1. Chapter 12 Child and Preadolescent Nutrition
Nutrition Through the Life Cycle
Judith E. Brown

2. Definitions of the Life Cycle Stage
Middle childhood—between the ages of 5 and 10 years
Preadolescence—ages 9 to 11 years for girls; ages 10 to 12 years for boys
Both may also be termed “school-age”

3. Tracking Child and Preadolescent Health
Data on U.S. children in 2006
8% lived in extreme poverty (< 50% of poverty)
40% lived in low-income families (<200% poverty)
11.7% had no health insurance
Disparities in nutrition status exist among different races & ethnic groups

4. Tracking Child and Preadolescent Health
Disparities in nutrition status exist among different races & ethnic groups. Prevalence of overweight and obesity is measured by BMI
Hispanic Male children have significantly higher BMIs
Non-Hispanic black female children significantly greater BMIs
African-Americans have higher percentages of total calories from dietary fat.

5. Healthy People 2010
A number of objectives are specific to children’s health and well-being
According to the proposed framework for healthy People 2020, many of the objectives will be retained

6. Normal Growth and Development
Measurement techniques
Growth velocity will slow down during the school-age years
Should continue to monitor growth periodically
Weight and height should be plotted on the appropriate growth chart

7. Normal Growth and Development
2000 CDC growth charts
Tools to monitor the growth of a child for the following parameters
Weight-for-age
Stature-for-age
Body mass index (BMI)-for-age
Can be downloaded from CDC website:

8. Normal Growth and Development
2000 CDC growth charts
Based on data from cycles 2 & 3 of the National Health & Examination Survey (NHES) & the National Health & Nutrition Examination Surveys (NHANES) I, II, & III
WHO Growth References
Available at

9. Normal Growth and Development

10. Physiological Development in School-Age Children
Muscular strength, motor coordination, & stamina increase
In early childhood, body fat reaches a minimum then increases in preparation for adolescent growth spurt
Adiposity rebounds between ages 6 to 6.2 years
Boys have more lean tissue than girls

11. Cognitive Development in School-Age Children
Self-efficacy…the knowledge of what to do and the ability to do it
Change from preoperational period to concrete operations
Develops sense of self
More independent & learn family roles
Peer relationships become important

12. Development of Feeding Skills
 motor coordination & improved feeding skills
Masters use of eating utensils
Involved in food preparation
Complexities of skills  with age
Learning about different foods, simple food prep and basic nutrition facts

13. Eating Behaviors
Parents & older siblings influence food choices in early childhood with peer influences increasing in preadolescence
Parents should be positive role models
Family meal-times should be encouraged
Media has strong influence on food choices

14. Body Image and Excessive Dieting
The mother’s concern of her own weight issues may increase her influence over her daughter’s food intake
Young girls are preoccupied with weight & body size at an early age

15. Body Image and Excessive Dieting
The normal increase in adiposity at this age may be interpreted as the beginning of obesity
Imposing controls & restriction of ”forbidden foods” may increase desire & intake of the foods

16. Energy and Nutrient Needs of School-Age Children
Energy needs vary by activity level & body size
The protein DRI is 0.95 g/kg body wt
Intakes of vitamins & minerals appear adequate for most U.S. children

17. DRI for Iron, Zinc and Calcium for School-Age Children

18. Common Nutrition Problems
Iron deficiency
Less common in children than in toddlers
Although rates are lower, they are still above the 2010 national health objectives
Dietary recommendations to prevent: encourage iron-rich foods
Meat, fish, poultry and fortified cereals
Vitamin C rich foods to help absorption

19. Common Nutrition Problems
Dental caries
Seen in half of children aged 6 to 8
Reduce dental caries by limiting sugary snacks & providing fluoride
Choose fruits, vegetables, and grains
Regular meal and snack times
Rinse (or better yet, brush the teeth) after eating

20. Prevention of Nutrition-Related Disorders
Prevalence of overweight among children is increasing
Data from NHANES I, II, & III suggest weight gain linked to inactivity rather than increases in energy intake
Excessive body weight increases risk of cardiovascular disease & type 2 diabetes mellitus

21. Prevalence of Overweight and Obesity
Definitions:
Overweight = BMI-for-age >95th%
At risk for becoming overweight = BMI-for-age from 85th to 95th%
Overweight more common in Mexican-American males & females and African-American females
Heaviest children are getting heavier

22. Characteristics of Overweight Children
Compared to normal weight peers, overweight children:
Are taller
Have advanced bone ages
Experience earlier sexual maturity
Look older
Are at higher risk for obesity-related chronic diseases

23. Predictors of Childhood Obesity
Age at onset of BMI rebound
Normal increase in BMI after decline
Early BMI rebound, higher BMIs in children later
Home environment
Maternal and/or Parental obesity predictor of childhood obesity

24. Effects of Television Viewing Time
Obesity related to hours of television viewing
Resting energy expenditure decreases while viewing TV
Healthy People 2010 objective:
Increase proportion of children who view 2 hours or less of TV per day from 60% to 75%

25. Television Viewing Time

26. Addressing the Problem of Pediatric Overweight and Obesity
“An ounce of prevention is worth a pound of cure”

27. Prevention and Treatment of Overweight and Obesity
Expert’s recommend a 4-stage approach:
The four stages:
Stage 1: Prevention Plus
Stage 2: Structured Weigh Management (SWM)
Stage 3: Comprehensive Multidisciplinary Intervention (CMI)
Stage 4: Tertiary Care Intervention (reserved for severely obese adolescents)

28. Prevention and Treatment of Overweight and Obesity

29. Prevention and Treatment of Overweight and Obesity
Treatment consists of a multi-component, family-based program consisting of:
Parent training
Dietary counseling/education
Physical activity
Behavioral counseling

30. Nutrition and Prevention of CVD in School-Age Children
Acceptable range for fat is 25% to 35% of energy for ages 4 to 18 year
Include sources of linoleic (omega-6) and alpha-linolenic (omega-3) fatty acids
Limit saturated fats, cholesterol & trans fats

31. Nutrition and Prevention of CVD in School-Age Children
Increase soluble fibers, maintain weight, & include ample physical activity
Diet should emphasize:
Fruits and vegetables
Low-fat dairy products
Whole-grain breads and cereals
Seeds, nuts, fish, and lean meats

32. Dietary Supplements
Supplements not needed for children who eat a varied diet & get ample physical activity
If supplements are given, do not exceed the Dietary Reference Intakes

33. Dietary Recommendations
Iron
Iron-rich foods: meats, fortified breakfast cereals, dry beans, & peas
Fiber
Increase fresh fruits and vegetables, whole grain breads, and cereals
Fat
Decrease saturated fat and trans fatty acids

34. Dietary Recommendations
Calcium & Vitamin D
Bone formation occurs during puberty
Include dairy products and calcium-fortified foods
Vitamin D from exposure to sunlight and vitamin D fortified foods
If lactose intolerant:
Do not completely eliminate dairy products but decrease only to point of tolerance

35. Fluid and Soft Drinks
Preadolescents sweat less during exercise than adolescents & adults
Provide plain water or sports drinks to prevent dehydration
Limit soft drinks because they provide empty calories, displace milk consumption & promote tooth decay

36. Recommended versus Actual Food Intake
Saturated fat—intake is 12.6% of calories (recommend <7%)
Total fat—intake excessive in African American boys & girls & Mexican-American girls
Caffeine—increasing because of soft drink consumption
Fast food—30.3% of children consume fast food each day

37. Other Considerations Cross-cultural Considerations
Healthy People 2010-a major goal-eliminate health disparities among different segments of the population
Health care professionals & teachers should learn about cultural dietary practices

38. Other Considerations Vegetarian Diets
Suggested daily food guides for vegetarians are available
Vegetarian diets should be planned to provide adequate calories, protein, calcium, zinc, iron, omega-3 fatty acids, Vitamin B12, riboflavin and Vitamin D

39. Physical Activity Recommendations
Children should engage in at least 60 minutes of physical activity each day
Parents should set a good example, encourage physical activity, and limit media & computer use
Actual:
Only 7.9% of middle & junior high schools require daily physical activity
Only about 36% of the 5-15 y/o children walk to school & 2% ride a bicycle to school

40. Determinants of Physical Activity
Determinants may include:
Girls are less active than boys
Physical activity decreases with age
Season & climate impact level of physical activity
Physical education classes are decreasing

41. Organized Sports
Participation in organized sports linked to lower incidence of overweight
AAP recommends:
Participation in a variety of activities
Organized sports should not take the place of regular physical activity
Emphasis should be on having fun and on family participation rather than being competitive

42. Organized Sports
Participation in organized sports linked to lower incidence of overweight
AAP recommends:
Use of proper equipment such as mouth guards, pads, helmets, etc.
Prevention of stress or overuse injuries
Awareness of disordered eating & heat injury

43. Nutrition Education
School-age: a prime time for learning about healthy lifestyles
Schools can provide an appropriate environment for nutrition education & learning healthy lifestyles
Education may be knowledge-based nutrition education or behavior based on reducing disease risk

44. Nutrition Education

45. Nutrition Integrity in Schools
All foods available in schools should be consistent with the U.S. Dietary Guidelines & Dietary Reference Intakes
Sound nutrition policies need community & school environment support
Community leaders should support the school’s nutrition policy
The School Health Index (SHI) should be completed & implemented

46. School Health Index

47. Nutrition Intervention for Risk Reduction
Model programs
The National Fruit and Vegetable Program
Formerly “5 A Day” program
Public-private partnership of the CDC and other health organizations
High 5 Alabama
Study to evaluate the effectiveness of a school-based dietary intervention

48. Public Food and Nutrition Programs
Child nutrition programs
Began in 1946
Provide nutritious meals to all children
Reinforce nutrition education
Require schools to develop a wellness policy

49. Public Food and Nutrition Programs
Financial assistance provided by the federal gov’t to schools participating in the National School Lunch Program
Five requirements
Lunches based on nutrition standards
No discrimination between those who can and cannot pay
Operate on a non-profit basis
Programs must be accountable
Must participate in commodity program

50. School Breakfast Program
Authorized in 1966
States may require schools who serve needy populations to provide school breakfast
The NSLP rules apply to the School Breakfast Program
Breakfast must provide ¼ the DRI

51. Other Nutrition Programs
Summer Food Service Program
Provides summer meals to areas with >50% of students from low-income families
Team Nutrition
Provides training, technical assistance, education, or support to promote nutrition in schools