Nutrition in Preschool Age

Introduction• Age period: 1-6 years of age• Changes occur in children’s

rate of growth and continuing maturation of fine and gross motor skills.

• Personality Development: – influence both the amount of

food they consume– and foods acceptable to

them

• Food habits, likes and dislikes begin to established.

• Nutrition plays a critical role in the development and growth of children.

• Environmental influences and parental behavior

• May reinforce or extinguish food related behaviors.

CHARACTERISTICS OF THEPRESCHOOL CHILD

• Preschool years:• Rates of growth decrease and as a

result appetite decrease• Growth rate slows considerably from

the first year of age.• Toddlers (1-2 years old)

Gain only from 2-4 kgs. each year.

• Preschoolers (3-4 years old)have even slower growth

averaging from 1-2 kgs. each year.

• From ages 3-5:There is a greater increase in height relative to

weight

• Each child will grow at his or her own rate as determined by heredity, state of health and nutritional adequacy of the diet.

• Between ages 1 and 2, children learn to feed themselves independently.

• Development of gross and motor skills:Allows them to learn to feed themselves and to prepare

simple foods such as sandwiches and cereal.

• They progress from eating with their hands to using utensils.

• Spilling and messiness characterize the first half of the second year but by age 2, hand-mouth coordination has improved and spilling seldom occurs.

• By 15 months of age, children can manage the cup, but not expertly.

• As the young child matures, self-help skills become more sophisticated.

• By the 18 months to two years, many toddlers are quite adept at feeding themselves.

• By age 5, children can effectively use knives and forks.

• Characteristics of toddler:Independence and curiosity

• Exploration of the environment is due to the child’s increasing mobility, manipulation and attempts at various skills.

• Food is one area where they attempt to show this characteristics.

• Preschoolers also learn to understand language and how to talk and ask about food.

• They learn about the variety of foods and the way it feels, tastes and smells.

• Younger pre-school children:interested in how food feels and often

prefer finger feeding and feeding themselves.

• Food that provides opportunities for finger feeding should be provided at each meal.

• They demand independence and refuse help in many tasks in which they are not skillful such as self-feeding.

• As they become older, they become less interested in food and more interested in their environment.

• They test and learn the limits of behavior that are acceptable.

• Idiosyncratic food choices are common.

• Likes and dislikes may change from day to day and week to week.

• However, the child should be allowed to choose foods they like.

• Rituals become part of food preparation and service.

• Appetites are usually erratic and unpredictable during the preschool period.

• The child may eat voraciously at one meal and refuse to eat the next.

NUTRIENT ALLOWANCES

• RDA TABLE FOR Filipino lists nutrient allowances for preschool children into 2 categories:

1-34-6

• Allowances are based on the needs of the middle year in each group (2 and 5), and are for moderate activity and average weight.

ENERGY• Energy requirement must take

into consideration basal metabolism, rate of growth and activity.

• Dietary energy must be sufficient to ensure growth and spare protein from being used as a source of energy.

• The average energy requirement for basal metabolism during the first 12-18 months of life is 55 kcal/kg body weight.

• The requirement of the weight specific basis declines to an adult level of 25-30 kcal/kg.

• As children grow older, the level of calories increases due to larger body size but the need for energy per unit size actually decreases.

• The contribution of physical activity to total energy expenditure varies daily and between each child.

• The energy needs of individual children of the same age, size and sex also varies.

• Observation has shown that in malnourished children the diet is often lacking in calories and not protein.

• Lack of calories in the diet leads to utilization of protein as source of energy resulting in protein energy malnutrition (PEM), or extreme wasting called marasmus.

• If calories are adequate but protein intake is inadequate, this results in condition called kwashiorkor.

PROTEIN• It is need for maintenance of tissue, changes in

body composition and synthesis of new tissue.

• Protein requirement increases from age 1-6 years.

• Protein needs for growth decreases as the rates of growth decline.

• On a weight-specific basis, protein requirement decreases from the first year of life through childhood and adolescence.

• FAO (Food and Agriculture Organization)recommends 1.5-2 g protein/kg body weight,

2/3 of which should be of high biological value.

This amount will provide for increase in skeletal and muscle tissues and protection against infection.

VITAMINS AND MINERALS

• It is necessary for normal growth and development.

• Insufficient intake can cause impaired growth and result in deficiency diseases.

• Vitamins requirements increase during the preschool age.

• The most common Vitamin Deficiency among preschoolers is Vitamin A, C, riboflavin and thiamine.

• Vitamin A is essential for growth, vision healthy skin and mucous membrane.

• Vitamin D is needed for calcium absorption and deposition of calcium in the bones.

• During childhood, mineral content and requirements of the body increases.

• Most common mineral deficiency is iron, calcium and zinc.

• Iron is needed for growth and development and formation of hemoglobin.

• Full-term infant’s iron stores that were deposited in fetal life are generally adequate for body needs up to 4-6 months of age.

• Calcium is needed for optimum mineralization of bone and prevents osteoporosis in later life.

• Zinc is essential for growth and a deficiency results in growth failure, poor appetite, decrease taste acuity and poor wound healing.

COMMON NUTRITION PROBLEMS

• The four most common malnutrition problems in the Philippines are:

• 1. Protein-Energy Malnutrition• 2. Iron deficiency anemia• 3. Vitamin A deficiency• 4. Iodine-deficiency Disorder

• …other nutrition problems are:• Obesity• Dental Caries

Protein-Energy Malnutrition

• This is due to lack of energy and protein in the diet.

• Age 1-3 years are vulnerable to PEM that is the most common and widespread form of malnutrition

• “major public health problem” causing a high rate of morbidity among preschool children.

• It is due to a deficiency of protein or of calories or both.

• “Marasmus” – severe form of PEM manifested by extreme wasting caused by prolonged restriction of both energy and protein.

• “Kwashiorkor” – due to a deficiency of CHON but energy intake is adequate.

• Manifestation of PEM is a weight for height that is below the reference standard.

Iron deficiency anemia

• Anemia – either low hemoglobin or a low hematocrit or both compared with normal concentrations.

• IDA is the most common form of anemia among children and usually occurs between the ages of 3mos. – 3 years of age.

• Lack of iron in the blood results in paleness of the eye, lips, fingernails, palms and skin, shortness of breathe and easy fatigability, reduced ability to learn and irritability.

• Anemic children do poorly on vocabulary, reading, mathematics, problem-solving and psychological tests.

• Lack of dietary iron may be due to the ignorance of parents on the importance and food sources of iron, poverty that restricts the amount and variety of foods available or the difficulty of providing dietary iron under the best circumstances.

• Treatment of anemia in childhood involves the therapeutic use of iron salts at level providing from 30 – 100 mg of iron a day, usually together with Vitamin C, until hemoglobin levels have returned to normal levels.

Vitamin A deficiency• It results in night blindness, xerophthalmia,

rough dry skin and membranes of nose and throat, increase susceptibility to infections, poor growth and blindness in severe cases.

• It is due to low intake of vitamin A from animal sources and leafy green vegetables as well as fat, a carrier of fat soluble vitamins.

Iodine-deficiency Disorder

• It refers to a group of clinical entities caused by inadequacy of dietary iodine that includes goiter, hot or cold intolerance, mental retardation, deaf-mutism, difficulty in standing or walking normally, and stunting of the limbs of children of goitrous mother.

Obesity• Over Nutrition is one of the most

widespread nutrition disorders of children in developed countries such as USA.

• However in the Philippines, this is not much of a problem compared with the lack or deficiency of nutrients and calories.

• Childhood obesity is associated with hyperinsulinemia, hypertriglyceridemia and reduced HDL-cholesterol.

• The causes of obesity can be genetic or familial, metabolic hormonal abnormality and environmental.

• However, it is attributed mostly to inactivity or sedentary lifestyle and poor eating habits.

• Too much viewing in television in children is a factor that can lead to obesity.

Dental Caries• Diet and nutrition have an important role in

preventing dental caries.

• Cariogenicity of a child’s diet is related more to the frequency of intake of sticky sugar-containing foods that cling to the teeth than to the total amount of sugar in the diet.

• Preventive dietary practices include restricting sugary foods to mealtimes, brushing teeth immediately after eating sugary foods, and decreasing the practice of allowing children to go to sleep with a bottle of containing juice, milk or other sugar containing fluid.

• Dental caries can also be prevented by flouridation of water supply and the use of flouride in toothpastes and mouthwashes.

NUTRITION ASSESSMENT• Anthropometric Assessment – The

following measurement should be complete for a preschool child:

– Weight– Stature– Head Circumference– Triceps Skinfold

WEIGHT• Children who can stand without assistance

are weighed standing on a scsle and wearing only lightweight undergarments.

• Weight should be recorded to the nearest100g.

• Consistency of technique and choice of weight units are important to avoid unnecessary sources of error.

• Weight for age is a complete index of height for age and weight for height.

• In preschooler, it is an indicator of acute malnutrition.

STATURE• Children between 2-3 years of age can be

measured in recumbent or standing position depending on their ability to cooperate.

• Children older than 3 years should be measured standing.

• To avoid error, the measurers eye should be level with the headboard.

• A low height for age is sometimes called growth stunting that may due to poor nutrition, a high frequency of infections or both.

• Stunting refers to a slowing of skeletal growth and stature, the end result of a reduce rate of linear growth.

HEAD CIRCUMFERENCE

• It should be measured in children until they are 36 months of age.

• A flexible, non-stretch tape about 0.6 cm is wide is used.

TRICEPS SKIN FOLD• Thickness is a measurement of a double

length of skin and subcutaneous fat on the back of the upper arm.

• It is useful index of relative fatness of the body because subcutaneous adipose tissue is a major component of body fat.

• The thickness of the skin and subcutaneous fat can also be measured with calipers.

BIOCHEMICAL ASSESSMENT• Hgb and Hct determination should be done to

determine the presence of anemia.

• Total Serum cholesterol level and LDL cholesterol may also be assessed using 170 mg/dl as cut off point for total cholesterol and 110 mg/dl for LDL cholesterol.

DIETARY ASSESSMENT

• The diet assessment methods used for adults can be adapted to child.

• However, the parent must provide the information about the child’s meal and snack pattern, food eaten, how foods were prepared and other dietary habits.

• The most common dietary assessment method used to determined children’s intake are:

• 24 hour food recall• Food record• Food frequency questionnaire

24 HOUR FOOD RECALL• This is a method of assessment whereby

an individual is asked to remember everything eaten during the previous 24 hours.

• It is widely used method because it is easy to administer, in person or by telephone, and lends itself to large population studies.

• This method is best suited to describing the intakes of populations, not individual.

FOOD RECORD• This is written record of the amounts of all

foods and liquids consumed during a set time period, usually 3-7 days, and often includes information on time, place and situation of eating.

• This method provides detailed information on foods eaten and methods of preparation.

• Accurate records can be obtained if respondents are highly motivated, literate and well trained.

Food frequency questionnaire

• This is a method of assessment in which the data collected relate to how often foods are consumed.

• Its advantage are:

– It is self administered– requires only 15-30 minutes to complete– Can be analyzed at a reasonable cost.

• Its limitation is similar to the 24-hour recall, in that the accurate reporting depends on memory.

• Also, the food list is often limited in scope and may overlook come foods commonly eaten by the population.

FACTORS INFLUENCE FOOD INTAKE

• Family Environment• Societal Trends• Media• Illness or Disease

FAMILY ENVIRONMENT

• The family has the major influence on the food habits of toddlers and preschoolers.

• Families can provide the appropriate role models and reinforcements that will most likely bring about desirable food habit changes.

• The influence of parents to children’s food behavior decrease as the amount of time spent in working outside the home increased.

• One of the basic responsibilities of a parent or caregiver is to provide nourishing food that is clean, safe and developmentally appropriate.

• A positive feeding relationship includes division of responsibility between parents and children.

• Parents provide safe, nutritious food as regular meals and snacks and children decide how much, if any, they eat.

• Ellen Satter states that “the parent is responsible for what is offered: the child is responsible of how much to eat.”

• Feeding and nutrition problems during childhood may result from inappropriate parent-child interactions.

• It is possible to set up a home environment that fosters the development of desirable eating patterns in young children.

• A positive environment is one in which sufficient time is set aside to eat, occasional spills are tolerated and conversion that includes all family members are tolerated.

SOCIAL TRENDS• There are more mothers now who work or

are employed outside the home.

• Therefore, they do not have much time to prepare meals for their families nor teach their children about good eating habits.

• They often have to rely on others to cook for them or they either purchase fast foods on convenience foods.

MEDIA• Mass media esp. television affects

children’s request for and attitudes towards food.

• TV influences eating habits and the nutritional status of children in several ways:– 1. Tv advertising influences family food purchase

and snaking patterns of children– 2. the use of food as depicted on TV shows food

being used for many activities other than to satisfy hunger

– 3. the few overweight children used on tv suggest that inappropriate used of food have no impact on health.

– 4. there is a relationship between increased TV watching and increased snaking.

– 5. TV encourages inactivity and passive use of leisure time so it is detrimental to children’s growth and development.

– Children spend more time watching TV than going to school or doing any other activity.

– Parents must set limits on the number of hours that children watch TV and should help them interpret food messages seen on the screen.

– They should not be persuaded by their children to buy non-nutritious foods seen in TV.

ILLNESS OR DISEASE

• Children who are ill have decrease appetite and limited food intake.

• Acute illness of short duration may require increase in fluids, protein and other nutrients.

• Chronic condition may take it more difficult to obtain nutrients for optimal growth.

• Children with illness are more likely to have behavior problems or family struggles around food.

DEVELOPMENT OF FEEDING PATTERNS

• The goals for the development of food patterns are as follows:

– 1. Children should be able to eat in sufficient quantities the foods given to them, just as they take care of their other daily needs.

– 2. children should be able to manage the feeding process independently and with dispatch, without either necessary dawdling or hurried eating.

– 3. Children should try to eat new foods in small portions the first time they are served to them to try them again and again until they like or at least willingly accept them.

FEEDING THE PRESCHOOL CHILD

• Milk: When, What, and How?Starting at age two, most children can safely drink reduced-fat milk, including 1% low-fat and 2% reduced-fat.

• That's because your youngster requires less of the fat and cholesterol concentrated in full-fat milk than she did during her first two years.

• That's not to say that you must serve skim or 1% low-fat or light milk, however.

• Your child may still need the calories that full-fat dairy products supply.

• Whatever milk you choose, make sure your child drinks enough to get the calcium required by growing bones.

• Three-year-olds need 500 milligrams of calcium a day, the equivalent of about 14 ounces of milk or fortified soy beverage.

• Four-, five-, and six-year-olds need much more: 800 milligrams of calcium daily, or about 24 ounces of milk or fortified soy beverage.

• Table 17-5 (refer to book) shows the right kinds and amounts of foods to eat everyday.

• This includes energy foods such as rice, corn, bread, yellow kamote or gabi; and fats and oils that also gives energy.

• Additionally, fats help the body make use of fat soluble vitamins such as A, D, E and K.

• The second are the body building foods such as milk for growth, strong bones and teeth and increased resistance to infection; and fish, meat, poultry, eggs and dried beans for growth, building firm and strong muscles, giving energy and helping keep the blood healthy.

• The last are the regulating foods consisting of GLV and yellow vegetables such as malunggay, kangkong, kamote tops, petsay, carrot and squash for vitamins and minerals; vitamins C rich fruits such as papaya, mango, suha, and dalanghita; and other fruits and vegetables such as banana, chico, avocado, sitao or eggplant.