Infancy: Nutrient needs
• Daily energy, protein, fat needs Breastmilk vs. Infant Formula
Energy: Birth-6m 108kcals
7-12m 98kcal
Protein: birth-6m 1.5 grams/kcal/day
7-12m 1.2 gram/kcal/day
Fat: birth-6m 31 grams
7-12m 30 grams
• Differences in the types and/or quantity of nutrients they contain (e.g., protein, fat,
minerals)
Breast Milk
protein: 7% of calories
fat: 55% of calories
carbs: 38% of calories
Formula
protein: 9-12% of calories
fat: 48-50% of calories
carbs: 41-43% of calories
Physical growth assessment
• What is/are the best way(s) to assess or
identify a change in infant growth
(weight, length)
measures over time identify change in growth rate and need for intervention
• Weight – changes during the first
doubles by 5-6 months and triples by 12 months
Feeding recommendations
• Breastfeeding recommendations
Exclusively breastfed for the first 6 months then through 1 year
• Cow’s milk introduction
can be introduced at 12 months old (should not be used in infancy); early
introduction can cause increase in protein and minerals and iron-deficiency
anemia
• Introducing foods/solids (including
texture and development; first foods) Behaviors signaling hunger & satiety Common
nutritional problems – for each, be able to describe: what it is; possible causes (if
known); treatment/prevention options
First foods: Make sure child is not too sleepy
Use small spoon with shallow bowl
• Avoid scraping spoon on infant’s gums
• Pace feeding to allow infant to swallow
• First meals may be 5-6 spoons over 10 minutes
Hungry signs: Watching food being opened in anticipation of eating
• Tight fists or reaching for spoon
• Irritation if feeding too slow or stops temporarily
Full signs: Playing with food or spoon
• Slowing intake or turning away
• Stop eating or spit out food
• Failure to thrive
Inadequate weight or height gain
– Energy deficit is suspected
– Can be diagnosed in infancy, but usually later
• Potential causes:
– Environmental factors; maternal depression; mental
illness; alcohol or drug abuse in home; over-dilution of
formula; feeding regimen
• Colic: Sudden onset of irritability, fussiness or crying
• Episodes may appear at the same or different time
• Usually disappears by 4-5 months old
• Cause: unknown, but associated with GI upset, infant
feeding practices
• Nutrition Intervention: good feeding position and
frequent burping may help
• Iron deficiency anemia
Less common in infants than in toddlers
• Infant iron stores reflect the iron stores of the mother
• Associated with:
– Cow’s milk intake; SES; intake of iron-rich
complementary foods
• Breastfed infants: may be given iron-supplements
and iron-fortified cereal at 4-6 months
• Formula-fed infants: iron-fortified formula
• Early childhood caries: Cavities
Avoid high-frequency consumption of sugar
• Limit use of bedtime bottle
• Avoid frequent breastfeeding after first tooth
• Bottle wean between 12 – 18 months
• Brush or wipe emerging teeth
• See a dentist by 12 months
• Food allergies & intolerances
• About 6 – 8% of children <4 years have food allergies
• Common symptoms: skin rashes, diarrhea, vomiting
• Not currently recommended that food introduction
be delayed
– variety in the diet and reinforces food rejection
• Treatment may consist of formula with hydrolyzed
Proteins
Immune system
• Development: takes several years for immune system to fully develop, different
antibodies in infants fed breast milk vs. formula
Toddlers & Preschoolers: Definitions (age ranges) Growth rates
• Compared with infancy and school- aged children
Toddlers:
– Characterized by: rapid in gross and fine motor skills
gain 8 oz and grow 0.4 inches
per month
• Preschool-Age Children:
– Characterized by: autonomy, broader social circumstances, language
skills, and expanding self-control
gain 4.4 lbs and grow 2.75 inches
per year
Nutritional needs
• Protein; vitamins and minerals of concern
Feeding behaviors
• Appetite –regulation and influence of growth spurts
toddlers: slowing growth during toddler year results in decreased appetite;
preschoolers: appetite related to growth, appetite increased prior to growth spurts
• Food preferences
may prefer familiar foods, serve child-sized portions, make food attractive,
strong-flavored or spicy foods may not be accepted, control amount eaten between
meals to ensure appetite for basic foods
• Parental influence
what the child is offered to eat and the environment in which food is served,
including when and where foods are offered
• Introducing new foods
serve new foods with familiar foods when child is hungry; may need 8-10
exposures to new foods before acceptance
Picky eating
• Parental perception
parent reports of toddler/preschooler picky eating is often a result of unrealistic
parental expectations bc 25-35% of toddler/preschooler's parents report them to
be poor or picky eaters while the majority have an appropriate appetite for their
age and rate of growth
• Division of responsibility
Child: whether they eat a particular meal or snack and how much they eat
Common nutritional problems – for each, be able to describe: what it is; possible causes
(if known); treatment/prevention options
• Iron deficiency anemia : Nutrition: limit cow’s milk consumption to 24 oz/day
• Infants at risk should be tested:
– At 9 – 12 months old
– At 15 – 18 months old
– Annually from 2 – 5 years old
Interventions for Iron Deficiency Anemia
• Dietary (heme sources consumed with vitamin C)
• Iron supplements
• Dental caries
Causes:
– Bedtime bottle with juice or milk
– Sticky carbohydrate foods (e.g., sticky candy)
– Grazing
• Streptococcus mutans
• Prevention:
– Fluoride: supplemental amounts vary by age and fluoride
content of water supply
– Feeding practices
• Constipation
Potential causes:
– ‘Stool holding’
• Cyclical problem
– Diet
• Prevention:
– Encourage child to go to the bathroom regularly
– Adequate fiber and fluid intake
• Whole grains, fruits, vegetables, legumes
• Fluids can be challenging because often less parental
Control
School-Age Children: Growth assessment
• Best measure(s) to assess growth and development of this age group
Nutritional needs and intake
BMI-for-age-perentile which accounts for normal, expected gains in weight and
height
• Protein, calcium, vitamin D- Actual intake vs. recommended intake
Protein: recommended: 0.95 g/kg
Calcium: recommended: 4-8 years (1000 mg/day) 9-13 years (1300 mg/day)
actual: intake falls short
Vitamin D: recommended: exposures to sunlight, vitamin D fortified food, fatty
foods, egg yolks
Feeding behaviors
• Common ones among this age group
parents and older siblings influence food choices in early childhood while peers
influence increases in preadolescence; family meal times should be encouraged,
snacks are still appropriate, and external regulation of intake beings
Adiposity rebound
Early childhood growth trajectory (BMI)
– 1st year of life: very rapid growth in height & weight
– 1 - 6 years: steady decline in BMI
• Growth in height outpaces weight
gains
– 7+ years: steady rise in BMI
Adiposity rebound: increase in BMI
following minimum BMI in early
childhood
Early AR (before 5.5 years of age)
• Consistently associated with increased risk of obesity
– Later childhood, adolescents, adulthood
• Also associated with increased fat deposition, insulin
resistance, type 2 diabetes, dyslipidemia, hypertension
Late AR (after 7 years of age)
• May have ‘protective’ role against obesity & other metabolic
abnormalities/complications
Iron deficiency anemia
Physical activity recommendations Children with special healthcare needs
• Why energy needs may vary
decrease in calories needed by children with slow growth or decreased muscle
mass (down syndrome) and increased calories needed as activity increases
(ADHD)
• Conditions that may interfere with adequate nutrient intake
chewing problems, PKU, cystic fibrosis, galactosemia
Adolescents: Physical development
• Sexual maturation/physiological changes associated with puberty – height, weight,
body composition (and differences between the sexes) – tanner scale
Males: peak weight gain occurs at the same time as peak linear growth and peak
muscle mass accumulation (~20 lbs per year); body fat decrease ~12%; almost
half of bone mass is accrued in adolescence
Females: peak weight gain follows linear growth spurt by 3-6 months (~18 lbs per
year); 44% increase in lean body mass and 120% increase in body fat; 17% body
fat needed for menarche; 25% body fat needed to maintain normal menstrual
cycle
• Timing of peak linear growth Nutritional needs
Female Peak: 6-12 months prior to menarche (menarche between 10.5-14 years
Male Peak: about 14 years of age (puberty begins between 12-16.5 years) about
14
years of age (puberty begins between 12-16.5 years)
• Optimal/ideal way to determine nutritional needs among adolescents
using sexual maturation or biological age bc there are variations in reaching
sexual maturity that affect nutrition requirements
• Energy needs – differences by sex
because males have greater increase in height, weight, and LBM, they have an
increased caloric need than females
• Daily intakes: protein, carbohydrate,
fiber, fat
Protein: 0.85 g/kg (low protein in linked to reductions in linear growth, delays in
sexual maturation, and reduced LBM)
Carb: 130 g/day or 45-65% of total daily caloric intake
Fiber: females: 26 g/day
males <14 years old: 31 g/day
males >14 years old: 38 g/day
Fat: 25-35% of total daily caloric intake; <10% from saturated fat (required to
support rapid growth and development)
• Calcium (changes in absorption during this time period), vitamin D, iron, folate
Calcium: DRI: 1300 mg/day (actual intake is way below that) critical to ensure
peak bone mass; females highest absorption rate around menarche and males highest
absorption rate during early adolescence
Vitamin D: RDA: 600 IU/day; essential role in facilitating intestinal absorption of
calcium and phosphorus
Iron: increased needs relates to: rapid rate of linear growth, increase in blood
volume, and menarche in females; females needs are greatest after menarche and
males are greatest during their growth spurt
Folate: DRI: 400 mcg/day; required for DNA, RNA, and protein synthesis
Feeding behaviors
• Factors affecting eating behaviors
peer influence, parental modeling, food availability, cost and convenience,
personal and cultural beliefs, mass media, body image, social norms
Recommended vs. actual dietary intake Physical activity recommendations
60 minutes daily; muscle-and-bone-strengthening activities 3 day/week
Public Food & Nutrition Programs:
For each of the public food and nutrition programs discussed in this course (WIC,
SNAP, NSLP, SBP), know the following:
• Goal/purpose
• Eligibility criteria for participation
• Nutritional guidelines/requirements outlined for the foods distributed
Wic: Provides supplemental foods, health care referrals, and nutrition education
for women, infants, and children
Eligibility requirements
• Nutrition risk:
– Pregnant women (conception – 6 wks postpartum)
– Breastfeeding women (up to infant’s 1st birthday)
– Non-breastfeeding postpartum women (up to 6 months postpartum)
– Infants (up to 1st birthday)
– Children (up to 5th birthday)
Gross income <185% of U.S. Poverty Income Guidelines
- OR – Participating in/receiving SNAP benefits and/or Medicaid
Snap: Offers nutrition assistance by helping adults in low- income households
purchase food to improve food security and nutrition of participants
• Monetary amount of food vouchers provided to
an eligible household depends on:
– Number of people in the household
– Household income
NSLP:
provides nutritionally balanced, low-cost or no-cost lunches to children each school day,
federal level (establishes nutritional guidelines and funding source) state level (monitors
compliance and distributes funding); fruit and vegetable, all whole grains, protein, milk
(fat-free can be flavored but low fat can not), zero trans fat per serving, specific calorie
range; free school meal (<130% of federal poverty level) reduced price (130-185% of
federal poverty level)
SBP
Children may be determined “categorically eligible”
for free meals through participation in certain Federal
Assistance Programs, such as the Supplemental
Nutrition Assistance Program, or based on their status as
a homeless, migrant, runaway, or foster child. Children
enrolled in a federally-funded Head Start Program, or a
comparable State-funded pre-kindergarten program, are
also categorically eligible for free meals. Children can
also qualify for free or reduced price school meals based
on household income and family size. Children from
families with incomes at or below 130 percent of the
Federal poverty level are eligible for free meals.
Human papillomavirus:
Viral infection
– ~100 different strains of the virus
– 14 considered high-risk because can lead to cervical cancer
• Most common sexually transmitted infection in the U.S.
Pap smear test for women No test for men
Prevention:
Abstinence or use of protective measures
– Condoms
• Significantly decreases risk of spreading HPV infection
– Be monogamous
– Have both partners tested for STIs
• HPV vaccine
All boys and girls should get their first dose between 1112 years of age
• Second dose given 6-12 months later
Overweight & Obesity:
Definition of overweight and obesity Risk factors
overweight: >85th percentile to <95th percentile
obese: >95th percentile
environment (physical activity, food access/availability, role modeling), genetics,
family income status, race/ethnicity, inadequate physical activity, dietary intake
Health implications Treatment/Management Strategies
Health implications: hypertension, dyslipidemia, insulin resistance or type II
diabetes, sleep apnea, hypoventilation disorders, orthopedic problems, body
image disturbances, low self-esteem/self-worth
Management:
multi-component approach, behavior/factors to target (dietary intake, food
access/availability, physical activity, policies/zoning), settings to target (home,
school, childcare, neighborhood, universities, food retailers, recreation centers)
support systems to target (parents, siblings, peers, teachers, caregivers,
politicians)
Getting the Nutrition Message Across: Trends in food marketing targeting children Food
marketing strategies targeting children Influence of food marketing on child health
Trends:
broadcast media, social media, brand licensing, event sponsorships, celebrity
endorsements, promotional characters, product placement, in-store marketing, with-in
school marketing fun foods, giveaways/contests
Influence:
thought to be too cognitively immature to differentiate between facts and marketing
communication, extraordinarily high recognition of popular characters, direct spending
by children, influence on parental spending (pester power), and life-long brand loyalty