Nutrition and

Childhood
 Kondisi kesehatan anak di
dunia
 Negara : Afrika,Asia Selatan,Amerika Slt
- terjadi kekurangan intake makanan kronis 
pengaruh status gizi  Buruk

>Berbeda negara China, Asia Timur

- terjadi perubahan politik dan reformasi
ekonomi  keadaan ekonomi membaik
 Usia dini (< 6 tahun)

 Kekurangan makanan berdampak buruk 

Gizi buruk, menyebabkan :
- retardasi pertumbuhan
- mudah infeksi
- gangguan belajar
- meningkatkan mortalitas
 Negara berkembang
 gizi buruk  penyebab
kematian anak
Negara maju (A.S)  sangat jarang
-- hanya daerah tertentu/kumuh/miskin/
kelompok minoritas
Status gizi di AS :
- Rujukan status gizi

- Penyebabnya : kurang Fe,Zn (70%)

kurang kalsium,vit B6,as.Folat

 Growth and Development
during Childhood:
Major influence :
- genetic
- nutrition during the growth years
Pertumbuhan dan perkembangan yg terjadi
1.Height and weight
2.Body composition
3.Organ system
 1.Height and weight

 Rapid growth in the first month

 The growth rate slows during the second year
 After second year : growth rate levels off even more
(slow and steady growth)
 TB dan BB dipengaruhi :
1. perbedaan jenis kelamin :
usia 6 th : laki2 >
usia 9 th : perempuan >
2.perbedaan ethnik : bayi negro < by kulit putih
orang Asia -> lebih putih dan lebih
pendek
 Childhood :
 A period of slow and steady growth between the
explosive growth of infancy and acceleration of
the pubertal growth spurt
 GROWTH CHARTS
 Why ?
- Predictable characteristic of N children
- growth- changes in nutrition
 The Function :
- evaluate nutritional status
- to separate N from abnormal growth
pattern
- to draw attention to unusual body size
 NCHS  data survey cross sectional – children in US
 standard ciurves show the 5th,10th,25th,50th,75th,90th ,100th percentile values for weight
and height for age both sexes.
 2 set charts : 1. is used for birth – 3 years
2. 2 – 18 years
 Examining serial measurement
 3 basic growth charts : 1.height for age
2..weight for age
3.weight or stature
 Height for age is good indicator of chronic nutritional
status
 Weight for height is better indicator of recent nutrient
intake than stature

 Wasting : BB kurang untuk TB

 Stunting : TB dan BB kurang untuk umur,tapi
BB sesuai untuk TB
 Catch up growth : rapid growth following a period of
growth restriction
 Stunting
 Many reasons :
- chronic inadequate intake (hypocaloric
dwarfism)
- genetically short
- insufficient GH
- other diseases unrelated to nutrition
 Obese :

- a child whose weight increase from 5Oth

to 9Oth percentile over a short time is a
risk of becoming obese
- weight for height is standard criterion for
determining obesitiy
- other measurement : skinfold measurement
(triceps skinfold)
 2.BODY COMPOSITION
 The percentage of body fat greatest in infancy
 12 month -8 years ,children become leaner
 Skeletal muscle and muscle mass account for
increasingly greater proportion of total body weight
 At about 8 years, body fat percentage begin increase (
prepubertal “fat spurt”)
 3.ORGAN SYSTEMS
 Skeletal muscle,bone,liver develop – similar – height &
weight – rapidly during infancy  then grow slower
but steady
 Growth of neural tissue is rapid during infancy  75-
80% complete by age 2 achieved 95% by age 10
 Genital tissue do not rapid until adolescent
 Lymphoid tissue (tonsil,thymus,spleen) develop rapidly
through preadolescent.
 Digestive System

- Develops rapidly in the early childhood

- The other are fully functional by age 2 years old
(kelenjar, enzym,defekasi)
- Capacity of stomach :
250-300cc at 1 year old
500cc at 2
900cc toward the end of the first decade
- By the end of the preschool periode,the digestive
system functionally mature
 The Dentition
 Calcification of the primary teeth third
trimestre of pregnancy  eruption begins at 5
to 6 month of age
 By age 3 , the 20 primary teeth have erupted
 Permanent teeth,eruption begins at 6-7 years old
 Urinary System
 Mature in early childhood
 Are fully functionally by age 2- 3 years old
 In preschool children have greater ability to
control water exchange than infant
 Dehydration can occur in infant .
 Nutrional requirement
during childhood :
 RDA (Recommended Dietary Allowance)

Function :
- to meet the needs of children of average height,weight and
activity

 Gender differences in size and body composition are minimal

before the onset of pubertal growth  so dietary allowances
are identical for both sexes
 ENERGY NEEDS
 Energy needs is determined by :
1. REE (Resting Energy Expenditure)
2. Level of activity
3. Needs for growth
 Protein needs
 Protein synthesis and deposition into new tissue are
characteristics of childhood growth.
 Estimates of protein need for growth are
1-4 gr of protein/kg of tissue
 Protein needs for children are calculated based on :
- maintenance requirements
-changes in body size and composition,and growth rates
 RDA for protein during childhood : 24-28 gr ( 3 cups of milk)
 Fat Requirements
 Major source of energy during childhood :
- from fat (36-38% of total energy in the diet
 Dietary cholesterol should be less than 300 mg
per day
 Carbohydrat requirements
 Generally about 40-60% of total calories should
come from carbohydrat
 Overconsumtion food rich of sugar: dental
caries
 Fibre Reqirement
 Adequate dietary fibre:
- lessen constipation
- lower chance of becoming obese
- unable consume adequate calories for growth
- may produce abdominal pain
- may interfere with the absorption of Zinc and
Mg
 Recommendation: whole grain
cereal,bread,fruit,vegetables
 Vitamin Requirements

 Vitamin larut dalam lemak

 Vitamin larut dalam air
 Mineral requirements

 Major minerals
 Trace Minerals
 Water and Elektrolits
 Infancy : daily turnover of water is rapid
(15-20% of total body water is taken in from
food and water and excreted each day)
 Control of water balance is less precise in early
childhood
 The younger child is more prone to dehydration
than the older child or adult.
 Feeding skills
 Beginning as early as 10 months and some as
late as 2 years
 Rotary chewing movements begin around 12
months  as primary dentition is established
 Preschool years : ages 2 to 5

 Changing family structure  influence

nutrition of children at home.
- single parent
- mothers are working outside the home
- responsibility for feeding children to
non family child care workers
(knowledge-quality-adequacy-the need to
nutrition standard for day care progr )
 Eating habits and schedules
 Reduce appetite- after first birthday
 Why?
Because nutritional demands fall as the growth rate decelarates,
during the second and third years of life
 Preschool age -- drink less milk,refuse vegetables 
kurang intake Ca, Riboflavin,iron,vit A
 Normal fluctuation  emotional, fatigue,excitement,recognize
hunger and satiety affect appetite in the normal,healthy child
 Normal preschool children  can regulate energy intake on their
own
 Food preferences

 By age 4 or 5 years
 Food preference and habit are shaped by
- the type of food
- how it is offered
- parental and peer attitudes toward food
 Prefer : carbohydrate
cereal,bread,crackers
milk,fresh fruit,fuit fresh beverage
easy to chew and swallow
(cheese,yogurt)
 INTRODUCING NEW FOODS AND ENCOURAGING
HEALTHY EATING

 There are several ways :

1. Eat in pleasant surroundings
2. Maintain a reasonable consistent
eating schedule by providing meals and
snacks at predictable times (three to
four hour interval)
3. Don’t force children to eat
 4.Avoid using reward
5.Try the “ one bite policy” ( at least one
bite
of new food )
6.Large portion discourage children
7.Role models are important
8.Allow the children to participate in food
preparation
 Food
temperature,taste,texture,appearance
 Not to chew at one site
 Soft texture
 Colorful foods
 Refuse to eat vegetables  mixing with
familiar foods (flavorful)
 Snacks and Food jags
 Not when a child eat (at snack time)
 Small stomach capacity,cannot eat large meal
 Difficult to get adequate calories from only 3
meals
 Snacks are important source of nutrient in
children diets ( energy,Ca,Riboflvn,vit C)
 Prevention of choking
 May death by asphyxiation
 Under 2 years old (preschooler)
 Hard candy,grapes,nuts,chips
 An adult should always be present when child is
eating
 Encourage to sit down
 Choking  when child is eating while running
or playing
 NUTRITION AT SCHOOL
(SCHOOL YEARS : AGES 5-10)
 School lunch and breakfast program contribute
to nutrient intake

 School Lunch Program

 School Breakfast Program : milk,fruit or
vegetable juice,bread,cereal
Eating Patterns in older children

Appetides and food preference,more predictable

Increasing activity stimulates a steady appetide
Difference in intake –> ages 6-7, marked as
children move into adolescence
Males – consume more protein and
micronutrient
Scholl age (US)- fat intake 35-40% of total
calories,sugar : 25% of calories (USDA ’87)
 Breakfast

 Rebuilds glycogen stores – depleted

during the night and provides energy for
morning activity
 reminded,doesn’t consist of traditional
foods- egg/cereal
 Encourage – to find nutritious food they
like to eat in the morning
Influences on Nutrition in childhood
 Parental influences
 TV advertising- fast food,candy,sofdrink
obes – > 2 hours of TV a day
 Childhood,Diet,Hyperactivity
 Behaviour : erratic
 Two common disorders : iron def,toxicity
 Skip breakfast : less able to concentrate
 Diet – hyperactivity
before age 7,result from genetic
and enviromental(food additive)
 Vitamin and mineral
supplementation
 AAP 1993 : doesn’t recommend routine
supplementation for healthy children
(special condition)
 Special situation :-parental
neglect,anorexia,dietary to manage
obesity,pregnant teenagers,no vegetable
foods,chronic diseases (liver
diseases,inflammatory bowel diseases)
 VEGETARIAN DIET
 Eating diets without meat  iron deficiency
anemia
 Growing children – adequate aa intake
 Protein of High biological value

 DENTAL HEALTH
 Malnutrisi  interfere calcification and eruption
 DIETARY FAT AND CHOLESTEROL
- RISK FACTOR CARDIOVASKULAR
DISEASE
- ARTERIOSCLEROSIS
-- reduction in fat and cholesterol in the
diets of children
 Food allergies
- family history
- cow’s milk protein
 Food allergen
- eggs – peanuts – fish – milk –beef
- pork
- chicken ,etc
 IRON DEFICIENcY ANEMIA
- PUBLIC HEALTH PROBLEM
- deficiency in children worldwide
- little meat,fish,ascorbic acid,intestinal
parasit
- cause : anemia, impair mental and motor
development
 Undernutrition in childhood
(worldwide)
 Protein Energy Malnutrition :
Kwashiorkor, marasmus
 Mild PEM : growth impairment
stunting,underweight,wasting
Kwashiorkor : adequate energy,low protein
(rice),edema

Marasmus : caused by starvation,inadequate

intake of protein,energy,other nutrition
 Micronutrient

 Vit A
Yodium
 SELAMAT BELAJAR