Spotlight F: Childhood Nutrition

  • Identify four primary objectives for sound nutritional guidance for children

  • Provide an overview of patterns of growth and development from preschool-aged children to early adolescence (puberty)

  • Describe how body mass index is used to assess if children are at a healthy weight for their age

  • Identify at least three nutritional challenges for children and adolescents

  • Describe how changes governing the types of foods that are offered at schools are expected to improve the nutrition profile of school meals

  • Describe how parents can use MyPlate to help in planning a healthy diet for their children

  • Describe at least three ways parents can foster positive eating habits and food choices

  • Discuss the consequences of childhood obesity on future health

  • Describe how food allergies develop, and identify four food allergens that are common among children

Hygiene Hypothesis

  • Less exposure to dirt and germs

  • Reduced exposure to childhood
    infections in developed countries

  • Impairs normal maturation and
    regulation of the immune system

  • May explain the increasing prevalence of food allergies and other immune disorders, such as asthma

Growth Charts

  • Indication of adequate nutrition

Growth in Early Childhood

• Rapid growth during infancy
• Growth slows in preschool
children aged 2-5 years
• Average increases
– Weight ↑ 4.5-6.6 pounds/year
– Height ↑ 3-4 inches/year

Growth in School-aged Children

  • Vary in height, weight, and build during the school years

  • Due to genetics, nutrition, and exercise patterns

  • Ages 6 to 11

    • Growth spurts = Periods of accelerated physical development

    • Average increases
      • Weight ↑ 6.5 pounds/year
      • Height ↑ 2+ inches/year

Growth During Puberty

  • A time of development with periodic growth spurts

  • Changes in body size, shape, composition, and sex-
    specific maturation

  • ~50% of adult body weight is gained during puberty

  • Boys
    – Typically begins at age 12 or 13
    – Span of about 4 years
    – Average increase

    • ~2.5 inches in height/year

    • 11+ pounds in weight/year

  • Girls
    – Typically begins at age 10 or 11
    – Average increase

    • ~2 inches in height/year

    • ~9 pounds/year in fat and lean mass

Dietary Intake for US Children


Diets of children in the U. S. are typically:
– ↑ energy-density
– ↓ nutrient-density
– ↓ greens and beans
– ↓ fiber
– ↓ vegetables
– ↓ whole grains
– ↓ plant proteins

According to the 2020 DGA, US children and adolescents aged 5-18
~ 80% exceeded added sugars
~ 80% exceeded saturated fats
> 95% exceeded sodium

  • More meals away from home

    • Fast-food tends to be energy-dense and nutrient-poor

      • Children who eat the most fast-food have higher intakes of
        total energy, saturated fat, and sodium

    • Larger portions

      • Children tend to eat less when can serve themselves

    • Fewer family mealtimes at home

      • Children who eat at home tend to eat more nutritious food

  • Drink less milk and more soft drinks

    • On average, children consume close to 10% of total calories from sugar-sweetened beverages


National School Lunch Program

  • Millions of children participate

  • Federally assisted program

  • Provides nutritionally balanced, low-cost or free meals to children each school day

  • 2010 Healthy, Hunger-Free Kids Act

    • USDA issued new standards in 2012 to ensure meals align with Dietary Guidelines for Americans

    • Increase fruits and vegetables

    • Emphasize whole grain–rich food

    • Serve only low-fat and nonfat milk

    • Limit calories

    • Reduce saturated fat and sodium

  • DGA are the foundation for nutrition standards for NSLP

Shaping Eating Behaviors of Children

  • Eating behavior is strongly influenced by:

    • Physical & Social Environment

    • Parental Influence

  • Children as young as 2 should control the quantity of
    food consumed to avoid excess intake and habitual
    overeating

Fostering positive eating behaviors & habits
– Provide a variety of nutritious foods
– Repeat exposure to nutritious foods
– Encourage, but do not force, nutritious foods
– Model food choices and practices

Food Jags

  • Habits or rituals formed by children
    – Ex. Eat only sandwiches cut into squares

  • Developmentally “normal” as they strive for more
    independence

  • Generally outgrown with patience and guidance

Physical Activity

  • Lower activity associated with lower diet quality

  • US Department of HHS recommend children and adolescents
    older than 6 years engage in:

    • 60 minutes or more of physical activity per day

  • Include aerobic & muscle- & bone-strengthening activities

  • 75% of U.S. youth do not meet physical activity guidelines

  • Health benefits
    – Lower risk excessive weight gain
    – Improved bone health and weight status
    – Improved cognitive function
    – Improved quality of sleep
    – Reduced symptoms depression and anxiety

Nutrients of Concern in Childhood

  • American children consume low levels of several
    important nutrients

  • Calcium
    – Important for bone health and optimizing bone mass

  • Iron
    – Supports growth and prevents iron-deficiency anemia
    – Replaces iron lost through menstruation in adolescent girls

  • Fiber
    – Alleviates constipation
    – Shown to reduce the risk of chronic diseases

  • Vitamin D
    – Crucial for skeletal health and optimal bone development
    – Healthcare providers may recommend supplementation as
    intake recommendation recently increased by 50%

Childhood Obesity

  • Prevalence has more than tripled since 1980

  • US children & adolescents (aged 2–19) 2017 - 2020

    • Almost 20% obese

    • Nearly 15 million obese

Childhood Obesity and Disease
• Obese children are at increased risk for multiple physical
and psychological problems:
– High blood pressure
– High cholesterol
– Type 2 diabetes
– Asthma
– Joint problems
– Fatty liver disease
– Psychological problems
– Negative stereotyping and bullying
– Obesity as adults

Factors of Childhood Obesity

  • Genetic

    • Overweight and obese parents
      – Body’s ability to regulate appetite and satiety is overwhelmed by
      conditions that influence decisions and food choice

  • Diet
    – Energy-dense diets
    – Larger portion sizes

  • Activity
    – Sedentary lifestyles
    – Screen time

    • Children ages 8-12 spend 4-6 hours a day

    • Teens spend up to 9 hours a day

    • Television and advertising appear to have negative effect on dietary quality

  • Socioeconomic
    – Living at poverty level
    – Living in food deserts

Preventing Obesity

  • National, state, and private programs are working to
    reduce and prevent prevalence of childhood obesity
    – Education
    – Health-related legislation
    – Food industry changes

  • Programs and initiatives

    • Alliance for a Healthier Generation

    • Robert Wood Johnson Foundation Healthy Children, Healthy Weight

    • National Heart, Lung, and Blood Institute: We Can!

    • Action for Healthy Kids

Food Allergies

  • Reproducible, adverse reaction to a food

  • Caused by an immune response to an allergen

  • Number of people with food allergies is growing without
    a clear reason why

    • CDC reported a 50% increase in food allergies in children
      between 1997 and 2011

    • Thought to affect as many as 7% of U.S. adults and 8% of
      children

    • One in every 18 US children has a food allergy

Most Common Food Allergens

According to the CDC cause 90% of allergic reactions

  • Milk

  • eggs

  • Peanuts

  • shellfish

  • Fish

  • soy

  • Wheat

  • Tree nut

Why are they becoming more common?

  • Heightened awareness

  • Hygiene hypothesis

  • Changes in food manufacturing and processing

  • Inadequate intake of

Food Intolerance

  • A reproducible adverse reaction to food, that is not a direct result of an immune response

    • Celiac disease, lactose intolerance

  • Not usually life-threatening

    • Can induce allergy-like GI and respiratory symptoms

Food Allergies

  • Why are they becoming more common?
    – Heightened awareness
    – The hygiene hypothesis
    – Changes in food manufacturing and processing
    – Inadequate intake of certain nutrients may contribute to risk of food allergies in children

  • Vitamin D, omega-3 fatty acids, folate
    – The timing of when foods are introduced to children

  • Delaying introduction of allergenic foods may be detrimental

Food Allergen Labeling

  • Food allergies
    – Not “cured”
    – Managed by avoiding allergen

  • Food Allergen Labeling and Consumer Protection Act of 2004

  • Manufacturers must declare presence of major food allergens on food packages

Tips to Minimize a Child’s Risk of Developing Food Allergies
From the Academy of Nutrition and Dietetics

  • Exclusive breastfeeding for at least four months
    decreases the risk of atopic dermatitis, cow’s milk
    allergy, and wheezing when compared to feeding infants cow’s milk-based formula

    • Soy formula does not seem to affect allergy risk

    • Solid foods should not be introduced before 4‒6 months of age

    • Delaying beyond this does not appear to be more protective

    • Avoiding common allergens such as fish, eggs, and peanuts during pregnancy, breastfeeding, or beyond 4‒6 months of age does not seem to be protective

Introducing Allergenic Foods during Infancy

  • 2017 new guidelines issued advising early introduction of foods containing peanuts to infants to reduce risk of peanut allergy

    • Introduce to infants at high risk for peanut allergy as early as 4-6 months

  • While still receiving majority of calories from breastmilk and not receiving other solid foods

  • LEAP study showed that introducing peanut-containing foods to infants at high risk of the allergy was safe and led to an 81% reduction in subsequent peanut allergy

    • Consult with healthcare provider for guidance and possible in-office supervision

Keeping Kids with Allergies as Safe as Possible

  • Academy of Nutrition and Dietetics recommendations for parents of a child with allergy:

  • Read food labels carefully

    • Educate family members, caregivers, and teachers about their child’s allergy severity

    • Teach their child about the allergy at a young age

    • Consult with a registered dietitian to develop a healthy eating plan that avoids allergen