NUTRITION - Chapter 15: Nutrition from Infancy Through Adolescence

How do health care providers assess the growth of infants and children?

By plotting measurements of height and weight on growth charts

Define growth charts

Charts used by health professionals to compare the growth of an individual child to normal patterns of growth in weight, stature, and head circumference over time

What is a z score?

a statistical comparison of a child’s anthropometric measurements to the average measurements of other children of the same age and biological sex

Why do we need to measure the infant’s head circumference?

The brain grows fast during 1st year than any other time of life. Unusual head circumference measurements is alerted to be various genetic disorders or growth problems
Small head - undernutrition
Big head - tumors or fluid in brain

Define Pediatric Malnutrition. List two possible causes

Imbalance between nutrient requirements and nutrient intake that leads to deficits of energy, protein or micronutrients
1. Illness cause low food intake, weight loss, and wasting

2. Social or environmental conditions

What age does growth ends?

At ages 14 in females and 15 in males, gains in height are no longer, end of bone fusing.

If a female child is short for her age due to a brief period of undernutrition between ages 10 to 12, can she catch up in growth after proper nutrition is restored? Why or why not?

Growth plates at the ends of the bones fuse, which begins around 14 years of age in girls. So yes she can catch up.

What are the BMI-for-Age Percentiles for Children ages 2 to 20

• Underweight - <5th percentile

• Healthy weight - 5th up to 85th percentile

• Overweight - 85th up to 95th percentile

• Obese - ≥95th percentile

What is a healthy range of fat intake for toddlers to children?

• 1 to 3 years - 30% to 40% of total calories

• Older children to teen - 25% to 35%

How do the energy needs of a 6-month-old infant compare to those of an adult?

For a 6 months old baby, they need around 548 to 656 kcal, depending on the their weight and height. Compared to adults, their calories range around 1,600 to 2,500 depending on height, weight, and gender.

Why is unaltered cow’s milk not recommended for infant feeding?

Cow’s milk has high mineral and protein content

What is the recommended carbohydrates intake for infants?

• 0 to 6 months - 60 grams

• 7 to 12 months - 95 grams

Is there an AI fiber for infants?

No set AI for fiber for infants younger than 1 year od age
As solid foods are introduced, some experts recommend working up to 5 grams of fiber per day by 1 year of age

What is the recommended protein intake for infants?

• 0 to 6 months - 9 grams per day

• 7 to 12 months - 11 grams per day

What is the recommended fat intake for infants?

• 0 to 6 months - 31 grams per day

• 7 to 12 months - 30 grams per day

Do infants require any supplemental vitamins or minerals? If so, which ones? What is the rationale for their use?

• Vitamin D - breastfed infants need them shortly after birth. Consume about 10 mg per day

• Vitamin K - newborns get dose at birth to prevent bleeding or hemorrhaging

• Iron - at 4 months exclusively breastfed infants need iron added to their diet, prevent iron-deficiency anemia

• Fluoride - After 6 months to aid in tooth development

• B12 - breast milk in vegan women is low in B12 supplements are recommended

  • Prevent anemia and optimize growth and development of nervous system

Antoinette is planning a family trip to the zoo on a hot summer day. How can she keep her 3-month-old baby from becoming dehydrated?

AAP doesn’t recommend supplemental water or juice during the first 6 months, even in hot water
Best to rely exclusively on breast milk or infant formula to meet infant fluid needs up to 6 month of age

Define childhood overweight and obesity in terms of BMI-for-age.

• A child from 8th up to the 95th percentile for BMI-for-age is considered overweight

• At or above the 95th percentile, a child is considered obese

Fats in breast milk

• Half of calories come from fat

• As feeding goes on, the fat content of the milk increases to fulfill energy needs and satisfy the infant

• Short and medium chain fatty acids are easily digested

• Arachidonic acid and docosahexaenoic acid are essential for brain and eye development

Carbohydrates in breast milk

• provide 40% to 45% of calories

• main carb in human milk is lactose (sweet) and easy for infants to digest

• contains some oligosaccharides - prebiotic effect

• microbial in GI tract helps immune system development

Protein in breast milk

• supplies less than 10% of the total calories

• kidneys not fully developed so it can be stressed with high intake

• easily digested

• promote proper immune system and enhance nutrient absorption

What is hydrolyzed protein formula?

Formula where proteins have been broken down into small polypeptides and individual amino acids

What are some tips for safe preparation and storage of infant formula?

• Clean containers and throughly washed

• Cold water to prepare infant formula

• Water should boil for 1 minute if water is contaminated. Cooled for 30 minutes

• Water must be testing for contaminants

• “Nursery water” formula contains high levels of fluoride

• Run hot water or sit it a pan to warm bottle

• Refrigerating prepared formula for 1 day is safe.

• Left out for an hour, throw away bc microbes and enzymes from infants saliva

List three similarities between human milk and infant formula. List three differences.

Similarities:

1. Essential Nutritions

2. Safety to nutritional standards

3. Both contain lactose and protein, nutrients needed

Differences:

1. Breastfeeding reinforce the ability to self-regulate food intake; has to work to get milk from mother

2. Formula-fed infants tend to gain weight more rapidly than breastfed infants in the first months

3. Easier to digest than the fats and proteins found in formula

What is early childhood caries? How can you avoid it?

• Tooth decay from formula or juice (even human milk) bathing the teeth as the child sleeps with a bottle in the mouth

• Likely affect upper teeth

Typical formula intake of infants

• <1 month: 2 to 3 fl oz (60 to 90 ml) every 3 to 4 hours

• 1 to 6 months: 4 to 6 fl oz (120 to 180 ml) every 4 to 6 hours

• 6 to 12 months: 6 to 8 fl oz (180 to 240 ml) every 4 to6 hours

Describe four ways to assess an infant’s readiness for solid foods

1. Nutritional Need - calorie and iron needs develop

2. Physiological capabilities - the ability to digest and metabolize a wider range of food components improves

3. Physical ability
   - disappearance of the extrusion reflex (pushing food out with tongue)

   - head and neck control
   - the ability to sit up with support

4. Allergy prevention

What are some tips to ease early attempts at feeding solid foods?

• Use a baby-size spoon (teaspoon size)

• Hold infant comfortably on the lap

• Put small dab of food on the spoon tip and gently place it on the infant’s tongue

• Convey a calm and casual approach

• Expect the infant to take only two or three bites of the first meals

• Present new food on several consecutive days. Repeated exposures can promote acceptance of new food items

Excessive intake of added sugars is common in late infancy. Describe several ways to limit intake of added sugars in an infant’s eating pattern

Natural sugars, such as those found in human milk, dairy products, and fruits, are excellent sources of energy for active, rapidly growing infants

List foods that should not be fed to infants during the first year of life

• Excessive infant formula or human milk

• Foods that tend to cause choking

• Potential food allergens before 4 months of age

• Cow’s milk (as a replacement for human milk or formula)

• Other plant-based milk alts

• Goat’s milk

• Do not overdo high-fiber foods

• Skip added sugars and excessive fruit juice

• Heavily seasoned and processed foods

• Food safety hazards - potential sources of foodborne illness

• Excessive nutrient supplementation

Why is picky eating common among preschoolers? Provide suggestions to help preschooler choose nutritious foods.

Decrease growth rate leads to a decreased appetite, which contributes to “pick eating”

1. Build on what they know and accept familiarity plays an important role in food acceptance - repeating exposure to new food choices

2. Enlist the child’s aid in food selection and preparation

3. Serve meals on a sectioned plate

4. Keep it crunchy - crisp textures and mild flavors are appealing to children

5. Finger foods are fun

6. Save the best for last

Fiber Recommendations for Children

Young Children

• 1-3 years: 19g per day

• 4-8 years: 25g per day

Males

• 9-13 years: 31g per day

• 14-18 years: 38g per day

Females

• 9-13 years: 26g per day

• 14-18 years: 26g per day

How often do preschoolers need to eat throughout the day? List three nutrient-dense snack ideas that would be appropriate for a 3-year-old child

Children have small stomachs and need to eat every 3 to 4 hours

1. almonds

2. unsweetened applesauce

3. bean and cheese burrito

Should toddlers and preschoolers take a multivitamin and mineral supplement? Why or why not?

• Multivitamin and mineral supplements are generally unnecessary for healthy children; its better to emphasize whole foods

• Consuming fortified foods and supplements may lead to intakes above the UL for some nutrients, such as vitamin A and zinc

Explain the connections between nutrition and oral health. List three ways to reduce risk for dental caries with healthy eating habits

1. Drink water (fluoridated, if available) as opposed to carbohydrate-rich or acidic beverages

2. Use small amounts of fluoridated toothpaste twice daily

3. Snack in moderation - constant exposure to teeth to sugars and acids throughout the day tends to promote caries

What are some nutrition concerns with autism spectrum disorder?

• They experience GI disorders, such as constipation, diarrhea or reflux disease - such disorders may impair nutrient intake or absorption

• Medications used to treat behavioral problems may alter appetite

• Selective eating behaviors; they are more sensitive to colors, tastes, temperatures, and textures

• dietary patterns may be deficient in key nutrients

Provide an example of a meal that resembles MyPlate and is appropriate for a 7-year-old child

Emphasize nutrient-dense sources of iron, zinc, calcium, and vitamin D while striving to limit intakes of saturated fat, added sugars, and sodium

What are some ways to reduce childhood obesity? In what significant way do weight-management strategies for children differ from those for adults?

1. Set appropriate limits on screen time, making sure to encourage plenty of physical activity

2. Promote healthy foods - moderation in calorie intake is important

Children have an advantage over adults in dealing with obesity because their bodies can se stored energy for growth

Describe appropriate beverage choices for school-age children. What are the implications of excessively consuming sugar-sweetened beverages?

• Replace sugary beverages with water and choose unflavored, low-fat, or fat-free milk instead of flavored milk

• Sugar-laden beverages are not only contributing excess calories but also linked to increased levels of inflammation and worsened blood lipid profiles among children

Tim refuses to eat breakfast before school. He doesn’t like cereal, toast, or any of the other usual breakfast foods. What can Tim’s parents do to help him choose nutritious foods before leaving for school?

Suggest protein drink, fruits, veggies, or smoothies

Which two minerals are most likely to be deficient in the dietary patterns of teens? Name two rich food sources of each of these minerals

Calcium and Vitamin D - dairy sources
Iron - lean meats and fortified products

Design a meal for a teen that resembles MyPlate and can be purchased from a fast-food restaurant.

• One layer of patty, select grilled instead of fried meat

• Skip condiments or request on the side

• Chose salad and reduced-fat dressing rather than fries

• Reduced-fat or fat-free milk as a nutrient-dense alternative or opt for water

Are energy drinks safe for consumption by children of any age? Why or why not?

• For children, AAP advises limiting caffeine intake to 100 mg per day, if it is used at all

• There is concern that excessive caffeine intake could affect normal neurological and cardiovascular development

List three consequences of alcohol abuse that are specific to adolescents

1. Exposure to alcohol can decrease brain mass in the area of the brain involved in decision making, memory, and learning

2. Strong predictor of alcohol abuse during adulthood

3. Nutritional status can be affected because alcohol abuse is often accompanied by nutrient-poor dietary patterns

Name nine foods containing common food allergens that must be listed on food labels in the United States?

1. Peanut

2. Milk

3. Shellfish

4. Tree nut

5. Egg

6. Fin Fish

7. Wheat

8. Soy

9. Sesame

Inadequate intake of which of the following results in poor growth?

Calories, Iron, and Zinc

Cow’s milk is nutrient-dense source of all of follow except

iron (it has protein, calcium, and zinc)

To ensure adequate vitamin and mineral intake for a picky eater

provide a fortified breakfast cereal

Should caregivers provide fruit juice in a bottle for infants?

No. Continuous exposure of developing teeth to the carbohydrates in fruit juice could promote early childhood caries.

You are trying to introduce an apple and blueberry puree to a 7-month-old infant, but she rejects it, You should

offer the food again on another day

Introduction to cow’s milk should be delayed until 12 months of age because it

contains too much protein

Which of the following nutrition interventions is recommended by the AAP for treatment of autism spectrum disorder?

None. (Camel’s milk, fish oil supplements, and gluten-free, casein-free diet)

If moderate weight loss is needed, a school-age child should

engage in physical activity for 60 minutes per day or more

Your niece breaks out in hives and feels nauseous after eating a salad containing mango. She probably has a food

allergy

What is the most common and most dangerous food allergen among children in the United States?

Peanuts, milk, shellfish, and tree nuts

What are food allergy symptoms?

• Skin, itching, tingling, redness, hives, swelling

• GI tract: Nausea, vomiting, diarrhea, intestinal gas, bloating, pain, constipation, and indigestion

• Respiratory tract: runny nose, wheezing congestion, and difficulty breathing

• Cardiovascular system: low blood pressure and rapid heart rate