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