Nutrition in Infants, Children & Adolescents

Nutrition in Infants, Children & Adolescents Introduction to Pediatric Nutrition ●​ ●​ Nutrition during infancy, childhood, and adolescence significantly impacts both short- and long-term physical and cognitive health. Overweight and obese children increases the risk of chronic diseases such as: ○​ Type 2 diabetes (DM2) ○​ Hypertension (HTN) ○​ Cardiovascular disease (CVD) Age Classifications Stage Age Range Infancy Birth–12 months Toddlerhood 1–3 years Preschool 3–5 years Middle Childhood 5–10 years Pre-Adolescence Adolescence Girls: 9–11 years Boys: 10–12 years Girls: 11–21 years Boys: 12–21 years Growth and Development Assessments ⇒ Assessment of growth includes four key categories: 1.​ Anthropometric Data (Physical Measurements) a.​ Weight b.​ Height/Length (varies by age) c.​ Head circumference if <2 yrs d.​ Length if <2 yrs e.​ Height or length 2-3 yrs f.​ Height >3 yrs 2.​ Biochemical Data (Lab Testing) a.​ Complete blood count (CBC) b.​ Serum electrolytes c.​ Iron status (hemoglobin, ferritin) i.​ Obese children at increased risk of iron deficiency d.​ Serum albumin ⇒ Assessment of nutritional and protein status** e.​ Glucose, lipid profile 3.​ Clinical/Physical Observations a.​ Signs of malnutrition or nutritional deficiencies. 4.​ Diet and Medical History a.​ Assess dietary intake and medical conditions. ⇒ Growth Patterns & Charts ●​ Infant Growth ○​ Birth weight doubles by 4–6 months and triples by 1 year* ○​ Warning signs: ■​ No weight or length gain ■​ Plateau in growth for >1 month ■​ Weight drop without recovery in a few weeks ■​ Typical increase in both weight and length ⇒ Child Growth: Growth velocity slows during childhood years Stage** Toddlers (1–3 years) Preschoolers (3–5 years) School-age children (5–10 years) Average Growth per Year +6 lbs +4.8 inches +4.4 lbs +2.75 inches +7 lbs 2.5 inches ⇒ Adolescent Growth: ●​ ●​ Males: Increase in muscle mass. Females: Increase in fat mass for reproductive development. ⇒ BMI Growth Charts -​ -​ -​ -​ BMI is more predictive of body fat** BMI-for-age is used after age 2+ Goal: Strive for BMI-for-age is to be within normal range, NOT a specific value Interpretation: if a male child is at the 90th% for weight-for-age, then that child weighs more than 90% of the males of his same age ●​ ●​ ●​ ●​ Appropriate growth: 10th–90th percentile* Underweight: Below 5th percentile* Overweight: 85th–95th percentile* Obese: Above 95th percentile* ○​ Need very close eval if readings are consistently greater than 90th or less than 10 % Nutrient Requirements for Infants, Children, and Adolescents ⇒ Energy needs vary by age, activity, and lean body mass (LBM). Macronutrient Needs: ⇒ Energy needs during infancy are higher per kg of body weight than at any other time!! Nutrient Carbohydrates Infants (0–12 months) 45–65% of total calories (same as adults)** Toddlers (1–3 years) Same as adults Children (4–18 years) Same as adults Infants: ~55% of total energy** Fat Children 1-3: 30-40%** 30–40% of total energy 25–35% of total energy Children 4-18: 25-35%** Protein Required for growth Increased needs Higher during puberty Key Micronutrient Needs: Nutrient Vitamin D Iron RDA Importance 400 IU/day (infants)* ●​ Bone development, prevents rickets ●​ Prevents anemia, essential for brain development 600 IU/day (children 1–12)* 14-18 yr old boys: 11 mg/day* 14-18 yr old girls: 15 mg/day* Calcium 1,000–1,300 mg/day ●​ Supports bone growth Fiber No specific RDA ●​ Prevents constipation, supports gut health I nfant Feeding Recommendations ●​ Breastfeeding vs. Formula Feeding ○​ AAP recommends exclusive breastfeeding for 6 months, followed by con tune breastfeeding as complementary foods are introduced ○​ If not breastfeeding, standard formula (20 kcal/oz) or preterm formula (22–24 kcal/oz) is used. ○​ Breastmilk and formula contain similar calorie counts. ○​ Breastfed preterm infant ⇒ 2mg/kg/day iron ○​ Formula preterm infant ⇒ 1 mg/kg/d'day iron ●​ Introduction of Solid Foods ○​ Introduce solids between 4–6 months. ○​ Most popular first food: Iron-fortified baby cereal (e.g., rice cereal). ■​ Mix with DM or formula ○​ Introduce one new food every 4–5 days (spacing) ■​ New foods may have to be introduced 5-10 days before a child accepts them ○​ Fruits and vegetables ■​ Cooked and puréed most common and easiest to eat ■​ Avoid raw veggies until morals come in to avoid choking ●​ Common first foods: ○​ Fruits and vegetables (pureed, no added sugar/salt) ○​ Pureed meats and eggs ○​ Avoid before 12 months: ■​ Honey and karo syrup (risk of botulism) ■​ Excessive salt and sugar ■​ Juice (limit to 4 oz/day after 12 months) ●​ Juice is NOT necessary ●​ Fruit should come from whole fruit Introduce cow’s milk at 1 year of age ○​ Whole cow's milk at ages 1-2 ○​ Reduced fat cows milk ages 2-5 ●​ Food Allergies and Sensitivities ●​ ●​ ●​ ●​ ●​ ●​ ●​ Major Food Allergens Under the Food Allergen Labeling and Consumer Protection Act (FALCPA), the eight major food allergens are: 1.​ Milk 2.​ Eggs 3.​ Fish 4.​ Crustacean shellfish 5.​ Tree nuts 6.​ Peanuts 7.​ Wheat 8.​ Soy Introducing Allergenic Foods ○​ Potentially allergenic foods should be introduced when other complementary foods are introduced ○​ Introduce peanut-containing foods in the first year to reduce allergy risk. ○​ Nut allergies differ: Peanut allergies do not always indicate tree nut allergies. Peanut and and nut allergies are different Peanuts are legumes, related to peas and lentils. But if you have a peanut allergy you are not allergic to all legumes Identification and testing is important Dust or residue from nuts can be potentially harmful/deadly Childhood Feeding Challenges Undernutrition ●​ Causes: ○​ Poor or suboptimal diet ○​ Inadequate caloric intake ○​ Specific nutrients may be inadequate or unbalanced Childhood Obesity ●​ Causes: ○​ ○​ ○​ ○​ Parental obesity ⇒ Risk factor Poor diet + inactivity Sedentary behaviors (screen time) Energy-dense foods and sugary drinks ●​ ○​ School food choices Complications: ○​ Type 2 diabetes ○​ Hypertension ○​ Emotional and social issues Adolescent Nutrition & Lifestyle ●​ Adolescent Energy Needs ○​ Higher during puberty growth spurts. ○​ Girls require more iron and protein. ○​ Boys need higher kcal and protein for muscle growth. ○​ BUT energy needs are much lower per Kg ●​ Adolescent Eating Habits that affect nutrition ○​ Skipping meals ○​ Increased junk food and sugary beverages intake ○​ Fad diets and eating disorders ○​ Changes in physical activity ●​ Signs and symptoms of eating disorders ○​ Dysfunctional eating habits ○​ Body image misperception ○​ Rapid weight loss ●​ Adolescent Obesity ○​ Long-term consequences: ■​ Grow taller at first, but do not tend to attain taller height as adult ■​ Excess adipose its ■​ Greater bone and muscle mass ⇒ “Stocky” ■​ Abnormal lipid profiles ■​ Increased risk of chronic diseases ■​ Psychological issues (stereotypes, discrimination) ○​ Prevention Strategies: ■​ Behavioral therapy ■​ Reduce sedentary behavior ■​ Nutritional education ■​ Physical activity promotion ■​ Notice growth chart trends early ■​ Consistent environment Promoting a Healthy Lifestyle in Children ●​ Family-Based Recommendations ○​ Encourage vegetables, fruits, and whole grains. ○​ Include lean protein sources and dairy. ○​ Promote physical activity. ○​ Limit screen time. ○​ Avoid forcing children to “clean their plates”. ○​ Involve children in meal prep and grocery shopping. ○​ Plan nutritious snacks. ○​ Encourage mindful eating—eat slowly and stop when full.