Chapter 15: Nutrition Infancy Through Adolescence

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Nutrition Infancy Through Adolescence Chapter 15: Nutrition

Infant Growth and Development

Rapid growth rate
Weight
- Doubles by 4-6 months
- Triples by 1 year
Length
- Increases 50% by end of 1st year
Nutrients needed to support proper
growth
Inadequate nutrition (including fat) can
inhibit growth

Current Status of Child Health

More children are receiving vaccinations
Fewer teenage pregnancies
Lower poverty rate
More cases of Obesity & Type 2 Diabetes
Less physical activity
Increased consumption of soft drinks

Effects of Undernutrition

Smaller in size (height and weight)
Growth is an indicator of nutritional
health
Adequate diet later won't compensate
for lost growth

Assessment of Growth

Growth Charts
-Height and weight correspond to a percentile
-50th percentile is considered average
Brain Growth: fastest in infancy
Over and Under feeding
-overfeeding increases number of adipose cells
-underfeeding may affect organ development
-unwise to restrict diet
-Fat intake higher for less than 3 years

Failure to Thrive

A condition in which the child does not grow physically and cognitively at a normal rate due to poor prenatal care or grossly inadequate and inattentive parenting.

Calorie Needs

EER - (89 kcal x kg) + 75 (0-3 months old) - (89 kcal x kb) + 44 (4-6 months) - (89 kcal x kg) - 78 (7-12 months)
 ~700 kcal/day for a 6 month old child
 Breast milk, formula provide sufficient kcals
 High energy needs - Rapid growth and metabolism rate - Higher body surface area (loss of heat)

Protein Needs

 9 - 14 grams/day (based on age)
 Half should be from essential amino acids
 Breast milk, formula provide sufficient protein
 High protein diet
- Stress on kidneys
- Excess nitrogen and minerals exceed infant's immature kidney abilities

Fat Needs

30 grams /day - 15% of total fat should be essential fatty
acids (also consider DHA, arachidonic acid)
- Excess fat intake may lead to poor fat digestion
 Vital to nervous system development
 Half of the energy supplied by breast milk and formula comes from fat

Vitamin K

Routinely given as injection at birth & intestinal bacteria then begin to synthesize it

Mineral Needs

Iron stores depleted by 4-6 month of age
- Iron-fortified formula for bottle fed infants
- Iron supplementation for breastfed infants
Introduction of iron-fortified solid foods
 Zinc and iodide
- Supplied by breast milk or formula
 Fluoride supplement

Water Needs

Fluid Needs - ~3 cups per day - Via breast milk or formula
 Supplemental water
- May be necessary in hot climate
- Diarrhea, vomiting also require additional fluids
 Babies are easily dehydrated - Can damage kidneys
 Under normal conditions additional water is not necessary

Formula Preparation

Boil cold water but not ot tap cause could lead to risk of lead poisoning
Well water and nitrates
Prepared bottles can be stored for up to only 24 hours

Formula Feeding

Cow's milk not tolerated by infants
 Formulas
- Must follow strict quality control guidelines
- Fortified with vitamins and minerals
(except fluoride)
 Cow's milk base formula
- Contains lactose/sucrose, casein, whey,
and vegetable oils
 Soy base formula contains soy protein
 Pre-digested formula

Feeding Technique

Spitting up is normal Burp during and after feeding Monitor for signs of satiety
Sudden Infant Death syndrome (SIDS)
- "Back to Sleep" Campaign - Place baby on back or (propped onto side) - Flat-head syndrome

Solids at Six Months

-Nutritional Needs: replenish iron stores and Vitamin D
-Physiological capabilities allow baby to be more mature in its digestive system and increased kidney function
-Physical ability is extrusion reflex disappears, better head and neck control and ability to sit up
-Allergy Prevention

First Foods

one food at a time
rice cereal
strained veggies, then fruits, then meats
no cow's milk until age 1

Feeding Solids

self-feeding skills, allow infants to practice, use baby sized spoon, hold infant comfortably, small dab of food,only few bites at first

AAP Infant Dietary Guidelines

Build to a variety of foods
Pay attention to infants appetite
Infants need fat
Choose fruits, vegetables, and grains but not overdoing fiber
Sugar and sodium should be moderate
Choose foods containing iron, zinc and calcium

NOT to Feed an Infant

Allergenic foods such as eggs whites, milk, chocolate and nuts
Honey or corn syrup
Highly seasoned foods
Excessive formula or breast milk
Foods that tend to cause choking
Cow's milk
Excessive apple or pear juice

Feeding Problems

-Low iron diet
-Absense of entire food group
-Drinking of raw milk
-Drinking of goat's milk
-Not drinking from a cup by the agoe f 1
-Continual feeding from a bottle after 18 months
-Intake of more than RDA for vitamins and minerals
-Drinking too much juice

Baby Bottle Tooth Decay

Tooth decay resulting from the pooling of sugars
-avoid bottles at bed/nap time
-avoid juice in bottles
-brush teeth/gums after feeding

Preschool Children

Average gain - 4.5 - 6.6 lb. per year - 3-4 inches per year
Tapering of growth rate Reduction in appetite
- Choose nutrient dense foods Promote good eating habits

Encouraging Nutritious Foods

Serve new foods
-repeat exposure
-sensitive taste buds
-wary of new foods
-one bite rule
Pregers crisp textures and mild flavors
Parents/Caregivers must teach by example
Make meal time a happy time

Problems with Feeding

Tension
- Between parents and/or children
- High expectations from parents
 Change in appetite
 Six small meals vs. three large meals
 Foster good eating habits with good food
choices

Not Eating as Much

 Drop in growth rate
- Loss of appetite
- Picky eating is an expression of independence
 Typical serving size - 1 tablespoon per year for most foods - Increase as needed (e.g., after age 5)
 Built-in feeding mechanism - In normal weight children - Avoid nagging, forcing, bribing - Allow some autonomy

Never Eats Vegetables

In, Introduce one at a time and repeatedly
 One-bite policy
 Don't force child to eat
 Offer new food with familiar ones
 Raw or blanched vegetables may be better
tolerated
 Serve with nutritious dip

Supplements

Not necessary
Focus on good food choices
Use of fortified cereals
Foods high in Iron and Zinc

Constipation

Rule out any medical causes
May result from intolerance to cow's milk
Treatment involves enemas, laxatives, fiber and fluids

Nutritional Problems in Preschoolers

Iron-deficiency anemia
- Poor oxygen supply to cells
-Compromised learning abilities
- Lower resistance to disease
- Iron-fortified cereals, lean meats

Dental Caries

Begin oral hygiene when teeth appear
 Seek early dental care
 Fluoridated water
 Fluoridated toothpaste
 Snacks in moderation
 Tooth sealants
 Avoid sticky foods
 Sugarless gum

Vegetarianism

Iron deficiency
Vitamin B-12 deficiency
Adequate intake of calories?
Focus on protein, vitamin B-12, iron, zinc, vitamin D, and calcium rich foods
Possible need for a vitamin/mineral supplement

Autism

Affects 1 of 150 children
May experience: constipation, diarrhea or reflux disease & feeding problems
Nutrition Interventions include gluten free diet, casein free diet and supplements of probiotics, vitamin b-6, magnesium and omega-3 fatty acids

Lead Poisoning

Causes: exposure to contaminated drinking water, consuming or inhaling lead dust, contaminated dietary supplements
Long term intellectual and behavioral impairments
Protection includes balanced meals with a variety of whole grains, lean meats, and low fat dairy products, and calcium iron and vitamin c

School-Age Children

Moderate fat, sugar and increase in serving size
Breakfast is fortified cereals that help meet nutritional needs and non traditional breakfast fare
Overemphasis of low fat diets

Type 2 Diabetes

Alarming increase in children
-obesity
-decreased physical activity
-family history
-ethnicity
Screening for at risk children
Increase physical activity is encouraged

Cardiovascular Disease

At risk: 2-10 years of age when screened
Risk factors:
-Over weight
-High blood pressure
-Smoking
-Diabetes
-Family history
Treatment: weight management and CHL medications

Obesity

30% of school age kids are over weight
40% of these kids become obese adults
80% of obese adolescents become obese adults

The Teenager

Rapid growth spurts:
10-13 for girls
12-15 boys
Height growth
10 inches-girls (fat and lean tissue)
12 inches-boys (lean tissue)
Increase in appetite
Peer Pressure

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

Getting Teens to Eat Right

Teens unaware of long-term health effects
Recommend smaller portions of high fat/sugar foods
Larger servings of low-fat dairy, lean meats, vegetables, fruits, and whole grains
Stress importance of nutrition on physical performance and fitness

Snacking and Teens

1/4-1/3 of energy needs are met by snacking
Snacking for socialization not hunger
Poor diet habits continue to adulthood
Increased risk for chronic diseases

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