Pediatric Nutrition

1. Pediatric Nutrition Ricci, chapters 25-29

2. 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 • Need 98-108 kcal/kg/day of body weight depending on age-same as about +7,000/day in adults. See Table 25.7

3. Energy and Nutrient Needs of Infants • Fat and carbs in the diet provides energy and are needed for brain development • Protein important due to physical growth rate • Vitamin and mineral needs are very high

4. 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 • For fluid needs see Table 25.7 • Breast milk or formula only for first 4-6 months • Introduce cup at 6-8 mos.

5. 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 • Not recommended for mothers with HIV, active TB, drug abuse. And not for infants with galactosemia (intolerance to galactose).

6. Breast Milk • Due to their low content in breast milk, infants who are breast fed need: • Vitamin D supplements • Iron supplements (after 4-6 mos) • Fluoride supplements (after 6 mos)

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

8. 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

9. Introducing Solid Foods • Begin at 4-6 months of age • Introduce single-ingredient foods, one at a time q 4-7d to assess for food allergies. • Rice cereal, then oat and barley (Fe fortified) + fruit juice (Vit C). Limit juice to 2-4 oz/d • Vegetables first then fruit may be best. • Finger foods 8 mos. • Egg yolks, meats about 10 mos.

10. 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, pnut butter, popcorn, raw celery, whole beans, and whole grapes (choking hazards) • Citrus, strawberries, wheat, cow’s milk, egg whites, pnut butter (allergy)

11. Toddler Nutrition • 2-3 cups of regular cow’s milk and other sources of calcium (need 500 mg/d)—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

12. Toddler Nutrition • “Physiologic anorexia” • Picky, fussy eaters; ritualistic • Give 1-2 TBSP; likes finger foods • Limit sweets • Buy child-designed utensils • Refusing food is a form of control • Wean from bottle by 14 mos

13. Mealtimes With Toddlers • High chair with foot support • Discourage unacceptable behavior • Let toddlers explore and enjoy food • Don’t force foods • Let children choose nutritious foods • Introduce new foods with favorite ones and more than once. • Make mealtimes pleasant. • Remember food habits and choices in adulthood start here! • Never leave them unattended!

14. 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

15. Nutrition During Childhood • Carbohydrate recommendations = adults • Fiber intake should be about 15-20 g • Fat intakes should be 20-30% 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

16. Nutrition During Childhood • Calories, 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 • Never require the child to clean his plate and never use food as reward.

17. 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

18. 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

19. 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)

20. 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

21. 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)

22. 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

23. 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

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

25. 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”

26. 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

27. 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 • Be a good role model with healthy eating and exercise.