FSHN 3620 • Exam 2 SG: Ch. 10/11

Early Childhood Nutrition

Growth and development in early childhood

Growth

Infants: weight 3x in first year

Toddler: ages 1-3 years

• Average growth: 3-5 lb, 3-5 in./yr

• Rapid increase in gross and fine motor skills

• Increasing independence, like to explore their environments, language skills develop

Preschool: ages 4-5 yrs

• Average growth: 4-6.5 lb, 2.75 in per yr

• Increasing autonomy, growing language skills

• Expanding behavior control

• Physical:

  • Increase in skull size, jaw widens to accommodate teeth

  • ‘Baby’ fat is lost, Protuberant abdomen by 4th yr

Development 

• Palmar grasp

• Pincer grasp

• Protective reflexes

  • Rooting, ability to suckle, coordinate sucking, swallowing, breathing

  • State of arousal provides a framework to observe, understand, & interact with infants

Reading and interpreting appropriate growth charts in early childhood

• 0 – 2 yrs: Use WHO Growth Charts

  • Standards to identify how children should grow when provided optimal conditions

• 2 – 19 yrs: Use CDC Growth Charts

• Weight, Length/height, head circumference for age, Weight by Length, BMI for age

Nutrient needs in early childhood and common nutrient problems

• 1 Tbsp of food per year of age

• Vitamin A

  • Required for:

    • Normal functioning of visual system

    • Maintenance of cell function and growth

    • Epithelial integrity

    • Red blood cell production

    • Immunity and reproduction

  • Deficiency

    • Common in lower income countries

    • Mostly due to low Vitamin A intakes

  • Deficiency symptoms

    • Xerophthalmia or dry eyes

      • Leading preventable cause of blindness in children

    • Decreased resistance to infection

Iron deficiency in children, milk anemia, and how it is prevented and treated

• Iron deficiency anemia

  • Rapid growth + inadequate intake = common deficiency

  • Children ages 1–5 yrs should not drink >24 oz/day of goat/cow/soy milk

  • Screening recommended for children at risk

  • Treat with iron drops and more meat, fish, poultry, & plant sources/Vitamin C to enhance absorption

  • If anemia and/or iron stores are not improving, there may be other causes

  • Pica

  • Consequences of Iron Deficiency

    • pallor

    • fast heartbeat

    • weakness

    • poor growth

    • anorexia

    • impaired immune function

    • anemia

    • cognitive disability

    Milk Anemia

    • Ca & casein bind iron in the intestine & hinder absorption

    • Over consumption of cow’s milk is the leading cause of iron-deficiency anemia in toddlers >1 y/o

    • AAP rec. No more than 16 oz (2 cups) of cow’s milk/day for 12-24 mo. old 

      • 2–5 y/o → 2-3 cups/day

    • Decreased iron absorption & higher risk of iron deficiency

    • Increased risk of blood loss from the GI track

Know how nutrient needs change with special health care needs

Children with Special Health-Care Needs

• Broad term for children with, or at risk for, chronic conditions and disabilities

• Can be caused by genetic or metabolic disorders, birth defects, preterm birth, infections, prenatal drug exposure, & more

• ~19.4% of children in the US have special health needs

• 90% of these children have nutrition-related problems

Feeding problems, both behavioral and neuromuscular, and tube feeding

Behavioral Feeding Problems 

• Attention deficit hyperactivity disorder (ADHD)

  • Usually diagnosed in school-age children

• Autism spectrum disorder (ASD)

  • Sensory and environmental preferences & factors can make it uncomfortable & difficult for children with autism to eat a variety of foods

  • Children with ASD often prefer to eat the same foods over & over

  • May prefer juices and protein shakes over solid foods

  • Intervention may include total vitamin & mineral supplementation while SLOWLY introducing food

  • There is a rise in gluten-free, casein-free, etc. diets for children with autism to improve behavior; the AAP does not recommend these diets unless there is a food allergy or intolerance

Neuromuscular Feeding Problems

• Hypertonia: rigid, high muscle tone. 

• Hypotonia: low muscle tone 

• Both are symptoms of some disabilities that make feeding oneself difficult

  • Difficulties holding a spoon, swallowing

  • Very frustrating for the child, & may begin to refuse eating

  • Tube feeding is required if nutritional needs can't be met my mouth

Tube Feeding

• Necessary when nutritional needs cannot be met by mouth

• Also utilized when infants and children are at risk for choking or aspirating food or fluids into the trachea and then lungs

• Nasogastric (NG) or gastrotomy (G) tubes

• Enteral tube feedings (ETF): tube placed into the stomach or SI.

• Total parenteral nutrition (TPN): tube inserted into a vein whereby nutrients enter the bloodstream directly.

Food allergies

• Basis for allergic reactions is the absorption of intact proteins

• Common symptoms are respiratory issues and skin rashes

• Children sometimes grow out of allergies

• Top 9 food allergenic foods are milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, soybeans, & sesame

• Peanut allergy

  • Leading cause of death related to food: anaphylaxis

Anaphylaxis: Sudden onset of a reaction with mild to severe symptoms, including a decrease in ability to breathe, wheezing, coughing or tightness in chest, which may be severe enough to cause a coma

Lead poisoning

• Elevated blood lead levels

  • Affects many tissues → including brain, blood, & kidneys

  • Low-level exposure → decreased IQ, impaired motor, behavioral, & physical abilities

  • Decrease growth

  • No safe level

  • Major sources of exposure → airborne lead, deteriorating paint

  • Risks → children putting things in their mouths to explore

  • ~25% children living in housing with deteriorated lead-based paint

    • Tastes sweet, tempting children to consume 

  • Risk factors → young age, poor nutrition, low socioeconomic status, pica

  • Adequate iron & calcium may decrease lead absorption

Vitamin C may increase lead excretion (not fully understood)

Other nutrition related conditions

• Galactosemia – must eliminate galactose from diet

• Von Gierke’s disease –provide glucose between meals

• Phenylketonuria – must eliminate phenylalanine from diet

• Maple Syrup Urine Disease – restriction of branched-chain amino acids

• Hartnup disease – provide megadoses of nicotinic acid

Global nutrition and malnutrition concerns such as stunting, wasting, PEM, etc.

Vitamin A Global Prevalence

• 33.3% of pre-school children in the world (low serum retinol)

• 0.9% are night blind

Iron

• Most common nutritional deficiency worldwide

• Anemia caused 50 million years of healthy life lost due to disability in 2019 (WHO)

• Children at growing age are at most risk because of increasing blood volume

• Reasons for iron deficiency:

  • Inadequate intake

  • Impaired absorption

  • Less bioavailable iron is the only option available

  • Hemorrhage

  • Repeated blood losses (parasitic infestation)

Wasting: Child too thin for height due to acute malnutrition.

• Not getting enough calories to support nutrition needs and faces an immediate risk of death

Stunting: Failure to grow physically and cognitively due to chronic or recurrent malnutrition.

• Effects last throughout the child’s whole life

Protein-Energy Malnutrition (PEM)

PEM: Results when protein or energy are not sufficient in diet.

• Primary reason: inadequate food intake

• Secondary reason: inadequate nutrient absorption, utilization, increased nutrient utilization and/or losses

Kwashiorkor: protein deficiency, but enough CHO.

• Severe protein deficiency but normal caloric intake

• Peripheral edema (around abdomen)

• Hair changes common – sparse & easily pulled out

• Dermatosis, flaky paint appearance of skin

• Poor appetite

• Reduced subcutaneous fat

• Fatty liver common

• Worse prognosis

Marasmus: deficiency in all energy – lack both CHO & protein.

• Severe deficiency of all nutrients & inadequate caloric intake

• Peripheral edema is absent

• Hair changes absent

• Skin is dry & wrinkled but no dermatosis

• Voracious appetite

• Absent subcutaneous fat

• Fatty liver uncommon

• Better prognosis

Lead

• Major health concerns here & around the world!

• Prevalence: 2.5 % of children 1 – 5 y/o

• Young children absorb lead more efficiently (50 vs 10%)

• Absorb 4-5x more lead in children than adults