Normal Nutrition and Development

1. Normal Nutrition and Development Childhood

2. Estimated cost of child born in 2000

3. Expenditure on child 12-14 • Middle income: $ 51,000 • Housing 2560 • Food 1790 • Transportation 1570 • Clothing 790 • Health care 780 • Child care/education 770 • Misc. 1210 Total 9220

4. Reference Population: Standard Normal Curve 50th Percentile 5th 95th

5. Development in childhood • Differing rates of attainment of milestones • Toddler 1-3 • Preschool 3-5 • School age 6-10 • Pre-adolescent 11-13

6. Basic principles Children will eat. Children are capable of regulating food intake. Children generally react negatively to new foods but will accept them with time and experience Parents can either support or disrupt a child’s food acceptance and regulation.

7. Toddlers A toddler’s job is to: Explore the world Establish a sense of self A parent’s job: Keep safe Set limits • tape

8. Preschool Children • Learning about how to get along • Trial and error • Wants to please • Enthusiastic! • Meals • Has experience • Social

9. Child feeding programs • Zinc, folate, vit D and E • WIC: • Food stamps: • Head start: • Opportunity missed? • CACFP • Maybe iron?

10. School age • Early • Positive, curious, shows initiative • Prelogical, egocentric • Late • Independence, achievement • Rules • The beginning of plans

11. School age • Low impact everyday activities increases bone density • Most active children had 12% more bone in hip than least active. • High TV watching in girls = less bone density • Boys were more active than girls and had greater bone density. • Janz KF, Pediatrics 2001;107:1387-1393

12. Misc. problems • Dieting • Half of girls report weight concerns • Mother’s attitudes matter more to girls • ADHD • Feingold diet: 5-10% benefit • Modified with fruits really ok • Ritalin or Dexadrine: stimulants • Decreased growth secondary to dec appetite • Decreased appetite from ½ hour after taking to 6 hours later • Allergies: associated with dietary deficiency

13. School breakfast • Universal Free School Lunch in Inner city schools • 33% of children were from families where hunger was common (10%) or likely (23%). • After 4 months: Children who ate breakfast • Were absent or tardy less often • There were less trips to the office! • Inc. math scores (2.8 vs 1.9) • Lower perception of hyperactivity by teachers

14. School breakfast • Children who ate breakfast • Were less depressed • Were less anxious • Tended to be healthier • Murphy JM, Arch Periatric Adolesc Med 1998;152;899-907

15. School Lunch factoids • If greater than 70% of students are eligible for free or reduced cost meals, school breakfast is free for everyone. • If breakfast is delivered to homerooms, participation increases. • School lunch and breakfast can be modified to fit a diet Rx, for free. • May pay for tube feeding formula.

16. Quality of children’s diets • Healthy Eating Index: ages 2-9 • Food guide pyramid • Fat % total and saturated • Cholesterol and sodium • Variety • 19% good diet • 72% needs improvement • 9% poor

17. % Children Meeting Dietary Recommendations variety veg milk fat chol

18. % Children Meeting Dietary Recommendations * * * * * variety fat veg milk chol

19. Differences • Good diet • 2-3 34% 4-6 16% 7-9 13% • Boy 20% Girl 18% • Low Income 16% Not low 20% • City 19% Suburb 21% Not 16%

20. Food sufficient • Poor diet • Sufficient 8% • Not sufficient 18% highest % in survey

21. Food choices: Texas • Breakfast: Cereal, juice, whole milk, white bread, low fat milk, sausage sugar • Lunch: Fruit, chocolate milk, white bread, vegetables, ground beef, cheese • Dinner: Vegetables, ground beef, white bread, soda, noodles, cheese potatoes • Snack: fruit, cookies, white bread, chips, soda, crackers, chocolate

22. Children’s food choices: NM • Frequency: Pizza, hamburger, apple, milk, orange, soda, taco, orange juice, banana, cereal, spaghetti, egg, chicken, ice cream, corn, chips, Kool-aid, apple juice, salad, grapes • Good for you: oranges, apples, bananas, fruits and vegetables, carrots • Not good for you: Pizza, hamburger, french fries, spaghetti, chips, lots of grease, tacos, potatoes, Fry bread

23. Fat in diet: 5th grades • Increased fat: • Comes from eating out, late night snacks • Living with single mothers • School lunch in “free” schools • Decreased with additional nutrition knowledge by children!

24. Iron deficiency • Anemia, iron deficiency without anemia and normal iron • NHANES data: 6-16 • Math scores • 86.4 87.4 93.7

25. Carbohydrate and learning • Epinephrine improves memory • Epinephrine inc blood glucose • In rats peak memory occurs with slightly inc glucose levels • In humans, overnight fast and then fed or not • Listen to a story and then tested for memory • 100% improvement • Inc. creativity

26. Sugar • Sugar load and then crash • Tiredness • Trend to inc weight correlated with inc intake soda • Overweight children drink more soda • Very low fat diets (<20%) may produce inc lipid levels

27. Health beliefs in food choice • For mothers choosing food for children: most important factor was health • Taste • Disease prevention • If choosing food for themselves switch taste and health • For children: taste and health • Pick health: ate less candy • Pick taste: more fruit and less protein

28. Fruit and veg. consumption • Child’s fruit intake: • mothers nutrition knowledge, • mother’s consumption, • mother’s belief reduces risk of cancer • Child’s vegetable intake: • Child’s preference • Mother concern for disease prevention • Candy: mother’s intake and child’s health concern

29. Fruit and veg. consumption • Child’s fruit intake: • mothers nutrition knowledge, • mother’s consumption, • mother’s belief reduces risk of cancer • Child’s vegetable intake: • Child’s preference • Mother concern for disease prevention • Candy: mother’s intake and child’s health concern

30. Food guidance

31. Food Guide Pyramid for kids • http://www.usda.gov/cnpp/KidsPyra/ • Ages 2-6 • Age adjusted portion sizes • Milk and meat 2 servings each • Fruits 2 and vegetables 3 • Breads 6