Dr. Azizah FKG - Nutrition in Infancy & Childhood

11/03/2014
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Life Cycle Nutrition:
Infancy & Childhood
2008 Thomson - Wadsworth
Outlines
Nutrition during Infancy
Energy and Nutrient Needs
Breast Milk
Infant Formula
Special Needs of Preterm
Infants
Introducing Cows Milk
Introducing Solid Foods
Mealtimes with Toddlers
Nutrition during Childhood
Hunger and Malnutrition in
Children
The Malnutrition-Lead
Connection
Hyperactivity and Hyper
Behavior
Food Allergy and Intolerance
Childhood Obesity
Mealtimes at Home
Nutrition at School
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Nutrition during infancy
The first year of life is a time of rapid growth &
development.
Breast milk or iron-fortified formula is the primary food
the first year with gradual introduction of solids beginning
at 6 months of age.
Preterm infants have very special nutrient needs.
Mealtimes with toddlers should be a pleasant and relaxed
environment.
Introduction
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Babys birth weight
2x5 months
3x1 year
Infants length changes more slowly
10 inches (from birth 1 year)
Energy requirement: high 2x adults (based on body
weight)
Newborn 450 kcal/d; adults 2000 kcal/d
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Infants Adults
Heart rate 120 140 70 80
Respiration rate 20 40 15 20
Energy needs 100 kcal/kg <40 kcal/kg
Comparison
Energy & nutrient needs
Energy Intake & Activity
Weight doubles the 1
st
5 months, triples by 1 year
High basal metabolic rate
Rapid growth
45 kcal/pound body weight
Energy Nutrients
Carbohydrates at 60%of energy intake, needed for
brain
Fat provides most of the energy
Protein especially important for growth and
development
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Vitamins & Minerals
More than double the needs of an adult in
proportion to weight
Vitamin A, vitamin C, vitamin D and iodine are
especially high
Water
Higher %of water compared to adults
Found outside the cells and easily lost
Dehydration from diarrhea and vomiting is a
concern
Energy & nutrient needs
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Breast milk
Frequency & Duration of Breastfeeding
First few weeks: 8-12 feedings per day on demand
Every 2 3 hours
10-15 minutes on each breast
Energy Nutrients
Lactose, the form of carbohydrate in breast milk,
enhances calcium absorption.
Alpha-lactalbuminis the form of protein in milk and
is easily digested and absorbed.
Fat is generous in essential fatty acids.
Vitamins
Vitamin D content is low.
Vitamin D supplementation is recommended by
AAP for breastfed infants.
Breast milk
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Minerals
Calcium is well absorbed
High bioavailability of iron and zinc
Low in sodium and fluoride
Supplements
Vitamin D, iron and fluoride during first year
A single dose of vitamin K is given at birth.
Breast milk
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Immunological Protection
Colostrum, the first secretions from the breast,
provides antibodies and white blood cells.
Bifidus factors allow for the growth of normal flora.
Lactoferrin is a protein that binds iron so that
bacteria cannot grow.
Lactadherin is a protein that fights viruses that
cause diarrhea.
Breast milk also contains growth factors and lipase
enzymes.
Breast milk
Allergy and Disease Protection
Fewer allergies than formula-fed babies
Lower blood pressure as adults
Lower blood cholesterol as adults
Other Potential Benefits
Less obesity as adults
Indications of positive effect on later intelligence
Breast milk
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Infant formula
Infant Formula Composition
Infants can be weaned to formula or other
appropriate foods when breastfeeding is ended.
Copy breast milk if possible
Iron-fortified
Risks of Formula Feeding
Be careful about lead-contaminated water.
Contains no antibodies
Use proper food handling techniques.
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Infant formula
Special Formula
For premature infants or those with inherited diseases
Hypoallergenic formulas or soy formulas for infants with allergies
Soy formulas for lactose intolerance and vegans
Inappropriate Formulas
Soy beverages are nutritionally incomplete and inappropriate.
Goats milk is deficient in folate.
Nursing Bottle Tooth Decay Formulas
Can be caused by formula, milk, or juice
Prolonged exposure to formula when sleeping
Upper and lower teeth may be affected by decay
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Introducing Cows Milk
No cows milk the first year
Contains the protein casein and may cause intestinal
bleeding and anemia in the first year of life
Whole cows milk from 1-2 years of age
Reduced-fat cows milk gradually introduced between 2-5
years of age
When to Begin
6 months
Timing varies from infant to infant depending on growth
rates, activities, and environmental conditions.
Food Allergies
Introduce single-ingredient foods, one at a time.
Period of 4 to 5 days between new foods
Rice cereal, then oat and barley, and lastly wheat
Allergic reactions include skin rash, digestive upset, or
respiratory discomfort.
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Choice of Infant Foods
Should be provided with variety, balance, and moderation
Palatable and nutritious
No added salt, sugar, or seasonings
Safe & convenient
Foods to Provide Iron
Iron-fortified cereals with vitamin C-rich foods and juices
Meat or meat alternatives such as legumes
Foods to Provide Vitamin C
Vegetables first, then fruits
Set limits on fruit juice consumption at 4-6 ounces per day.
Foods to Omit
Concentrated sweets
Products with sugar alcohols (sorbitol) that may cause
diarrhea
Canned vegetables contain too much sodium.
There is a botulism risk with honey and corn syrup.
Choking hazards from carrots, cherries, gum, hard or gel-like
candies, hot dogs, marshmallows, nuts, peanut butter,
popcorn, raw celery, whole beans, and whole grapes
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Foods at One Year
2-3 cups cows milk
Be careful of milk anemia when milk is consumed
excessively.
Balance and variety from all food groups
Drink liquids from a cup, not a bottle
Mealtimes with Toddlers
Discourage unacceptable
behavior.
Let toddlers explore and
enjoy food.
Dont force foods.
Let children choose
nutritious foods.
Limit sweets.
Make mealtimes pleasant.
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Nutrition during childhood
Introduction
Energy needs, nutrient needs, and appetites during
childhood vary because of growth and physical activity.
Hunger and nutrient deficiencies affect behavior.
Nutrition concerns at this age include lead poisoning, high
energy, sugar and fat intakes, iron deficiency, caffeine
consumption, food allergies, and food intolerances.
Adults and schools need to provide children with
nutrient-dense foods.
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Energy Intake and Activity
Needs vary widely because of growth and physical activity.
Energy requirements:
1 year: 800 kcalories
6 years: 1,600 kcalories
10 years: 2,000 kcalories
Inactivity can lead to obesity.
Vegans may have difficulty in meeting energy needs.
Carbohydrate and Fiber
Carbohydrate recommendations are the same as those for
adults.
Fiber intakes change with age.
Fat and Fatty Acids
Children 1-3 years should have 30-40%of energy from fat.
Children 4-18 years should have 25-35%of energy from fat.
Low-fat diets may have low vitamin and mineral content.
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Protein
Needs increase slightly with age
Requirement considers nitrogen balance, the quality of
protein consumed, and the added needs of growth
Vitamins and Minerals
Needs increase with age.
Balanced diet meets all needs except iron
Iron-fortified foods are important.
Supplements
Rely on foods
Supplements not needed
Planning Childrens Meals
Variety of foods from each food group
Proper portion sizes
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Hunger & Malnutrition in Children
Hunger and Behavior
Missing meals, especially breakfast, affects behavior and
academic performance.
Low blood glucose, smaller glycogen stores
Iron Deficiency & Behavior
Affects behavior and intellectual performance
Affects attention span and learning ability
Brain is affected by low iron before the blood is affected.
Other Nutrient Deficiencies and Behavior
Marginal malnutrition may affect behavior.
Affects personal appearance also
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Food Allergy (food-hypersensitivity reactions)
& Food Intolerance
Detecting Food Allergy
Immunologic response with the production of antibodies,
histamines, and other defensive agents
3-5%of children are diagnosed
Asymptomatic allergy produces antibodies without
symptoms
Symptomatic allergy produces antibodies and symptoms
Food Allergy & Intolerance
Food Labeling
Eight common allergens (eggs, milk, soy, peanuts, tree nuts,
wheat, fish, and shellfish) must appear on a food label.
If cross-contamination is possible, this must be stated on the
label.
Food Intolerances
Adverse reactions to foods like stomachaches, headaches,
rapid pulse rate, nausea, wheezing, hives, bronchial irritation,
coughs, and other discomforts are not all food allergies.
Symptoms without antibody production
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Childhood Obesity
Childhood Obesity
Genetic and Environmental Factors
Parental obesity is a risk factor. Parents act as role
models.
Poor diet and physical inactivity are risk factors.
Convenience foods and meals eaten away from
home
Non-nutritious choices at school
Sedentary activities, e.g. watching television
Energy-dense soft drinks
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Percentage of children classified as overweight
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Childhood Obesity
Growth
Grow taller at first, then stop growing at a shorter height
Greater bone and muscle mass to support weight, thus
stocky appearance
Physical Health
Abnormal blood lipid profile
Increases the risk for high blood pressure, type 2 diabetes,
and respiratory disease
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Childhood Obesity
Psychological Development
Emotional and social problems
Stereotypes & discrimination
Prevention and Treatment of Obesity
Integrated approach with diet, physical activity, psychological
support, and behavioral changes
Begin early treatment before adolescence
Childhood Obesity
Diet
Reduce rate of weight gain, rather than attempt weight loss
Strategies
Serve kcalorie-controlled family meals.
Involve children in shopping and preparing meals.
Encourage children to eat when hungry, eat slowly, enjoy food, and
stop eating when full.
Teach them to select nutrient-dense foods.
Limit high-fat and high-sugar foods.
Never force children to clean plates.
Plan for nutritious snacks.
Discourage eating while watching television.
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Dietary Recommendations for Children
Moderation, Not Deprivation
Less saturated fat
More fruits and vegetables
Nuts, vegetable oils, and some fish provide essential fatty acids.
Treat problems with diet first, then drugs.
Childhood Obesity
Physical Activity
Active children have better lipid profiles.
Habits developed at this age are carried into later life.
Limit sedentary activities.
Encourage regular vigorous activity.
Parents need to set good examples.
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Childhood Obesity
Psychological Support
Weight-loss programs with parental involvement
Positive influence on eating behaviors
Behavioral Changes
Focus on how to eat
Parental and media influence
Teaching consumer skills
Mealtimes at Home
with parents as gatekeepers
Honoring Childrens Preferences
Offer variety of foods
Fun mealtimes
Learning through Participation
Help plan meals
Assist with food preparation
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Mealtimes at Home
Avoiding Power Struggles
Children need to regulate their own food intakes.
Can determine their own likes and dislikes
Offer new foods at the beginning of meals and in small
quantities.
Choking Prevention
Be alert to foods that are common causes of choking.
Make sure children are sitting, not running or in danger of
falling when eating.
Mealtimes at Home
Playing First
Schedule outdoor play before meals.
Relax and take time while eating.
Snacking
Teach how to snack
Limit access to concentrated sweets.
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Mealtimes at Home
Preventing Dental Caries
Brush and floss after meals.
Brush or rinse after snacks.
Avoid sticky foods.
Select crisp and fibrous foods.
Serving as Role Models
Children learn through imitation of parents, older siblings,
and care givers.
Help children to develop positive attitudes toward food and
eating.
Nutrition at School
Meals at School
Breakfast and lunch at a reasonable cost
Some free and reduced cost to low-income
children
Offer variety of choices
1/3 RDA for energy, protein, vitamin A, vitamin C,
iron, and calcium
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Nutrition at School
Competing Influences at School
Short lunch periods and long lines
Snack bars, school stores and vending machines
State laws and school policies
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Reference
Whitney E, Rolfes SR. Life Cycle Nutrition: Infancy,
Childhood & Adolescence, in: Understanding Nutrition12th
ed. Intl student ed. Thomson Learning Inc., USA. 2011, pp
529 59.

Dr. Azizah FKG - Nutrition in Infancy & Childhood

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