Infancy, Childhood, and Adolescence

Chapter 11:

Infancy, Childhood,

and AdolescenceJ Pistack MS/Ed

GrowthInfants usually double their

weight by 4-6 monthsThey triple their weight by 1 year

Development Development - changing from a

simple to more complex organismA psychological development is

trust – need consistent handling Failure to thrive (FTT) term of

inadequate growth

Nutritional Needs of the Term InfantThe American Academy of

Pediatrics recommends exclusive breastfeeding the first 6 months of life◦Prevents against infectious disease◦Decreases allergic responses◦May decrease chances for later

obesity◦Infants are often developmentally

ready for complementary foods at 4 to 6 months of age

Nutritional Advantages of Breast MilkInfection-fighting agents—

immunoglobulin A (IgA) and leukocytes

Allergy prevention—correct proteins, which are hydrolyzed that are less likely cause allergic response◦An infant can absorb whole proteins

but that is what causes the allergic reaction

Obesity—evidence suggest decreased obesity later in breastfed infants

Formula-Fed InfantsBreastfeeding may not be

possible for all mothersFormulas are regulated in the

United StatesDo contain more protein than

breast milkCome in many concentrations—

powder, mix, ready to feed

Formula PreparationsDirections for preparing the formula

◦Cleanliness/sterility of equipment◦Water to use for dilution

Sterility Fluoride content Possible lead contamination Safe storage Use of correct strength formula Safe heating of the formula before feeding the

infant

Discard prepared bottles of formula that are unrefrigerated for 1 hour or partially consumed

Soy Protein FormulasFree of cow’s milk protein and lactose and

iron-fortifiedThe American Academy of Pediatrics

recommends using soy protein–based formulas in term infants for:◦Galactosemia and hereditary lactase deficiency

- disease in which the transformation of galactose to glucose is blocked, allowing galactose to increase to toxic levels in the body.

◦Those whose parents desire a vegetarian diet◦Secondary lactose intolerance following acute

gastroenteritis

Soy Formulas (Continued)The Academy does not

recommend soy protein–based formula under the following circumstances:◦Preterm infants◦Cow’s milk allergy◦Routine treatment of colic◦Healthy or high-risk infants to

prevent atopic disease

Providing Nutrition to Preterm Infants Human milk from the infant’s

mother is the gold standard Special formulas for premature

infants May need calcium, phosphorus,

and sodium supplements Greater risk for iron deficient

anemia due to smaller iron stores—may need iron supplementation

Necrotizing Enterocolitis (NEC)The most serious gastrointestinal

disorder of neonates Acquired injury to the bowelInflammatory bowel disease

results in inflammation and bacterial colonization of the bowel wall

Causes significant morbidity and mortality in preterm infants

Nutritional Problems in InfancyColic: cause unknown, spasms of

colon, “Rule of 3”—crying 3 hours/day, 3 days/week, 3 weeks

Diarrhea: rotavirus, enteritis, or food intolerance—more than three watery stools per day; hydration is key; monitor signs and symptoms of dehydration

Allergies: hypersensitivity to a food; some severe; treatment is avoidance of allergen

Food Allergies in InfancyMost common protein foods:

milk, eggs, peanuts, tree nuts, fish, crustacean shellfish, soy, wheat

Diagnosis: allow time between food introduction to locate source

Anaphylactic reactions to food (e.g., peanuts)— emergency!

Nutrition of the Toddler (1–3 Years Old)Foods not recommended until after

age 1; gradually introduce if allergies are not a concern

Foods include:◦Unmodified cow’s milk◦Egg white◦Wheat◦Citrus fruits ◦Seafood◦Chocolate◦Nut butters

Nutrition of Preschool Child (3–6 Years Old)Adequate dentition and good

nutrition are mutually supportive The American Dietetic

Association has addressed meeting children’s nutrition and nutrition education needs while in child care

Child Care RecommendationsEight hours or less: should be

offered one meal and two snacks or two snacks and one meal

Eight or more hours: offer two meals and two snacks or three snacks and one meal

Serve fruits and vegetables high in vitamin C daily

High in vitamin A at least three times a week

Child Care Recommendations (Continued)Caregivers should not add extra

salt or sugar to foodGood institutional food

management practices should be implemented◦Good hand washing◦Adequate refrigeration◦Proper storage of supplies

Nutrition of School-Age Child(6–12 Years Old)A balanced diet suitable for

healthy adults will also be good for a school-age child

Exercise can help growth and development by stimulating osteoblasts and expending energy to control weight

Nutrition in AdolescenceDo not meet the daily recommendation for

fruits, vegetables, and whole grainsExceed the daily recommended amount of

sodiumDrink more full-calorie soda per day than

milk (Centers for Disease Control and Prevention, 2013)

Peak growth spurt is known to take place between ages 10 ~14 for girls and 12~16 for boys

During the peak growth spurt, the mineral and protein content of the body is increased so healthy nutrition intake is important

Concerns Regarding Adolescent NutritionDiet lacks calcium and iron—

some correlation to fractures in this age-group

Skipping breakfast Overemphasis on weightAcne—linked or not to food

The Growing Concern About Overweight ChildrenPediatricians treating diseases of aging

◦Hypertension◦High blood cholesterol◦Non–insulin-dependent diabetes mellitus

Contributing factors ◦Genetics◦Food environment◦Sedentary lifestyle◦ Internal cues of hunger and satiety

extinguished◦Lack of recognition of problem by adults

Prevention and Early DiagnosisPlot yearly body mass index on

CDC growth charts

Encourage healthy dietsLow-fat dairy after age 2Fruit and vegetable intakePromote physical activityLimit screen time to 2 hours per

day