K.25 Nutrition in Childhood

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    NUTRITION IN

    CHILDHOOD

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    Nutrient requirement

    Children growing & developing

    need more nutritious food May be at risk for malnutrition if :

    - poor appetite for a long period

    - eat a limited number of food- dilute their diets significantly with

    nutrient poor foods

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    Energy

    Energy needs of healthy childrendetermined on :

    - basis of basal metabolism

    - rate of growth

    - energy expenditure

    Must be sufficient to ensure growth & spare

    protein, but not so excessive Suggested intake proportions :

    50 60% carbohydrate, 25 35% fat,

    10 15% protein

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    Daily dietary reference intakes forenergy for children

    Age Males Females

    (yr) (kcal) (kcal)

    1 2 1046 992

    3 8 1742 1642

    9 13 2279 2071

    IOM, Food and Nutrition Board, 2002

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    Protein

    Early childhood 1.1 g /kg BW

    Late childhood 0.95 g/kg BW

    At risk for inadequate protein intake :- strict vegan diets

    - with multiple food allergies

    - who have limited food selection because

    of fad diets

    - behavioral problems

    - inadequate access to food

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    Daily dietary reference intakes forprotein for children

    Age Grams Grams / kg

    (yr)

    1 3 13 1.1

    4 8 19 0.95

    9 13 34 0.95

    IOM, Food and Nutrition Board, 2002

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    Minerals and vitamins

    Necessary for normal growth & development Insufficient intake impaired growth

    deficiency disease

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    Iron

    Children 1 3 years high risk for iron

    deficiency anemia Rapid growth period Hb & total iron

    diet may not be rich in iron-containing food

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    Calcium

    Needed for adequate mineralization &maintenance of growing bone

    DRI : 1300 mg/day 9 18 yrs800 mg/day 4 8 yrs

    500 mg/day 1 3 yrs

    Primary sources : milk & dairy product children who consumed no or limitedamountat risk for poor bonemineralization

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    Zinc

    Essential for growth if deficiency :

    - growth failure

    - poor appetite- decreased taste acuity

    - poor wound healing

    RDA : 3 mg / day 1 3 yrs5 mg / day 4 8 yrs

    8 mg / day 9 13 yrs

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    Best sources : meats & seafood

    Marginal zinc deficiency reported in

    children from middle & low-income families(Robert & Heyman, 2000)

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    Vitamin D

    Needed for calcium absorption & deposition

    calcium in the bones The amount required from dietary sources

    is depend on nondietary factors (geographiclocation & time spent outside)

    Primary sources : vitamin D-fortified milk

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    Vitamin-Mineral supplement

    Do not necessarily fulfill specific nutrient needs

    Children who take supplement do not

    exceed the RDA Should not take megadoses, particularly fat

    soluble vitamins toxicity

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    Children at risk who may benefit fromsupplementation :

    - from deprived families- with anorexia, poor appetites, poor eating habits

    - with chronic diseases (cystic fibrosis, liver dis)

    - enrolled in dietary programs from weight

    management

    - vegetarian diets with inadeq intake of dairy product

    or calcium containing foods

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    FEEDING PRESCHOOL CHILDREN(1 6 yrs)

    Still gaining height & weight

    Start to walk & talk

    Depend on brain development

    Depend on genetic & environmentalinfluences stimulation & nutrition

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    Marked by vast development and theacquisition of skills

    Decreased interest in food a difficult timefor parents

    Smaller stomach capacity & variableappetite small serving

    Eat 4-6 x/day snacks is importantshould be chosen carefully

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    Should not be given any food or drink within1 hours of meal

    Excessive intake of fruit juices chronic non

    specific diarrhea Excess juice intakemay replace the

    consumption of higher energy foodschilds appetite food intake & poor

    growth Children usually eat well in group setting

    ideal environment for nutrition educationprogram

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    May participate in the school lunch programor bring a lunch from home

    FEEDING SCHOOL-AGECHILDREN (6 - 12 yrs)

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    NUTRITIONAL CONCERNS

    Obesity Increased prevalence Not a benign condition

    The longer a child has been overweight

    themore likely the is to be overweight duringadolescent & adulthood

    Factors contributing :

    - food establishment

    - eating tied to leisure activities

    - larger portion size

    - inactivity

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    Underweight & Failure to Thrive

    Etiology :

    - chronic illness

    - restricted diet- poor appetite

    - feeding problems

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    Iron deficiency

    One of the most common nutrient disordersof childhood (9% of toddlers)

    Possible factors associated : dietary intake,parents educational level, access to medicalcare

    1-yr old child who consume large quantities

    of milk only

    milk anemia Do not like meat iron consumed in the

    nonheme form

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    Prevention :

    - consuming good dietary sources of iron

    - the amount of ascorbic acid and MFP to absorption

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    Dental Caries

    Drink sweetened liquids from a bottle atbedtime susceptible to early childhood

    caries (Baby bottle tooth decay) Snacks choose that are least cariogenic

    Chewing sugarless gum salivary pHbeneficial

    Toothbrush should be introduced

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    Allergies

    Usually develop during infancy &childhood and more likely when family

    history (+) Allergic responses most often include

    respiratory or GI symptom & skin reaction

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    Autism Spectrum Disorders

    Affect the childrens nutrient intake & eatingbehaviors

    Typically eat only specific foods

    restricted diet

    at risk for inadequate nutrient intake

    Usually refuse fruit & vegetables

    Commonly very resistant to taking supplement

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    Popular dietary intervention : gluten-free andcasein-free diet

    Nutrition assessment should include :

    - the possibility of medication and nutrientinteraction

    - use of alternative therapies, herbal and

    supplement

    Nutrition intervention may include abehavioral program types of foodaccepted

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    PREVENTING CHRONIC DISEASEDietary fat & cardiovascular health

    NCEP recommendation ( 2 yrs) :

    - no more than 30% of calories from fat( 10% SAFA, 10% PUFA, 10-15% MUFA)

    - no more than 300 mg/day of cholesterol

    > 2 yrs gradually adopt a lower fat diet4 yrs meet the NCEP guidelines

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    Calcium & bone health

    Osteoporosis prevention :

    - begins in childhood by maximizing

    calcium retention & bone density- most efficient during childhood &

    adolescent

    Education is needed to encourage youngpeople to consume an appropriate amount

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    Fiber

    Needed for health & normal laxation

    Education is needed to help increase fiber

    intake

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