ch 13

Nutrition for Infants, Children, and Adolescents

children and adolescents who do not obtain proper nutrients are at an increased risk of ___________

chronic diseases

infancy age

birth to 1 year

Birth weight doubles by ______ of age. Rapid growth continues from ______ but at a slower pace

4-6 months; 6-12 months

Fat provides _______ of calories in breast milk and infant formulas

40% to 50%

Babies are born with low amounts of ______ stored in the body and a decreased ability to utilize it, and are therefore given an IM dose at birth

vitamin K

Breast milk health benefits

• Reduced risk of diarrhea and respiratory tract infection

• Possible protective effect against inflammatory bowel disease, leukemias, and certain types of type 1 diabetes

• Lowered risk of obesity in some populations; lower risk of atopic illness (chronic inflammatory conditions caused by common allergens)

• Close mother–infant bonding

All infants exclusively breastfed/receiving breast milk and formula need a _______ supplement of 400 IU/day

vitamin D

Infant Formula

• Specialized ________ are specifically altered to be lacking or deficient in one or more nutrients

  • Not suitable for healthy infants

• Preterm formulas are designed to promote “catch-up growth”

  • higher in calories, protein, and certain minerals

• most to least calorie dense: preterm formula, premature infant discharge formula, term formulas

  • Premature infant discharge formulas may be used to supplement breastfed preterm infants

newborn feeding cues

• rooting, sucking, and hand movements

  • rooting = baby turning their head with an open mouth looking for food

older infant feeding cues

hand-to-mouth movements, lip smacking, crying, excited arm and leg movements, opening the mouth, and moving toward a spoon as it comes near

general satiety cues

• depends on the infants age

• fussiness during feedings, slowing the pace of eating, turning away from the nipple, stopping sucking, spitting out/refusing the nipple, falling asleep, or spitting up milk

Frequency of Breastfeeding

• In the first months of life, a minimum of 8-12 times every 24 hours

  • about every 2 to 3 hours

• Feedings become less frequent as the infant grows

  • Supply = Demand

Formula Feeding frequency - first weeks of life

• 2 oz every 2-3 hours

• More formula should be offered if the infant still appears hungry

Formula Feeding frequency - Beginning at 2 months

6-8 feedings every 24 hours

Formula Feeding frequency - 4-months-old

~31 oz per day (range of 26–36oz) without complementary foods

Formula Feeding frequency - 6-months-old and older

• 24-32oz per day in addition to complementary foods

• As solid food intake increases, the volume of formula consumed decreases

infancy - solid foods

• Solids become a necessary source of nutrients around 6 months of age

• most infants are ready to spoon feed at around 4-6 months of age

• First solid foods should be iron-rich; continue through 11 months to maintain adequate stores

• Formula-fed infants should continue to use iron-fortified formula

• At 6 months of age, infants need supplemental fluoride

• Establishing regular meal times and snack times will help prevent overweight and obesity

infancy - feeding guidelines

• Avoid plain cow's milk until 12 months due to low iron and excessive sodium, potassium, and protein compared to formula or breast milk

• 3-5 solid food feedings per day are appropriate

  • Include in family meals whenever possible

  • Fat intake should not be restricted

  • Trust the child’s natural ability to eat the amount of food they need

• Early exposure to various foods reduces picky eating

Foods and beverages that should not be given during infancy

• high in sodium

• have added sugars

• contain low- and no-calorie sweeteners

• contain honey in any form, including cooked or pasteurized

  • can be a source of foodborne illness (botulism)

• that are unpasteurized

• that may cause choking

  • Round foods, large pieces of foods, stingy/sticky foods

infancy - food allergens

• Introducing things early = less of a chance for an allergen

• High-risk infants can have peanuts at 4-6 months

  • moderate-risk at 6 months

  • low-risk when age-appropriate (after 6 months if exclusively breastfed).

• Eating high allergen foods during pregnancy can also help the child prevent allergens to those foods

Early Childhood age

1-5 yrs

Physical activity guidelines for preschool-aged children

• ages 3 through 5 should be physically active throughout the day

• Adult caregivers should encourage active play that includes a variety of activity types

Parental Influences on Eating Habits

• Types of foods

• Portion sizes

• Frequency of eating

• Social environment

• Relationship with food

  • Reward system (should not be used)

  • “Clean plate club” = forcing a child to eat everything on the plate if they are no longer hungry

  • dieting/restriction

Developmental Milestones Related to Eating

• age 1 → should be drinking from a cup

  • 15 months of age → may develop food jags as a normal expression of autonomy

• age 2 → should eat most of the same foods as the rest of the family

  • The typical daily pattern is 3 meals and 2 to 3 snacks

  • should be able to use utensils and spill little of their food

  • End of the second year: can completely self-feed and can seek food independently

• At risk of choking until around the age of 4

Dramatic decrease in growth after age 1 = ________ in appetite

decrease

early childhood - daily calorie needs

• Ages 12-23 months → 800-1000 cal/day for both girls and boys

• Ages 2-5 → 1000-1600 cal/day depending on activity

• Nutrient dense foods

Fluid from 12-23 Months

• Whole milk = major source of nutrients, including fat, but should not exceed 2 to 3 cups daily

• 1-4 cups of water per day, including being offered when child is thirsty

• Avoid sugar-sweetened beverages as well as caffeinated beverages

Fluid from ages 2-5

• 2 -2½ cups per day of low fat or nonfat milk and 1-5 cups of water daily

• Give 100% fruit juice only if whole fruit isn’t available, limiting to 4oz daily for ages 2-3 and 4-6 oz for ages 4-5

early childhood food guidelines

• Age-appropriate serving sizes: 1 tbsp of food per year of age until 4

  • 2 tbsp at 2 years old, 3 tbsp at 3 years old, etc

  • By age 4-6, serving size may be close to adult size

• Foods that are difficult to chew and swallow should be avoided until around the age of 4

• supervised meals and snacks

• Should not be allowed to eat or drink from a cup while lying down, playing, or strapped in a car seat

Behaviors in young children that may indicate nutrition risk

• poor appetite

• inadequate intake from any food group

• frequent intake of fast food

• consumption of sugar-sweetened or artificially sweetened beverages

• persistent bottle feeding

• child does not eat with the family

• growth or weight concerns

Annually, a child grows ___ inches in height and gains about ___ pounds

2.5, 7

Middle Childhood age

6-10 years of age

middle childhood - calorie intake

• Sedentary boys = 1400-1600 cal/day

• sedentary girls = 1200-1400 cal/day

• Moderately active children need an extra 200 cal/day, with an additional 200 cal/day for active children.

Adolescents age

11–18 years

Girls require ______ calories than boys because they have more fat tissue and less muscle mass from the effects of estrogen and also experience less bone growth than boys

fewer

Recommended that clinicians screen for obesity in children and adolescents aged __ and older

6

risk factors for obesity in kids

• Parental obesity

  • Whatever the parents are eating tend to be available to the child as well

• Poor diet

• Low levels of physical activity

• Inadequate sleep

• Sedentary behaviors

• Low family income

obesity treatment stage 1

• prevention plan

• not about weight loss but about weight maintenance

• Encourage healthy habits: 5+ fruits/veggies daily, <1 hr screen time, ≥1 hr exercise, no sugary drinks, structured meals.

• Office visits with brief counseling.

obesity treatment stage 2

• structured weight management

• Monthly visits with a healthcare provider.

• More structured meals and snacks.

• Limit screen time to <1 hr/day, increase exercise.

• Self-monitor diet and activity.

obesity treatment stage 3

• comprehensive multidisciplinary intervention

• Intensive program with structured diet, exercise, and behavior changes.

• Weekly sessions (8-12 weeks), then monthly follow-ups.

• Strong family involvement, especially for kids <12 years.

obesity treatment stage 4

• tertiary care intervention

• For severe obesity or health issues.

• Supervised treatment at a pediatric weight center.

• Possible treatments: strict diets, medication, or surgery.