6. Prevention and management of infections
and diarrhea
7. Regular growth monitoring of weight and
height
NUTRITION OF YOUNG AGE



1 to 5 years old children – rapidly growing
o Nutritionally vulnerable and undergo
crucial food habits development
Formative years = 0 to 8 years old
During the first 1,000 days, the brain grows
more quickly than any other time in a person’s
life.
PROBLEMS ON NUTRITION
Malnutrition
- Deficiencies, excesses, or imbalances in a
person’s intake of energy and/or nutrients.
- Wasting – low weight for the height; acute
- Stunting – low height for age; chronic
o In the Philippines, Top 10 in the world in
having the highest number of stunted
children.
o 1 out of 10 = severely stunted
o 30% of Filipino children
- Underweight – low weight for age
- A child needs to reach a height of 80 cm when
he or she is 2 years old.
FACTORS AFFECTING NUTRITIONAL STATUS
Causes of Stunting
- Environment and quality of health services –
important determinants of growth in first years
of life.
- Mother, inadequate care, inadequate
breastfeeding, inadequate complementary
feeding, home, poor quality foods, food and
water safety, infection
INTERVENTIONS
 PPAN Priority actions with focus on the first
1000 days
1. Maternity protection and improving
capacities of workplaces on breastfeeding
2. Establishing lactation stations in non-health
establishments
3. Nutrition promotion for behavior change
4. Supplementary feeding of pregnant women
and children
5. Iron-folic acid and other micronutrients
supplementation of pregnant women

Legislation
o Executive Order 51 – Philippine Milk
Code
o RA 11148 – Kalusugan at Nutrisyon ng
Mag-Nanay Act
o RA 10028 – Expanded Breastfeeding
Promotion Act
o RA 11210 – Expanded Maternity Leave
Act
o RA 11037 – Masustansyang Pagkain
para sa Batang Pilipino Act
o RA 11223 – Universal Health Act
o RA 11310 – Institutionalizing the 4Ps
SIGNS OF GOOD NUTRITION
1. Good attention span
2. Alert, vigorous, and happy
3. Has endurance
4. Sleeps well
5. Normal height and weight
6. Stands erect, arms and legs straight
7. Clear, bright eyes
8. Smooth, healthy skin
9. Lustrous hair
10. With firm and developed muscles
NUTRIENT ALLOWANCE
 Energy
o 55% = metabolic activities
o 25% = physical activity
o 12% = growth needs
o 9% = fecal loss (90-100kcal/kg)
 Energy intake
o Average for 1-2 y/r old = 1350 kcal





CHON = 1.5 to 2 g/kg BW
Vitamins = Vitamin A, Vitamin C, Riboflavin, and
Thiamin
Minerals = Calcium and Iron, Iodine, Fluoride,
and Zinc
MEAL PLANNING
GUIDELINES
 Set a good example of eating the right food.
 Associate food with love and understanding.
 Not all children have the same response
towards food.
 What a child feels about himself, and his world
shows up on his sentiments about food.
 A child is very keen on the taste, flavor, texture,
and temperature of food.
o Introduce one new food at a time.
 Satisfy his curiosity by giving him an
opportunity to handle ingredients and
acquainting him with names and pictures of
foodstuffs.
Foods Recommended
 Energy foods – rice, corn, bread, yellow
kamote, or gabi to keep them on the go.
 Fats and oils – supply heat and energy
o Keep skin smooth and help the body
make use of vitamin A.
Give at least 1 cup whole milk daily
 Fresh whole milk (carabao, cow, or goat)
o Simmer for 30 minutes to make it last
longer
 Powdered whole milk
 Evaporated milk
Recommended milk is skim milk with butter oil
added to restore normal fat content
Other kinds of milk
o Evaporated filled milk
o Skim milk
o Sweetened condensed milk
 Avoid using condensed milk
FEEDING PROBLEMS
1. Child is eating too little
o Cause: the child likes few foods (food
jogging)
o Remedies: Go slow in adding new foods.
Start the meal with foods he/she likes
best.
2. Child is eating too much
o Causes
 Heredity
 Temperament
 Appetite
 Insistence on a clean plate
o Remedies: refrain from serving rich
foods like cakes, pastries, pies, and ice
cream.
3. Child is dawdling during meal tie
o Causes
 Trying to get attention
 Not be feeling well
 May be given portions which are
too large
o Remedies:
 Have the child regularly checked
by a pediatrician.
 Avoid fussing over him/her
 Let the child enjoy eating
4. Child is gagging especially when fed coarse
foods.
o Cause: The child lacks proper training in
eating chopped foods.
o Remedies:
 Encourage self-feeding
 Put the child in a well-ventilated
bright clean eating place.
 Provide the child with a colorful
plate, an eye-catching cup, and
utensils which he or she can
manage easily.
5. Child has aversion towards some foods.
o Give fruits as substitute for vegetables.
o Mix vegetables with familiar foods like
noodles and eggs or stuffing them inside
mashed potatoes or “kamote”
o Give milk through “halo-halo,” or “leche
flan,” “gulaman,” “pinipig,” “mais con
yelo’” or breakfast cereals.
6. Child has some allergies
o Causes
 Chemicals in the air
 Food preservatives
 Food coloring
o Remedies
 Monitor nutrient intake
 Make food substitution
FOOD GUIDELINES AND SAFETY ISSUES
 1-2 years old
o Provide simple finger food
o Teach them how to wash hands
o Cut food into small pieces
o Monitor chewing
o Place small serving on plate
o Introduce one new food at a time
 2-3 years old
o Continue with the introduction of
new tastes/new look
o Provide variety and observe right
kind and amount per food pyramid
o Make mealtimes enjoyable
o No nuts or sticky foods that could
stay on the throat
 3-5 years old
o Bring child into food shopping
o Include suggestions in meal planning
COMMON NUTRITIONAL PROBLEMS
1. Developing desirable food habits
2. Anemia
3. Diarrhea
4. Constipation
5. GERD
6. Failure to Thrive
7. Obesity
8. Lead Poisoning
9. Dental problems
NUTRITION OF CHILDREN





Period between 7-12 years.
Characterized by a slow and steady growth
A quiet stage, in preparation for adolescence.
(Lull before the storm)
Starts to assert individuality.
Can be taught to see the relationship of food to
a healthy body.
SIGNS OF GOOD NUTRITION
 Well-developed body with normal weight for
height
 Firm and well-developed muscles
 Good posture
 Healthy skin, no lesions and dyspigmentation
 Smooth and glossy hair
 Clear eyes
 Alert facial and good disposition
 Sound sleep
 Good digestion and elimination
 Good appetite
NUTRIENT ALLOWANCES
Energy
 1600 kcal (7-9 y/o)
 1920-2140 kcal (10-12 y/o)
CHON
 43-54 g
Vitamins and Minerals
 Supplementation of Vit ADEK
o Iron = 11-19 mg
o Vitamin C
 7-9 years = 35 mg
 10-12 years = 45 mg
o Calcium = 700-1000 mg/day
o Iodine = 120 mcg
MEAL PLANNING FOR SCHOOL AGE CHILDREN
1. Make green, leafy, and yellow vegetables and
fruit a “must” in daily family meals. Stimulate
appetite with various forms, colors, sizes, and
shapes of food served.
2. Pack nutritious lunch. Remember that one
packed lunch should supply at least 1/3 of the
child’s daily food needs.
3. Avoid serving too spicy and highly seasoned
foods. These may destroy the appetite for the
more bland but highly nutritious foods.
4. Make snacks count. Serve nutritious snack like
root crops, beans, or fresh fruits instead of
candies and soft drinks.
HOW TO PREPARE PACK LUNCH
1. Plan the meals that are cheap and easy to
prepare.
– Choose food in season.
– Prepare easy-to-pack dishes like fried
fish or pork adobo with slices of
tomatoes, fish/meat omelet, beef tapa,
or boiled kangkong tops with alamang
– Use fruit in season for dessert.
2. If child prefers, prepare sandwich fillings the
day or night before to save time in the usual
busy mornings. Wrap sandwiches separately.
3. If possible, include foods like milk and fruit juice
for beverage.
FEEDING THE SCHOOL CHILD
1. Psychological Factors
a) More confident, expresses own food
choices.
b) Strong urge to eat what his friends eat.
2. School Environment – goals of school feeding
program in the Philippines.
a) To improve the nutrition of school children
by furnishing them wholesome food at the
lowest reasonable cost.
b) To aid in strengthening the nutrition and
health education program of the public
schools.
c) To foster proper eating habits.
3. Food Preferences
a) Child eats a wider variety of foods and has
more food likes and dislikes.
b) Wants simple and plain dishes.
c) Eats what most adults do.
d) Develops fondness for food products seen
in TV commercials and appetite for food
favorites of his movie idol.
FEEDING PROBLEMS
1. Skipping breakfast/inadequate meals
 ¼ to 1/3 of the daily nutrient allowance is often
missed or hurriedly eaten by school children.
 Cause:
o Nothing to eat
o Late bed riser
o Arrival of school bus
o Fear of being late in school
o Rush in preparing oneself for school
 A good breakfast may consist of the following
example below:
o Vitamin C rich fruits like papaya
o Cereal like oatmeal or fried rice or
pan de sal
o protein-rich foods like egg, “tuyo,”
cheese, or milk
2. Poor appetite
 Causes
o Demanding school work
o Tiring extracurricular activities
o New outdoor experiences
o Confections and soft drinks in school
 Remedies:
o School cafeteria should offer snacks
or “merienda” which are nutritious
and inexpensive.
 Carbohydrate-rich snack
products which provide little
or no vitamins and minerals
must be replaced with milk
and fruit beverages, “turon,”
“munggo,” peanuts, fresh
fruits, and bread.
3. Sweet Tooth
 Causes
o Hungry growing bodies recognize
the need for extra calories
o Parents give sweets as rewards or
pasalubong to kids.
NUTRITION PROBLEMS AND INTERVENTIONS
1. Protein-Energy Malnutrition
 Inadequate intake of energy or protein or both
 Has three forms:
o Underweight
o Stunting
o Wasting
2. Micronutrient Malnutrition
 Common: start omitting breakfast (negative
impact on children’s academic performance)
 Iron Deficiency Anemia – cause negative
impact on cognitive (problem solving), behavior
performance
o Management: Iron rich food,
Vitamin C
 Vitamin A Deficiency
o Low intake of Vit. A rich foods
o Poor absorption of Vit A due to poor
intake of fats
3.



Parasitism
Parasites interfere with Fe & fat absorption
Decrease nitrogen and vitamin c retention
Management: deworming
4. Dental Caries
 Cause: long exposure of teeth in acidic
environment
 Management:
o Avoid/minimize eating/drinking
beverage, candies, deserts, sweets
o Encourage nuts, eggs, meat, hard
cheese
o Fluoride application
5. Obesity
 May result in psychosocial difficulties and
diseases like HPN, DM
 Contributing factors:
o Inactivity
o Poor eating habits
 Management:
o Family involvement in diet
modification, nutrition information,
activity planning, and behavioral
component.
GUIDELINES FOR ENSURING CHILDHOOD HEALTH
1. Schedule regular mealtimes & allow child to
plan, prepare & serve meals, as well as
clean up.
2. Maintain variety of foods.
3. Have nutritional snacks readily available like
carrots, celery sticks, yogurts.
4. Have the child wake up early especially at
breakfast.
5. Encourage physical activity.
6. Avoid using food as a reward or bribe.
7. Turn off TV during meals.
HELPFUL MEALTIME HINTS FOR SCHOOL-AGED
CHILDREN
 Always serve breakfast, even if it has to be "on
the run. “
 Take advantage of big appetites after school by
serving healthy snacks such as the following:
o Fruits
o Yogurt
o Sandwich
o Milk and cereal
 Set good examples for eating habits.
NUTRITION OF ADOLESCENCE






Transition period between childhood and
adulthood.
Between 10-13 in girls; 13-16 in boys
Period of rapid growth that causes major
changes in physical, cognitive, social, and
emotional maturity.
o Physical changes = bones grow and
gain density, muscle, and fat tissue
develop, and blood volume
increases
Growth spurt – height increase of 3 inches a
year for girls and 4 inches a year for boys
“the beginning” with the gradual appearance of
primary and secondary sex characteristics
Girls mature earlier than boys.
PRIMARY
BOYS
enlargement of
the penis and
testes, and the
first spermarche
( i.e., the first
ejaculation of
mature sperm).
SECONDARY are those sexually
dimorphic that
are not directly
involved in
reproduction.
changes in voice
quality, facial and
chest hair,
increased body
hair, pelvic build
(lack of rounded
hips), upper body
muscular build,
and the ability to
generate muscle
mass at a faster
GIRLS
first
menarche, or
first
menstrual
period
The first
menarche
indicates girls
have begun
to ovulate.
body changes
such as:
enlargement
of breasts,
uterus, vagina
due to
estrogens.
feminizing
hormones
and absence
of testicular
androgens,
narrow
shoulder,
broad hips,
diverging
arms, female
rate than the
female.
distribution
of fat, highpitched voice,
less body
hair, more
scalp hair,
growth of
pubic and
axillary hair
due to
adrenal
cortex and
ovarian (less)
androgens.
NUTRITIONAL OBJECTIVES
 Provide optimum nutritional support for
demands of rapid growth and high energy
expenditure.
 Growing adolescents require increased caloric
intake, increased good quality CHON, liberal
amount of vitamins and minerals
 Males need more nutrients because they have
more lean muscle mass.
o More physically active
 Females need more iron, CHON, and other
nutrients
o Because of menstruation
 Support development of good eating habits.
CHALLENGING ADOLESCENT CHARACTERISTICS
 Accelerated growth and development.
 Changes in lifestyle, including food habits.
 Involvement in social and physical activities.
 Emotional problems
 Problems that demand special nutritional needs
PROMOTION OF OPTIMAL HEALTH
1. Effective health education focus on:
a. Irregularity of meals and skipping
breakfast
b. Poor choice of snack item
c. Personal concern of their figure
development
d. Obesity
e. Teenage pregnancy, street drugs, and
alcohol abuse
2. Independent, active involvement of the
adolescent in the selection of a nutritious diet
3. Adequate sleep and rest
NUTRITIONAL NEEDS
Calories
 Daily recommended intake for light to
moderate activity
o 50 kg male (13-15) = 2,800 kcal
o 58 kg male (16-18) = 2,840 kcal
o 49 kg female (13-15) = 2,250 kcal
o 50 kg female (16-18) = 2,050 kcal
Protein
 Increased CHON intake
 Males
o 13-15 = 71 g
o 16-18 = 73 g
 Females
o 13-15 = 63 g
o 16-18 = 59 g
Vitamins and Minerals
 Male – slightly increase in females, except iron.
Minerals
 Calcium RDA: 1000 mg/day for males and
females
o Support peak bone mass, uses for
bone mineralization
 Iron
o Boys
 13-15 = 20 mg
 16-18 = 14 mg
o Girls
 13-15 = 21 mg
 16-18 = 27 mg


Rationale: increase Iron in
female because of periodic
menstrual cycle


Iodine
o 150 mcg for both sexes 13-18 years
old
o Supplied in diet in the form of
iodized salt.
Fiber
 Female, 14-18 years old = 25 g
 Male, 14-18 years old = 31 g
 decreased fruit and vegetable = decreased fiber
intake
 skipping breakfast lowers fiber intake
Fat
 Total fat: less than 30% of total calories
 Saturated fat: less than 10% of total calories
 Dietary cholesterol: less than 300 mg/day
 Adolescents consume approximately 33% of
total calories from fat & 12% from saturated fat
COMMON PROBLEMS ASSOCIATED WITH
NUTRITION IN ADOLESCENTS
1. Overweight and obesity
o Obesity – excessively high amount of
body fat or adipose tissue in relation to
lean body mass.
 BMI > 95th percentile
o Overweight - refers to the state of
increase body weight in relation to
height
 BMI = 85-95th percentile
o Possible complications
 Physical = HTN, DM, Coronary
Artery Disease, Pulmonary
Dysfunction, Ischemic Stroke,
Orthopedic Problems
 Emotional/Psychological – poor
body image, low self-esteem,
social isolation, depression,
rejection
Theories of Obesity
 Hypothalamic Factor- tumor/lesions impact
satiety signaling pathways, structural damage
leads to hyperphagia & rapid weight gain

Heredity
Adipose Cell Theory- idea is that each body is
programmed to have a basic set number of fat
cells; creation of new fat cells is far easier than
losing old ones
Set-Point Theory- there is a control system
built into every person dictating how much fat
he/she should carry; some have high setting,
others have low one
Risk Factors of Obesity
 Socio-cultural factors
 Psychological factors
 Decreased physical activity
Therapeutic Management
 Motivation
 Diet
o Decrease intake of problem food
o Regulate food portion size
 Exercise
 Behavioral Therapy
 Medical Therapies
 Prevention
2. Dieting behaviors
 Common in females
 50% - 60% of females consider they are
overweight
 Places adolescents at risk for eating disorders
 Associated w/ inadequate intake of essential
nutrients
3. Body dissatisfaction
 Body image & self- esteem are closely related.
 Overweight adolescents can strive toward a
realistic leaner & healthier body
 Acne - healthy meals, good hygiene should be
emphasized
4. Eating disorders
 Anorexia nervosa
o Serious, chronic & often lifethreatening disorder defined by
preoccupation with weight & refusal
to eat to maintain minimal body
weight


o Compulsion: Exercise excessively,
starvation, frequent checks weight
o S/S
 Brittle hair & nails yellowish,
dry skin
 Hypothermia
 Depression
 Emaciation
o Diagnostic Criteria
 Weight loss of at least 15%
below normal or Ideal body
weight (IBW) for height or
age.
 Weight loss is self-induced by
avoiding fattening foods.
 There is self-perception of
being too fat with an
overwhelming dread of
fatness.
 There is widespread
hormonal disorder w/c may
lead to amenorrhea in
women & loss of sexual
interest in men.
Bulimia
o Eating disorder marked by weight
preoccupation & destructive binge
eating, followed by purging.
o Compulsion:
 Binge eating, purging, using
laxatives & diuretics,
vomiting, excessive exercise
o S/S
 Erosion of dental enamel,
sore at the back of hand,
depression, weight loss
Binge Eating Disorders
o Disorder characterized by eating too
much even if they are not hungry &
feel disgusted after eating
o “ Stress” / “emotional eating”
o Diagnostic Criteria
 Recurrent episodes of
overeating at least 2x a week
over period of 3 mos. Large
amounts of food are
consumed in short period of
time.



Persistent preoccupation
with eating & a strong desire
or sense of compulsion to
eat.
Person attempts to
counteract the fattening
effects of food by selfinduced vomiting, selfinduced purging, alternating
periods of starvation, drugs
e.g. appetite depressants or
diuretics.
There is a self-perception of
being too fat with an
excessive fear of fatness.
5. Lactose intolerance in adolescents
 Not able to digest ingested lactose in small
intestines that may cause bloating, flatulence,
abdominal cramping & diarrhea
 Management: Lessen the amount of milk
intake, eat yogurt or aged cheese as substitute
and other fermented products.
6. Allergies in food
 Risk: with family history
 S/S: dyspnea, wheezing, abdominal pain,
vomiting, skin reactions, swelling of lips or
tongue
 Management
o total avoidance of foods causing
allergy
o substitute other foods
ADOLESCENT ATHLETE
 Calorie intake of carbohydrates should be
increased to fuel as energy.
 B vitamins are increased because they are
necessary for energy metabolism.
 Athletes should be well hydrated before
exercise and drink enough fluid during and after
exercise to balance fluid levels.
 Additional water, calories, thiamine, riboflavin,
niacin, sodium, potassium, iron, and protein to
prevent dehydration.
 Amount of calories needed is determined by
the kind, duration of activity, intensity &
frequency of performing activities.


Vulnerable to fad foods & myths that would
enhance performance( eg. ergogenic aids –
steroid drugs).
Good diet, good health habits and practice,
combined with innate talent, remain the
essentials for athletic success.
HELPFUL HINTS IN PREPARING MEALS FOR
ADOLESCENTS
 Arrange for teens to find out about nutrition for
themselves.
 Take their suggestions regarding foods to
prepare at home.
 Experiment w/ food outside your own culture.
 Have several nutritious snack foods readily
available.
 If there are foods that you do not want your
teens to eat, avoid bringing them into the
home.
Best nutrition advise to keep adolescents healthy
 Eat variety of foods
 Balance the food you eat with physical activity
 Choose a diet with plenty of grain products,
vegetables and fruits
 Choose a diet low in fat, saturated fat, and
cholesterol
 Choose a diet moderate in sugars and salt
 Choose a diet that provides enough calcium
and iron to meet their growing body's
requirements.
Sanitation and Safety
 Proper washing of hands before eating.
 Pack lunch or foods should be safe to eat after
2-4 hrs of preparation.
 Be observant of food handlers when eating in
fast foods.
 Be sure that foods are served with right temp.
 Restaurants & fast foods are checked by
sanitary surveyors for food sanitation & safety
& have sanitary permit.