Child and preadolescent Nutrition

Chapter 12 & 13
 Definitions of the life cycle stages
◦ Middle childhood: Term used to describe children between
the ages of 5-10 years . It is also referred to as school-age
◦ Preadolescent: is generally defined as ages 9 to 11 years for
girls and 10 to 12 years for boys. School age is also used to
describe preadolescence
 Key Nutrition Concepts
◦ Children continue to grow and develop
◦ Physically, cognitively and emotionally during
the middle childhood and preadolescent years
◦ In preparation for the physical and emotional
changes of adolescence
◦ Children continue to develop eating and physical
activity behaviors that affect their current and
future states of health.
 Key Nutrition Concepts
◦ Children’s families continue to exert the
most influence over their eating and physical activity habits
◦ External influences begin to have more impact on
children’s health habits.
◦ Teachers
◦ Coaches
◦ Peers
◦ Media
AAP - Understanding the Impact of
Media on Children and Teens

What do you call a consumer who wants to buy everything you

have, doesn't care what it costs and is less than five feet tall? A
marketer's dream? Nope.
You call them kids. –
Ad Relevance Intelligence Report, 2000
 Key Nutrition Concepts
◦ With increasing independence
◦ Children begin to eat more meals and
snacks away from home
◦ Need to be equipped to make good food
choices.
 Importance of Nutrition
◦ Adequate nutrition continues to play an important role during this
period
◦ Nutrition problems can still occur, such as iron-deficiency anemia,
undernutrition, and dental caries

◦ The prevalence of obesity is increasing. The beginning of eating

disorders can also be detected in some school-age.
◦ Healthy eating behaviors can help in preventing chronic diseases such
as obesity, type 2 diabetes, and /or cardiovascular later in life.

◦ Eating breakfast has been associated with improved academic

performance in school and reduced tardiness and absences
 Normal Growth and Development
◦ Child’s growth is steady
◦ The average annual growth during this stage is 3-3.5 kg in weight and 6
cm in height
◦ Children continue to have spurts of growth that usually coincide with
periods of increased appetite and intake
◦ During periods of slower growth, the child’s appetite and intake will
decrease
◦ Parents should not be overly concerned with this variability
◦ Periodic monitoring of growth continues to be important in order to
identify any deviations in child’s growt5h pattern
◦ School health Department should play an important role to track
underweight and obesity among school children
◦ Weight and height should be taken each year using -growth charts )
BMI for age)
 Physiological and Cognitive
Development
◦ Physiological development
◦ Muscular strength and motor coordination increase progressively
◦ Able to perform complex pattern movements and to participate in activities such as
dance, gymnastics and other physical activities
◦ In the early childhood years
◦ Percent body fat reaches a minimum of 16% in females and 13% in males
◦ It occurs on average at 6-6.3 years of age
◦ Then it increases in preparation for the adolescent growth spurt.
◦ The increase in %fat with puberty is earlier and greater in females than in males
(19% for F and 14% M)
◦ Boys have more lean body mass per centimeter of height than girls
◦ Differences become more pronounced during adolescence
◦ BMI is not constant throughout childhood
◦ BMI for age percentile within the normal range
◦ Role of parents in reassuring child for these changes
 Physiological and Cognitive
Development (cont)
◦ Cognitive Development
◦ Major achievement development : self-efficacy, the
knowledge of what to do and the ability to do it
◦ Children move from preoperational period of
development to one of concrete operations
◦ The child is developing a sense of self
◦ Become independent
◦ Learning their role in the family, at school and in
the community
◦ Peer relationships become important and begin to
separate from their own families
 Physiological and Cognitive
Development (cont)
◦ Development of feeding skills
◦ School children develop increased feeding skills
◦ They can use eating utensils
◦ They can learn by doing or participating in sample food preparation or food
purchasing
◦ Eating behaviors
◦ Parents and older siblings continue to have the most influence on child’s attitudes
toward food and food choices
◦ Culture and food habits of parents
◦ The child is responsible for how much she eats
◦ Families should try to eat meals together: there is a positive relationship between
families eating dinner together and the overall quality of the children’s diets
(higher intakes of nutrients: fiber, vitamins and minerals).
◦ Parents need to continue to be positive role models
◦ Peer influence becomes greater as the child’s world expands beyond the family
◦ Eating behaviors
◦ The influence of media (TV and Posters) on child’s food
selection
◦ Snacks continue to contribute significantly to a child’s
daily intake

◦ Body image and excessive dieting

◦ Young girls seem to have a preoccupation with weight
and size at an early age
◦ With the normal increase in BMI or body fatness in
preadolescence, many girls and their mothers may
interpret this phenomenon as a sign of that child is
developing a weight problem
◦ By imposing controls and restrictions over their
daughter’s intakes, mothers may actually be promoting
the intake of unhealthy foods.
◦ The influence of parents may lead that girls adopt a
negative attitude toward foods
 Energy & Nutrient Needs of
School-Age Children
◦ Energy needs
◦ Dependent on body size, body composition, rate of growth and
physical activity level
 Energy & Nutrient Needs of
School-Age Children
◦ Protein needs
◦ 0.95 g protein/kg body weight for 4-13 year-old girls and
boys
◦ Vitamins and Minerals
◦ DRI’s established for school-age children
 Common Nutrition Problems
◦ Iron deficiency age Hb HT
◦ Less common a problem than in the
toddler
◦ Diagnostic Criteria for Anemia

5-8 <11.5% <34.5

8-12 <11.9% <35.4

 Diet-Related Problems in Children
◦ Iron-deficiency anemia
◦ Most common cause of anemia in the Gulf region. Prevalence of iron deficiency
anemia among school children has reached 30-37% depending on the country
◦ Connections have been found between iron deficiency and behavior
◦ Lessens motivation to persist at intellectually
◦ challenging tasks
◦ Such children may be irritable, aggressive, disagreeable, sad, or withdrawn
◦ May be labeled “hyperactive,” “depressed,” or “unlikable”
◦ Dental caries
◦ Affect 70% of all children
◦ Obesity
◦ Associated with hyperinsulinemia, hypertriglyceridemia, reduced HDL- cholesterol
◦ High prevalence of obesity especially among girls
◦ High blood cholesterol
◦ Children have higher blood cholesterol levels when compared to other developed
countries
 Toxic Environment

◦ Availability and Types of Foods:

◦ Fast food restaurants
◦ High in fat, SF; low in fiber and other protective
nutrients
◦ McDonald’s corporate goal
◦ No person in the US will live more than 4
minutes from a restaurant
 TV and Media Influence

◦ 1990: Children’s TV Act regulates

◦ # of commercials
◦ nature of commercials
◦ More than US kids reported watched TV at least 2h /day
◦ Watching TV more than 4h/day was associated with greater BMI and body fat
compared with watched 2 h/day
◦ Direct correlation between TV hrs and blood lipids

➢ Current Problems
➢ Food Ads (types of foods)
➢ Inactivity
Nutrition and Prevention of CVD in
School-Age Children

◦ Acceptable range for fat is 25% to 35%

of energy for ages 4 to 18 year
◦ Limit saturated fats, cholesterol & trans
fats
◦ Increase soluble fibers, maintain weight,
& include ample physical activity
 Fluid and Soft Drinks
◦ Preadolescents sweat less during exercise than adolescents &
adults
◦ Provide plain water or sports drinks to prevent dehydration
◦ Limit soft drinks because they provide empty calories, displace
milk consumption & promote tooth decay
 Physical Activity
Recommendations

◦ Recommendations:
◦ Children should engage in at least 60 minutes of physical activity
each day
◦ Parents should should set a good example, encourage physical
activity, and limit media & computer use

◦ Actual:
◦ Only 17% of middle & junior high schools require daily physical
activity
◦ Only about 36% of the 5-15 y/o children walk to school & 2% ride a
bicycle to school
 Nutrition Education
◦ School-age: a prime time for learning about healthy lifestyles
◦ Schools can provide an appropriate environment for nutrition
education & learning healthy lifestyles
◦ Education may be knowledge-based nutrition education or behavior
based on reducing disease risk
 “Children Are Children First” –
What Does That Mean?
◦ Children with special health care needs are children
first
◦ Even if their conditions change, their nutrition,
medical, and social needs, expectations are similar
◦ Individuals with Disabilities Education Act (IDEA)
◦ Requires the least restrictive environment
◦ Resulting in inclusive settings for more children
with disabilities
◦ Children with special health care needs vary
in nutritional requirements
◦ Low energy intake with small muscle size
◦ High protein, fluid, or fiber
◦ Increases or decreases in vitamins or
minerals
◦ Long-term use of prescribed medications
◦ Frequent hospitalizations
FORMULA
Pediatric versions of complete nutritional
supplements, such as Pediasure
Adult complete nutritional supplements, such as
Ensure
Enrichment of beverages, such as Carnation
Instant Breakfast added to milk
Predigested formula with amino acids and
medium-chain fatty acids, such as Peptamen
Junior
Special formulas for inborn errors of metabolism
(PKU), such as Phenex-2
High-energy booster for cystic fibrosis, such as
Scabdishake
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website, in whole or in part.
Comments
Generally recommended for children under 10 years of
age; can be used for gastrostomy or oral nutrition
support
Generally 1 calorie per milliliter strength is
recommended for children
Requres that milk is tolerated
For conditions in which intestinal absorption may be
impaired
Usually a powder that is mixed as a beverage, but other
forms such as bars and capsules are available
Generally 2.5 calories per milliliter to concentrate
energy in a small volume
◦ Vitamin and mineral supplements for chronic
conditions
◦ Supplements may be beneficial to assure adequate
intake
◦ Determination of total intake of supplemented
nutrients is part of nutrition assessment
◦ Excessive intake can happen inadvertently
◦ Special attention to calcium and vitamin D
Growth Assessment
From Table 13.1 Examples of specialty growth charts2,20
Conditions with special growth charts Comment

Achrondroplasia From of dwarfism

Down syndrome Short stature, variable weight
Trisomy 13
Trisomy 18
Fragile X syndrome Short stature, primary in males
Prader- Willi syndrome Short stature, overweight
Rubinstein- Tabyi syndrome Short stature
Sickle-cell disease Short stature
Turner syndrome Short stature
Spastic quadriplegia Short stature, low weight
Marfan syndrome Tall stature

© 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible
website, in whole or in part.
 Eating and Feeding Problems in
Children with Special Health Care
Needs
◦ Eating and feeding problems are diagnosed when
children have difficulty:
◦ Accepting foods
◦ Chewing them safely
◦ Ingesting enough foods and beverages
◦ 70 percent of children with developmental delays
have feeding difficulties
 Feeding Challenges for Children with Health Care Needs
◦ Example situations:
◦ Assistance and supervision due to low self-feeding skills
◦ Low food intake due to meal length or food loss
◦ Adjustment in timing of meals and snacks
◦ Children without intellectual disabilities may have behaviors
◦ Families may use mealtime to help cope
 Cystic fibrosis
◦ One of most common genetic conditions
◦ Affects all exocrine organs with lung
complications causing death in adulthood
◦ malabsorption of nutrients due to lack of
pancreatic enzymes
◦ Nutrition interventions include monitoring
growth, assessing food and nutrient intake,
and increasing energy and protein
 Diabetes mellitus
◦ Disorder in insulin regulation and
glucose metabolism
◦ Type 1: virtually no insulin
production
◦ Type 2: high blood sugar only
◦ Treatment includes timing and
composition of meals and snacks,
insulin injections, or other medications
 Seizures
◦ Uncontrolled electrical disturbances in brain
◦ Epilepsy and seizures are the same disorder
◦ Results of a seizure range from mild
blinking to severe jerking
 Seizure treatment
◦ Feeding or eating during postictal state: not
recommended due to choking risk
◦ Medications: may effect growth and/or
appetite
◦ Ketogenic diet for uncontrollable seizures:
severely limited carbohydrate diet with
increased calories from fat
 Cerebral palsy (CP)
◦ Broad range of disorders due to brain damage early
in life
◦ Spastic quadriplegia, involving all the limbs,
presents most nutritional problems
◦ Nutrition concerns: slow growth and difficulty
feeding and eating, and changes in body
composition
 Illustration 13.3 Growth chart of child with
spastic quadriplegia and scoliosis who is
fed by gastrostomy tube

© 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible
website, in whole or in part.
 Inborn errors of metabolism
◦ Require interventions to manage breakdown
products from foods and beverages metabolized
incompletely or inadequately
◦ Molecular and cellular level blocks
◦ Glycogen storage diseases
◦ Medium-chain fatty acid disorders
◦ PKU, well-known example, defective or absent
enzyme needed to metabolize phenylalanine, an
amino acid
 ◦ Attention deficit hyperactivity disorder (ADHD)
◦ Most common neurobehavioral problem: 11 percent of
children
◦ Medication can decrease appetite, resulting in weight
loss or slow growth
◦ Effect of ADHD medications on appetite is variable
◦ Children with ADHD who are not on medication may
have a chaotic meal and snack pattern and inability to
stay seated for a meal
 Childhood celiac disease
◦ Chronic condition increasing in prevalence
◦ Presents differently than in adults
◦ Underdiagnosed in children
◦ May interfere with learning and growth
◦ Most effective treatment: avoiding gluten
for life