Chapter 1 – Title of Chapter - Nutrition Gardener



Chapter 16 – Life Cycle Nutrition: Infancy, Childhood, and Adolescence

Learning Objectives

1. Describe growth patterns of infants and demonstrate the ability to use growth charts.

2. Identify nutritional and other health benefits of breast feeding.

3. Discuss the factors used in the selection of an infant formula.

4. Discuss the appropriate age and procedure used for the introduction of cow’s milk and solids into an infant’s diet.

5. Explain the nutritional needs of young children, including energy, protein, lipids, vitamins, minerals, and water.

6. Discuss the effect of nutritional deficiency on behavior.

7. Discuss food allergies and intolerances in children and identify common allergens.

8. Describe the incidence of childhood obesity and the role of heredity and environmental factors in obesity development.

9. Discuss the nutritional programs in schools, including the school lunch program.

10. Describe the nutritional needs of adolescents.

11. Discuss the role of childhood obesity in the early development of type 2 diabetes and cardiovascular disease.

Lecture Presentation Outline

I. Nutrition during Infancy

The first year of life is a time of rapid growth and development. Breast milk or iron-fortified formula is the primary food the first year with gradual introduction of solids beginning at four to six months of age. Preterm infants have very special nutrient needs. Mealtimes with toddlers should be a pleasant and relaxed environment.

A. Energy and Nutrient Needs

1. Energy Intake and Activity

a. Weight doubles the first five months, triples by one year.

b. High basal metabolic rate.

c. Growth slows by the end of the 1st year of life.

d. 100 kcalories per kilogram of body weight.

2. Energy Nutrients

a. Carbohydrates at 60% of energy intake; needed for brain.

b. Fat provides most of the energy.

c. Protein especially important for growth and development.

3. Vitamins and Minerals

a. More than double the needs of an adult in proportion to weight.

b. Vitamin A, vitamin C, vitamin D, and iodine are especially high.

4. Water

a. Higher percentage of water compared to adults.

b. Found outside the cells and easily lost.

c. Dehydration from diarrhea and vomiting is a concern.

B. Breast Milk

1. Frequency and Duration of Breastfeeding

a. First few weeks: 8-12 feedings per day on demand.

b. Every two to three hours.

c. 10-15 minutes on each breast.

2. Energy Nutrients

a. Lactose, the form of carbohydrate in breast milk, enhances calcium absorption.

b. Alpha-lactalbumin is the form of protein in milk and is easily digested and absorbed.

c. Fat is generous in essential fatty acids.

3. Vitamins

a. Vitamin D content is low.

b. Vitamin D supplementation is recommended by AAP for breastfed infants.

4. Minerals

a. Calcium is well absorbed.

b. High bioavailability of iron and zinc.

c. Low in sodium and fluoride.

5. Supplements

a. Vitamin D, iron, and fluoride during first year.

b. A single dose of vitamin K is given at birth.

6. Immunological Protection

a. Colostrum, the first secretions from the breast, provides antibodies and white blood cells.

b. Bifidus factors allow for the growth of normal flora.

1. Lactoferrin is a protein that binds iron so that bacteria cannot grow.

2. Lactadherin is a protein that fights viruses that cause diarrhea.

c. Breast milk also contains growth factors and lipase enzymes.

7. Allergy and Disease Protection

a. Fewer allergies than formula-fed babies.

b. Lower blood pressure as adults.

c. Lower blood cholesterol as adults.

8. Other Potential Benefits

a. May protect against obesity later in life.

b. Indications of positive effect on later intelligence.

9. Breast Milk Banks

a. Donated milk can be provided to those who are unable to provide sufficient milk to their infant.

b. Cigarette smokers, and those who use illegal drugs, take medications, drink alcoholic beverages (greater than 2 per day), or have communicable diseases are not allowed to donate.

c. Available by prescription.

d. May be used for very-low-birthweight infants.

C. Infant Formula

1. Infants can be weaned to formula or other appropriate foods when breastfeeding is ended.

2. Infant Formula Composition

a. Copy breast milk if possible.

b. Iron-fortified.

3. Risks of Formula Feeding

a. Be careful about contaminated water.

b. Contains no antibodies.

c. Use proper food handling techniques.

4. Infant Formula Standards

a. In the United States, standards are developed by the AAP.

b. FDA mandates safety and nutritional qualities.

5. Special Formulas

a. For premature infants or those with inherited diseases.

b. Hydrolyzed protein formulas available for those allergic to lactose and soy protein.

c. Soy formulas for lactose intolerance and vegans.

6. Inappropriate Formulas

a. Soy beverages are nutritionally incomplete and inappropriate.

b. Goat’s milk is deficient in folate.

7. Nursing Bottle Tooth Decay

a. Can be caused by formula, milk, or juice.

b. Prolonged exposure to formula when sleeping.

c. Upper and lower teeth may be affected by decay.

D. Special Needs of Preterm Infants

1. Limited nutrient stores.

2. Physical and metabolic immaturity.

3. Long-chain fatty acids are important for the healthy growth of blood vessels and bones.

4. Preterm breast milk fortified with preterm supplement.

E. Introducing Cow’s Milk

1. No cow’s milk the first year; contains the protein casein and may cause intestinal bleeding and anemia in the first year of life.

2. Whole cow’s milk from 1-2 years of age.

3. Reduced-fat cow’s milk gradually introduced between 2-5 years of age.

F. Introducing Solid Foods

1. When to Begin

a. 4-6 months.

b. Timing varies from infant to infant depending on growth rates, activities, and environmental conditions.

c. Beikost is any nonmilk foods given to an infant.

2. Food Allergies

a. Introduce single-ingredient foods, one at a time.

b. Period of 4 to 5 days between new foods.

c. Rice cereal, then oat and barley, and lastly wheat.

d. Allergic reactions include skin rash, digestive upset, or respiratory discomfort.

3. Choice of Infant Foods

a. Should be provided with variety, balance, and moderation.

b. Palatable and nutritious.

c. No added salt, sugar, or seasonings.

d. Safe and convenient.

e. Fat information is not provided on food labels.

4. Foods to Provide Iron

a. Iron-fortified cereals with vitamin C-rich foods and juices.

b. Meat or meat alternatives such as legumes.

5. Foods to Provide Vitamin C

a. Vegetables first, then fruits.

b. Set limits on fruit juice consumption at 4-6 ounces per day.

6. Foods to Omit

a. Concentrated sweets.

b. Products with sugar alcohols (sorbitol) that may cause diarrhea.

c. Canned vegetables contain too much sodium.

d. There is a botulism risk with honey and corn syrup.

e. Choking hazards include raw carrots, cherries, gum, hard or gel-like candies, hot dogs, marshmallows, nuts, peanut butter, popcorn, raw celery, whole beans, and whole grapes.

7. Vegetarian Diets during Infancy

a. Rice milk is inappropriate for infants and toddlers.

b. Iron-fortified cereals needed until the second year of life.

c. Milk products and variety are important to proper nutrition.

d. Deficiencies of vitamin D, vitamin B12, iron, and calcium may develop.

e. Energy-dense foods are required.

8. Foods at One Year

a. 2-3 cups cow’s milk.

b. Be careful of milk anemia when milk is consumed excessively.

c. Balance and variety from all food groups.

d. Drink liquids from a cup, not a bottle.

G. Mealtimes with Toddlers

1. Discourage unacceptable behavior.

2. Let toddlers explore and enjoy food.

3. Don’t force foods.

4. Let children choose nutritious foods.

5. Limit sweets.

6. Make mealtimes pleasant.

II. Nutrition during Childhood

Energy needs, nutrient needs, and appetites during childhood vary because of growth and physical activity. Hunger and nutrient deficiencies affect behavior. Nutrition concerns at this age include lead poisoning, high energy, sugar and fat intakes, iron deficiency, caffeine consumption, food allergies, and food intolerances. Adults and schools need to provide children with nutrient-dense foods.

A. Energy and Nutrient Needs

1. Energy Intake and Activity

a. Needs vary widely because of growth and physical activity.

b. Energy requirements:

1. 1 year: 800 kcalories.

2. 6 years: 1,600 kcalories.

3. 10 years: 2,000 kcalories.

c. Inactivity can lead to obesity.

d. Vegans may have difficulty in meeting energy needs.

2. Carbohydrate and Fiber

a. Carbohydrate recommendations are the same as those for adults.

b. Fiber intakes change with age.

3. Fat and Fatty Acids

a. Children 1-3 years should have 30-40% of energy from fat.

b. Children 4-18 years should have 25-35% of energy from fat.

c. Low-fat diets may have low vitamin and mineral content.

4. Protein

a. Needs increase slightly with age.

b. Requirement considers nitrogen balance, the quality of protein consumed, and the added needs of growth.

5. Vitamins and Minerals

a. Needs increase with age.

b. Balanced diet meets all needs except iron.

c. Iron-fortified foods are important.

6. Supplements

a. Should rely on foods.

b. Supplements not needed.

7. Planning Children’s Meals

a. Variety of foods from each food group.

b. Proper portion sizes.

B. Hunger and Malnutrition in Children

1. Hunger and Behavior

a. Missing meals, especially breakfast, affects behavior and academic performance.

b. Low blood glucose due to smaller glycogen stores.

2. Iron Deficiency and Behavior

a. Affects behavior and intellectual performance.

b. Affects attention span and learning ability.

c. Brain is affected by low iron before the blood is affected.

3. Other Nutrient Deficiencies and Behavior

a. Marginal malnutrition may affect behavior.

b. Also affects personal appearance.

C. The Malnutrition-Lead Connection

1. Malnourished children are more vulnerable to lead poisoning.

2. Anemia caused by lead may be mistaken for an iron problem.

3. Exposure disrupts normal brain development.

4. Can develop learning disabilities and behavioral problems.

5. Ban on lead in food and the environment has helped.

D. Hyperactivity and “Hyper” Behavior

1. Hyperactivity

a. Interferes with social development and academic behavior.

b. Dietary changes and alternative therapies do not solve true hyperactivity.

c. No evidence that sugar causes hyperactivity.

d. Certain food additives may contribute to hyperactivity.

2. Misbehaving

a. Need consistent care.

b. Should receive regular hours of sleep, regular mealtimes, and regular outdoor activity.

E. Food Allergy and Intolerance

1. Detecting Food Allergy

a. Immunologic response with the production of antibodies, histamines, and other defensive agents.

b. 3-5% of children are diagnosed.

c. Asymptomatic allergy produces antibodies without symptoms.

d. Symptomatic allergy produces antibodies and symptoms.

2. Anaphylactic Shock

a. Life-threatening food allergy reaction.

b. Foods may include eggs, milk, soy, peanuts, tree nuts, wheat, fish, and shellfish.

c. Often outgrow allergies to eggs, milk, and soy.

d. Recognize symptoms.

e. Epinephrine injections (adrenalin) can be used to counteract anaphylactic shock.

f. Food labeling to identify common allergens and additives.

3. Food Labeling

a. Eight common allergens must appear on a food label.

b. If cross-contamination is possible, this must be stated on the label.

4. Food Intolerances

a. Adverse reactions to foods like stomachaches, headaches, rapid pulse rate, nausea, wheezing, hives, bronchial irritation, coughs, and other discomforts are not all food allergies.

b. Symptoms without antibody production.

c. A tolerance level for pesticides has been set based on the effects on development.

F. Childhood Obesity

1. Genetic and Environmental Factors

a. Parental obesity is a risk factor. Parents act as role models.

b. Poor diet and physical inactivity are risk factors.

c. Convenience foods and meals eaten away from home.

d. Non-nutritious choices at school.

e. Sedentary activities, e.g. watching television.

f. Energy-dense soft drinks.

2. Growth

a. Grow taller at first, then stop growing at a shorter height.

b. Greater bone and muscle mass to support weight, thus “stocky” appearance.

3. Physical Health

a. Abnormal blood lipid profile.

b. Increases the risk for high blood pressure, type 2 diabetes, and respiratory disease.

4. Psychological Development

a. Emotional and social problems.

b. Stereotypes and discrimination.

5. Prevention and Treatment of Obesity

a. Integrated approach with diet, physical activity, psychological support, and behavioral changes.

b. Begin early treatment – before adolescence.

6. Diet

a. Reduce rate of weight gain, rather than attempt weight loss.

b. Strategies

1. Limit sugar-sweetened beverages.

2. Eat fruits and vegetables every day.

3. Eat age-appropriate portions of food.

4. Eat foods low in energy density.

5. Eat a nutritious breakfast.

6. Eat a diet high in calcium.

7. Eat a diet balanced in carbohydrate, fat, and protein.

8. Eat a high-fiber diet.

9. Eat together as a family.

10. Limit the frequency of eating out.

11. Limit television watching.

12. Engage in at least 60 minutes of activity per day.

7. Physical Activity

a. Limit sedentary activities.

b. Encourage regular vigorous activity.

c. Parents need to set good examples.

8. Psychological Support

a. Weight-loss programs with parental involvement.

b. Positive influence on eating behaviors.

9. Behavioral Changes

a. Focus on how to eat.

b. Parental and media influence.

c. Teaching consumer skills.

10. Drugs

a. Long-term impact on growth and development are unknown.

b. Two approved for children are orlistat and sibutramine.

11. Surgery – May result in significant weight loss and decrease disease risk.

G. Mealtimes at Home – with parents as gatekeepers

1. Honoring Children’s Preferences

a. Offer variety of foods.

b. Fun mealtimes.

2. Learning through Participation

a. Help plan meals.

b. Assist with food preparation.

3. Avoiding Power Struggles

a. Children need to regulate their own food intakes.

b. Can determine their own likes and dislikes.

c. Offer new foods at the beginning of meals and in small quantities.

4. Choking Prevention

a. Be alert to foods that are common causes of choking.

b. Make sure children are sitting, not running or in danger of falling, when eating.

5. Playing First

a. Schedule outdoor play before meals.

b. Relax and take time while eating.

6. Snacking

a. Teach how to snack.

b. Limit access to concentrated sweets.

7. Preventing Dental Caries

a. Brush and floss after meals.

b. Brush or rinse after snacks.

c. Avoid sticky foods.

d. Select crisp and fibrous foods.

8. Serving as Role Models

a. Children learn through imitation of parents, older siblings, and care givers.

b. Help children to develop positive attitudes toward food and eating.

H. Nutrition at School

1. Meals at School

a. Breakfast and lunch at a reasonable cost.

b. Some free and reduced cost to low-income children.

c. Offer variety of choices.

d. 1/3 RDA for energy, protein, vitamin A, vitamin C, iron, and calcium.

2. Competing Influences at School

a. Short lunch periods and long lines.

b. Snack bars, school stores, and vending machines.

c. State laws and school policies.

III. Nutrition During Adolescence

Another rapid state of growth occurs during adolescence. Nutrient needs rise, and iron and calcium are especially important. Busy lifestyles make it challenging to meet nutrient needs and develop healthy habits. Peer pressure is significant among adolescents.

A. Growth and Development

1. Growth speeds up and continues for about 2 ½ years.

2. Gender differences

a. Females begin puberty at 10-11 years of age, grow 6 inches taller, add fat, and gain about 35 pounds.

b. Males begin puberty at 12-13 years of age, grow 8 inches taller, add lean body mass, and gain 45 pounds.

B. Energy and Nutrient Needs

1. Energy Intake and Activity

a. Needs vary depending on rate of growth, gender, body composition, and physical activity.

b. Energy needs can range from 1800 kcalories per day for an inactive female to 3500 kcalories per day for a highly active male.

c. Problems with overweight and obesity.

2. Vitamins

a. Needs for all vitamins increase.

b. Vitamin D needs special attention because it allows for calcium absorption.

3. Iron

a. Females’ needs increase because of menstruation.

b. Males’ needs increase because of developing lean body mass.

c. Iron deficiency is a concern.

4. Calcium

a. Crucial time for peak bone mass.

b. Increase milk and milk products.

c. Low calcium intakes and physical inactivity may cause problems with osteoporosis in later life.

C. Food Choices and Health Habits

1. Snacks

a. Provide ¼ of daily energy intake.

b. Favorite snacks are often high in fat and sodium and low in fiber.

2. Beverages

a. Soft drinks replace fruit juices and milk.

b. Caffeine may be an issue.

3. Eating Away from Home

a. 1/3 of meals are consumed away from home.

b. Influence of fast-food restaurants.

4. Peer influence is strong when making nutritional choices.

5. Drug Abuse

a. Use money to buy drugs, not food.

b. Lose interest in foods.

c. Use drugs that suppress appetite.

d. Lifestyles fail to promote good eating.

e. Infectious disease affects nutrition.

f. Medications to treat drug abuse alter nutrition status.

6. Alcohol Abuse

a. Provides energy, no nutrients.

b. Displaces nutritious foods from the diet.

c. Alters nutrient absorption and metabolism.

7. Smoking

a. Eases feelings of hunger.

b. Lower vitamin and fiber intakes.

c. Increases needs for vitamin C.

d. Need antioxidant fruits and vegetables to reduce cancer risk.

8. Smokeless tobacco has many drawbacks including cancer of the mouth.

IV. Highlight: Childhood Obesity and the Early Development of Chronic Diseases

Nutrition and health education programs during childhood and adolescence are effective when combined with heart-healthy meals at home and school, fitness activities, and parental involvement. Cardiovascular disease (CVD) damages the heart.

A. Early Development of Type 2 Diabetes

1. On the increase in recent years.

2. Risk factors include obesity, sedentary lifestyle, and family history.

3. Insulin resistance.

4. Increased blood cholesterol and blood pressure leading to atherosclerosis and CVD.

5. Many complications leading to a shorter life span.

B. Early Development of Heart Disease

1. Atherosclerosis

a. Is often a part of cardiovascular disease.

b. Artery walls thicken with plaque.

c. Fatty streaks begin to accumulate in fibrous connective tissue.

d. Lesions in the arteries.

2. Blood Cholesterol

a. Tends to rise as dietary saturated fat increases.

b. Correlation with childhood obesity.

c. Family relationship.

d. Screening and education are key.

2. Blood Pressure

a. May be a sign of underlying disease.

b. More common in obese children.

C. Physical Activity

1. Active children have better lipid profiles.

2. Habits developed at this age are carried into later life.

D. Dietary Recommendations for Children

1. Moderation, Not Deprivation

a. Less saturated fat.

b. More fruits and vegetables.

c. Nuts, vegetable oils, and some fish provide essential fatty acids.

2. Treat problems with diet first, then drugs.

E. Smoking

1. Increases risk for heart disease.

2. Half of teens who continue to smoke will die of smoking-related causes.

Case Study

Ryan is a 6-year-old elementary school student. At his last well child exam, he measured 46 inches tall and weighed 60 pounds with an excessive increase in his weight gain over the past year. His usual diet consists of sweetened cereal with juice and whole milk for breakfast and juice drink and crackers for mid-morning snack. Most school days, he buys school lunch; his favorite menu items are pizza and tacos. His mother states that she started a new job this past year so Ryan has begun to go to an after-school program until 5:30 or 6 in the evening. He gets a snack there, usually juice and crackers. Ryan’s parents have noticed that Ryan seems to be “always hungry” and they will often stop for his favorite fast food “happy meal” (chicken nuggets, fries, and a soda) on late evenings when the family is too tired to cook. Ryan likes to play video games and has a computer and television in his room. His father complains that he spends “hours” in his room rather than playing outside. Ryan’s mother is overweight and his father is normal weight, although he states he was overweight as a child. The family has discussed getting more exercise on the weekends but have not come up with a plan they can agree on.

1. Calculate Ryan’s body mass index (BMI) and evaluate his weight status using information in Figure 16-10.

2. From information in this chapter, what are some factors that may contribute to Ryan’s excess weight gain?

3. Considering his age, what would be an initial goal to manage Ryan’s weight?

4. Using the recommendations in Table 16-7, what practical advice could you give Ryan and his parents that they could incorporate into their current lifestyle?

5. Based on his usual intake, identify at least 2 or 3 nutrients likely deficient in Ryan’s diet. What major food groups provide these nutrients?

6. Using the guidelines in Table 16-4, plan a daily menu for Ryan that includes 3 meals and 2 snacks and provides approximately 1400 kcalories per day.

Answer Key:

1. BMI = 60 pounds x 703 ÷ 46 inches ÷ 46 inches = 19.9; BMI on graph for age and sex >95th percentile, indicates obesity.

2. Diet high in refined sugars, juice, and sweetened beverages, but low in fiber, fruits, and vegetables; frequent restaurant meals; excessive television and video time; overweight parents; physical inactivity; emotional eating due to change in mother’s work schedule.

3. Reduce the amount of weight gain; maintain his weight as he continues to grow.

4. Limit juice and sweetened beverages; serve water and milk instead. Encourage whole fruit instead of juice; include more vegetables in meals and snacks. Switch to low-fat milk and whole-grain cereal for breakfast. Set limits on restaurant meals and do not have televisions or computers in bedrooms. Plan at least 60 minutes of play or other physical activity each day.

5. Calcium, vitamin D, fiber. Dairy foods fortified with vitamin D, fruits, vegetables, whole grains.

6. Breakfast: ½ cup low-fat milk, 1 oz whole-grain cereal. Snack: ½ cup mixed fruit. Lunch: 1 slice pizza, ¾ cup salad with dressing, 8 oz low-fat milk. Snack: 1 cup apple slices, peanut butter on graham crackers. Dinner: 1 cup pasta with tomato sauce and meatballs, ½ cup broccoli, ½ cup low-fat milk.

Critical Thinking Questions

These questions will also be posted to the book’s website so that students can complete them online and e-mail their answers to you.

1. A patient you are seeing is a new mother whose infant is having some troubles “latching on” to her breast for breastfeeding. She is considering opting for formula to feed her baby. What information might you provide her that would encourage her to pursue the breastfeeding approach further?

Answer: A mother should be able to choose between breastfeeding or formula feeding; however, there are several reasons why breastfeeding is the preferred option. The RD should try to approach this patient by allowing her to understand that she does have the final choice and that the RD is there to help her make an informed decision.

One of the first means of support that the RD should provide is a lactation specialist or educator. The specialist can be of significant benefit to a new mother by assisting with multiple issues when infants have breastfeeding problems. Along with the RD’s information, this individual can be a major support to the mother and infant in achieving a positive breastfeeding experience.

Breast milk is the preferred nutrient source for an infant for the first six months because it provides all nutrients the infant requires in a sterile environment. The only vitamin requiring supplementation is vitamin D, which can be provided by the sun. However, for those infants in cold climates and for those infants with dark skin, supplementation is recommended. Breast milk also provides many “protective factors” such as antibodies, oligosaccharides, bifidus factors, lactoferrrin, lactadhrin, growth factor, and lipase enzyme. The combination of these agents helps to fight infection in the infant, protect the infant from allergies, and support the infant’s growth and development.

Breastfeeding does require a significant commitment given that the mother is the infant’s source of nutrients. Therefore, whenever the infant is hungry, the mother must be available, unless she is pumping her milk and storing some for later bottle feedings. This in itself requires considerable planning on the part of the mother and can be very exhausting. A breastfeeding mother must also remember to maintain a nutrient-rich diet and drink plenty of fluids to maintain her milk production. The mother must also be on a lookout for any foods that she eats that cause the infant discomfort. Sometimes spicy foods or gassy vegetables can cause the infant distress and the mother must either cut them out of her diet or eat them sparingly.

Formula-fed infants do not benefit from the protective factors found in breast milk or share its sterile environment. Formula-fed infants are more likely to have allergic reactions to a particular formula and require special formulas for feeding and, of course, formula is much more expensive when compared to breastfeeding.

Some women and infants do have a particularly hard time with breastfeeding and are unable to accomplish breastfeeding successfully. For these individuals, formula feeding is a better option. Mothers with cracked or infected nipples suffer from significant pain while breastfeeding, which makes the experience very uncomfortable. For these mothers the experience becomes so negative that the infant also suffers.

Feeding time for both baby and mother should be a pleasant experience. Breastfeeding does have many benefits but is not for everyone. After working with a lactation specialist and considering one’s options, the mother must ultimately decide what is best for her and her infant.

2. As the infant grows throughout the first year of life, many milestones are reached. The infant also progresses through a series of milestones with their nutrient intake. Discuss nutrient intake milestones throughout the first year of life for the child who is premature or who has developmental delays.

Answer: The progression of introduction of solid foods to an infant within the first year of life, beyond breast milk or formula, is based on their physiological development or maturation of their GI system as well as their gag reflex and the strength of the body to sit erect.

Premature infants may be considered medically by their date of gestation until they are able to reach appropriate milestones for their current age. For example, if an infant was 4 weeks premature, that infant may be considered 4 weeks behind their birth age until the infant reaches the milestones for their birth age. In that manner, a premature infant might not be considered for introduction of cereals until 5-7 months, depending on the infant’s ability to handle the liquid cereal. Over the first year of life, some premature infants progress rapidly while others require a bit longer to progress through stages.

Whatever the age of the infant, it is always important to ascertain that the infant does have the swallow reflex, GI function, and other appropriate physiological abilities to handle the food being introduced. It is also important to introduce only a very small amount of a new item and allow some time to pass prior to serving a great deal more of any new food substance to an infant. Some infants can have food allergies or reactions, and in the case of premature babies or developmentally delayed babies, many sorts of physiological problems that can cause obstruction. Allow the infant plenty of time to process their food.

For each developmentally delayed infant, the case can be different. Therefore, it will be important for the parents to have the full advice and support of the medical team and the RD and to monitor the progress of food introduction in these infants. Some developmentally delayed infants require feeding tubes for a good length of time to allow the body to grow and mature prior to oral introduction of solids. Caution and patience are always advised when introducing new foods to special needs infants.

3. As Chapter 16 points out, children between the ages of one and adolescence grow considerably over this time period. The body is actively developing and strengthening into what will someday be the individual’s final adult body. Clearly, this is a very important time to teach children about good nutrition and exercise. Some adults are so afraid of obesity that they feed their young infant/child fat-free everything, while others apparently have no restrictions on their child’s diet. How might you approach raising a nutritionally intelligent, healthy, and happy child and adolescent given today’s stresses of two career families, fast-food options, and sedentary lifestyles?

Answer: With this question, each student should approach the question from their own perspective and add their own flavor and approach to the answer. Just saying we would like to do something is much easier than actually putting a plan into action. Therefore, there might be some discussion of the challenges of how to put some of the plans into action given all the obstacles that can prevent “best laid plans”! If you have some adult learners in your class, perhaps they can share their experiences raising nutritionally healthy children with multiple challenges.

In order for a child grow successfully through any approach, the parents must encourage the child to explore all types of foods. After consuming many types of foods over time, the child is then able to discern what foods they really don’t like.

Parents should also be discouraged from getting into food battles with their children. Food is for nourishment and to be enjoyed, not to be battled over or used as a bribe/weapon. Foods should also not be used exclusively as comfort foods. Parents should provide the child with comfort and love or stress management and discourage reliance on food for comfort.

Both parents and children need to understand what a normal or average serving size is as recognized by the American Dietetic Association or the Pediatric Group. Americans have lost their sense of normal serving sizes, which has added many kcal to the American diet.

Children love to grow the foods they eat. If at all possible, parents are encouraged to plant a garden with their children. The foods in the garden can be used in dinner meals that the children can also be a part of preparing. The more the children are involved, the greater knowledge they gain about cooking and nutrition and a greater partnership they have with their parents.

Growing a garden, walking to the store, or any other exercise is an important part of every day. Exercise should be integrated into each day as a fun activity. Children that grow up active will remain active and children that grow up healthy have a greater chance of remaining healthy.

These are just a few of the ideas that the students should be thinking about in their own plans. I am sure they will come up with many others. As always, sharing their plans helps others to learn about options they had not considered.

4. Children from lower socioeconomic communities and families may fail to receive enough nutrient-rich foods to support growth of a strong body. Families struggling to “make ends meet” often eat diets that are high in fat and refined carbohydrates and low in high-quality protein. It is not uncommon for young children in very deprived socioeconomic areas to display behaviors of “pica” or eating nonfood items such as dirt and old paint. Discuss the problems with the diet described for a young, growing child (for both short- and long term-health) and suggest how an RD might be able to help impoverished families.

Answer: A diet that is high in fat and carbohydrates and low in high-quality protein for a growing child can have devastating effects on the child’s short- and long-term health. Children require protein for growth of tissues and muscles. High-quality protein is very important for a child’s progress in growing, despite the fact that the child does not need abundant quantities. Carbohydrates are important to a child for energy; however, if the carbohydrates are not complex carbohydrates they do not provide important nutrients such as minerals that are also important for the child’s growing body. An assumption may be made that some of the carbohydrates may be rice or other complex carbohydrates, which are good sources of nutrients and energy for children. Legumes can also provide amino acids in the absence of other proteins. A diet that is high in fat can be satiating but is not healthy for a growing child. This type of diet can advance cardiovascular disease and obesity. If his or her diet is poor, the child may have little energy to be active, further advancing obesity and subsequent diabetes.

The diet described is void of fruits and vegetables, both importance sources of vitamins and minerals. The poor nutrient quality of the diet from the lack of fruits, vegetables, and high-quality protein is evidenced by the pica behavior. Pica might be indicative of iron deficiency, which is certainly possible given a diet with few iron sources.

As partially described above, this diet puts the child at risk for many chronic diseases and heightens the child’s risk of more serious outcomes from childhood illnesses, broken bones, etc. The child is not consuming a diet that provides a plentiful supply of vitamins, minerals, and balanced macronutrients, and therefore the child’s immune system is less efficient; the child’s muscles, enzymes, and other protein components cannot be well developed; and all the while, if the child is not active, excess adipose tissue is amassing.

It is particularly important to help educate this family about their diet and the changes that need to be made for their heath and that of their child. To alleviate the pica, a laboratory assessment is required and supplementation must begin with close observation of the child to make sure that the behavior does not continue. The family will require lots of support and guidance because much of this is economic; much of their situation also becomes habit.

While this is a very unfortunate situation and all too common, the family does have many options for assistance the RD can consider. There are, of course, many food banks that donate food stuffs to families in need. These food banks do have lesser amounts of goods during economic crisis times, but they remain open and are always willing to provide whatever they can to a family.

The family should take advantage of SNAP if they have not already done so. Call the county clerk’s office to find out where the family can go to apply for SNAP and any other local, state, or federal assistance that may be available to support the family in crisis.

There are also many church, county, and hospital programs that will support families in need and particularly those with young children. Check with the local churches, hospitals, or youth groups to see if there are any local options for this family.

Arrange for the mother or the person that prepares the food to be driven, bussed, or transported with a group of other community members to a regional Wal-Mart, Sam’s Club, or similar kind of grocery store. Many times, intercity communities are not able to shop at a large discount retailer and therefore purchase groceries at a local grocer that charges three times what they would pay at a discount grocer. Helping the disadvantaged to discount shop affords their grocery dollars to be stretched much further. That added with basics from the food bank can really support a much healthier diet plan for someone who is economically challenged.

Check with grocery stores and restaurants regarding their trash vegetables. Both sources often throw away massive amounts of fairly good vegetables and fruits that can be cooked or canned. The RD or health professional may be able to get big boxes of these items for clients and help to make a major difference between a healthy diet and a very poor diet for no cash at all. Restaurants and grocers often toss items that have a spot because they want to please the consumer when there is nothing really wrong with the fruit or vegetable.

The child may also have access to breakfast and lunches at their school that can provide proper nourishment. This is quite valuable for a child in this situation and the RD should make sure that the child is signed up for all meals and snacks that are available in that school district.

5. Adolescence is a time of tremendous change, not only within the body but also in the individual’s choices and options in activities and diet. The adolescent is in the final stages of development and preparation prior to becoming a “young adult” and going out on her/his own. Adolescents often challenge their parent’s choice of music, lifestyle, and diet. What are nutritional/dietary issues that are prevalent or could be of concern during the adolescent years, and how might they impact the individual physiologically? How can parents supervise these challenging years, with regard to nutrition, and when should a parent be concerned and seek advice or help?

Answer: It is important to note that there are clearly many avenues to approach this question and that the more students can add “to the mix” the more robust the answer will be for the entire class. In the final analysis, share the summary of answers so that all students benefit from the exercise.

Parents may find that during adolescence their son/daughter may no longer eat foods that were once preferred. Many adolescents or young college students go through a period of experimenting with vegetarianism. Many young ladies and some young men diet. Peer pressure and body image are very important at this stage of life, which is beginning earlier now than in previous generations. Children at 8 and 10 years are now worried about “being fat” and body image, whereas once that was something that waited until adolescence. Many factors are thought to be involved in this, which is a thesis in itself.

Nonetheless, acceptance for the adolescent is important. Older friends may be dropped and a whole new group of friends may become part of your son’s/daughter’s social network. This social network, of course, has it’s own eating pattern: some are vegetarians, some prefer hamburgers and fries, and others might choose all ethnic foods. Whatever the case, family social roles are often disregarded in favor of the friends network.

Adolescence is a busy time with many activities including, depending on your child, sports, clubs, or hanging out. School work is stressful for adolescents and trying to fit in, along with academics, long days, a rapidly changing body, and many big decisions to make (where to go to college or not to go to college) weigh heavily on the adolescent.

For those adolescents that have developed good nutritional and exercise habits and retain a good sense of self, this period of time can be a bit easier; however, adolescence remains a challenge to everyone for all of the above and more reasons. Individuals that understand serving sizes, enjoy healthy foods, enjoy activity and exercise, and have come into adolescence in good health and of normal weight may use this strong foundation to learn about new foods, learn new skills and activities, and meet new people.

Unfortunately, a growing number of individuals are moving into adolescence obese, not understanding what a normal serving size is, choosing a fairly sedentary lifestyle, and after many years of ridicule about their weight, not maintaining a strong sense of self. Food is often used as comfort for stress; therefore, during these stressful years, further weight is added because the adolescent has not learned how to handle stress effectively. Peer groups and peer acceptance can be hard to gain entrance into and food abusers can become drug abusers or turn to smoking cigarettes or alcohol to avoid eating and to deal with stress.

Adolescents that desire to try vegetarianism or other dietary options should work with the RD to be fully educated about how to consume a nutrient-rich diet. The parent can make an appointment with the RD and either go with the adolescent into the appointment or let them go alone and have a separate appointment to make sure that the parent fully understands the dietary needs. It is important to stress upon the adolescent that skin, hair, weight, etc. will look better and be positively enhanced by a diet rich in vitamins and minerals. The RD can help the adolescent achieve this with the appropriate intake of foods.

New vegans can eat diets that are deficient in vitamin B12, and all new vegetarians may become deficient in iron and some essential amino acids if they do not eat a variety of foods. Depending on the type of vegetarian they choose to become, calcium can also be a concern. Overall, for the adolescent vegetarian, the RD might advise the intake of a vitamin and mineral supplement to ensure that they are getting an appropriate amount of all nutrients daily. This, however, is not a replacement for food.

For adolescents that require weight loss, a moderate approach is desirable. Consuming a diet that is nutrient rich provides and 250-500 fewer kcal a day will provide a slow and desirable weight loss over time. During this high growth period, if the adolescent is only slightly overweight, it is sometimes advisable to allow the child to “grow into their height” by increasing exercise and improving their diet with less stress on cutting calories. Whatever approach, it is very important to spend time with the adolescent, teaching them proper dietary habits as well as appropriate serving sizes of all foods. This is a good “teachable time” in an individual’s life and weight loss during this time period can often be very successful throughout the adult years.

During adolescence, it is especially important to watch for eating disorders in both men and women. While more prevalent in women, eating disorders have been diagnosed in men. Any adolescent that appears to be losing significant weight, obsessed with exercise, and eating very little, in addition to wearing bulky clothes, frequently being cold, and being obsessed with grades, baking, or being around food should be watched for anorexia nervosa. Additional signs, other than the emaciated body, would include dry and broken hair, dry skin, and eyes that are sunken into their sockets.

The individual with bulimia nervosa will exhibit bouts of eating excessive amounts of foods, often simple sugars but occasionally proteins. These individuals’ teeth may be stained or eroded from acid from the stomach contents, or the mouth may have sores. An individual that is bulimic may enjoy eating a very large amount of food (greater than 15,000 kcal) and then feel guilty and induce vomiting. This is the binge-purge syndrome.

Finally, there is a disordered eating classification in which the individual will eat a great deal, such as when watching a football game, etc., and then fast the next day “to make up for eating so much yesterday.” This individual feels guilty about eating all the food, and so denies their body the next day. This cycle often repeats itself.

All of these eating disorders are dangerous and can lead to death, particularly the first two. Noted celebrities have died of anorexia and many others have struggled from the disease. Bulimia nervosa also affects many individuals and both diseases often start during the adolescent years when the teenager is growing independent and trying to gain control over their eating habits, body weight, and self image. They are complex and difficult diseases to treat, and clients may resist treatment. The sooner an adolescent is assessed with an eating disorder and placed into treatment, the more positive the outcome becomes.

Parents that can support their adolescent’s sense of discovery in these years will be more successful during this period. It is important for parents to understand that the adolescent is trying to understand themselves as an independent individual and prepare themselves for the day of separation. The parent’s job is to help them work through this period without hurting themselves or others. Testing other dietary patterns is a normal and healthy way to learn about other cultural and ethnic norms. Provide the adolescent with education and allow them to make the choice based on their knowledge and family role models. Often, saying no will make the teenager do just the opposite; therefore, allow them to make choices with some guidance on the part of the parents. In this manner, both parents and adolescent are educated and can learn together. Parents may want to experiment with some of the food choices with the adolescent. Such experimentation can be fun and a growing experience for the adult.

Watch for signs that there is something different or “wrong” with the teenaged child that would indicate that the adolescent is involved in drugs or alcohol or has an eating disorder. Parents should be alert for signs of drug paraphernalia, loss of appetite, and unusual smells as well as the smell of alcohol on the teenager’s breath. Also check pupil size and reaction. Pupils that are small and slow to react are indicative of drug use. When in doubt, most pharmacies now carry drug urine testing kits that the parents can utilize. Don’t be afraid to ask or check; it is the life and future of your child that are at stake.

6. The prevalence of obesity in children and adolescents is rising so dramatically in the United States that it is frightening to consider the health of our adult population in fifty years. Consider the discussion in Highlight 16 regarding childhood obesity and its relationship to type 2 diabetes, atherosclerosis, high blood cholesterol and blood pressure, and sedentary lifestyles. In your region (county and state), what is the prevalence of childhood obesity? Compare your regional rate of childhood obesity with that of the national average. How does your region compare?

Based on the climate, geography, culture, prevalence of chronic disease, and target area needs for childhood obesity education and programming, develop an integrated obesity program for children in a local target area. Discuss why you chose the particular target region, how you will develop an integrated program and with whom, what specific selected outcomes over what period of time would be pursued, and why and how this would impact long-term risk nationwide for chronic disease.

Answer: There are many types of approaches and programs available to solve the problem of childhood obesity. It appears that few are successful with the continued increase in childhood obesity and its co-morbidities. Throughout the nationwide picture, each region has its own needs, challenges, and opportunities. In this exercise, students are challenged to find out a bit more about the childhood obesity problem in their region and state when compared to the rest of the United States. Then they are asked to think creatively about how to develop an integrated obesity program that would utilize the resources of your region. For instance, in the Northeast, students might take advantage of hiking in the summer and skiing in the winter while on the west coast, students might use the ocean as a means of exercise as well as food supply.

Students need to think about obesity programming as multifaceted with professionals such as exercise physiologists, psychologists, nurses, etc. involved to assist the parents and their children in their weight-loss efforts. It is also important to think about the programming and consider if success might be based on focused programming by region and the needs of individuals by region.

While students may have many similar ideas, students may also put together many unique ideas that will benefit others when shared.

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download