Chapter 12Child and Preadolescent
Nutrition
Nutrition Through the Life Cycle Judith E. Brown
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”
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
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.
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
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
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
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
Normal Growth and Development
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
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
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
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
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
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
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
DRI for Iron, Zinc and Calcium for School-Age Children
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
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
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
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
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
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
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%
Television Viewing Time
Addressing the Problem of Pediatric Overweight and
Obesity
“An ounce of prevention is worth a pound of cure”
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)
Prevention and Treatment of Overweight and Obesity
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
Nutrition Education
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
School Health Index
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
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
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
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
Other Nutrition Programs
• Summer Food Service Program– Provides summer meals to areas with >50% of
students from low-income families
• Team Nutrition– Provides training, technical assistance,
education, or support to promote nutrition in schools
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