NUTRITION IN CHILDHOOD

Nutrient requirement

Children growing & developing

need more nutritious food May be at risk for malnutrition if : - poor appetite for a long period - eat a limited number of food - dilute their diets significantly with nutrient poor foods

Energy
Energy needs of healthy children determined on : - basis of basal metabolism - rate of growth - energy expenditure Must be sufficient to ensure growth & spare protein, but not so excessive Suggested intake proportions : 50 60% carbohydrate, 25 35% fat, 10 15% protein

Daily dietary reference intakes for energy for children

Age (yr) 12 38 9 13 Males (kcal) 1046 1742 2279 Females (kcal) 992 1642 2071

IOM, Food and Nutrition Board, 2002

Protein

Early childhood 1.1 g /kg BW Late childhood 0.95 g/kg BW At risk for inadequate protein intake : - strict vegan diets - with multiple food allergies - who have limited food selection because of fad diets - behavioral problems - inadequate access to food

Daily dietary reference intakes for protein for children

Age (yr) 13 48 9 13 Grams Grams / kg

13 19 34

1.1 0.95 0.95

IOM, Food and Nutrition Board, 2002

Minerals and vitamins

Necessary for normal growth & development Insufficient intake impaired growth deficiency disease

Iron

Children 1 3 years high risk for iron deficiency anemia Rapid growth period Hb & total iron diet may not be rich in iron-containing food

Calcium

Needed for adequate mineralization & maintenance of growing bone DRI : 1300 mg/day 9 18 yrs 800 mg/day 4 8 yrs 500 mg/day 1 3 yrs Primary sources : milk & dairy product children who consumed no or limited amount at risk for poor bone mineralization

Zinc

Essential for growth if deficiency : - growth failure - poor appetite - decreased taste acuity - poor wound healing RDA : 3 mg / day 1 3 yrs 5 mg / day 4 8 yrs 8 mg / day 9 13 yrs

Best sources : meats & seafood Marginal zinc deficiency reported in children from middle & low-income families (Robert & Heyman, 2000)

Vitamin D

Needed for calcium absorption & deposition calcium in the bones The amount required from dietary sources is depend on nondietary factors (geographic location & time spent outside) Primary sources : vitamin D-fortified milk

Vitamin-Mineral supplement

Do not necessarily fulfill specific nutrient needs Children who take supplement do not exceed the RDA Should not take megadoses, particularly fat soluble vitamins toxicity

Children at risk who may benefit from supplementation :

from deprived families with anorexia, poor appetites, poor eating habits with chronic diseases (cystic fibrosis, liver dis) enrolled in dietary programs from weight management - vegetarian diets with inadeq intake of dairy product or calcium containing foods

FEEDING PRESCHOOL CHILDREN (1 6 yrs)

Still gaining height & weight Start to walk & talk Depend on brain development Depend on genetic & environmental influences stimulation & nutrition

Marked by vast development and the acquisition of skills Decreased interest in food a difficult time for parents Smaller stomach capacity & variable appetite small serving Eat 4-6 x/day snacks is important should be chosen carefully

Should not be given any food or drink within 1 hours of meal Excessive intake of fruit juices chronic non specific diarrhea Excess juice intake may replace the consumption of higher energy foods childs appetite food intake & poor growth Children usually eat well in group setting ideal environment for nutrition education program

FEEDING SCHOOL-AGE CHILDREN (6 - 12 yrs)

May participate in the school lunch program or bring a lunch from home

NUTRITIONAL CONCERNS Obesity

Increased prevalence Not a benign condition The longer a child has been overweight the more likely the is to be overweight during adolescent & adulthood Factors contributing :
food establishment eating tied to leisure activities larger portion size inactivity

Underweight & Failure to Thrive

Etiology : - chronic illness - restricted diet - poor appetite - feeding problems

Iron deficiency

One of the most common nutrient disorders of childhood (9% of toddlers) Possible factors associated : dietary intake, parents educational level, access to medical care 1-yr old child who consume large quantities of milk only milk anemia Do not like meat iron consumed in the nonheme form

Prevention : - consuming good dietary sources of iron - the amount of ascorbic acid and MFP to absorption

Dental Caries

Drink sweetened liquids from a bottle at bedtime susceptible to early childhood caries (Baby bottle tooth decay) Snacks choose that are least cariogenic Chewing sugarless gum salivary pH beneficial Toothbrush should be introduced

Allergies

Usually develop during infancy & childhood and more likely when family history (+) Allergic responses most often include respiratory or GI symptom & skin reaction

Autism Spectrum Disorders

Affect the childrens nutrient intake & eating behaviors Typically eat only specific foods
restricted diet

at risk for inadequate nutrient intake Usually refuse fruit & vegetables Commonly very resistant to taking supplement

Popular dietary intervention : gluten-free and casein-free diet Nutrition assessment should include : - the possibility of medication and nutrient interaction - use of alternative therapies, herbal and supplement Nutrition intervention may include a behavioral program types of food accepted

PREVENTING CHRONIC DISEASE Dietary fat & cardiovascular health

NCEP recommendation ( 2 yrs) : - no more than 30% of calories from fat ( 10% SAFA, 10% PUFA, 10-15% MUFA) - no more than 300 mg/day of cholesterol > 2 yrs gradually adopt a lower fat diet 4 yrs meet the NCEP guidelines

Calcium & bone health

Osteoporosis prevention : - begins in childhood by maximizing calcium retention & bone density - most efficient during childhood & adolescent Education is needed to encourage young people to consume an appropriate amount

Fiber

Needed for health & normal laxation Education is needed to help increase fiber intake

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