NUTRITION THROUGH
THE LIFE CYCLE
357 FP 52
NUTRITION IN CHILDHOOD
30TH MARCH, 2019
DMI ST EUGENE UNIVERSITY, DEAPARTMENT OF FOOD AND NUTRITION 1

Nutrition during Pre-school stage
Pre-school - Growth and development of preschool children, Food habits, and nutrient intake of
preschool children.
DMI ST EUGENE UNIVERSITY, DEAPARTMENT OF FOOD AND NUTRITION 2

Unit II: Nutrition in Infancy, Pre-school, and
School going age
Dietary allowances and supplementary foods.
School-going age -, Nutritional status of school children, school lunch program, factors to be
considered in planning a menu, food habits, nutritional requirement, packed lunch.
DMI ST EUGENE UNIVERSITY, DEAPARTMENT OF FOOD AND NUTRITION 3

OUTLINE OF PRESENTATION
INTRODUCTION
GROWTH AND DEVELOPMENT
NUTRIENT REQUIREMENT
PROVIDING AN ADEQUATE DIET
NUTRITIONAL CONCERNS
PREVENTING CHRONIC DISEASE
DMI ST EUGENE UNIVERSITY, DEAPARTMENT OF FOOD AND NUTRITION 4

INTRODUCTION
Childhood is period that begins after infancy and lasts until puberty
Often referred to as the latent or quiescent period of growth
Physical growth is less remarkable and proceeds at a steadier pace
than the first year of life
The group is composed of pre-school and school going children
This time is significant for social, cognitive and emotional growth
DMI ST EUGENE UNIVERSITY, DEAPARTMENT OF FOOD AND NUTRITION 5

GROWTH AND DEVELOPMENT –
GROWTH PATTERNS
The rate of growth slows considerably after the first year of life
In contrast to the tripling of birth weight that occurs in the first 12
months, another year passes before the birth weight quadruples.
Likewise, birth length increases by 50% in the first year
but does not double until approximately the age of 4 years.
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GROWTH AND DEVELOPMENT –
GROWTH PATTERNS
Increments of change are small compared with those of infancy and
adolescence;
weight typically increases an average of 2 to 3 kg per year until the
child is 9 or 10 years old
Then the rate increases, signaling the approach of puberty.
Height increase increments average 6 to 8 cm per year from 2 years
of age until puberty
DMI ST EUGENE UNIVERSITY, DEAPARTMENT OF FOOD AND NUTRITION 7

GROWTH AND DEVELOPMENT –
GROWTH PATTERNS
Growth is generally steady and slow during the pre-school and
school-age years, but it can be erratic in individual children, with
periods of no growth followed by growth spurts.
These patterns usually parallel similar changes in appetite and food
intake
For parents, periods of slow growth and poor appetite can cause
anxiety, leading to mealtime struggles
DMI ST EUGENE UNIVERSITY, DEAPARTMENT OF FOOD AND NUTRITION 8

GROWTH AND DEVELOPMENT –
GROWTH PATTERNS
Body proportions of young children change significantly after the
first year.
Head growth is minimal, trunk growth slows substantially, and limbs
lengthen considerably, all of which create more mature body
proportions.
Because of walking and increased physical activity the legs
straighten, and the abdominal and back muscles strengthen to
support the now erect child.
These changes are gradual and subtle, occurring over years
DMI ST EUGENE UNIVERSITY, DEAPARTMENT OF FOOD AND NUTRITION 9

GROWTH AND DEVELOPMENT –
GROWTH PATTERNS
The body composition of preschool and school-age children remains relatively constant.
Fat gradually decreases during the early childhood years, reaching a minimum between 4 and 6
years of age.
Children then experience the adiposity rebound, or increase in body weight in preparation for
the pubertal growth spun
Earlier adiposity rebound has been associated with increased adult body mass index (BMI)
Sex differences in body composition become increasingly apparent-boys have more lean body
mass per centimeter of height than girls.
Females have a higher percentage of weight as fat than males, even in the preschool years, but
these differences in lean body mass and fat do not become significant until adolescence
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GROWTH AND DEVELOPMENT – CATCH
UP GROWTH
A child who is recovering from an illness or undernutrition and
whose growth has slowed or ceased experiences a greater than-
expected rate of recovery.
This recovery is referred to as catch-up growth, a period during
which the body strives to return to the child's normal growth
channel
The degree of growth suppression is influenced by the timing,
severity, and duration of the precipitating cause
DMI ST EUGENE UNIVERSITY, DEAPARTMENT OF FOOD AND NUTRITION 11

GROWTH AND DEVELOPMENT – CATCH
UP GROWTH
The nutritional requirements for catch-up growth depend on
whether the child has stunted growth and is chronically
malnourished or primarily wasted
A chronically malnourished child may not be expected to gain weight
as rapidly as a child who is primarily wasted
DMI ST EUGENE UNIVERSITY, DEAPARTMENT OF FOOD AND NUTRITION 12

GROWTH AND DEVELOPMENT – CATCH
UP GROWTH
Nutrient requirements, especially for energy and protein, depend on
the rate and stage of catch-up growth.
For example, more protein and energy are needed during the very
rapid weight gain period and for those in whom lean tissue is the
major component of the weight gain.
In addition to energy, other nutrients are important, including
vitamin A, iron, and zinc
Supplementation is a low-cost, effective intervention to decrease
growth retardation in those with infectious diseases
DMI ST EUGENE UNIVERSITY, DEAPARTMENT OF FOOD AND NUTRITION 13

GROWTH AND DEVELOPMENT – CATCH
UP GROWTH
Current growth parameters are used to determine the child's weight for age (the
age corresponding to the child's weight at the 50th percentile), ideal (median)
weight for age, and ideal (median) weight for actual stature.
Formulas are then used to calculate the minimum and maximum energy needed
for catch-up growth
After a child who is wasted catches up in weight, dietary management changes
to slow the weight gain velocity to avoid excessive gain
The catch-up in linear growth reaches its peak about 1 to 3 months after
treatment starts, whereas weight gain begins immediately
DMI ST EUGENE UNIVERSITY, DEAPARTMENT OF FOOD AND NUTRITION 14

GROWTH AND DEVELOPMENT –
ASSESSING GROWTH
Because children are constantly growing and changing, periodic
assessments allow any problems to be detected and treated early.
Unfortunately, many children are seen by health care professionals
only when they are ill; thus growth and development may not be the
focus of care.
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GROWTH AND DEVELOPMENT –
ASSESSING GROWTH
A complete assessment of nutritional status includes the collection of anthropometric data.
This includes length or standing height, weight, and weight for length or BMI, all of which are
plotted in growth charts
Other measurements that are less commonly used but that provide estimates of body
composition include upper arm circumference and triceps or subscapular fat folds.
Care should be taken to use standardized equipment and techniques for obtaining and plotting
growth measurements.
Charts designed for birth to 36 months of age are based on length measurements and nude
weighs, whereas chars used for 2- to 20-year-olds are based on standing height and weight with
light clothing and without shoes
DMI ST EUGENE UNIVERSITY, DEAPARTMENT OF FOOD AND NUTRITION 16

GROWTH AND DEVELOPMENT –
ASSESSING GROWTH
The proportion of weight to length or height is a critical element of growth assessment.
This parameter is determined by plotting the weight-for-length measurement
Growth measurements obtained at regular intervals provide a growth pattern.
One-time height and weight measurements do not allow for an interpretation of growth status.
Children generally maintain their heights and weights in the same growth channels during the
preschool and childhood years, although the channels are not well established until after 2 years
of age.
Individual children sometimes grow at faster or slower rates; nonetheless, they should follow
along the same channels
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GROWTH AND DEVELOPMENT –
ASSESSING GROWTH
Regular monitoring of growth enables problematic trends to be
identified early and intervention or education initiated so that long-
term growth is not compromised
Weight that increases rapidly and crosses growth channels suggests
the development of obesity.
Lack of weight gain or loss of weight over a period of months may be
a result of undernutrition, an acute illness, an undiagnosed chronic
disease, or significant emotional or family problems.
DMI ST EUGENE UNIVERSITY, DEAPARTMENT OF FOOD AND NUTRITION 18

NUTRIENT REQUIREMENT
since children are growing and developing bones, teeth, muscles,
and blood, they need more nutritious food in proportion to their size
than do adults
They may be at risk for malnutrition when they have a poor appetite
for a long period, eat a limited number of foods, or dilute their diets
significantly with nutrient-poor foods
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NUTRIENT REQUIREMENT
The dietary reference values (DRIs) are based on current knowledge of nutrient intakes needed
for optimal health
They include estimated average requirements (EARs), recommended dietary allowances (RDA),
adequate intakes (AIs), and tolerable upper intake levels (ULs).
Most data for preschool and school-age children are values inserted from data on infants and
adults
These reference intakes are meant to improve the long term health of the population by
reducing the risk of chronic disease and preventing nutritional deficiencies.
Thus, when intakes are less than the recommended level, it cannot be assumed that a particular
child is inadequately nourished
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NUTRIENT REQUIREMENT - ENERGY
DietaThe energy needs of healthy children are determined on the
basis of basal metabolism rate of growth, and energy expenditure.
ry energy must be sufficient to ensure growth and spare protein
from being used for energy but not allow excess weight gain.
Suggested intake proportions of energy are 45% to 65% as
carbohydrates, 30% to 40% as fat, and 5% to 20% as protein for 1 to
3 year olds, with carbohydrates the same for 4 to 18 year olds, 25%
to 35% as fat, and 10% to 30% as protein
DMI ST EUGENE UNIVERSITY, DEAPARTMENT OF FOOD AND NUTRITION 21

NUTRIENT REQUIREMENT - PROTEIN
The need for protein per kilogram of body weight decreases from
approximately 1.1 g in early childhood to 0.95g in late childhood
Protein intake can range from 5% to 30% of the energy DRV based on
age
DMI ST EUGENE UNIVERSITY, DEAPARTMENT OF FOOD AND NUTRITION 22

NUTRIENT REQUIREMENT – MINERALS
AND VITAMINS
Minerals and vitamins are necessary for normal growth and
development.
Insufficient intake can cause impaired growth and result in deficiency
diseases
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NUTRIENT REQUIREMENT – MINERALS
AND VITAMINS
IRON
Children between I and 3 years of age are at high risk for iron
deficiency anemia.
The rapid growth period of infancy is marked by an increase in
hemoglobin and total iron mass.
Children with prolonged bottle feeding are at highest risk for iron
deficiency
In addition, the diet may not be rich in iron-containing foods.
Recommended intakes must factor in the absorption rate and
quantity of iron in foods, especially those of plant origin
DMI ST EUGENE UNIVERSITY, DEAPARTMENT OF FOOD AND NUTRITION 24

NUTRIENT REQUIREMENT – MINERALS
AND VITAMINS
CALCIUM
Calcium is needed for adequate mineralization and maintenance of
growing bone in children.
The DRI for calcium for children
1 to 3 years old is 500 mg/day;
4 to 8 years it is 800 mg/day;
9 to 18 yearsit is 1300m g per day
Actual need depends on individual absorption rates and dietary
factors such as quantities of protein, vitamin D, and phosphorus
DMI ST EUGENE UNIVERSITY, DEAPARTMENT OF FOOD AND NUTRITION 25

NUTRIENT REQUIREMENT – MINERALS
AND VITAMINS
CALCIUM – CONT.
Since calcium intake has very little influence on the degree of urinary
calcium excretion during periods of rapid growth, children need two
to four times more calcium per kilogram than adults.
consume limited amounts of the calcium rich foods are at risk for
poor bone mineralization
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PROVIDING AN ADEQUATE DIET
Food and eating are more than the simple provision of nutrients for
body growth and maintenance.
The development of feeding skills, food habits, and nutrition
knowledge matches the cognitive development that takes place in a
series of stages, each laying the groundwork for the next.
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PROVIDING AN ADEQUATE DIET – INTAKE
PATTERN
DMI ST EUGENE UNIVERSITY, DEAPARTMENT OF FOOD AND NUTRITION 28

PROVIDING AN ADEQUATE DIET –
FACTORS INFLUENCING FOOD INTAKE
Numerous influences determine the food intake and habits of
children
Habits, likes, and dislikes are established in the early years and
carried through to adulthood.
The major influences on food intake in the developing years include
family environment societal trends, the media, peer pressure, and
illness or diseases
DMI ST EUGENE UNIVERSITY, DEAPARTMENT OF FOOD AND NUTRITION 29

PROVIDING AN ADEQUATE DIET –
FACTORS INFLUENCING FOOD INTAKE
FAMILY ENVIRONMENT
For toddlers and preschool children the family is the primary
influence in the development of food habits.
In young children's immediate environment, parents and older
siblings are significant models.
Food attitudes of parents can be a strong predictors of food likes and
dislikes and diet complexity in children of primary-school age.
Similarities between children's and their parents' food preferences
are likely to reflect genetic and environmental influences
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PROVIDING AN ADEQUATE DIET –
FACTORS INFLUENCING FOOD INTAKE
SOCIETAL TRENDS
almost all of women with school-age children who are employed outside
the home, children eat one or more meals at child-care homes, or schools.
In these settings all children should have access to nutritious meals served
in a safe and sanitary environment that promotes healthy growth and
development
Due to time constraints, family meals may include more convenience or
fast foods.
However, having a mother who is employed outside the home does not
seem to affect children's dietary intakes negatively
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PROVIDING AN ADEQUATE DIET –
FACTORS INFLUENCING FOOD INTAKE
MEDIA MESSAGES
Food is marketed to children using a variety of techniques, including
television advertising, in-school marketing, sponsorship, product
placement, Internet marketing, and sales promotion.
Of these, television is perhaps the most popular means worldwide with
marketing to pupils in school being second
Preschool children are generally unable to distinguish commercial
messages from regular programs.
In fact, they often pay more attention to the commercials; thus they
remember and request the advertised items
DMI ST EUGENE UNIVERSITY, DEAPARTMENT OF FOOD AND NUTRITION 32

PROVIDING AN ADEQUATE DIET –
FACTORS INFLUENCING FOOD INTAKE
PEER INFLUENCE
As children grow, their world expands and their social contacts become more
important.
Peer influence increases with age and affects food attitudes and choices.
This may result in a sudden refusal of a food or a request for a currently popular food.
Decisions about whether to participate in school meals may be made more on the basis
of friends' choices than on the menu.
Such behaviors are developmentally typical.
Positive behaviors such as a willingness to try new foods can be reinforced.
Parents need to set limits on undesirable influences but also need to be realistic;
struggles over food are self-defeating.
DMI ST EUGENE UNIVERSITY, DEAPARTMENT OF FOOD AND NUTRITION 33

PROVIDING AN ADEQUATE DIET –
FACTORS INFLUENCING FOOD INTAKE
ILLNESS OR DISEASE
Children who are ill usually have a decreased appetite and limited food intake.
Acute viral or bacterial illnesses are often short-lived but may require an
increase in fluids, protein, or other nutrients.
Chronic conditions such as asthma or diabetes may require a special diet and
have to adjust to the limits of foods allowed.
they also have to deal with issues of independence and peer acceptance as they
grow older.
Some rebellion against the prescribed diet is typical, especially as children
approach puberty.
DMI ST EUGENE UNIVERSITY, DEAPARTMENT OF FOOD AND NUTRITION 34

PROVIDING AN ADEQUATE DIET –
FEEDING PRESCHOOL CHILDREN
From I to 6 years of age children experience vast developmental
progress and acquisition of skills.
One-year-old children primarily use fingers to eat and may need
assistance with a cup.
By 2 years of age, they can hold a cup in one hand and use a spoon
well, but may prefer to use their hands at times.
Six-year-old children have refined skills and are beginning to use a
knife for cutting and spreading.
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PROVIDING AN ADEQUATE DIET –
FEEDING PRESCHOOL CHILDREN
As the growth rate slows after the first year of life, appetite decreases, which often
concerns parents.
Children have less interest in food and an increased interest in the world around them.
They can develop food jags or periods when foods that were previously liked are
refused, or they can request a particular food at every meal.
This behavior may be attributable to boredom with the usual foods or may be a means
of asserting newly discovered independence
Parents and other caregivers should continue to offer a variety of foods, including the
child's favorite ones, and not make substitutions a routine.
Preschool children tend to vary considerably in their meal intakes during the day, but
their total daily energy intake remains fairly constant
.
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PROVIDING AN ADEQUATE DIET –
FEEDING PRESCHOOL CHILDREN
With smaller stomach capacity and variable appetites, preschool children
eat best with small servings of food offered four to six times a day.
Snacks are as important as meals in contributing to the total daily nutrient
intake.
Carefully chosen snacks are dense in nutrients and least likely to promote
dental caries
Wholesome snacks enjoyed by many young children include fresh fruit,
raw vegetable sticks, milk, fruit juices, wholegrain crackers, dry cereal, and
peanut butter sandwiches.
A general rule of thumb is to offer 1 tablespoon of each food for every
year of age and to serve more food according to the child's appetite
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PROVIDING AN ADEQUATE DIET –
FEEDING SCHOOL AGE CHILDREN
Growth from ages 6 to 12 years is slow but steady, paralleled by a
constant increase in food intake.
Children are in school a greater part of the day; and they begin to
participate in clubs, organized sports, and recreational programs.
The influence of peers and significant adults such as teachers,
coaches, or sports idols increases.
Except for severe issues, most behavioral problems connected with
food have been resolved by this age, and children enjoy eating to
alleviate hunger and obtain social satisfaction
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