FSHN 3620 • Exam 2 SG: Ch. 12/13

School Age Nutrition

Growth and development in childhood and preadolescence

• During early school years, growth is slow and steady preceding to pre-pubertal growth spurt

• Growth spurt:

  • Girls: 10 years

  • Boys: 12 years

• Limb length increases more than trunk length

• Growth of brain decreases after infancy

• Assess head circumference measurement only up to 3 years

• Throughout childhood, percent weight as fat remains same but fat free mass (muscle, bone, soft tissue protein) increases

• Shift in body fat accumulation location - leaner

• Increases in skeletal muscle mass

• Bone formation exceeds bone resorption

Growth hormone – where it originates, its role and purpose, etc.

• Small protein that is made by the pituitary gland and secreted into the bloodstream

• Pituitary puts out GH in bursts

  • Levels rise following exercise, trauma, and sleep

  • More GH is produced at night than during the day

• GH is available as a prescription drug that is administered by injection

  • GH is indicated for children with GH deficiency and others with very short stature

• HGH doping and athletic performance

  • Banned!

BMI Rebound

increase in body fat % in preparation for a growth spurt.

• early rebound (before age 5) associated w/ increased risk of overweight & obesity

• Body fat minimum

  • 16% in girls

  • 13% in boys

Calculating and interpreting Z scores

used to compare and individual’s anthropometric measurement (like weight, height, or BMI) to a reference population’s mean and standard deviation

• The World Health Organization (WHO) provides growth standards with mean & standard deviation values for different age & sex groups, which are used to calculate

• Z-scores are only meaningful when compared to a specific reference population

• Formula: z-score = O – M/SD

  • O = observed value

  • M = median value of the reference population

  • SD = standard deviation value of reference population

• Statistical measure of how many standard deviations the values lies from the mean

  • Negative = values below the mean

  • Positive = values above the mean

Understand Growth Velocity, Growth Spurts, and when they happen in boys and girls

Growth spurt

• Girls: 10 years

• Boys: 12 years

• Limb length increases more than trunk length

• Growth of brain decreases after infancy

• Assess head circumference measurement only up to 3 years

• Throughout childhood, percent weight as fat remains same but fat free mass (muscle, bone, soft tissue protein) increases

• Shift in body fat accumulation location - leaner

• Increases in skeletal muscle mass

• Bone formation exceeds bone resorption

Growth velocity: the rate of change in growth over a set period of time.

• If too slow, monitor closely

• Midgrowth spurt – small increase in growth velocity between 4-8 years

• Not all children experience this (more boys than girls)

• Occurs before puberty

• Somewhat dependent on the season

• Children 3-8 usually grow:

  • At least 2 in per yr

  • Around 4.4 lbs per yr

Factors Influencing Growth & Development 

1. Genetics 

2. Hormones – GH is most important hormone involved in the growth process

   • Primary role: Induce growth in height by making bones grow

   • Pituitary Gland secretes GH

   • Amount of GF released changes during a person’s lifespan

   • Peaks during Puberty

3. Nutrition 

4. Environment

Know the protein and mineral needs for children of different ages, and why these nutrients are important

• Protein

  • Rec. intake is 0.95 g per kg body weight/day for 4- to 13-year-old girls & boys

  • Children can meet this recommendation by following healthy dietary patterns

• Vitamins & minerals

  • Children’s mean intake of most nutrients meets or exceeds recommendations

  • Certain subsets of children do not meet nutrient needs for iron, zinc, & calcium

  • Calcium & vitamin D

    • Adequate intake important for development of peak bone mass

    • Adequate vitamin D needed for calcium absorption

    • Vitamin D from fortified foods and sunlight

      • Increased skin pigmentation

      • Limited sunlight exposure

      • Supplements need to be given under guidance of physician or RDN

  • Iron 

    • Add good vitamin C source for enhancing absorption

    • Increased needs related to rapid rate of linear growth, increase in blood volume, & menarche in females

      • Females → greatest need after menarche

      • Males → greatest need during growth spurt

• Fluoride

  • Hydroxyfluoroapatite on the enamel — crystalline structure of bones & teeth composed of calcium carbonate & calcium phosphate with fluoride in a collagen matrix gives strength and rigidity to the bones

What children are at particular risk of vitamin deficiency?

• Children of deprived families

• Children with anorexia, poor eating habits and fad diets

• Chronic disease

• Dietary regimen to manage obesity

• Pregnant teenage children

• Vegan/vegetarian  diet

Compare the current dietary recommendations vs actual intakes of the average American child

review photo

Understand the basics of the School Lunch Program and School Breakfast Program

School Lunch Program

• Child nutrition programs began in 1946

  • purpose: provide nutritious meals to all children

• Reinforce nutrition education in the classroom

• Schools should have a wellness plan

School Breakfast Program

• Authorized in 1966

• Must provide 25% of the DRIs for the children being served

• National School Lunch Program rules apply

• States may require schools that serve certain populations to provide breakfast

Cystic fibrosis

genetic mutation in cystic fibrosis transmembrane conductance regulator (CFTR) gene. Affects all exocrine organs in body with lung complications often causing death during adult yrs. 

• Malabsorption of fat & fat-soluble vitamins due to lack of pancreatic enzymes

  • Slower rate of weight & height gain 

  • Higher energy needs due to chronic lung infections 

• Close monitoring to avoid malnutrition

• Intensive nutrition interventions

• Adequate nutrition & growth link to better pulmonary function

• Req 

  • fat-soluble vitamin supplements due to poor intestinal absorption

Cerebral palsy

damage to brain early in life (before or after birth); progression of secondary effects occurs over time. 

• Secondary effects → contractures, scoliosis, gastroesophageal reflux & constipation (due to coordinated muscle movements part of bowel emptying)

• Most nutrition problems is spastic quadriplegia (involving all limbs)

  • May appear thin bc of smaller muscle size

  • Slow weight gain 

  • Difficulty w/ feeding & eating

  • Changes in body composition

  • Nutrient problems w/ → bone density, calcium, & vitamin D or other nutrients bc of medication side effects

• No specific vitamins or minerals to correct CP

• Lower energy needs

• Nutrition interventions

  • Stimulating oral feeding

  • Promoting healthy eating at school

  • Adjusting menus & timing of meals & snacks at home or school for meeting nutrient needs from foods that minimize fatigue during meals

  • Assessing & adjusting child’s dietary plan over time

  • Using adapted self-feeding utensils or other types of feeding equipment

Down syndrome

• Low percentile heights are normal for a child w/ Down syndrome

• Short stature, low muscle tone, & low weight compared to age-matched peers shouldn’t be attributed to low energy intake 

  • Natural consequences of neuromuscular changes within Down syndrome population

Prescription of growth hormone (GH)

• Children with CF, Down syndrome, Prader-Willi syndrome & other chromosomal disorders

• If prescribed – time of initiation & discontinuation to be noted in growth assessment to interpret correct growth patterns

Prader-Willi syndrome

Rare genetic condition that leads to physical, mental and behavioral problems.

• Short stature, overweight

• Key feature: Hyperphagia = feeling hungry ALL THE TIME

• As babies, have hypotonia, difficulty feeding

• As children, have low growth hormone and behavior problems

• 80% of energy needs as child of same age/sex w/o the syndrome

• At some point in childhood, begin excessive binge eating & cannot stop

• Dietitians play a big role in their lives!