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Chapter 15: Nutrition Infancy Through Adolescence

Nutrition Infancy Through Adolescence Chapter 15: Nutrition
Infant Growth and Development
Rapid growth rate
- Doubles by 4-6 months
- Triples by 1 year
- Increases 50% by end of 1st year
Nutrients needed to support proper
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
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
- 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
- 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
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
Serve with nutritious dip
Not necessary
Focus on good food choices
Use of fortified cereals
Foods high in Iron and Zinc
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
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
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
-decreased physical activity
-family history
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
-Family history
Treatment: weight management and CHL medications
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