Nutrition in

Infancy and
Childhood
dr. Dewi Martha Indria, M. Kes, IBCLC
Dr. Yeni Amalia, SpA, Mbiomed

Fakultas Kedokteran Universitas Islam Maalang

2018
“Every infant and child
has the right to good
nutrition.”
(The Convention on the Rights of the Child)
 Under nutrition is associated with 45% of child deaths

Key 162 million children under 5 were estimated to be stunted (2012)

Facts: 51 million have low weight-for-height mostly as a consequence of poor feeding & repeated
infections (2012)
44 million were overweight or obese (2012)

38% of infants 0 to 6 months old are exclusively breastfed

In many countries only a third of breastfed infants 6–23 months of age meet the criteria of
dietary diversity & feeding frequency that are appropriate for their age
About 800.000 children's lives could be saved every year among children under 5, if all children
0–23 months were optimally breastfed
 WHO GLOBAL TARGET 2015

40% reduction 50% reduction 30% reduction no increase in increase the reduce and
in the of anaemia in in childhood rate maintain
number of women of low birth overweight of exclusive childhood
children reproductive weight breastfeeding wasting
under-5 who age in the first 6 to less than
are stunted months up to 5%
at least 50%
PHYSIOLOGIC DEVELOPMENT
 After birth, the growth of an infant is influenced by genetics and nourishment
 Body weight
 Infant lose app.6 % of their body weight during the 1st day of age  regained by the
7th – 10th day
 Infant usually double their birth weight by 4 – 6 months of age & triple it by the age of
1 year

 Body length
 Increase their length by 50% during the 1st year & double it by 4 years

 Total body fat increases rapidly during the 1st 9 months

 Total body water decrease throughout infancy from 70% at birth to 60% at 1
year (almost in extracellular water – 42% at birth to 32% at 1 yr)
PHYSIOLOGIC
DEVELOPMENT
 The stomach capacity of infants increase from a range of
10 – 20 mL at birth to 200 mL by 1 year
 Human milk fat is well absorbed, with fecal excretions of 20 – 48%
 Pancreatic amylase remain low during the first 6 months
 If consumes starch before 6 months  the activity of salivary amylase & digestion in
the colon usually compensate

 The neonate has functional but physiologically immature kidney  the ability to
form acid, urine & concentrate solute is often limited  by 6 weeks, most
infants can concentrate urine at adult levels
NEONATAL GROWTH & NUTRITION
 Growth rates are most rapid in the first six months of human life
 Nutrient requirements on a weight basis are highest during the
first six months
 Rapid organ growth and development occurs during the last
trimester and first six months
 The detrimental effects of nutritional insufficiencies are magnified
during periods of rapid organ growth (I.e., vulnerable periods for
brain growth)
 Provide sufficient macro- and micronutrient delivery to promote
normal growth rate and body composition, as assessed by curves
which are generated from the population
NUTRIENT
REQUIREMENTS
ENERGY
 An effective methods for determining the adequacy of
an infant’s energy intake  monitor gains using growth
chart
 Curves exist for:
o Standard anthropometrics: weight, length, head
circumference
o Special anthropometrics: arm circumference, skinfold
thickness
o Body proportionality: weight/length, mid-arm
circumference, head circumference ratio
Ideal Body Weight Percentage

𝐴𝑐𝑡𝑢𝑎𝑙 𝐵𝑊
Ideal Body Weight % = x 100 %
𝐼𝑑𝑒𝑎𝑙 𝐵𝑊

 Ideal Body Weight based on WHO Growth Chart

 Decide actual height/length using length for age chart
 Decide ideal weight based on actual length/height using weight for length chart

Growth Chart WHO

Boys, 12 month, height 70 cm, weight 7 kg
 7
 IBW = x 100 % = 82,35 % (Mild Malnutrition)
8,5

Nutrition Status (Waterlow, 1972)

IBW Percentage (%) Nutrition Status
> 120 Obesity
110 – 120 Overweight
90 – 110 Normal
80 – 90 Mild Malnutrition
70 – 80 Moderate Malnutrition
< 70 Severe Malnutrition
ENERGY REQUIREMENTS IN INFANCY
 Term infants require :
 85-90 Kcal/kg/day  breast-fed
 100-105 Kcal/kg/day  formula
 Differences are due to increased digestibility and absorbability of
breast milk  presence of compensatory enzymes (lipases)
 Energy requirements are 20% higher in premature infants due to:
 Higher basal metabolic rate
 Lower coefficient of absorption for fat and carbohydrates

 Energy requirements decrease to 75 Kcal/kg/day between 5-12

months
Kcal per pound of body weight
Nutritional Needs of Infants

Copyright 2010, John Wiley & Sons, Inc.

CARBOHYDRATE
 Should supply 30 – 60% of the energy intake during infancy
 Primary sources of CHO in newborn and infant diet are disaccharides (esp.
lactose)
 Disaccharides must be broken into component monosaccharide to be absorbed
 Lactose = glucose + galactose (lactase)
 Sucrose = glucose + fructose (sucrase)
 Maltose = glucose + glucose (maltase)

 Intestinal lactase concentrations are low at birth and are not inducible
 Amylase, necessary for breaking down starches, are not adequate until > 4
months
PROTEIN
 Protein is needed for:
 Tissue replacement
 Deposition of lean body mass
 Growth

 Late gestation and infancy is the time of highest protein accretion

in human life
 Infants require a larger percentage of total amino acids as
essential amino acids than adult
 Essential amino acids for infants  histidine
 Nonessential AA (but essential) for premature infants  tyrosine,
cystine, taurine
 Protein requirements during the rapid growth of infancy are higher
per kg/body weight than those for older children or adults
 Protein requirements range from 1.5 g/kg/day (healthy breast-fed infant) to
3.5 g/kg/day (septic, preterm infant)

 Recommendations for protein intake  based on the composition

of human milk
 The amount of protein in human
milk is adequate for the 1st 6 months of life 
the amount of protein of human milk is
considerably less than in infant formula
LIPIDS
 Infants younger than 1 year of age  have to consume minimum of 30 g of
fat/day
 Lower fat intake  inadequate energy intake

 Human milk  contains essential FA : ARA (arachidonic acid) & DHA

(docosahexaenoic acid)
 Linoleic acid : 4.4 g/day (< 6 months), 4.6 g/day (7 mo – 1 yrs)

 Percentage of dietary fat absorbed

Adult 95 %
Term infant 85 – 95 %
Preterm infant 50 – 90 % (depends on source of fat)
WATER
 The water requirement for infant is determined by the amount lost from the skin
and lungs and in the feces and urine  with addition the small amount needed
for growth
 Water requirements of infants and children
Age Water requirement (ml/kg/day)
10 days 125 – 150
3 months 140 – 160
6 months 130 – 155
1 year 120 – 135
2 year 115 – 125
6 year 90 – 100
10 year 70 – 85
14 year 50 – 60
Potential micronutrients infant deficiencies
 Water-soluble vitamins (B, C, folate, etc.) are rarely a problem in
newborns and infants; babies are born with adequate stores
and/or all food sources have adequate amounts
 Fat-soluble vitamins (A,E,D,K) may present significant problems
because of relatively poor fat absorption by newborn infants
(especially premature infants)
MINERALS
 Calcium
 Breastfed infants retain app. 2/3 of their calcium intake from breast milk
 Adequate intake of calcium
 200 mg/day (0 – 6 months)
 260 mg/day (7 – 12 months)

 Flouride
 Breast-milk is low in fluoride
 Flouride supplementation is not recommended for infants younger than 6 months of
age
 Tolerable upper intake level for flouride
 0,7 mg/day (0 – 6 months)
 0,9 mg/day (7 – 12 months)
MINERALS
 Iron
 Babies are born with stores and iron in human milk, although not abundant, is very
well absorbed.
 Iron in human milk is highly bioavailable than other sources.
 Recommendation of Iron supplementation 1 mg/kg/day by 4 – 6 months age
 After 6 months, stores are depleted, hence iron-fortified rice cereal or iron-fortified
formula
 Cow’s milk is a poor source of iron  should not be given before 12 months of age

 Zinc
 Newborn infants are immediately dependent on a dietary source of zinc
 Zinc is better absorbed from human milk than from infant formula
VITAMINS
 VITAMIN B12:
 Breast-milk of vegans mothers can be deficient in B12

 VITAMIN K:
 Needs to be given at birth to prevent hemorrhagic disease of newborn
 Adequate thereafter due to synthesis by intestinal bacteria  the gut of the newborn is sterile
(no microbial synthesis)
 Can’t cross the placenta efficiently and breast-milk is low in vitamin K
 Single intramuscular injection to the infant (0.5-1mg of vitamin K)
 Adequate intake
 2 mcg/day (0 – 6 months)
 2,5 mcg/day (7 – 12 months)
 VITAMIN D:
 Very low in breast-milk, so sunlight exposure is important.
 Infant formula is fortified. Brest-fed infants are often supplemented.
 AAP recommends 400 IU/day for all infants.

 VITAMIN A:
 Essential for normal structural collagen synthesis
 Retinal development deficiency in premature infants contribute to fibrotic chronic lung disease

 VITAMIN E:
 Antioxidant that protects against peroxidation of lipid membranes
 Preterms have poor antioxidant defense and are subjected to large amounts of oxidant stress
 Vitamin E deficiency causes severe hemolytic anemia
BREASTMILK
Breast Milk as a Food Source
 Committee on Nutrition of the IDAI & AAP strongly recommends
breastfeeding for infants
 It is necessary to breastfeed for at least 6 months to achieve the
immunologic and disease preventative benefits of breast milk
 Physician’s role is to support, counsel and trouble-shoot
Breastfeeding = a normative model
(American Pediatric Academy, 1997)
Breastfeeding is a preferred mode of feeding considering
benefits:
 Nutritional
 Immunological
 Health (morbidity, mortality)
 Developmental
 Economical
Nutritional Benefits of Breast Milk
 Composition changes in the course of development (preterm, fullterm infants),
single feeding (foremilk, hindmilk), in relation to exposure to infection
Risks of artificial feeding
(in developing countries risks are elevated above these levels)

• Increased risk of acute illness:

 Gastroenteritis: 3-4x risk (developing countries 17-25x)
 Acute otitis media: 3-4x risk
 Lower respiratory tract infections (e.g. pneumonia)
 Bacterial infection requiring hospitalization: 10x risk
 Meningitis: 4x risk (e.g. Enterobacter sakazakii)
 Higher mortality from sudden infant death syndrome (SIDS)
Risks of artificial feeding

• Increased risk of chronic conditions and illnesses:

 Allergies - atopic dermatitis, asthma
 Type 1, type 2 diabetes
 Obesity
 Crohn’s disease, ulcerative colitis, coeliac disease
 Childhood lymphomas (5-8x risk), leukaemia
Risks of artificial feeding

• Dose-related difference in mental development:

 Lower scores of mental development tests at 18 months
 Difference in mental development and school performance at 3-5 years
 Lower scores in prematures on intelligence tests at 7-8 years
 Deficits in neurological development (lack of essential fatty acids)
 Difference in visual acuity
Risks of artificial feeding

• Effects on mother:
 Increased risk of anaemia due to early return of menstruation
 Increased risk of new pregnancy
 Higher risk of impaired bonding, abuse, neglect and
abandonment of the child
 Increased risk of breast and ovarian cancer
Optimal Infant Feeding Practices
(WHO Global Strategy on Infant & Young Child Feeding, 2002)

• Exclusive breastfeeding for 6 months

• Complementary feeding with continued
breastfeeding from 6 to 24 months and beyond
– Timely
– Adequate
– Safe
– Appropriately fed
Infant Formula
 Promotes adequate growth, but not brain and immunologic
development compared to human milk
 New formulas contain LC-PUFAs, prebiotics, probiotics
 Most are cow-milk based, although soy-protein based and fully
elemental formulas are available
 Cow’s milk (not formula) is contraindicated in the first year of life
 High solute load can lead to azotemia
 Inadequate vitamin D and A
 Milk fat poorly tolerated
 Low in calcium; can lead to neonatal seizures
 Gastrointestinal blood loss/sensitization to cow-milk protein
 New Infant Formulas: since 2002

Fortified with lc-PUFAs

• Long chain polyunsaturated fatty acids
• derived from algae and fungi

• DHA and ARA

• Major fatty acids in neural tissue
• Important component of photoreceptor in retina

• CLAIM: improves mental and visual development

Comparing Breast Milk and Formula

Copyright 2010, John Wiley & Sons, Inc.

Acceptable Medical Reason for Use Breast-milk
Substitutes (WHO & UNICEF, 2009)
FEEDING
Feeding process = a complex of activities
involving:
Organs
& its
function

Foods

Body Brain &

Position mind
 Sequence of Development and
Feeding Skills in Healthy (full term infant)
Age Mouth Patterns Hand and body skills Feeding Skills/Abilities

4 – 6 mo • Up & down munching movement • Sits with support • Takes in a spoonful of

• Transfer food from front to back to • Good head control pureed/strained food &
swallow • Uses whole hand to swallow without
• Draws in upper/lower lips as spoon grasp object (palmar choking
removed grasp) • Drinks a small amount
• Tongue thrust & rooting begin to • Recognizes spoon & from cup when held by
disappear holds mouth open as another person with
• Gag diminished spoon approaches spilling
• Open mouth when sees spoon
approaching
 Sequence of Development and
Feeding Skills in Healthy (full term infant)
Age Mouth Patterns Hand and body skills Feeding Skills/Abilities

5 – 9 mo • Begins to control position of food in • Begins to sit alone • Begins to eat mashed
the mouth unsupported foods
• Up & down munching movement • Follows food with eyes • Eats from spoon easily
• Positions food between jaws for • Transfers food from • Drinks from cup with
chewing one hand to the other some spilling
• Tries to grasp food with • Begins to feed self with
all fingers and pull hands
them into the palm
 Sequence of Development and
Feeding Skills in Healthy (full term infant)
Age Mouth Patterns Hand and body skills Feeding Skills/Abilities

8 – 11 mo • Moves food from side to side in
mouth
• Begins to use jaws & tongue to mash
food
• Begins to curve lips around rim of
cups
• Begins to chew in rotary pattern
• Sits alone easily • Begins to eat ground or
• Transfers objects from finely chopped food &
hand to mouth small pieces of soft
• Begins to use thumb food
and index finger to pick • Begins to experiment
up objects (pincer with spoon but prefers
grasp) to feed self with hands
• Feeds self finger foods • Drinks from a cup with
• Plays with spoon at less spilling
mealtimes but does not
spoon-feed yet
 Sequence of Development and
Feeding Skills in Healthy (full term infant)
Age Mouth Patterns Hand and body skills Feeding Skills/Abilities

10 – 12 mo • Rotary chewing (diagonal • Foods self easily with • Begins to eat chopped
movement of the jaw) fingers food and small pieces
• Begins to put spoon in of soft cooked table
mouth food
• Dips spoon in food • Begins to spoon-
rather than scooping feeding self with help
• Demands to spoon- • Bites through a variety
feed self of texture
• Begins to hold cup with
two hands
• Drinks from a straw
• Good eye-hand-mouth
coordination
Switching to Solid Food (WHO, 2010)
Age

Frequency

Amount

Texture

Variety

Active/Responsive

Hygiene
Energy Requirement for 6 – 23 months infancy
Daily Energy Requirement

6 – 8 month 600 kkal

9 – 11 month 700 kkal

12 – 23 month 900 kkal

Switching to Solid Foods
 Certain foods are dangerous and should be avoided
 Egg whites, cow’s milk, and peanut butter
 Honey may carry Clostridium botulinum and cause botulism in infants
 Seasonings are not needed
 Juice often displaces necessary nutrients and should be limited to 100% juice and
given in moderation
 Infants should never be put on weight-loss diets
 An infant must be physically, physiologically, and nutritionally ready before
being introduced to solid foods
 Solid foods should be introduced gradually and cautiously
 Foods that may pose a choking hazard should be avoided and infants should
always be supervised when eating
 Common food allergens, honey, and herbal teas should be avoided for the first
year of life and seasonings should not be added to infant food
 To keep their children healthy parents need to educate themselves about foods
that are safe and appropriate for infants
Water Requirement
 Give drink water several times/day after switching to solid food
 Without any additional drink water  dehydration

Age Water Requirement (ml/kg/day)

10 days 125 – 150
3 mo 140 – 160
6 mo 130 – 155
1 yr 120 – 135
2 yr 115 – 125
6 yr 90 - 100
 Rekomendasi Pemberian Makanan Pendamping (WHO, 2010)
Frekuensi (per Kuantitas rata-rata setiap kali Tekstur Keberagaman
Usia
hari) makan (kekentalan/
konsistensi)

Mulai MPASI 1 sampai 2 kali - Mulai dengan 2 sampai Bubur kental

saat bayi ditambah 3 sendok makan (puree, buah dan
sayuran tumbuk ASI (susui sesering
mencapai usia dengan - Mulai dengan sesuai halus, daging yang bayi inginkan)
6 bulan menyusu selera lalu tingkatkan lumat) +
Bahan makanan
sesering kuantitas secara hewani (bahan lokal)
keinginan bayi bertahap +
Pangan pokok
(bubur, bahan lokal)
+
Kacang-kacangan
tepat (bahan lokal)
+
Buah/sayuran (bahan
lokal)
terlalu
encer
 Rekomendasi Pemberian Makanan Pendamping (WHO, 2010)
Frekuensi (per Kuantitas rata-rata setiap kali Tekstur Keberagaman
Usia
hari) makan (kekentalan/
konsistensi)
Dari 6 sampai - 2 sampai 3 Tingkatkan secara Bubur kental
9 bulan kali ditambah bertahap hingga atau bubur
dengan setengah (½) dari saring ASI (susui sesering
yang bayi inginkan)
menyusu cangkir/mangkuk +
sesering ukuran 250 ml Bahan makanan
hewani (bahan lokal)
keinginan bayi +
- 1 sampai 2 Pangan pokok
(bubur, bahan lokal)
kali makanan +
ringan Kacang-kacangan
(bahan lokal)
+
Buah/sayuran (bahan
lokal)
 Rekomendasi Pemberian Makanan Pendamping (WHO, 2010)
Frekuensi (per hari) Kuantitas rata-rata setiap Tekstur
Usia
kali makan (kekentalan/ Keberagaman
konsistensi)

Dari 9 sampai - 3 kali ditambah Setengah (½) - (¾) Makanan cincang

12 bulan dengan menyusu dari cangkir/ mangkuk halus, tidak keras
dan mudah ASI (susui sesering
sesering ukuran 250 ml dijumput yang bayi inginkan)
keinginan bayi +
- 2 kali makanan Bahan makanan
hewani (bahan lokal)
ringan +
Pangan pokok (bubur,
bahan lokal)
+
Kacang-kacangan
(bahan lokal)
+
Buah/sayuran (bahan
lokal)
 Rekomendasi Pemberian Makanan Pendamping (WHO, 2010)
Frekuensi (per hari) Kuantitas rata-rata setiap Tekstur
Usia
kali makan (kekentalan/ Keberagaman
konsistensi)

Dari 12 3 sampai 4 kali Satu cangkir/ Makanan yang

sampai 24 ditambah mangkuk ukuran 250 bisa digenggam,
bulan dengan menyusu ml makanan ASI (susui sesering
keluarga, yang bayi inginkan)
sesering +
dicincang jika Bahan makanan
keinginan bayi
perlu hewani (bahan lokal)
1 sampai 2 kali +
makanan ringan Pangan pokok (bubur,
bahan lokal)
+
Kacang-kacangan
(bahan lokal)
+
Buah/sayuran (bahan
lokal)
CHILDHOOD
Toddlers versus Preschoolers
 Toddlers
 1–3 years old
• 1-2 years: on
 Growth rate is high, but slower than infancy
average, grows 12
 Age 2: Gain 3–5 pounds, 3–5 inches cm, gains 3.5 kg.
• Rate of growth slows
 Preschoolers by 4 years.
 3–5 years old • 6-8 cm/year
 Need same nutrients as adults, but have • 2-4 kg/year
 Lower energy needs
• Brain growth triples
 Smaller appetites
 Smaller stomachs
by 6 years.
Growth and Development
 Growth charts
 Used by pediatricians
 Monitor height and weight
 Compare to national standards for age and gender
 Place child in a percentile

 BMI-for age Z-scores boys, 2 – 5 y (WHO)

 BMI-for age Z-scores, girls 2 – 5 y (WHO)
BMI-for age z-scores (WHO)
BMI Status
< - 3SD Severe thinness
< - 2SD Thinness
> + 1SD Overweight
> + 2SD Obesity
Determining Estimated Energy Requirements
 For 13 – 35 months children

EER (kcal) = (89 x weight [kg] – 100) + 20

 An 18 month-old boy, length = 84 cm, weights = 12,5 kg
EER = (89 x 12,5 – 100) + 20
EER = (1113 – 100) +20
EER = 1033 kcal
Determining Estimated Energy Requirements
 For girls 3 – 8 years
EER (kcal) = 135,3 – (30,8 x age [y] + physical activity x (10 x
weight [kg] + 934 x height [m]) + 20
 A 6,5 y.o. girl is 1,12 m tall, weight 20,8 kg & has moderate activity (PA coefficient of
1,31)
EER
= 135,3 – (30,8 x 6,5) + 1,31 x (10 x 20,8 + 934 x 1.12) + 20
= 135,3 – 200,2 + 1642,9 + 20
= 1598 kcal
Calculate Nutrition Need
 Indirect Calorimeter  highly
accurate
Age (years) RDA
 Harris-Benedict Formula  REE 0–1 110 – 120
 WHO  REE 1–3 100
4–6 90
 Schofield Formula  REE
7–9 80
 RDA (Recommended Dietary 10 – 12 60 – 70 (boy)
Allowances)  simple method 50 – 60 (girl)
12 – 18 50 – 60 (boy)
40 – 50 (girl)
Catch-Up Growth
 Child who grow under normal growth due to malnutrition or chronic disease
need additional calorie and protein to catch-up growth.
 The nutritional requirements for catch-up growth depend on whether:
 The child has overall stunted growth (both height & weight are proportionally low)
 The child is chronically malnourished
 The child is primarily wasted (the weight deficit exceeds the height deficits)

 A chronic malnourished child may not be expected to gain more than 2 – 3

g/kg/day
 A child who is primarily wasted may gain as much as 20 g/kg/day

Kcal = RDA (kkal/kg) for actual height x ideal BW (kg)

 NUTRIENT REQUIREMENTS
 The energy need of healthy children are determined by:
 Basal metabolism
 Rate of growth
 Energy expenditure

Age Carbohydrate Protein Fat

1 – 3 yr 45 – 65 % 5 – 20 % 30 – 40 %
Dietary energy must be 4 – 18 yr 45 – 65 % 10 – 30 % 25 – 35 %
sufficient to ensure growth and
spare protein from being used
for energy, but not allow excess
weight gain.
MINERAL AND VITAMINS
 Calcium
 Necessary for healthy bone development
 RDA for calcium
 700 mg/day (1 – 3 years)
 1000 mg/day (4 – 8 years)
 1300 mg/day (9 – 18 years)
 Actual needs depends on individual absorption rate & dietary factors such
as quantities of protein, vitamin D and phosphorus.

 Zinc
 Essential for growth
MINERAL AND VITAMINS
 Vitamin D
 DRI for children is 600 IU (15 mcg)/day

 Iron
 Necessary during periods of rapid growth
 Child between 1 – 3 years of age are at high risk for iron deficiency anemia
 Good sources of iron for children include lean meats, beans, and iron-
fortified cereals
 Cow’s milk is a poor source of iron
 Feeding, Nutrition & Piaget’s Theory of
Cognitive Development
Developmental Cognitive Characteristics Relationships to Feeding & Nutrition
Period
Preoperational Thought process become Eating becomes less the center of attention & is secondary
(2 – 7 years) internalized; they are to social, language, & cognitive growth
unsystematic & intuitive
Use of symbols increases Food is described by color, shape, & quantity, but the child
has only a limited ability to classify food into “groups”
Reasoning is based on Food tends to categorized into “like” and “don’t like”
appearances & happenstance
The child’s approach to Food can be identified as “good for you”, but reasons why
classification is functional & they are healthy are unknown or mistaken.
unsystematic
The child’s world is viewed
egocentrically
 Feeding, Nutrition & Piaget’s Theory of
Cognitive Development
Developmental Cognitive Characteristics Relationships to Feeding & Nutrition
Period
Concrete The child can focus on several The child begins to realize that nutritious food has a positive
operational (7 – aspects of a situation effect on growth & health but has a limited understanding
11 years) simultaneously how and why.
Cause-and-effect reasoning
becomes more rational &
systematics
The ability to classify, reclassify
& generalize emerges
A decrease in egocentrism • Mealtimes take on a social significance
permits the child to take • The expanding environment increases the opportunities
another’s view for influences on food selection, for example: peer
influence increases
 Feeding, Nutrition & Piaget’s Theory of
Cognitive Development
Developmental Cognitive Characteristics Relationships to Feeding & Nutrition
Period
Formal Hypothetical & abstract thought The concept of nutrients from food functioning at physiologic
operational (11 expand & biochemical levels be understood
years or
beyond)
The child’s understanding of Conflicts in making food choices may be realized
scientific and theoretical (knowledge of the nutritious value of foods may conflict with
processes deepens preferences & nonnutritive influences)
 Family
environment

Intake Societal
Patterns trends
Adequate
Diet
Influenced Media
Factors messages

Peer
influence

Illness
Food Behaviors
 Eating habits form early in life
 Children will adapt to foods offered to them

 A variety of food should be offered to young children

 A child may need to be exposed to a new food at least 10 times before accepting it

 Division of responsibility
 Parents = What, when, and where food is offered
 Child = Whether or not to eat, and how much

 “Cleaning the plate” may encourage overeating

Food Preferences
 Parents have strong influence over children’s food
preferences
 Children model after adult behaviors, both healthy and
unhealthy
 Including young children in food shopping, menu planning, and
meal preparation can encourage variety in their food
consumption
Food Preferences
 Picky eating and “food jags” are common in young children
 Picky eating – not wanting to try new food
 Food jags – tendency to eat only a small selection of food
 Very common and normal, but also temporary
 Can be identified through a food diary
 Long-term jags increase risk of nutrient deficiency
 Solutions include
 Offering a variety of food items within the preferred food type
 Gradually weaning the child from the food item
Vegetarianism
 Young children can grow and develop normally on a well-
balanced vegetarian diet
 Vegetarian foods such as beans, nuts, seeds, and whole grains are high in
fiber
 Multiple servings per day may exceed a young child’s fiber needs
 Good sources of calcium, iron, and zinc need to be included in the diet
 Supplementation of vitamin B12 may be necessary
School-Aged Children
 Ages 6–12 years
 Are not fully grown
 Each year, gain about 7 pounds and 2.5 inches

 Compared to toddlers and preschoolers they

 Do not eat as many times per day
 Tend to be less hungry (maintain blood glucose longer)
 Can eat more food at each sitting

 Can impact healthy development through dietary choices

 Continue to develop habits based on modeling adult behaviors
MyPyramid
for Kids
A visual tool for
children and
parents to
understand
healthy eating
MyPyramid for Kids
 Key messages
 Be physically active every day
 Choose healthier foods from each group
 Eat more of some food groups than others
 Eat foods from every food group every day
 Make the right choices for you
 Take it one step at a time
The Role of Breakfast
 Eating breakfast may be associated with healthy body
weight among children and adolescents
 Eating breakfast may benefit
 Cognitive function, including memory
 Academic performance
 School attendance
 Psychosocial function
 Mood
Developing Healthy Habits
 Offer a variety of healthy foods and snacks.

 Encourage fruit and vegetable intake.

 No junk food snacking.

 Limit intake of juices ( 4 oz per day).

 Increase intake of water (no soda).

 Encourage low fat dairy products (3-4 servings/ day).

 Make fun physical activity a habit.

 Limit TV to no more than 1 to 2 hours per day.

 Track growth and development carefully.

 Be a good role model.

Nutritional Concerns
 Overweight and obesity
 Underweight & failure to thrive
 Malnutrition and poverty
 Iron deficiency
 Dental caries
 Allergies
 Attention Deficit Hyperactivity Disorder, Autism Spectrum Disorders
Thank you....