Nutrition

At approximately age one, children enter the latent period of growth. During this period,
until the onset of puberty , growth and development are more gradual than during the first
year. Physical growth steadies, and the body begins to look more proportioned as it
prepares for an "upright" lifestyle .

The immediate stages following infancy are toddlerhood (ages one through three) and the
preschool years (ages three through five). Characterized by temper tantrums, exploration,
and endless questions, these periods can be trying for parents. Individual children
experience growth spurts and plateaus —during which growth seems to stop completely.
Food intake, and a liking of certain foods, may change constantly, causing a great deal of
anxiety for parents.

Parents need to recognize that these changes are a normal part of development.
Understanding the nutritional requirements of these age groups may help parents adapt to
the new challenges. In addition, parents should be aware of the potential problems
associated with feeding young children—and the ways to prevent them.

>Vitamin and mineral needs

Iron is a vital component of hemoglobin , the carrier of oxygen in the blood. As a young
child grows, blood volume increases, and so does the need for iron. Preschoolers and
toddlers typically eat less iron-rich foods than they did in infancy. In addition, the iron
that children get is usually non-heme iron (from plant sources), which has a lower
availability than heme iron (from animal sources). As a result, children up to three years
of age are at high risk for iron-deficiency anemia . The RDA for iron for both toddlers
and preschoolers is ten milligrams (mg) per day.

Calcium is needed for bone and teeth mineralization and maintenance. The amount of
calcium a child needs is determined in part by the consumption of other nutrients, such as
protein, phosphorus and vitamin D , as well as the child's rate of growth. During this
period of development, children need two to four times as much calcium per kilogram of
body weight as adults do. The AI for toddlers is 500 mg/day, while for preschoolers it is
800 mg/day. Since dairy foods are the primary source of calcium, children who do not
consume enough dairy or have an aversion to dairy products may be at risk for calcium
deficiency.

Zinc is essential for proper development. It is needed for wound healing, proper sense of
taste, proper growth, and normal appetite. Preschoolers and toddlers are sometimes at risk
for marginal zinc deficiencies because the best sources are meats and seafoods, foods
they may not eat regularly. The recommended intake of zinc is 10 mg/day.

Vitamin and mineral supplements are popular with more than 50 percent of parents of
preschoolers and toddlers. Most use a multivitamin/mineral supplement with iron. Parents
should be aware, however, that such supplements do not necessarily fulfill the needs for
marginal or deficient nutrients. For example, although calcium is often a nutrient that is
low in children, most multivitamin/mineral supplements do not include it, or include it in
very low doses. Although there is no harm in giving children a standard children's
supplement, megadoses should always be avoided, and caution should be used when
supplementing the fat-soluble vitamins (vitamins A, D, E, and K).

>Potential Feeding Problems

As young children develop their likes and dislikes and learn to feed themselves, parents
need to allow them to become more independent. As a result of these changes, potential
concerns arise. Common feeding problems among preschoolers and toddlers are: obesity ,
nursing bottle mouth syndrome, food jags, and iron-deficiency anemia.

Prevention education is the key to lowering the incidence of obesity in children. Success
has been shown in programs that include family involvement, nutritional information and
modification, activity planning, and behavior therapy.

Most often seen in children under age three, nursing bottle mouth syndrome (or baby
bottle tooth decay) results from extended bottle feeding. It occurs when a child is
routinely given a bottle with sweetened beverages (such as milk or juice) at bedtime. As
the child sleeps, the liquid pools around the teeth. The result is severe caries on the
incisors and cheek surfaces of molars . Parents should avoid giving a bottle at bedtime
and begin serving beverages in a cup as early as possible.

Most children undergo a normal part of development know as a food jag. Food jags occur
when children either refuse to eat a previously accepted food, or when they insist on
eating one particular food all the time. A food jag is generally a case of a child testing his
or her independence. Although annoying for most parents, food jags are rarely a reason
for concern. The best strategy is to continue offering a variety of foods every day, while
keeping the favorite food available. Most children will eventually return to a normal
eating pattern. Letting a food jag take its course is the best plan of action; force will
accomplish little.

>Feeding Strategies for Parents

• Allow kids to eat five to six small meals per day.

• Allow them to eat when they are hungry and do not force them to eat when they are not.

• Do not use food as a reward or punishment.

• Be aware of the risk of choking in these age groups. Avoid foods that are round, hard,
or do not easily dissolve in saliva (such as hot dogs, grapes, raw vegetables, popcorn,
nuts, peanut butter, and hard candy).
• Avoid feeding too many sweetened beverages (especially in the bottle); encourage them
to drink plenty of water.

Despite the wide availability of iron-rich foods, iron-deficiency anemia is the most
common nutrient deficiency in the world. Reasons for this deficiency in toddlers may be
the consumption of large quantities of milk, and thus limited intake of solids and iron-
fortified foods. In addition, many young children do not like the best sources of iron, such
as meats and seafoods. Parents should pay special attention to include good dietary
sources of iron in their children's diet. When meat or seafood sources are limited, the
availability of iron from plant sources can be increased with the consumption of ascorbic
acid (vitamin C).

The preschool and toddler years often create anxiety in parents as food likes, dislikes, and
requirements may change continuously. Understanding that these changes are a normal
part of development, and understanding the nutritional requirements for this age group,
will help parents make educated decisions. Parents should also be aware of the potential
feeding problems of this group, and of the ways to prevent them.

>Childhood Obesity

There have always been overweight children. Historically, chubby babies and toddlers
were more likely to survive infections and contagious diseases, and overweight children
and family members were often signs of affluence and financial security in a community.
Thus, in some cultures, overweight was a valued body type.

Today, being overweight puts a child at risk of developing chronic diseases such as type
II diabetes , hypertension , and high cholesterol levels. Obesity can promote degenerative
joint disease, which will result in painful knees, hips, feet, and back, and it can severely
limit physical activity. These are health concerns previously seen only in adults, usually
in those over age forty. Obesity can be measured using a tool called body mass index
(BMI). The BMI of an individual can be derived from tables or calculated using a
formula (weight in kilograms divided by height in meters squared). Using this criteria,
children and teens are not labeled " obese "; technically, they are only "at risk of
overweight" or "overweight."

It is generally agreed that the longer and more overweight a child is, the more likely it is
that the condition will continue into adulthood. Predisposing factors are complex and
include a mix of genetic , social, cultural, environmental, and lifestyle factors.

Statistics show that a child with two obese parents has an 80 percent risk of becoming
overweight, a child with only one obese parent has a 40 percent risk, and a child with
normal weight parents has a 7 percent risk of becoming overweight. Twins who were
adopted by different families were found to be more similar in weight to the biological
parents than to their adoptive parents. Although the exact cause is still unknown, prenatal
factors such as maternal obesity, excess pregnancy weight gain, and diabetes may also
predispose a child to becoming overweight.

Other risk factors include meal patterns (e.g., skipping breakfast, meals and snacks eaten
outside of the home, infrequent family dinners), unhealthful dietary intake (e.g., high fat
intake, low intake of fruit and vegetables, fast-food meals, low fiber intake, high soft-
drink intake), psychosocial factors such as acculturation and parenting style, and
declining rates of physical activity. Based on data from NHANES II and III, among
children twelve to seventeen years of age the prevalence of overweight increases 2
percent for each additional hour of TV viewed daily.

Prevention is the best treatment. Restricting calories can lead to stunted growth, adversely
affect bone density, and even lead to eating disorders. Intervention strategies should
involve the family and focus on permanent lifestyle changes under the supervision of a
primary care physician or a registered dietitian. Parents can begin by limiting dining out
to special occasions and by making time to enjoy regular meals at home together as a
family. Time involved in sedentary activities such as playing video games or using the
computer should be monitored and supervised, and the whole family should be
encouraged to participate in thirty to sixty minutes of vigorous activity each day. To be
successful, the entire family must be willing and ready to institute the many gradual,
permanent changes needed.

Pharmacological and surgical treatments are associated with long-term risks and serious
complications, and they constitute, at best, a last resort for severely overweight
adolescents. Prolonged weight maintenance is recommended for many overweight
children and allows a gradual decline in BMI as the child grows in height. However, if
medical complications related to obesity already exist ( sleep apnea , hypertension,
dyslipidemia and orthopedic problems) weight loss of approximately one pound per
month is recommended.

*Observe the eating habit and the food they eat. Vegetarian diet…Observe the activity of
the child. Regular balanced diet.

>Focus on the benefits if regular balanced diet, fruits and veggies. This may also require
monitoring by the endocrinologist or monitoring by the endocrinologist or monitoring of
food intake.

>This may be inclined in the discussion.

>Proper scheduling of food intake.

 Discourage preschooler to take snacks an hour before meal time.