Nutrition for Infants, Children and Adolescents Chp. 12 PDF

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Nutrition for Infants, Children and Adolescents
Llynn’ Newman M.S., C.N. NYS. Lic. AHG.
Chapter 12...

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Nutrition in Nursing and Healthcare Llynn’ Newman M.S., C.N. NYS. Lic. AHG. Chapter 12 Nutrition for Infants, Children, and Adolescents • Intake of adequate calories and nutrients promotes optimal physical, social, and cognitive growth and development. • Children and adolescents who do not consume enough calories and nutrients are at increased risk of impaired health and certain chronic diseases in adulthood. • Actual nutrient requirements vary according to health status, activity pattern, and growth rate. Infancy (Birth to 1 Year) • Growth in the first year of life is more rapid than at any other time in the life cycle. • Birth weight – Doubles by 4 to 6 months of age – Triples by the first birthday • Length increases by approximately 10 inches during the first year. • Infant’s needs are much higher per kilogram of body weight. • Breast milk – Specifically designed to support optimal growth and development in the newborn – Composition makes it uniquely superior for infant feeding. – Exclusive breastfeeding for the first 6 months of life followed by optimal complementary feeding are critical public health measures. – Adequacy of intake is determined by monitoring weight for height on growth charts. – Research shows that breastfeeding decreases the incidence and/or severity of infectious diseases. – Some studies suggest that older children and adults who were breastfed have a lower risk of • Type 1 and type 2 diabetes • Lymphoma and leukemia • Hodgkin disease • Overweight and obesity • Hypercholesterolemia • Asthma – American Academy of Pediatrics recommends exclusive breastfeeding for the first 6 months of life. – Even after solid foods are introduced, breastfeeding should continue until at least the first 12 months of age. • Infant formula Infant formulas may be used in place of breastfeeding, to supplement breastfeeding, or when exclusively breastfed infants are weaned before 12 months of age – When compared to exclusively breastfed infants, formula-fed infants exhibit few, if any, differences up to 6 months of age. – After 6 months of age, formula-fed infants grow slightly faster. – Routine formulas are prepared from cow’s milk made to resemble human milk.

– Formula is iron-fortified. – The Infant Formula Act – Because the minimum recommended amount of each nutrient exceeds the amount provided in breast milk, nutrient supplements are unnecessary. – Approximately 25% of the formulas used in the United States are made from soy. – Variety of formulas is available for infants with special needs. – Phenylketonuria (PKU) – Maple syrup urine disease – Low-birth-weight formulas – The amount of formula provided per feeding and the frequency of feeding depend on the infant’s age and individual needs. – Overfeeding is one of the biggest hazards of formula feeding. – To avoid nursing bottle caries, infants and children should not be put to bed with a bottle of formula, milk, juice, or other sweetened liquid. • Complementary foods: introducing solids – Solids become a necessary source of nutrients around 6 months of age. – Developmentally, most infants exhibit readiness to spoon-feed at around 4 to 6 months of age. – Eruption of teeth indicates readiness to progress from strained to mashed to chopped fine to regular consistency foods. – Iron-fortified infant cereal is generally the first solid food introduced. • Give a small amount of formula or breast milk to take the edge off hunger before beginning the cereal. • Recommended until the infant is 12 to 18 months old – Traditionally, the order of foods introduced after iron-fortified cereals was • Vegetables • Fruits • Meats • Eggs – Order is no longer considered important. – WHO and Pan American Health Organization recommend that “meat, poultry, fish, or eggs should be eaten daily or as often as possible.” – New foods should be introduced in plain and simple form one at a time for a period of 5 to 7 days. – Peanuts and peanut butter should be avoided. – Infants differ in the amount of food they want or need at each feeding. – Infants and children should be allowed to self-regulate the amount of food consumed. – Fruit juices were once considered essential complementary foods. Nutrition for Toddlers • The period between age 1 and 2 years is a time of transition. • “Physiologic anorexia” • At age 1 year, the toddler should be – Drinking from a cup – Eating many of the same foods as the rest of the family • Around 15 months of age, food jags may develop.

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By the end of the second year, children can completely self-feed and can seek food independently. • At age 1 year, whole milk becomes a major source of nutrients. – Milk anemia can occur. • The American Academy of Pediatrics recommends that low-fat or nonfat milk not be started until after the age of 2 years. • Little research on the best ways to achieve optimal nutritional intakes exists, and there are no nutritional guidelines. • Feeding Infants and Toddlers Study (FITS) – American infants and toddlers consume a nutritionally adequate diet with little risk of nutrient deficiencies. – Sizable percentages of toddlers consume high-calorie, high-fat, and salty snacks as well as carbonated beverages and sweetened fruit drinks. – For children aged 19 to 24 months, French fries are the most frequently consumed vegetable. – Until the age of 4 years, young children are at risk of choking. • Decrease the risk of choking • Foods that are difficult to chew and swallow should be avoided. • Meals and snacks should be supervised. • Foods should be prepared in forms that are easy to chew and swallow (e.g., cut grapes into small pieces and spread peanut butter thinly). • Infants should not be allowed to eat or drink from a cup while lying down, playing, or strapped in a car seat. Foods That Most Often Cause Choking • Hot dogs • Candy • Nuts • Grapes • Raw carrots • Tough meat • Celery • Popcorn • Peanut butter • Watermelon with seeds Question • When is the period of “physiologic anorexia”? a. Age 0 to 12 months b. Age 1 to 2 years c. Age 2 to 3 years d. Age 3 to 4 years Answer b. Age 1 to 2 years

Rationale: The period between age 1 and 2 years is a time of transition between infancy and childhood. The dramatic decrease in the growth rate is reflected in a disinterest in food, a “physiologic anorexia” due to lower calorie needs per kilogram of body weight. Nutrition for Children • Childhood represents a more latent period of growth. – Annually, a child grows 2 to 3 inches in height and gains about 5 pounds. • School-age children maintain a relatively constant intake in relation to their age group. • Calories and nutrients – Total calorie needs steadily increase during childhood. – Calorie needs per kilogram of body weight progressively fall. – Challenge in childhood is to meet nutrient requirements without exceeding calorie needs. – Content of childhood diets should be similar to that of adults. – The Dietary Reference Intakes for children are divided into two age groups: 1- to 3-year-olds and 4- to 8-year-olds. • Eating practices – As children get older • They consume more foods from nonhome sources. • Have more outside influences on their food choices – Today • Many children do not eat breakfast. • Get at least one-third of their calories from snacks • Many obtain a significant portion of their calories from sweetened beverages. • Promoting healthy habits – Parents are the primary gatekeepers and role models of their young children’s food intake and habits. – A rule-of-thumb guideline to determine age-appropriate serving sizes is to provide 1 tablespoon of food per year of age. – Children who eat more meals with their families have healthier diets. – Follow the Dietary Guidelines for Americans. Nutrition for Adolescence (12 to 18 Years of Age) • The slow growth of childhood abruptly and dramatically increases with pubescence until the rate is as rapid as that of early infancy. • Calorie and nutrient needs increase. • Gender differences are obvious. • Calories and nutrients • MyPlate-recommended calorie intakes for adolescents are based on DRIestimated energy expenditure calculations. • Generally, nutrient requirements are higher during adolescence than at any other time in the life cycle, with the exception of pregnancy and lactation. • Suggested amount of calories for moderately active females aged 12 to 18 years is 2000, whereas for males, the need ranges from 2200 to 2800 calories.

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Requirements for calcium and iron (for males only) are higher during adolescence than at any other time in the life cycle. Adolescents have increased needs for iron. • In boys, peak iron requirement occurs between 14 and 18 years of age. • Requirement for iron in adolescent girls increases from 8 to 15 mg/day at the age of 14 years to account for menstrual losses.

Question • What are the MyPlate recommendations for adolescents based on? a. DRI-estimated energy-expenditure calculations for adolescents b. DRI average growth rate for adolescents c. DRI-estimated weight gain adjusted for gender for adolescents d. DRI-estimated growth rate adjusted for gender for adolescents Answer a. DRI-estimated energy-expenditure calculations for adolescents Rationale: MyPlate-recommended calorie intakes for adolescents are based on DRIestimated energy-expenditure calculations that account for age, gender, weight, height, physical activity level, and energy deposition. •

Eating practices – In early adolescence, peer pressure overtakes parental influence on food choices. o Risk of overeating o Lack adequate fruits, vegetables, dairy foods, and whole grains – Nutrients most likely to be deficient o Fiber, vitamin A, calcium, iron, and potassium Nutrition Concerns During Childhood and Adolescence • Breakfast skipping – Children aged 6 to 13 years – Adolescent females are more likely to skip breakfast than males of similar age. – African American adolescents (24%) are more likely to skip breakfast than white adolescents (13%). – Results in lower intakes of vitamins and minerals • Increased consumption of soft drinks – In the last 50 years, the ratio of milk to soft drink consumption has changed dramatically. – Soft drinks and sweetened beverages provide calories without nutrients. – Soft drink consumption is linked to low intakes of vitamins A and C, some B vitamins, calcium, and phosphorus. • Overweight and obesity – The prevalence of obesity among youth has risen dramatically in the United States. – Overweight and obesity in childhood or adolescence increase the risk of several diseases in adulthood. – Overweight and obesity can have negative social and psychological consequences.

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– Fundamental cause of overweight and obesity is an imbalance between calorie intake and calorie expenditure. Healthy lifestyles and obesity prevention – Prevention of obesity is critical. – Barriers to parents taking action • Lack of time • Believe that children will outgrow their excess weight • Lack of knowledge • Fear they will cause eating disorders – The American Academy of Pediatrics recommends that BMI be calculated and plotted at each well visit. – A key recommendation in the Dietary Guidelines for Americans, 2010 is that overweight or obese children and adolescents change their eating and physical activity behaviors to prevent an increase in BMI and that health professionals be consulted to manage weight. Adolescent pregnancy – Associated with physiologic, socioeconomic, and behavioral factors that increase health risks to both infant and mother – Infants are at risk for low birth weight and premature birth and are more likely to die within the first year of life. – Pregnant adolescents are at higher risk for anemia, high blood pressure, and excessive postpartum weight retention. Compared with adult women, pregnant adolescents – Are more likely to be physically, emotionally, financially, and socially immature – May not have adequate nutrient stores – May give low priority to healthy eating – May have poor intake and status of certain micronutrients – Must gain weight early and steadily – Are more concerned with body image – Are more likely to smoke during pregnancy – Seek prenatal care later...