Chapters 10 and 12:

Nutrition in Childhood

OBJECTIVES

1.Growth Expectations for stages of

childhood
2.Energy Needs for children during
childhood stages
3.Feeding Issues for Toddlers and
Preschoolers
4.Government Programs
5.Childhood Obesity

CHILDHOOD STAGES

Toddler: 1-3 years of age

Pre-school: 3-5 years of age

School age: 6-12 years of age

NUTRITIONAL
REQUIREMENTS
Determination of energy
(calorie) needs in chilhood:
1. basal metabolism
2. rate of growth
3. energy expenditure
Energy needs decrease with age
from ~ 100 kcal/kg in infancy to
~ 40 kcal/kg in adolescence

APPROXIMATE ENERGY
REQUIREMENTS PER KG

Birth 12 months: 100

kcal/kg/day
2-3 years: 90 kcal/kg/day
3-8 years : 70 kcal/kg/day
8-11 years: 60 kcal/kg/day

CHILDREN ARE NOT

JUST LITTLE ADULTS
More specialized nutrition
energy, and protein needed for:
Linear Growth
Bone development
Dental development
Muscle development
Pubertal Development

TODDLER, AGE 1-3

Developmental stage
Parent or daycare modeling
Competitive Foods
Development of
flavor preferences

FEEDING, NUTRITION
AND COGNITIVE
DEVELOPMENT
Birth-2 yrs: Sensorimotor
Satisfy hunger
Environmental exploration
Practice fine motor skills

TODDLER, AGE 1-3

Variety: chopped, table food

Should be off all infant foods:
texture, fingers and utensils
Whole milk and water
Iron and zinc-containing foods
Fiber-containing foods

TODDLER AND PRE-SCHOOL

SERVING SIZESRule of thumb: 1 TBLS. each of
protein, starch and 1-2 vegs for
each year of age up to age 6
Or
~1/4-1/3 of adult portion to age 3
~1/2-1/3 of adult portion to age 6

FEEDING THE TODDLER

Skills Hands, cups, spoons, forks

Textures
Behaviors/Independence
Snacks: valuable nutrients
Snacks vs. Treats

TODDLERS
Rate of growth slows
Body proportions change
significantly
Head growth is less
Limbs lengthen

TODDLERS

Calories: 90 kcal per

Protein: 1.1 g/per kg/day
Fat: 30-40% of calories

Iron: 7 mg/day
from 11 mg in infancy

COGNITIVE DEVELOPMENT, AGE AND

FEEDING, CONTINUED

2-7: Pre-operational
Symbols: colors, shapes

Ego-centric: I like and I

dont like

PRE-SCHOOL OBESITY

http://www.npr.org/player/v2/mediaP
layer.html?
action=1&t=1&islist=false&id=209
715770&m=209751953
http://www.khastv.com/news/local/D
espite-Nationwide-ImprovementNebraska-Still-Seeing-ProblemsWith-Obesity-Rates-in-Children218773771.html

COGNITIVE
DEVELOPMENT, AGE AND
FEEDING, CONTINUED
7-11 yrs: Concrete operations
Limited awareness that
nutrition affects health
but not how or why
Peer influence
Families
http://www.sesamestreet.org/par
ents/topicsandactivities/toolkit
s/food/feelinggood

CHILD HEALTH ISSUES

RELATED TO DIET
FTT (Failure to Thrive)
Overweight and Obesity
Dental Caries (cavities)
ASDs
Constipation: Fiber
High blood lipids and Type 2
diabetes related to overweight

Food allergies

IRON DEFICIENCY
Most Common nutrient
disorder of childhood
Affects approximately 9% of
toddlers
Linked to lower test scores
Dietary factors

IRON-DEFICIENCY
ANEMIA AGES 1-3
Transition off formula
Reliance on food for Iron
Excessive use of bottle
with milk or other liquids
Poor quality diets with
inadequate meats, poultry,
beans

IRON-DEFICIENCY
ANEMIA AGES 1-3
Blood volume expands with
rapid growth
Increased hemoglobin (Hg)
Hg is main component of red
blood cells (RBCs)
Hemoglobin carries 02

LEAD POISONING
& NUTRITION

o Older homes (<1960) paint with lead

o Scraping paint inside & outside: paint
chips/dust
o Children ingest/inhale
o 1997 screening guidelines
Previous max: 10-25 mcg/dl blood
o

Reduced to < 10

LEAD AND
NUTRITION
o More lead is absorbed when
stomach is empty so 3 meals
and snacks

o Need to assure good intake of

calcium, iron and zinc

ZINC -TRACE MINERAL

o Often deficient, esp. young children

o Food sources: Mostly meats,

seafood, some in whole grains
o Deficiency:
oPoor appetite
oDiminished taste acuity
oPoor wound healing
oPoor weight gain and growth
o Important study in Egyptian boys

ZINC
o Needed for DNA formation.
o DNA is in every cell
o Extra DNA needed during
childhood (stage of rapid
growth)
o Especially in times of catch-up
growth

SUPPLEMENT AD

More vitamin C and zinc!

Immune support*
ChefsBest Award:Best Taste
Zinc) 3mg

(20% DV)

Regular Gummy Vite has 2.7 mg. Zinc

Dose: 2 Gummies ( for 3 mg.)

ZINC SUPPLEMENTATION
Flintstones Complete :
Dosage: 1 tablet 4 and up
tablet ages 2-3
Provides: 12 mg. per tablet

FEEDING PRESCHOOL
CHILDREN
oGrowth rate slows
oParents control foods offered
and provide environmental
structure
oSnacks v. treats
o Competitive foods

FEEDING PRESCHOOL
CHILDRENCONTD
o Physical environment
o Excessive intake of fruit juice
o Meals and snacks in day-care
o Peer influence

AAP POLICY STATEMENT,

2001
USE AND MISUSE OF FRUIT
JUICE IN PEDIATRICS

Increases risk of :
Obesity
Cavities
Toddlers Diarrhea
Poor diet quality
Vitamin D and Calcium
Deficiency
Low fiber intake

 AAP RECOMMENDATIONS
< 6 months of age: no juice
6 -12 months: can drink up to
4 to 6 ounces of juice, but only
in a cup, not a bottle
1 to 6 years: not more than 4
to 6 ounces of juice
> 6 years: not more than 8 to
12 ounces of juice
Encourage children to eat whole
fruits
Encourage children to drink
water

GOVERNMENT PROGRAMS
FOR CHILDREN
1. USDAs Child and
Adult Care Food Program (CACFP)
2. Head Startenhanced day care w/medical, dental,
mental health and nutritional services as
well as parent outreach
3. WIC Program: Pregnant/Lactating Women
and children up to 5 years.
http://wicworks.nal.usda.gov/
ACTIVITY- PLAN ONE DAY MENU
http://www.cdph.ca.gov/programs/wicworks/
Documents/NE/WIC-NE-EdMaterialsFeedMeAge4to5.pdf

FEEDING SCHOOL-AGED
CHILDREN
Slow steady growth
School lunches
Home-packed lunches
Restaurants
Snacks vs. treats
Competitive foods

FOOD PATTERNS
-CHILDHOOD
o Explosion of products that are
available commercially.
o Less milk, more soda, juice and
assorted drinks
o More energy from snacks
o Less eating at home

RESTAURANT AND
MAGAZINE
http://site.burtonsgrill.com/bchoosy-children-menu/

http://www.chopchopmag.org/

http://www.chopchopmag.org/recipe
s/fish-tacos

 http://ctcf.org/why-cooking-togethercooking-forever.php

HEI
In class activity

HEI-2010 COMPONENTS
AND SCORING SYSTEM

HEI RESULTS FOR

CHILDREN- 2010
Ulearn Site

AGE GROUPS: SCHOOL AGE

USDA: National School
Lunch Program:
1/3 of daily DRI
Improvement seen with SCHOOL
WELLNESS COUNCILS
Packed lunches monotonouspreferred foods packed often,
non-perishable foods needed

SCHOOL LUNCHES
AROUND THE WORLD

http://www.stumbleupon.com/su/2ifK
Gx/todayilearned.co.uk/2011/04/20/
what-kids-of-the-world-eat-at-school/

Changes in Minimum Amounts and Types of

Food: Lunch
Food
Group

Current
Requirement

New
Recommendation
3/4 1 cup of vegetables
plus
1/2 1 cup of fruit per day

Fruit and
Vegetables

1/2 - 1 cup of fruit

and vegetables
combined

Vegetables

No specifications as Weekly requirements for

to type of
dark green and orange
vegetable
vegetables and legumes

Meat/Meat
Alternates

Grains

1.53 oz
1.62.4 oz equivalents
equivalents (daily
(daily average over 5-day
average over 5-day
week)
week)
1.83 oz
1.82.6 oz equivalents
equivalents (daily
(daily average over 5-day
average over 5-day
week)
week)

Whole Grains Encouraged

At least half of the grains to

be whole grain-rich

Milk

1 cup, 1% fat or less

1 cup

SCHOOLS
o Many resources have been
devoted to nutrition ed
o Largely unsuccessful unless
parents were included
o Better success w/ changing the
food and providing opportunity
for physical activity

VIDEOS

http://www.whitehouse.gov/
champions/chefs/timothycipriano
http://www.youtube.com/wa
tch?v=ovO18E-hgew
http://www.youtube.com/wa
tch?v=TArHCS_GbhE

FARM TO SCHOOL

CHILD NUTRITION
REAUTHORIZATION HEALTHY,
HUNGER-FREE KIDS ACT 2010

o Increases access to healthy food

for low-income children
o What is the goal?
Reduction of childhood
obesity and
improved nutrition

USDA AND 2010 ACT

o Nutritional standards for all foods
sold in schools, including vending
machines, a la carte lunch
lines, and school stores.
o Additional funding to schools that
meet updated nutritional
standards for federally-subsidized
lunches.
o Promote farm-to school networks,
create school gardens,.

o Expands access to drinking water

in schools, particularly during
meal times (free water)

VITAMIN D
Produced in the skin after
exposure of 7-dehydrocholesterol
to sunlight
Promotes intestinal calcium
absorption

FOOD SOURCESVITAMIN D

Fish: 3.0-3.5 ounces:

Catfish
Salmon, Mackeral
Sardines in oil
Tuna in oil

425 IU
350 IU
450IU
235IU

Whole egg 41IU

Fish liver oils, e.g.,cod liver
oils,
1 TBLS, 1360 IU

Mushrooms are only vegan

source: 14 iu for 100g

HTTP://WWW.YOUTUBE.COM/
WATCH?V=BKJMZEEQULE

FOOD ALLERGIES

o Food allergies most often

manifest in infancy and
childhood. Prevalence: 48%
o Allergic responses include
respiratory or
gastrointestinal
symptoms, skin reactions,
fatigue, or behavior
changes

FOOD ALLERGIES
IN CHILDHOOD
o Milk, egg, wheat, soy, peanuts, tree
nuts, fish, shellfish 90% of
allergies
o Milk, egg, wheat, soy & peanut are
most common in childhood
o Allergy to CMP is most common in
infants including infants who are
breastfed.

August 5, 2010

56

INCIDENCE & PREVALENCE

OF FOOD ALLERGIES IN
CHILDHOOD
1997-2007 Report from Centers for
Disease Control:
oIncidence: Increase of 18%
o50% increase in peanut allergy
oPrevalence: 4-8% of children and
~ 2% of adults

August 5, 2010

57

FOOD ALLERGY

oAdverse immune response

to the protein in a food
oMolecular weight
dependent

August 5, 2010

58

IMMUNOGLOBULINS
(ANTIBODIES)
o Made by the immune system
o Attach to a specific antigen
o Make it easier for immune cells
o to destroy the antigen
o Specific to each substance and
have memory
o http://www.insidermedicine.com/ar
chives/VIDEO_If_I_Had_A_Food
_Allergy_Dr_Leslie_Grammer_MD_
Northwestern_University_School_
of_Medicine_Feinberg_School_of_
Medicine_3507.aspx

IMMUNE RESPONSE
Immune reaction to bacteria,
viruses, dander, etc.
Mast Cells can also react to
ordinarily harmless foods.
Chemical reaction occurs.
This overreaction
symptoms
from mild (hives) to severe
(anaphylactic shock).

August 5, 2010

60

HEREDITY AND ATOPY

Chance of developing food allergy:
o 5-15%: no atopic parent
o 20-40%: one atopic parent
(stronger maternal influence)
o 40-60%: both parents atopic
o 25-35%: one sibling but neither
parent atopic

August 5, 2010

61

PREVIOUS AAP GUIDELINES

ALLERGY PREVENTION

o In place for >30 years:

o All Infants to12 mos: avoid:
o CMP (milk, yogurt, cheese and
foods containing CMP)
o peanuts
o egg whites

August 5, 2010

62

REPLACES EARLIER AAP

POLICY STATEMENT
Effects of Early Nutritional
Interventions on the Development
of Atopic Disease in Infants and
Children:
The Role of Maternal Dietary
Restriction, Breastfeeding,
Hydrolyzed Formulas and Timing
of Introduction of Complementary
Food

Greer FR, Sicherer S, Burks W and Committee on Nutrition and Section on

Allergy and Immunology. Pediatrics 2008;121;183-91

August 5, 2010

63

2008 AAP POLICY STATEMENT

Children not at risk for

allergies: No evidence the
following prevents food
allergies:
Maternal pregnancy/lactation
restriction of food allergens
Delayed solids beyond 6
months
Restriction of specific foods
until after 12 months of age
This includes highly allergenic
foods such as eggs, peanut, fish
64

TREATMENT- TEAM
APPROACH
o Avoidance of allergens
o Diet substitutions
o Nutritional Supplementation if
necessary, e.g., Ca++, Vit D
o Recipes- palatability, cost
o Shopping Guidance
o Psychological Support

PREVENTING CHRONIC
DISEASE

Roots of chronic diseases in adults,

such as heart disease, cancer,
diabetes, and obesity.

Diet quality and calories

Calcium and bone health
Fiber
Sodium
Physical activity

OVERWEIGHT/OBESITY
Increasing prevalence more so
among poor families/minorities
Influences:
access to food

competitive foods
eating tied to leisure
activities
children making food decisions
portion sizes
inactivity/ TV passive
activity

OVERWEIGHT/OBESITY

BMI >85th%:
overweight
BMI >95th%: obese
Persistence of obesity
into adulthood

OBESITY INCREASES
RISK
Cardiovascular and Metabolic
Disorders:
Hyperlipidemia
Hypertension
Type 2 Diabetes
Fatty Liver

Steatohepatitis

MULTICENTER STUDYNAFLD
Subjects:
131 children with NAFLD 1995 to
2007
5 centers in US &Canada
Incidence:
9% if normal weight and 38% if obese

Age range: 4-18 years

INTERVENTIONS FOR
CHILDHOOD OBESITY
o Family involvement
o Dietary modifications
o Nutrition information
o Physical activity
o Behavioral strategies
o Prevention

Staged Care Treatment

based on BMI- p. 387- Read
p. 387-88
1.

PREVENTION PLUS

Healthy diet and activity

practices:
> 5 Fruits and vegs/day
Limit SSBs
Be active for >60
minutes/day
Limit screen time to <2
hours/day
Advice tailored to teens
Delivered by single
provider

Stage 2- SWM

Similar advice but

more structure for
accountability

Food and Exercise

Logs

Limit screen time

to <1 hour

Meal plan

Non-food rewards

Health care
provider w/
training in pedi
behavioral health
care

Possible referral
to PT or
counseling

Stage 3Comprehensiv
e
Multidisciplina
ry Education

Multidisciplinar
y Team

8-16 weeks w/
child and family

Highly
structured
meal plan, PA
schedule and
formal behavior
mod program

Group Weight Management for

Children 8-12- Criteria for
Effectiveness
Treatment

of long duration, > 16

weeks
Nutritional

education w/ structured

diet
Psychological
Physical
Parents

intervention

activity component
are the agents of change

Children

and parents treated in 2

separate groups
Some

evidence: parents treated

alone with children omitted from

treatment even more effective

TELEVISION VIEWING
TIME AND ADS

Pre-school ~27 hours per

week
School age - ~ 23 hours per
week
o Ads for fastfood/soda/drinks
& convenience food
o Children cant distinguish
between ads and programs

TV AND CHILDREN
AAP recommendation:
No TV less than 2 years of age
2 hours or less in children
Major association with hours of TV and
obesity

Snack eating shown more often than

B,L,D combined

PHYSICAL ACTIVITY

o Helps control weight

o Helps with learning
o Improves strength/endurance
o Reduces stress
o Build bone mineral density

GUIDELINES

IOM: 60 minutes per day of

moderate to vigorous PA

FAT AND
CARDIOVASCULAR RISK
o High saturated/trans fat diet
o High blood cholesterol
o Atherosclerosis can begin in
childhood and adolescence

AAP AND FAT

After 2, begin
gradually reducing
fat until diet
provides 30% of
calories from fat by
age 5

NATIONAL CHOLESTEROL
EDUCATION PROGRAM (NCEP)
Recommendations for Children
> 2 yrs of age same as for
adults
No more than 30% of calories
from fat
Guidelines for how much should
be sat., unsat., polys