1. W Promotion of normal growth rate, organ development, and body composition W Prevention of later disease — Obesity — Cardiac — Allergic — Cancer

2. W Birth weight triples by 1 year, but does not quadruple until age 2 W Birth length increases by 50% in year 1, but does not double until age 4 W After age 2, children average 2 -3 kg and 6 - 8 cm of growth per year

3. W Serve as a guide for estimating nutrient need W DRIs recently revised for specific childhood ages (Institute of Medicine) W Much of the data are extrapolated from adult, but increasingly more specific W Since they are group recommendations, they include a margin of safety

4. The Two Factors Which Contribute to Childhood Malnutrition POVERTYIGNORANCE

5. W Children after the age of 1 are largely unprotected because — Programs are much less specific regarding nutrient requirements compared with < 1 year — A child’s diet and an adult diet are similar; thus, children can be shortchanged in a general assistance paradigm

6. W Willful or unwitting ignorance by parents may contribute to nutritional imbalances: — Parent allowing child to choose foods leading to unbalanced diet — Parent willfully manipulating diet without consideration for balance and nutrient needs » Imposition of adult diet on young child » Fad foods/”nutriceuticals”

7. W Vary considerably among children W Dependent on: — Basal metabolic rate — The Barker Hypothesis & Fetal “Programming” — Growth rate — Physical activity — Body size W Range from 1000 Kcal/d at 1 year to 2200 Kcal/d at 12 years

8. W Absorption of amino acids increases protein synthesis in children (unlike adults) W The body is unable to store excess dietary amino acids — Uses them for energy production if energy intake is low — Or converts them to glucose or fat if energy intake is adequate

9. (Continued) W Daily protein requirement ranges from 12 grams at 1 year to 35 grams at 12 years W Note that protein requirements during childhood are low compared to newborn or teen — Growth rates are slower — Tissue synthetic rates are slower W Amino acid needs for growth decrease from 56% of total intake at birth to 5% at 5 years

10. W The DRIs are largely extrapolated from infant or adult data W Exceptions are for energy, protein and iron where balance studies have been performed

11. (Continued) W Minerals/elements that are likely to be low in the diet of young children — Calcium » Crucial for preteen girls re: future osteopenia — Iron — Zinc — Magnesium

12. W Healthy, growing children consuming a varied diet do not need vitamin supplementation W Children at nutritional risk who may benefit from vitamin supplementation — Those from deprived, neglectful or abusive families — Those consuming fad diets — Those with chronic disease, particularly affecting the GI tract — Those on dietary programs for managing obesity — Those on vegetarian diets without adequate dairy products

13. W Protein, energy and protein-energy malnutrition — Endemic areas include sub-Saharan Africa W Iron deficiency — World-wide for various reasons » Intestinal blood loss (parasitic) in developing countries » Inadequate intake (cow’s milk) in developed countries W Vitamin A deficiency

14. W Obesity — Begins generally after the age of 2 - do not restrict dietary fat before this age — 30% of children are obese: rate is increasing — Childhood obesity is not generally “outgrown” — Growth adiposity rebound between 5 and 7 years is critical in predicting adult obesity » Early rebound more predictive of later obesity

15. GIRLS 2 - 18 yrs

16. W Obesity (continued) — Young children will not innately choose a well- balanced diet unless appropriate foods are presented and models of food acceptance given — Parents and school lunch programs must provide nutritious foods at regular meals and snacks, and allow the children to decide how much they eat — Children do best 4-6 times a day with relatively low volume foods » Snacks should be considered normal meals

17. W Obesity (continued) — The influence of advertising should not be underestimated be underestimated » 50% of television advertising is for foods (higher in children’s programs) » Most foods shown on TV are high in fat, sugar and salt (e.g., sweetened cereal, fast foods, snack products, candy) » TV messages have primarily emotional/psychological appeal — Physical inactivity likely plays the largest role in childhood obesity

18. W Iron Deficiency: 6-13% — Children at risk due to low iron stores at birth (up to 250,000 per year) » Growth-retarded infants » Infants of diabetic mothers — Children at risk due to inadequate intake » Early introduction of cow’s milk (before 12 months) » Unsupplemented infant formula (up to 30% of sales) » Breastfeeding without iron supplementation (20% at 9 months — Children with increased GI blood loss

19. W Vary significantly based on gender and age W DRIs for males — 13 - 15 years old: 2000 Kcal/d — 16 - 18 years old: 3200 Kcal/d W DRIs for females * — 13 - 15 years old: 2200 Kcal/d — 16 - 18 years old: 2100 Kcal/d * add 300 Kcal for pregnancy; 450 Kcal for lactation

20. W Second peak of protein accretion during childhood — Associated with significant growth spurt W DRIs for males — 11 - 14 years (pre-growth spurt): 45 g/d — 15 - 18 years (growth spurt): 59 g/d

21. NutrientGender Increment Increment Suggested (average) (peak of growth spurt) (average) (peak of growth spurt) Calcium M 210 400 1100 F 110 240 1200 * F 110 240 1200 * Iron M 0.57 1.1 10 F 0.23 0.9 13 ** F 0.23 0.9 13 ** Zinc M 0.27 0.50 12 F 0.18 0.31 9 F 0.18 0.31 9 All values are mg/d * to increase bone mineral stores * increased iron turnover due to menses

22. W Onset of puberty in both sexes increases: — Energy needs for increased physical activity — Protein needs for rapid skeletal growth — Calcium needs for bone mineralization W Onset of menstruation in girls increases: — Iron demand to replace blood loss and match expanding blood volume — Calcium need to protect against later osteopenia

23. W Low energy intake (dieting) creates difficulties in obtaining adequate levels of micronutrients W Replacement of milk (or other high-calcium foods) with soft drinks, coffee, etc., results in a low calcium intake associated with a high protein intake — leads to negative calcium balance and increased risk of osteoporosis W High iron requirements to sustain rapidly expanding blood volume and lean body mass and to offset menstrual losses in females are frequently not met; iron deficiency is particularly prevalent in female athletes

24. W Positive zinc balance is essential for adolescent growth; zinc deficiency is characterized by growth failure, hypogonadism, decreased taste acuity; increased prevalence in Middle East W Vegetarian diets without eggs and milk lead to vitamin D and B12, riboflavin, protein, calcium, iron and zinc deficiency; adolescents on vegan diets must learn to assess protein quality and balance W Obesity, often carried over from preteen years, becomes worse with poor quality snacks, limited food choice and frequent eating away from home

25. W Nutritional issues in childhood and adolescence differ in developing and developed countries W The antecedents of adult diseases are found in childhood nutritional disorders WObesity WAllergy W?Cancer