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  • 1. CHAPTER 12Nutrition for Normal Growth and Development Sharon M. Nickols-Richardson Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 2. Individual Needs of Children Growth may be defined as an increase in body size Biologic growth of an organism occurs through cell multiplication (hyperplasia) and cell enlargement (hypertrophy) Development is the associated process by which growing tissues and organs take on a more complex function Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 2
  • 3. Normal Life Cycle Growth Pattern Normal human life cycle includes the following four general stages:  Infancy • Growth velocity is rapid during the first year of life • At 6 months weight has doubled; at 1 year weight has tripled  Childhood • The growth rate slows and becomes erratic Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 3
  • 4. Normal Life Cycle Growth Pattern – Cont’d Adolescence • With the beginning of puberty, the second period of growth acceleration occurs Adulthood • Final stage of a normal life cycle; growth levels off on the adult plateau Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 4
  • 5. Measuring Childhood Physical GrowthGrowth Charts Children grow at widely varying individual rates A child’s pattern of growth is compared with percentile growth curves derived from measurements of large numbers of children throughout the growth years Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 5
  • 6. Measuring Childhood Physical Growth – Cont’dGrowth Charts – cont’d Two age intervals are presented, with separate curves for boys and girls:  Birth to 3 years  2 to 20 years Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 6
  • 7. Measuring Childhood Physical Growth – Cont’dAnthropometry Monitors a child’s growth, with growth charts and other clinical standards as points of reference A number of methods and measures may be used Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 7
  • 8. Measuring Childhood Physical Growth – Cont’dAnthropometry – cont’d Body weight and height  Common general measures of physical growth  Provide a basic measure of change in body size but give only a crude index of growth without the finer details of individual variations in body fat or muscle or bone Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 8
  • 9. Measuring Childhood Physical Growth – Cont’dAnthropometry – cont’d Body circumferences and skinfolds  Head circumference is a valuable measure in infants  Skinfold measures are performed with special calipers and require skill and practice for accuracy Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 9
  • 10. Measuring Childhood Physical Growth – Cont’dClinical Signs Various clinical signs of optimal growth can be observed as indicators of a child’s nutritional statusLaboratory Tests Include studies of blood and urine to determine levels of hemoglobin, vitamins, and similar substances Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 10
  • 11. Measuring Childhood Physical Growth – Cont’dNutritional Analysis Provides helpful information for assessing the adequacy of the diet for meeting growth needs Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 11
  • 12. Motor, Mental, and Psychosocial DevelopmentMotor Growth and Development Gross motor skills develop within the first 18 months of life Fine motor skills gradually develop over a longer period of time Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 12
  • 13. Motor, Mental, and Psychosocial Development – Cont’dMental Growth and Development Measures of mental growth involve the following:  Abilities in speech and other forms of communication  Ability to handle abstract and symbolic material in thinking Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 13
  • 14. Motor, Mental, and Psychosocial Development – Cont’dEmotional Growth and Development Measured in the capacity for love and affection, as well as the ability to handle frustration and anxieties Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 14
  • 15. Motor, Mental, and Psychosocial Development – Cont’dSocial and Cultural Growth and Development Measured as the ability to relate to others and to participate in group living and cultural activities Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 15
  • 16. Nutritional Requirements for GrowthEnergy Needs Intake of a 5-year-old child is spent Total daily energy as follows:  Approximately 50% supplies basal metabolic requirements (BMR)  Approximately 5% is used in the thermic effect of food (TEF) Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 16
  • 17. Nutritional Requirements for Growth – Cont’dEnergy Needs – cont’d Total daily energy intake of a 5-year-old child is spent as follows: – cont’d  Approximately 25% goes toward daily physical activity  Approximately 12% is needed for tissue growth  Approximately 8% is lost in the feces Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 17
  • 18. Nutritional Requirements for Growth – Cont’dProtein Needs First 6 months of life an infant requires 1.52 g of protein per kilogram per day This amount gradually decreases throughout childhood until adulthood Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 18
  • 19. Nutritional Requirements for Growth – Cont’dEssential Fatty Acid Needs Linoleic acid is required for the synthesis of brain and nerve tissue and normal mental developmentCarbohydrate Needs Carbohydrates are primary energy source and are important in sparing protein for its vital role in tissue formation Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 19
  • 20. Nutritional Requirements for Growth – Cont’dFiber Important to satiety and bowel regulation and affects blood lipid and glucose concentrations Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 20
  • 21. Nutritional Requirements for Growth – Cont’dWater Requirements Infant’s body content of water is approximately 70% to 75% of total body weight A child’s water need is related to energy intake and urine concentration An infant generally drinks a daily amount of water equivalent to 10% to 15% of body weight Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 21
  • 22. Nutritional Requirements for Growth – Cont’dMineral and Vitamin Needs Minerals and vitamins play essential roles in tissue growth and maintenance and in overall energy metabolism Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 22
  • 23. Nutritional Requirements for Growth – Cont’dMineral and Vitamin Needs – cont’d Calcium is needed for tooth development, muscle contraction, nerve excitation, blood coagulation, and heart muscle action Iron is essential for hemoglobin formation and mental and psychomotor development Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 23
  • 24. Stages of Growth and DevelopmentPsychosocial Development The developmental problem at each stage has a positive ego value and a conflicting negative counterpart, as follows:  Infancy: trust versus distrust  Toddler: autonomy versus shame and doubt  Preschooler: initiative versus guilt  School-age child: industry versus inferiority Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 24
  • 25. Stages of Growth and Development – Cont’dPsychosocial Development – cont’d The developmental problem at each stage has a positive ego value and a conflicting negative counterpart, as follows: – cont’d  Adolescent: identity versus role confusion  Young adult: intimacy versus isolation  Adult: generativity versus stagnation  Older adult: ego integrity versus despair Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 25
  • 26. Infant (Birth to 1 Year)Nutrition for the Full-Term Infant Breast milk or infant formula generally provides all the nutrients required by a healthy infant for the first 6 months of life Exclusive breast-feeding can be adequate for the first 12 months of life Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 26
  • 27. Infant (Birth to 1 Year) – Cont’dNutrition for the Full-Term Infant – cont’d Nearly all infants born in a hospital receive an injection of vitamin K shortly after birth By the age of 6 months, semisolid foods such as iron-fortified cereals may be added to the diet to help meet increasing nutritional needs Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 27
  • 28. Infant (Birth to 1 Year) – Cont’dPsychosocial and Motor Development Core psychosocial developmental task during infancy is the establishment of trust in others Feeding is the infant’s primary means of establishing human relationships Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 28
  • 29. Infant (Birth to 1 Year) – Cont’dBreast-Feeding Ideal food for the human infant is human milk Experienced nutritionists and nurses, many of whom are certified professional lactation consultants, advise flexibility rather than a rigid approach to breast-feeding Toward the end of the prenatal period, the breasts secrete a thin, yellowish fluid called colostrum Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 29
  • 30. Infant (Birth to 1 Year) – Cont’dBreast-Feeding – cont’d Typically by the end of the second week, mature milk is produced Breast milk is produced under the stimulating influence of the hormone prolactin Another pituitary hormone, oxytocin, stimulates the ejection of the milk (let-down reflex) Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 30
  • 31. Infant (Birth to 1 Year) – Cont’dBreast-Feeding – cont’d The mother should follow the baby’s lead with an on-demand schedule Feedings are usually about every 2 to 3 hours in the first few weeks after birth A breast-feeding mother needs to be aware that her infant will likely gain weight more slowly than bottle-fed infants, but this should not be a concern Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 31
  • 32. Infant (Birth to 1 Year) – Cont’dBottle-Feeding A variety of commercial formulas that attempt to approximate the composition of human milk are available Special formulas have been developed for infants with allergies, lactose intolerance, diarrhea, fat malabsorption, or other problems Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 32
  • 33. Infant (Birth to 1 Year) – Cont’dBottle-Feeding – cont’d For hypoallergenic formulas, all proteins are completely hydrolyzed to free amino acids Use of soy protein–based formulas has been growing among parents who wish to feed their infants vegetarian diets Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 33
  • 34. Infant (Birth to 1 Year) – Cont’dBottle-Feeding – cont’d Any remaining formula should be thrown away and not refrigerated for reuse Most infants are fed on demand versus scheduled, which works out to be about every 2 to 3 hours Only infant formula and water are appropriate for bottle-feeding; other fluids should not be used Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 34
  • 35. Infant (Birth to 1 Year) – Cont’dBreast-Feeding and Formula-Feeding Combination Some women may desire the flexibility of both breast-feeding and formula-feeding their infants Regular unmodified cow’s milk is not suitable for infants for several reasons:  It causes gastrointestinal bleeding  Its renal solute load is too concentrated for the infant’s renal system to handle Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 35
  • 36. Infant (Birth to 1 Year) – Cont’dBreast-Feeding and Formula-Feeding Combination – cont’d Regular unmodified cow’s milk is not suitable for infants for several reasons: – cont’d  Early exposure to cow’s milk increases the risk of developing allergies to milk proteins  It adversely affects nutritional status Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 36
  • 37. Infant (Birth to 1 Year) – Cont’dPremature and Small-for-Gestational-Age Infants These infants should be fed breast milk, usually fortified with additional protein, vitamins, and minerals Formulas developed for the premature infant may have as much as 30% more protein per fluid volume, as well as higher amounts of calcium, zinc, and the B-complex vitamins Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 37
  • 38. Infant (Birth to 1 Year) – Cont’dPremature and Small-for-Gestational- Age Infants – cont’d Nutrition support of the high-risk infant requires a team approach:  Pediatrician  Nurse  Dietitian  Lactation consultant Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 38
  • 39. Infant (Birth to 1 Year) – Cont’dBeikost: Solid Food Additions Beikost feeding begins the transition from a predominantly liquid diet to a predominantly solid food diet Solid foods should be introduced to an infant no earlier than 4 to 6 months of age Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 39
  • 40. Infant (Birth to 1 Year) – Cont’dBeikost: Solid Food Additions – cont’d Developmental abilities to use the hands and fingers are required before self-feeding can be initiated Smaller amounts of food, eaten on a more frequent basis, may contribute to the pattern of eating in moderation Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 40
  • 41. Infant (Birth to 1 Year) – Cont’dBeikost: Solid Food Additions – cont’d Vegetables, fruits, potato, egg yolk, and finally meat can be added to the diet in a gradual sequence Two foods require special attention in infant feeding:  1. Honey  2. Fruit juices Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 41
  • 42. Infant (Birth to 1 Year) – Cont’dBeikost: Solid Food Additions – cont’d The following two basic principles should guide the feeding process:  1. Nutrients are needed, not specific foods  2. Food is a main basis of early learning Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 42
  • 43. Toddler (1 to 3 Years)Physical Characteristics and Growth The growth rate of children slows after the first year Legs become longer, and the child begins losing “baby fat” Energy demands are lower because of the decelerated growth rate The child has six to eight teeth at the beginning of the toddler period Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 43
  • 44. Toddler (1 to 3 Years) – Cont’dPsychosocial and Motor Development As physical mobility increases with increased gross and fine motor skill development, the sense of autonomy and independence grows Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 44
  • 45. Toddler (1 to 3 Years) – Cont’dFood and FeedingEnergy Rises to a range of 1160 to 1680 kcal/day for boys and 1080 to 1650 kcal/day for girls by age 3 From age 1 to 2, some children do not eat as much as they did in the second half of infancy Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 45
  • 46. Toddler (1 to 3 Years) – Cont’dFood and Feeding – cont’dProtein The toddler requires about 13 g of protein per day At least half of this protein should be of animal origin Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 46
  • 47. Toddler (1 to 3 Years) – Cont’dFood and Feeding – cont’dMinerals Calcium and phosphorus are needed for bone mineralization Adequate levels of zinc are necessary to support protein synthesis and cell division Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 47
  • 48. Toddler (1 to 3 Years) – Cont’dFood and Feeding – cont’dVitamins Fat-soluble and water-soluble vitamins are critical to macronutrient utilization and growth and development Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 48
  • 49. Toddler (1 to 3 Years) – Cont’dFood and Feeding – cont’dFiber 19 g/day is recommended for children age 1 to 3 yearsFood Choices About 2 to 3 cups of milk daily is sufficient for the young child’s needs Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 49
  • 50. Preschooler (3 to 6 Years)Physical Characteristics and Growth Each child tends to settle into a regular genetic growth channel as physical growth continues in spurts Mental capacities are developing Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 50
  • 51. Preschooler (3 to 6 Years) – Cont’dPhysical Characteristics and Growth – cont’d 13 to 19 g/day of good-quality protein is needed Calcium and iron are needed to support growth and to build body stores A variety of fruits and vegetables should be provided Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 51
  • 52. Preschooler (3 to 6 Years) – Cont’dPsychosocial and Motor Development Children are beginning to develop their superego—the conscience This is a period of increasing imitation Self-feeding skills increase, and eating takes on greater social aspects Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 52
  • 53. Preschooler (3 to 6 Years) – Cont’dFood and FeedingFruits and Vegetables Fruits are usually well liked Vegetables usually are the least well liked by children Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 53
  • 54. Preschooler (3 to 6 Years) – Cont’dFood and Feeding – cont’dMilk, Cheese, Egg, Meat, and Legumes It is helpful if children can set their own goals of quantities of food; portions need to be relatively smallGrains Whole grains provide important fiber Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 54
  • 55. The School-Age Child (6 to 12 Years)Physical Characteristics and Growth During this stage, the rate of growth slows and body changes occur very gradually By now the body type has been established, and growth rates vary widely Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 55
  • 56. The School-Age Child (6 to 12 Years) – Cont’dPsychosocial and Motor Development Children have increased cognitive capacity and the ability to problem solve They cooperate in group activities and begin to experience a sense of adequacy and accomplishment and sometimes the realities of competition Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 56
  • 57. The School-Age Child (6 to 12 Years) – Cont’dFood and Feeding The slowed rate of growth during this period results in a gradual decline in the food requirement per unit of body weight Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 57
  • 58. The School-Age Child (6 to 12 Years) – Cont’dSchool and the Learning Environment Breakfast is particularly important for the school- age child Schools should also take a premier role in promoting lifelong physical activity patterns in children Sound nutrition is especially critical for the child athlete Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 58
  • 59. The AdolescentPhysical Characteristics and Growth Final growth spurt of childhood Adolescent growth accounts for wide fluctuations in physical size, metabolic rate, food needs, and even illness Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 59
  • 60. The Adolescent – Cont’dPsychosocial and Motor Development Adolescence is an ambivalent period marked by stresses and strains Emergence of a self-identity is the major psychosocial developmental task of the adolescent years Pressure for peer group acceptance is strong Social tensions and family conflicts are often created Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 60
  • 61. The Adolescent – Cont’dFood and FeedingEnergy The kilocalorie (kcalorie or kcal) needs increase with the metabolic demands of growth and energy expenditure Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 61
  • 62. The Adolescent – Cont’dFood and Feeding – cont’dProtein Girls require 46 g/day and boys require 52 g/day to sustain daily needs and to maintain nitrogen reserves Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 62
  • 63. The Adolescent – Cont’dFood and Feeding – cont’dMinerals Calcium requirement for all adolescents rises to 1300 mg/day Fluid replacement in any exercise or performance period is essential Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 63
  • 64. The Adolescent – Cont’dEating Habits Physical and psychosocial pressures influence adolescent eating behavior Two factors combine to increase issues surrounding nutrition and food intake in adolescent girls:  1. Physiologic sex difference  2. Social and personal tensions Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 64
  • 65. Health PromotionChildren and Adolescents: Seeking Fitness The Dietary Guidelines for Americans 2005 provides direction for the development of a healthy diet and lifestyle for all persons age 2 years and older Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 65
  • 66. Health Promotion – Cont’dWeight Management Body weight and physical activity are intrinsically related Body fat increases rapidly during the first year of life and then slows until about age 6 Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 66
  • 67. Health Promotion – Cont’dPhysical Activity Television, computer games, the Internet, and similar sedentary pastimes are growing in popularity The goal is to have children and adolescents engage in a minimum of 1 hour of exercise every day Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 67
  • 68. Health Promotion – Cont’dHelping Children Develop an Active Lifestyle Parents and caregivers, schools, and communities need to work together to increase physical activity among children Parents and role models should also demonstrate such behavior Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 68