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XNB151 Week 11 Child & adolescent nutrition


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XNB151 Week 11 Child & adolescent nutrition

  2. 2. GROWTH IN CHILDHOOD Weight & height Organ & tissue growth Body composition
  4. 4. ENERGY & NUTRIENTREQUIREMENTS FOR GROWTH Adequate food supply essential for normal growth inheight & weight Estimating energy & nutrient requirements based on What healthy infants eat or on, Base requirements on the amount of nutrientsaccumulated in the body during growth RDIs usually based on both
  5. 5. ENERGY & NUTRIENTREQUIREMENTS FOR GROWTH Energy requirement is generally based on size Energy requirement ↓ dramatically after the 1st year Energy intake of children of similar age & size differsbecause of activity levels Nutrient requirements may be better expressed withreference to the child‟s height (i.e. per cm) rather thanage
  6. 6. FAT NEEDS OF CHILDREN Relatively high fat intakes are recommended until growth iscomplete Essential fatty acids, cholesterol & fat soluble vitamins areneeded in relatively higher amounts than for adults for e.g.CNS development Low fat intakes are related to growth failure& chronic diarrhoea
  7. 7. RECOMMENDED FAT INTAKES FORCHILDREN 0-2 years old: 50-55 % of energy from fat in breastmilk• 40 % of energy from fat after introduction of solids• NO skim or reduced fat milk 2-5 years old: 35-40 % of energy from fat• reduced fat milk if warranted 5-13 years old: 35 % of energy from fat 14 years & over: 20-35 % of energy from fat= adult recommendation
  8. 8. INTRODUCTION TO FOODSWhen, Why? At about 6 months of age (NHMRC Infant feedingguidelines, WHO recommendations) To meet developmentally appropriate nutrient needs sitting upright, mouth control iron stores depleting
  9. 9. INTRODUCTION TO FOODS ~ 6 MONTHS 4-5 breast milk or formula feeds first solid food iron fortified infant rice cereal mixed with breast milk orformula start at one feed/day gradual introduction – one food at atime – pureed vegetables, fruits, meats strained/finely sieved  mashed no added salt, sugar, oil, butter,margarine
  10. 10. INTRODUCTION TO FOODS ~ 9 MONTHS 3 feeds holds objects with index finger & thumb can chew lumps, teething solids before milk boiled cow‟s milk (small amounts) roughly mashed no sausages, peanuts, raw carrots, hard nuts orsweets, whole peas, salt, sugar, honey small amount of butter or margarine on bread
  11. 11. INTRODUCTION TO FOODS ~ 12 MONTHS Foods like the rest of the family 600-700 mL breast milk/formula snacks are important sugar, salt, honey, butter/margarineused sparingly small amounts of cow‟s milk finger food encouraged highly textured food avoid foods likely to cause choking (e.g. nuts)Credit: CC STUDIO/SCIENCEPHOTO LIBRARY
  12. 12. INTRODUCTION TO FOODS – GOLDEN RULES Kids will learn the eating habits of their parents Hygiene in the kitchen is vital It takes 8 - 10 exposures to a food before it becomes aroutinely accepted food No healthy child ever starved through food refusal When children are hungry enough they will eat
  13. 13. NUTRITION RELATED CONCERNS DURINGINFANCY - GROWTH PATTERNS/FAILURE TOTHRIVEPattern of growth usually monitored over time usinggrowth charts to compare infants failing to thrive usually cross growth centiles
  14. 14. NUTRITION RELATED CONCERNS DURINGINFANCY - OTHER iron deficiency can lead to irreversible, long term neurocognitiveabnormalities & increased risk of infections symptoms of colic, reflux, vomiting & diarrhoea allergies or intolerances restricted diets – vegetarian, vegan, low fat
  15. 15. AGES & STAGES – 1-3 YEARS Eats family diet 600 mL milk Full cream cow‟s milk Encourage breads, cereals, fruits, vegetables Encourage water; discourage too much juice Firm likes & dislikes develop Fussy eating / food fads may begin
  16. 16. AGES & STAGES – 1-3 YEARSBF FruitCerealToastMT FruitPlain biscuitMilkL SandwichMilkAT Slice breadDiluted juiceD Small serve meatPotato & other vegFruit & custard
  17. 17. AGES & STAGES – 3-5 YEARS Language well developed Independent Ready to learn table manners Encourage participation in food preparation Full cream milk can still be given Encourage water Discourage salt, sugar, fat & junk foods Can still be fussy Don‟t force foods
  18. 18. AGES & STAGES – 5-12 YEARS Learning to take control of eating Learning food preparation Taking part in the social occasion of eating Becoming responsible for planning & preparationof foods Being responsible for own social role
  19. 19. NUTRITION RELATED CONCERNS DURINGCHILDHOOD Food refusal Anaemia Dental caries Obesity
  20. 20. FOOD REFUSAL – TODDLERS Most toddler feeding problems start with the parents Food needs are related to growth needs If food is rejected – CALMLY clear the food away a child will eat when hungry no healthy child has starved to death through foodrefusal Bribing can lead to food rejection Children learn to manipulate parents through foodrefusal – it‟s a form of entertainment Fun not Fuss with Food – program of Qld Health
  21. 21. FOOD FADS/UNUSUAL EATING PATTERNS Toddlers can develop strong likes & dislikes If they change frequently the diet is actually quite varied Find acceptable substitutes: milk (milkshakes, yogurt, cheese, custard, ice-cream,puddings) vegetables (mixed, salads, finger foods) meat (baked beans, fortified cereals, eggs, dairy foods) fruit (fresh chopped, canned, frozen) it pays to be cunning (hide milk, cottage cheese & egg inother foods)
  22. 22. SOME GOLDEN RULES Kids will learn the eating habits ofof their parents Hygiene in the kitchen is vital It takes 8 - 10 exposures to a food before itbecomes a routinely accepted food No healthy child ever starved through food refusal,it is usually self limiting – when children are hungryenough they will eat
  23. 23. INTERVENTION GOALS FOR FEEDINGDIFFICULTIES Eating should be pleasurable Provide a conducive environment Provide suitable seating arrangements Provide suitable utensils (if appropriate) Assist development of skills Provide support
  24. 24. ANAEMIA Most common nutritional deficiency of early childhood May cause irreversible physical & mental retardation & ↓resistance to infections Most likely in Australia due to: excess milk without good sources of iron repeated gastroenteritis vegetarian diets – high in bulk, low absorbable iron Importance of appropriate introduction of solids
  25. 25. DENTAL CARIES Serious problem in Australia Queensland children have the highest rates ofdental caries in Australia (AIHW, 2006) Related to fluoride, saliva, plaque, bacteria, diet(sugars, frequency, retention on teeth) Bottle caries
  26. 26. SUGAR & TOOTH DECAYIncreased by: eating frequently sticky foods fermentable CHOs dehydration bottle to sleepDecreased by: water rinsing eating cheese,milk, nuts chewing gum using straw
  27. 27. OBESITY Increasing prevalence “eye balling” +++ complex factors contributingbut basic energy balance applies For weight management: not severe energy restricteddiets avoid high energy low nutrientfoods & drinks; encourageactivity ensure adequate intake forgrowth & nutrient needs
  28. 28. COMPLICATIONS OF CHILDHOOD OBESITY34Ebbeling, Pawlak, Ludwig (2002) Childhood obesity: public-health crisis,common sense cure Lancet, p 475
  29. 29. School-basedinterventionIndividualinterventionGroup-based interventionPopulationinterventionINTERVENTIONS TO ADDRESS OBESITY
  30. 30. NUTRITION ANDADOLESCENCE Adolescent eating patterns Dieting
  31. 31. ADOLESCENCEA TIME OF CHANGE!Breaking away from family influencesMaking own decisions in relation to newinfluencesMediaSocial expectationsGender rolesAcceptance & nurturingof the new „self‟ –self images
  32. 32. EATING PATTERNS The need for $ & opportunityto socialise via food Grazing instead of meals;take-away; social eating &drinking Physiological changes –growth requirements ofhigher energy intakes Learning to take controlCredit: DR M.A. ANSARY/SCIENCE PHOTOLIBRARY
  33. 33. ALCOHOL39•By 14 y, around 90 per cent of Australian high school students had tried alcohol•By the age of 17, around 70 per cent of students had consumed alcohol in themonth before the survey (White & Hayman 2004 in NHMRC Guidelines 2009)NHMRC 2009 Australian guidelines toreduce health risks from drinkingalcoholChikritzhs et al (2000) in NHMRC Guidelines 2009)
  34. 34. DIETING Causes of obesity in adolescence aremultifactorial – social, psychological,physiological Particularly distressing at this age Fear of overweight can be strong Extreme or fad diets or behaviours –can have long term undesirable effects Cultural representations of thinness asideal No evidence of causing eating disorders There are specific diagnostic criteriarelating to diagnosis of eating disorders 40Blonde Bather, 1881,Pierre August Renoir