Nutrition Health and Well-being

Abstract
Good nutrition is essential for survival, physical growth, mental
development, performance, productivity, health and well-being across
the entire life-span: from the earliest stages of foetal development, at
birth, and through infancy, childhood, adolescence and on into
adulthood. Poor nutrition in the first 1,000 days of children’s lives can
have irreversible consequences. For millions of children, it means they
are, forever, stunted. Every infant and child have the right to good
nutrition according to the Convention on the Rights of the Child; so, the
World Health Assembly has adopted a new target of reducing the
number of stunted children under the age of 5 by 40 percent by 2025.
The first 2 years of a child’s life are particularly important, as optimal
nutrition during this period lowers morbidity and mortality, reduces the
risk of chronic disease, and fosters better development overall.
Breastfeeding and complementary feeding are a critical aspect of caring
for infants and young children.
Key Words: Breastfeeding, Infant, Nutrition, Child Health.

Nutrition health and well-being during infancy

1- Introduction
6.6 million children under the age of five
died in 2012 - more than 750 every hour.
Most of these children could survive and
thrive with access to simple, affordable
interventions. The loss of a child is a
tragedy - families suffer and human
potential is wasted. WHO is improving
child health by helping countries deliver
 integrated, effective care in a continuum, starting with a healthy
pregnancy for the mother, through birth and care up to five years
of age? Investing in health systems is a key to delivering this
essential care

2- Materials and Methods

The current study is a review survey which was conducted to
evaluate of Infant and Young Child Feeding in the world by
studying WHO website, Canters for Disease Control and
Prevention (CDC), United Nations Children's Fund (UNICEF) and
United Nations (UN) websites and scientific texts about this
subject. To evaluate the texts and websites, the singular or
combination forms of the following key words were used: “Child
feeding”, “Infant feeding” “Worldwide” and “Nutrition”. To evaluate
the electronic databases the following websites were searched:
Google, Ministry of Healthcare, Google Scholar, Scopus and
PubMed. Library search was performed by referring to the journal
archives of libraries, and evaluating the available Persian and
English references and also, articles of research-scientific journals,
and articles of the annual seminar of Nutrition and Public health.

3- Results
3.1: Key facts about infant feeding
•Every infant and child have the right to good nutrition according to the
Convention on the Rights of the Child.
• Undernutrition is associated with 45% of child deaths.
• Globally in 2013, 161.5 million children under 5 were estimated to be
stunted, 50.8 million were estimated to have low weight-for height, and
41.7 million were overweight or obese
• About 36% of infants 0 to 6 months old are exclusively breastfed.
• Few children receive nutritionally adequate and safe complementary
foods; in many countries less than a fourth of infants 6–23 months of
age meet the criteria of dietary diversity and feeding frequency that are
appropriate for their age.
• About 800 000 children's lives could be saved every year among
children under 5, if all children 0– 23 months were optimally breastfed
(2)

First foods for infants

From around six months, babies need solid food in addition to breast
milk or formula, for adequate nutrients and energy. Introducing solid food
at this age is also important to help
children develop skills required for eating
such as chewing.

Foods provided to infants in long day care

should be nutritious and of appropriate
textures for their ages and developmental
stages. See ‘Food textures and
consistencies for age and developmental
stage’ on the next page.

The daily menu should offer a variety of age-appropriate nutritious foods

each day for adequate energy and nutrients.

Iron

In line with the Infant Feeding Guidelines, to prevent iron deficiency,

nutritious foods that contain iron should be among the first foods
introduced. Iron-rich foods include iron-fortified infant cereals, pureed
meat, poultry and fish, egg, cooked plain tofu and legumes (e.g.,
chickpeas, red, green or brown lentils, split peas) and beans (e.g.,
kidney beans, navy beans, broad beans, azuki beans, mung beans, lima
beans, pinto beans).
As long as foods that contain iron are among the first foods introduced,
other nutritious foods can be introduced in any order and at any rate that
suits the infant. Although cow’s milk products (including full-fat yoghurt,
cheese and custard) may be given, cow’s milk should not be provided as
a main drink before 12 months.

By 12 months of age infants should be enjoying a variety of nutritious

foods from the five food groups, and eating from the regular daily menu.
Breast milk or infant formula should be continued while introducing
solids. Long day care services should ensure they have sufficient stock
of expressed breast milk or infant formula (provided by families) to
support infants’ needs.

Note
Mashed vegetables are a good source of nutrients for infants, but do not
provide the iron that babies need for growth and development. To
prevent iron deficiency, include iron-rich foods in the menu for babies
each day, such as:

• iron-fortified infant cereal

• pureed meat, poultry and fish
• cooked plain tofu and legumes (e.g., chickpeas, red, green or
brown lentils, split peas) and beans (e.g., kidney beans, navy
beans, broad beans, azuki beans, mung beans, lima beans, pinto
beans).

Food textures and consistencies for age and developmental stage

Increasing and varying food texture for infants is essential for their oral
motor development (e.g., learning skills required for eating, such as
chewing) and to help them accept different food textures. It is important
to always offer foods that are an appropriate texture and consistency for
infants’ developmental stages. This means progressing quickly through
the puree/mashed phase and offering foods with varied textures.

Infants should be introduced to a

variety of foods of different colours
and flavours (e.g., coloured fruit and
vegetables). If foods are pureed or
mashed (e.g., soft vegetables), they
should not be mashed together but
should be presented individually
either in pieces or on a spoon to
encourage infants to taste and accept individual flavours.

The following can be used as a guide for preparing foods of appropriate

texture for children in care.

• From around 6 months – offer coarsely pureed/mashed foods,

progressing to lumpy and finely chopped options.
• By 8 months – offer chopped and finger foods to encourage
children to start feeding themselves.
• By 12 months – offer foods from the regular menu with a variety of
tastes and textures in children’s size portions.

Drinks for infants – birth to one year and beyond

Breast milk or infant formula should be the main drink in the first 12
months of life. From around 6 months, small amounts of cooled, boiled
tap water can supplement breast milk or infant formula.

After 12 months, water and full cream cow’s

milk should be the main drinks offered at
long day care. Tap water is an important
source of fluoride for young children. Clean
and safe tap water should be offered where
available.
Low fat and reduced fat milks are not recommended in the first 2 years
of life, but are suitable for children over the age of 2 years.
What not to include on the menu for infants

When providing food and drinks for infants in care it is important to keep
the following in mind:

• For the first three years of life, avoid giving foods with a high risk of
choking. Always supervise children during meal and snack times.
• Cow’s milk should not be given as the main drink before 12
months of age.
• Salt and sugar should not be added to infants’ food. Offering sweet
and salty foods in early childhood can result in children developing
a preference for these foods which may be carried into later life.
• Infants should not be given foods with high levels of saturated fat,
added sugar and/or added salt (e.g., cakes, biscuits, confectionery
and potato chips).
• Honey should not be given to babies, as it may contain bacterial
spores that can cause infant botulism if given to babies under 12
months of age.
• Sweet drinks like fruit juice and fruit drinks, flavoured milk, soft
drinks and cordials should not be given to infants and children.
These drinks add sugar to the diet and can increase the risk of
children becoming overweight and developing oral health
problems.
• Tea (including herbal tea) and coffee are not appropriate drinks for
infants and children.

Special diets

Allergies

There is emerging evidence that delaying the introduction of solids

beyond 7 months of age can increase allergies (particularly introducing
allergens like wheat, egg, nuts, soy, fish and cow’s milk). Avoidance of
egg, peanuts and other nuts, wheat, cow’s milk and fish are no longer
routinely recommended, even in children with a family history of allergy.
Some families may request that their children are not given specific
foods because of fear of allergies. This should be discussed with
families and health professionals as required.
Appropriate complementary foods should be provided for children with a
diagnosed food allergy.

Plant-based diets

Plant-based diets, such as vegetarian and vegan diets, may not provide
babies with enough important nutrients like iron, zinc and vitamin B12.
The use of iron-fortified foods, such as iron-fortified cereals, is especially
important for babies eating a plant-based diet because iron is vital for
their neurocognitive development.

Advice from a health professional (such as a dietitian) may be required

to ensure that the diet of vegetarian and vegan babies includes enough
of these important nutrients. This should be discussed with parents.

Adapting the menu for infants

Providing a menu that meets the nutrition and developmental needs of

infants and young children does not need to be a difficult task.
By making simple changes to your regular menu, you can provide tasty
meals and snacks that are appropriate for infants’ developmental
stages.

Important points for food and drinks for babies:

• Include iron-rich foods such as meat, chicken, fish, tofu and

legumes every day.
• Don’t delay introducing meat.
• Move on from smooth mashed and pureed foods, to minced and
chopped foods as soon as possible. Encourage finger foods and
self-feeding from around 8 months.
• Encourage a variety of colourful fruit and vegetables.
 • It can be easy – just modify the regular centre menu.

Nutrition Health and well-being of pre-school children

Pre-schooler Nutrition

Helpful feeding information for your pre-schooler

Preschool-age children (ages 3 to 5) are still developing their eating

habits and need encouragement to eat healthy meals and snacks.
These children are eager to learn. They will often imitate eating
behaviours of adults. They need supervision at mealtime as they are still
working on chewing and swallowing skills.

These are some helpful mealtime hints for preschool-age children:

• Make meals, give regularly scheduled snacks, and limit unplanned

eating.
• Discourage poor behaviour at mealtime. Focus on eating, not
playing with food, or playing at the dinner table.
• Running or playing while
eating can cause a child to
choke. Have your child sit
when eating.
• Keep offering a variety of
foods. Have the attitude that,
sooner or later, your child will
learn to eat almost all foods.
• Make mealtime as pleasant
as possible. Don't put pressure on your child to eat. Don't force
your child to "clean" his or her plate. This may lead to overeating,
which can cause your child to gain too much weight. Children will
be hungry at mealtime if snacks have been limited during the day.
• Provide examples of healthy eating habits. Pre-schoolers copy
what they see their parents doing. If you have unhealthy eating
habits, your child will not learn to eat healthy.
Healthy food choices

The MyPlate icon is a guideline to help you and your child eat a healthy
diet. MyPlate can help you and your child eat a variety of foods while
encouraging the right number of calories and fat.

The USDA and the U.S. Department of Health and Human Services
have prepared food plates to help parents select foods for children age
2 and older.

The MyPlate icon is divided into 5 food group categories, emphasizing

the nutritional intake of the following:

• Grains. Foods that are made from wheat, rice, oats, cornmeal,
barley, or another cereal grain are grain products. Examples
include whole-wheat, brown rice, and oatmeal. Aim for mostly
whole-grains.
• Vegetables. Vary your vegetables. Choose a variety of colourful
vegetables. These can include dark green, red, and orange
vegetables, legumes (peas and beans), and starchy vegetables.
• Fruits. Any fruit or 100% fruit
juice counts as part of the fruit
group. Fruits may be fresh,
canned, frozen, or dried, and
may be whole, cut up, or
pureed. The American
Academy of Paediatrics
recommends no more than 4
ounces of juice per day for
children 1 to 3 years of age, and 4 to 6 ounces per day for children
4 to 6 years of age.
• Dairy. Milk products and many foods made from milk are
considered part of this food group. Focus on fat-free or low-fat
products, as well as those that are high in calcium.
 • Protein. Go lean on protein. Choose low-fat or lean meats and
poultry. Vary your protein routine. Choose more fish, nuts, seeds,
peas, and beans.
Oils are not a food group, yet some, like nut oils, have essential nutrients
and can be included in the diet. Animal fats, which are solid fats, should
be avoided.

Encourage exercise and everyday physical activity with a healthy dietary

plan.

Nutrition and activity tips

Here are some tips to follow:

• Try to control when and where food is eaten by your children by

providing regular daily meal times. Include social interaction and
demonstrate healthy eating behaviours.
• Involve children in the choosing and preparing of foods. Teach
them to make healthy choices by helping them to pick foods
nutritious based.
• Select foods with these nutrients when possible: calcium,
magnesium, potassium, and fibre.
• Most Americans need to cut the number of calories they consume.
When it comes to weight control, calories do count. Controlling
portion sizes and eating no processed foods helps limit calorie
intake and increase nutrients.
• Parents are encouraged to provide recommended serving sizes for
children.
• Parents are encouraged to limit children’s screen time to less than
2 hours daily. Instead, encourage activities with that call for more
movement.
• Children and adolescents need at least 60 minutes of moderate to
vigorous physical activity on most days for good health and fitness
and for healthy weight during growth.
• To prevent dehydration, encourage children to drink fluid regularly
during physical activity and drink several glasses of water or other
fluid after the physical activity is completed.

Nutrition: School-Age

Helpful feeding information for your school-age child

School-age children (ages 6 to 12) need healthy foods and nutritious
snacks. They have a steady but slow rate of growth and usually eat 4 to
5 times a day (with snacks). Many food habits, likes, and dislikes are set
during this time. Family, friends, and the media (chiefly TV) effect their
food choices and eating habits. School-age children are often willing to
eat a wider variety of foods than their younger siblings. Eating healthy
after-school snacks is important, too, as these snacks may contribute up
to one-fourth of the total calorie intake for the day. School-age children
can also help with meal prep.

Helpful mealtime hints for school-age children

These are some helpful mealtime hints:

• Always serve breakfast, even if it has to be "on the run." Some

ideas for a quick, healthy breakfast include:
o Fruit
o Milk
o Bagel
o Cheese toast
o Cereal
o Peanut butter sandwich
• Take advantage of big appetites after school by serving healthy
snacks, such as:
o Fruit
o Vegetables and
dip
o Yogurt
o Turkey or chicken
sandwich
o Cheese and
crackers
o Milk and cereal
• Set good examples for eating habits.
• Let children help with meal planning and preparation.
• Serve meals at the table, instead of in front of the TV, to avoid
distractions.

OVERVIEW OF CHILDREN’S NUTRITION-RELATED HEALTH

CONCERNS
The rising rate of obesity in children has become a major health
concern, both because of its impact on childhood health and its potential
effect on the development of chronic disease in adulthood. Obesity
status is usually indicated by the body mass index (BMI), which is a
measure in which weight is adjusted for height. More specifically, BMI is
defined as weight in kilograms divided by height in meters squared. For
adults, weight status is based on the absolute BMI level, and in children
BMI percentile. BMI measurements in children adjust the children’s
weight and stature by their age and gender. In this report, the term
“obesity” is used to refer to children and adolescents who have a BMI at
or above the age and sex-specific 95th percentile of the BMI charts
developed by the centres for Disease Control and Prevention (CDC) in
2000. Those children and adolescents who have a BMI between the
85th and 95th percentile for age and sex are termed at risk for obesity.
In most children and youth, a BMI level at or above the 95th percentile
indicates elevated body fat and reflects the presence or risk of related
chronic disease (IOM, 2005b, 2007).
Trends in Childhood Obesity
Childhood obesity has been increasing steadily, particularly during the
past two decades. The number of children above the 95th percentile of
weight for height has tripled among those in the age bracket of 12 to 19
years, rising from 5 percent in 1976–80 to 17 at
present (Ogden et al., 2002, 2006). The National
Health and Nutrition Examination Survey
(NHANES) III (1988–1994) found an increase from
7 to 11 percent in obesity for 6- to 11-year-old
children, compared to NHANES II a decade earlier
(1976–1980) (Ogden et al., 2002). Further
NHANES survey data (1999–2004) confirmed the
continued rise in obesity. Another 15 percent of
children and adolescents are estimated to be at risk for obesity (85th to
95th percentile), making a third of children and adolescents obese or at-
risk for obesity (Ogden et al., 2002, 2006). These trends are shown
in Figure 2-1.
Although childhood obesity has increased in every demographic
population group in the United States, some have been more affected
than other
FIGURE 2-1 Trends in child and adolescent obesity in males and
females aged 6–19 years.

Healthy Eating Habits for Children

• Guide your family's choices rather than dictate foods. Make a

wide variety of healthful foods available in the
house. This practice will help your children learn
how to make healthy food choices. Leave the
unhealthy choices like chips, soda, and juice at the
grocery store. Serve water with meals.
• Encourage your children to eat slowly. A child can
detect hunger and fullness better when they eat slowly. Before
offering a second helping or serving, ask your child to wait at least 15
minutes to see if they are truly still hungry. This will give
the brain time to register fullness. Also, that second helping should
be much smaller than the first. And if possible, load that second
helping with more veggies
• Eat meals together as a family as often as possible. Try to make
mealtimes pleasant with conversation and sharing, not a time for
scolding or arguing. If mealtimes are unpleasant, children may try to
eat faster to leave the table as soon as possible.
They then may learn to associate eating with stress.
• Involve your children in food shopping and
preparing meals. These activities will give you hints
about your children's food preferences, an
opportunity to teach your children about nutrition, and
 provide your kids with a feeling of accomplishment. In addition,
children may be more willing to eat or try foods that they help
prepare.
• Plan for snacks. Continuous snacking may lead to overeating, but
snacks that are planned at specific
times during the day can be part of a
nutritious diet, without spoiling a child's
appetite at meal times. You should
make snacks as nutritious as possible,
without depriving your children of
occasional chips or cookies, especially at parties or other social
events. Have healthy snacks within reach and at eye level.
• Set some family goals. Perhaps restricting desserts to weekends
and only having sodas on weekends. Making sure water bottles are
empty before dinner time. to encourage hydration
• Discourage eating meals or snacks while watching TV. Try to eat
only in designated areas of your home, such as the dining room or
kitchen. Eating in front of the TV may make it difficult to pay attention
to feelings of fullness, and may lead to overeating.
• Encourage your children to drink more
water. Over consumption of sweetened
drinks and sodas has been linked to
increased rates of obesity in children.
• Try not to use food to punish or reward
your children. Withholding food as a
punishment may lead children to worry that they will not get enough
food. For example, sending children to bed without any dinner may
cause them to worry that they will go hungry. As a result, children
may try to eat whenever they get a chance. Similarly, when foods,
such as sweets, are used as a reward, children may assume that
these foods are better or more valuable than other foods. For
example, telling children that they will get dessert if they eat all of
their vegetables sends the wrong message about vegetables.
• Make sure your children's meals outside the home are
balanced. Find out more about their school lunch program, or pack
their lunch to include a variety of foods. Also, select healthier items
when dining at restaurants.
• Pay attention to portion size and ingredients. Read food labels
and limit foods with trans-fat. Also, make sure you serve the
appropriate portion as indicated on the label.