Chapter 12 Child and Preadolescent Nutrition

1. Chapter 12Child and Preadolescent Nutrition Nutrition Through the Life Cycle Judith E. Brown

2. Definitions of the Life Cycle Stage • Middle childhood—between the ages of 5 and 10 years • Preadolescence—ages 9 to 11 years for girls; ages 10 to 12 years for boys • Both may also be termed “school-age”

3. Tracking Child and Preadolescent Health • Data on U.S. children in 2006 • 8% lived in extreme poverty (< 50% of poverty) • 40% lived in low-income families (<200% poverty) • 11.7% had no health insurance • Disparities in nutrition status exist among different races & ethnic groups

4. Tracking Child and Preadolescent Health • Disparities in nutrition status exist among different races & ethnic groups. Prevalence of overweight and obesity is measured by BMI • Hispanic Male children have significantly higher BMIs • Non-Hispanic black female children significantly greater BMIs • African-Americans have higher percentages of total calories from dietary fat.

5. Healthy People 2010 • A number of objectives are specific to children’s health and well-being • According to the proposed framework for healthy People 2020, many of the objectives will be retained • www.healthypeople.gov/hp2020

6. Normal Growth and Development • Measurement techniques • Growth velocity will slow down during the school-age years • Should continue to monitor growth periodically • Weight and height should be plotted on the appropriate growth chart

7. Normal Growth and Development • 2000 CDC growth charts • Tools to monitor the growth of a child for the following parameters • Weight-for-age • Stature-for-age • Body mass index (BMI)-for-age • Can be downloaded from CDC website: www.cdc.gov/nchs

8. Normal Growth and Development • 2000 CDC growth charts • Based on data from cycles 2 & 3 of the National Health & Examination Survey (NHES) & the National Health & Nutrition Examination Surveys (NHANES) I, II, & III • WHO Growth References • Available at www.who.int/childgrowth

9. Normal Growth and Development

10. Physiological Development in School-Age Children • Muscular strength, motor coordination, & stamina increase • In early childhood, body fat reaches a minimum then increases in preparation for adolescent growth spurt • Adiposity rebounds between ages 6 to 6.2 years • Boys have more lean tissue than girls

11. Cognitive Development in School-Age Children • Self-efficacy…the knowledge of what to do and the ability to do it • Change from preoperational period to concrete operations • Develops sense of self • More independent & learn family roles • Peer relationships become important

12. Development of Feeding Skills •  motor coordination & improved feeding skills • Masters use of eating utensils • Involved in food preparation • Complexities of skills  with age • Learning about different foods, simple food prep and basic nutrition facts

13. Eating Behaviors • Parents & older siblings influence food choices in early childhood with peer influences increasing in preadolescence • Parents should be positive role models • Family meal-times should be encouraged • Media has strong influence on food choices • http://pediatrics.aappublications.org/content/early/2011/04/27/peds.2010-1440.abstract?papetoc

14. Body Image and Excessive Dieting • The mother’s concern of her own weight issues may increase her influence over her daughter’s food intake • Young girls are preoccupied with weight & body size at an early age

15. Body Image and Excessive Dieting • The normal increase in adiposity at this age may be interpreted as the beginning of obesity • Imposing controls & restriction of ”forbidden foods” may increase desire & intake of the foods

16. Energy and Nutrient Needs of School-Age Children • Energy needs vary by activity level & body size • The protein DRI is 0.95 g/kg body wt • Intakes of vitamins & minerals appear adequate for most U.S. children

17. DRI for Iron, Zinc and Calcium for School-Age Children

18. Common Nutrition Problems • Iron deficiency • Less common in children than in toddlers • Although rates are lower, they are still above the 2010 national health objectives • Dietary recommendations to prevent: encourage iron-rich foods • Meat, fish, poultry and fortified cereals • Vitamin C rich foods to help absorption

19. Common Nutrition Problems • Dental caries • Seen in half of children aged 6 to 8 • Reduce dental caries by limiting sugary snacks & providing fluoride • Choose fruits, vegetables, and grains • Regular meal and snack times • Rinse (or better yet, brush the teeth) after eating

20. Prevention of Nutrition-Related Disorders • Prevalence of overweight among children is increasing • Data from NHANES I, II, & III suggest weight gain linked to inactivity rather than increases in energy intake • Excessive body weight increases risk of cardiovascular disease & type 2 diabetes mellitus

21. Prevalence of Overweight and Obesity • Definitions: • Overweight = BMI-for-age >95th% • At risk for becoming overweight = BMI-for-age from 85th to 95th% • Overweight more common in Mexican-American males & females and African-American females • Heaviest children are getting heavier

22. Characteristics of Overweight Children • Compared to normal weight peers, overweight children: • Are taller • Have advanced bone ages • Experience earlier sexual maturity • Look older • Are at higher risk for obesity-related chronic diseases

23. Predictors of Childhood Obesity • Age at onset of BMI rebound • Normal increase in BMI after decline • Early BMI rebound, higher BMIs in children later • Home environment • Maternal and/or Parental obesity predictor of childhood obesity

24. Effects of Television Viewing Time • Obesity related to hours of television viewing • Resting energy expenditure decreases while viewing TV • Healthy People 2010 objective: • Increase proportion of children who view 2 hours or less of TV per day from 60% to 75%

25. Television Viewing Time

26. Addressing the Problem of Pediatric Overweight and Obesity “An ounce of prevention is worth a pound of cure”

27. Prevention and Treatment of Overweight and Obesity • Expert’s recommend a 4-stage approach: • The four stages: • Stage 1: Prevention Plus • Stage 2: Structured Weigh Management (SWM) • Stage 3: Comprehensive Multidisciplinary Intervention (CMI) • Stage 4: Tertiary Care Intervention (reserved for severely obese adolescents)

28. Prevention and Treatment of Overweight and Obesity

29. Prevention and Treatment of Overweight and Obesity • Treatment consists of a multi-component, family-based program consisting of: • Parent training • Dietary counseling/education • Physical activity • Behavioral counseling

30. Nutrition and Prevention of CVD in School-Age Children • Acceptable range for fat is 25% to 35% of energy for ages 4 to 18 year • Include sources of linoleic (omega-6) and alpha-linolenic (omega-3) fatty acids • Limit saturated fats, cholesterol & trans fats

31. Nutrition and Prevention of CVD in School-Age Children • Increase soluble fibers, maintain weight, & include ample physical activity • Diet should emphasize: • Fruits and vegetables • Low-fat dairy products • Whole-grain breads and cereals • Seeds, nuts, fish, and lean meats

32. Dietary Supplements • Supplements not needed for children who eat a varied diet & get ample physical activity • If supplements are given, do not exceed the Dietary Reference Intakes

33. Dietary Recommendations • Iron • Iron-rich foods: meats, fortified breakfast cereals, dry beans, & peas • Fiber • Increase fresh fruits and vegetables, whole grain breads, and cereals • Fat • Decrease saturated fat and trans fatty acids

34. Dietary Recommendations • Calcium & Vitamin D • Bone formation occurs during puberty • Include dairy products and calcium-fortified foods • Vitamin D from exposure to sunlight and vitamin D fortified foods • If lactose intolerant: • Do not completely eliminate dairy products but decrease only to point of tolerance

35. Fluid and Soft Drinks • Preadolescents sweat less during exercise than adolescents & adults • Provide plain water or sports drinks to prevent dehydration • Limit soft drinks because they provide empty calories, displace milk consumption & promote tooth decay

36. Recommended versus Actual Food Intake • Saturated fat—intake is 12.6% of calories (recommend <7%) • Total fat—intake excessive in African American boys & girls & Mexican-American girls • Caffeine—increasing because of soft drink consumption • Fast food—30.3% of children consume fast food each day

37. Other Considerations • Cross-cultural Considerations • Healthy People 2010-a major goal-eliminate health disparities among different segments of the population • Health care professionals & teachers should learn about cultural dietary practices

38. Other Considerations • Vegetarian Diets • Suggested daily food guides for vegetarians are available • Vegetarian diets should be planned to provide adequate calories, protein, calcium, zinc, iron, omega-3 fatty acids, Vitamin B12, riboflavin and Vitamin D

39. Physical Activity Recommendations • Recommendations: • Children should engage in at least 60 minutes of physical activity each day • Parents should set a good example, encourage physical activity, and limit media & computer use • Actual: • Only 7.9% of middle & junior high schools require daily physical activity • Only about 36% of the 5-15 y/o children walk to school & 2% ride a bicycle to school

40. Determinants of Physical Activity • Determinants may include: • Girls are less active than boys • Physical activity decreases with age • Season & climate impact level of physical activity • Physical education classes are decreasing

41. Organized Sports • Participation in organized sports linked to lower incidence of overweight • AAP recommends: • Participation in a variety of activities • Organized sports should not take the place of regular physical activity • Emphasis should be on having fun and on family participation rather than being competitive

42. Organized Sports • Participation in organized sports linked to lower incidence of overweight • AAP recommends: • Use of proper equipment such as mouth guards, pads, helmets, etc. • Prevention of stress or overuse injuries • Awareness of disordered eating & heat injury

43. Nutrition Education • School-age: a prime time for learning about healthy lifestyles • Schools can provide an appropriate environment for nutrition education & learning healthy lifestyles • Education may be knowledge-based nutrition education or behavior based on reducing disease risk

44. Nutrition Education

45. Nutrition Integrity in Schools • All foods available in schools should be consistent with the U.S. Dietary Guidelines & Dietary Reference Intakes • Sound nutrition policies need community & school environment support • Community leaders should support the school’s nutrition policy • The School Health Index (SHI) should be completed & implemented

46. School Health Index

47. Nutrition Intervention for Risk Reduction • Model programs • The National Fruit and Vegetable Program • Formerly “5 A Day” program • Public-private partnership of the CDC and other health organizations • High 5 Alabama • Study to evaluate the effectiveness of a school-based dietary intervention

48. Public Food and Nutrition Programs • Child nutrition programs • Began in 1946 • Provide nutritious meals to all children • Reinforce nutrition education • Require schools to develop a wellness policy

49. Public Food and Nutrition Programs • Financial assistance provided by the federal gov’t to schools participating in the National School Lunch Program • Five requirements • Lunches based on nutrition standards • No discrimination between those who can and cannot pay • Operate on a non-profit basis • Programs must be accountable • Must participate in commodity program

50. School Breakfast Program • Authorized in 1966 • States may require schools who serve needy populations to provide school breakfast • The NSLP rules apply to the School Breakfast Program • Breakfast must provide ¼ the DRI