Nutrition from Infancy Through Adolescence

Infancy

Infant Growth and Physiological Development

. Infant birth weight doubles in the first 4-6 months then triples within the first year . Rapid growth requires a lot of sleep and nutrients . After first year it takes 5 more years to double weight . Increase in length in first year by 50% and height is complete by early 20’s . Head size is in proportion to total height but shrinks from 1/4 to 1/8 . Human body needs a lot more food to support growth and development than it does to merely maintain its size once growth stops . Nutrient poor diets do not support growth . Developing countries . Under-nutrition observed . When breast feeding ceases children are feed a high carbohydrate, low protein diet . Diets are also low in energy, protein, calcium, iron and zinc . Causing slower growth and shorter stature . Infant development follows a pattern . Body water falls from 70% at birth to 60% at 1 year . Body nitrogen content increases from 2% at birth to 3% at 1 year – indicating new lean tissue synthesis

Effects of Under-nutrition on Growth

. Long term effects of nutritional problems in infancy and childhood depend upon severity, timing, and duration of the nutritional insult to cell processes . Best indicator of a child’s nutritional status is growth (HEIGHT and WEIGHT)

Assessment of Infant Growth and Development

. CDC released growth charts . Look at growth chart in the book . Growth charts based on percentile rank and/or BMI for girls and boys from birth to 36 months . Options for charts: weight-for-height, length-for-age, weight-for-length, and head circumference . Preferred growth chart for children and adolescence (2-20) is BMI . BMI for adults is fixed but not true for children . BMI is age and gender specific . Takes 1-3 years for an infant to establish his/her own genetic percentile

Brain growth

. Rapid growth until 18 months

Infant Needs

. Infant formula at first . Compare composition of Human milk, Cow’s milk, and infant formula . Human milk provides most energy (kcal/L), carbohydrates (g/L) and fat (g/L) . Cow’s milk provides most protein (g/L) and minerals (g/L) . Protein sources: casein and whey proteins . BUT infants usually cannot tolerate cow’s milk . Infant formulas provide similar amounts of all nutrients . Solid foods introduced at six months but formula still primary food source until year one . Energy . 0-3 months [89 X weight (kg)] + 75 . 4-6 months [89 X weight (kg)] + 44 . 7-12 months (89 X weight (kg)] -78 . kcals in first 6 months is 2-4 times more energy need than adults . High energy need result from high growth and metabolism . Carbohydrates . From milk and solid foods (after month 6) . 0-6 months 60g/day . 7-12 months 95g/day . Proteins . 1.5g/kg body weight/day . Half of total protein intake should come from essential amino acids . Human or infant formula are sources . Too high of protein intake could stress kidneys . Fat . 30g of fat per day . AI = 30 – 31 grams . Essential fatty acids should make up 15% of total (4-5g/day) . Human infant and infant formula are sources . Two fatty acids found to be absolutely necessary: Arachidonic acid (AA) and Docosahexaenoic acid (DHA) . AA and DHA used in brain and eye development . AA and DHA found in human milk and currently found in infant formula . Vitamins . Vitamin K injection given at birth . Infant formula fortified with vitamins . Vitamins in human milk dependent on mother’s diet . Minerals . Iron stores are depleted quickly in infants . Give iron fortified formula . Zinc and iodide may be lacking . Fortification of zinc and iodide necessary for growth . Fluoride necessary for tooth development . Water . Infant needs 2 ounces per pound per day . 150 ml/kg . Too little water and too much water may lead to health problems . Conditions leading to water loss calls for supplemental water . BUT excess fluid can be harmful, especially to the brain . Limit supplemental fluids to 4 ounces per day . Nutrient Labels . Serving size . Based on average eaten at one time by a child under two years of age . Total fat . Does not list calories from fat, saturated fat, or cholesterol . Infants and toddlers need fat for growth and development . Parents should not restrict fat intake . Daily Values . For infants and children under four years old . Lists percentage of protein, vitamins, and minerals

Introduction of Solid Foods

. Recommendations for timing the introduction of solid foods: . Nutritional needs . Iron and vitamin D may be low in breast milk and unfortified formulas . Physiological capabilities . Starch digestion and protein metabolism . Physical ability . Disappearance of extrusion reflex (thrusting tongue forward) . Head and neck control . Ability to sit up . Allergy prevention . Introduction of certain proteins too early may predispose a child to future allergies . Solids foods . First solid foods should be iron-fortified cereals . Introduce after breastfeeding or formula feeding – edge has been taken off hunger . Rice cereal best to begin with – least likely to cause allergies . Pediatricians may recommend lean ground (strained) meats for iron source . After a week of introducing a new food without ill effects another food item can be introduced . Recommended to introduce vegetables before fruits (may cause preference for sweet taste) . Recommended not to introduce mixed foods until each component of mixed food has been given separately – if not a food allergy may develop . Foods not to feed an infant . Honey – may contain spore of Clostridium botulinum . Very salty or very sweet foods . Excessive infant formula or human milk . Foods that may cause choking . Cow’s milk – contains high protein and mineral content an infant cant process well; after two years a child is able to process 1% and non-fat milk . Feeding excessive amounts of pear or apple juice – fructose and sorbitol may cause diarrhea

Health Problems Related to Infant Nutrition

. Colic – sharp abdominal pain that generally occurs in otherwise healthy infants . Diarrhea – caused by bacterial and viral infections as well as dietary intolerances . Milk Allergy – cow milk allergy due to proteins . Iron deficiency anemia – anemia as a result of low iron in diet . Gastroesophageal reflux – esophageal sphincter may not fully close . Early childhood caries – tooth decay resulting from formula or juice bathing teeth as child sleeps with a bottle in his/her mouth

Preschool Children

Growth (3-5 yrs of age) and Needs

. Average annual weight gain is 4.5 to 6.6 lbs . Average annual height gain is 3 to 4 inches . Tapering growth rate may lead to reduced appetite and changed eating behavior (“picky eaters”) . Energy requirements (1-3 yrs old): [89 X weight (kg)] -80 . Carbohydrates: 130g/day . Proteins: 1.1g/kg weight/day; 13-19g/day 1-3 years . Fat : no specific needs set but at least 5g/day of essential fatty acids needed . Vitamins: No supplements necessary; emphasize good foods . Minerals: . No supplements necessary; emphasize good foods . 500-800mg/day of Calcium needed . 10mg/day of Iron needed . USDA created a food guide pyramid for ages 2-6 . 6 servings of grains . 3 servings of vegetables . 2 servings of fruits . 2 servings of milk . 2 servings of meat . “Eat less” fats and sweets

Health Problems in Preschool Children

. Iron Deficiency Anemia . Constipation . Fiber recommendation: 19g/day for children 1-3 years . Water intake recommendation: 5 cups per day for toddlers . Dental caries

School Aged Children to Preteens

Growth (6-13) and Needs

. Food guide pyramid remains the same except serving size increases . Energy requirements: . Boys 3-8: . 88.5 – (61.9 X Age [in years]) + (PA X (26.7 X Weight [kg] + 903 X Height [meters]) + 20 . PA (physical activity): 1.00 (sedentary). 1.16 (low active), 1.26 (active) and 1.42 (very active) . Girls 3-8: . 135.3 – (30.8 X Age [in years]) + (PA X (10.0 X Weight [kg]] = 934 X Height [meters]) + 20 . PA (physical activity): 1.00 (sedentary). 1.16 (low active), 1.31 (active) and 1.56 (very active) . Note: + 20 in formula for both boys and girls is replaced with + 25 in older children . Carbohydrates: 130g/day . Proteins: 0.95g/kg weight/day; 34-52g/day for older children . Fats: none specified . Vitamins and minerals: . Recommended amounts just under those of adults . Possible introduction of vitamin and mineral supplements

Health Problems

 Type 2 Diabetes  Obesity

Teenagers

Growth (14-18) and Needs

. Food guide pyramid for this group nearly reflects those for adults . Energy requirements: reflect adult caloric intake . Carbohydrates: 130g/day . Proteins: 0.85g/kg weight/day; or 52 g/day males and 46 g/day females . Fats: none specified . Vitamins and minerals: o Recommended amounts equal those of adults o Possible introduction of vitamin and mineral supplements

Health Problems

. Anorexia and Bulimia . Iron Deficiency . Lack of calcium . Increased sodium intake Chapter Objectives

After reading chapter seventeen - A student should be able to...

1. Describe infant growth and physiological development (birth till 18 months) 2. Discuss how infant growth and development is assessed 3. Discuss the effects of under-nutrition on growth 4. Describe the nutrition needs (milk, energy, carbohydrates, protein, fat, vitamins, minerals, and water) of infants 5. Compare adult nutrition labels to nutrition labels on infant food 6. Discuss the introduction of solid foods to infants 7. List and discuss health related problems in infants associated with nutrition 8. Describe pre-school children growth and development 9. Describe the nutritional needs (energy, carbohydrates, protein, fat, vitamins, and minerals) of pre-school children 10. Discuss the food guide pyramid for pre-school children – compare this to adults 11. List and discuss health related problems for pre-school children associated with nutrition 12. Describe the nutritional needs (energy, carbohydrates, protein, fat, vitamins, and minerals) in school aged children and preteens 13. List and discuss health related problems for school aged children and preteens 14. Describe the nutritional needs (energy, carbohydrates, protein, fat, vitamins, and minerals) in teens 15. List and discuss health related problems in teens