Children and Adolescents: Nutrition Issues, Services and Programs

1. Children and Adolescents: Nutrition Issues, Services and Programs Dr. Dina Qahwaji

2. Children and adolescence • Good health is fundamental to growth, development and well-being of all children and adolescence • Protect them from chronic disease as adult • This group is dependent and at high risk of nutritional and health problem Dr. Dina Qahwaji

3. Factors interact to shape food choice in young children • Nutrition attitudes and knowledge of parents and child-care providers • Economic and social status of the family • Birth order of the child • Peers, media and advertising • Source of food (home, day care and fast-foods restaurants) Dr. Dina Qahwaji

4. Healthy People 2010 • Objective: understanding and improving health • Through physical activity, nutrition and dental care • Decrease overweight and obesity rate • The proportion of students who participate in physical activity declined from 42% in 1991 to 29% in 1999. And incidence of diabetes as well as overweight & obesity increased Dr. Dina Qahwaji

5. Healthy People 2010 recommended steps • Promote the beginning of behaviour therapy for overweight children before puberty • Educate children and their families about health benefits of PA and weight reduction Dr. Dina Qahwaji

6. Healthy People 2010 recommended steps • Encourage schools for health-promoting ways • Demonstrate to school that regularly PE during the school day can ↑ academic achievement • Develop ways to increase PA among children with disabilities Dr. Dina Qahwaji

7. What are children and adolescence actually eating? • Children are failing to meet recommendation guideline by not consuming enough fruit and vegetables and by eating too much food high in fat and salts • Eating habit is changed since last 2 decade • The USDA’s Centre for Nutrition Policy and Promotion uses the Healthy Eating Index (HEI) as an indicator of diet quality • It provides an overall picture of the variety and quantity of food people choose to eat Dr. Dina Qahwaji

8. What are children and adolescence actually eating? • Effect of family status, children from poor families’ are more likely to have a diet rated as poor or needs improvement • Diet from childhood to adolescence • ↓ dietary quality • ↓ consumption of vegetables, fruits & milk • ↑ consumption of soda drink Dr. Dina Qahwaji

9. A Healthy Eating Report Card for Children aged 2-9 Source: Centre for Nutrition Policy and Promotion, USDA, 2001

10. Childhood Obesity • Eating practices influence a child’s physical growth • During the past 2 decades: • The lack of good nutrition habits and physical inactivity, has lead to an epidemic of overweight children and adolescents • Percentage of overweight children has nearly doubled • Percentage of overweight adolescents has tripled • Associated with chronic diseases, Type 2 diabetes, high blood lipids and hypertension Dr. Dina Qahwaji

11. Childhood obesity and early development of chronic diseases • Overweight children are at risk for CVD, insulin resistance, Type 2 diabetes, and other serious health problems • Overweight children and adolescents more likely to become overweight and obese adults • 60% of overweight children shown to have at least one CVD risk factors Dr. Dina Qahwaji

12. Other Nutrition-Related Problems • Under-nutrition • Iron deficiency anaemia • Dental caries • High blood cholesterol Dr. Dina Qahwaji

13. Nutrition standards for child-care programs • Three guiding principles set the tone of the nutrition section of the standards: • Food should help to meet the child’s daily nutritional needs and reflect individual and cultural differences. • A nutrition specialist or food service expert is a central member of the facility’s planning team • To prevent food-borne illness, suitable equipment and food handling are essential Dr. Dina Qahwaji

14. General Recommendations • Meal plans: • ⅓ of RDAs should be met if the child present 4-7 hours per day, ½ - ⅔ of RDAs should be met for a child present 8 hours or more per day. • Meals and snacks with a variety of nutritious. • Attention should be given to cultural food patterns, appetizing colours and qualities. Dr. Dina Qahwaji

15. General Recommendations • Preparation and food service: • Salt, fat and sugar should be kept to a minimum. • Fruits, vegetables and whole-grain foods should be promoted. • Nutrition guidance: • Registered dietitians should employed to review and guide a quality program. Dr. Dina Qahwaji

16. General Recommendations • Nutrition education and training: • Education for children and parents • Parents can serve as instructors and facilitators • Physical and emotional environment: • Positive, enjoyable interaction among children and adults is preferred Dr. Dina Qahwaji

17. Child Nutrition Programs: National School Lunch Program • NSLP is the Nation's second largest food and nutrition assistance program. It operated in over 95,000 public and nonprofit private schools (grades K-12) and provided low-cost or free lunches to over 30 million children daily • Free lunches are available to children in households with incomes at or below 130 % of poverty Dr. Dina Qahwaji

18. School cafeterias served more than 5 billion lunches, more than half of them free or at a reduced price. The NSLP also provided more than 180 million afterschool snacks in 2007. The cost to USDA of providing lunches and snacks was $8.7 billions • Meals must meet nutritional standards and stay within the budget • Calories must be enough to meet nutritional needs Dr. Dina Qahwaji

19. Child Nutrition Programs: School Breakfast Program • Founded by the Child Nutrition Act of 1966, SBP like NSLP, provides nutritional meals to students at participating schools (and to children in a few housing child care institutions). • Eligible students receive free or reduced-price breakfasts Dr. Dina Qahwaji

20. The number of schools participating in the SBP ↑ in 1990 • Growing by 9% annually between 1989 and 1995 • The number of participating schools has continued to increase • In 2007, 79,950 schools participated in the SBP, up from 78,017 in 2006 Dr. Dina Qahwaji

21. In 1989, 3.7 million students participated in the program on a given school day, and a total of 658 million breakfasts were served • In 2007, 10.1 million students participated in the program daily, 4 % more than the previous year • 1.7 billion breakfasts served, 71 % were free and another 10 % were provided at reduced price Dr. Dina Qahwaji

23. Child Nutrition Programs: Child and Adult Care Food Program • CACFP provides meals and snacks to children at family day care homes, child care centers, homeless protects, and after-school programs, and to adults at adult day care centers • In 2007, more than 3 million children and 103,603 adults received CACFP meals and snacks on an average day. Total cost to USDA for CACFP in 2007 was $2.2 billion Dr. Dina Qahwaji

24. Meals and snacks provided through CACFP important to working parents, improving day care quality and making day care more possible • It give refunds for family child care homes participating in the CACFP, with higher refunds for homes serving primarily low-income children Dr. Dina Qahwaji

25. Child Nutrition Programs: USDA Fruit and Vegetable Program • The Program makes fruit and vegetable snacks available at no cost to all children in participating schools • The program began in 2002 as a pilot program in a small number of schools • It has become a permanent program that was expanded to cover selected schools in all 50 States, as part of the 2008 Farm Bill Dr. Dina Qahwaji

26. USDA's Economic Research Service evaluated the pilot based on: • Analyses of administrative school records • School reports • Site visits to schools • Focus groups and interviews with school staff and parents Dr. Dina Qahwaji

27. Most schools participating in the pilot considered the program doing well and strongly supported its continuation • Pilot sites chosen to represent a mix of large and small; rural, suburban, and urban; and elementary, middle, and high schools • Schools included students from different ethnic backgrounds and family income levels, based on the proportion of students qualified as eligible for free and reduced-price lunches Dr. Dina Qahwaji

28. Nutrition Intervention for Risk-Reduction: Model Program • Bright Futures: Aim of Program: To further trusting relationships between the child, health professional, the family, and the community to promote best health for the child • The guideline are developmentally based and address the physical, mental, and social devolvement of children and their families • Nutrition supervision guideline are given for each group, interview, questionnaire, screening, assessment, counselling are provided Dr. Dina Qahwaji

29. Bright Futures • Nutrition is based on: • Nutrition must be added into the lives of infants, children, adolescents, and families • Good nutrition requires balance • An element of joy increase nutrition, health, and well-being Dr. Dina Qahwaji

30. Head Start and Early Head Start US Dept of Health & Human Services • Complete child development programs serving children from • Birth to 5 • Pregnant women • Their families • 1 million children participate • Nutrition services are part of provision Dr. Dina Qahwaji

31. Head Start and Early Head Start • The overall goals is to increase readiness for school of children from low-income families • Work on education and early childhood development, medical, dental and mental health services, nutrition services and parent education Dr. Dina Qahwaji

32. Food Stamps • USDA Administered • Designed for low income adults to buy food • Average monthly benefit per person was $79 in 2002 which is enough to help family pay for portion of the food they need • It’s now progressing from stamps to electronic cards • Participants in the program is associated with increase intake of number of nutrients Dr. Dina Qahwaji

33. Other federal program • Summer Food Service Program • Provide meal to children from poor area when school is not in session • Federal government provide financial assistance to program where 50% of participants children are from family’s income lower than 185% of the poverty level • Important source of food for many children from food-insecure families Dr. Dina Qahwaji

34. Other federal program • Team Nutrition • USDA’S Food and Nutrition Services • Aim to improve children’s lifelong eating & physical activity level • Partnership of public and private organization interested in improving the health of children Dr. Dina Qahwaji

35. Impact of child nutrition programs on children’s diets • Promoted healthful eating habits and contributed to the quality of children’s overall diets • Have positive effect on children’s consumption of milk, fruit, vegetables and some vitamins and minerals • Improve the quality and nutritional value of school meals Dr. Dina Qahwaji

36. Key points shared by all nutrition and health program • Know and Identify the problem within specific target group • Have good educational background about the target group • To focus on health problem’s related behaviour to be change • Chose most suitable way to help change the behaviour to protect or by reducing health problem