1. CHILDHOOD & ADOLESCENT
NUTRITION
XNB151 Food and
Nutrition

2. GROWTH IN CHILDHOOD
 Weight & height
 Organ & tissue growth
 Body composition

6. DIETARY GUIDELINES TODDLERS

8. ENERGY & NUTRIENT
REQUIREMENTS FOR GROWTH
 Adequate food supply essential for normal growth in
height & weight
 Estimating energy & nutrient requirements based on
 What healthy infants eat or on,
 Base requirements on the amount of nutrients
accumulated in the body during growth
 RDIs usually based on both

9. ENERGY & NUTRIENT
REQUIREMENTS FOR GROWTH
 Energy requirement is generally based on size
 Energy requirement ↓ dramatically after the 1st year
 Energy intake of children of similar age & size differs
because of activity levels
 Nutrient requirements may be better expressed with
reference to the child‟s height (i.e. per cm) rather than
age

10. FAT NEEDS OF CHILDREN
 Relatively high fat intakes are recommended until growth is
complete
 Essential fatty acids, cholesterol & fat soluble vitamins are
needed in relatively higher amounts than for adults for e.g.
CNS development
 Low fat intakes are related to growth failure
& chronic diarrhoea

11. RECOMMENDED FAT INTAKES FOR
CHILDREN
 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

12. INTRODUCTION TO FOODS
When, Why?
 At about 6 months of age (NHMRC Infant feeding
guidelines, WHO recommendations)
 To meet developmentally appropriate nutrient needs
 sitting upright, mouth control
 iron stores depleting

13. INTRODUCTION TO FOODS ~ 6 MONTHS
 4-5 breast milk or formula feeds
 first solid food iron fortified infant rice
 cereal mixed with breast milk or
formula
 start at one feed/day
 gradual introduction – one food at a
time – pureed vegetables, fruits, meats
 strained/finely sieved  mashed
 no added salt, sugar, oil, butter,
margarine

14. 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 or
sweets, whole peas, salt, sugar, honey
 small amount of butter or margarine on bread

15. 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/margarine
used 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/SCIENCE
PHOTO LIBRARY

16. 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 a
routinely accepted food
 No healthy child ever starved through food refusal
 When children are hungry enough they will eat

17. NUTRITION RELATED CONCERNS DURING
INFANCY - GROWTH PATTERNS/FAILURE TO
THRIVE
Pattern of growth usually monitored over time using
growth charts to compare
 infants failing to thrive usually cross growth centiles

20. NUTRITION RELATED CONCERNS DURING
INFANCY - OTHER
 iron deficiency
 can lead to irreversible, long term neurocognitive
abnormalities & increased risk of infections
 symptoms of colic, reflux, vomiting & diarrhoea
 allergies or intolerances
 restricted diets – vegetarian, vegan, low fat

21. 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

22. AGES & STAGES – 1-3 YEARS
BF Fruit
Cereal
Toast
MT Fruit
Plain biscuit
Milk
L Sandwich
Milk
AT Slice bread
Diluted juice
D Small serve meat
Potato & other veg
Fruit & custard

23. 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
http://www.socialmoms.com/food/avoiding-frustration-dinner-table/

24. 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 & preparation
of foods
 Being responsible for own social role

25. NUTRITION RELATED CONCERNS DURING
CHILDHOOD
 Food refusal
 Anaemia
 Dental caries
 Obesity

26. 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 food
refusal
 Bribing can lead to food rejection
 Children learn to manipulate parents through food
refusal – it‟s a form of entertainment
 Fun not Fuss with Food – program of Qld Health
http://www.health.qld.gov.au/health_professionals/food
/funnotfusswithfood.asp

27. 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 in
other foods)

28. SOME GOLDEN RULES
 Kids will learn the eating habits of
of their parents
 Hygiene in the kitchen is vital
 It takes 8 - 10 exposures to a food before it
becomes a routinely accepted food
 No healthy child ever starved through food refusal,
it is usually self limiting – when children are hungry
enough they will eat

29. INTERVENTION GOALS FOR FEEDING
DIFFICULTIES
 Eating should be pleasurable
 Provide a conducive environment
 Provide suitable seating arrangements
 Provide suitable utensils (if appropriate)
 Assist development of skills
 Provide support

30. 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
http://healmed.ru/health-child/anaemia.htm

31. DENTAL CARIES
 Serious problem in Australia
 Queensland children have the highest rates of
dental caries in Australia (AIHW, 2006)
 Related to fluoride, saliva, plaque, bacteria, diet
(sugars, frequency, retention on teeth)
 Bottle caries
http://www.youtube.com/watch?v=-nBSQQHYdkE
http://www.youtube.com/watch?v=xV1veIIjxGQ

32. 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

33. OBESITY
 Increasing prevalence
 “eye balling”
 +++ complex factors contributing
but basic energy balance applies
 For weight management:
 not severe energy restricted
diets
 avoid high energy low nutrient
foods & drinks; encourage
activity
 ensure adequate intake for
growth & nutrient needs

34. COMPLICATIONS OF CHILDHOOD OBESITY
34
Ebbeling, Pawlak, Ludwig (2002) Childhood obesity: public-health crisis,
common sense cure Lancet, p 475

35. School-based
intervention
Individual
intervention
Group-based intervention
Population
intervention
INTERVENTIONS TO ADDRESS OBESITY

36. NUTRITION AND
ADOLESCENCE
 Adolescent eating patterns
 Dieting

37. ADOLESCENCE
A TIME OF CHANGE!
Breaking away from family influences
Making own decisions in relation to new
influences
Media
Social expectations
Gender roles
Acceptance & nurturing
of the new „self‟ –
self images

38. EATING PATTERNS
 The need for $ & opportunity
to socialise via food
 Grazing instead of meals;
take-away; social eating &
drinking
 Physiological changes –
growth requirements of
higher energy intakes
 Learning to take control
Credit: DR M.A. ANSARY/SCIENCE PHOTO
LIBRARY

39. ALCOHOL
39
•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 the
month before the survey (White & Hayman 2004 in NHMRC Guidelines 2009)
NHMRC 2009 Australian guidelines to
reduce health risks from drinking
alcohol
Chikritzhs et al (2000) in NHMRC Guidelines 2009)

40. DIETING
 Causes of obesity in adolescence are
multifactorial – 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 as
ideal
 No evidence of causing eating disorders
 There are specific diagnostic criteria
relating to diagnosis of eating disorders 40
Blonde Bather, 1881,
Pierre August Renoir