolescent females than males May be linked with poor body image or low self-esteem Teens often adopt unhealthy habits such as Skipping meals Using food substitutes Taking diet pills or nutritional supplements Purging through vomiting, laxatives, or diuretics Eating family meals promotes healthy eating patterns

Quick Review Height and weight increase during the growth spurt in adolescence This prompts an increased need for calcium and iron Adolescents have increased power over their food decisions Soda and sports drinks may replace water and milk Peers and the media exert a strong influence on teens As a result, unhealthy habits may be formed Disordered eating may exist in teens with poor body image

Putting It All Together Toddlers and preschoolers benefit from eating frequent, small meals consisting of nutrient-dense meals Exposure to a variety of healthy foods is necessary to promote good nutrition Picky eating and “food jags” are common, temporary behaviors In childhood, obesity may result from overconsumption of kilocalories, especially in the form of soda or candy Parents can serve as good role models by choosing healthy foods for themselves at family meals Adolescence is characterized by a growth spurt which increases calcium and iron needs A teenager’s eating habits may be influenced by peers or the media