1. Chapter 18: Nutrition Through the Life Cycle: Childhood and Adolescence
© 2017 Pearson Education, Inc.

2. Toddlers Age 12 months to 36 months
Rapid growth rate of infancy begins to slow
Gain 5.5 to 7.5 inches, average 9 to 11 pounds
Higher energy expended for increased activity levels
Increased nutrient needs are based on their larger body size
© 2017 Pearson Education, Inc.

3. Toddlers (cont.) Macronutrients:
Estimated Energy Requirement (EER) varies according to the toddler's age, body weight, and level of activity
30−40% of total kcal from fat
1.1 grams of protein per kg body weight
130 grams carbohydrates per day (most of the carbohydrates should be complex)
14 grams fiber per 1,000 kcal/day
© 2017 Pearson Education, Inc.

4. Toddlers (cont.) Micronutrients:
Ensure adequate intake of the micronutrients obtained from fruits and vegetables, including: vitamins A, C, E, calcium, iron, zinc, potassium
Vitamin D supplements recommended for some children
Until age 2, drink whole milk for calcium
Iron-deficiency anemia is the most common nutrient deficiency in young children
© 2017 Pearson Education, Inc.

5. Toddlers (cont.)
As toddlers become more active, they lose more fluids through sweat
An active toddler may need more fluids
© 2017 Pearson Education, Inc.

6. © 2017 Pearson Education, Inc.

7. Nutritious Food Choices
Most are able to match intake with needs
Healthful variety of food available
Food should not be forced on a child
Frequent, small meals for small stomach
Developmentally appropriate foods
Small portions, limited healthful alternatives
Role modeling is important
© 2017 Pearson Education, Inc.

8. © 2017 Pearson Education, Inc.

9. Allergy Watch
Continue to watch for common food allergies: wheat, peanuts, cow's milk, soy, citrus, egg whites, seafood
Introduce one new food at a time and monitor for allergic reactions
© 2017 Pearson Education, Inc.

10. Vegetarian Families Eggs and dairy: part of a healthful diet
Vegan diet may be low in protein, minerals (calcium, iron, zinc), vitamins (D and B12)
High fiber may impair iron and zinc absorption and promote a premature sense of "fullness" at mealtimes
Fortified foods and supplement use to ensure adequate nutrition
© 2017 Pearson Education, Inc.

11. Preschool and School-Age Children
Growth slows: average gain 2–4 in./year
Encourage physical activity
EER varies according to age, body weight, and level of activity.
From age 4 through 8, values for most nutrients increase
Sexual maturation begins ages of 8 and 9: DRI values are separately defined for boys and girls beginning at age 9
© 2017 Pearson Education, Inc.

12. Macronutrients
Total fat intake should gradually drop to a level closer to adult fat intake
25−35% of total energy from fat
130 grams carbohydrate per day
14 grams fiber per 1,000 kcal
0.95 grams protein per kg body weight
© 2017 Pearson Education, Inc.

13. Micronutrients
Consuming adequate fruits and vegetables in the diet continues to be a concern (vitamins A, C, and E, fiber and potassium)
"Milk displacement"—low-calcium diets also tend to be low in other nutrients
RDAs for iron and zinc also increase
If fluoride is not available in municipal water supply, fluoride supplements may be needed
© 2017 Pearson Education, Inc.

14. Fluid
Children: about 5 to 8 cups of beverages each day, including water
Exact amount depends on activity and weather
Beverages should be free of caffeine and added sugars
USDA Daily Food Plan meets the nutrient requirements for preschoolers
© 2017 Pearson Education, Inc.

15. © 2017 Pearson Education, Inc.

16. Nutrition-Related Concerns
Nutritious food choices
Iron-deficiency anemia
Food insecurity and hunger
© 2017 Pearson Education, Inc.

17. Nutritious Food Choices
Peer pressure encourages unhealthful food choices
Body image plays an important role
Families who plan, prepare, and eat meals together are more successful at promoting good food choices
Frequent family meals reduce the risk for disordered eating, substance abuse, and depression
© 2017 Pearson Education, Inc.

18. © 2017 Pearson Education, Inc.

19. Iron-Deficiency Anemia
Higher among children from Mexican-American and low-income families
Children with very poor appetites or erratic eating behaviors may need iron supplements
If left untreated, iron-deficiency anemia can lead to behavioral, cognitive, motor delays, and impaired immunity
© 2017 Pearson Education, Inc.

20. Food Insecurity and Hunger
16 million children faced with food hunger and insecurity
Without adequate breakfast, children can't concentrate or pay attention
Impaired nutrient status can blunt children's immune responses.
Psychosocial health associated with food insecurity
Government and private programs can provide nutrition benefits
© 2017 Pearson Education, Inc.

21. Role of School Attendance
School breakfasts: optimize nutrient intake and avoid behavioral and learning problems from hunger in the classroom
No monitoring for adequacy of food eaten
Soft drinks and snack foods in school
School lunches: what's actually eaten (not planned/served) tends to be higher in fat
Options to entice healthful selections
© 2017 Pearson Education, Inc.

22. Adolescents Adolescence continues to 18 years
Puberty: secondary sexual characteristics develop; capacity for reproduction
During this developmental phase, they may be less responsive to parental guidance
Most adolescents navigate the challenges into mature and healthy adults
© 2017 Pearson Education, Inc.

23. Adolescents (cont.)
Growth spurts begin at age 10−11 for girls, 12−13 for boys
Average 20−25% increase in height
Average girl reaches almost full height by the onset of menstruation (menarche); boys can continue to grow during early adulthood
Skeletal growth ceases closure of the epiphyseal plates
Weight and body composition also change
© 2017 Pearson Education, Inc.

24. © 2017 Pearson Education, Inc.

25. Macronutrients
EER for adolescents is based on gender, age, activity level, height, and weight
25−35% of total energy from fat
≤10% of total energy from saturated fat
45−65% of kcal from carbohydrates
0.85 grams protein per kg body weight
26−38 grams of fiber per day
© 2017 Pearson Education, Inc.

26. Micronutrients
Calcium intakes must be sufficient for achieving peak bone density: 1,300 mg/day
Iron needs are relatively high: 11 mg/day for boys, 15 mg/day for girls
Vitamin A is critical for supporting rapid growth and development
Supplement should not be considered a substitute for a balanced, healthful diet
© 2017 Pearson Education, Inc.

27. Fluid Recommendations
The need to maintain fluid intake is increased with higher activity levels
Boys: 11 cups/day
Girls: 10 cups/day
Importance of including water
© 2017 Pearson Education, Inc.

28. Nutritious Food Choices
Parents can act as role models
Strong influence of peers, mass media, personal preferences
Encourage whole grains, fruits, vegetables, and milk or calcium-rich beverages
© 2017 Pearson Education, Inc.

29. Nutrition-Related Concerns
Adequate calcium intake maximizes bone calcium uptake and bone mineral density
Disordered eating and eating disorders can begin in these years
Acne is not caused by diet, but a healthy diet can optimize skin health
Cigarette smoking, alcohol, and illegal drugs can have an impact on nutrition
© 2017 Pearson Education, Inc.

30. Pediatric Obesity
Overweight: BMI above the 85th percentile of the same age and gender
Obese: BMI above the 95th percentile
Higher risk of health problems:
Exacerbates asthma
Causes sleep apnea
Impairs the child's mobility
Leads to intense teasing
Low self-esteem
Social isolation
© 2017 Pearson Education, Inc.

31. Pediatric Obesity
Greater risk for type 2 diabetes, high blood lipids, high blood pressure, gallstones, depression, and other medical problems
Higher risk of becoming overweight adults
Reversal of pediatric obesity can be accomplished through an aggressive, comprehensive nationwide health campaign
© 2017 Pearson Education, Inc.

32. Pediatric Obesity (cont.)
Early tendency during toddler years
Monitor if >80th percentile for weight
Encourage physical activity
Limit foods with low nutrient density
Early intervention is often the most effective measure against lifelong obesity
© 2017 Pearson Education, Inc.

33. Role of the Family Provide nutritious food choices
Encourage a healthful breakfast
Sit down to a shared family meal each evening, or as often as possible
No television at mealtimes: encourage attentive eating, enjoyment of the food
Parents should retain control over the purchasing and preparation of food
© 2017 Pearson Education, Inc.

34. Role of the School
Federal school lunch program: limit the amount of fat, sugar, and sodium served
Many schools sell foods and beverages that exceed federal guidelines
Nutrition education programs: health departments, Dairy Councils
Consistent and repeated school-based messages on good nutrition
© 2017 Pearson Education, Inc.

35. Physical Activity
Institute for Medicine recommends aerobic physical activity for at least an hour each day
Physical Activity Guidelines for Americans: bone- and muscle-strengthening activities at least 3 days each week
Encourage noncompetitive, fun, and structured activities in ways that allow self-pacing
© 2017 Pearson Education, Inc.

36. © 2017 Pearson Education, Inc.

37. Physical Activity (cont.)
Parental and adult role models
Shared activities: ball games, bicycle rides
Television/electronic games: ≤ 2 hours/day
Electronic games: virtual tennis, step aerobics, dancing, other active simulations
© 2017 Pearson Education, Inc.

38. Physical Activity (cont.)
Overweight children can "catch up" to their weight as they grow taller without restricting food (nutrient) intake
Acquire motor skills and muscle strength
Establish good sleep patterns
Develop self-esteem; lower stress
Optimize bone mass
Enhance cardiovascular and respiratory function
© 2017 Pearson Education, Inc.

39. Physical Activity (cont.)
Physically fit children:
Have improved behavior
Are more attentive
Are more focused
Have higher levels of academic achievement
Parents, healthcare providers, and community members can work with school boards to optimize opportunities for physical activity
© 2017 Pearson Education, Inc.

40. Pediatric Obesity Treatment
Stage 1: lifestyle modifications to improve dietary intake while decreasing energy intake, and to increase physical activity
Stage 2: consultations with a Registered Dietitian Nutritionist, self monitoring, and monthly visits with healthcare provider
Stage 3: care team expands to include behavioral health an exercise specialist, and weekly visits with healthcare provider
© 2017 Pearson Education, Inc.