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Leny Budhi Harti

1. Overveiw of toddler & preschooler 2. Normal growth development 3. Physiological and cognitive development 4. Energy and nutrient needs (Dietary and physical activity recomendation) 5. Common nutritional problems 6. Prevention of nutrition-releted problems 7. Growth assessment 8. Feeding problem 9. Nutrition related condition 10. Food allergies and intolerance

Overveiw of Toddler & Preschooler

Toddlers are generally defined as children between the ages of 1 and 3 years This stage of development is characterized by a rapid increase in gross & fine motor skills Preschool-age children are between 3 and 5 years of age. Characterized by increasing language skill, staying with friends an relatives, and expending their ability to control behavior

Normal Growth Development

Berat badan Tinggi badan Status gizi Nafsu makan
Toddler terjadi peningkatan BB 0,23 kg/bln dan TB 1 cm/ bln Preschool terjadi peningkatan BB 2 kg/thn dan TB 7 cm/thn

Mengalami penurunan nafsu makan Status gizi dapat diketahui melalui metode : IMT for age atau menggunakan the 2000 CDC growth chart

Physiological and Cognitive Development

An explosion in the development of new skill happens during the toddler years Gross motor skill such as sitting and climbing develop rapidly at this age Age (months) 15 18 24 30 36 Gross motor skill Crawl up stairs Run stiffly Jump in a place Advance to going up stair by alternating their feet Ready for tricycles

Physiological and Cognitive Development

Children become increasingly mobile and independent with improvement in gross motor skills Toddler have no sence of dengerous situations children are especially vulnerable to accidental injuries and ingestion of harmful substance

Cognitive Development in Toddler

Processes the ability to explore the environment and to develop new relationship Fears for certain situations : darkness, wind, rain,& lound sounds Social development : imitating others (parents, caretakers) children begin to learn about familys cultur Dramatic development of language skills :
18 mo : children have 10 15 words 24 mo : children have 100 words 36 mo : children use 3 word sentences

Development of Feeding Skills in Toddler

Gross and fine motor development during toddler years enhances childrens ability to chew foods of different textures and to self-feed Between 12-18 mo toddler are able to move the tongue from side to side, learn to chew food with rotary, use the tongue to clean the lips, handle meats, raw fruits and vegetables amd multiple texture of food.

Feeding Behaviors of Toddlers

To circumvent food jags, parents can serve new foods along with familiar foods. New foods are better accepted if they are served when the child is hungry, and if she sees other members of family eating these foods. Toddler are great immitators, which includes imitating the eating behavior of others

Cognitive Development of Preschool-Age Children

Language develop rapidly during the preschool years and is an important indicator of both cognitive and emotional development. Between age 2 and 5, childrens vocabularies increase from 50 to 100 words to more than 2000 words, and their labguage progressess from two-to-three-word sentences to complete sentences

Development of Feeding Skills & Innate Ability to Control Energy Intake

The preschool-age child can use a fork and a spoon and uses a cup well An important principle of nutrition for young children and one with direct application to child feeding is childrens ability to self regulate food intake Although children can self-regulate caloric intake, no inborn mechanism direct them to select and consume a well-balanced diet

Development of Feeding Skills & Innate Ability to Control Energy Intake

Children learn healthful eating habits Preschool children continue to learn about food and food habits by observing their parents, caretakers, peers, and siblings, and they begin to be influenced by what they see on TV

Energy and Nutrient Needs

Kebutuhan energi untuk usia 13 35 bulan :
1. 100 kkal/kg DBW 2. EER : (89 x berat badan) 80

Kebutuhan energi untuk anak usia 3 8 tahun (EER) Boys : 108.8 (61.9 x age (y)) + PA x {(26.7 x weight (kg) + (903 x height (m)} Girls : 155.3 (30.8 x age (y)) + PA x {(10.0 x weight (kg) + (934 x height (m)} Usia 4 6 tahun : 90 kkal/kg DBW

Physical Activity
PAL Boys Sedentary Low active Active Very active 1,00 1,13 1,26 1,42 PA Girls 1,00 1,16 1,31 1,56


Berdasarkan AKG di atas, prosentase kebutuhan protein untuk anak usia 1 3 thn dan 4 6 tahun adalah 10% dari total kebutuhan energi

Berdasarkan ADA, 2004. Kebutuhan protein untuk anak usia 1 3 tahun sebesar 1.1 g/kg BB dan menurun 0.95 g/kg BB untuk anak usia 4 -8 tahun dan 9 13 tahun Atau 5 20% dari kebutuhan energi 50% merupakan protein yang bernilai biologis tinggi

Berdasarkan ADA, 2004. Kebutuhan lemak untuk anak usia 1 3 tahun sebesar 30 40% dari total energi Untuk anak usia 4 18 tahun sebesar 25 35% dari total energi Kurangi sumber lemak yang berasal dari lemak jenuh dan trans fatty acid

Berdasarkan ADA, 2004 kebutuhan karbohidrat sebesar 45 65% dari total energi

Kenutuhan cairan : 50 60 ml/ kg BB Cairan berasal dari air putih, jus buah, susu, dan sayuran

Berdasarkan ADA, 2004, Kebutuhan serat adalah sebagai berikut : 1. Untuk usia 1 3 tahun : 19 gram/day. 2. Untuk usia 4 8 tahun : 25 gram/ day Serat berasal daribuah, sayur dan bijibjian.serat dapat digunakan untuk mencegah terjadinya konstipasi

Vitamin dan Mineral

Kebutuhan vitamin dan mineral dapat merujuk pada AKG Vitamin dan mineral dapat berasal dari buah,sayur, lauk hewani dan nabati serta bijibijian

Nutrition Guidance
Prinsip makanan untuk anak baduta dan pre school :
1. Kalori diberikan tinggi untuk menyediakan energi yang cukup, agar protein tidak digunakan sebagai sumber energi 2. Protein diberikan tinggi untuk menunjang pertumbuhan dan mengganti sel-sel yang rusak 3. Lemak diberikan cukup untuk menyediakan alat transport vitamin larut lemak 4. Vitamin dan mineral cukup untuk menunjang proses metabolisme tubuh 5. Cairan dan serat cukup melancarkan defekasi

Nutrition Guidance
Syarat :
1. Mudah cerna 2. Tekstur makanan tidak terlalu keras agar tidak merusak gigi geligi 3. Suhu makanan tidak terlalu panas dan dingin 4. Mengurangi makanan yang manis-manis dapat menekan nafsu makan 5. Menu dipilih yang disukai anak 6. Disajikan dengan penampilan menarik 7. Hindari cemilan yang terlalu banyak

Contoh Menu
Untuk anak usia 12 bulan :
Waktu pagi Menu Bubur kuah semur ayam dan sayur BM Beras Berat( Penukar g) 25 Energi 110

Ayam Wortel Kacang merah minyak Selingan Roti panggang Roti Selai

9 25 5 1,25 35 5

Contoh Menu
Untuk Anak usia > 13 tahun Sore : Nasi lembek Ungkep hati ayam Bola tempe saus kuning Cah oyong dan wortel

Contoh Menu
Untuk anak usia 3 6 tahun Siang :
Nasi Ayam goreng kremes Perkedel tahu kukus Sayur sup kacang merah Buh semangka

Common Nutritional Problems

1. Iron deficiency anemia 2. Dental caries 3. Constipation 4. Food security 5. Food safety

Iron Deficiency Anemia

Increase iron requirentment Inadequate iron absorption Inadequate iron intake Decrease iron stores

Iron deficiency

Iron depletion Iron deficiensy anemia symptoms

Iron Deficiency Anemia

Treatment : supplementation with iron drops at a dose 3 mg/kg per day perlu dilakukan skreening pada 4 minggu setelah diberikan intervensi Perlu dilakukan pemeriksaan kadah Hb dan hematokrit setiap 6 bulan Jika Hb dan hematokrit setelah 4 minggu perlu pemeriksaan lebih lanjut

Dental Caries
Penyebab : Kebiasaan minum susu/jus dengan botol diwaktu tidur Bahan makanan sumber KH streptococcus mutan mengasilkan asam yang dapat merusak gigi

Treatment : Suplementation Flouride : 6 mo 3 y : 0,25 g 3 6 y : 0,5 g Kelebihan fluorosis

Diet providing adequate total fiber for age:
o 1 3 y : 19 g/day o 4 8 y : 25 g/day

Some of the best food sources of fiber : whole grain breads, cereals, legumes, fruit and vegetables Too much fiber should avoid diarrhea, decrease energy dense food, decrease bioavailability of some vitamin and mineral (Fe, Ca)

Food Security
Food security is particularly important for young children because of their high nutrient needs for growth and development Young children are a vulnerable group because they must depend on their parents to supply them with adequate access to food

Food Safety
Young children are especially vulnerable to food poisoning because they can become ill from smaller doses of organism Key foodborn pathogens include :
Campylobacte Salmonella E. Choli Listeria monocytogenes

Food Safety
Contamination of food products can occur at any point along the way from production to consumption. One major food safety education program :
o Clean : wash hands and sufaces often o Separate : dont cross contaminan o Cook : cook to proper temperature o Chill : refrigerate promptly

Prevention of Nutrition-Releted Problems

1. Prevention and treatment of overweight and obesity 2. Prevention of cardiovascular disease 3. Vitamin and mineral supplements

Prevention and Treatment of Overweight and Obesity

Prevention is the best approach for overweight and obesity Parenting techniquea such as finding reasons to praise the childs behavior, but never using food as a reward, foster the development of healthy eating behaviors in children and help them to self-regulate food intake Example of behavior changes of lifestyle : o physical activity o Not caloric dense o Offering nutrient dense

Prevention of cardiovascular disease

Children with familial hyperlipidemia and obese children LDL cholesterol High intake of saturated fat, trans fatty acids LDL cholesterol in children

Jika kadar LDL tinggi membatasi jumlah lemak, lemak jenuh 7% dari total kalori, kolesterol tidak lebih dari 200 mg/day

Pencegahan DRI for fat : 1 - 3 y : 30 40% dari total energi 4 18 : 25 35% dari total energi

Children need to screening periodicly

Vitamin and Mineral Supplements

Anak yang mengkonsumsi makanan yang bervariasi tidak memerlukan suplementasi, karena kebutuhan zat gizi dapat terpenuhi dari makanan Menurut The American Academy of Pediatrics , beberapa kondisi yang membutuhkan suplementasi vitamin dan mineral :
Anorexia Anak yang menjalani fat diet vegetarian

Growth Assessment
The need for nutrition services is identified by answer to these sorts of questions :
1. Is the child growth on track? 2. Is his or her diet adequate 3. Are the childs feeding or eating skills appropriate for the childs age 4. Does the diagnosis affect nutritional needs?

Growth Assessment
1. Berat badan 2. Tinggi badan 3. Status gizi IMT for age, CDC 4. Intake zat gizi recall 3 x 24 jam 5. Kebiasaan makan FFQ

Feeding Problem
1. Behavior feeding problem 2. Excessive fluid intake 3. Feeding problems and food safety 4. Feeding problem from disabilities involving neuromuscular control

Behavior Feeding Problem &Excessive fluid intake

Behavioral disorder that affect nutritional status are autism and attention-focusing problems, such as ADHD The child refuses to eat many foods and is rigid in what he will eat When he is not given food he likes, he refuse to eat all foods he prefer drink rather than eat food kelebihan intake cairan

Feeding Problem from Disabilities Involving Neuromuscular Control

Nutrition Related Condition

1. Failure to Thrive (FTT) 2. Diarrhea and Caliac Disease 3. Autism 4. Pulmonary problems

Failure to Thrive (FTT)

Diarrhea and Caliac Disease

Diare pada anak biasanya disebabkan karena kelebihan mengkonsumsi jus yang mengandung sorbitol atau sukrosa Caliac disease : terjadi pada orang yang sensitif terhadap gluten, komponen dari wheat, rye, barley Caliac disease diare Jika anak menderita caliac disease hindari makanan yang mengandung gluten seperti : tepung, roti, pasta, dll

No scientifically proven diet is now recommended for prevention or treatment of autism A gluten free and casein free diet is well known to families who educate themselves on internet

Pulmonary Problem
Breathing problems increase nutritional needs, lower interest in eating, slow growth rate Feeding difficulties have several causes in a toddler :
1. The normal progression of feeding skills is interrupted 2. Medication & their side effect high nutritional needs 3. Interrupted sleep and fatigue

Pulmonary Problem
Dietary recommendation :
o Small, frequent meals with foods that are concentrated sources of calories o Easy to eat o Nutritional suplement : pediasure, vitamin and mineral

Food Allergies and Intolerance

Food allergies anaphylaxis Example food allergies that may result in anaphylaxis : milk, eggs, wheat, peanuts, walnuts, soy, fish Strict and complete avoidance of food that causes tha allergies is required.

Contoh Kasus
Anak perempuan, berusia 4 tahun, berat badan 15 kg, tinggi badan 100 cm. Ibunya sibuk bekerja. Selama ibu bekerja, anak tinggal dirumah bersama pembantu. Nafsu makan anak angin-anginan, kadang baik kadang tidak. Anak tidak memiliki bakat alergi. Anak aktif dan biasa tidur siang. Kesukaannya mengkonsumsi buah dan sayur.

1. Berapakah BB ideal anak? 2. Bagaimana status gizinya? 3. Bagaimana pendapat anda tentang keiasaan makan anak tersebut? 4. Berapakah kebutuhan energi dan zat gizi nya sehari? 5. Buatlah menu sehari untuk anak tersebut!

1. Brown, Judith E. Nutrition Through the Life Cycle. Second Edition. Thomson. Unted State of America.2005 2. Mahan, L.K; Stump, S.E; 2004; Krauses Food & Nutrition Therapy 11th ed; Sanders Elsevier; St. Louis, Missouri 3. Leonberg, L. Beth. 2008. ADA Pocket Guide to Pediatric Nutrition Assessment. Unites State of America 4. Stump, Sylvia Escott. 2008. Nutrition and Diagnosis Related Care. Lippincott Wiliams & Wilkins. Philadelphia 5. Soetjiningsih. 1995. Tumbuh Kembang Anak. EGC : Jakarta 6. Kaswari, S. Rum Teguh , dkk. 2009. Buku Panduan Studi Kasus dan Praktikum Nutrition in the Life Cycle. Universitas Brawijaya Malang 7. Kurniasih, Dedeh. 2010. Sehat & Bugar Berkat Gizi Seimbang. Kompas Gramedia: Jakarta