1. Williams' Basic Nutrition & Diet Therapy Chapter 11 Nutrition During Infancy, Childhood, and Adolescence Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 1 14 th Edition

2. Nutrition in Infancy 1.Normal growth of individual children varies within a relatively wide range of measures. 2.Human growth and development require both nutritional and psychosocial support. Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 2

3. Nutrition for Growth and Development (p. 195) Life cycle growth pattern ◦ Infancy: first year of life ◦ Childhood: between infancy and adolescence ◦ Adolescence: onset of puberty ◦ Adulthood: physical maturity Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 3

4. Measuring Childhood Growth (p. 196) Individual growth rates: vary widely Physical growth: WHO and CDC growth charts used Charts use height (or length), weight, and head circumference Psychosocial development: various assessments available Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 4

5. Energy Needs (p. 196) Energy needs in kilocalories ◦ *average 5 year old’s basal metabolic rate is 50% of his/her daily caloric intake Needs are relatively large in childhood Macronutrients ◦ *Carbohydrates as main energy source ◦ *Protein for building tissue  Sources? ◦ Fat for backup energy and essential fatty acids Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 5

6. Requirements for Water, Minerals, and Vitamins (p. 198) Water requirements ◦ Metabolic needs, especially during periods of rapid growth ◦ *Infants require more water per unit of body weight than do adults (larger proportion of the infants total body water is in the ECF space) ◦ Table 11-2* Minerals and vitamins ◦ Calcium: critical in early life for skeleton and teeth ◦ Iron: essential for hemoglobin and cognitive development in early years Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 6

7. Mineral and Vitamin Needs Calcium ◦ Critical during the most rapid growth periods of infancy through adolescence* Iron ◦ After 6 months, the infants nutrition needs for iron exceeds that provided by breast milk and the addition of solid foods such as enriched cereal is needed* Copyright © 2013, 2009, 2005 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

8. Vitamin Supplements (p. 201) Vitamin K given to nearly all infants, critical for blood clotting Vitamin D drops recommended for breast-fed infants Excessive amounts of vitamins A and D over time are of concern in children and may cause ignorance, carelessness or misunderstanding* Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 8

9. Age Group Needs: Infancy (p. 201) Immature infants ◦ Weight: defined by birth weight: LBW, VLBW, ELBW  *Low birth weigh less than 2500g  Gestational age: premature, small-for- gestational age ◦ Type of milk: breast milk recommended ◦ Methods of feeding: nursing or bottle- feeding usually is possible with support Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 9

10. Age Group Needs: Infancy (cont’d) (p. 203) Term infants ◦ Better developed body systems ◦ Grow rapidly ◦ Add iron-fortified solid foods at about 6 months Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 10

11. Breast-Feeding (p. 203) **Ideal first food for infants Importance of colostrum ◦ Thin yellow fluid that is first secreted by the mammary glands a few days after childbirth, preceding the mature breast milk* Mature breast milk after 3 to 5 days Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 11

12. Bottle-Feeding (p. 203) Follow safety precautions Standard commercial formulas or formulas for infants with allergies Follow instructions precisely Positioning of baby and bottle Follow terminal sterilization method Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 12

13. Formula Follow manufactures guidelines for mixing formula Baby bottle tooth decay ◦ Don’t put children to sleep with a bottle of milk or fruit juice!!* Copyright © 2013, 2009, 2005 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

14. Weaning and Cow’s Milk (p. 204) Weaning ◦ Children set own pace ◦ May need encouragement to wean Cow’s milk ◦ *Never in first year of life ◦ No reduced-fat cow’s milk for those less than 2 years  Concentration may cause GI bleeding and it provides too heavy a load of solutes for the infants renal system Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 14

15. Solid Food Additions (p. 205) *Not before 6 months ◦ Inability to digest Development of certain motor skills is signal ◦ Should be able to hold head upright* Possibly vegetables or meat before fruit table 11-4  At 6 months-iron fortified cereal* Foods may be homemade ◦ Do not add sugar or salt when preparing * Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 15

16. Guidelines AAP recommendations: Water and juice not necessary until 6 months of life Allergens ◦ Wheat, egg white, citrus juice, nuts and chocolate Honey ◦ Botulism risk Choking hazards Copyright © 2013, 2009, 2005 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

17. Nutrition in Childhood and Adolescence 1. A variety of food patterns and habits supply the energy and nutrient requirements of normal growth and development, although basic nutritional needs change with each growth period. Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 17

18. Childhood (p. 206) Toddlers (1 to 3 years) ◦ Increase variety of foods ◦ Pleasant surroundings ◦ Limit sweets Preschool children (3 to 5 years) ◦ Growth and appetite continue in spurts ◦ Patterns and attitudes form ◦ Occasional food jags ◦ Child-friendly version of MyPlate Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 18

19. How infants learn to eat 1-3 months ◦ Rooting, sucking and swallowing 4-6 months ◦ Munching pattern 7-9 months ◦ Pincer grasp* 10-12 months ◦ Bring bottle to mouth Copyright © 2013, 2009, 2005 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

20. Feeding made simple Toddlers ◦ Offer variety ◦ *serve small portions  Ask for seconds if still hungry Be patient Copyright © 2013, 2009, 2005 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

21. Childhood (cont’d) (p. 209) School-age children (5 to 12 years) ◦ Slow, irregular growth during early years* ◦ Breakfast is important ◦ School breakfast and lunch programs ◦ Competitive foods harm nutrition Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 21

22. Common Nutrition Problems in Childhood (p. 209) *Failure to thrive: many possible causes, brief hospital stay may be used to identify etiology ◦ Do not grow and develop normally* Anemia: infants consuming formula or cereal not iron-fortified Obesity: climbing since 1970s, parents play important role Lead poisoning: from lead-based paint, damages CNS Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 22

23. Adolescence (p. 213) Physical growth ◦ *Rapid growth during onset of puberty ◦ Boys and girls differ in fat, muscle gain ◦ Risk of obesity continues ◦ Growth chart-can be used for any age to determine adequate nutrition** Eating patterns ◦ **Influenced by rapid growth, peer pressure ◦ Alcohol abuse ◦ Pressure to be thin Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 23

24. Eating Disorders (p. 214) Social, family, personal pressures Self-imposed crash diets, semistarvation Mother’s main source of pressure to remain thin Fathers may be emotionally distant Early detection and intervention are critical Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 24