Childhood & Adolescent Nutrition

185 Pages·2012·2.28 MB·English

Childhood & Adolescent Nutrition
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Childhood &
Adolescent Nutrition
8th edition • Revised March 2010
by Kala Shipley, ,
rd ld
Accredited Continuing Professional Education Course
7950 Jones Branch Drive, 7th Floor, McLean, VA 22107
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Childhood & Adolescent Nutrition
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Childhood &
Adolescent Nutrition
8th Edition • Revised March 2010
By Kala Shipley, ,
rd ld
Contains material written by Susan Magrann, MS, RD, and published in previous editions of this course.
About the author:
Kala Shipley, rd, ld is a registered dietitian and has over 15 years of experience providing nutri-
tion education to families of young children at WIC clinics and Head Start classrooms, as well
as providing technical assistance as a community health consultant with the state WIC Program
and the Iowa Nutrition Network. She has also provided program planning for communities in
the areas of child welfare and early childhood health and education. Currently employed as the
executive officer for the health promotion unit at the Iowa Department of Public Health, Kala
serves as the education liaison to the Iowans Fit for Life program. Education: Dietetic Intern-
ship, University of Iowa Hospitals and Clinics; BA University of Iowa.
Important - Read Before Proceeding
EXPIRATION DATE: Students of all professions must submit this course for credit no later than
December 31, 2015. Credit will not be awarded for this course after that date.
Course Code: RD69, CHES69, FIT69, AT69
This course approved for RD,
DTR ................................8 CPEU
CDM .................8 Clock Hours
CHES ............................8 CECH
ACE ...............................0.9 CEC
NATABOC ....................7 CEU
ABMP ...............................9 CEU
NSCA-CC ...................0.9 CEU
ACSM .............................9 CEU*
*equivalent to ACE CECs
Editing/proofreading: Dale Ames Kline, Gwen Hulbert
Design/Production: Knotwork Graphic Design & Typesetting
© 1989-2010 OnCourse Learning Corporation
No part of this course may be reproduced, duplicated or copied in any way without the written permission of
the copyright holder. (See note on Page ii)
ii
Childhood & Adolescent Nutrition
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iii
Childhood & Adolescent Nutrition
Contents
1 Introduction Nutrition Objectives for the Year 2010
Defining terms
7 Chapter One: Growth and Development
Changes in weight, height, stature and body composition • Skeletal maturity
13 Chapter Two: Identifying Potential Problems
Dietary assessment • Exercise: Determining BMI
19 Chapter Three: Nutritional Assessment
Nutrients at risk • Social indicators
27 Chapter Four: Food Choices and Menu Planning
The Food Guide Pyramid • Planning healthy meals
What American children are eating • Vitamin and Mineral Supplements
39 Chapter Five: Eating Behaviors
Creating a positive environment /Emotional and social factors
Food "jags" • Adolescent food choices • Family meals
47 Chapter Six: Cholesterol and Children
Measuring cholesterol • Lowering cholesterol • The population approach
The individual approach • Genetic factors • Cholesterol testing
Cholesterol-lowering medications
65 Chapter Seven: Obesity, Overweight and Eating Disorders
Health risk • Health factors related to obesity • Obesity into adulthood
Treating overweight children • Setting goals • Expert committee recommendations
Eating disorders: anorexia, bulimia, binge eating disorder, "orthorexia"
87 Chapter Eight: Food Allergies and Sensitivities
Defining and diagnosing food allergies • The allergic reaction
Treatment • Prevention of food allergies
103 Chapter Nine: Hyperactivity
The Feingold Diet • Biochemical and environmental factors
Treatment • Sugar
111 Chapter Ten: Comprehensive School Nutrition Programs
School food service programs • Other foods on campus
School-based nutrition education
125 Chapter Eleven: Food Choices for Children
TV and Food Choices • Dietary "bad guys" • Fast foods
Fat, cholesterol and sugar traps • Healthier fast food selections
135 Chapter Twelve: Young Athletes and Nutrition
Protein needs • Supplements and ergogenic aids • Weight gain and loss
Pre-exercise meal • Fluids • Glycogen loading • Post-event meals
145 Chapter Thirteen: Dental Health
Tooth development • Dental Caries Prevention • Fluoride
153 Appendices
• Growth Charts • Dietary Guidelines for Americans-2005
• Calcium Contents of Foods & Supplements • Vitamin & Mineral Supplements
• Triceps Skinfolds Percentiles • Diagnostic Criteria for ADHD
• Obesity Treatment Guidelines • Popular Selections at Fast Food Restaurants
• DRI and RDA for Children and Adolescents • Healthier Selections at Fast Food Restaurants
• Food Frequency Form
175 Examination
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Childhood & Adolescent Nutrition
Learning Objectives
Upon successful completion of the course, the student will be able to:
1. Describe the nutrition guidelines for healthy eating for children and adolescents and how
growth and development are assessed.
2. Identify environmental, cultural, socio-economic and family influences for the prevention of
childhood overweight.
3. Understand current legislation that influences the school meals program and how this program
can improve the health and academic success of students.
4. State pros and cons of vitamin/mineral supplements for children and adolescents.
5. Define food allergies and discuss methods of diagnosing and treating.
6. State scientifically documented relationships between hyperactivity and food; psychoses/behav-
ior and food; and performance/learning abilities and food.
7. State why nutritional counseling and intervention strategies should be targeted at the teen him/
herself rather than the parents.
8. State three areas of concern regarding nutrition in adolescent athletes and state how to evaluate
the diet for adequacy.
9. Describe the following nutrition-related problems and list how to treat or prevent: nutritional
anemias, obesity, anorexia and bulimia.
10. State the nutrition problems related to fast food consumption and list three optimal meal
choices to minimize these problems.
11. Describe food jags, at what ages they usually occur, and how parents can best handle them.
12. Describe the influence television has on children’s food choices and recommend two ways for
parents to cope with it.
13. Discuss the ramifications of high serum cholesterol in children, including etiology of athero-
sclerosis, risk assessment and measuring techniques, and treatment modalities.
14. Discuss how nutrition affects dental health.
Childhood & Adolescent Nutrition 1
Introduction
T
his course is designed to increase knowledge, confidence and competence in
handling nutrition problems of children and teenagers. It provides tools to identify
nutrition problems and how to handle them, such as height and weight charts, and
guidelines for types and amounts of food necessary for health and growth.
Most importantly, this course is designed to give practitioners a sense of inspira-
tion about the teenagers and children with whom they work in the area of nutrition.
Practitioners working with children and adolescents face some big challenges — the
intention of this course is to help you feel that you can make a difference.
The US Department of Health and Human Services (DHHS) has defined several
objectives related to nutrition in children and adolescents (Healthy People 2020, 1990;
Splett and Story, 1991). In 1990, DHHS released Healthy People 2000 which listed health
objectives for Americans. In 2000, these objectives were revised and released as Healthy
People 2010, most recently revised to Healthy People 2020. It is critical that health care
professionals, parents, teachers and all school personnel are committed to accomplish-
ing the nutrition and overweight objectives listed in Healthy People 2020.
The nutrition and physical activity objectives related to children and adolescents
are:
Nutrition:
• NWS-1: Increase the number of States with nutrition standards for foods and
beverages provided to preschool-aged children in child care.
• NWS-2: Increase the proportion of schools that offer nutritious foods and bever-
ages outside of school meals.
• NWS-5: Increase the proportion of primary care physicians who regularly mea-
sure the body mass index (BMI) in the patients.
• NWS-10: Reduce the proportion of children and adolescents considered obese.
Childhood & Adolescent Nutrition 2
• NWS-11: Prevent inappropriate weight gain in youth and adults.
• NWS-12: Eliminate very low food security among children.
• NWS-14: Increase the proportion of fruit in the diets of the population aged 2
years and older.
• NWS-15: Increase the contribution of total vegetables to the diets of population
aged 2 years and older.
• NWS-16: Increase the contribution of whole grains to the diets of population
aged 2 years and older.
• NWS-17: Reduce the consumption of calories from solids fats and added sugars
in the population aged 2 years and older.
• NWS-18: Reduce the consumption of saturated fat in the population aged 2 years
and older.
• NWS-19: Reduce the consumption of sodium in the population aged 2 years and
older.
• NWS-20: Increase consumption of calcium in the population aged 2 years and
older.
• NWS-21: Reduce iron deficiency among young children and females of child-
bearing age.
Physical Activity:
• PA-3: Increase the proportion of adolescents who meet current Federal physical
activity guidelines for aerobic activity and for muscle-strengthening activity.
• PA-4: Increase the proportion of the Nation's public and private schools that
require daily physical education for all students.
• PA-5: Increase the proportion of adolescents who participate in daily school
physical education.
• PA-6: Increase regularly scheduled elementary school recess in the US.
• PA-7: Increase the proportion of school districts that require or recommend
elementary school recess for an appropriate period of time.
• PA-8: Increase the proportion of children and adolescents who do not exceed
recommended limits for screen time.
• PA-9: Increase the number of States with licencing regulations for physical
activity provided in child care.
• PA-10: Increase the proportion of the Nation's public and private schools that
provide access to their physical activity spaces and facilities for all periods
outside of normal school hours (that is, before and after the school day, on
weekends, and during summer and other vacation.).
• PA-13: Increase the proportion of trips made by walking.
• PA-14: Increase the proportion of trips made by bicycling.
• PA-15: Increase legislative policies for the built environment that enhance access
and availability of physical activity opportunities.
Childhood & Adolescent Nutrition 3
It will take parents, schools, health professionals and communities working to-
gether as a team to achieve the targets set in Health People 2020.
The nutritional health of our nation’s children is the basis of our nation’s future
public health. It will impact how many people will be diagnosed with chronic disease or
die of heart attacks or strokes in the future, reduce their quality of life and their ability
to work and produce healthy future generations.
An investment of time, planning, reserves, programming and care will provide
significant dividends now and in the next century. With this in mind, most of the above
goals have been addressed in this course, to further support you in your work toward
the national nutrition objectives.
In order to better assess and understand the needs of children, it is important to
have a clear understanding of the various periods of childhood. These distinct periods
are defined in the chart on the following page. Note that, as children move into the
school years, there’s an age distinction between females and males. Males actually begin
to develop two years later than females. The school years for boys are between age 6
and 12, versus 6 to 10 years for girls. The distinction continues through the periods of
adolescence. This is important to keep in mind when dealing with children’s nutritional
and dietary problems. Boys and girls are not all on the same track.
First, we’ll look at growth and development patterns in kids. Knowing how chil-
dren change in terms of weight, height, body composition, skeletal maturation and
brain growth at certain ages provides a good basis for understanding nutrition needs
and problems.
To do this, the distinctions between growth and development will be specified.
Growth is the increase in physical size of the body or any of its parts. Development, in
contrast, is all the remaining changes that go on, both in maturation and function.
Periods of Childhood
INFANCY – Birth to 2 years
CHILDHOOD – Female: 2 to 10 years Male: 2 to 12 years
Preschool Years: Female: 2 to 6 years
Male: 2 to 6 years
School Years: Female: 6 to 10 years
Male: 6 to 12 years
ADOLESCENCE – Female: 10 to 18 years Male: 12 to 20 years
Prepubescence: Female: 10 to 12 years
Male: 12 to 14 years
Pubescence: Female: 12 to 14 years
Male: 14 to 16 years
Postpubescence: Female: 14 to 18 years
Male: 16 to 20 years
Childhood & Adolescent Nutrition 4
There are three phases of growth:
• Hyperplasia is an increase in cell number. Organ systems go through this fairly
consistently when they’re growing.
• Hyperplasia and hypertrophy is usually the next step; it is an increase in both
cell size and cell number.
• Hypertrophy, the final stage, is an increase in cell size only — the organism is
growing by increasing the size of its cells, not creating new cells.
Logically, which of these is the most critical time when a nutritional deficiency is
the most dangerous to the organism? The answer is, during hyperplasia, when the cells
are actually being created. This is true particularly in the brain. About 2 to 3 months
before birth, when the glial cells (components of the central and peripheral nervous
system) are being formed, may be one of the only times when a nutrition deficit causes
permanent damage and can’t be made up later. From that time until about 2 years of
age, both hyperplasia and hypertrophy are seen. After age 2 to 3, we see no more in-
creases in cell number; growth occurs due to hypertrophy alone.
Compare that to what goes on in fat tissue, or the adipose organ in the body. Up to
about 2 to 3 months before a child is born, fat cells grow in number (hyperplasia) alone.
Then there’s a phase where fat increases by hyperplasia and hypertrophy — the child
creates fat cells all the way up to about age 2.
From then on, the child increases the size of the fat organ mainly by increasing the
size of the fat cells (hypertrophy). Typically, children don’t create new cells until the
adolescent growth spurt, when hyperplasia and hypertrophy occur again. After that, in
the postpubescent period, fat cell size is the main way that fat in the body increases. In
this respect adipose tissue is distinct from other organs.
Debate and research on fat cells continues. New theories hold that if calorie con-
sumption is high enough, human beings, even after pubescence, can increase the num-
ber of fat cells indefinitely through adulthood. The issue is not yet resolved.
There are four factors that influence growth and development: genetics, hormones,
environment (specifically nutrition) and behavior.
Some may argue for genetics, but until proven otherwise, nutrition is the number one
influence, thought to be most critical in growth and development.
As evidence of the relative importance of genetic heritage and environment, con-
sider what happens when Japanese families move to America. When they arrive, Japa-
nese children are usually below our national norms for height and weight. After two or
three generations in the United States, the Japanese-American population approximates
the national norms. Why? Obviously it is more than just genetics. They are consuming
an increased amount of calories, protein and calcium.
Something that is often considered genetic, such as height, may be influenced by
environmental factors like nutrition. If we consider genetic heritage as potential — as a
general population tendency — and environment as actual —an individual application,
we come closer to understanding the proper influence of these factors.
Childhood & Adolescent Nutrition 5
That’s why infant and childhood nutrition is so important, and why any significant
deviation from normal growth or development should be a signal to look at the child’s
nutritional status.
Whether you are a health care professional, school food service worker, fitness
professional, nutritionist — or simply an interested parent, consider what this course
has to say about children and nutrition and apply it to your own daily experiences.
Children are human beings, and because we want them to become the best people they
can be, we need to respect their individuality.
In today’s changing health care environment, dental professionals often are the
most continuously involved professional in a child's life and a chapter on dental
health is included. Accordingly, they can and should play a proactive role in children’s
health and nutrition. We hope dental professionals taking this course will be encour-
aged to study nutrition and intervene whenever appropriate.
Growth and Development
GROWTH
• Increase in physical size
-- increasing cell number
-- increasing cell size
DEVELOPMENT
• Changes that occur during maturation
-- cell differentiation
-- maturation of individual organ systems
THREE PHASES OF GROWTH
• Hyperplasia
-- increase in cell number
• Hypertrophy
-- increase in cell size
• Hyperplasia and Hypertrophy
R
EFERENCES
__________Healthy People 2010: National Health Promotion and Disease Prevention, US Dept. of Health
and Human Services, Public Health Services, Washington DC, 2010 www.healthlypeople.gov/
2020/default.aspx
Splett PL and Story M. Child Nutrition: Objectives for the decade. J Am Diet Assoc, 91(6): 665-668, 1991.