Chapter 12

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

CHAPTER 12

Nutrition for Normal Growth and

Development

Sharon M. Nickols-Richardson

Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 2

Individual Needs of Children

Growth may be defined as an increase in

body size

Biologic growth of an organism occurs

through cell multiplication (hyperplasia) and

cell enlargement (hypertrophy)

Development is the associated process by

which growing tissues and organs take on a

more complex function


Normal Life Cycle Growth Pattern

Normal human life cycle includes the following

four general stages:

Infancy

• Growth velocity is rapid during the first year of life

• At 6 months weight has doubled; at 1 year weight has tripled

Childhood

• The growth rate slows and becomes erratic


Adolescence

• With the beginning of puberty, the second period of growth acceleration occurs

Adulthood

• Final stage of a normal life cycle; growth levels off on the adult plateau

Normal Life Cycle Growth Pattern – Cont’d


Measuring Childhood Physical Growth

Growth Charts

Children grow at widely varying individual rates

A child’s pattern of growth is compared with

percentile growth curves derived from

measurements of large numbers of children

throughout the growth years


Measuring Childhood Physical Growth –

Cont’d

Growth Charts – cont’d

Two age intervals are presented, with separate

curves for boys and girls:

Birth to 3 years

2 to 20 years



Cont’d

Anthropometry

Monitors a child’s growth, with growth charts and

other clinical standards as points of reference

A number of methods and measures may be

used



Cont’d

Anthropometry – cont’d

Body weight and height

Common general measures of physical growth

Provide a basic measure of change in body size but give

only a crude index of growth without the finer details of

individual variations in body fat or muscle or bone



Cont’d

Anthropometry – cont’d

Body circumferences and skinfolds

Head circumference is a valuable measure in infants

Skinfold measures are performed with special calipers and

require skill and practice for accuracy



Cont’d

Clinical Signs

Various clinical signs of optimal growth can

be observed as indicators of a child’s

nutritional status

Laboratory Tests

Include studies of blood and urine to

determine levels of hemoglobin, vitamins, and

similar substances



Cont’d

Nutritional Analysis

Provides helpful information for assessing the

adequacy of the diet for meeting growth needs


Motor, Mental, and Psychosocial

Development

Motor Growth and Development

Gross motor skills develop within the first 18

months of life

Fine motor skills gradually develop over a longer

period of time



Development – Cont’d

Mental Growth and Development

Measures of mental growth involve the following:

Abilities in speech and other forms of communication

Ability to handle abstract and symbolic material in

thinking




Emotional Growth and Development

Measured in the capacity for love and affection,

as well as the ability to handle frustration and

anxieties




Social and Cultural Growth and

Development

Measured as the ability to relate to others and to

participate in group living and cultural activities


Nutritional Requirements

for Growth

Energy Needs

Intake of a 5-year-old child is spent Total

daily energy as follows:

Approximately 50% supplies basal metabolic

requirements (BMR)

Approximately 5% is used in the thermic effect of

food (TEF)



for Growth – Cont’d

Energy Needs – cont’d

Total daily energy intake of a 5-year-old child is

spent as follows: – cont’d

Approximately 25% goes toward daily physical activity

Approximately 12% is needed for tissue growth

Approximately 8% is lost in the feces




Protein Needs

First 6 months of life an infant requires 1.52 g

of protein per kilogram per day

This amount gradually decreases throughout

childhood until adulthood




Essential Fatty Acid Needs

Linoleic acid is required for the synthesis of

brain and nerve tissue and normal mental

development

Carbohydrate Needs

Carbohydrates are primary energy source and

are important in sparing protein for its vital role

in tissue formation




Fiber

Important to satiety and bowel regulation and

affects blood lipid and glucose concentrations




Water Requirements

Infant’s body content of water is approximately

70% to 75% of total body weight

A child’s water need is related to energy intake

and urine concentration

An infant generally drinks a daily amount of

water equivalent to 10% to 15% of body weight




Mineral and Vitamin Needs

Minerals and vitamins play essential roles in

tissue growth and maintenance and in overall

energy metabolism




Mineral and Vitamin Needs – cont’d

Calcium is needed for tooth development,

muscle contraction, nerve excitation, blood

coagulation, and heart muscle action

Iron is essential for hemoglobin formation and

mental and psychomotor development


Stages of Growth

and Development

Psychosocial Development

The developmental problem at each stage

has a positive ego value and a conflicting

negative counterpart, as follows:

Infancy: trust versus distrust

Toddler: autonomy versus shame and doubt

Preschooler: initiative versus guilt

School-age child: industry versus inferiority


Stages of Growth

and Development – Cont’d

Psychosocial Development – cont’d

The developmental problem at each stage

has a positive ego value and a conflicting

negative counterpart, as follows: – cont’d

Adolescent: identity versus role confusion

Young adult: intimacy versus isolation

Adult: generativity versus stagnation

Older adult: ego integrity versus despair


Infant (Birth to 1 Year)

Nutrition for the Full-Term Infant

Breast milk or infant formula generally

provides all the nutrients required by a

healthy infant for the first 6 months of life

Exclusive breast-feeding can be adequate for

the first 12 months of life


Infant (Birth to 1 Year) – Cont’d

Nutrition for the Full-Term Infant – cont’d

Nearly all infants born in a hospital receive an

injection of vitamin K shortly after birth

By the age of 6 months, semisolid foods such as

iron-fortified cereals may be added to the diet to

help meet increasing nutritional needs



Psychosocial and Motor Development

Core psychosocial developmental task during

infancy is the establishment of trust in others

Feeding is the infant’s primary means of

establishing human relationships



Breast-Feeding

Ideal food for the human infant is human milk

Experienced nutritionists and nurses, many of

whom are certified professional lactation

consultants, advise flexibility rather than a

rigid approach to breast-feeding

Toward the end of the prenatal period, the

breasts secrete a thin, yellowish fluid called

colostrum



Breast-Feeding – cont’d

Typically by the end of the second week,

mature milk is produced

Breast milk is produced under the stimulating

influence of the hormone prolactin

Another pituitary hormone, oxytocin,

stimulates the ejection of the milk (let-down

reflex)



Breast-Feeding – cont’d

The mother should follow the baby’s lead with

an on-demand schedule

Feedings are usually about every 2 to 3 hours

in the first few weeks after birth

A breast-feeding mother needs to be aware

that her infant will likely gain weight more

slowly than bottle-fed infants, but this should

not be a concern



Bottle-Feeding

A variety of commercial formulas that attempt to

approximate the composition of human milk are

available

Special formulas have been developed for

infants with allergies, lactose intolerance,

diarrhea, fat malabsorption, or other problems



Bottle-Feeding – cont’d

For hypoallergenic formulas, all proteins are

completely hydrolyzed to free amino acids

Use of soy protein–based formulas has been

growing among parents who wish to feed their

infants vegetarian diets



Bottle-Feeding – cont’d

Any remaining formula should be thrown

away and not refrigerated for reuse

Most infants are fed on demand versus

scheduled, which works out to be about every

2 to 3 hours

Only infant formula and water are appropriate

for bottle-feeding; other fluids should not be

used



Breast-Feeding and Formula-Feeding

Combination

Some women may desire the flexibility of both

breast-feeding and formula-feeding their

infants

Regular unmodified cow’s milk is not suitable

for infants for several reasons:

It causes gastrointestinal bleeding

Its renal solute load is too concentrated for the

infant’s renal system to handle



Breast-Feeding and Formula-Feeding

Combination – cont’d

Regular unmodified cow’s milk is not suitable

for infants for several reasons: – cont’d

Early exposure to cow’s milk increases the risk of

developing allergies to milk proteins

It adversely affects nutritional status



Premature and Small-for-Gestational-Age

Infants

These infants should be fed breast milk, usually

fortified with additional protein, vitamins, and

minerals

Formulas developed for the premature infant

may have as much as 30% more protein per

fluid volume, as well as higher amounts of

calcium, zinc, and the B-complex vitamins



Premature and Small-for-Gestational-

Age Infants – cont’d

Nutrition support of the high-risk infant

requires a team approach:

Pediatrician

Nurse

Dietitian

Lactation consultant



Beikost: Solid Food Additions

Beikost feeding begins the transition from a

predominantly liquid diet to a predominantly

solid food diet

Solid foods should be introduced to an infant no

earlier than 4 to 6 months of age



Beikost: Solid Food Additions – cont’d

Developmental abilities to use the hands and

fingers are required before self-feeding can be

initiated

Smaller amounts of food, eaten on a more

frequent basis, may contribute to the pattern of

eating in moderation




Vegetables, fruits, potato, egg yolk, and

finally meat can be added to the diet in a

gradual sequence

Two foods require special attention in infant

feeding:

1. Honey

2. Fruit juices




The following two basic principles should guide

the feeding process:

1. Nutrients are needed, not specific foods

2. Food is a main basis of early learning


Toddler (1 to 3 Years)

Physical Characteristics and Growth

The growth rate of children slows after the

first year

Legs become longer, and the child begins

losing “baby fat”

Energy demands are lower because of the

decelerated growth rate

The child has six to eight teeth at the

beginning of the toddler period


Toddler (1 to 3 Years) – Cont’d


As physical mobility increases with increased

gross and fine motor skill development, the

sense of autonomy and independence grows



Food and Feeding

Energy

Rises to a range of 1160 to 1680 kcal/day for

boys and 1080 to 1650 kcal/day for girls by

age 3

From age 1 to 2, some children do not eat as

much as they did in the second half of infancy



Food and Feeding – cont’d

Protein

The toddler requires about 13 g of protein per

day

At least half of this protein should be of

animal origin




Minerals

Calcium and phosphorus are needed for bone

mineralization

Adequate levels of zinc are necessary to support

protein synthesis and cell division




Vitamins

Fat-soluble and water-soluble vitamins are

critical to macronutrient utilization and growth

and development




Fiber

19 g/day is recommended for children age 1

to 3 years

Food Choices

About 2 to 3 cups of milk daily is sufficient for

the young child’s needs


Preschooler (3 to 6 Years)


Each child tends to settle into a regular

genetic growth channel as physical growth

continues in spurts

Mental capacities are developing


Preschooler (3 to 6 Years) – Cont’d

Physical Characteristics and Growth –

cont’d

13 to 19 g/day of good-quality protein is

needed

Calcium and iron are needed to support

growth and to build body stores

A variety of fruits and vegetables should be

provided




Children are beginning to develop their

superego—the conscience

This is a period of increasing imitation

Self-feeding skills increase, and eating takes

on greater social aspects



Food and Feeding

Fruits and Vegetables

Fruits are usually well liked

Vegetables usually are the least well liked by

children




Milk, Cheese, Egg, Meat, and Legumes

It is helpful if children can set their own goals

of quantities of food; portions need to be

relatively small

Grains

Whole grains provide important fiber


The School-Age Child

(6 to 12 Years)


During this stage, the rate of growth slows and

body changes occur very gradually

By now the body type has been established, and

growth rates vary widely



(6 to 12 Years) – Cont’d


Children have increased cognitive capacity and

the ability to problem solve

They cooperate in group activities and begin to

experience a sense of adequacy and

accomplishment and sometimes the realities of

competition




Food and Feeding

The slowed rate of growth during this period

results in a gradual decline in the food

requirement per unit of body weight




School and the Learning Environment

Breakfast is particularly important for the school-

age child

Schools should also take a premier role in

promoting lifelong physical activity patterns in

children

Sound nutrition is especially critical for the child

athlete


The Adolescent


Final growth spurt of childhood

Adolescent growth accounts for wide

fluctuations in physical size, metabolic rate,

food needs, and even illness


The Adolescent – Cont’d


Adolescence is an ambivalent period marked

by stresses and strains

Emergence of a self-identity is the major

psychosocial developmental task of the

adolescent years

Pressure for peer group acceptance is strong

Social tensions and family conflicts are often

created



Food and Feeding

Energy

The kilocalorie (kcalorie or kcal) needs

increase with the metabolic demands of

growth and energy expenditure




Protein

Girls require 46 g/day and boys require 52

g/day to sustain daily needs and to maintain

nitrogen reserves




Minerals

Calcium requirement for all adolescents rises

to 1300 mg/day

Fluid replacement in any exercise or

performance period is essential



Eating Habits

Physical and psychosocial pressures

influence adolescent eating behavior

Two factors combine to increase issues

surrounding nutrition and food intake in

adolescent girls:

1. Physiologic sex difference

2. Social and personal tensions


Health Promotion

Children and Adolescents: Seeking

Fitness

The Dietary Guidelines for Americans 2005

provides direction for the development of a

healthy diet and lifestyle for all persons age 2

years and older


Health Promotion – Cont’d

Weight Management

Body weight and physical activity are intrinsically

related

Body fat increases rapidly during the first year of

life and then slows until about age 6



Physical Activity

Television, computer games, the Internet,

and similar sedentary pastimes are growing

in popularity

The goal is to have children and adolescents

engage in a minimum of 1 hour of exercise

every day



Helping Children Develop an Active

Lifestyle

Parents and caregivers, schools, and

communities need to work together to

increase physical activity among children

Parents and role models should also

demonstrate such behavior

Chapter 12

Technology

Transcript of Chapter 12