1. Children and Adolescents: Nutrition Issues, Services and Programs Dr. Dina Qahwaji

2. Children and adolescence  Good health is fundamental to growth, development and well-being of all children and adolescence  Protect them from chronic disease as adult  This group is dependent and at high risk of nutritional and health problem Dr. Dina Qahwaji

3. Factors interact to shape food choice in young children  Nutrition attitudes and knowledge of parents and child-care providers  Economic and social status of the family  Birth order of the child  Peers, media and advertising  Source of food (home, day care and fast- foods restaurants) Dr. Dina Qahwaji

4. Healthy People 2010  Objective: understanding and improving health  Through physical activity, nutrition and dental care  Decrease overweight and obesity rate  The proportion of students who participate in physical activity declined from 42% in 1991 to 29% in 1999. And incidence of diabetes as well as overweight & obesity increased Dr. Dina Qahwaji

5. Healthy People 2010 recommended steps  Promote the beginning of behaviour therapy for overweight children before puberty  Educate children and their families about health benefits of PA and weight reduction Dr. Dina Qahwaji

6. Healthy People 2010 recommended steps  Encourage schools for health-promoting ways  Demonstrate to school that regularly PE during the school day can ↑ academic achievement  Develop ways to increase PA among children with disabilities Dr. Dina Qahwaji

7. What are children and adolescence actually eating?  Children are failing to meet recommendation guideline by not consuming enough fruit and vegetables and by eating too much food high in fat and salts  Eating habit is changed since last 2 decade  The USDA’s Centre for Nutrition Policy and Promotion uses the Healthy Eating Index (HEI) as an indicator of diet quality  It provides an overall picture of the variety and quantity of food people choose to eat Dr. Dina Qahwaji

8. What are children and adolescence actually eating?  Effect of family status, children from poor families’ are more likely to have a diet rated as poor or needs improvement  Diet from childhood to adolescence  ↓ dietary quality  ↓ consumption of vegetables, fruits & milk  ↑ consumption of soda drink Dr. Dina Qahwaji

9. A Healthy Eating Report Card for Children aged 2-9 Source: Centre for Nutrition Policy and Promotion, USDA, 2001

10. Childhood Obesity  Eating practices influence a child’s physical growth  During the past 2 decades:  The lack of good nutrition habits and physical inactivity, has lead to an epidemic of overweight children and adolescents  Percentage of overweight children has nearly doubled  Percentage of overweight adolescents has tripled  Associated with chronic diseases, Type 2 diabetes, high blood lipids and hypertension Dr. Dina Qahwaji

11. Childhood obesity and early development of chronic diseases  Overweight children are at risk for CVD, insulin resistance, Type 2 diabetes, and other serious health problems  Overweight children and adolescents more likely to become overweight and obese adults  60% of overweight children shown to have at least one CVD risk factors Dr. Dina Qahwaji

12. Other Nutrition-Related Problems  Under-nutrition  Iron deficiency anaemia  Dental caries  High blood cholesterol Dr. Dina Qahwaji

13. Nutrition standards for child-care programs  Three guiding principles set the tone of the nutrition section of the standards:  Food should help to meet the child’s daily nutritional needs and reflect individual and cultural differences.  A nutrition specialist or food service expert is a central member of the facility’s planning team  To prevent food-borne illness, suitable equipment and food handling are essential Dr. Dina Qahwaji

14. General Recommendations  Meal plans:  ⅓ of RDAs should be met if the child present 4-7 hours per day, ½ - ⅔ of RDAs should be met for a child present 8 hours or more per day.  Meals and snacks with a variety of nutritious.  Attention should be given to cultural food patterns, appetizing colours and qualities. Dr. Dina Qahwaji

15. General Recommendations  Preparation and food service:  Salt, fat and sugar should be kept to a minimum.  Fruits, vegetables and whole-grain foods should be promoted.  Nutrition guidance:  Registered dietitians should employed to review and guide a quality program. Dr. Dina Qahwaji

16. General Recommendations  Nutrition education and training:  Education for children and parents  Parents can serve as instructors and facilitators  Physical and emotional environment:  Positive, enjoyable interaction among children and adults is preferred Dr. Dina Qahwaji

17. Child Nutrition Programs: National School Lunch Program  NSLP is the Nation's second largest food and nutrition assistance program. It operated in over 95,000 public and nonprofit private schools (grades K-12) and provided low-cost or free lunches to over 30 million children daily  Free lunches are available to children in households with incomes at or below 130 % of poverty Dr. Dina Qahwaji

18.  School cafeterias served more than 5 billion lunches, more than half of them free or at a reduced price. The NSLP also provided more than 180 million afterschool snacks in 2007. The cost to USDA of providing lunches and snacks was $8.7 billions  Meals must meet nutritional standards and stay within the budget  Calories must be enough to meet nutritional needs Dr. Dina Qahwaji

19. Child Nutrition Programs: School Breakfast Program  Founded by the Child Nutrition Act of 1966, SBP like NSLP, provides nutritional meals to students at participating schools (and to children in a few housing child care institutions).  Eligible students receive free or reduced-price breakfasts Dr. Dina Qahwaji

20.  The number of schools participating in the SBP ↑ in 1990  Growing by 9% annually between 1989 and 1995  The number of participating schools has continued to increase  In 2007, 79,950 schools participated in the SBP, up from 78,017 in 2006 Dr. Dina Qahwaji

21.  In 1989, 3.7 million students participated in the program on a given school day, and a total of 658 million breakfasts were served  In 2007, 10.1 million students participated in the program daily, 4 % more than the previous year  1.7 billion breakfasts served, 71 % were free and another 10 % were provided at reduced price Dr. Dina Qahwaji

23. Child Nutrition Programs: Child and Adult Care Food Program  CACFP provides meals and snacks to children at family day care homes, child care centers, homeless protects, and after-school programs, and to adults at adult day care centers  In 2007, more than 3 million children and 103,603 adults received CACFP meals and snacks on an average day. Total cost to USDA for CACFP in 2007 was $2.2 billion Dr. Dina Qahwaji

24.  Meals and snacks provided through CACFP important to working parents, improving day care quality and making day care more possible  It give refunds for family child care homes participating in the CACFP, with higher refunds for homes serving primarily low- income children Dr. Dina Qahwaji

25. Child Nutrition Programs: USDA Fruit and Vegetable Program  The Program makes fruit and vegetable snacks available at no cost to all children in participating schools  The program began in 2002 as a pilot program in a small number of schools  It has become a permanent program that was expanded to cover selected schools in all 50 States, as part of the 2008 Farm Bill Dr. Dina Qahwaji

26.  USDA's Economic Research Service evaluated the pilot based on:  Analyses of administrative school records  School reports  Site visits to schools  Focus groups and interviews with school staff and parents Dr. Dina Qahwaji

27.  Most schools participating in the pilot considered the program doing well and strongly supported its continuation  Pilot sites chosen to represent a mix of large and small; rural, suburban, and urban; and elementary, middle, and high schools  Schools included students from different ethnic backgrounds and family income levels, based on the proportion of students qualified as eligible for free and reduced-price lunches Dr. Dina Qahwaji

28. Nutrition Intervention for Risk- Reduction: Model Program  Bright Futures: Aim of Program: To further trusting relationships between the child, health professional, the family, and the community to promote best health for the child  The guideline are developmentally based and address the physical, mental, and social devolvement of children and their families  Nutrition supervision guideline are given for each group, interview, questionnaire, screening, assessment, counselling are provided Dr. Dina Qahwaji

29. Bright Futures  Nutrition is based on:  Nutrition must be added into the lives of infants, children, adolescents, and families  Good nutrition requires balance  An element of joy increase nutrition, health, and well-being Dr. Dina Qahwaji

30. Head Start and Early Head Start US Dept of Health & Human Services  Complete child development programs serving children from  Birth to 5  Pregnant women  Their families  1 million children participate  Nutrition services are part of provision Dr. Dina Qahwaji

31. Head Start and Early Head Start  The overall goals is to increase readiness for school of children from low-income families  Work on education and early childhood development, medical, dental and mental health services, nutrition services and parent education Dr. Dina Qahwaji

32. Food Stamps  USDA Administered  Designed for low income adults to buy food  Average monthly benefit per person was $79 in 2002 which is enough to help family pay for portion of the food they need  It’s now progressing from stamps to electronic cards  Participants in the program is associated with increase intake of number of nutrients Dr. Dina Qahwaji

33. Other federal program  Summer Food Service Program  Provide meal to children from poor area when school is not in session  Federal government provide financial assistance to program where 50% of participants children are from family’s income lower than 185% of the poverty level  Important source of food for many children from food-insecure families Dr. Dina Qahwaji

34. Other federal program  Team Nutrition  USDA’S Food and Nutrition Services  Aim to improve children’s lifelong eating & physical activity level  Partnership of public and private organization interested in improving the health of children Dr. Dina Qahwaji

35. Impact of child nutrition programs on children’s diets  Promoted healthful eating habits and contributed to the quality of children’s overall diets  Have positive effect on children’s consumption of milk, fruit, vegetables and some vitamins and minerals  Improve the quality and nutritional value of school meals Dr. Dina Qahwaji

36. Key points shared by all nutrition and health program  Know and Identify the problem within specific target group  Have good educational background about the target group  To focus on health problem’s related behaviour to be change  Chose most suitable way to help change the behaviour to protect or by reducing health problem