chapter 12 child and preadolescent nutrition nutrition through the life cycle judith e. brown
TRANSCRIPT
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