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Chapter 12 Child and Preadolescent Nutrition

Chapter 12 Child and Preadolescent Nutrition. Nutrition Through the Life Cycle Judith E. Brown. Definitions of the Life Cycle Stage. Middle childhood—between the ages of 5 and 10 years Preadolescence—ages 9 to 11 years for girls; ages 10 to 12 years for boys

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Chapter 12 Child and Preadolescent Nutrition

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  1. Chapter 12Child and Preadolescent Nutrition Nutrition Through the Life Cycle Judith E. Brown

  2. Definitions of the Life Cycle Stage • Middle childhood—between the ages of 5 and 10 years • Preadolescence—ages 9 to 11 years for girls; ages 10 to 12 years for boys • Both may also be termed “school-age”

  3. Tracking Child and Preadolescent Health • Data on U.S. children in 2006 • 8% lived in extreme poverty (< 50% of poverty) • 40% lived in low-income families (<200% poverty) • 11.7% had no health insurance • Disparities in nutrition status exist among different races & ethnic groups

  4. Tracking Child and Preadolescent Health • Disparities in nutrition status exist among different races & ethnic groups. Prevalence of overweight and obesity is measured by BMI • Hispanic Male children have significantly higher BMIs • Non-Hispanic black female children significantly greater BMIs • African-Americans have higher percentages of total calories from dietary fat.

  5. Healthy People 2010 • A number of objectives are specific to children’s health and well-being • According to the proposed framework for healthy People 2020, many of the objectives will be retained • www.healthypeople.gov/hp2020

  6. Normal Growth and Development • Measurement techniques • Growth velocity will slow down during the school-age years • Should continue to monitor growth periodically • Weight and height should be plotted on the appropriate growth chart

  7. Normal Growth and Development • 2000 CDC growth charts • Tools to monitor the growth of a child for the following parameters • Weight-for-age • Stature-for-age • Body mass index (BMI)-for-age • Can be downloaded from CDC website: www.cdc.gov/nchs

  8. Normal Growth and Development • 2000 CDC growth charts • Based on data from cycles 2 & 3 of the National Health & Examination Survey (NHES) & the National Health & Nutrition Examination Surveys (NHANES) I, II, & III • WHO Growth References • Available at www.who.int/childgrowth

  9. Normal Growth and Development

  10. Physiological Development in School-Age Children • Muscular strength, motor coordination, & stamina increase • In early childhood, body fat reaches a minimum then increases in preparation for adolescent growth spurt • Adiposity rebounds between ages 6 to 6.2 years • Boys have more lean tissue than girls

  11. Cognitive Development in School-Age Children • Self-efficacy…the knowledge of what to do and the ability to do it • Change from preoperational period to concrete operations • Develops sense of self • More independent & learn family roles • Peer relationships become important

  12. Development of Feeding Skills •  motor coordination & improved feeding skills • Masters use of eating utensils • Involved in food preparation • Complexities of skills  with age • Learning about different foods, simple food prep and basic nutrition facts

  13. Eating Behaviors • Parents & older siblings influence food choices in early childhood with peer influences increasing in preadolescence • Parents should be positive role models • Family meal-times should be encouraged • Media has strong influence on food choices • http://pediatrics.aappublications.org/content/early/2011/04/27/peds.2010-1440.abstract?papetoc

  14. Body Image and Excessive Dieting • The mother’s concern of her own weight issues may increase her influence over her daughter’s food intake • Young girls are preoccupied with weight & body size at an early age

  15. Body Image and Excessive Dieting • The normal increase in adiposity at this age may be interpreted as the beginning of obesity • Imposing controls & restriction of ”forbidden foods” may increase desire & intake of the foods

  16. Energy and Nutrient Needs of School-Age Children • Energy needs vary by activity level & body size • The protein DRI is 0.95 g/kg body wt • Intakes of vitamins & minerals appear adequate for most U.S. children

  17. DRI for Iron, Zinc and Calcium for School-Age Children

  18. Common Nutrition Problems • Iron deficiency • Less common in children than in toddlers • Although rates are lower, they are still above the 2010 national health objectives • Dietary recommendations to prevent: encourage iron-rich foods • Meat, fish, poultry and fortified cereals • Vitamin C rich foods to help absorption

  19. Common Nutrition Problems • Dental caries • Seen in half of children aged 6 to 8 • Reduce dental caries by limiting sugary snacks & providing fluoride • Choose fruits, vegetables, and grains • Regular meal and snack times • Rinse (or better yet, brush the teeth) after eating

  20. Prevention of Nutrition-Related Disorders • Prevalence of overweight among children is increasing • Data from NHANES I, II, & III suggest weight gain linked to inactivity rather than increases in energy intake • Excessive body weight increases risk of cardiovascular disease & type 2 diabetes mellitus

  21. Prevalence of Overweight and Obesity • Definitions: • Overweight = BMI-for-age >95th% • At risk for becoming overweight = BMI-for-age from 85th to 95th% • Overweight more common in Mexican-American males & females and African-American females • Heaviest children are getting heavier

  22. Characteristics of Overweight Children • Compared to normal weight peers, overweight children: • Are taller • Have advanced bone ages • Experience earlier sexual maturity • Look older • Are at higher risk for obesity-related chronic diseases

  23. Predictors of Childhood Obesity • Age at onset of BMI rebound • Normal increase in BMI after decline • Early BMI rebound, higher BMIs in children later • Home environment • Maternal and/or Parental obesity predictor of childhood obesity

  24. Effects of Television Viewing Time • Obesity related to hours of television viewing • Resting energy expenditure decreases while viewing TV • Healthy People 2010 objective: • Increase proportion of children who view 2 hours or less of TV per day from 60% to 75%

  25. Television Viewing Time

  26. Addressing the Problem of Pediatric Overweight and Obesity “An ounce of prevention is worth a pound of cure”

  27. Prevention and Treatment of Overweight and Obesity • Expert’s recommend a 4-stage approach: • The four stages: • Stage 1: Prevention Plus • Stage 2: Structured Weigh Management (SWM) • Stage 3: Comprehensive Multidisciplinary Intervention (CMI) • Stage 4: Tertiary Care Intervention (reserved for severely obese adolescents)

  28. Prevention and Treatment of Overweight and Obesity

  29. Prevention and Treatment of Overweight and Obesity • Treatment consists of a multi-component, family-based program consisting of: • Parent training • Dietary counseling/education • Physical activity • Behavioral counseling

  30. Nutrition and Prevention of CVD in School-Age Children • Acceptable range for fat is 25% to 35% of energy for ages 4 to 18 year • Include sources of linoleic (omega-6) and alpha-linolenic (omega-3) fatty acids • Limit saturated fats, cholesterol & trans fats

  31. Nutrition and Prevention of CVD in School-Age Children • Increase soluble fibers, maintain weight, & include ample physical activity • Diet should emphasize: • Fruits and vegetables • Low-fat dairy products • Whole-grain breads and cereals • Seeds, nuts, fish, and lean meats

  32. Dietary Supplements • Supplements not needed for children who eat a varied diet & get ample physical activity • If supplements are given, do not exceed the Dietary Reference Intakes

  33. Dietary Recommendations • Iron • Iron-rich foods: meats, fortified breakfast cereals, dry beans, & peas • Fiber • Increase fresh fruits and vegetables, whole grain breads, and cereals • Fat • Decrease saturated fat and trans fatty acids

  34. Dietary Recommendations • Calcium & Vitamin D • Bone formation occurs during puberty • Include dairy products and calcium-fortified foods • Vitamin D from exposure to sunlight and vitamin D fortified foods • If lactose intolerant: • Do not completely eliminate dairy products but decrease only to point of tolerance

  35. Fluid and Soft Drinks • Preadolescents sweat less during exercise than adolescents & adults • Provide plain water or sports drinks to prevent dehydration • Limit soft drinks because they provide empty calories, displace milk consumption & promote tooth decay

  36. Recommended versus Actual Food Intake • Saturated fat—intake is 12.6% of calories (recommend <7%) • Total fat—intake excessive in African American boys & girls & Mexican-American girls • Caffeine—increasing because of soft drink consumption • Fast food—30.3% of children consume fast food each day

  37. Other Considerations • Cross-cultural Considerations • Healthy People 2010-a major goal-eliminate health disparities among different segments of the population • Health care professionals & teachers should learn about cultural dietary practices

  38. Other Considerations • Vegetarian Diets • Suggested daily food guides for vegetarians are available • Vegetarian diets should be planned to provide adequate calories, protein, calcium, zinc, iron, omega-3 fatty acids, Vitamin B12, riboflavin and Vitamin D

  39. Physical Activity Recommendations • Recommendations: • Children should engage in at least 60 minutes of physical activity each day • Parents should set a good example, encourage physical activity, and limit media & computer use • Actual: • Only 7.9% of middle & junior high schools require daily physical activity • Only about 36% of the 5-15 y/o children walk to school & 2% ride a bicycle to school

  40. Determinants of Physical Activity • Determinants may include: • Girls are less active than boys • Physical activity decreases with age • Season & climate impact level of physical activity • Physical education classes are decreasing

  41. Organized Sports • Participation in organized sports linked to lower incidence of overweight • AAP recommends: • Participation in a variety of activities • Organized sports should not take the place of regular physical activity • Emphasis should be on having fun and on family participation rather than being competitive

  42. Organized Sports • Participation in organized sports linked to lower incidence of overweight • AAP recommends: • Use of proper equipment such as mouth guards, pads, helmets, etc. • Prevention of stress or overuse injuries • Awareness of disordered eating & heat injury

  43. Nutrition Education • School-age: a prime time for learning about healthy lifestyles • Schools can provide an appropriate environment for nutrition education & learning healthy lifestyles • Education may be knowledge-based nutrition education or behavior based on reducing disease risk

  44. Nutrition Education

  45. Nutrition Integrity in Schools • All foods available in schools should be consistent with the U.S. Dietary Guidelines & Dietary Reference Intakes • Sound nutrition policies need community & school environment support • Community leaders should support the school’s nutrition policy • The School Health Index (SHI) should be completed & implemented

  46. School Health Index

  47. Nutrition Intervention for Risk Reduction • Model programs • The National Fruit and Vegetable Program • Formerly “5 A Day” program • Public-private partnership of the CDC and other health organizations • High 5 Alabama • Study to evaluate the effectiveness of a school-based dietary intervention

  48. Public Food and Nutrition Programs • Child nutrition programs • Began in 1946 • Provide nutritious meals to all children • Reinforce nutrition education • Require schools to develop a wellness policy

  49. Public Food and Nutrition Programs • Financial assistance provided by the federal gov’t to schools participating in the National School Lunch Program • Five requirements • Lunches based on nutrition standards • No discrimination between those who can and cannot pay • Operate on a non-profit basis • Programs must be accountable • Must participate in commodity program

  50. School Breakfast Program • Authorized in 1966 • States may require schools who serve needy populations to provide school breakfast • The NSLP rules apply to the School Breakfast Program • Breakfast must provide ¼ the DRI

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