Nutrition Makeover FSCN 3612 - Lifecycle Nutrition Brandi Green

BACKGROUND This paper addresses concerns regarding my niece, Amica. She is 15 months old, and as of her latest doctors visit, in the 90th percentile for both height and weight, according to the World Health Organizations growth charts for children up to two years of age (WHO, Chapter 5). She is a vibrant little girl with a very healthy appetite and playful demeanor. Amica eats five to six times each day. She starts with her breakfast, shortly after waking, has a mid-morning snack, lunch a few hours later, an afternoon snack, dinner, and a bottle before going to sleep for the night. Some of her favorite food items are cereals, bananas, avocados, cheese, bean and cheese burritos, greek yogurt, and the Ellas Kitchen pureed fruit and vegetable blends. PROBLEM The concern with Amicas diet is whether or not she is getting enough protein. Although she is within the 90th percentile, which most parents consider to be a very healthy child (Laraway et al, 343), after she came to visit for a week (she lives in Washington with my sister and her husband), my mother became concerned that Amica doesnt eat enough protein. This concern arose for two reasons: First, her diet is primarily vegetarian, focusing on grains, fruits, and vegetables; second, because my sister eats very little meat and dairy, she doesnt think to feed her daughter large quantities of either of those. What my mother did not take into account is that although Amicas diet does not focus on the items my mother considers to be high quality protein, she does still eat cheese, greek yogurt,

Nutrition Makeover FSCN 3612 - Lifecycle Nutrition Brandi Green

legumes, and whole grains. All of which, supply protein to her diet. Because she is also very young, her portion sizes should be much smaller than the portion sizes of an adult. The RDA for protein for a child between 1 and 3 years of age is 1.1 g/kg/day or 13g/day. Weighing in at about 25 pounds (11.36 kg), Amicas protein requirements are around 12.5 grams of protein daily (Brown, 278). Using the formula (89 * Weight (kg) - 100) +20, her calorie needs are also around 931.04 calories/day (Brown, 277). ACTION TAKEN Observing Amica for a day, I took note of the items she ate. She began with a breakfast that consisted of half of a Vans Wheat and Gluten free waffle, a third of a Chobani blueberry greek yogurt container (about 2 ounces), and a half of a banana. For a mid-morning snack, she had Cheerios (about a third of a cup). She followed up with lunch a couple of hours later that consisted of a slice of deli turkey, a slice of colby cheese, and a half of an Ellas kitchen packet of Sweet Potatoes, Pumpkin, Apples, and Blueberries. For her afternoon snack, she had some Gerbers Graduates Yogurt Melts (about a quarter of a cup), and a couple of hours later, she had some dinner, which consisted of a quarter of an avocado, another slice of colby cheese, and a small piece of baked sweet potato. Before going down for the night, she had a bottle with about 8 ounces of Enfamil Gentlease formula in it. With the following breakdown of foods, Amica consumed 31.9 grams of protein and 761.8 calories:

Item

Grams of Protein

Calories

Nutrition Makeover FSCN 3612 - Lifecycle Nutrition Brandi Green

Vanss Waffle (1/2) Chobani Yogurt (2 oz.) Banana (1/2) Cheerios (1/3 c) Deli Turkey (1 slice) Cheese (1 slice - colby) Ellas Kitchen (1 pouch) Gerbers Graduates (1/4 c) Avocado Cheese (1/2 slice - colby) Sweet Potato (1/4) Enfamil Formula (8 oz) TOTAL

0.5 4.7 0.6 1.0 3.3 6.8 0.5 1.0 1.3 6.8 1.2 4.2 31.9

57.5 47.0 52.5 33.3 15.0 110.0 30.0 30.0 62.5 110.0 54.0 160.0 761.8

With these numbers in mind, its obvious to see that even though Amica missed the mark on her total calorie intake for the day, she more than doubled her protein requirements for the day. Like most children, Amica gets the majority of her calories from formula and dairy products (Fox et al, S28.e5). In spite of the fact that Amica is in such a high percentile for height and weight, she is actually scoring lower than the 25th percentile for both protein and calorie intake for the average 12 - 23 month old toddler (Butte et al, S32). Keeping these numbers in mind, I discussed with my mother than Amicas protein intake is more than adequate. She was still concerned that once Amicas family left to go back to Washington, she wouldnt continue to eat the same foods she had while visiting us and that her

Nutrition Makeover FSCN 3612 - Lifecycle Nutrition Brandi Green

protein intake would drop. I explained that even if she doesnt eat half the amount of protein that she did on the day I observed her, she will still obtain significant protein for healthy growth and development. We also discussed that she could actually take in nearly 200 more calories each day, particularly now that shes more mobile. I suggested adding in more whole grains, fruits, and vegetables. If she was still concerned about Amica meeting her protein requirements, she could add in a small piece of chicken, or since Amica really likes it, more Greek yogurt. ASSESSMENT Overall, I feel that this intervention went very well. My mother now seems to understand that just because Amica is not eating what she would traditionally consider to be adequate proteins, that doesnt mean that she isnt getting sufficient protein to fuel her lifestyle, as well as healthy growth and development. My sister also has a better understanding of what Amicas energy needs are and will be working to focus on ensuring that her daughter is getting adequate nutrition. She also understands that the things she eats or doesnt eat as an adult to feel healthy, is not necessarily the healthiest options for her young daughter.

Nutrition Makeover FSCN 3612 - Lifecycle Nutrition Brandi Green

WORKS CITED Butte, Nancy F. PhD, RD, Mary Kay Fox MEd, Ronette R. Briefel DrPH, RD, Anna Maria Siega-Riz PhD, RD, Johanna T. Dwyer, DSc, RD, Denise M. Deming, PhD, and Kathleen C. Reidy, DrPH, RD. Nutrient Intakes of US Infants, Toddlers, and Preschoolers Meet or Exceed Dietary Reference Intakes. Journal of the American Dietetic Association 110.12 (2010): S27S37. Print. Brown, Judith E. Nutrition Through the Life Cycle. 4th ed. Mason, OH: Cengage, 2011. Print. Fox, Mary Kay, Kathleen Reidy, Timothy Novak, and Paula Ziegler. Sources of Energy and Nutrients in the Diets of Infants and Toddler. Journal of the American Dietetic Association 106.1 (2006): 28.e1 - 28.e25. Print. Laraway, Kelly A., Leann L. Birch, Michele L. Shaffer, and Ian M. Paul. Parent Perception of Healthy Infant and Toddler Growth.Clinical Pediatrics 49.4 (2010): 343-349. Print. WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards: Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: Methods and development. Geneva: World Health Organization, 2006 (312 pages). Print.