Nutrition for 6-12 year olds

1. Nutrition for 6-12 year olds Ruth Charles Consultant Paediatric Dietitian Ballinderry Clinic, St. Francis Hospital, Mullingar, Co. Westmeath. www.nutrikids.ie

2. Key growth periods in childhood • Birth-age 1 • Puberty

3. Growth in early years

4. Puberty growth spurt

5. Growth factors • Genetics: parental height • Race • Genetic disordersSyndromes: Down’s, Turner’s • Congenital abnormalities: heart defects • Trauma (brain/bone injury, emotional) • Parasitic infection • Social environment & hygiene • Nutrition & food

6. Energy requirements for children Adapted from Recommended Dietary Allowances for Ireland 1999, Food Safety Authority of Ireland

7. Nutrient requirements for Irish children

8. www.fsai.ie 1999 www.dohc.ie 2004http://www.dohc.ie/publications/pdf/primary_schools.pdf?direct=1 2003

9. Meal planning: Special considerations • Food allergy or intolerance: peanut free (egg, milk) • Vegetarian • Cultural food customs • Modified consistency (puree, mash, liquid) • Iron • Bone health • Dental health • Obesity • Athletic/active children • School Healthy Eating Policy

10. Food Allergy & Diabetes. • Diabetes: • Frequency and timing of eating. • Low GI foods • Exercise and food • Food Allergy: • Reaction type/severity • What food involved

12. Bone health: Calcium (Phosphorus) • Dairy: 3 servings per day for children. 5 servings a day for teenagers and pregnant/breastfeeding women. • Serving= glass of milk (1/3 pint or 189 ml), 1 pot of yogurt or a matchbox-sized (1oz) piece of cheese. • There is relatively no difference in the calcium content between full fat, low-fat and skimmed milk. • Low fat milk is suitable for children over 2 years ( provided they are eating well) and • Skimmed milk should not be introduced before the age of 5 years.

13. Bone health Vitamin D Active form Vitamin D3 is required (cholecalciferol) Non Food sources: UV radiation . Season, time of day, length of day, cloud cover, smog, skin melanin content, and sunscreen are among the factors that affect UV radiation  (>SPF 8) 5–30 minutes of sun exposure between 10 AM and 3 PM at least twice a week to the face, arms, legs, or back  Dietary sources: Most margarines Some fortified brands of soya milks, yogurts and desserts – check the label A few fortified breakfast cereals – check the label Dried skimmed milk Fortified yoghurts Eggs Oily fish: mackerel, herring, tuna, salmon Careful consideration needed: Exposure to sun, dark skin, elderly, infants. NEW RECOMMENDATION Vitamin D3 requirement: Children 0-1 year: 5µg/200 i.u. Ruth Charles, Consultant Paediatric Dietitian.www.nutrikids.ie

14. Cultural food customs

15. Dental Health

16. Obesity • 1 in 5 Irish Children are overweight/obese • Personal and parental accountability is paramount.  • More children will die of obesity associated medical problems without national strategies. • Cancer • Coronary artery disease • Insulin resistance & Diabetes • Joint & bone health • Prevention better than cure • Healthy Eating & Food Pyramid • Physical Activity

17. At least one hour of moderate intensity every day

18. Role of physical activity in childhood • Bone strength & density: weight bearing exercise. • Agility, balance, coordination and speed. • Key motor skills • “proficiency barrier” developing the simple activities of early childhood to the more complex activities of later years. • Self esteem & confidence • Cardiovascular health

19. Fuel for sport Calories/energy sources Fluids Time to eat Need for snacks

20. Food refusal • Common • Learned behaviour • Repeated if the desired result is obtained • 10-15 new food exposures required • before acceptance • Disguise the food/taste • Eating at the same time. Eating new foods together. Sitting together at the table.

21. School lunch Should be considered as a meal Enough allocated time? Important part of the school day. With increasing age, more time spent in school.

22. Translating recommendations to practice

23. Energy Carbohydrates: Cereals, grains, bread, Potatoes. Wholegrain varieties Sandwiches, Popcorn, pretzels, crackers, oatcakes. (sugar coated cereals, white pan bread, pasta, convenience frozen/ready to eat food, deep fried food) Sugar: natural (fruit, usually fructose) vs. added (usually sucrose) Sugar free usually means sucrose free (fructose/glucose) Fat: PUFA/MUFA better for health than saturated/trans fats Ruth Charles, Consultant Paediatric Dietitian.www.nutrikids.ie

24. Getting “wholegrain” into children’s diets

25. How to read a food label

26. Fruit and veg. • More than 4 portions a day • Different coloured fruit and veg: broccolli, peppers, carrot, tomato, blueberries • Homemade soup/gravy • Raw carrot, celery/cucumber sticks • Mixed salad • Smoothies using pulped fruit • (Pure fruit juices)

27. Reduce intake of top shelf foods:twice per weeks is reasonable

28. Healthy Snacks

29. Suitable drinks

31. Menu planning

32. Checklists • Food allergy or intolerance • Vegetarian • Cultural food customs • Modified consistency (puree, mash, liquid) • Iron • Bone health • Dental health • Obesity • Athletic/active children

33. Free resources • www.healthpromotion.ie • www.irishheart.ie/media/pub/kids/on_the_go_booklet_final.pdf • www.littlesteps.eu • www.fooddudes.ie • www.indi.ie

34. Thank you

38. School lunch Healthy lunch box – putting ideas into practice: Wholemeal bread with cheese slice and tomato + 1 banana + sugar free squash Pitta bread with cooked ham, low-fat mayonnaise lettuce and cucumber + orange segments + milk to drink Burger bun with chicken, relish, lettuce and grated carrot + dried fruit + yoghurt + water to drink Toasted wholemeal bread with cooked beef, tomato and cucumber + small apple + milk to drink Cooked pasta with tuna, lettuce, tomato and carrot + 2 mandarins + yoghurt + unsweetened pure fruit juice Salad box with cooked rice, lettuce, tomato, cheese cubes, celery sticks, carrot sticks + dried fruit + water to drink White roll with mashed hard boiled egg, lettuce and cucumber + handful of grapes + sugar free squash/milk to drink. Wholemeal bap with lean grilled bacon, tomato and sweetcorn + peach + milk to drink Crackers with cheese slices, sliced peppers, grated carrot +apple and orange segments + water to drink Cooked rice with cooked peas, carrot and chicken pieces + dried fruit + unsweetened fruit juice Hummus sandwich + Banana + unsweetened fruit juice Drinks It is important that children take in enough fluids during the day. Almost 2/3 of the body is made of water. If children do not drink enough water, they may become dehydrated, thirsty, tired and weak. Drinks should always be included for lunch and break-time. Water and milk are the best choices and milk is also a valuable source of calcium, which is important for healthy bones and teeth. Unsweetened fruit juice/ diluted sugar free squashes are also suitable drinks if taken with meals. Children should be encouraged to drink fluids with meals and not to fill up on drinks before meals