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Childhood Nutrition

Definition

Childhood nutrition refers to the dietary needs of healthy children aged 2 years through 11 years of age. Since children younger than 2 years of age and children over the age of 11 years of age have unique nutritional requirements and concerns, the focus of this summary is primarily on healthy children aged 2 to 11 years. (Children with special health care needs and who have special dietary needs require additional guidance beyond what will be discussed and should seek the skills of a Pediatrician or a Registered Dietitian).

Proper nutrition for a healthy child aged 2-11 years of age should provide adequate essential nutrients, fiber and energy, sufficient enough to maintain proper growth, maximize cognitive development and promote health. It should introduce balance among the foods consumed such that foods rich in some nutrients do not displace foods that are rich in other nutrients. Balance within the diet helps to ensure adequate nutrient intake within the diet. A child’s diet should provide sufficient energy intake for proper growth and development while preventing excess weight gain. To do so, foods selected should be high in nutrient density, meaning the food should have a high nutrient to calorie ratio. The diet should be moderate enough so not to deliver too much of a dietary constituent. It should also ensure variety using different foods on different occasions to

Minimum nutrient and calorie levels for school lunches

(school week averages)

PreshcoolGrades K–6Grades 7–12
Calories517664825
Total fat (percentage of total food energy)*1*1,2*2
Saturated fat (percentage of actual total food energy)*1*1,3*3
RDA for protein (g)71016
RDA for calcium (mg)267286400
RDA for iron (mg)3.33.54.5
RDA for vitamin A (RE)150224300
RDA for vitamin C (mg)141518

*1 The Dietary Guidelines for Americans recommends that after 2 years of age, children should gradually adopt a diet, that by about 5 years of age, contains no more than 30 percent of calories from fat.

2 Not to exceed 30 percent over a school week.

3 Less than 10 percent over a school week.

“RE” refers to “retinol equivalent,” a measure of the vitamin A activity in foods.

(Illustration by GGS Information Services/Thomson Gale.)

ensure adequacy, balance and moderation among all nutrients needed to support the child”s growth and developmental needs.

Origins

Prior to World War II, the main nutritional problems in the United States stemmed from both a limited supply of food and lack of nutrient variety. During this time, scientists began to discover essential nutrients for basic growth and development and began the process of defining the minimum nutrients essential for growth and survival. In the United States the health status of children improved over the decades. An improvement in child nutrition was seen in lower rates of infant mortality and declines in infant, and child nutrient deficiencies.

As the food supply in the United States became more accessible and varied, nutritional concerns began to focus on an overabundance of food and specific nutrients. Around this time, research began to demonstrate links between dietary excesses and chronic diseases such as heart disease and cancers. While the number of children who were overweight increased.

These findings led to the development of dietary recommendations intended to reduce Americans” risk of chronic disease. By the late 1970s, the U.S. Senate Select Committee on Nutrition and Human Needs issued the Dietary Goals for the United States. Since then, dietary guidance for children has broadened from an earlier focus on issues of under consumption.

KEY TERMS

Dietary deficiency—Lack or shortage of certain vitamins or minerals within the diet that can result in illnesses.

Healthy Eating Index (HEI)—A measure of diet quality that assesses conformance to federal dietary guidance.

and nutrient deficiencies to over consumption and decreased energy expended in physical activity. As more research in childhood nutrition began to emerge, it placed more of a focus on optimal growth and cognitive development of children.

Description

Public health dietary guidelines for childhood nutrition resonate a diet that relies on fruits, vegetables, whole grains, low-fat and nonfat dairy products, legumes, fish, and lean meats. They also emphasize low intakes of saturated fats cholesterol, added sugar and salt while recommending little to no trans fat intake.

Function

Healthful eating habits in childhood have been shown to prevent chronic under-nutrition and growth retardation as well as acute child nutrition problems such as iron-deficiency anemia and dental caries. A healthful childhood diet should also help prevent obesity and weight-related diseases, such as diabetes.

Adequate intake of calcium are the first preven-tative measure against osteoporosis later in life. Calcium intake is crucial during childhood, adolescence and early adulthood to help reach peak bone mass. Failure of children to meet calcium requirements in combination with a sedentary lifestyle makes achievement of maximal skeletal growth and bone mineralization challenging. Thus, most recommendations include two to three servings a day of milk or dairy products within a children”s diet.

Iron deficiency has negative effects on a child’s motor and mental development and thus on their capacity to do school work. Foods high in iron, such as meats and fortified breakfast cereals are important to a child’s diet to ensure that iron requirements are met.

Research supports that children who are overweight experience psychological stress, decreased body image scores, and lower self-esteem when compared to normal weight children of the same age. They are also more likely than normal-weight children to become obese adults, which can increase their risk of coronary heart disease, hypertension, type 2 diabetes, gallbladder disease, osteoarthritis, and some cancers. For this reason, many guidelines will support enough calories for growth and activity while limiting foods of low nutritional value and high in refined sugar.

High intakes of saturated fat have been associated with increased plasma total and low-density lipopro-tein (LDL) cholesterol in childhood and can ultimately increase the risk of cardiovascular disease. Most recommendations will suggest fat reduced foods such as lean meats, low- or non-fat dairy products and limited high fat snacks, pastries and candies.

Guidelines

Many children’s health organizations support the guidelines of the United States Department of Agriculture, Food Guide Pyramid for children.

Grains

At least half of the grains a child consumes each day should be from whole grains, such as oatmeal, or 100% whole-wheat products. The amount should increase gradually from age 2 to 5 years, at age 2 this would be too much, about one quarter to a third should be whole grains. Consuming whole grains adds dietary fiber to the diet that can help protect against diseases like heart disease and diabetes, and also help control a child’s weight. Refined grains, such as those in white bread and white rice, which have been processed, and many of the nutrients have been taken out are to be used in reduced amounts.

Dairy

Low-fat or non-fat dairy products are recommended In the United Kingdom, low-fat milk is not recommended for children until they reach age 2 and skim milk is not recommended until age 5. Children 2 to 8 years old are suggested to have the equivalent to 2, 8-ounces of milk per day. For children 9 to 11 years old should have the equivalent to 3, 8-ounces of milk per day.

Fruits

Aim for 1–2 cups of fruits per day. Limit fruit juice consumption to meal times. Consumption of whole fruits, fresh, frozen, canned, dried, rather than fruit juice for the majority of the total daily amount is suggested to ensure adequate fiber intake.

QUESTIONS TO ASK YOUR DOCTOR

  • How can I teach my child healthy eating behaviors?
  • How much should I feed my child?
  • How should I handle food struggles?
  • How can I get my child to try new foods?
  • Is my child growing at a proper height-for-weight ratio?
  • What can I do if my child does not drink milk?
  • Should I give my child vitamin/mineral supplements?

Vegetables

Children should have 2–3 cups of vegetables per day. Select from dark green, orange, starchy vegetables, and other vegetables several times per week. Offer them for snacks and with meals daily.

Lean protein, legumes, nuts/seeds, meat alternatives

Recommend 2 grams of protein for each pound the child weighs. This can be in the form of cooked lean protein or fish, nuts, seeds, eggs or legumes and soy products. Children should also eat from lean protein sources and include non-fried fish into their diets on a regular basis.

Precautions

The Healthy Eating Index (HEI) is used to assess a populations diet quality. The HEI score for children ages 2 to 9 years determined that most children’s diets “needed improvement” or were “poor” The percentage of children’s diets that were reported to “need improvement” among children 2 to 3, 4 to 6, and 7 to 9 years was 60%, 76%, and 80%, respectively; diets reported as “poor” were 4%, 7%, and 8%, respectively.

Average intakes of most vitamins and minerals for children 2 to 11 years of age exceed 100% of the 1989 RDA. Average dietary fiber intake among children ages 3 to 5 years and 6 to 11 years is 11.4 g/day and 13.1 g/day, respectively; and has remained virtually unchanged since 1976. The food choices of most US children do not meet the recommended food group servings from the Food Guide Pyramid. Children do not eat the recommended amount of fruits and vegetables. For children 2 to 9 years of age, 63% are not consuming the recommended number of servings of fruits, and 78% are not consuming the recommended number of servings for vegetables. Average daily servings are 2.0 for fruits and 2.2 for vegetables. For children 6 to 11 years of age, average daily total grain intake was 6.5 servings, whereas daily whole grain intake was 0.9 servings per day. The proportion consuming an average of two or more servings of whole grains daily was 12.7%. There is also an increase in restau! rant food consumption and other eating outside the home, larger portion sizes, shifts in beverage consumption, meal patterns and meal frequency, and school meal participation among children 2 to 11 years of age. This data shows that many children can improve their diets using the above recommendations from the USDA.

Research and general acceptance

Numerous research articles support that healthy eating is associated with reduced risk for many diseases, including the three leading causes of death: heart disease, cancer, and stroke. It is common knowledge among child nutrition experts that healthy eating in childhood and adolescence is important for proper growth and development and can prevent health problems such as obesity, dental caries, and iron deficiency anemia.

BOOKS

Nissenberg, Sandra K. Quick Meals for Healthy Kids and Busy Parents: Wholesome Family Recipes in 30 Minutes or Less From Three Leading Child Nutrition Experts.

Shield, Jodie, MEd, RD and Mary Catherine Mullen, MS, RD. ADA Guide to Healthy Eating for Kids: How Your Children Can Eat Smart from 5 to 12.

ORGANIZATIONS

American Academy of Family Physicians. <http://www.aafp.org>

American Academy of Pediatrics. <http://www.aap.org>

The American Dietetic Association. <http://www.eatright.org>

The United States Department of Agriculture, USDA Dietary Guidelines. <http://www.mypyramid.gov>

Megan C.M. Porter, RD, LD


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