Nutrition Through the Life Cycle: Childhood and Adolescence

1. 17 Nutrition Through the Life Cycle: Childhood and Adolescence

2. Toddlers • Age 12 to 36 months • Rapid growth rate of infancy begins to slow • Gain 5.5 to 7.5 inches, average 9 to 11 pounds • Higher energy expended for increased activity levels • Increased nutrient needs are based on their larger body size

3. Toddlers • Macronutrients: • Estimated Energy Requirement (EER) varies according to the toddler’s age, body weight, and level of activity • 30−40% of total kcal from fat • 1.1 grams of protein per kg body weight • 130 grams carbohydrates per day (most of the carbohydrates should be complex) • 14 grams fiber per 1,000 kcal/day

4. Toddlers • Micronutrients: • Ensure adequate intake of the micronutrients obtained from fruits and vegetables, including: vitamins A, C, E, calcium, iron, zinc, potassium • Until age 2, drink whole milk for calcium • Iron-deficiency anemia is the most common nutrient deficiency in young children

5. Toddlers • Fluid needs: active toddler may need more • Physicians may recommend supplements: • Toddlers with erratic eating habits • Fluoride supplement, if the community water supply is not fluoridated • Vegan families • Medical conditions or dietary restrictions • Supplement should not exceed 100% Daily Value for any nutrient per dose

7. Nutritious Food Choices • Most are able to match intake with needs • Healthful variety of food available • Food should not be forced on a child • Frequent small meals for small stomach • Developmentally appropriate foods • Small portions, limited healthful alternatives • Role modeling is important

11. Allergy Watch • Continue to watch for common food allergies: wheat, peanuts, cow’s milk, soy, citrus, egg whites, seafood • Introduce one new food at a time

12. Vegetarian Families • Eggs and dairy: part of a healthful diet • Vegan diet may be low in protein, minerals (calcium, iron, zinc), vitamins (D and B12) • High fiber may impair iron and zinc absorption and promote a premature sense of “fullness” at mealtimes • Fortified foods and supplement use to ensure adequate nutrition

13. Children • Growth slows: average gain 2–4 in./year • Values for most nutrients increase • For children ages 6−11 years: USDA developed a MyPyramid for Kids • Sexual maturation begins ages of 8 and 9: DRI values are separately defined for boys and girls beginning at age 9

15. Macronutrients • Total fat intake should gradually drop to a level closer to adult fat intake • 25−35% of total energy from fat • 130 grams carbohydrate per day • 14 grams fiber per 1,000 kcal • 0.95 grams protein per kg body weight

16. Micronutrients • Consuming adequate fruits and vegetables in the diet continues to be a concern (vitamins A, C, and E, fiber and potassium) • “Milk displacement”—low-calcium diets also tend to be low in other nutrients • RDAs for iron and zinc also increase

17. Nutritious Food Choices • Peer pressure encourages unhealthful food choices • Families who plan, prepare, and eat meals together are more successful at promoting good food choices

19. School • School breakfasts: optimize nutrient intake and avoid behavioral and learning problems from hunger in the classroom • No monitoring for adequacy of food eaten • Soft drinks and snack foods in school • School lunches: what’s actually eaten (not planned/served) tends to be higher in fat • Options to entice healthful selections

20. Nutrition-Related Concerns • Iron-deficiency anemia • Dental caries • Body image • Food insecurity

22. Adolescents • Adolescence continues to 18 years • Puberty: secondary sexual characteristics develop; capacity for reproduction • Emotions and behaviors unpredictable and confusing

23. Adolescents • Growth spurts begin at age 10−11 for girls, 12−13 for boys • Average 20−25% increase in height • Skeletal growth ceases closure of the epiphyseal plates • Weight and body composition also change

25. Macronutrients • EER for adolescents is based on gender, age, activity level, height, and weight • 25−35% of total energy from fat • <10% of total energy from saturated fat • 45−65% of kcal from carbohydrates • 0.85 grams protein per kg body weight • 26−38 grams of fiber per day

26. Micronutrients • Calcium intakes must be sufficient for achieving peak bone density: 1,300 mg/day • Iron needs are relatively high: 11 mg/day for boys, 15 mg/day for girls • Vitamin A is critical for supporting rapid growth and development • Supplement should not be considered a substitute for a balanced, healthful diet

27. Fluid Recommendations • The need to maintain fluid intake is increased with higher activity levels • Boys: 11 cups/day • Girls: 10 cups/day • Importance of including water

28. Nutritious Food Choices • Parents can act as role models • Strong influence of peers, mass media, personal preferences • Encourage whole grains, fruits, vegetables, and milk or calcium-rich beverages

29. Nutrition-Related Concerns • Adequate calcium maximizes bone calcium uptake and bone mineral density • Disordered eating and eating disorders can begin in these years • Acne and diet • Cigarette smoking, alcohol, and illegal drugs can have an impact on nutrition

30. Pediatric Obesity • Overweight: BMI above the 85th percentile of the same age and gender • Obese: BMI above the 95th percentile • Higher risk of health problems: • Exacerbates asthma • Causes sleep apnea • Impairs the child’s mobility • Leads to intense teasing • Low self-esteem • Social isolation

31. Pediatric Obesity • Greater risk for type 2 diabetes, high blood lipids, high blood pressure, gallstones, depression, and other medical problems • Higher risk of becoming overweight adults • Reversal of pediatric obesity can be accomplished through an aggressive, comprehensive nationwide health campaign

32. Pediatric Obesity • Early tendency during toddler years • Monitor if >80th percentile for weight • Encourage physical activity • Limit foods with low nutrient density • Early intervention is often the most effective measure against lifelong obesity ABC Video Obesity in Children

33. Role of the Family • Provide nutritious food choices • Encourage a healthful breakfast • Sit down to a shared family meal each evening or as often as possible • No television at mealtimes: encourage attentive eating, enjoyment of the food • Parents should retain control over the purchasing and preparation of food

34. Role of the School • Federal school lunch program: limit the amount of fat, sugar, and sodium served • Many schools sell foods and beverages that exceed federal guidelines • Nutrition education programs: health departments, Dairy Councils • Consistent and repeated school-based messages on good nutrition

36. Physical Activity • Recommendation: daily physical activity and exercise for at least an hour each day • Bone- and muscle-strengthening activities at least 3 days each week • Encourage noncompetitive, fun, and structured activities in ways that allow self-pacing • Fitness Pyramid for Kids: guide children toward a physically active lifestyle

39. Physical Activity • Parental and adult role models • Shared activities: ball games, bicycle rides • Television/electronic games: < 2 hours/day • Electronic games: virtual tennis, step aerobics, dancing, other active simulations

40. Physical Activity • Overweight children can “catch up” to their weight as they grow taller without restricting food (nutrient) intake • Acquire motor skills and muscle strength • Establish good sleep patterns • Develop self-esteem; lower stress • Optimize bone mass • Enhance cardiovascular and respiratory function

41. Physical Activity • Physically fit children: • Have improved behavior • Are more attentive • Are more focused • Have higher levels of academic achievement • Parents, healthcare providers, and community members can work with school boards to optimize opportunities for physical activity