Nutrition in Infancy, Childhood, and Adolescence Chapter 11

1. Nutrition in Infancy, Childhood, and Adolescence Chapter 11 In any culture, food nurtures both the physical and emotional process of “growing up” for each infant, child, or adolescent. Objectives: Identify nutrition for growth and development Identify age group needs

2. Key Concepts Normal growth of individual children varies within a relatively wide range of measures Human growth and development require both nutritionals and psychological support A variety of food patterns and habits supply the energy and nutrient requirements of normal growth and development, although basic nutritional needs change with each growth period

3. Nutrition for Growth and Development Life cycle growth pattern follows four general stages of overall growth, with individual variances along the way: • Infancy – growth is rapid during the first year of life; tapers off toward the latter half of the year. • Double wt by 6 months, triple weight by 1 yr • Increase birth length by 50% in the first year • Childhood – Growth rate slows and becomes irregular • Growth occurs in small spurts during which the child has increased appetite and eats accordingly. • Appetites usually taper off during periodic plateaus

4. Nutrition for Growth and Development

5. Nutrition for Growth and Development • Adolescence – Onset of puberty begins the next stage of rapid growth • Growth hormones and sex hormonesbody changes • Long bones grow rapidly, sex characteristics develop, and fat and muscle mass increase • Adulthood – final phase of a normal life cycle • Physical maturity – growth levels off and gradually declines during old age • Mental and psychosocial development lasts a lifetime (unless impacted by disease affecting cognitive process)

6. Nutrition for Growth and Development

7. Measuring Childhood Growth Measuring Childhood Growth • Individual growth rates vary • Physical growth: measured by growth charts of height, weight, head circumference, and body mass index (BMI) • Growth charts: assessment tool, guideline • Psychosocial development – Tests are used to measure mental, emotional, social and cultural growth and development – including food attitudes

10. Measuring Childhood Growth BMI is the current measurement recommended Children who are over the 95th percentile for their age in BMI are considered obese BMI=WEIGHT KG/HEIGHT IN METERS2 OR (WEIGHT LBS/HEIGHT IN2) X 703

11. Nutritional Requirements for Growth Energy needs – The demand for energy, as measured in kcalories from food, is relatively large during childhood. First 3 years of life an infant/child needs: 80– 110 kcal/kg per day (much higher than adults 30 – 40 kcal/kg per day ) – Premature infants are even higher 110 -130 kcal/kg/day

12. Nutritional Requirements for Growth Table 11-1 : energy and protein needs at different ages. • The total daily caloric intake of an average 5 year old is spent in the following ways: • Basal metabolism: 50%; Physical activity: 25%; Tissue growth: 12%; fecal loss: 8%; Metabolic effect of food: 5%

13. Nutritional Requirements for Growth Energy nutrients • Carbohydrates are the main energy source Act as a protein-sparer so that the protein vital for building tissue in not diverted for energy needs • Fat is a back-up energy source Protein needs • Protein is the fundamental tissue-building substance of the body –supplies essential amino acids for tissue growth and maintenance

14. Nutritional Requirements for Growth Protein needs cont. As a child grows, the protein requirements per unit of body weight gradually increase • first 6 mo. of life, need 1.52g/kg of body weight • adult, only 0.8g/kg

15. Nutritional Requirements for Growth Water requirements • Water is an essential nutrient, second only to oxygen for life • Metabolic needs • periods of rapid growth, demand adequate fluid intake. • Infant: requires more water per body weight than adults because : • more of their body is water • more is outside the cells so can be lost easier  dehydration

16. Nutritional Requirements for Growth

17. Nutritional Requirements for Growth Mineral and Vitamin Needs • important roles in tissue growth and maintenance and overall energy metabolism • Calcium • Critical during bone growth from infancy through adolescence • Iron • Essential for hemoglobin formation and cognitive development in the early years- Infants who are not breast fed need iron fortified formula

18. Nutritional Requirements for Growth Vitamin supplements – two vitamins may be needed in the form of supplements: Vit K and D 1 mg Vit K shot when born (to help with blood clotting) Vitamin D : It was thought that Vit. D can be adequate via breast milk if the mother has been adequately exposed to sunlight and has enough Vitamin D in her diet. If exposure or intake is inadequate, supplementation is needed. Infants on formula do not need additional supplementation because formulas are fortified with Vit D. AAP recommends breastfed infants receive 400 IU vitamin D supplements

19. Age Group Needs Immature infants – categories defined by “weight” and “gestational age” Weight: LBW – less than 5 lbs8 oz or 2500 g VLBW - less than 3 lbs5 oz or 1500 g ELBW - less than 2 lbs 3 ozor 990 g Gestational age: Preterm = < 2500g (5lbs) Small-for-gestational-age (SGA) = born full term but have suffered some degree of intrauterine growth failure before birth All immature infants are subject to problems with growth and nutrition because their bodies are not fully formed/developed

20. Age Group Needs Immature infants have: More body water, less protein, fewer minerals Less subcutaneous fat to maintain body temp Poorly calcified bones Incomplete nerve and muscle development making their sucking reflexes weak Limited ability for digestion-absorption and renal function Immature liver, lacking developed metabolic enzyme systems or adequate iron stores

21. Age Group Needs These “tiny babies” need care when feeding Type of milk – breast milk or special formulas Methods of feeding Breastfeeding, supplemented breastfeeding, tube feeding and bottle feeding If sucking is inadequate, may need tube feeding (may use breast milk if mother willing to pump) Special cases: peripheral vein Feeding process is an important component of the bonding relationship

22. Age Group Needs Breast feeding Colostrum – thin fluid first 2 -3 days Fore Milk – the first milk to “let down” is the lowest in fat content Mid Milk – more fat content Hind Milk – milk coming at the end of the feeding, has the highest fat content

23. Age Group Needs Breastfeeding: Nutrients in human milk are uniquely adapted to meet the growth of the infant More easily digested, absorbed, and used Supports early immunity Helps the uterus return to normal size Helps control postpartum bleeding Reduces the risk of infant mortality and morbidity

24. Age Group Needs Bottle feeding Formula Preparation: Sterile procedure is needed. Newborns do not have intestinal bacteria to fight microorganisms Many babies who are hospitalized for vomiting and diarrhea may be bottle fed. Cleansing equipment and storing formula properly may reduce incidence of vomiting and diarrhea A “ready to feed” formula only requires a sterile nipple and bypasses many problems; but is more expensive Feeding the formula – tilt bottle to prevent air; Cuddle

25. Age Group Needs Weaning – may start as early as 6-8 months of age, with increasing amounts of other foods used. Some children self wean as desire for independence grows Cow’s milk – not for the first year. Its concentration may cause GI bleeding and provides too heavy a load of solutes for the infant’s renal system. When start cow’s milk, toddlers under 2 yrs. should not be fed “reduced fat” cow’s milk because: Insufficient energy provided Linoleic acid (Omega 6) for growth is in the fat portion Solid food additions: may be started at 6 months – 1 year

26. Age Group Needs

27. Age Group Needs Summary guidelines Breastfeeding – Ideal for at least one year Commercial formulas – Up to one year- fluoride supplements may be mixed in if it’s not in water Solid foods – may start 4 – 6 months Whole cow’s milk – 1-2 years Iron-fortified formula – If not getting solid foods Allergens – Wheat, egg whites, citrus juice, nuts chocolate add later to prevent allergies Honey – not to infant under 1 year (botulism spores) Food with high risk for choking and aspiration – nuts, seeds, hot dog, carrots, beans, popcorn, cherries, peanut butter, and round candy

28. Age related Needs - Childhood Toddlers (1 to 3 years) – may eat less due to ability to walk and explore his/her new world; easily distracted Increasing the variety of foods available helps develop good food habits. Preschool children (3 to 5 years) – growth spurts Continue to form life patterns in attitudes and basic eating habits Food variety, small portions important group eating =socialization influences

29. Age related Needs - Childhood School-age children (5 to 12 years)- slow and irregular growth rate; body changes occur gradually Food preferences are the product of earlier years New stimuli, including TV, influence food habits Establishing breakfast as an important meal; nutritious lunches Some school programs

30. Age related Needs - Childhood Common nutritional problems in childhood Failure to thrive – fail to grow and develop normally Affects children 1-5years of age, both sexes Careful nutrition assessment is essential May be hospitalized for assessment, classification, and treatment Possible Contributing factors: Clinical Disease Neuromotor problems (poor sucking; abnormal muscle tone; eating, chewing, swallowing problems

31. Age related Needs - Childhood FTT- Possible contributing factors cont.: Dietary practices – age- appropriate foods; inappropriate formula feeding or improper dilutions in mixing formula Unusual nutrient needs or losses – adequate diet but inadequate nutrient absorption  excessive fecal loss Psychosocial problems – emotional deprivationthe need for medical-nutritional intervention

32. Age related Needs - Childhood Anemia: Iron-deficiency anemia still a common problem in the US Children most often deficient in overall iron stores are those formula-fed infants who are not receiving iron-fortified formula and infants (6+ months) who are not consuming iron-fortified cereals and foods “Milk anemia” – term used for toddlers 1+ yrs old who have excessive consumption of non-human milk and are relying on cow’s milk for the majority of their nutrients. Milk is a poor source of iron

33. Age related Needs - Childhood Obesity – HTN and Type II DM increasingly a problem in school-age children • Genetics and environment play a role • Environmental factors: high fat foods, low physical activity

34. Age related Needs - Childhood Lead Poisoning: >250,000 children between ages 1-5 years old Most common exposure: deteriorating buildings with lead paint Old, chipped pain increases the levels of lead in the dust Children living below the poverty line and in old homes are at greater risk.

35. Age Group Needs Adolescence (12 to 18 years): Physical growth – final growth spurt of childhood occurs with the onset of puberty Sexual maturation and risk for obesity are related Eating patterns – greatly influenced by their rapid growth as well as by their self-conscious peer pressure  acceptance of popular food fads

36. Age Group Needs Eating Patterns cont. Tendency to skip lunch; get a great deal of energy from snacks; eat at fast food places; likely to eat any kind of food any time of day Alcohol – some teens begin to get a significant portion of their total caloric intake from alcohol. Even a mild form of alcohol abuse when combined with the elevated nutritional demands of adolescence, can affect their nutritional status

37. Age Group Needs

38. Age Group Needs Eating patterns cont. Boys – overall fare better than girls because of their larger appetite and volume of food consumed usually ensure an adequate intake of nutrients Girls – under greater social pressure for “thinness” – tend to restrict their food  inadequate nutrient intake

39. Age Group Needs Eating disorders Social, family, and personal pressures concerning figure-control strongly influence many young girls. As a result, often follow unwise, self-imposed “crash” diets for weight loss. In some cases, “self-starvation” occurs. Anorexia Nervosa and Bulimia Nervosa can develop  severe effects, involve a distorted body image, and a morbid, irrational pursuit of thinness

40. Age Group Needs Teenage pregnancy – Pregnancy on the rise again, many have poor nutritional status to start with  poorly prepared for the demands of pregnancy. Still completing their own growth and development while supplying the extra needs of the baby. At-risk for complications

41. Further nursing considerations High Risk Mothers and Babies Important to identify nutritional risk factors and address them early in pregnancy Three types of dietary patterns that do not support optimal maternal and fetal nutrition: 1. Insufficient food intake 2. Poor food selection 3. Poor food distribution throughout the day

42. Further nursing considerations High Risk Mothers and Babies cont. Planning Personal Care: Help each mother develop a food plan that is both practical and nourishing Identify fad diets, extreme macrobiotic diets , or pica (craving for and consumption of non-food items such as dirt, chalk, laundry starch and clay) Remember, it’s the nutrients in the food that are important. Nutritional and nourishing foods are available in most ethnic diets.