Nutrisi.pdf

Nutrition in Infancy and Childhood dr. Dewi Martha Indria, M. Kes, IBCLC Dr. Yeni Amalia, SpA, Mbiomed Fakultas Kedokteran Universitas Islam Maalang 2018

“Every infant and child has the right to good nutrition.” (The Convention on the Rights of the Child)

Key Facts:

Under nutrition is associated with 45% of child deaths 162 million children under 5 were estimated to be stunted (2012) 51 million have low weight-for-height mostly as a consequence of poor feeding & repeated infections (2012)

44 million were overweight or obese (2012) 38% of infants 0 to 6 months old are exclusively breastfed In many countries only a third of breastfed infants 6–23 months of age meet the criteria of dietary diversity & feeding frequency that are appropriate for their age About 800.000 children's lives could be saved every year among children under 5, if all children 0–23 months were optimally breastfed

WHO GLOBAL TARGET 2015

40% reduction in the number of children under-5 who are stunted

50% reduction of anaemia in women of reproductive age

30% reduction in low birth weight

no increase in childhood overweight

increase the rate of exclusive breastfeeding in the first 6 months up to at least 50%

reduce and maintain childhood wasting to less than 5%

PHYSIOLOGIC DEVELOPMENT 

After birth, the growth of an infant is influenced by genetics and nourishment



Body weight





Infant lose app.6 % of their body weight during the 1st day of age  regained by the 7th – 10th day



Infant usually double their birth weight by 4 – 6 months of age & triple it by the age of 1 year

Body length 

Increase their length by 50% during the 1st year & double it by 4 years



Total body fat increases rapidly during the 1st 9 months



Total body water decrease throughout infancy from 70% at birth to 60% at 1 year (almost in extracellular water – 42% at birth to 32% at 1 yr)

PHYSIOLOGIC DEVELOPMENT 

The stomach capacity of infants 10 – 20 mL at birth to 200 mL



Human milk fat is well absorbed, with fecal excretions of 20 – 48%



Pancreatic amylase remain low during the first 6 months 



increase from a range of by 1 year

If consumes starch before 6 months  the activity of salivary amylase & digestion in the colon usually compensate

The neonate has functional but physiologically immature kidney  the ability to form acid, urine & concentrate solute is often limited  by 6 weeks, most infants can concentrate urine at adult levels

NEONATAL GROWTH & NUTRITION 

Growth rates are most rapid in the first six months of human life



Nutrient requirements on a weight basis are highest during the first six months



Rapid organ growth and development occurs during the last trimester and first six months



The detrimental effects of nutritional insufficiencies are magnified during periods of rapid organ growth (I.e., vulnerable periods for brain growth)



Provide sufficient macro- and micronutrient delivery to promote normal growth rate and body composition, as assessed by curves which are generated from the population

NUTRIENT REQUIREMENTS

ENERGY 

An effective methods for determining the adequacy of an infant’s energy intake  monitor gains using growth chart



Curves exist for: o Standard

anthropometrics: weight, length, head circumference o Special anthropometrics: arm circumference, skinfold thickness o Body proportionality: weight/length, mid-arm circumference, head circumference ratio

Ideal Body Weight Percentage 𝐴𝑐𝑡𝑢𝑎𝑙 𝐵𝑊 Ideal Body Weight % = x 100 % 𝐼𝑑𝑒𝑎𝑙 𝐵𝑊



Ideal Body Weight based on WHO Growth Chart 

Decide actual height/length using length for age chart



Decide ideal weight based on actual length/height using weight for length chart

Growth Chart WHO

Boys, 12 month, height 70 cm, weight 7 kg



IBW =

7 8,5

x 100 % = 82,35 % (Mild Malnutrition)

Nutrition Status (Waterlow, 1972) IBW Percentage (%)

Nutrition Status

> 120

Obesity

110 – 120

Overweight

90 – 110

Normal

80 – 90

Mild Malnutrition

70 – 80

Moderate Malnutrition

< 70

Severe Malnutrition

ENERGY REQUIREMENTS IN INFANCY 

Term infants require : 85-90 Kcal/kg/day  breast-fed  100-105 Kcal/kg/day  formula  Differences are due to increased digestibility and absorbability of breast milk  presence of compensatory enzymes (lipases) 



Energy requirements are 20% higher in premature infants due to: 

Higher basal metabolic rate  Lower coefficient of absorption for fat and carbohydrates 

Energy requirements decrease to 75 Kcal/kg/day between 5-12 months

Kcal per pound of body weight

Nutritional Needs of Infants

Copyright 2010, John Wiley & Sons, Inc.

CARBOHYDRATE 

Should supply 30 – 60% of the energy intake during infancy



Primary sources of CHO in newborn and infant diet are disaccharides (esp. lactose) 

Disaccharides must be broken into component monosaccharide to be absorbed 

Lactose = glucose + galactose (lactase)



Sucrose = glucose + fructose (sucrase)



Maltose = glucose + glucose (maltase)



Intestinal lactase concentrations are low at birth and are not inducible



Amylase, necessary for breaking down starches, are not adequate until > 4 months

PROTEIN 

Protein is needed for: 

Tissue replacement



Deposition of lean body mass



Growth



Late gestation and infancy is the time of highest protein accretion in human life



Infants require a larger percentage of total amino acids as essential amino acids than adult 

Essential amino acids for infants  histidine



Nonessential AA (but essential) for premature infants  tyrosine, cystine, taurine



Protein requirements during the rapid growth of infancy are higher per kg/body weight than those for older children or adults 

Protein requirements range from 1.5 g/kg/day (healthy breast-fed infant) to 3.5 g/kg/day (septic, preterm infant)



Recommendations for protein intake  based on the composition of human milk



The amount of protein in human milk is adequate for the 1st 6 months the amount of protein of considerably less

of life  human milk is than in infant formula

LIPIDS 

Infants younger than 1 year of age  have to consume minimum of 30 g of fat/day 



Human milk  contains essential FA : ARA (arachidonic acid) & DHA (docosahexaenoic acid) 



Lower fat intake  inadequate energy intake

Linoleic acid : 4.4 g/day (< 6 months), 4.6 g/day (7 mo – 1 yrs)

Percentage of dietary fat absorbed Adult

95 %

Term infant

85 – 95 %

Preterm infant

50 – 90 % (depends on source of fat)

WATER 

The water requirement for infant is determined by the amount lost from the skin and lungs and in the feces and urine  with addition the small amount needed for growth



Water requirements of infants and children Age

Water requirement (ml/kg/day)

10 days

125 – 150

3 months

140 – 160

6 months

130 – 155

1 year

120 – 135

2 year

115 – 125

6 year

90 – 100

10 year

70 – 85

14 year

50 – 60

Potential micronutrients infant deficiencies 

Water-soluble vitamins (B, C, folate, etc.) are rarely a problem in newborns and infants; babies are born with adequate stores and/or all food sources have adequate amounts



Fat-soluble vitamins (A,E,D,K) may present significant problems because of relatively poor fat absorption by newborn infants (especially premature infants)

MINERALS 

Calcium 

Breastfed infants retain app. 2/3 of their calcium intake from breast milk



Adequate intake of calcium 200 mg/day (0 – 6 months)  260 mg/day (7 – 12 months) 



Flouride 

Breast-milk is low in fluoride



Flouride supplementation is not recommended for infants younger than 6 months of age



Tolerable upper intake level for flouride 0,7 mg/day (0 – 6 months)  0,9 mg/day (7 – 12 months) 

MINERALS 

Iron 

Babies are born with stores and iron in human milk, although not abundant, is very well absorbed.



Iron in human milk is highly bioavailable than other sources.



Recommendation of Iron supplementation 1 mg/kg/day by 4 – 6 months age



After 6 months, stores are depleted, hence iron-fortified rice cereal or iron-fortified formula 



Cow’s milk is a poor source of iron  should not be given before 12 months of age

Zinc 

Newborn infants are immediately dependent on a dietary source of zinc



Zinc is better absorbed from human milk than from infant formula

VITAMINS 

VITAMIN B12: 



Breast-milk of vegans mothers can be deficient in B12

VITAMIN K: 

Needs to be given at birth to prevent hemorrhagic disease of newborn



Adequate thereafter due to synthesis by intestinal bacteria  the gut of the newborn is sterile (no microbial synthesis)



Can’t cross the placenta efficiently and breast-milk is low in vitamin K



Single intramuscular injection to the infant (0.5-1mg of vitamin K)



Adequate intake 

2 mcg/day (0 – 6 months)



2,5 mcg/day (7 – 12 months)







VITAMIN D: 

Very low in breast-milk, so sunlight exposure is important.



Infant formula is fortified. Brest-fed infants are often supplemented.



AAP recommends 400 IU/day for all infants.

VITAMIN A: 

Essential for normal structural collagen synthesis



Retinal development deficiency in premature infants contribute to fibrotic chronic lung disease

VITAMIN E: 

Antioxidant that protects against peroxidation of lipid membranes



Preterms have poor antioxidant defense and are subjected to large amounts of oxidant stress



Vitamin E deficiency causes severe hemolytic anemia

BREASTMILK

Breast Milk as a Food Source 

Committee on Nutrition of the IDAI & AAP strongly recommends breastfeeding for infants



It is necessary to breastfeed for at least 6 months to achieve the immunologic and disease preventative benefits of breast milk



Physician’s role is to support, counsel and trouble-shoot

Breastfeeding = a normative model (American Pediatric Academy, 1997) Breastfeeding is a preferred mode of feeding considering benefits: 

Nutritional



Immunological



Health (morbidity, mortality)



Developmental



Economical

Nutritional Benefits of Breast Milk 

Composition changes in the course of development (preterm, fullterm infants), single feeding (foremilk, hindmilk), in relation to exposure to infection

Risks of artificial feeding (in developing countries risks are elevated above these levels)

• 

Increased risk of acute illness:

Gastroenteritis: 3-4x risk (developing countries 17-25x)  Acute otitis media: 3-4x risk  Lower respiratory tract infections (e.g. pneumonia)  Bacterial infection requiring hospitalization: 10x risk  Meningitis: 4x risk (e.g. Enterobacter sakazakii)  Higher mortality from sudden infant death syndrome (SIDS)

Risks of artificial feeding • 

Increased risk of chronic conditions and illnesses:

Allergies - atopic dermatitis, asthma  Type 1, type 2 diabetes  Obesity  Crohn’s disease, ulcerative colitis, coeliac disease  Childhood lymphomas (5-8x risk), leukaemia

Risks of artificial feeding •

Dose-related difference in mental development:



Lower scores of mental development tests at 18 months Difference in mental development and school performance at 3-5 years Lower scores in prematures on intelligence tests at 7-8 years Deficits in neurological development (lack of essential fatty acids) Difference in visual acuity

   

Risks of artificial feeding •    

Effects on mother: Increased risk of anaemia due to early return of menstruation Increased risk of new pregnancy Higher risk of impaired bonding, abuse, neglect and abandonment of the child Increased risk of breast and ovarian cancer

Optimal Infant Feeding Practices (WHO Global Strategy on Infant & Young Child Feeding, 2002)

• •

Exclusive breastfeeding for 6 months Complementary feeding with continued breastfeeding from 6 to 24 months and beyond – –

– –

Timely Adequate Safe Appropriately fed

Infant Formula 

Promotes adequate growth, but not brain and immunologic development compared to human milk 

New formulas contain LC-PUFAs, prebiotics, probiotics



Most are cow-milk based, although soy-protein based and fully elemental formulas are available



Cow’s milk (not formula) is contraindicated in the first year of life    



High solute load can lead to azotemia Inadequate vitamin D and A Milk fat poorly tolerated Low in calcium; can lead to neonatal seizures Gastrointestinal blood loss/sensitization to cow-milk protein

New Infant Formulas: since 2002

Fortified with lc-PUFAs • Long chain polyunsaturated fatty acids • derived from algae and fungi

• DHA and ARA • Major fatty acids in neural tissue • Important component of photoreceptor in retina • CLAIM: improves mental and visual development

Comparing Breast Milk and Formula

Copyright 2010, John Wiley & Sons, Inc.

Acceptable Medical Reason for Use Breast-milk Substitutes (WHO & UNICEF, 2009)

FEEDING

Feeding process = a complex of activities involving: Organs & its function

Foods

Body Position

Brain & mind

Sequence of Development and Feeding Skills in Healthy (full term infant) Age

Mouth Patterns

Hand and body skills

Feeding Skills/Abilities

4 – 6 mo

• Up & down munching movement • Transfer food from front to back to swallow • Draws in upper/lower lips as spoon removed • Tongue thrust & rooting begin to disappear • Gag diminished • Open mouth when sees spoon approaching

• Sits with support • Good head control • Uses whole hand to grasp object (palmar grasp) • Recognizes spoon & holds mouth open as spoon approaches

• Takes in a spoonful of pureed/strained food & swallow without choking • Drinks a small amount from cup when held by another person with spilling

Sequence of Development and Feeding Skills in Healthy (full term infant) Age

Mouth Patterns

Hand and body skills

Feeding Skills/Abilities

5 – 9 mo

• Begins to control position of food in the mouth • Up & down munching movement • Positions food between jaws for chewing

• Begins to sit alone unsupported • Follows food with eyes • Transfers food from one hand to the other • Tries to grasp food with all fingers and pull them into the palm

• Begins to eat mashed foods • Eats from spoon easily • Drinks from cup with some spilling • Begins to feed self with hands

Sequence of Development and Feeding Skills in Healthy (full term infant) Age

Mouth Patterns

Hand and body skills

Feeding Skills/Abilities

8 – 11 mo

• Moves food from side to side in mouth • Begins to use jaws & tongue to mash food • Begins to curve lips around rim of cups • Begins to chew in rotary pattern

• Sits alone easily • Transfers objects from hand to mouth • Begins to use thumb and index finger to pick up objects (pincer grasp) • Feeds self finger foods • Plays with spoon at mealtimes but does not spoon-feed yet

• Begins to eat ground or finely chopped food & small pieces of soft food • Begins to experiment with spoon but prefers to feed self with hands • Drinks from a cup with less spilling

Sequence of Development and Feeding Skills in Healthy (full term infant) Age

Mouth Patterns

Hand and body skills

Feeding Skills/Abilities

10 – 12 mo

• Rotary chewing (diagonal movement of the jaw)

• Foods self easily with fingers • Begins to put spoon in mouth • Dips spoon in food rather than scooping • Demands to spoonfeed self • Begins to hold cup with two hands • Drinks from a straw • Good eye-hand-mouth coordination

• Begins to eat chopped food and small pieces of soft cooked table food • Begins to spoonfeeding self with help • Bites through a variety of texture

Switching to Solid Food (WHO, 2010) Age Frequency Amount Texture

Variety Active/Responsive Hygiene

Energy Requirement for 6 – 23 months infancy

Daily Energy Requirement

6 – 8 month

600 kkal

9 – 11 month

700 kkal

12 – 23 month

900 kkal

Switching to Solid Foods 

Certain foods are dangerous and should be avoided 

Egg whites, cow’s milk, and peanut butter



Honey may carry Clostridium botulinum and cause botulism in infants



Seasonings are not needed



Juice often displaces necessary nutrients and should be limited to 100% juice and given in moderation



Infants should never be put on weight-loss diets



An infant must be physically, physiologically, and nutritionally ready before being introduced to solid foods



Solid foods should be introduced gradually and cautiously



Foods that may pose a choking hazard should be avoided and infants should always be supervised when eating



Common food allergens, honey, and herbal teas should be avoided for the first year of life and seasonings should not be added to infant food



To keep their children healthy parents need to educate themselves about foods that are safe and appropriate for infants

Water Requirement 

Give drink water several times/day after switching to solid food



Without any additional drink water  dehydration Age

Water Requirement (ml/kg/day)

10 days

125 – 150

3 mo

140 – 160

6 mo

130 – 155

1 yr

120 – 135

2 yr

115 – 125

6 yr

90 - 100

Rekomendasi Pemberian Makanan Pendamping (WHO, 2010) Usia

Mulai MPASI saat bayi mencapai usia 6 bulan

Frekuensi (per hari)

Kuantitas rata-rata setiap kali makan

1 sampai 2 kali ditambah dengan menyusu sesering keinginan bayi

- Mulai dengan 2 sampai 3 sendok makan - Mulai dengan sesuai selera lalu tingkatkan kuantitas secara bertahap

Tekstur (kekentalan/ konsistensi)

Bubur kental (puree, buah dan sayuran tumbuk halus, daging lumat)

tepat

terlalu encer

Keberagaman

ASI (susui sesering yang bayi inginkan) + Bahan makanan hewani (bahan lokal) + Pangan pokok (bubur, bahan lokal) + Kacang-kacangan (bahan lokal) + Buah/sayuran (bahan lokal)

Rekomendasi Pemberian Makanan Pendamping (WHO, 2010) Usia

Frekuensi (per hari)

Dari 6 sampai - 2 sampai 3 9 bulan kali ditambah dengan menyusu sesering keinginan bayi - 1 sampai 2 kali makanan ringan

Kuantitas rata-rata setiap kali makan

Tingkatkan secara bertahap hingga setengah (½) dari cangkir/mangkuk ukuran 250 ml

Tekstur (kekentalan/ konsistensi)

Bubur kental atau bubur saring

Keberagaman

ASI (susui sesering yang bayi inginkan) + Bahan makanan hewani (bahan lokal) + Pangan pokok (bubur, bahan lokal) + Kacang-kacangan (bahan lokal) + Buah/sayuran (bahan lokal)

Rekomendasi Pemberian Makanan Pendamping (WHO, 2010) Usia

Frekuensi (per hari)

Kuantitas rata-rata setiap kali makan

Dari 9 sampai - 3 kali ditambah Setengah (½) - (¾) dengan menyusu dari cangkir/ mangkuk 12 bulan sesering ukuran 250 ml keinginan bayi - 2 kali makanan ringan

Tekstur (kekentalan/ konsistensi)

Makanan cincang halus, tidak keras dan mudah dijumput

Keberagaman

ASI (susui sesering yang bayi inginkan) + Bahan makanan hewani (bahan lokal) + Pangan pokok (bubur, bahan lokal) + Kacang-kacangan (bahan lokal) + Buah/sayuran (bahan lokal)

Rekomendasi Pemberian Makanan Pendamping (WHO, 2010) Usia

Dari 12 sampai 24 bulan

Frekuensi (per hari)

Kuantitas rata-rata setiap kali makan

3 sampai 4 kali Satu cangkir/ ditambah mangkuk ukuran 250 dengan menyusu ml sesering keinginan bayi 1 sampai 2 kali makanan ringan

Tekstur (kekentalan/ konsistensi)

Makanan yang bisa digenggam, makanan keluarga, dicincang jika perlu

Keberagaman

ASI (susui sesering yang bayi inginkan) + Bahan makanan hewani (bahan lokal) + Pangan pokok (bubur, bahan lokal) + Kacang-kacangan (bahan lokal) + Buah/sayuran (bahan lokal)

CHILDHOOD

Toddlers versus Preschoolers 

Toddlers 

1–3 years old



Growth rate is high, but slower than infancy 



Age 2: Gain 3–5 pounds, 3–5 inches

Preschoolers 

3–5 years old



Need same nutrients as adults, but have 

Lower energy needs  Smaller appetites  Smaller stomachs

• 1-2 years: on average, grows 12 cm, gains 3.5 kg. • Rate of growth slows by 4 years. • 6-8 cm/year • 2-4 kg/year • Brain growth triples by 6 years.

Growth and Development 

Growth charts 

Used by pediatricians 

Monitor height and weight



Compare to national standards for age and gender



Place child in a percentile



BMI-for age Z-scores boys, 2 – 5 y (WHO)



BMI-for age Z-scores, girls 2 – 5 y (WHO)

BMI-for age z-scores (WHO)

BMI

Status

< - 3SD

Severe thinness

< - 2SD

Thinness

> + 1SD

Overweight

> + 2SD

Obesity

Determining Estimated Energy Requirements 

For 13 – 35 months children

EER (kcal) = (89 x weight [kg] – 100) + 20 

An 18 month-old boy, length = 84 cm, weights = 12,5 kg EER = (89 x 12,5 – 100) + 20 EER = (1113 – 100) +20

EER = 1033 kcal

Determining Estimated Energy Requirements 

For girls 3 – 8 years

EER (kcal) = 135,3 – (30,8 x age [y] + physical activity x (10 x weight [kg] + 934 x height [m]) + 20 

A 6,5 y.o. girl is 1,12 m tall, weight 20,8 kg & has moderate activity (PA coefficient of 1,31) EER = 135,3 – (30,8 x 6,5) + 1,31 x (10 x 20,8 + 934 x 1.12) + 20 = 135,3 – 200,2 + 1642,9 + 20 = 1598 kcal

Calculate Nutrition Need 

Indirect Calorimeter  highly accurate

Age (years)

RDA



Harris-Benedict Formula  REE

0–1

110 – 120



WHO  REE

1–3

100

4–6

90

7–9

80

10 – 12

60 – 70 (boy) 50 – 60 (girl)

12 – 18

50 – 60 (boy) 40 – 50 (girl)



Schofield Formula  REE



RDA (Recommended Dietary Allowances)  simple method

Catch-Up Growth 

Child who grow under normal growth due to malnutrition or chronic disease need additional calorie and protein to catch-up growth.



The nutritional requirements for catch-up growth depend on whether: 

The child has overall stunted growth (both height & weight are proportionally low)



The child is chronically malnourished



The child is primarily wasted (the weight deficit exceeds the height deficits)



A chronic malnourished child may not be expected to gain more than 2 – 3 g/kg/day



A child who is primarily wasted may gain as much as 20 g/kg/day

Kcal = RDA (kkal/kg) for actual height x ideal BW (kg)

NUTRIENT REQUIREMENTS 

The energy need of healthy children are determined by: 

Basal metabolism



Rate of growth



Energy expenditure

Dietary energy must be sufficient to ensure growth and spare protein from being used for energy, but not allow excess weight gain.

Age

Carbohydrate

Protein

Fat

1 – 3 yr

45 – 65 %

5 – 20 %

30 – 40 %

4 – 18 yr

45 – 65 %

10 – 30 %

25 – 35 %

MINERAL AND VITAMINS 

Calcium 

Necessary for healthy bone development



RDA for calcium







700 mg/day (1 – 3 years)



1000 mg/day (4 – 8 years)



1300 mg/day (9 – 18 years)

Actual needs depends on individual absorption rate & dietary factors such as quantities of protein, vitamin D and phosphorus.

Zinc 

Essential for growth

MINERAL AND VITAMINS 

Vitamin D 



DRI for children is 600 IU (15 mcg)/day

Iron 

Necessary during periods of rapid growth



Child between 1 – 3 years of age are at high risk for iron deficiency anemia



Good sources of iron for children include lean meats, beans, and ironfortified cereals



Cow’s milk is a poor source of iron

Feeding, Nutrition & Piaget’s Theory of Cognitive Development Developmental Period

Cognitive Characteristics

Relationships to Feeding & Nutrition

Preoperational (2 – 7 years)

Thought process become internalized; they are unsystematic & intuitive

Eating becomes less the center of attention & is secondary to social, language, & cognitive growth

Use of symbols increases

Food is described by color, shape, & quantity, but the child has only a limited ability to classify food into “groups”

Reasoning is based on appearances & happenstance

Food tends to categorized into “like” and “don’t like”

The child’s approach to classification is functional & unsystematic

Food can be identified as “good for you”, but reasons why they are healthy are unknown or mistaken.

The child’s world is viewed egocentrically

Feeding, Nutrition & Piaget’s Theory of Cognitive Development Developmental Period

Cognitive Characteristics

Relationships to Feeding & Nutrition

Concrete operational (7 – 11 years)

The child can focus on several aspects of a situation simultaneously

The child begins to realize that nutritious food has a positive effect on growth & health but has a limited understanding how and why.

Cause-and-effect reasoning becomes more rational & systematics The ability to classify, reclassify & generalize emerges A decrease in egocentrism permits the child to take another’s view

• Mealtimes take on a social significance • The expanding environment increases the opportunities for influences on food selection, for example: peer influence increases

Feeding, Nutrition & Piaget’s Theory of Cognitive Development Developmental Period

Cognitive Characteristics

Relationships to Feeding & Nutrition

Formal operational (11 years or beyond)

Hypothetical & abstract thought expand

The concept of nutrients from food functioning at physiologic & biochemical levels be understood

The child’s understanding of scientific and theoretical processes deepens

Conflicts in making food choices may be realized (knowledge of the nutritious value of foods may conflict with preferences & nonnutritive influences)

Family environment

Adequate Diet

Intake Patterns

Societal trends

Influenced Factors

Media messages Peer influence

Illness

Food Behaviors 

Eating habits form early in life 



A variety of food should be offered to young children 





Children will adapt to foods offered to them

A child may need to be exposed to a new food at least 10 times before accepting it

Division of responsibility 

Parents = What, when, and where food is offered



Child = Whether or not to eat, and how much

“Cleaning the plate” may encourage overeating

Food Preferences 

Parents have strong influence over children’s food preferences  

Children model after adult behaviors, both healthy and unhealthy Including young children in food shopping, menu planning, and meal preparation can encourage variety in their food consumption

Food Preferences 

Picky eating and “food jags” are common in young children 

Picky eating – not wanting to try new food



Food jags – tendency to eat only a small selection of food   

Very common and normal, but also temporary Can be identified through a food diary Long-term jags increase risk of nutrient deficiency 

Solutions include  Offering a variety of food items within the preferred food type  Gradually weaning the child from the food item

Vegetarianism 

Young children can grow and develop normally on a wellbalanced vegetarian diet 

Vegetarian foods such as beans, nuts, seeds, and whole grains are high in fiber 

Multiple servings per day may exceed a young child’s fiber needs



Good sources of calcium, iron, and zinc need to be included in the diet



Supplementation of vitamin B12 may be necessary

School-Aged Children 

Ages 6–12 years



Are not fully grown 



Each year, gain about 7 pounds and 2.5 inches

Compared to toddlers and preschoolers they 

Do not eat as many times per day



Tend to be less hungry (maintain blood glucose longer)



Can eat more food at each sitting



Can impact healthy development through dietary choices



Continue to develop habits based on modeling adult behaviors

MyPyramid for Kids A visual

tool for children and parents to understand healthy eating

MyPyramid for Kids  Key 

messages

Be physically active every day  Choose healthier foods from each group  Eat more of some food groups than others  Eat foods from every food group every day  Make the right choices for you  Take it one step at a time

The Role of Breakfast 

Eating breakfast may be associated with healthy body weight among children and adolescents



Eating breakfast may benefit     

Cognitive function, including memory Academic performance School attendance Psychosocial function Mood

Developing Healthy Habits 

Offer a variety of healthy foods and snacks.



Encourage fruit and vegetable intake.



No junk food snacking.



Limit intake of juices ( 4 oz per day).



Increase intake of water (no soda).



Encourage low fat dairy products (3-4 servings/ day).



Make fun physical activity a habit.



Limit TV to no more than 1 to 2 hours per day.



Track growth and development carefully.



Be a good role model.

Nutritional Concerns 

Overweight and obesity



Underweight & failure to thrive



Malnutrition and poverty



Iron deficiency



Dental caries



Allergies



Attention Deficit Hyperactivity Disorder, Autism Spectrum Disorders

Thank you....