NUTRITION DURING INFANCY, CHILDHOOD, & ADOLESCENCE CHPTR 11

Biological age

The child's physical maturity or developmental level.

Nutritional needs are influenced more by a child's biological age than chronological age.
Nutritional needs depend more on biological age, particularly during infancy and puberty.

Chronological age

The child's actual age based on the amount of time they have lived.

Infancy growth rate

Most rapid growth of lifecycle, especially during the first 6 mos

Childhood growth rate

Growth slows and becomes irregular, with periods of growth spurts and plateaus

• During growth spurts, appetite increases.

• During plateaus, appetite decreases.

Adolescence growth rate

Another period of rapid growth. Long bones grow, sex characteristics develop, and fat and muscle mass increase.

• sex & growth hormones increases

Adulthood growth rate

Physical growth plateaus and gradually declines with age

Growth Charts

Growth charts are used to assess a child's growth patterns over time & help assess growth patterns and identify potential growth concerns. NOT TO BE USED TO LABEL CHILDREN TALL OR SHORT

They measure:

• Height or length

• Weight

• Head circumference in infants

• BMI-for-age

WHO, CDC, & BMI-for-age growth charts uses

Growth chart	Used for
WHO (world health organization)	Birth to 2 years
CDC	Children 2 years and older
BMI-for-age	Ages 2 years through adulthood

Examples of specialized growth charts

Condition
Down syndrome	A genetic condition caused by an extra copy of chromosome 21. Children may have slower physical growth and shorter stature.
Low and very low birth weight	Charts used for infants born weighing less than 2,500 g (low birth weight) or less than 1,500 g (very low birth weight) to monitor growth and development.
Achondroplasia	A genetic condition that affects bone growth, causing disproportionate short stature (dwarfism), with shorter arms and legs.
Fragile X syndrome	An inherited genetic condition that can affect intellectual development, behavior, and physical characteristics. Growth charts help monitor physical growth.
Prader-Willi syndrome	A genetic condition associated with poor muscle tone, feeding difficulties in infancy, and later excessive appetite and risk of obesity.
Sickle cell disease	An inherited blood disorder in which red blood cells become rigid and sickle-shaped, potentially affecting oxygen delivery and normal growth.
Spastic quadriplegia	A form of cerebral palsy affecting all four limbs, with increased muscle stiffness (spasticity). Growth may be affected by feeding difficulties and increased muscle tone.

Three things essential for accurate growth assessment

1. Appropriate growth chart

• Select the correct chart based on sex, age, and whether WHO or CDC charts should be used.

2. Accurate measurements

• Obtain accurate height/length, weight, and head circumference when appropriate.

3. Accurate age calculation

• The child's age must be calculated correctly to plot measurements accurately.

Nutrient Requirements for Growth

Children require more nutrients relative to their body weight than adults because they are growing and developing.

Energy requirements

Energy needs are measured in calories.

Age group	Energy needs
First 2 months of infancy	108–113 kcal/kg/day
Approximately 3 months to 3 years	76–84 kcal/kg/day
Premature infants	115–140 kcal/kg/day
Adults	30–40 kcal/kg/day

Important:

fat requirements

fats: source of energy

ages 1-3 (30-40 %)

Fat requirements

• Infants require more fat to support growth and development.

• Fat provides energy and essential fatty acids.

Age	Recommended percentage of calories from fat
Ages 1–3	30–40%
Ages 4–18	25–35%
Adults	20–35%

Fluids and water needs in Infants

Infants have higher water requirements relative to their body weight than adults.

Reasons include:

• Higher percentage of total body water.

• Larger extracellular fluid compartment.

• Larger surface area relative to body weight.

• Higher metabolic rate.

• Greater potential for fluid loss.

daily water needs

	Approximate daily water needs
Infants	10–15% of body weight
Adults	2–4% of body weight

Phosphors & protein

help with bone mineralization

calcium & vitamin D

help with bone bone development

vitamin d facilitates calcium absorption

Nearly half of adult bone mineral density is deposited when?

during adolescence (ages 10-18)

Calcium absorption, deposition, and retention peak just before puberty.

• Bone mineral density accumulation peaks at approximately:

  • Females: 12.5 years

  • Males: 14 years

Calcium absorption, deposition, and retention peak just before ___

• right before PUBERTY

• Bone mineral density accumulation peaks at approximately:

  • Females: 12.5 years

  • Males: 14 years

Approximately 95% of adult bone mass is finalized within four years before or after peak bone accretion.

IRON

• important for brain development & hemoglobin

• needs increase about 6 mos due to breast milk needs

• meat, egg yolk, fortified cereals

vitamin k

Vitamin K

• Newborns receive a vitamin K injection at birth.

• Newborns have minimal vitamin K stores.

• Their intestines are initially sterile and lack the bacterial flora that produce vitamin K.

• Vitamin K is necessary for blood clotting.

Vitamin D

Vitamin K is given at birth by injection; vitamin D is provided through drops during infancy for breastfed infants.

• Breastfed infants should receive vitamin D drops.

• The textbook identifies 400 IU daily, beginning at hospital discharge.

• Continue supplementation throughout breastfeeding.

• Breast milk vitamin D content varies based on the mother's vitamin D levels and season.

• Formula contains supplemental vitamin D.

Gestational age and infant classifications

Gestational age is measured in weeks of pregnancy.

Classification	Definition
Full term	37–42 weeks
Premature	Before 37 weeks
Low birth weight (LBW)	Less than 2,500 g
Very low birth weight (VLBW)	Less than 1,500 g
Extremely low birth weight (ELBW)	Less than 1,000 g

Premature infants have additional nutritional needs because they may have:

• Less protein and mineral storage.

• Less body fat.

• Poorly calcified bones.

• Immature digestive and absorption abilities.

• Immature kidney and liver function.

• Weak or absent sucking reflexes.

• Lower iron stores.

Breast milk

Human milk is the preferred nutrition during infancy.

• Its composition adapts to the infant's needs.

• Fat content changes throughout a feeding.

• Breast milk contains immune factors.

• Breastfeeding is recommended for at least the first year.
  
  

Bottle propping can increase the risk of:

• Choking.

• Aspiration.

• Ear infections.

• Baby bottle tooth decay / early childhood caries (ECC).
  
  

• Never warm formula in a microwave.

• Warm it in a bowl of warm water

• -Never prop a baby's bottle or leave the baby alone while feeding.

  
  

Signs of readiness for solid foods

• Good head control.

• Opens mouth or reaches for food.

• Shows interest in eating.

• Can move food from the spoon toward the throat and swallow.

• Has generally doubled birth weight.

Guidelines for introducing solid foods

• Introduce one new food at a time.

• Wait approximately 3–5 days between new foods to observe tolerance.

• Start with small amounts.

• There is no required sequence for all foods.

• Begin with iron-fortified cereal and other appropriate pureed foods.

• Introduce allergenic foods after the infant tolerates standard first foods.