Pediatric Nutrition

Pediatric Nutrition Perry, pp. 881-886; 972-976; 1029-1031; 1053-1054; 1089-1090; 1118-1119

Energy and Nutrient Needs of Infants • First year of life is a time of very rapid growth and development • High growth rate leads to high basal metabolic rate (45 kcal/pound of body weight-same as about +7,000/day in adults)

Energy and Nutrient Needs of Infants • Fat and carbs in the diet provides the energy and are needed for brain development • Protein important due to physical growth rate • Vitamin and mineral needs are very high especially A,C,D and iodine

Energy and Nutrient Needs of Infants • Infants have a higher percentage of body water than adults, leading to greater risk of dehydration; therefore, encourage water intake • Birth to 4-6 mos-breast milk or formula only

Breast Milk • Carbohydrate is in the form of lactose which enhances calcium absorption • Protein is in a form that is easily digested and absorbed • Fat is generous in essential fatty acids • High bioavailability of iron and zinc

Breast Milk • Due to their low content in breast milk, infants who are completely breast fed need: • Vitamin D supplements • Iron supplements • Fluoride supplements

Infant Formula • Copies breast milk through artificial methods • Is iron-fortified • Special formulas may be needed: • Hypoallergenic formulas for infants with allergies • Soy formulas for lactose intolerance

Risks of Formula and Other Milks • Contaminated water • Contains no antibodies • Improper food handling techniques • Bottle caries • Goat, cow, and soy milk are nutritionally incomplete and can cause allergic reactions

Introducing Solid Foods • Begin at 4-6 months of age • Introduce single-ingredient foods, one at a time to assess for food allergies • Rice cereal, then oat and barley, and lastly wheat (Fe fortified) + fruit juice (Vit C). Limit juice to 4-6 oz/d • Vegetables first then fruit • Egg yolks, meats about 5-8 mos • Finger foods 9-10 mos

Foods to Avoid • Concentrated sweets • Products with sugar alcohols may cause diarrhea • Honey and corn syrup-botulism risk • Carrots, cherries, gum, hard or gel-like candies, hot dogs, marshmallows, nuts, peanut butter, popcorn, raw celery, whole beans, and whole grapes (choking hazards)

Foods at One Year • 2-3½ cups of regular cow’s milk—not low-fat until age 2 • Be careful of milk anemia—some may need iron supplement • Balance and variety from all food groups • Drink liquids from a cup not a bottle

Nutrition During Toddlerhood • “Physiologic anorexia” • Picky, fussy eaters; ritualistic • Give 1-2 TBSP; likes finger foods • Refusing food is a form of control • Do not restrict fat intake—needed for brain growth • Wean from bottle by 14 mos

Mealtimes With Toddlers • Discourage unacceptable behavior • Let toddlers explore and enjoy food • Don’t force foods • Let children choose nutritious foods • Limit sweets • Make mealtimes pleasant • Remember food habits and choices in adulthood start here!

Nutrition During Childhood (3-12 yr) • Needs and appetites change during childhood because of growth and physical activity; inactivity—obesity • Adults and schools need to assist children in choosing nutrient-dense foods • Need variety and less than adult portions

Nutrition During Childhood • Carbohydrate recommendations = adults • Fiber intake should = age + 5 grams • Fat intakes should be 25-40% of total energy intake (the older the child the lower the fat intake should be) • Protein needs are increased with age-especially important during high growth times

Nutrition During Childhood • Vitamin and mineral needs increase with age • Balanced diet meets all vitamin and mineral needs except iron • No supplements should be needed with balanced diet that includes iron fortified foods

School Age/Adolescence • Nutritional problems include anorexia and obesity • Rapid growth period raises need for calcium, protein, calories, iron, Vit D for bone, teeth, and muscle development, and menstrual periods

Adolescent Food Choices • Eating habits and behaviors—skipping breakfast, snacking, dieting, eating hi-fat fast food and very little fruits and vegs • Beverages-generally tend to want soft drinks (high in sugar and caffeine) • Eating away from home-1/3 of meals are consumed away from home and tend to come from fast-food restaurants

Adolescent Food Choices • Peer influence is strong • Drug and alcohol abuse-changes appetite, leads to poor absorption of some nutrients, causes decreased money, may provide energy but no nutrients • Smoking-eases feelings of hunger, lowers vitamin intake (Half of teens who continue to smoke will die of smoking related causes)

School Age/Adolescence • Teaching good nutrition is not enough • Must also have access to quality foods and snacks @ home and school • Relationship between attractive appearance and healthy lifestyle may be effective • Provide info, role model, and involve teen—don’t dictate and judge

Nutritional Assessment • Especially important for children with evidence of nutritional problems • Dietary recalls are frequently unreliable • Most common is 24h but is only useful if day is typical; 3 day diaries are more helpful (one day should be weekend day)

Nutritional Assessment • Look at hair, teeth, skin, mm, build • Assess ht, wt, BMI • %IBW (current wt/IBW x 100) • Waist to hip ratio • TSF—extent of obesity • H/H, Fe, pre-albumin, lipids, glucose

Hunger and Malnutrition in Children • Regular meal times and routines are important for children • Missing meals, especially breakfast, affects behavior, academic performance • In iron deficiency, brain is affected before the blood which leads to: • Behavior changes • Decreased intellectual performance • Decreased attention span

Effects of Childhood Obesity • Physical health—abnormal lipid levels, high blood pressure, type 2 diabetes • Psychological development—emotional and social problems, stereotypes and discrimination, and body image issues

Food Allergies • Adverse food reactions include-stomachaches, headaches, rapid pulse rate, nausea, wheezing, hives, bronchial irritation, cough • Common foods that cause problems-eggs, milk, soy, peanuts, wheat, food coloring • Food labeling may help identify “hidden allergens”

Tips for Parents • Honor children’s preferences. • Set children up to make good food decisions while allowing for choices • Avoid power struggles regarding food; children should regulate their own food intake and dislikes with adult supervision

Tips for Parents • Limit high fat and high sugar snacks • Choking prevention-be alert to foods that are common causes of choking, and make sure children are sitting still while eating • Brush and floss after meals and snacks

Pediatric Nutrition