The preschool age period is from 1 to 6 years of age. At this period, changes occur in children’s rate of growth and development, continuing maturation of fine and gross motor skills. Personality development influences both the amount of food they consume and also the food acceptable to them.

Characteristics of the Preschool Child

• The rate of growth decrease and as a result appetite decreases.

• Toddlers (1-2 years old) gain only from 2 to 4kg each year.

• Preschoolers (3-4 years old) have even a slower growth averaging from 1 to 2kg each year.

• Children are often disinterest in food and eat very little at time.

• From ages 3-5, there is a greater increase in height relative to weight.

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

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

Nutrient Allowances• Energy- requirement must take into consideration basal

metabolism, rate of growth and activity. The average energy requirement for basal metabolism during the first 12-18 months of life is 55 kcal/ kg body weight. After that, the requirement on weight specific basis decline to an adult level of 25-30kcal/kg.

• Protein- is needed for maintenance of tissue, changes in body composition and synthesis of new tissue. Protein requirement increases from age 1 to 6 years. Fifty percent (50%) of protein requirement is used for growth in the first two months of life. FAO (Food and Agriculture Organization) recommends 1.5-2g protein/kg body weight, 2/3 of which should be of high biological value. This amount will provide for increase in skeletal and muscle tissue and protection against infection.

• Vitamins and Minerals- are necessary for normal growth and development.

• 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.

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

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

• Zinc- is essential for growth and a deficiency result in growth failure, poor appetite, decreased taste acuity and poor wound healing.

Common Nutritional Problem among Preschool age and their Dietary Intervention

The four most common malnutrition problems in the Philippines

1. Protein-Energy Malnutrition (PEM)- This is due to lack of energy and protein in the diet. Preschoolers, particular those who are aged 1-3 years are vulnerable to PEM that is the most common and widespread form of malnutrition in the Philippines.

PEM is due to a deficiency of protein or of calories or both.

• Marasmus- the severe form of PEM, manifested by extreme wasting caused by prolonged restriction of both energy and protein.

• Kwashiorkor- is due to a deficiency of protein but energy intake is adequate. Manisfestations of Kwashiorkor include growth failure, moon-face, edema, skin lesions, hair changes, apathy and low resistance to infections.

• 2. Iron deficiency anemia (IDA)- Anemia is defined as either low hemoglobin or a low hematocrit or both compared with normal concentrations. It is the common form of anemia among children and usually occurs between the ages of three months to three years of age. Lack of iron in the blood result in paleness of the eyes, lips, fingernails, palms and skin, shortness of breath and easy fatigability, reduced ability to learn and irritability.

• 3.Vitamin A deficiency- A deficiency of vitamin A result in night blindness (inability to see in dim light), xerophthalmia (dryness of the eyes), rough dry skin and membranes of nose and throat, increased susceptibility to infection, poor growth and blindess in severe cases. The deficiency is due to low intake of vitamin A from animal source and leafy green vegetables as well as fat, a carrier of fat-soluble vitamins.

4. Iodine-deficiency Disorder- This refer to a group of clinical entities cause by inadequacy of dietary iodine that includes goiter, hot or cold intolerance, mental retardation, deaf-mutism, difficult in standing or walking normally and stunting of the limbs of the children of goitrous mother.

Other Nutrition Problem• Obesity- Prevalence estimate range from 10 to 30%

depending on how obesity is defined. Is still considered a risk factor because of its link to hypertension and chronic conditions such as coronary heart disease, cancer and diabetes. Childhood obesity is associated with hyperinsulinemia, hypertriglyceridemia, and reduces HDL-cholesterol.

• Dental Caries- this is a major problem affecting 98% of children in the county making it a widespread public health problem.

Nutrition Assessment Anthropometric Assessment the measurement should

be complete for a preschool child.• Weight- should be record to the nearest 100g (0.1kg or

¼ lb) for preschool.

• Stature- children between 2 to 3 years of age can be measured in a recumbent or standing position depending on their ability to cooperate.

• Head Circumference should be measured in children until they are 36 months of age. A flexible, non stretch tape about 0.6 cm wide is used. The tape is placed just above the eyebrows where the head has its maximum circumference.

• Triceps skinfold- thickness is a measurement of double length of skin and subcutaneous fat on the back of upper arm.

Biochemical Assessment- Hemoglobin (Hb) or Hematocrit (Hct) determinations should be done to determine the presence of anemia.

Dietary Assessment- is a comprehensive evaluation of a person's food intake.

Methods of Dietary Assessment 24 hour 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 a written record of amount of all foods and liquids consumed during a set time period, usually 3 to 7 day, and often includes information on time, place and situation of eating.

• Food Frequency Questionnaire- This is method of assessment in which the data collected relate to how often food are consumed, i.e., daily, once or several times, a week, monthly or several times a month or never.

Clinical Assessment- this consist of a medical history and a physical examination to detect physical sign and symptoms associated with malnutrition.

Factors Influencing Food Intake

Family Environment- the family has the major influence on the food habits of toddlers and preschoolers.

Societal Trends- There are more mother now who work or are employed outside the home. Therefore, they do not have time to prepare meals for their families nor teach their children about good eating habits.

Media- Mass media especially television affects children’s request for attitudes towards food. TV influences eating habits and the nutritional status of children in several ways:

• TV advertising family food purchases and snacking patterns of children.

• The use of food as depicted on TV shows food being used for many activities other than to satisfy hunger.

• The few overweight children used on TV suggests that inappropriate use of food have no impact on health.

• There is a relationship between increase TV watching and increase snacking.

• TV encourages inactivity and passive used of leisure time so it is determine to children’s growth and development.

Illness or Disease- Children who are ill have decreased appetite and limited food intake.

 

Feeding the Preschool Child• When a child is tired, they should be allowed to rest

before meals.• Also, snack should not be given 1 to 1-1/2 hour before

meal because this reduces appetite• Too much attention by parent can also be a cause for

refusal to eat.• Children should eat their meals at the family table so

they will have an opportunity to learn table manner and interact with family.

 Feeding Problem

• Complain about what is served• Refuses food especially vegetables and fruits• Refuses food like meat• Pushes, hides or throws food during mealtime• Eats slowly or holds food in the mouth• Eats the same food for all the meal• Eats snack instead of meals• Throws tantrum at mealtime