Chapter 11: Nutrition through the Life Span: Infancy, Childhood, and Adolescence

Nutrition
through the Life
Span: Infancy,
Childhood, and
Adolescence
1111
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© Cengage Learning 2017
Nutrition of the Infant
• Nutrient needs during infancy
– Growth directly reflects nutritional well-being
– Nutrients to support growth
• Birthweight doubles by 5 months, triples by 1 year
• High basal metabolic rate
• Nutrients particularly important for infants:
– Energy nutrients
– Vitamins and minerals critical to growth (e.g., vitamins A
and D, calcium)

Weight Gain of Human Infants in Their
First Five Years of Life

Nutrition of the Infant:
Nutrient Needs during Infancy (cont’d.)
• Nutrient needs to support growth
– As a percentage of body weight, infants need
more than twice as much of most nutrients as
an adult (Figure 11-2)
– Infants spontaneously reduce energy intakes
when growth slows
• Water
– What conditions may require an electrolyte
solution for infants?

Nutrition of the Infant (cont’d.)
• Breast milk
– Complete nutrient source for first 6 months
– Frequency and duration of breastfeeding
• More easily digested than formula
• Approximately 8 to 12 feedings per day, on
demand
– Energy nutrients
• Carbohydrate is lactose, which enhances calcium
absorption
• What is the benefit of oligosaccharides in breast
milk?

Percentages of Energy-Yielding Nutrients
in Breast Milk/Recommended Adult Diets

Nutrition of the Infant: Breast Milk
(cont’d.)
• Energy nutrients
– Protein: alpha-lactalbumin
– Lipids:
• Main source of energy in infant’s diet
• Linoleic, linolenic, arachidonic, and
docosahexaenoic acids
• DHA in visual and mental development

(cont’d.)
• Vitamins and minerals
– Generous amounts of vitamin C
– What factors contribute to the likelihood of
vitamin D deficiency in infants?
– Ideal calcium content
– Iron and zinc in absorbable forms
• Supplements for infants
– After 6 months: vitamin D, iron, and fluoride
– At birth: single dose of vitamin K

(cont’d.)
• Immunological protection
– Colostrum and breast milk provide maternal
antibodies and other agents (Table 11-3)
– Protection against infections and allergies
• Other potential benefits
– What are some other benefits of
breastfeeding?

• Infant formula
– Infant formula composition
• Iron-fortified formula recommended by AAP
– Infant formula standards (U.S.)
• Based on AAP recommendations
• FDA mandates quality control procedures
– Special formulas
• Soy protein
• Hydrolyzed protein

Percentages of Energy-Yielding Nutrients in
Breast Milk, Infant Formula, and Cow’s Milk

• Infant formula
– Risks of formula feeding
• What risks are associated with formula feeding?
– Nursing bottle tooth decay
• Child should not be put to bed with a bottle
• The transition to cow’s milk
– Reduced-/low-fat milk when ≥12 months old,
obtaining 2/3 of energy from solid foods

• Introducing first foods
– When to introduce solid food
• Purpose: to provide nutrients no longer supplied
adequately by breast milk/formula
• Factors governing addition of foods:
– Infant’s nutrient needs
– Infant’s physical readiness
– Need to detect and control allergic reactions

Introducing First Foods (cont’d.)
• Foods to provide iron, zinc, and vitamin C
– Iron: fortified cereals, meats, legumes
– Zinc: protein foods (especially animal-derived)
– Vitamin C: fruits, vegetables
• Physical readiness for solid foods
– Swallowing solids, sitting up, handling foods
• Allergy-causing foods
– How should new foods be introduced?

Introducing First Foods (cont’d.)
• Choice of infant foods
– Provide variety, balance, and moderation
• Foods to omit
– Sweets, canned vegetables, honey, and corn
syrup
– Foods that might cause choking
• Foods at one year
– What should a 1-year-old child eat and drink?

• Looking ahead
– Encourage healthy eating habits in first year
– Introduce a variety of nutritious foods
– Do not force child to finish the bottle or baby
food
– Avoid empty-kcalorie foods
– Do not use food as a reward or punishment

• Mealtimes
– Discourage unacceptable behavior at meals
– Allow exploration and enjoyment of food
– Don’t force food on children
– Offer nutritious foods and allow children to
choose which and how much to eat
– Limit sweets
– Make mealtimes pleasant occasions

Nutrition during Childhood
• Growth slows at 1 year of age
• Energy and nutrient needs
– Appetite diminishes at age 1, then fluctuates
– Energy intake controlled by internal appetite
regulation in normal-weight children
– Children’s appetites
• Intake varies from meal to meal
• Total daily energy intake remarkably constant in
normal-weight children

Body Shape of a One-Year-Old and a
Two-Year-Old Compared

Nutrition during Childhood:
Energy and Nutrient Needs (cont’d.)
• Energy
– Needs vary widely, depending on growth and
physical activity
– Approximate energy needs
• 1-year-old: 800 kcal/day
• 6-year-old (active): 1600 kcal/day
• 10-year-old (active): 2000 kcal/day

• Carbohydrate and fiber
– Carbohydrate: same as for adults after 1 year
– Fiber: proportional to energy intake
• Fat and fatty acids
– 1 to 3 years old: 30% to 40% of energy
– 4 to 18 years old: 25% to 35% of energy
• Protein
– Needs increase slightly with age

• Vitamins and minerals
– Needs increase with age
– Typically met through balanced nutrition
– Iron
• Iron-deficiency anemia a worldwide problem
• Foods should provide 7 to 10 mg iron/day
• What iron-rich foods do children like? (Table 11-7)
– Vitamin D
• Fortified milk or cereals, supplements

• Supplements
– Specific recommendations for fluoride, iron,
and vitamin D during infancy/childhood
– Others not needed with balanced nutrition
• Food patterns for children
– Variety of foods from each food group
– Amounts to suit appetite and energy needs

MyPlate Resources for Children

• Food patterns for children
– What concerns about children’s diets are
raised by survey results?
• Children’s food choices
– Provide nutritious and appealing foods
– Limit concentrated sweets
– Help overweight children achieve energy
balance

Nutrition during Childhood (cont’d.)
• Hunger and malnutrition in children
– Hunger and behavior
• Short-term hunger impairs the child’s ability to pay
attention and to be productive
• Long-term hunger Impairs growth and immune
defenses
– Iron deficiency and behavior
• Affects behavior and intellectual performance

• Hunger and malnutrition in children
– Other nutrient deficiencies
• Can cause irritability, aggression, sadness,
withdrawal
• Child’s diet should be assessed when children
exhibit abnormal appearance or behavior

• Lead poisoning in children
– Why are malnourished children more
vulnerable?
– Impairment of balance, motor development,
and nerve message relay to and from the
brain
– Box 11-4 offers suggestions for avoiding lead
toxicity

• Food allergy
– Allergies typically diminish with age
– Rising peanut allergy prevalence
– Food protein or other large molecule
absorbed into the blood and elicits an
immunologic response
– Detecting allergy: requires medical testing
and food challenges

Food Allergy (cont’d.)
• Immediate or delayed reactions
• Anaphylactic shock
– Life-threatening whole-body allergic reaction
– Prevention after exposure: epinephrine
• Food labeling
– Must identify any common allergens present
in plain language

Food Allergy (cont’d.)
• Other adverse reactions to foods
– How do food intolerances differ from food
allergies?
• Food dislikes
– Aversions may indicate adverse reactions

• Hyperactivity
– Affects behavior and learning
– No convincing evidence that sugar causes or
worsens hyperactivity
– Some food additives, e.g., food colorings,
may aggravate hyperactivity
– Box 11-5: disruptive behavior case study

• Childhood obesity
– How are overweight and obesity defined in
children and adolescents?
– Genetic and environmental factors
• Parental obesity
• Diet (excessive solid fats and added sugars)
• Physical inactivity (screen time)

Childhood Obesity (cont’d.)
• Growth: characteristic physical traits
– Early puberty
– “Stocky” appearance, even following weight
loss
• Physical health
– High blood lipids
– High blood pressure
– Increased risks of type 2 diabetes and
respiratory diseases

• Psychological development
– Emotional and social problems:
discrimination, poor self-image, negative
stereotypes, etc.
• Prevention and treatment of obesity
– Prevention begins at birth
– Treatment
• Main goal: improve long-term physical health
through permanent healthy lifestyle habits

• Prevention and treatment of obesity
– Treatment integrates diet, physical activity,
psychological support, and behavioral
changes
• Diet
– Initial goal: maintain weight during growth so
BMI falls as height increases
– Weight loss requires individualized approach

• Physical activity: Table 11-12
• Behavioral changes
– Parent/caregiver involvement improves
success
• Drugs: orlistat
• Surgery
– Table 11-13: selection criteria for surgery
candidates

• Mealtimes at home
– Provide a variety of nutrient-dense foods
– Nurture self-esteem and well-being
– Honoring children’s preferences
– Avoiding power struggles
• Try tips for feeding picky eaters (Table 11-14)
– Choking prevention
– Play first

• Mealtimes at home
– Child participation
• Meal planning and preparation
• Food skills and developmental milestones of
preschool children (Table 11-15)
– Snacks: think food groups; choose nutrient-
dense, low-kcal foods (see Table 11-16)
– Preventing dental caries
– Serving as role models

• Nutrition at school
– AND nutrition standards for childcare
programs (Table 11-17)
– School Breakfast Program
– School Lunch Program
• Table 11-18 shows lunch patterns for different ages
– Competing influences at school
• USDA’s standards for all foods sold in schools
(Table 11-19)

Nutrition during Adolescence
• Growth and development during
adolescence
– Females: growth spurt begins at age 10 or 11
– Males: growth spurt begins at age 12 or 13
– What body composition changes occur in
males and females during puberty?

Nutrition during Adolescence
– Vary due to growth rate, gender, body
composition, and physical activity
– Obesity
• Problems in adolescence likely to continue into
adulthood
– Vitamin D
• Deficiency risk: blacks, females, overweight
• Supplements may be required

Nutrition during Adolescence (cont’d.)
– Iron
• Increased needs during adolescence due to
growth, greater lean body mass (in males), and
menstruation (in females)
• Deficiency most prevalent among teen girls
– Calcium
• Crucial for developing dense bones
• Teen girls are most vulnerable to low intakes

• Food choices and health habits
– Importance of breakfast
– Affected by busy schedules and desire for
freedom
– Adults serve as gatekeepers
– Snacks
• Should be nutrient dense rather than energy dense

• Food choices and health habits
– Beverages
• Frequent soft drink consumption yields higher
energy intake and lower calcium intake
– Eating away from home
• Should compensate for nutrient-poor fast-food
meals at other meals
• Some healthier choices now available
– Peer influence

Nutrition in Practice: Childhood Obesity and
the Early Development of Chronic Diseases
• Childhood obesity → early adulthood CVD
• Genetics play a permissive role
• Fetal programming
• “Adult” diseases in children
– Type 2 diabetes
– Atherosclerosis, high blood lipids
– Hypertension

Nutrition in Practice: Childhood Obesity and
the Early Development of Chronic Diseases
• Dietary recommendations for risk
reduction (Table NP11-2)
• Cholesterol-lowering medications
• Cigarette smoking

Chapter 11: Nutrition through the Life Span: Infancy, Childhood, and Adolescence

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