Life Cycle Nutrition: Infancy, Childhood, and Adolescence

1. Life Cycle Nutrition: Infancy, Childhood, and Adolescence Chapter 16

3. Nutrition during Infancy • Infant growth during first year • Reflects nutrient intake • Birthweight changes • Infant’s length • Energy requirement • Twice that of an adult

4. Weight Gain of Infants in Their First Five Years of Life

6. Nutrition during Infancy • Energy nutrients • Birth weight should double by 5 months and triple by 12 months • Kcal needs : 100 kcal/kg, unlike ~30 kcal/kg for adults • 6-12 months kcal include solid foods • Carbohydrates (glucose) especially needed for brain • Brain size proportionately larger than adult’s • Fat provides most of the energy in brst milk/formula • Protein- MOST important for growth • Basic building material of body’s tissues • Protein overload stresses liver, kidneys • Acidosis, diarrhea, high serum ammonia & urea • Feeding with nonfat milk or conc. formula

9. Nutrition during Infancy • Vitamins and minerals • Needs are greater than adults • Water • Percentage of body weight as water highest as young infant • Dehydration from vomiting, diarrhea, high temperature require supplemental water or electrolyte fluid (Pedialyte)

10. Recommended Intakes of an Infant & an Adult Compared Based on Body Weight

12. Percentages of Energy-Yielding Nutrients in Breast Milk & in Recommended Adults Diets

13. 6% 21% 26% 55% 53% 39% Breast milk Recommended adult diets Key: Protein Fat Carbohydrate

14. Slower growth More activity

15. Breast Milk • Practice of breastfeeding • Length of exclusive breastfeeding 6 months • Breastfeeding and complementary foods 6-12 months • Frequency and duration of feedings • Breast milk more digestible and less filling • Energy nutrients • Lactose • Oligosaccharides not in cow’s milk or formula • Essential fatty acids • Protein- less than cow’s milk, α-lactalbumin more digestible

17. Breast Milk • Practice of breastfeeding • Vitamins and minerals • Vitamin D tends to be low in breast milk, supplement it • Iron less but highly bioavailable, due to lactoferrin • Immunological protection • Colostrum • Bifidus factors • Antibodies and white blood cells • Lactadherin inhibits replication of diarrhea virus

19. Immunological Protection of Breast Milk • Allergy, infection and disease protection • Colostrum • Bifidus factors • Antibodies and white blood cells • Lactadherin inhibits replication of diarrhea virus • Lower incidence of allergic reactions • Protection against development of cardiovascular disease • Protection against excessive weight gain • Intelligence • Controversial

20. Breast Milk • Breast milk banks • Donation of breast milk • Screening • Life-saving solution for fragile infants

21. Infant Formula • Composition • Attempt to copy composition of breast milk • Iron-fortified • No protective antibodies • Safe preparation

22. 6% 9% 20% 49% 55% 51% 42% 39% 29% Breast milk Infant formula Cow’s milk Key: Protein Fat Carbohydrate

24. Infant Formula • Risk of lead poisoning • Infant formula standard set to “well-nourished mothers during first or second month of lactation” • Special formulas for preemies or genetic diseases • Inappropriate formulas as total diet • Goat’s milk • Soy milk • Rice milk • Nursing bottle tooth decay

25. Nursing Bottle Tooth Decay

26. Special Needs of Preterm Infants • 1 of 8 births is preterm • Preterm or premature • Incomplete fetal development • Leading cause of infant deaths • Often low-birthweight infants • Benefits of third trimester for infant’s nutrient stores • Preterm breast milk • More protein, less volume • Supplements can be added too

27. Introducing Cow’s Milk • Cow’s milk never advised before age 1 • Children 1 to 2 years of age • Whole milk 4% (red cap) milk • If it seems to be linked to chest and nasal congestion, try goat’s milk, much closer to human milk • Benefits of goat's milk • Children aged 2 to 5 • Gradual transition from whole to lower-fat milks

28. Introducing Solid Foods • When to begin • Between 4 and 6 months • Developmental capability • Purpose of solid foods • Food allergies • Single-ingredient foods • One at a time in small portions • Waiting period before next food is introduced

30. Introducing Solid Foods • Choice of infant foods • Provide variety, balance, and moderation • Commercially prepared vs. homemade foods • Food labels • No fat information listed or needed for children younger than two • Need for fat due to growth rate and essential fatty acids for brain development

31. Introducing Solid Foods • Foods to provide iron • Breast milk or iron-fortified formula • Iron-fortified cereals • Meat and meat alternates • Foods to provide vitamin C • Fruits and vegetables • Limit 100% juice to 4-6 oz/day • Foods to omit • Honey and corn syrup • Soda, sweetened “fruit drinks”-- C-fortified or not

33. Introducing Solid Foods • Vegetarian diets • Newborn is a lacto-vegetarian • Beyond six months • Vegan diets slow down growth and development • Well-balanced vegetarian diet is doable; continue iron supplement and/or children’s MVI • Foods at 1 year • Cow’s milk- 2-3 cups/day- no more • Displacement of iron-rich food sources by milk can lead to anemia

35. Mealtimes with Toddlers • Deficiencies of vitamin D, vitamin B12, iron, and calcium may develop. Energy-dense foods are required. • Feeding guidelines currently in vogue • Discourage unacceptable behavior • Let toddler explore and enjoy foods • Don’t force food on children • Provide nutritious foods • Let child choose which ones and how much • Limit sweets • Don’t turn dining table into battleground

37. Nutrition during Childhood • Annual growth • Height • Weight • Body composition and shape changes • Energy needs, nutrient needs, and appetites during childhood vary because of growth and physical activity. Hunger and nutrient deficiencies affect behavior. • Concerns include lead poisoning, high energy, sugar and fat intakes, iron deficiency, caffeine consumption, food allergies, and food intolerances. Adults and schools need to provide children with nutrient-dense foods.

38. The body shape of a 1 year old (left) changes dramatically by age 2 (right). The 2 year old has lost much of the baby fat; the muscles (especially in the back, buttocks, and legs) have firmed and strengthened; and the leg bones have lengthened.

39. Energy and Nutrient Needs in Childhood • Appetites diminish around 1 year of age • 1 yr to adolescence: ↑2-3 inches, ↑5-6 lbs • Food intakes coincide with growth patterns • Energy intakes vary from meal to meal • Energy needs vary widely • 1 yr old- 800 kcal/d • 6 yr old- 1600 kcal/d • Growth and physical activity • Difficulty meeting energy needs

41. Energy and Nutrient Needs in Childhood • Carbohydrate and fiber • Recommendations are the same for children and adults • Fiber recommendations in proportion • Fat and fatty acids • DRI Committee recommendation • Fat should be 30-40% of total kcal for 1 to 3 year olds • Fat 25 - 35 % of total kcal for 4 to 18 year olds (same as adults)

42. Energy and Nutrient Needs in Childhood • Protein recommendations • Considerations • Nitrogen balance • Quality of protein • Added needs of growth • Vitamins and minerals • Needs increase with age • Iron and vitamin D • Supplements

43. Energy and Nutrient Needs in Childhood • Planning children’s meals • Variety of foods from each food group • No added salt, sugar, or seasonings. • Amounts suited to appetite and needs • Feeding Infants and Toddlers Study (FITS) • Findings • Greater variety of nutrient-dense vegetables and fruits are needed • Inadequate intakes of vitamins and minerals

44. What have we learned from FITS 2008? • Where we’re improvingMothers are breastfeeding longer Fewer numbers of infants and toddlers are consuming sweets Where we still need improvement • 25% of toddlers are not consuming a single serving of fruit and 30% don’t eat a single serving of vegetables on a given day • Preschoolers are consuming more white potatoes than the healthier dark green or orange vegetables • Sodium intakes are above the upper limit for 70% of 2 year olds and 84% of 3 year olds • Preschoolers 24–48 months are consuming more than the recommended amount of saturated fat

45. Food Guide Pyramid for Young Children

50. Hunger and Malnutrition in Children • Even mild malnutrition affects intellectual performance • Very low-income families • Greater risk of hunger and malnutrition • Meal skipping and academic performance • Benefits of breakfast consumption • Iron-deficiency and behavior • Behavior, attention span, and learning ability • Testing for iron status • Effects of deficiency occur before blood effects occur