Nutritional Requirements

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Life Cycle Nutrition: Childhood through
Adolescence

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Toddlers versus Preschoolers
 Toddlers
• 1–3 years old
• Growth rate is high, but slower than infancy
- Age 2: Gain 3–5 pounds, 3–5 inches
 Preschoolers
• 3–5 years old
• Need same nutrients as adults, but have
- Lower energy needs
- Smaller appetites
- Smaller stomachs

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Growth and Development
 Growth charts
• Used by pediatricians
- Monitor height and weight
- Compare to national standards for age and gender
- Place child in a percentile

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Eating Patterns and Nutrient Needs
 Young children need to eat frequent, small meals and
nutrient-dense foods
• Energy needs: 1,000–1,600 kcal per day
• Appropriate portion sizes
- Child-sized plates and cups
- “Mini”-sized food items, such as bagels
- Rule of thumb is to serve 1 tablespoon of food per
year of age at a meal

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Food Safety
 Avoid choking hazards
• Offer bite-sized pieces of food
• Limit availability of
- Hot dogs
- Nuts or seeds
- Chunks of meat, cheese, or peanut butter
- Whole grapes or raisins
- Hard candy or gum
- Popcorn
- Raw vegetables

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Nutrient Needs
 Carbohydrate
• At least half of grain intake should be from whole grains
• Fiber recommendations:
- Ages 1–3 years = 19 grams
- Ages 4–8 years = 25 grams

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Nutrient Needs
 Protein
• RDA (toddlers) = 1.1 grams per kilogram of body weight
• RDA (school-age) = 0.95 grams per kilogram of body
weight
 Fat
• Ages 2–3 years old = 30–35% of kilocalories from fat
• Age 4 and over = 25–35% of kilocalories from fat

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Nutrient Needs: Calcium and Iron
 Calcium
• Necessary for healthy bone development
• Ages 1–3 years need 500 milligrams per day
- 8 ounces of milk provides 300 milligrams
 Iron
• Necessary during periods of rapid growth
• Good sources of iron for children include lean meats,
beans, and iron-fortified cereals
• Cow’s milk is a poor source of iron

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Iron: Deficiency versus Toxicity
 Deficiency (Anemia)
• Most common nutrient deficiency in young children
• Can lead to developmental delays
• Exacerbates attention deficit hyperactivity disorder
• Associated with lead poisoning
 Toxicity
• Leading cause of death in children under age 6
• Occurs because iron can build up in tissues and organs
- Ingesting 200 milligrams of iron can be fatal

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Nutrient Needs
 Vitamin D
• American Academy of Pediatrics recommends
- Ages 1–8 years consume 10 micrograms (400 IU) of
vitamin D per day
- Sources include fortified milk, egg yolk, and some fish
- Two 8-oz glasses of milk only provides half of the
recommended intake
- Supplements or fortified cereals may be needed

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Nutrient Needs
 Young children need nutrient-dense beverages
• Fluid recommendations are based on body weight
- Drinking too much fluid may reduce fiber or iron
intake
• Preferred beverages include water and milk
• 100% fruit juice can be provided in moderation
• Soda and sugary drinks should be avoided

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Food Behaviors
 Eating habits form early in life
• Children will adapt to foods offered to them
 A variety of food should be offered to young children
• A child may need to be exposed to a new food at least 10
times before accepting it
 Division of responsibility
• Parents = What, when, and where food is offered
• Child = Whether or not to eat, and how much
 “Cleaning the plate” may encourage overeating

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Food Preferences
 Parents have strong influence over children’s food
preferences
• Children model after adult behaviors, both healthy and
unhealthy
• Including young children in food shopping, menu
planning, and meal preparation can encourage variety in
their food consumption

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Food Preferences
 Picky eating and “food jags” are common in young
children
• Picky eating – not wanting to try new food
• Food jags – tendency to eat only a small selection of
food
- Very common and normal, but also temporary
- Can be identified through a food diary
- Long-term jags increase risk of nutrient deficiency
- Solutions include
- Offering a variety of food items within the
preferred food type
- Gradually weaning the child from the food item

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Vegetarianism
 Young children can grow and develop normally on a well-
balanced vegetarian diet
• Vegetarian foods such as beans, nuts, seeds, and whole
grains are high in fiber
- Multiple servings per day may exceed a young child’s
fiber needs
• Good sources of calcium, iron, and zinc need to be
included in the diet
• Supplementation of vitamin B12 may be necessary

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Quick Review
 Toddlers grow at a slower rate than infants, and have
smaller appetites
 Frequent, small meals may be needed to provide adequate
kilocalories, macronutrients, calcium, iron, and vitamin D
 Appropriate beverages include water, milk, and 100% fruit
juice
 Small portion sizes should be encouraged, while “cleaning
the plate” should be discouraged
 A variety of foods should be offered, and parents should
serve as role models for healthy eating
 “Food jags” are normal and usually temporary

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School-Aged Children
 Ages 6–12 years
 Are not fully grown
• Each year, gain about 7 pounds and 2.5 inches
 Compared to toddlers and preschoolers they
• Do not eat as many times per day
• Tend to be less hungry (maintain blood glucose longer)
• Can eat more food at each sitting
 Can impact healthy development through dietary choices
 Continue to develop habits based on modeling adult
behaviors

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Child Obesity
 Body Mass Index (BMI) is the measurement tool used to
determine weight status
• For children, the categories are
- Overweight = BMI ≥ 95th percentile
- At risk for overweight = BMI ≥ 85th percentile

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Child Obesity
 What is considered child obesity?
• Condition of a child’s having too much body weight for
his or her height.
• The use of the word “obese” to describe children is
controversial
 What causes child obesity?
• Genetics: Only a small percent of cases
• Environment: Excess kilocalories, inadequate exercise
• Obese parents
• Prenatal overnutrition

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Child Obesity: Excess Kilocalories
 Sources include
• Regular soda, candy bars, potato chips
- Many of these products are sold within school
buildings through vending machines or the cafeteria
- Also available in most convenience stores and
shopping centers
- Typically replace healthy options such as milk, water,
or fresh fruits and vegetables
• Increased portion sizes at meals and snacks
- Occurs both within and outside of the home

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Child Obesity: Food Preferences
 High sugar and high-fat foods are often preferred by
school-aged children
• This could lead to an excess kilocalorie intake
 These preferences are formed by
• Overexposure to television advertisements featuring
appealing characters or famous spokespeople
• Modeling of parent or sibling eating behavior

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Debate: Does Sugar Cause ADHD?
 Attention deficit/hyperactivity disorder (ADHD) occurs
when children are inattentive, hyperactive, and impulsive
 No cause has been identified, but a high sugar intake has
been proposed to cause hyperactive behavior
• American Dietetic Association conclusion: Sugar intake
does not have an effect on behavior or learning
• American Academy of Pediatrics conclusion: No
evidence exists that ADHD is caused by eating too much
sugar
What do you think?

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Child Obesity: Inadequate Physical
Activity
 Low levels of exercise occur in school-aged children due to
• Increased “screen time” – exposure to a television,
computer, or video games
• Less access to physical education in schools
• Increased use of a car for transportation

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Child Obesity: Prevention
 American Academy of Pediatrics recommendations
• Parents must ensure their children receive adequate
nutrients without excess kilocalories
• A variety of healthy food must be offered to children
• “Screen time” must be limited to two hours or less per
day

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Child Obesity: Treatment
 Weight loss is not recommended for overweight children
 Weight maintenance allows for healthy growth
 Increased physical activity is encouraged

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Obesity-Diabetes Relationship
 Type 2 diabetes – a disease typically diagnosed in adults
• Very likely to occur in obese children
 Prevention tips
• Identify high-risk individuals based on family history
• Reduce risk factors such as being overweight or
sedentary
 Treatment tips
• Educate all members of the family about diabetes
• Provide support by eating the same foods as the child
• Encourage physical activity

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School-Aged Children and Dental Hygiene
 42% of children and adolescents (6–19 years) have at least
one cavity or filling. Source: CDC, 2005
 School-aged children are susceptible to dental caries, but
sometimes do not practice good oral hygiene
 American Dental Association recommends
• Regular brushing and flossing
• Consuming a balanced diet in accordance with the
Dietary Guidelines for Americans
• Limiting consumption of high-sugar foods such as soda,
fruit juice, or milk

29. Figure 18.3
MyPyramid for Kids
 A visual tool for children and parents to understand healthy
eating

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MyPyramid for Kids
 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 food group every day
• Make the right choices for you
• Take it one step at a time

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National School Lunch Program (NSLP)
 Serves nutritious, low-cost or free lunches to 30.5 million
school-aged children each day
 NSLP nutrient guidelines have specific recommendations
establishing
• Minimum intakes
• Maximum intakes

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The Role of Breakfast
 Eating breakfast may be associated with healthy body
weight among children and adolescents
 Many schools with the National School Lunch Program
also offer a school breakfast
 Eating breakfast may benefit
• Cognitive function, including memory
• Academic performance
• School attendance
• Psychosocial function
• Mood

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Quick Review
 Rates of overweight and obesity are increasing among
school-aged children
 Risk of type 2 diabetes increases in obese individuals
 Limiting excess kilocalorie intake from high-sugar or high-
fat foods can help prevent obesity
 Engaging in physical activity and reducing “screen time” is
necessary to maintain a healthy body weight
 MyPyramid for Kids provides information about healthy
eating patterns
 Schools may provide nutritious breakfast and lunch meals
 Parents must continue to serve as role models for healthy
behavior

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Adolescence
 Developmental period between childhood and adulthood
• Ages 9–19 years
• Physical changes occur, including a growth spurt
- Height increases
- Weight increases due to bone growth and gains in lean
body mass and body fat stores
• Hormonal changes occur including the onset of
menstruation for females
• A healthy diet is necessary at this time to ensure
adequate nutrients, especially kilocalories, protein,
calcium, and iron

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Nutrition-Related Behaviors
 Desire for independence and individuality
• Making own food choices
• Having own transportation to access food
 Influence of peers, media, and nonparent role models
• Exposure to unrealistic or unsafe eating practices
• May lead to adoption of damaging habits

36. © 2010 Pearson Education, Inc. Figure 18.4
Nutrient Needs: Calcium
 ½ of peak bone mass
accumulates in adolescence
 AI for calcium = 1,300 mg
for ages 9–18 years
• Inadequate calcium
intake can lead to low
peak bone mass and is a
risk factor for
osteoporosis

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Nutrient Needs: Iron
 Additional iron supports muscle growth and increased
blood volume
• Adolescent females need iron to support menstruation
 RDA for iron
• Females aged 14–18 years = 15 milligrams
• Males aged 14–18 years = 11 milligrams
 Iron deficiency is common in adolescence, especially
among individuals who limit intake of enriched grains, lean
meats, and legumes

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Disordered Eating
 Disordered eating patterns are more prevalent in adolescent
females than males
• May be linked with poor body image or low self-esteem
 Teens often adopt unhealthy habits such as
• Skipping meals
• Using food substitutes
• Taking diet pills or nutritional supplements
• Purging through vomiting, laxatives, or diuretics
 Eating family meals promotes healthy eating patterns