1. © 2011 Pearson Education, Inc. 17 Nutrition Through the Life Cycle: Childhood and Adolescence

2. © 2011 Pearson Education, Inc. Toddlers Age 12 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

3. © 2011 Pearson Education, Inc. Toddlers 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

4. © 2011 Pearson Education, Inc. Toddlers Micronutrients: Ensure adequate intake of the micronutrients obtained from fruits and vegetables, including: vitamins A, C, E, calcium, iron, zinc, potassium Until age 2, drink whole milk for calcium Iron-deficiency anemia is the most common nutrient deficiency in young children

5. © 2011 Pearson Education, Inc. Toddlers Fluid needs: active toddler may need more Physicians may recommend supplements: Toddlers with erratic eating habits Fluoride supplement, if the community water supply is not fluoridated Vegan families Medical conditions or dietary restrictions Supplement should not exceed 100% Daily Value for any nutrient per dose

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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

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11. 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

12. © 2011 Pearson Education, Inc. Vegetarian Families Eggs and dairy: part of a healthful diet Vegan diet may be low in protein, minerals (calcium, iron, zinc), vitamins (D and B 12 ) 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

13. © 2011 Pearson Education, Inc. Children Growth slows: average gain 2–4 in./year Values for most nutrients increase For children ages 6−11 years: USDA developed a MyPyramid for Kids Sexual maturation begins ages of 8 and 9: DRI values are separately defined for boys and girls beginning at age 9

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15. 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

16. © 2011 Pearson Education, Inc. 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

17. © 2011 Pearson Education, Inc. Nutritious Food Choices Peer pressure encourages unhealthful food choices Families who plan, prepare, and eat meals together are more successful at promoting good food choices

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19. School 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

20. © 2011 Pearson Education, Inc. Nutrition-Related Concerns Iron-deficiency anemia Dental caries Body image Food insecurity

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22. Adolescents Adolescence continues to 18 years Puberty: secondary sexual characteristics develop; capacity for reproduction Emotions and behaviors unpredictable and confusing

23. © 2011 Pearson Education, Inc. Adolescents Growth spurts begin at age 10−11 for girls, 12−13 for boys Average 20−25% increase in height Skeletal growth ceases closure of the epiphyseal plates Weight and body composition also change

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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

26. © 2011 Pearson Education, Inc. 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

27. © 2011 Pearson Education, Inc. 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

28. © 2011 Pearson Education, Inc. 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

29. © 2011 Pearson Education, Inc. Nutrition-Related Concerns Adequate calcium maximizes bone calcium uptake and bone mineral density Disordered eating and eating disorders can begin in these years Acne and diet Cigarette smoking, alcohol, and illegal drugs can have an impact on nutrition

30. © 2011 Pearson Education, Inc. 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

31. © 2011 Pearson Education, Inc. 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

32. © 2011 Pearson Education, Inc. Pediatric Obesity 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 ABC Video Obesity in Children

33. © 2011 Pearson Education, Inc. 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

34. © 2011 Pearson Education, Inc. 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

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36. Physical Activity Recommendation: daily physical activity and exercise for at least an hour each day Bone- and muscle-strengthening activities at least 3 days each week Encourage noncompetitive, fun, and structured activities in ways that allow self- pacing Fitness Pyramid for Kids: guide children toward a physically active lifestyle

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39. Physical Activity 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

40. © 2011 Pearson Education, Inc. Physical Activity 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

41. © 2011 Pearson Education, Inc. Physical Activity 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