Nutrition from Infancy Through Adolescence

1. Nutrition from Infancy Through Adolescence Chapter 18 BIOL1400 Dr. Mohamad H. Termos

2. Infant growth and nutrition needs The growing infant • Infant weight doubles within 6 months of age and triples within the first year of age. • This rapid growth requires a very high amount of nutrients because otherwise growth would slows or cease

3. Infant growth and nutrition needs Under-nutrition - Half of the world's children short and underweight for age because of poor nutrition • Child does not receive breast milk, instead high carbohydrate, low protein and other nutrients - The best indicator of nutritional status is growth

4. Infant growth and nutrition needs Infant growth and development can be assessed using growth charts which give ratios of weight Vs height, height Vs age, weight Vs age. - 10th percentile means a child is smaller than 90 out of 100

5. Infant growth and nutrition needs Adipose (fat) tissue growth • It is very unwise to greatly restrict diet and fat intake before age 2. This is because restricting fat cells development would mean a reduction in energy intake which would affect growth of other organ systems. - Effects of overfeeding in infancy are speculative. Most overweight infants become normal-weight preschoolers without excessive diet restrition.

6. Infant nutritional needs 1. Calorie or Energy needs: a. 0 - 3 months: (89 Kcal x wt in kg) + 75 b. 4 - 6 months: (89 Kcal x wt in kg) + 44 c. 7 - 12 months: (89 Kcal x wt in kg) - 78 d. Human milk and formula provide about 640 kcalories / quart 2. Carbohydrates: a. 0 - 6 months: 60 grams/day b. 7 - 12 months: 95 g/day c. These goals are easily met by proper diet 3. Protein: a. 0 - 6 months: 9 grams/day b. 7 - 12 months: 14 g/day c. These goals are easily met by breast milk or formula

7. Infant nutritional needs 4. Fat: a. 30 g/day with 15% (~5g) of total kcal as essential fatty acids b. Essential fatty acids (DHA and AA) are vital to the development of the eyes and nervous system 5. Vitamins of special interest: a. Vitamin K given by injection to all newborns b. Breastfed infants need Vitamin D supplementation until they are weaned. c. Vitamin B12 supplement if breastfeeding mother is vegan

8. Infant nutritional needs 6. Minerals of special interest: a. Iron - Stores generally depleted by age 4 to 6 months - Infant > 6 months need dietary iron source b. Iodine and zinc generally met if energy needs met c. Fluoride supplement if water not fluoridated 7. Water: a. 700-800 ml (3 c) needed per day b. Human milk and formula usually meet this need c. More required in hot, humid weather or with vomiting, diarrhea, fever d. Limit supplemental fluids to 4 ounces per day. Excessive fluid can be harmful especially to the brain

9. Formula feeding for infants Formula composition - Carbohydrate: generally lactose or sucrose - Protein: heat-protein from cow's milk - Fat: vegetable oils - Soybean-based for lactose or cows milk intolerant - Predigested (hydrolyzed) protein: protein easier to digest

10. Formula feeding for infants Formula preparation - Use clean bottles and mixing utensils - Mix formula with clean, cool water as hot water may contain more lead from pipes - Boiled, cooled well-water is OK if it has been tested for contaminates like nitrates - Prepared formula can be kept in refrigerator for 1 day. - Do not use microwave to heat as hot spots can occur - Discard formula left over from a feeding (might be contaminated by saliva bacteria and enzymes

11. Formula feeding for infants Feeding technique - Burp infants during feeding every 1 to 2 ounces or every 10 minutes - Burp again at end of feeding - Stop feeding when infant indicates he/she is full - Place infants to sleep on their back - Time on stomach while awake to prevent flattening of the head - Sleeping on stomach linked to sudden death syndrome (SIDS)

12. Expanding the infants mealtime choices - By about 6 months infants are ready to begin eating solids - By 1 year infants consume a variety of meat, grain, fruit and vegetable - Respond to infant cues of hunger and satiety

13. Expanding the infants mealtime choices - Until 6 mo nutrient needs met by breast milk or formula - Other nutrients and additional kcal needed after 6 months - Iron stores depleted by 6 mo Physiological capabilities of infant: - Ability to digest starch after 3 months - At about 4 to 6 months the following develop: A) Tongue thrust control B) Head and neck control C) Ability to sit with support

14. Infant growth and nutrition needs Foods to match needs and developmental ability during the first year: - < 6 months, primary goal meet iron needs - Start with tsp serving of single food, gradually increase portion size - Feed same food for 1 week then add another food - Introduce vegetables before fruits - One food at a time helps identify possible allergies - Common allergy-causing foods to avoid during infancy: Egg whites, Chocolate, Nuts, Cow’s milk

15. Infant growth and nutrition needs By 9-10 months - Infants explore, experience, and play with food - Present new food for several consecutive days to aid acceptance of the food By 1 year - Finger feeding is more efficient - Give baby sized spoon - Breast and bottle feed in more upright position for easier swallowing - Maintain calm and casual tone during mealtimes - Infant may take only 2 or three bits at some meals

16. Weaning from breast to bottle - Sippy cup can be introduced at 6 months - Drinking from cup not bottle helps prevent early childhood carries - Continual bottle-feeding baths teeth in carbohydrate rich fluid. Ideal growth medium for bacteria that make acid that decays teeth - Wean night feedings by giving pacifier or water

17. Dietary Guidelines for Infant Feeding Statements from American Academy of Pediatrics - Include variety of foods - Pay attention to signs of hunger and satiety - Infants need fat in the diet - Include fruits, vegetables and grains but not too much fiber - Avoid artificial sweeteners, include natural sugars for calories - Include foods containing zinc, iron and calcium

18. Food Allergies and Intolerances Allergies and intolerances broadly defined as adverse reactions to foods. Symptoms Include: 1. Sneezing 2. Coughing 3. Nausea or vomiting 4. Diarrhea 5. Hives, other rashes

19. Food Allergies - Immune system response, occurs when the body mistakes an ingredient in food as harmful and creates a defense system to fight. - Symptoms develop after interaction between our antibodies and the food (mostly proteins)

20. Food Allergies Types of reactions: - Itching, asthma, and swelling - Nausea, diarrhea, and indigestion - Headache and skin reactions - Anything milder than the above symptoms is called a "food sensitivity"

21. Food Intolerances Food Intolerances: - Adverse reactions not involving allergic mechanism • Digestive system response, occurs when a constituent in food irritates the digestive system. • Other causes include: Certain synthetic compounds added to foods, Food contaminants, Toxic contaminants, Deficiencies in digestive enzymes Treatment: Avoidance or consume smaller amounts

22. Preschool children: Nutrition concerns - Between 2 - 5 years old growth rate slows, average weight gain is 4.5 - 6.6 pounds per year, and average height gain is 3" to 4" - Rapid development of food habits and development of life- long eating patterns - Decreased appetite associated with decreased growth rate - Emphasize fruit, vegetables and whole grains and limit fatty and sweet foods choices

23. Preschool children: Nutrition concerns Nutritional problems in preschool children 1- Iron-deficiency anemia - Occurrence most likely from 6 to 24 mo - Decreased stamina and learning ability - Emphasize sources of iron in the diet with vitamin C sources 2- Constipation - Can be associated with more serious condition - Eat more dietary fiber, fruits, vegetables, whole-grain breads and cereals, and beans

24. Preschool children: Nutrition concerns 3- Dental caries - Begin oral hygiene when teeth appear - Seek early pediatric dental care - Drink fluoridated water - Use small amounts of fluoridated toothpaste twice daily - Avoid sticky, high-sugar snacks 4- Vegetarianism in Childhood: Risks include: a. Iron deficiency b. B-12 deficiency c. Vitamin D deficiency

25. School-age children - Generally, nutritional concerns and goals are the same as preschoolers - Serving size increases as energy needs increase - Children who eat breakfast are more likely to meet their daily nutritional needs than children who do not eat breakfast - Areas of diet needing improvement: increase fruit, vegetable, whole-grain, and dairy choices and reduced soda consumption

26. School-age children Type 2 diabetes 1. Primarily due to obesity coupled with inactivity 2. Blood glucose screening in at risk children every 2 years starting at age 10 3. Intervention: proper diet and physical activity 4. Medications may be necessary

27. School-age children Obesity • In the US, 15% of school-age children are overweight. Effects: Cardiovascular disease, type 2 diabetes, hypertension in adulthood - 40% of obese children become obese adults - Potential causes: Heredity, diet, and inactivity Treatment: - 60 minutes or more of planned physical activity per day - Moderate energy intake

28. The teenage years Rapid growth spurt Age: - Girls: 10 to 13; Boys: 12 to 15 Height gains: Girls: gain 10 inches, Boys: gain 12 inches Body composition - Girls gain fat and lean tissue - Boys gain mostly lean tissue - During growth spurts teenagers eat more - Chose nutritious food to meet nutrient needs

29. The teenage years Nutritional problems and concerns of teens 1. Anorexia and bulimia 2. Sodium intake often high 3. Iron-deficiency anemia