April 7 th , 2011

1. April 7th, 2011 • Childhood Nutrition

2. Objectives: Discuss the basic eating habits of toddlers and preschoolers. Describe foods most appropriate for toddlers and preschoolers, including three foods to avoid. List two child-friendly sources of the nutrients calcium, iron, vitamin D, and fiber. Define “food jags” and “picky eating.” Identify child and school-aged children caloric needs according to age, gender, and activity level. Briefly explain the likely cause of the rise in childhood obesity in the U.S. List three key messages from MyPyramid for Kids. List nutrients for which the National School Lunch Program must provide minimum levels.

3. Growth and Development Ages 1-6 yrs • After age 1 yr, the growth rate slows • Wt gain about 4-6 lbs/year • Length or height increases 3 inches/yr • Body fat decreases, muscle and bone mass increase • Acquire skills to allow self-feeding, eating • Develop food preferences

4. Nutrient Needs • Energy • Age 1: about 1000 kcals/day • Age 3: about 1300 kcals/day • Age 10: about 2000 kcals/day • Protein RDA • 1-3 yrs= 1.1 g/kg 13g/day • 4-8 yrs= 0.95 g/kg 19g/day • Maintains tissue, make new tissue, plasma, hormones, enzymes and antibodies

5. Young Children’s Nutritional Needs and Issues Two age categories during early childhood: Toddlers: 1-3 years old Preschoolers: 3-5 years old Growth slows significantly: Average weight gain in 2nd year: 3-5 pounds Average height gain: 3-5 inches

6. Young Children’s Nutritional Needs and Issues Appetite decreases: monitor growth to determine if child is eating enough Tend not to eat much at one sitting Need to eat small meals and nutrient-dense foods Toddlers are very active; need 1,000–1,600 calories daily Provide nutrient-dense meats, bean, fruits, vegetables, milk, whole grains Avoid choking hazards: hot dogs, nuts, whole grapes, hard candy, popcorn, raisins, raw vegetables should not be given to children younger than four

7. Nutrient needs • Fat • Use whole milk (not low fat or skim milk) until the child is 2 yrs old and eating other foods that contain fat • Essential fatty acid: Linoleic acid • Deficiency results in poor growth and the skin condition eczema • Food sources: Safflower oil, Sunflower oil, Corn oil, Sesame oil, Walnut oil, nuts (walnuts, almonds, peanuts), seeds, whole grains legumes, tofu and chicken (dark meat)

8. Minerals and Vitamins • Eat a variety of foods from all food groups • Milk and dairy products are good sources of calcium and phosphorous • Iron-deficiency anemia is the most common nutritional deficiency in young children, iron-rich foods are important

9. Young Children’s Nutritional Needs and Issues Young children need to consume enough calcium and iron. Children 1–3 years of age: 500 mg/day of calcium Two 8 oz. glasses of milk provide about 600 mg Iron deficiency is most common nutritional deficiency in children, can lead to developmental delays Results from too much milk or other iron-poor foods Provide lean meats, iron-fortified cereals

10. Young Children’s Nutritional Needs and Issues Young children need to consume enough vitamin D and fiber. Vitamin D important to prevent rickets Ages 1-8 need 5 µg (200 IU) Fiber: 1-3 years need 19 g/day; 4-8 years: 25 g/day Whole grains, fruits, vegetables can meet needs Young children need nutrient-dense beverages. Need milk and water, avoid sodas, sugary drinks Too much milk can displace important nutrients such as iron.

11. Nutrition issues • Iron deficiency anemia • Decreases the energy level of the child • Iron carries oxygen in the blood and transports oxygen within cells where it is needed to produce energy • Affects attention span, mood, learning ability and intellectual performance

12. Preventing Iron Deficiency • Limit milk to 3-4 cups/day so as not to displace iron-rich foods • Include iron-rich foods in meals & snacks • Beef, pork, chicken, fish, tofu, eggs, cooked beans, cereals with iron, enriched corn or flour tortillas, enriched rice or pasta, dark leafy greens, peas, dried fruits

13. Preventing Iron Deficiency • Include Vit C rich foods/drinks to increase absorption of iron • Vit. C foods: • Vegetables (tomato, broccoli, cabbage, bell pepper, potato) • fruits (orange, mango, strawberry, papaya) • juices (orange, grapefruit, tomato) • Make sure foods eaten provide 10mg/iron per day, or else supplement may be needed

14. Fluids • Milk • 100% fruit juice • Water • Young children can become dehydrated if they have fever, diarrhea, or vomiting if fluids are not replaced

15. My kid is eating macaroni and cheese for 10 days in a row, is it normal?

16. Yes, it is normal, and is called food jag • Nothing lasts forever • It’s common • Continue to offer wide variety of foods, different shapes, color/texture.

17. Young Children’s Nutritional Needs and Issues “Picky eating” and “food jags” are common in small children. Parents should: Serve as good role models Encourage variety and new foods Determine what food is offered, when and where Children should be allowed to determine whether or not to eat the food and how much to eat. Food jags are usually temporary and usually not a health problem.

18. Food preferences in a Pre-school child • Single foods not combination dishes • Finger foods • Moist foods, dry foods hard to swallow • Warm foods, not hot foods • Colorful foods • New foods should be introduced one at a time in small amounts • Eat with other children • Small servings, small plates, small tables+chairs for small people

19. Dental Caries • Development of caries from • 1. Diet composition, especially sucrose, a carbohydrate • 2. Presence of acid-producing bacteria in dental plaque • 3. Saliva, buffer to raise pH and provides mechanical cleansing of teeth

20. Preventing Dental Caries • Decrease intake of sucrose-containing food and items (gum, breath mints, soda) • Avoid solid, soft, sticky sweets that stick to teeth • Encourage child to snack on crisp, fibrous foods • Brush and floss daily after meals & snacks • Visit dentist for cleaning and check-up regularly

21. Food Allergies • Involve antibody production, reaction to a food protein or other large molecule • Possible symptoms: nausea, vomiting, skin rash, inflamed nasal and lung passages, asthma, or anaphylactic shock • Foods that cause allergic reaction: Nuts, eggs, milk, soybeans, wheat, chicken, fish, shellfish

22. Food intolerance • Symptoms of an adverse food reaction without antibody production

23. Calculating Age for Plotting

24. Method to calculate age • A. Write down the date when measurements are taken in year, month and day • B. Write down the child’s date of birth and subtract from A • C. If #s cannot be subtracted, borrow 12 months from the year and 30 days from the month

25. Sample Calculation 1 • Measurement date: July 20, 1997 • Birthdate: April 3, 1994 • What age should be used to plot her measurements? • Year Month Day =17 days->1 month • 1997 7 20 =3+1 month->4mon • -1994 -4 - 3 =4 mon->1/4 year • 3 3 17= 3 years, 4 mos =3 ¼ years

26. Sample Calculation 2 • Measuring Date: February 21, 2008 • Birthdate: October 27, 2005 • Year Month Day • 2008 2 21 • -2005 -10 -27 • 2 years, 3 months, 24 days • 2 years, 4 months • 2 ¼ years

27. Sample Calculation 3 • Measurement Date: March 8, 2008 • Birth Date: June 19, 2001 • 6 years, 8 months, 19 days • 6 years, 9 months • 6 ¾ years

28. Growth and Development Age 6 to 9 years • Growth rate slows down after age 7-8 yrs until the adolescent growth spurt which occurs around 9-14 yrs in girls and 11-16 yrs in boys

29. Nutrient needs • Energy: 90 kcals/kg for 4-6 yr olds • 70 kcals/kg for 7-10 yr olds • Protein 1.1 g/kg in 1-3 yr olds • 0.95g/kg in 4-8 yr olds • Growth rate indicates if energy intake is adequate

30. Nutrient Needs • Vitamin A (helps with vision) • Milk, yogurt, cheese, dark leafy green vegetable or dark yellow vegetables and fruits • Iron • Calcium • Zinc (if low: poor appetite, depressed growth) • Milk, yogurt, cheese, meat, poultry, fish

31. Attention Deficit Hyperactivity Disorder (ADHD) • Onset is before 7 yrs old, affects 5-10% of school-age children • Inattention, excess motor activity, impulsiveness, and poor tolerance for frustration • Additives and sugar do not cause it • Controlled using stimulant medications • Anorexia/Loss of appetite is a side effect of medication • Give medication with or after meals

32. What affects food choices in school age children?

33. TV • Friends • School meals • Vending machines at school • Parents/caretaker • After school activities

34. Nutrition Education Activities • Field trips to a farm, cannery, bakery • Making cheese or ice cream • Grow produce in a garden • Bake bread, prepare a recipe • Keep a food record • Cultural foods lessons and potluck • Teach science and math with nutrition

35. How do eating habits learned in childhood affect habits during adulthood?

36. Childhood eating habits develop a nutritional foundation for the rest of the child’s life. • Children mimic behaviors • Caregiver serves as a role model

37. Does my child need a vitamin & mineral supplement?

38. Depends on the child and his/her individual needs • Compare child’s diet to food pyramid, if consistent lack in certain food groups, this child might need supplement • Is it a vegan child? • Always remember food first • Watch out for overdosage!

39. Obesity is becoming more prevalent in children, how can parents reduce their children’s risk?

40. Preventing Childhood Obesity • Emphasize foods that provide a balance of nutrients and appropriate kcals to reduce wt gain not achieve wt loss • Modify meal/snack(< desserts, fried foods) • Parents/caregivers set a good example • Respond to child’s hunger & satiety cues • Encourage physical activity

41. Increase Physical Activity • Role model • Balanced and healthy meal planning • Decrease TV/computer time

42. Making Meals Matter for your School-Age Child • Write a menu for a 9 yr-old child • Name 1 creative or fun way to teach the child about your assigned food group

43. School-Aged Children’s Nutritional Needs and Issues Quality of diet impacts growth Caregivers should encourage and model healthy habits. School-aged children are experiencing higher rates of obesity and diabetes. Due to many factors: too many calories, too little physical activity Excess calories from sugary drinks, sports drinks, high fat foods, larger portions Less physical activity due to increased “screen” time, less physical education at school

44. Calorie Needs for Children and Adolescents Table 13.1

45. School-Aged Children’s Nutritional Needs and Issues American Academy of Pediatrics recommends: Caregivers act as role models of healthy eating Offer children healthy snacks of vegetables, fruits, whole grains Increase physical activity Limit screen time to no more than two hours daily Childhood obesity increases risk of type 2 diabetes Early intervention and treatment important Entire family should adopt healthy diet and exercise to manage diabetes

46. School-Aged Children’s Nutritional Needs and Issues MyPyramid for Kids can help guide food choices: Ages 2-5; 6-11 Slogan: “Eat Right. Exercise. Have Fun.” 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 group every day. Make the right choices for you. Take it one step at a time.

47. MyPyramid For Kids Figure 13.1

48. School-Aged Children’s Nutritional Needs and Issues National School Lunch Program provides nutritionally balanced, low-cost or free lunches. Meals must meet certain nutrient guidelines Regulated by USDA USDA donates commodity foods to lower costs Some schools also have school breakfast programs. Eating breakfast associated with healthier body weight, academic performance, psychosocial function, school attendance rate May benefit cognitive function (especially memory)

49. Minimum Nutrient and Calorie Levels for School Lunches (School Week Averages) Table 13.2

50. What’s in a School Lunch? Table 13.3