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
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
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
Notas del editor
Credit:DR M.A. ANSARY/SCIENCE PHOTO LIBRARYCaption: Teenager eating fast food. Teenage girl eating a beefburger in a shopping precinct.