Infancy & Preschoolers (Growth & Development Issues in Promoting Good Health)

Nutrition in Infancy

is critical aspect of a child’s overall health and development. During the first year of life, infants experience rapid growth and development, and their nutritional needs are unique compared to other stages of life. Proper nutrition during infancy lays the foundation for long-term health and well-being.

Calories: 100-120 cal/kg b.w.

Protein: 1.5-2.2 g/kg b.w.

Fats: 30-40%

CHO: 45-65%

Nutrition Allowances in Normal Full-Term Infants

100-120 cal/kg b.w.

Nutrition Allowances in Normal Full-Term Infants

Calories

1.5-2.2 g/kg b.w.

Nutrition Allowances in Normal Full-Term Infants

Protein

30-40% of total calories

Nutrition Allowances in Normal Full-Term Infants

Fats

45-65%

Nutrition Allowances in Normal Full-Term Infants

CHO

1. Obesity/over nutrition

2. Food allergies

3. Baby bottle tooth

4. Colic

5. Diarrhea and constipation

6. GERD

Nutrition Concerns for infants

Term Infant

ONE WHO IS BORN BETWEEN THE 37TH & 42ND WEEK OF GESTATION

Preterm/premature infant

ONE WHO IS BORN THE 37THWEEK OFGESTATION

Post term infant

ONE WHO IS BORN AFTER

42 WEEKS OF GESTATION

Low Birth Weight

AN INFANT WHO

WEIGHS LESS THAN 2500 g (5 1⁄2 lb)

2500 g (5 ½ lb)

LBW infant weighs less than

triples

In the first year, an infants birthweight may ____ but over the following several years the rate of weight gain gradually diminishes

Alpha-lactalbumin

chief protein in human breast milk, as casein (CAY-seen) is the chief protein in cow’s milk.

Lactoferrin

a factor in breast milk that binds iron and keeps it from supporting the growth of the infant’s intestinal bacteria

Colostrum

a milklike secretion from the breast that is rich in protective factors; is present during the first day or so after delivery, before milk appears.

Bifidus factors

factors in colostrum and breast milk that favor the growth of the “friendly” bacterium Lactobacillus (lack-toe-ba-SILL-us) bifidus in the infant’s intestinal tract. These bacteria prevent other, less desirable intestinal inhabitants from flourishing

Lactobacillus bifidus

in the infant’s intestinal tract. These bacteria prevent other, less desirable intestinal inhabitants from flourishing

Milk

____ intake associated with increased cognition

Breakfast

_____ leads to improved mental performance in school

plain, simple; mixtures

Toddler feeding guide

Young children like ____,____ food; avoid ____

1 tbsp of each food per serving for each year of age

Toddler feeding guide

Rule of thumb: ___ of each food per serving for each ____

Toddlers

Age group: provide cups with handles; snippy cups avoid spills

Toddlers

Age group: promote one-taste rule, but avoid food battles

Toddler

Age group: provide structured choices (e.g. Would you like carrots on this side of the plate or the other side?)

+5

Toddler feeding guides

Age ___ for fiber goal

Picky eaters

Toddlers’ are ___ eaters

10

Research shows a food has to be tried ___ times before acceptance

Offer a new food with well-liked foods

How to combat picky eating?

Tactile defensiveness

picky eating may be related to ____ ____; speech language pathologist may be helpful

Authoritarian

Picky eating: avoid ____ approach since related to poor vegetable intake

Preschool age

Age group: Encourage food diversity by involving child in food shopping and preparation; help children identify foods by looking at food labels

Preschool Age

Age group: Make eating fun; read Green Eggs and Ham

Preschool Age

Age group: Avoid using food bribes

Preschool age

Age group: Food jags are common, with same foods desired for several weeks at a time

4

Exposure to a variety of foods before age ___ encourages the child to continue acceptance of these foods when older

Early school age

Age group: Encourage breakfast for enhanced school performance

Early school years

Age group: Help children learn about good nutrition through the MyPyramid Food Guidance System. Ask “What food group is cantaloupe in?”

Early school years

Age group: Remember parent role, “Provide nutritious food in a pleasant environment,” and child’s role, “Choose what, when, and how much to eat”

Adolescent years

Age group: Recognize that body fat increase precedes puberty

Adolescent Years

Age group: Remember parent role: have a variety of foods available for choices teen can make (e.g., popcorn, pretzels, and fruits instead of only chips and cookies)

Adolescent years

Age group: Help teens pack foods for delayed meals, such as when sports events delay dinner

Adolescent years

Age group: Teens need high kcalorie, protein, and calcium and vitamin D intake for good growth

Adolescent years

Age group: Help teens in decision making for food purchases

1. Anemia and iron deficiency

2. lead poisoning

3. Baby bottle tooth decay

4. Obesity

5. Poor weight gain

6. Asthma

7. Food allergies

8. Childhood constipation

9. Eating disorders

Common nutritional problems of children and adolescents

Anemia & iron-deficiency

Common problem

• Generally due to periods of rapid growth (early childhood and adolescence)

• Preference for low-iron foods contributes

• Possible malabsorption due to parasites from lack of hand-washing after outdoor playing or due to celiac disease

• Adolescent girls high-risk with menstrual losses and rapid growth

Lead poisoning

Common problem

• Encourage children to wash their hands before eating or putting hands in mouth

• Maintain good iron status for reduced lead absorption

1. Before

2. Grazing

3. 9

4. Chewing

5. Fluoride

Promote dental health

1. Brush or clean teeth with a wet washcloth ____ eating to help remove oral bacteria; encourage brushing and flossing after meals, but especially before bedtime

2. Encourage planned snacks versus “___,” with inclusion of protein and fat source along with CHO source to help neutralize acid

3. Don’t give sweet liquids in bottle, especially at bedtime; promote use of cup by ___ months of age for juices

4. Encourage thorough ____ to promote release of saliva to help neutralize acid

5. ____ exposure advised until adult teeth are fully formed (ascertain source)

*Oral bacteria feeds on CHO (both sugars and starches) causing acid production. It is the acid production that damages dental enamel

1. -

2. -

3. Fiber; magnesium

4. Seltzer

Common Problem: obesity

1. Discourage excess television and computer use

2. Encourage physical activity

3. Promote high-___ foods for satiety and encouragement of bone growth from minerals, especially ___

4. Promote appropriate milk and water intake; discourage sweet beverages – juice diluted with mostly ____ is a healthy alternative to soda pop

5. Encourage children to eat fruit rather than drink it

1. Praise

2. Hugs

3. Talking and telling stories

4. Give flowers

5. Give stickers

5 Nonfood rewards

1. 250-500 kcal

2. Unsaturated fat

Goals to poor weight gain:

1. Add ___ kcal daily

2. Individualize goals with ___ ____ sources if family history such as nuts, mayo, avocado

1. Magnesium; zinc; 100% DRI

2. Omega-3 fats

Asthma

1. Provide foods high in ____ and ____ or supplements with ____

2. Consider ____ ___ for anti inflammatory functions

1. Allergy; intolerance

2. -

3. Vitamin E; carotenoids

4. Outgrow

Food allergies

1. Verify ___ versus ____

2. Ensure positive nutritional intake to support growth and development needs; refer to RD as needed

3. Increase intake of foods high in ____ ____ and ____ for possible reduced sensitivity

4. Children tend to ___ food allergies

1. Epsom salts; magnesium

2. Peristalsis

Childhood constipation

1. Generally result of inadequate fluids and fiber

2. General treatment: Increase, fluids, fiber, exercise

3. Use caution with laxatives:

   1. ____ ____ can provide excessive amount of ____ for children and have been linked with toxicity for this population

   2. Avoid laxative abuse, since ___ of GI tract can be seriously impaired

True

True or false: Do not restrict food intake or label foods “good and bad” to help prevent eating disorders

Anorexia nervousa

food restricting (may be masked as vegetarian diet or complaints of GI discomfort)

Bulimia

purging with vomiting and/or laxative abuse

Bulimorexia

combination of anorexia and bulimia

1. 25%

2. Tiny

3. Exercise

4. Amenorrhea

5. -

6. -

7. Control

Anorexia nervosa indicators

1. Weight loss of at least ___% of original body weight

2. Bizarre eating habits (cutting food into extremely ____ pieces or having food rituals)

3. Compulsive ___ habits

4. ___ (lack of menstrual cycle) among girls

5. Disturbed body image with irrational, intense fear of becoming obese and refusal to maintain appropriate body weight

6. Underlying low self-esteem

7. Need to gain ___ in life that feels out of control

1. Diarrhea

2. Dermatitis

3. Dementia

4. Death

Physical indicators of anorexia nervosa: Pellagra 4D’s

1. Dehydration

2. Dry mouth

3. Dental erosion

Bulimia symptoms

Prepubescence: 80 kcal/kg BW

Adolescent Males: 45 kcal/kg BW

Adolescent Females: 38 kcal/kg BW

Sport nutrition in adolescence: General kcal needs

80 kcal/kg BW

Sport nutrition in adolescence: General kcal needs

Prepubescence

45 kcal/kg BW

Sport nutrition in adolescence: General kcal needs

Adolescent Males

38 kcal/kg BW

Sport nutrition in adolescence: General kcal needs

Adolescent Females

Children: 1500 kcal

Female athletes: 1700-1800 kcal

Male athletes: 2000 kcal

Sports nutrition in adolescence: Minimum Needs

1500 kcal

Sports nutrition in adolescence: Minimum Needs

Children

1700-1800 kcal

Sports nutrition in adolescence: Minimum Needs

Female Athletes

2000 kcal

Sports nutrition in adolescence: Minimum Needs

Male Athletes

1. Amenorrhea

2. Osteopenia, osteoporosis

3. Eating disorder

Female athlete triad

Protein: 1.5 g/kg BW (~0.75 g/lb)

Carb: ≥ 6 g/kg BW with 30-60 g extra per each hr of exercise

Fat: >30 g to meet EFA needs

Sports nutrition: Macronutrient needs

1.5 g/kg BW (~0.75 g/lb)

Sports nutrition: Macronutrient needs

Protein

≥ 6 g/kg BW with 30-60 g extra per each hr of exercise

Sports nutrition: Macronutrient needs

Carbs

>30 g to meet EFA needs

Sports nutrition: Macronutrient needs

Fat

Calcium: 1300 mg along with ≥ 200 IU Vitamin D

Sports nutrition: vitamin and mineral needs

Ergogenic aids

• risk vs benefit grater in children and adolescents than in adults

Creatinine; mad cow; cyanamide

Ergogenic aids

___ products may have possible contaminants such as with ___ ___ disease (muscle source of creatinine) and ___ may be used in manufacturing

Anabolic steroids

• Can damage heart muscle, cause atherosclerosis, increase risk of heart attack and stroke, cause liver failure, psychiatric and behavioral disturbances

• Among males: reduced testosterone levels w/ breast enlargement

16 oz fluids for every 1 lb weight loss during an event

Hydration Needs

16 oz fluids 1-2 hrs before

Hydration Need: Before Sports Event

20-40 oz/hr w/ 30-60g CHO and 500-700mg Na+/L

Hydration Need: For intense exercise or activity > 1 hr

>200g CHO via 1 cup juice (30g CHO) 4 times/hr for 4-5 hr to replenish glycogen stores

Hydration Need: Post-Event Needs

1. 16 oz

2. 20-40 oz; 30-60 g; 500-700 mg

3. 200 g; 30 g

Hydration needs: goals

1. ___ oz fluids 1-2 hr before sports event

2. For intense exercise or activity > 1 hr: ___-___ oz/hr w/ ___-___ g CHO and ___-___ mg Na++/L to prevent hyponatremia

3. Post-event needs: > ___ g CHO via 1 cup juice (___ g CHO) 4 times/hr for 4-5 hr to replenish glycogen stores.