1. Chapter 14: Nutrition from Infancy Through Adolescence

2. Child Health More children are receiving vaccinations
Fewer teenage pregnancies
Lower poverty rate
Increase number of obesity
Increase number of Type 2 diabetes
Decrease physical activity
Increase in consumption of sodas

3. Infant Growth and Development
Rapid growth rate
Weight doubles by 4-6 month of age
Weight triples by 1 year
Length increases 50% by the end of the 1st year
Nutrients needed to support proper growth
Inadequate nutrition (including fat) can inhibit growth

4. Effects of Undernutrition
More prevalent in developing countries
Smaller in size
Growth is an indicator of nutritional status
Following an adequate diet later won’t compensate for lost growth
WIC program

5. Assessment of Growth Growth charts
Height and weight correspond to a percentile
50th percentile is considered average
Brain growth (fastest in infancy)
Over-feeding may increase the number of adipose cells
Restriction may affect organ development

6. Failure to Thrive Usually due to poor parent-infant interaction
Infants need physical contact & eye contact
Diet restriction not recommended
Infants are dependent on others for nutrition

7. Infant’s Nutritional Needs
Human milk or formula for the first year
Supplemented with solid food at 4-6 month of age
High energy needs
High protein needs
Higher fat needs
Vitamin K given at birth
Vitamin D or sunshine
Vitamin B-12 if mom is a vegan
All can be met by feeding infant with human milk or formula

8. Calorie Needs 45-50 kcal per pound of body weight
~700 kcal/day for a 6 month old child
Breast milk or formula is ideal
High energy needs due to rapid growth & metabolism rate
Lose more heat from the skin due to higher body surface area

9. Protein Needs 0.7 – 1.0 g protein / pound (1.6-2.2 g/kg)
Half should be from essential amino acids
Breast milk or formula is ideal
Total protein should not exceed 20% of total energy needs
Excess nitrogen and minerals exceed the infant’s immature kidney abilities

10. Fat Needs
Under the age of 2, fat can provide 40% of total energy needs
More than 50% may lead to poor fat digestion
Half of the energy supplied by breast milk & formula comes from fat

11. Vitamin K Routinely given as an injection
Intestinal bacteria will begin to synthesize

12. Mineral Needs Iron store depleted by 4-6 month of age
Change to iron-fortified formula for bottle fed infants
Possible iron supplementation for breastfed infants
Introduction of iron-fortified solid foods
Zinc and iodide supplied by breast milk or formula
Fluoride supplement after 6 month of age for tooth development

13. Water for Babies? 2 oz/pound of body weight/day
Most fluid needs are met via breast milk or formula
Supplemental water may be necessary in hot climate
Diarrhea, vomiting will require additional fluids
Babies are easily dehydrated and can damage kidneys
Under normal condition, additional water is not necessary

14. Formula Feeding Cow’s milk is not tolerated by infants
Formulas must follow strict guidelines
Soy base contains soy protein
Fortified with vitamins and minerals

15. Feeding Skills Grasps & transfers objects by 6-7 months
Holds bottle, play with food by 7-8 months
Self-feeding & drink from a cup around 10 months
More independence

16. When Should Solids Be Introduced?
Reached 13 pounds
Drinks 32+ oz a day (or breastfeeding/day)
Introduce solids at ~6 month of age

17. First Foods Iron-fortified cereals--rice cereal
Introduce one food at a time
Wait a week before introducing a new food
Strained foods & meats
Introduce vegetable before fruit
Do not introduce mixed food
Offer juice in a sippy cup (prevent early childhood caries)
No cow’s milk until 1 year of age

18. What NOT To Feed An Infant
Allergenic foods
Honey or corn syrup (contains Clostridium botulinum)
Highly seasoned foods
Excessive formula or breast milk
Choking potential foods
Cow’s milk
Excessive apple or pear juice

19. Limit Highly Allergenic Foods
Egg whites
Chocolate
Nuts
Cow’s milk

20. Key to Feeding Infants
Patience
Patience
Patience
Patience
Patience

21. Guidelines For Infant Feeding
Build to a variety of foods
Pay attention to infant’s appetite to avoid overfeeding
Infant needs fat
Choose fruits, vegetables, grains but limit high-fiber foods
Sugar in moderation
Sodium in moderation
Choose foods containing iron, zinc, and calcium

22. Common Infant Health Problem: Colic
Repeated crying spell lasted 3 or more hours
Affects 10%-30% of all infants
Usually goes away in a few months
No physical problem identified with the infant
Associated with digestive problems
Change formula, or avoid certain foods if breastfeeding

23. Diarrhea Numerous loose stools in a day Risk for dehydration
Infant needs additional fluids
Electrolytes-replacement fluids may be recommended
May switch to soy-based formula for a few days
Continue to breastfeed

24. Milk Allergy
Cow’s milk contains 40+ different proteins that can cause allergic reactions
Causes vomiting, diarrhea, blood in the stool, constipation
Switch to soy base, or pre-digested protein formula
May want to limit cow’s milk from breastfeeding mom

25. Iron-Deficiency Anemia
Occurs in older infants consuming too few solid foods
Cow’s milk is a poor source of iron
Feed iron-fortified formula
Feed iron-fortified cereals/meats
May need iron supplement

26. Preschool Children (age 2 - 5)
Average weight gain lb. per year
Average height gain is 3-4 inches per year
Tapering of growth rate*
Reduction in appetite*
Promote good eating habits

27. Encouraging Nutritious Foods
Serve new foods & repeat exposure
Preschooler has sensitive taste buds & avoid new foods
Prefers crisp texture and mild flavor
Parents/caregivers must teach by example
Make meal time a happy time

28. Food Guide Pyramid for Children

29. Feeding Problems Tension between parents and/or children
High expectations from parents
Change in appetite
Six small meals vs. 3 bigger meals
Foster good eating habits with good food choices

30. Not Eating As Much Drop in growth rate Loss of appetite
Typical serving size =
1 tablespoon per year old
Built-in feeding mechanism in normal weight children
Avoid nagging, forcing, bribing

31. Always Snacking and Never Finishes a Meal
Six small meals vs. three large meals
Smaller stomach capacity
Offers nutritious snacks
Do not overreact
Means of getting attention
Children will never starve themselves

32. Never Eats Vegetables Introduce one at a time & repeatedly
Raw or blanched may be better tolerated
Serve with nutritious dip

33. Is He Eating Healthfully?
Compare to Food Guide Pyramid
Vitamin and mineral supplements are not necessary
Focus on good food choices
Use of fortified cereals
Foods with iron and zinc

34. Nutritional Problems in Preschoolers
Iron-deficient anemia
Poor oxygen supply to cells
Compromised learning abilities
Lower resistance to disease
Iron-fortified cereals, lean meats
WIC

35. School-Age Children Breakfast School lunch programs
More likely to meet their nutritional needs
School lunch programs
Fat content to decrease to 30% of total energy
Overemphasis of low-fat diets is linked to eating disorder
Need for nutrition education to promote wise food choices

36. Type 2 Diabetes Alarming increase in the frequency in children
Rise in obesity & drop in physical activity
Screening for at-risk children
Family history
Ethnicity
Encourage intake of low glycemic index foods

37. Obesity 25-30% of school-age are overweight
~40% of obese children become obese adults
~80% of obese adolescents become obese adults
Health threat
Encourage physical activity daily (>60 min./day)

38. Obesity
~34 hours a week spent in front of a TV, video game, or computer
Moderate kcal intake
Limit high fat foods
Weight loss diet may not be necessary
Obesity and self esteem

39. The Teenager Rapid growth spurt between age 10-13 in girls*
Rapid growth spurt between age in boys*
Girls gain ~10 inches
Boys gain ~12 inches
Girls gain fat & lean tissue
Increase in appetite
Peer pressure

40. Nutritional Problems of Teens
Anorexia nervosa and bulimia nervosa
Poor food choices
High fat intake
High sodium intake
Lack of calcium rich foods
Iron-deficiency anemia
No link between food & acne

41. Diets of Teenage Girls Adoption of fad diets
Desire social acceptance; fat phobia
Increase meals away from home
Missed meals
Limited food choices
Increase snacking
44% are trying to lose weight
Diet commonly low in iron, calcium, zinc, vitamins folate, A and C

42. Get Teens to Eat Right!
Teens are unaware of long-term affect on health
Recommend smaller portions of high fat/sugar foods
Larger servings of low-fat dairy, lean meats, vegetables, fruits, and grains
Stress the importance of nutrition & physical fitness

43. Snacking and Teens 1/4-1/3 of energy needs met by snacking
Snack mostly on chips, candies, cola, ice cream
“Snacking for socialization reason, not hunger”
Poor dietary habits will continue into adulthood
Increased risk for chronic diseases