Nutrition for Infants, Children, and Adolescents
Chapter 12
Nutrition for Infants, Children, and Adolescents
Intake of adequate calories and nutrients promotes optimal physical, social, and cognitive growth and development
Children and adolescents who do not consume enough calories and nutrients are at increased risk of impaired health and certain chronic diseases in adulthood
Actual nutrient requirements vary according to health status, activity pattern, and growth rate
Infancy (Birth to 1 Year)
Growth in the first year of life is more rapid than at any other time in the life cycle
Birth weight
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Doubles by 4 to 6 months of age
–
Triples by the first birthday
Length increases by approximately 10 inches during the first year
Infant’s needs are much higher per kilogram of body weight
Infancy (Birth to 1 Year) (cont’d)
Breast milk
Specifically designed to support optimal growth and development in the newborn
Composition makes it uniquely superior for infant feeding
Exclusive breastfeeding for the first 6 months of life followed by optimal complementary feeding are critical public health measures
Infancy (Birth to 1 Year) (cont’d)
Breast milk (cont’d)
Adequacy of intake is determined by monitoring weight for height on growth charts
Research shows that breastfeeding decreases the incidence and/or severity of infectious diseases
Infancy (Birth to 1 Year) (cont’d)

Breast milk (cont’d)
Some studies suggest that older children and adults who were breastfed have a lower risk of: o Type 1 and type 2 diabetes o Lymphoma and leukemia o Hodgkin’s disease o Overweight and obesity o Hypercholesterolemia o Asthma
Infancy (Birth to 1 Year) (cont’d)
Breast milk (cont’d)
American Academy of Pediatrics recommends exclusive breastfeeding for the first 6 months of life
Even after solid foods are introduced, breastfeeding should continue until at least the first 12 months of age
Infant formula
Infant formulas may be used in place of breastfeeding; to supplement breastfeeding; or when exclusively breastfed infants are weaned before 12 months of age
Infancy (Birth to 1 Year) (cont’d)
Infant formula (cont’d)
When compared to exclusively breastfed infants, formula-fed infants exhibit few if any differences up to
6 months of age
After 6 months of age, formula-fed infants grow slightly faster
Routine formulas are prepared from cow’s milk made to resemble human milk
Formula is iron-fortified
Infancy (Birth to 1 Year) (cont’d)
Infant formula (cont’d)
The Infant Formula Act

o Because the minimum recommended amount of each nutrient exceeds the amount provided in breast milk, nutrient supplements are unnecessary
Approximately 25% of the formulas used in the U.S. are made from soy
Infancy (Birth to 1 Year) (cont’d)
Infant formula (cont’d)
Variety of formulas are available for infants with special needs o Phenylketonuria (PKU) o Maple syrup urine disease
Low–birth-weight formulas
The amount of formula provided per feeding and the frequency of feeding depend on the infant’s age and individual needs
Infancy (Birth to 1 Year) (cont’d)
Infant formula (cont’d)
Overfeeding is one of the biggest hazards of formula feeding
To avoid nursing bottle caries, infants and children should not be put to bed with a bottle of formula, milk, juice, or other sweetened liquid
Complementary foods: introducing solids
Solids become a necessary source of nutrients around 6 months of age
Developmentally, most infants exhibit readiness to spoon-feed at around 4 to 6 months of age
Question
How do infants who are fed commercial formula after the first 6 months of life differ from breastfed infants? a. They have higher calcium stores. b. They develop slightly faster. c. They have lower iron stores. d. They grow slightly faster.
Answer

d. They grow slightly faster.
Rationale: When compared to exclusively breastfed infants, there are few if any differences in the rate of growth, blood components, or body composition in formula-fed infants up to 4 to 6 months of age (Shils, et al., 2006). Thereafter, formula-fed infants grow slightly faster, confirming that formula adequately supports infant growth and development.
Infancy (Birth to 1 Year) (cont’d)
Complementary foods: introducing solids (cont’d)
Eruption of teeth indicates readiness to progress from strained to mashed to chopped fine to regular- consistency foods
Iron-fortified infant cereal is generally the first solid food introduced o Give a small amount of formula or breast milk to take the edge off hunger before beginning the cereal o Recommended until the infant is 12 to 18 months old
Infancy (Birth to 1 Year) (cont’d)
Complementary foods: introducing solids (cont’d)
Traditionally, the order of foods introduced after iron-fortified cereals was: o Vegetables o Fruits o Meats o Eggs
Infancy (Birth to 1 Year) (cont’d)
Complementary foods: introducing solids (cont’d)
Order is no longer considered important
WHO and Pan American Health Organization recommend that “meat, poultry, fish, or eggs should be eaten daily or as often as possible”
New foods should be introduced in plain and simple form one at a time for a period of 5 to 7 days
Infancy (Birth to 1 Year) (cont’d)
Complementary foods: introducing solids (cont’d)

Peanuts and peanut butter should be avoided
Infants differ in the amount of food they want or need at each feeding
Infants and children should be allowed to self-regulate the amount of food consumed
Fruit juices were once considered essential complementary foods
Nutrition for Toddlers
The period between age 1 and 2 is a time of transition
“Physiologic anorexia”
At age one, the toddler should be:
Drinking from a cup
Eating many of the same foods as the rest of the family
Nutrition for Toddlers (cont’d)
Around 15 months of age, food jags may develop
By the end of the second year, children can completely self-feed and can seek food independently
At age one, whole milk becomes a major source of nutrients
Milk anemia can occur
The American Academy of Pediatrics recommends that low-fat or nonfat milk not be started until after the age of 2
Little research on the best ways to achieve optimal nutritional intakes exists and there are no nutritional guidelines
Nutrition for Toddlers (cont’d)
Feeding Infants and Toddlers Study (FITS)
American infants and toddlers consume a nutritionally adequate diet with little risk of nutrient deficiencies
Sizable percentages of toddlers consume high-calorie, high-fat, and salty snacks as well as carbonated beverages and sweetened fruit drinks
For children aged 19 to 24 months, French fries are the most frequently consumed vegetable
Nutrition for Toddlers (cont’d)

• Until the age of 4, young children are at risk of choking
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Decrease the risk of choking o Foods that are difficult to chew and swallow should be avoided o Meals and snacks should be supervised o Foods should be prepared in forms that are easy to chew and swallow
(e.g., cut grapes into small pieces and spread peanut butter thinly) o Infants should not be allowed to eat or drink from a cup while lying down, playing, or strapped in a car seat
Foods That Most Often Cause Choking
Hot dogs
Candy
Nuts
Grapes
Raw carrots
Tough meat
Celery
Popcorn
Peanut butter
Watermelon with seeds
Question
When is the period of “physiologic anorexia”? a. Age 0 to 12 months b. Age 1 to 2 years c. Age 2 to 3 years
Answer d. Age 3 to 4 years

b. Age 1 to 2 years
Rationale: The period between age 1 and 2 is a time of transition between infancy and childhood. The dramatic decrease in the growth rate is reflected in a disinterest in food, a “physiologic anorexia” due to lower calorie needs per kilogram of body weight.
Nutrition for Children
Childhood represents a more latent period of growth
Annually, a child grows 2 to 3 inches in height and gains about 5 pounds
School-age children maintain a relatively constant intake in relation to their age group
Nutrition for Children (cont’d)
Calories and nutrients
Total calorie needs steadily increase during childhood
Calorie needs per kg of body weight progressively fall
Challenge in childhood is to meet nutrient requirements without exceeding calorie needs
Content of childhood diets should be similar to that of adults
The dietary reference intakes for children are divided into 2 age groups: 1- to 3-year-olds and 4- to 8year- olds
Nutrition for Children (cont’d)
Eating practices
As children get older o They consume more foods from non-home sources o Have more outside influences on their food choices
Today o Many children do not eat breakfast o Get at least one third of their calories from snacks o Many obtain a significant portion of their calories from sweetened beverages
Nutrition for Children (cont’d)
Promoting healthy habits

Parents are the primary gatekeepers and role models of their young children’s food intake and habits
A rule-of-thumb guideline to determine age-appropriate serving sizes is to provide 1 tablespoon of food per year of age
Children who eat more meals with their families have healthier diets
Follow the Dietary Guidelines for Americans
Nutrition for Adolescence
(12 to 18 Years of Age)
The slow growth of childhood abruptly and dramatically increases with pubescence until the rate is as rapid as that of early infancy
Calorie and nutrient needs increase
Gender differences are obvious
Nutrition for Adolescence
(12 to 18 Years of Age) (cont’d)
Calories and nutrients
MyPyramid-recommended calorie intakes for adolescents are based on DRI-estimated energy expenditure calculations
Generally, nutrient requirements are higher during adolescence than at any other time in the life cycle with the exception of pregnancy and lactation
Suggested amount of calories for moderately active females aged 12 to 18 is 2,000, whereas for males the need ranges from 2,200 to 2,800 calories
Nutrition for Adolescence
(12 to 18 Years of Age) (cont’d)
Calories and nutrients
Requirements for calcium and iron (for males only) is higher during adolescence than at any other time in the life cycle
Adolescents have increased needs for iron o In boys, peak iron requirement occurs at 14 to 18 years of age o Requirement for iron in adolescent girls increases from 8 mg to 15 mg/day at the age of 14 to account for menstrual losses

Question
What are the MyPyramid recommendations for adolescents based on? a. DRI-estimated energy-expenditure calculations b. DRI average growth rate for adolescents c. DRI-estimated weight gain adjusted for gender d. DRI-estimated growth rate adjusted for gender for adolescents for adolescents for adolescents
Answer a.
DRI-estimated energy-expenditure calculations for adolescents
Rationale: MyPyramid-recommended calorie intakes for adolescents are based on DRI- estimated energy-expenditure calculations that account for age, gender, weight, height, physical activity level, and energy deposition.
Nutrition for Adolescence
(12 to 18 Years of Age) (cont’d)
Eating practices
In early adolescence, peer pressure overtakes parental influence on food choices o Risk of overeating o Lack adequate fruits, vegetables, dairy foods, and whole grains
Nutrients most likely to be deficient o Fiber, vitamin A, calcium, iron, and potassium
Nutrition Concerns
During Childhood and Adolescence
Breakfast skipping
Children aged 6 to 13
Adolescent females are more likely to skip breakfast than males of similar age
African American adolescents (24%) are more likely to skip breakfast than white adolescents (13%)
Results in lower intakes of vitamins and minerals
Nutrition Concerns During Childhood and Adolescence (cont’d)

Increased consumption of soft drinks
In the last 50 years, the ratio of milk to soft- drink consumption has changed dramatically
Soft drinks and sweetened beverages provide calories without nutrients
Soft-drink consumption is linked to low intakes of vitamins A and C, some B vitamins, calcium, and phosphorus
Nutrition Concerns During Childhood and Adolescence (cont’d)
Overweight and obesity
The prevalence of obesity among youth has risen dramatically in the United States
Overweight and obesity in childhood or adolescence increase the risk of several diseases in adulthood
Overweight and obesity can have negative social and psychological consequences
Fundamental cause of overweight and obesity is an imbalance between caloric intake and caloric expenditure
Nutrition Concerns During Childhood and Adolescence (cont’d)
Healthy lifestyles and obesity prevention
Prevention of obesity is critical
Barriers to parents taking action o Lack of time o Believe that children will outgrow their excess weight o Lack of knowledge o Fear they will cause eating disorders
Nutrition Concerns
During Childhood and Adolescence (cont’d)
Healthy lifestyles and obesity prevention (cont’d)
The American Academy of Pediatrics recommends that BMI be calculated and plotted once a year for all youth aged 2 and older as part of routine pediatric health visits
A key recommendation in the 2005 Dietary Guidelines for Americans is that the rate of weight gain be reduced in overweight children while allowing for growth and development

Nutrition Concerns
During Childhood and Adolescence (cont’d)
Adolescent pregnancy
Associated with physiologic, socioeconomic, and behavioral factors that increase health risks to both infant and mother
Infants are at risk for low birth weight and premature birth and are more likely to die within the first year of life
Pregnant adolescents are at higher risk for anemia, high blood pressure, and excessive postpartum weight retention
Nutrition Concerns During Childhood and Adolescence (cont’d)
Compared with adult women, pregnant adolescents:
Are more likely to be physically, emotionally, financially, and socially immature
May not have adequate nutrient stores
May give low priority to healthy eating
Must gain weight early and steadily
Are more concerned with body image
Are more likely to smoke during pregnancy
Seek prenatal care later