The week 4 signature Diet Analysis assignment has been designed for you to analyze and assess your own diet using the US Dietary Guidelines for Americans.
dream86
PPTS_CH09.pptxChapter 9 Nutrition in Childhood and Adolescence
Nutrition in Childhood and Adolescence
A small number of U.S. children eat the recommended amount from Food Guide Pyramid for grains, fruits, vegetables, dairy products, and meat or meat alternatives.
Majority consume high calorie-dense snacks and meals, added sugars, and larger portion sizes.
Total fat, saturated fat, and sodium intake are above recommended levels.
They consume large amounts of beverages high in added sugars (soft drinks and fruit drinks).
Nutrition Status of Children and Adolescents in the United States Continued
Healthy People 2010’s (HP) goal is to increase the proportion of adolescents who participate in daily school physical education to 50 percent.
To increase the proportion of adolescents who engage in moderate physical activity (> 30 minutes on > 5 days of the previous 7) and activity that promotes cardiorespiratory fitness three days per week.
Growth and Physical Development and Assessment: Physical growth slows down during the preschool and school years until the pubertal growth spurt of adolescence.
Nutrition Status of Children and Adolescents in the United States Continued
Growth and Physical Development Continued
By age 2, children quadruple their birth weight.
They gain an average of four and a half to six and a half pounds (2 to 3 kg) per year between the ages of 2 and 5.
Between these ages, children grow 2 1/2 to 3 1/2 inches (6 to 8 cm) in height per year.
A 1-year-old child has several teeth and digestive and metabolic systems are functioning at or near adult capability.
Nutrition Status of Children and Adolescents in the United States Continued
Eating behaviors of toddlers include:
Feeding themselves independently during the second year of life.
Using a cup, with some spilling, at 15 months.
Two-year-olds prefer fingers foods.
Playing with food and refusing any help.
Toddlers tend to be apprehensive of new foods offers about 15 times.
They are curious about new foods, but may be reluctant to try them.
See Table 9-1 for Food Guide for Toddlers and Preschoolers.
Nutrition Status of Children and Adolescents in the United States Continued
Using Surveys to Monitor Nutrient Intake: Healthy Eating Index (HEI) represents different aspects of a healthful diet.
It provides an overall picture of the type and quality of foods people eat.
Their compliance with specific dietary recommendations, and the variety in their diets.
Children ages 2 to 3 mean score for fruits and vegetables was significantly higher compared with older children's scores.
Nutrition-Related Concerns During Childhood and Adolescence
Iron Deficiency Anemia: Many iron-deficient children come from low-income families with poor diets.
Cultural traditions and lack of nutrition knowledge for iron requirements are factors that contribute to iron deficiencies.
Iron deficiency is defined as:
Absent bone marrow iron stores
An increase in hemoglobin concentration
< 1.0g/dl after treatment with iron
Nutrition-Related Concerns During Childhood and Adolescence Continued
Iron Deficiency Anemia Continued
Other abnormal laboratory values, such as serum ferritin concentration
Children 1 to 2 years of age are diagnosed with anemia if:
Hemoglobin concentrations were < 11.0 g/dl and hematocrit < 32.9 percent.
Children ages 2 to 5 years, a hemoglobin value of 11.1 g/dl or hematocrit of 33.0 percent.
Low blood iron levels affect the child’s resistance to disease, attention span, behavior, and intellectual performance.
Nutrition-Related Concerns During Childhood and Adolescence Continued
Lead Poisoning can cause iron deficiency, and an iron deficiency can impair the body’s ability to prevent lead absorption.
Satisfactory calcium intake may slow lead’s absorption or interfere with its toxicity.
Lead poisoning is common among children under age six and can cause:
learning disabilities and behavior problems
slow growth
brain damage and central nervous system damage
Nutrition-Related Concerns During Childhood and Adolescence Continued
Strategies for preventing lead poisoning include providing:
nutritious foods
screening children for lead poisoning
preventing children from eating non-food items
avoiding water-containing lead and preventing children from putting dirty or old painted objects in their mouths
Nutrition-Related Concerns During Childhood and Adolescence Continued
Dental Caries: About 1 in 5 children ages 2 to 4 years has decay in the primary or permanent teeth.
Suggestions for reducing dental caries:
Brush teeth to remove carbohydrates from the teeth.
Rinse the child’s mouth with water.
Use fluoridated water.
Give crunchy foods such as carrot sticks and apple slices for a snack (less likely to promote tooth decay than sticky candies or raisins).
Nutrition-Related Concerns During Childhood and Adolescence Continued
Overweight and Obesity: Overweight and obesity is the accumulation of excess body fat.
Body Mass Index (BMI) between 85th and 95th percentile for age and sex is considered at risk for overweight.
BMI at or above the 95th percentile is considered overweight or obese.
Nutrition-Related Concerns During Childhood and Adolescence Continued
Factors that contribute to obesity in children and adolescents include:
the amount of television viewing
inactivity and sedentary lifestyle
genetic factors
environmental factors
cultural environment seem to play major roles in the prevalence of obesity worldwide
medical causes such as hypothyroidism and growth hormone deficiency
Nutrition-Related Concerns During Childhood and Adolescence Continued
Medical Problems Related to Childhood Obesity: Common medical problems in obese children and adolescents are hypercholesterolemia, dyslipidemia, and hypertension and can affect cardiovascular health.
The endocrine system (hyperinsulinism, insulin resistance, impaired glucose tolerance, type 2 diabetes mellitus, and menstrual irregularity)
Mental health (depression, and low self-esteem)
Some children may develop sleep apnea, liver and gall bladder diseases, osteoporosis, and some cancers
Nutrition-Related Concerns During Childhood and Adolescence Continued
Dealing with Overweight and Obesity: Childhood eating and exercise habits can be modified more easily than adult habits.
Focus on parents’ knowledge of nutrition.
Parental education should include information about low-fat foods, good physical activities, and monitoring of television viewing.
Nutrition-Related Concerns During Childhood and Adolescence Continued
High Blood Cholesterol: Atherosclerosis is a progressive, complex disease that often begins in childhood and adolescence.
Atherosclerosis is related to high serum total cholesterol levels, low-density lipoprotein, very low-density lipoprotein, and high-density lipoprotein levels.
Children and adolescents with elevated LDL-cholesterol levels, often have family members with high incidence of coronary heart disease.
Dieting Behavior and Abnormal Eating: 95 percent of individuals diagnosed with clinical eating disorders are female.
Nutrition-Related Concerns During Childhood and Adolescence Continued
Dieting Behavior and Abnormal Eating Continued
It is estimated that 0.5-1 percent of the general population suffers from anorexia, 2 percent from bulimia nervosa, and 2 percent from binge eating disorders.
Factors contributing to eating disorders:
Sociocultural pressures
Onset of bulimia nervosa usually follows a period of dieting to lose weight
Dietary restraint may contribute to bulimia
Nutrition-Related Concerns During Childhood and Adolescence Continued Criteria for Eating Disorders
Anorexia nervosa
BMI of less than 17.5 kg/m2 in adults
Intense fear of gaining weight, and absence of anorexia nervosa
Amenorrhea for postmenarchal female
Disturbance in the way in which body size or weight is perceived
Bulimia nervosa
Recurrent episodes of binge eating
Recurrent purging behavior
Too much exercise or fasting
Self-evaluation overly influenced by body shape and weight
Nutrition-Related Concerns During Childhood and Adolescence Continued
Provisional criteria for binge eating:
Recurrent episodes of at least three behavioral and attitudinal characteristics, such as:
Eating large amounts when not physically hungry
Feeling disgusted or guilty after overeating
Eating much more rapidly than normal
Occurs on average at least 2 days a week for 6 months
Regular use of purging, fasting, and too much exercise
Malnutrition in Children
Malnutrition and hunger are responsible for nearly half of the deaths of preschool children throughout the world.
Deficiencies in vitamin A, zinc, iron, and protein results in illness, stunted growth, and limited development, and in the case of vitamin A, possibly permanent blindness.
Malnutrition in Children Continued
Malnutrition includes undernutrition, which means not consuming enough nutrients, and overnutrition, which includes excessive consumption of any particular nutrient.
Children, mainly infants and those under 5 years of age are at an increased risk for undernutrition due to increased need of energy and nutrients.
Malnutrition in Children Continued
Protein-Energy Malnutrition (PEM) occurs throughout the life cycle, but it is more common during infancy/childhood.
PEM is classified into two parts:
Primary
Secondary
In most cases, PEM is caused by a combination of both.
Malnutrition in Children Continued Primary
Biological
Maternal malnutrition prior to or during pregnancy and lactation
Genetic factors
Sociological
Poverty
Unavailability of food
Ecological
Disasters leading to famine
Profound social inequalities either at the individual level (discrimination, refugees, prisoners) or at the community or country level
Malnutrition in Children Continued Secondary
Biological conditions that interfere with food intake
Congenital anomalies (e.g., cleft lip)
Gastrointestinal problems that may cause malabsorption of nutrients (e.g., tropical sprue)
Genetic factors (e.g., phenylketonuria)
Biological conditions that increase energy and nutrients needs
AIDS
All infectious diseases accompanied with fever
Malnutrition in Children Continued
Secondary Continued
Other diseases that increase catabolism (e.g., tuberculosis)
Social causes
Lack of education
Inadequate weaning practices
Child abuse
Alcoholism and other drug addictions
Malnutrition in Children Continued
The Prevalence and Effect of Malnutrition in Children in the United States: About 13 million children live in families with incomes below the federal poverty level.
About 20 percent of children under 6 years old live in poor families.
Approximately 17.8 percent of the children 6 years or older live in poor families.
About 15.6 percent of households with children under 6 years old were food-insecure.
Children and Adolescents with Special Healthcare Needs/Childhood Disability
The prevalence of childhood disability is increasing: about 7–18 percent of children and adolescents ages birth to 18 years in the United States have a chronic physical, behavioral, developmental, or emotional condition.
There are various causes of developmental disabilities and special healthcare needs are comprehensive.
Children and Adolescents with Special Healthcare Needs/Childhood Disability Continued
They may have physical impairments, developmental delays, or chronic medical conditions that are caused by or related with these factors:
Genetic conditions (diabetes, sickle cell anemia, etc.)
Congenital infections
Inborn errors of metabolism (phenylketouria, lactose intolerance, galactosemia, etc.)
Prematurity
Neural tube defects
Maternal substance abuse
Environmental toxins (lead mercury, etc.)
Children and Adolescents with Special Healthcare Needs/Childhood Disability Continued
Nutrition risk factors may be physical, biochemical, psychological, or environmental in nature.
Physical conditions such as a cleft lip or palate.
Biochemical conditions such as:
A disease process such as galactosemia may limit an individual’s ability to feed, digest, or absorb food.
Drug nutrient interactions may alter digestion, absorption or the bioavailability of nutrients from the diet.
Children and Adolescents with Special Healthcare Needs/Childhood Disability Continued
Psychological conditions such as depression or stress that may alter an individual’s appetite and motivation to follow a specified diet plan.
Environmental factors such as:
Family and social support
Finances
To receive the nutrition benefits, the child must have a diet prescription from a physician.The prescription must include:
A statement identifying the disability and how the disability affects the adolescent’s diet.
Children and Adolescents with Special Healthcare Needs/Childhood Disability Continued
The prescription must include (continued):
A statement identifying the major life activity affected by the disability.
A specific list of dietary changes, modifications, or substitutions required for the diet.
The Effect of Television on Children’s Eating Habits
Children watch an average of 3 hours of advertisements per week and 19,000 to 22,000 commercials over a 1-year period.
Children from families with high-television use consume an average:
6 percent more of their total daily energy intake from meats
5 percent more from pizza, salty snacks, and soda
About 5 percent less of their energy intake from fruits, vegetables, and juices than children from families with low-television use
Nutrition During Childhood and Adolescence
Nutrients most likely to be low or deficient are calcium, iron, zinc, vitamin B6, and vitamin A.
Children living in poor families are more likely to consume diets that are low in calories; vitamins A, C, E, and B6, folate, iron, zinc, thiamin, and magnesium.
Growth and Development during puberty:
Height and weight increase.
Many organ systems enlarge.
Increase in lean body mass and changes in the distribution of fat.
Nutrition During Childhood and Adolescence Continued
Growth and Development Continued
Normally, growth spurts begin between ages 10.5 and 11 for girls, and peak at about 12 years of age.
Boys’ growth spurts start between 12.5 and 13 and peak at about age 14. This spurt lasts about two years.
The most rapid linear growth spurt for an average boy occurs between 12 and 15 years of age.
Nutrition During Childhood and Adolescence Continued
During adolescence:
Boys gain more weight than girls.
Boys experience greater increases in lean body mass.
Girls accumulate more body fat.
Specifically around the hips and buttocks, upper arms, breasts, and upper back.
Nutrition During Childhood and Adolescence Continued
Adolescent Eating Behaviors are not static; they fluctuate throughout adolescence.
They may use foods to establish individuality and to express their identity.
Experimentation may lead to certain eating behaviors such as skipping meals.
Breakfast is the most-skipped meal.
Reasons for their change in eating habits.
Spending less time with family and more time with their peer group.
Nutrition During Childhood and Adolescence Continued
They eat more meals and snacks away from home, including many fast foods high in fat and calories.
The average teenager eats at fast food restaurants twice a week.
Fast-food visits account for 31 percent of all food eaten away from home and make up 83 percent of their visits to restaurants.
Food and Nutrition Programs for Children and Adolescents
National School Lunch Program was established in 1946 and is under the direction of the USDA.
Children at or below 130 percent poverty level are eligible for a free lunch.
School Breakfast Program began as a pilot project in 1966 and was made permanent in 1975.
Special Milk Program was established in 1955 by USDA.
Summer Food Service was established in 1975 after a pilot program in 1968.
Food and Nutrition Programs for Children and Adolescents
Team Nutrition Program started in 1995 by USDA.
To “improve the health and education of children through better nutrition.”
Head Start was established in 1965 program for children between the ages of 3 and 5 for low-income families.
Provides education, health services (medical, nutritional, dental, and mental health), and social services.
National Youth Sports Program (NYSP) is a federal program designed to assist low-income children ages 10 to 16 in a summer program.
Challenges to Implementing Quality School Nutrition Programs
School meals face a variety of challenges:
Students’ preferences for fast foods, soft drinks, and salty snacks
Mixed messages sent by school personnel
School food preparation and serving space limitations
Inadequate meal periods
Lack of education standards for school food service directors
Challenges to Implementing Quality School Nutrition Programs Continued
Promoting Successful Programs in Schools: Encouraging healthful behaviors may be achieved through implementation of a Coordinated School Health Program (CSHP).
A CSHP would combine health education, disease prevention, health promotion, and access to health and social services in an integrated comprehensive manner.
Successful Community Strategies
As a pilot project for the San Francisco Unified School District (SFUSD), Aptos Middle School made changes in its vending and à la carte food service programs.
The purpose of the project was to establish nutrition standards for competitive foods.
The principal, a physical education program, and a group of parents, teachers, and volunteers initiated the change in the food service program.
This group met electronically (via e-mail) to share concerns and data and to attain a consensus.
Successful Community Strategies Continued
Changes instituted included:
Removed soft drinks from the vending machines located in the physical education department and replaced with bottled water.
Fruit options for students were expanded beyond apples, oranges, and bananas to include kiwifruit, grapes, strawberries, and melons.
Jicama, raw broccoli, spinach, and romaine lettuce were available for salads.
Soft drinks were removed from the à la carte line in the cafeteria and replaced with water, milk, and 100-percent juice (no more than 12 ounces per serving)..
Successful Community Strategies Continued
High-fat foods, such as French fries and nachos, were removed from cafeteria meals.
High-fat/high-sugar foods were removed from the à la carte line and replaced with fresh, healthier options and more appropriate portion sizes.
The new food options included turkey sandwiches, sushi, homemade soup, salads, and baked chicken with rice.
Vending machines, and any other food sold outside cafeterias adhered to these standards.
Topics for Discussion
What are the nutrients most likely to be deficient in school-age children and adolescence?
What are the causes of PEM?
What are the nutrition-related risk factors for children and adolescents with special healthcare needs?
What are some of the challenges facing school meal programs?
What are the eating behaviors of adolescents and toddlers?
What are the contributing factors to eating disorders and the difference between bulimia and anorexia nervosa?
