Chapter 15 NUTR

Chapter 15

Life Cycle Nutrition:
Infancy, Childhood, and
Adolescence

© 2009 Cengage - Wadsworth

Nutrition during Infancy
• The first year of life is a time of rapid
growth and development.
• Breast milk or iron-fortified formula is the
primary food the first year with gradual
introduction of solids beginning at four to
six months of age.
• Preterm infants have very special nutrient
needs.
• Mealtimes with toddlers should be a
pleasant and relaxed environment.


• Energy and Nutrient Needs
 Energy Intake and Activity
• Weight doubles the first five months, triples by
one year.
• High basal metabolic rate
• Rapid growth
• 45 kcal/pound body weight
 Energy Nutrients
• Carbohydrates at 60% of energy intake, needed
for brain
• Fat provides most of the energy
• Protein especially important for growth and
development


 Vitamins and Minerals
• More than double the needs of an adult in
proportion to weight
• Vitamin A, vitamin C, vitamin D and iodine are
especially high
 Water
• Higher % of water compared to adults
• Found outside the cells and easily lost
• Dehydration from diarrhea and vomiting is a
concern.



• Breast Milk
Frequency and Duration of
Breastfeeding
• First few weeks: 8-12 feedings per day
on demand
• Every two to three hours
• 10-15 minutes on each breast


• Breast Milk
 Energy Nutrients
• Lactose, the form of carbohydrate in breast milk,
enhances calcium absorption.
• Alpha-lactalbumin is the form of protein in milk
and is easily digested and absorbed.
• Fat is generous in essential fatty acids.
 Vitamins
• Vitamin D content is low.
• Vitamin D supplementation is recommended by
AAP for breastfed infants.


• Breast Milk
Minerals
• Calcium is well absorbed
• High bioavailability of iron and zinc
• Low in sodium and fluoride
Supplements
• Vitamin D, iron and fluoride during first
year
• A single dose of vitamin K is given at
birth.


• Breast Milk
 Immunological Protection
• Colostrum, the first secretions from the breast,
provides antibodies and white blood cells.
• Bifidus factors allow for the growth of normal
flora.
– Lactoferrin is a protein that binds iron so that
bacteria cannot grow.
– Lactadherin is a protein that fights viruses that
cause diarrhea.
• Breast milk also contains growth factors and
lipase enzymes.



• Breast Milk
Allergy and Disease Protection
• Fewer allergies than formula-fed babies
• Lower blood pressure as adults
• Lower blood cholesterol as adults
Other Potential Benefits
• Less obesity as adults
• Indications of positive effect on later
intelligence


• Breast Milk
 Breast Milk Banks
• Donated milk can be provided to those who are
unable to provide sufficient milk to their infant.
• Cigarette smokers, and those who use illegal
drugs, take medications, drink alcoholic
beverages (greater than 2 per day), or have
communicable diseases are not allowed to
donate.
• Available by prescription
• May be used for very-low-birthweight infants


• Infant Formula
 Infant Formula Composition
• Infants can be weaned to formula or other
appropriate foods when breastfeeding is ended.
• Copy breast milk if possible
• Iron-fortified
 Risks of Formula Feeding
• Be careful about lead-contaminated water.
• Contains no antibodies
• Use proper food handling techniques.


• Infant Formula
 Infant Formula Standards
• AAP guidelines
• FDA mandates safety and nutritional qualities
 Special Formulas
• For premature infants or those with inherited
diseases
• Hypoallergenic formulas or soy formulas for
infants with allergies
• Soy formulas for lactose intolerance and vegans


• Infant Formula
 Inappropriate Formulas
• Soy beverages are nutritionally incomplete and
inappropriate.
• Goat’s milk is deficient in folate.
 Nursing Bottle Tooth Decay
• Can be caused by formula, milk, or juice
• Prolonged exposure to formula when sleeping
• Upper and lower teeth may be affected by decay.



• Special Needs of Preterm Infants
Limited nutrient stores
Physical and metabolic immaturity
Long-chain fatty acids are important
for the healthy growth of blood
vessels and bones.
Preterm breast milk fortified with
preterm formula



• Introducing Cow’s Milk
No cow’s milk the first year
Contains the protein casein and may
cause intestinal bleeding and anemia
in the first year of life
Whole cow’s milk from 1-2 years of
age
Reduced-fat cow’s milk gradually
introduced between 2-5 years of age



• Introducing Solid Foods
When to Begin
• 4-6 months
• Timing varies from infant to infant
depending on growth rates, activities,
and environmental conditions.
• Beikost is any nonmilk foods given to an
infant.



Food Allergies
• Introduce single-ingredient foods, one at
a time.
• Period of 4 to 5 days between new foods
• Rice cereal, then oat and barley, and
lastly wheat
• Allergic reactions include skin rash,
digestive upset, or respiratory
discomfort.



Choice of Infant Foods
• Should be provided with variety, balance,
and moderation
• Palatable and nutritious
• No added salt, sugar, or seasonings
• Safe and convenient
• Fat information is not provided on food
labels


Foods to Provide Iron
• Iron-fortified cereals with vitamin C-rich
foods and juices
• Meat or meat alternatives such as
legumes
Foods to Provide Vitamin C
• Vegetables first, then fruits
• Set limits on fruit juice consumption at
4-6 ounces per day.


 Foods to Omit
• Concentrated sweets
• Products with sugar alcohols (sorbitol) that may
cause diarrhea
• Canned vegetables contain too much sodium.
• There is a botulism risk with honey and corn
syrup.
• Choking hazards from carrots, cherries, gum,
hard or gel-like candies, hot dogs, marshmallows,
nuts, peanut butter, popcorn, raw celery, whole
beans, and whole grapes


Vegetarian Diets during Infancy
• Rice milk is inappropriate for infants and
toddlers.
• Iron-fortified cereals needed until the
second year of life
• Milk products and variety are important
to proper nutrition.
• Deficiencies of vitamin D, vitamin B12,
iron, and calcium may develop.
• Energy-dense foods are required.



Foods at One Year
• 2-3 cups cow’s milk
• Be careful of milk anemia when milk is
consumed excessively.
• Balance and variety from all food groups
• Drink liquids from a cup, not a bottle



• Mealtimes with Toddlers
Discourage unacceptable behavior.
Let toddlers explore and enjoy food.
Don’t force foods.
Let children choose nutritious foods.
Limit sweets.
Make mealtimes pleasant.


Nutrition during Childhood
• Energy needs, nutrient needs, and
appetites during childhood vary because of
growth and physical activity.
• Hunger and nutrient deficiencies affect
behavior.
• Nutrition concerns at this age include lead
poisoning, high energy, sugar and fat
intakes, iron deficiency, caffeine
consumption, food allergies, and food
intolerances.
• Adults and schools need to provide
children with nutrient-dense foods.

Energy Intake and Activity
• Needs vary widely because of growth and
physical activity.
• Energy requirements:
– 1 year: 800 kcalories
– 6 years: 1,600 kcalories
– 10 years: 2,000 kcalories
– Inactivity can lead to obesity.
• Vegans may have difficulty in meeting
energy needs.


 Carbohydrate and Fiber
• Carbohydrate recommendations are the same as
those for adults.
• Fiber intakes change with age.
 Fat and Fatty Acids
• Children 1-3 years should have 30-40% of energy
from fat.
• Children 4-18 years should have 25-35% of
energy from fat.
• Low-fat diets may have low vitamin and mineral
content.


Protein
• Needs increase slightly with age
• Requirement considers nitrogen balance,
the quality of protein consumed, and the
added needs of growth
Vitamins and Minerals
• Needs increase with age.
• Balanced diet meets all needs except iron
• Iron-fortified foods are important.



Supplements
• Rely on foods
• Supplements not needed
Planning Children’s Meals
• Variety of foods from each food group
• Proper portion sizes



• Hunger and Malnutrition in Children
Hunger and Behavior
• Missing meals, especially breakfast,
affects behavior and academic
performance.
• Low blood glucose, smaller glycogen
stores


• Hunger and Malnutrition in Children
 Iron Deficiency and Behavior
• Affects behavior and intellectual performance
• Affects attention span and learning ability
• Brain is affected by low iron before the blood is
affected.
 Other Nutrient Deficiencies and Behavior
• Marginal malnutrition may affect behavior.
• Affects personal appearance also



• The Malnutrition-Lead Connection
Malnourished children are more
vulnerable to lead poisoning.
Anemia caused by lead may be
mistaken for an iron problem.
Can develop learning disabilities and
behavioral problems
Ban on lead in food and the
environment has helped



• Hyperactivity and “Hyper” Behavior
Hyperactivity, also called attention-
deficit/hyperactivity disorder (ADHD)
• Interferes with social development and
academic behavior
• Dietary changes and alternative therapies
do not solve true hyperactivity.
• No evidence that sugar causes
hyperactivity



• Hyperactivity and “Hyper” Behavior
Misbehaving children need consistent
care.
• Regular hours of sleep
• Regular mealtimes
• Regular outdoor activity


• Food Allergy (also called food-
hypersensitivity reactions) and Intolerance
 Detecting Food Allergy
• Immunologic response with the production of
antibodies, histamines, and other defensive
agents
• 3-5% of children are diagnosed
• Asymptomatic allergy produces antibodies
without symptoms
• Symptomatic allergy produces antibodies and
symptoms


• Food Allergy and Intolerance
 Anaphylactic Shock
• Life-threatening food allergy reaction
• Foods may include eggs, milk, soy,
peanuts, tree nuts, wheat, fish, and
shellfish
• Often outgrow allergies to eggs, milk,
and soy
• Recognize symptoms
• Epinephrine injections (adrenalin) can be
used to counteract anaphylactic shock.
• Food labeling to identify common
allergens and additives

• Food Allergy and Intolerance
 Food Labeling
• Eight common allergens must appear on a food
label.
• If cross-contamination is possible, this must be
stated on the label.
 Food Intolerances
• Adverse reactions to foods like stomachaches,
headaches, rapid pulse rate, nausea, wheezing,
hives, bronchial irritation, coughs, and other
discomforts are not all food allergies.
• Symptoms without antibody production
• A tolerance level for pesticides has been set
based on the effects on development.


Percentage of children classified as overweight


• Childhood Obesity
 Genetic and Environmental Factors
• Parental obesity is a risk factor. Parents act as
role models.
• Poor diet and physical inactivity are risk factors.
• Convenience foods and meals eaten away from
home
• Non-nutritious choices at school
• Sedentary activities, e.g. watching television
• Energy-dense soft drinks


Growth
• Grow taller at first, then stop growing at
a shorter height
• Greater bone and muscle mass to
support weight, thus “stocky” appearance
Physical Health
• Abnormal blood lipid profile
• Increases the risk for high blood
pressure, type 2 diabetes, and
respiratory disease


Psychological Development
• Emotional and social problems
• Stereotypes and discrimination
Prevention and Treatment of Obesity
• Integrated approach with diet, physical
activity, psychological support, and
behavioral changes
• Begin early treatment – before
adolescence


 Diet
• Reduce rate of weight gain, rather than attempt
weight loss
• Strategies
– Serve kcalorie-controlled family meals.
– Involve children in shopping and preparing meals.
– Encourage children to eat when hungry, eat slowly,
enjoy food, and stop eating when full.
– Teach them to select nutrient-dense foods.
– Limit high-fat and high-sugar foods.
– Never force children to clean plates.
– Plan for nutritious snacks.
– Discourage eating while watching television.



Physical Activity
• Limit sedentary activities.
• Encourage regular vigorous activity.
• Parents need to set good examples.



Psychological Support
• Weight-loss programs with parental
involvement
• Positive influence on eating behaviors
Behavioral Changes
• Focus on how to eat
• Parental and media influence
• Teaching consumer skills



• Mealtimes at Home – with parents as
gatekeepers
Honoring Children’s Preferences
• Offer variety of foods
• Fun mealtimes
Learning through Participation
• Help plan meals
• Assist with food preparation


• Mealtimes at Home
 Avoiding Power Struggles
• Children need to regulate their own food intakes.
• Can determine their own likes and dislikes
• Offer new foods at the beginning of meals and in
small quantities.
 Choking Prevention
• Be alert to foods that are common causes of
choking.
• Make sure children are sitting, not running or in
danger of falling when eating.



Playing First
• Schedule outdoor play before meals.
• Relax and take time while eating.
Snacking
• Teach how to snack
• Limit access to concentrated sweets.


 Preventing Dental Caries
• Brush and floss after meals.
• Brush or rinse after snacks.
• Avoid sticky foods.
• Select crisp and fibrous foods.
 Serving as Role Models
• Children learn through imitation of parents, older
siblings, and care givers.
• Help children to develop positive attitudes toward
food and eating.



• Nutrition at School
Meals at School
• Breakfast and lunch at a reasonable cost
• Some free and reduced cost to low-
income children
• Offer variety of choices
• 1/3 RDA for energy, protein, vitamin A,
vitamin C, iron, and calcium



• Nutrition at School
Competing Influences at School
• Short lunch periods and long lines
• Snack bars, school stores and vending
machines
• State laws and school policies


Nutrition during
Adolescence
• Another rapid state of growth occurs
during adolescence.
• Nutrient needs rise, and iron and
calcium are especially important. B
• usy lifestyles make it challenging to
meet nutrient needs and develop
healthy habits.
• Peer pressure is significant among
adolescents.


Nutrition during
Adolescence
• Growth and Development
Growth speeds up and continues for
about 2 ½ years.
Gender differences
• Females begin puberty at 10-11 years of
age, grow 6 inches taller, add fat, and
gain about 35 pounds.
• Males begin puberty at 12-13 years of
age, grow 8 inches taller, add lean body
mass, and gain 45 pounds.


Nutrition during
Adolescence
Energy Intake and Activity
• Needs vary depending on rate of growth,
gender, body composition, and physical
activity.
• Energy needs can range from 1800
kcalories per day for an inactive female
to 3500 kcalories per day for a highly
active male.
• Problems with overweight and obesity


Nutrition during
Adolescence
 Vitamins
• Needs for all vitamins increase
• Vitamin D needs special attention because it
allows for calcium absorption.
 Iron
• Females’ needs increase because of
menstruation.
• Males’ needs increase because of developing lean
body mass.
• Iron deficiency is a concern.


Nutrition during
Adolescence
Calcium
• Crucial time for peak bone mass
• Increase milk and milk products
• Low calcium intakes and physical
inactivity may cause problems with
osteoporosis in later life.


Nutrition during
Adolescence
• Food Choices and Health Habits
Snacks
• Provide ¼ of daily energy intake
• Favorite snacks are often high in fat and
sodium and low in fiber.
Beverages
• Soft drinks replace fruit juices and milk.
• Caffeine may be an issue.


Nutrition during
Adolescence
• Food Choices and Health Habits
Eating Away from Home
• 1/3 of meals are consumed away from
home.
• Influence of fast-food restaurants
Peer influence is strong when making
nutritional choices.


Nutrition during
Adolescence
• Problems Adolescents Face
Marijuana
• Enhances enjoyment of sweets
• Affects appetite, pain and memory
Cocaine
• Stimulates nervous system
• Elicits the stress response
• Weight loss is common.


Nutrition during
Adolescence
 Ecstasy
• Serotonin flooding alters mood; may also damage
nerve cells and impair memory
• Tend to lose weight
 Drug Abuse, in General
• Use money to buy drugs, not food
• Lose interest in foods
• Use drugs that suppress appetite
• Lifestyles fail to promote good eating
• Infectious disease affects nutrition.
• Medications to treat drug abuse alter nutrition
status.


Nutrition during
Adolescence
 Alcohol Abuse
• Provides energy, no nutrients
• Displaces nutritious foods from the diet
• Alters nutrient absorption and metabolism
 Smoking
• Eases feelings of hunger
• Lower vitamin and fiber intakes
• Increases needs for vitamin C
• Need antioxidant fruits and vegetables to reduce
cancer risk
 Smokeless tobacco has many drawbacks
including cancer of the mouth.

Childhood Obesity and the
Early Development of
Chronic Diseases


Childhood Obesity and the Early
Development of Chronic Diseases

• Nutrition and health education
programs during childhood and
adolescence are effective when
combined with heart-healthy meals
at home and school, fitness activities
and parental involvement.
• Cardiovascular disease (CVD)
damages the heart.


Type 2 Diabetes
• On the increase in recent years
• Risk factors include obesity, sedentary
lifestyle, and family history.
• Insulin resistance
• Increased blood cholesterol and blood
pressure leading to atherosclerosis and
CVD
• Many complications leading to a shorter
life span


Heart Disease
• Atherosclerosis
Is often a part of cardiovascular
disease
Artery walls thicken with plaque
Fatty streaks begin to accumulate in
fibrous connective tissue
Lesions in the arteries


Heart Disease
• Blood Cholesterol
Tends to rise as dietary saturated fat
increases
Correlation with childhood obesity
Family relationship
Screening and education are key.
• Blood Pressure
May be a sign of underlying disease
More common in obese children


Physical Activity

• Active children have better lipid
profiles.
• Habits developed at this age are
carried into later life.


Dietary Recommendations
for Children
• Moderation, Not Deprivation
Less saturated fat
More fruits and vegetables
Nuts, vegetable oils, and some fish
provide essential fatty acids.
• Treat problems with diet first, then
drugs.


Smoking

• Increases risk for heart disease
• Half of teens who continue to smoke
will die of smoking-related causes.


Chapter 15 NUTR

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Chapter 15 NUTR