Preview (15 of 51 pages)

This Document Contains Chapters 14 to 15 CHAPTER 14 PREGNANCY AND BREASTFEEDING OVERVIEW Pregnancy and lactation are critical periods of physiological stress that substantially increase the demand for nutrients and energy. This chapter begins with a description of fetal growth and development and definition of a successful pregnancy. Increased nutrient needs during pregnancy and recommended weight gain are explained. An appropriate food plan for pregnancy is outlined, including the need for supplements and modifications for a pregnant vegetarian. Physiological changes of pregnancy and associated problems, such as morning sickness, anemia, and hypertensive disorders of pregnancy are discussed. The section on breastfeeding explains lactation physiology and milk release. Dietary recommendations for the breastfeeding mother are covered. The concerns about, advantages of, and barriers to breastfeeding are also presented. The Nutrition and Your Health section explores the role of nutrition and lifestyle in prevention of birth defects. KEY TERMS Alcohol-related birth defects (ARBDs) Alcohol-related neurodevelopmental disorders (ARNDs) Atopic disease Colostrum Congenital hypothyroidism Eclampsia Embryo Fetal alcohol spectrum disorders (FASDs) Fetal alcohol syndrome (FAS) Fetal origins hypothesis Fetus Gestation Gestational diabetes Gestational hypertension Infertility Lactation Lactobacillus bifidus factor Let-down reflex Lobules Low birth weight (LBW) Ovum Oxytocin Physiological anemia Pica Placenta Polycystic ovary syndrome (PCOS) Preeclampsia Preterm Prolactin Small for gestational age (SGA) Spontaneous abortion Teratogen Trimesters Zygote STUDENT LEARNING OUTCOMES Chapter 14 is designed to allow you to: 14.1 Describe how nutrition affects fertility. 14.2 Summarize the physiological changes of pregnancy, how they affect the nutrient requirements of a woman, and exemplify nutrients that may need to be supplemented during pregnancy. 14.3 Define "success" in pregnancy and identify lifestyle factors that promote a successful pregnancy for both the mother and the infant. 14.4 Specify optimal ranges of weight gain during pregnancy for women with low, healthy, or high prepregnancy BMI. 14.5 Outline guidance for exercise during pregnancy. 14.6 Describe the discomforts and complications of pregnancy that can be managed by dietary changes. 14.7 Summarize the physiological processes involved in breastfeeding and how breastfeeding affects the nutritional requirements of a woman. 14.8 Design an adequate, balanced meal plan for a pregnant or breastfeeding woman based on the Dietary Guidelines and MyPlate. 14.9 Enumerate several advantages of breastfeeding for both the mother and the infant. 14.10 Relate nutritional status of the parents to the risk of birth defects in the child. LECTURE OUTLINE 14.1 Nutrition and Fertility A. Overview 1. Nutritional habits of all women of childbearing potential are important 2. 50% of all pregnancies are unplanned 3. Discovery of pregnancy occurs several weeks after conception 4. Medical care for pregnancy does not begin until 2–3 months after conception 5. Infertility refers to inability of a couple to conceive after 1 year of unprotected intercourse. 6. Nutritional status of mother and father-to-be can affect likelihood of conception. B. Energy Balance 1. Prolonged energy imbalance can impair fertility. 2. Synthesis of reproductive hormones, maintenance of normal menstrual cycles, pregnancy, and breastfeeding require calories. 3. Underweight women often experience amenorrhea (impaired ovulation). 4. Overweight women experience decreased fertility as well a. Insulin resistance decrease effectiveness of ovulation and implantation in women. b. Overweight decreased sperm production in men. 5. Losing 5 to 10% body weight can increase chances of conception C. Polycystic Ovary Syndrome 1. Characterized by many tiny cysts that surround the ovaries 2. Leading cause of female infertility 3. Symptoms a. Increased testosterone leading to excess hair growth on face, acne, and abdominal fat deposition b. Increased insulin production and insulin resistance c. Irregular or absent periods d. Difficulty conceiving e. Higher rates of miscarriage 4. High risk for diabetes, high blood pressure, and cardiovascular disease. 5. Weight loss is best to improve metabolic and fertility issues 6. Daily physical activity can improve insulin sensitivity. 7. Controlling carbohydrate intake (quality and quantity) can help control PCOS. D. Folate 1. Folate is important for fertility due to its involvement in DNA synthesis, which is important for the sperm and egg. 2. Folate found in foods (green leafy vegetables, strawberries, orange juice) 3. Folic acid found in supplements and fortified foods E. Antioxidants 1. Oxidation can damage DNA and cell membranes, including the egg and sperm, and disrupt effective implantation and maturity of fertilized egg 2. Diets rich in antioxidants are linked to improved fertility in men and women F. Minerals 1. Zinc important for male fertility a. Helps protect sperm from oxidative damage b. Required for normal sexual maturation 2. Iron and zinc are important for female fertility a. Required for normal ovulation b. Specifically iron supplementation and higher intake of nonheme iron are related to improved fertility G. Dietary Fat 1. Adults should limit saturated and trans fat when trying to conceive. 2. High intakes of saturated and trans fat are linked to poor sperm quality 3. High intakes of saturated and trans fat promote insulin resistance and impair ovulation in women. H. Alcohol 1. Avoid alcohol when trying to conceive 2. Alcohol can decrease levels of estrogen and testosterone and impair ovulation and sperm production. 14.2 Prenatal Growth and Development A. Overview 1. Normal pregnancy is 38 to 42 weeks 2. Pregnancy divided into trimesters 3. First 8 weeks after conception—embryo develops from fertilized ovum into a fetus 4. Fetus nourished by placenta (see Fig. 14-1) B. Early Growth—The First Trimester Is a Very Critical Time 1. Formation of the human organism (see Fig. 14-2) a. Fertilized ovum is known as a zygote until it divides b. 30 hours—zygote divides in half to form two cells c. 4 days—cell number climbs to 128 cells d. 14 days—the group of cells is known as an embryo e. 35 days—heart is beating, eyes and limb buds are clearly visible f. 8 weeks—the embryo is known as a fetus g. 13 weeks—end of first trimester; most organs formed, fetus can move 2. First trimester is MOST critical time a. Risk of spontaneous abortions 1) Half or more of pregnancies end in spontaneous abortion; may not be known by mother 2) Usually result from genetic defect or fatal error in development b. Harmful substances pose great risk to developing fetus c. Diet quality more important than quantity during this phase d. Although nutrition and lifestyle choices influence outcome of pregnancy, some genetic and environmental factors are beyond our control C. Second Trimester 1. Fetus weighs about 1 ounce 2. Appendages are fully formed by the beginning of this phase 3. Fetus may still be affected by exposure to toxins 4. Mother’s breast weight increases by approximately 30% due to deposition of fat for breastfeeding D. Third Trimester 1. At the beginning: fetus weighs about 2 to 3 pounds 2. Infants born after 26 weeks of gestation have a good chance of survival 3. Full term: fetus weighs 7 to 9 pounds and is about 20 inches long 14.3 Success in Pregnancy A. Overview 1. A successful pregnancy involves a. Protection of mother's physical and emotional health so that she can return to prepregnancy health b. Gestation greater than 37 weeks c. Birth weight greater than 5.5 pounds 2. Fetal origins hypothesis—theory linking nutritional and environmental insults that occur during gestation (i.e., famines, fasting, exposure to alcohol) to the future health of the offspring 3. Infant birthweight a. Low birth weight (LBW): 3 x RDA are teratogenic 2. Primary defects include facial and cardiac defects 3. Toxicity is rarely seen from food sources; heavy use of fortified foods or megadose supplements are typical culprits F. Caffeine 1. Decreases maternal iron absorption 2. May reduce blood flow to the placenta 3. Fetus is unable to detoxify caffeine 4. Heavy caffeine use during pregnancy may lead to withdrawal symptoms in newborn 5. Risks are seen at doses > 500 mg/d (~5 cups of coffee) 6. Moderate use of caffeine (200–300 mg/d) is not associated with risk for birth defects G. Aspartame 1. For women with phenylketonuria, high amounts of phenylalanine can disrupt fetal brain development 2. Diet soft drinks are primary source of aspartame 3. Focus on higher-quality beverages H. Obesity and Chronic Health Conditions 1. Obesity, high blood pressure, and uncontrolled diabetes increase risk for birth defects 2. Medications used to control illnesses may harm developing fetus 3. Seizure disorders or metabolic disorders can affect fetal development 4. Uncontrolled maternal PKU places infants at heightened risk for brain defects 5. Gaining control over body weight and other health conditions prior to conception reduces risk of birth defects I. Alcohol 1. Consuming more than 4 alcoholic drinks at a sitting poses harm to the fetus 2. Highest risk during first trimester 3. No use of alcohol is advised during pregnancy 4. Fetal alcohol spectrum disorders (FASDs) a. Fetal alcohol syndrome (FAS) is the most severe of these disorders 1) Poor fetal and infant growth 2) Physical deformities 3) Mental retardation b. Alcohol-related neurodevelopmental disorders (ARNDs): include behavior and learning problems associated with exposure to alcohol in utero c. Alcohol-related birth defects (ARBDs): malformations of the heart, kidneys, bones, and/or ears J. Environmental contaminants 1. Difficult to establish links between environmental contaminants and risk for birth defects 2. Exercise prudence to decrease intake of pesticides and other contaminants a. Peeling, removing outer leaves, or washing produce b. Remove skin, trim visible fat, and discard drippings from meat, poultry, and fish 3. To limit mercury intake, avoid eating swordfish, shark, king mackerel, tile fish, and largemouth bass; intake of other fish and shellfish should not exceed 12 ounces per week 4. Consuming a variety of foods reduces risk of exposure to contaminants in the food supply K. Summing Up 1. Some risks are beyond our control 2. Parents-to-be should do everything possible to increase odds of healthy pregnancy outcome a. Varied and balanced diet, such as that suggested by MyPyramid b. Balanced multivitamin and mineral supplement with 400 micrograms folic acid (decreases risk of all birth defects by estimated 50%) c. Early and consistent prenatal care d. Avoid alcohol e. Lifestyle and nutrition practices of both mother and father are important BEST PRACTICES: TEACHING STRATEGIES, DEMONSTRATIONS, ACTIVITIES, ASSIGNMENTS, AND MORE 1. Assign students the Rate Your Plate activity, “Putting Your Knowledge About Nutrition and Pregnancy to Work.” Have them hand it in as a written assignment. 2. Give students a sample "typical" diet consumed by a pregnant woman along with a list of her food preferences. Ask the student to make a list of recommendations that would be appropriate to make the diet meet nutritional recommendations within the energy allowance. Next, the student should list recommendations that should be given to modify her diet for breastfeeding. Have students use guidelines given in the chapter to evaluate the diet. 3. Have students visit a local pharmacy and record the nutrient composition and cost of prenatal supplements they find there. Another group of students could use the PDR to determine the content of prescription supplements. Cost could be obtained by contacting the pharmacy. Use this as a springboard for class discussion about prenatal supplements. Students should answer questions such as: "Are prescription or over-the-counter supplements more expensive?," "Do they contain more nutrients than are needed?," "Do they provide amounts of iron and folate suggested in the chapter?" 4. Have students plan a nutritionally adequate one-day menu for a pregnant woman who is a vegan. Would supplements be required? If so, what ones? Have them use guidelines given in the chapter. 5. Ask an expert from the local community or someone from an organization like the La Leche League to lead a discussion about breastfeeding, and its advantages and disadvantages. 6. Have a class debate on advantages and disadvantages of breastfeeding. Have two groups of volunteers research the topic and have an in-class debate. 7. Ask students to interview their mothers to find out how much the student weighed at birth, where they were born, were they bottle-fed or breastfed, when were solid foods introduced, etc. Have a class discussion comparing current infant feeding standards with the standards when they were infants. CHAPTER 15 NUTRITION FROM INFANCY THROUGH ADOLESCENCE OVERVIEW Nutritional needs change from infancy through adolescence. This chapter discusses growth and development chronologically and outlines nutritional needs, feeding practices, and nutrition-related problems at each stage. The discussion of feeding practices during infancy includes formula feeding, breastfeeding, weaning, and the introduction of solid foods. Infant feeding practices to avoid also are addressed. The slower rate of growth and decreased appetite during preschool years is used to emphasize the importance of nutrient-dense foods. A brief section on prevention of childhood obesity is provided. During adolescence, another growth spurt occurs, increasing nutritional needs at a time when food habits may result in a limited diet. Nutrition-related problems of this growth period are discussed and suggestions for promoting a nutritious diet are outlined. The Nutrition and Your Health section presents the latest information regarding food allergies and intolerances. KEY TERMS Allergen Anaphylaxis Antigen Atopic disease Avoidant/restrictive food intake disorder Early childhood caries Elimination diet Failure to thrive Fecal impaction Food allergy Food intolerance Food sensitivity Overnutrition Percentile Undernutrition STUDENT LEARNING OUTCOMES Chapter 15 is designed to allow you to: 15.1 Describe the extent to which nutrition affects growth and physiological development from infancy through adolescence. 15.2 List specific nutrients often found to be lacking in the diets of infants, toddlers, preschoolers, and teenagers and make recommendations to remedy the problem. 15.3 Identify diet guidelines to meet the basic nutritional needs for normal growth and development for an infant and discuss some do’s and don’ts associated with infant feeding. 15.4 Outline several challenges parents might face in dealing with eating habits during childhood and adolescence. 15.5 Describe the long-term effects of childhood obesity and suggest ways to prevent or treat the problem. 15.6 Identify common food allergens and suggest several practices that may reduce the risk of developing a food allergy. LECTURE OUTLINE 15.1 Assessing Growth A. Overview 1. During infancy, caregivers have opportunity to shape lifelong eating habits by modeling healthy eating and maintaining flexibility. 2. The family environment should encourage healthy eating habits and behaviors 3. Attention, stimulating environment, and sense of security are needed in addition to proper nutrition. B. The Growing Infant 1. Rapid growth means nutrient needs are high a. Birth weight doubles in 4 to 6 months, triples within first year b. Length increases 50% in first year 2. When nutrients are low or missing, growth slows or ceases. 3. Undernutrition a. ~1/3 children under 5 years of age in developing countries are short and underweight for age because of poor nutrition. b. In poor countries, after weaning from breast milk, children receive high-carbohydrate diet lacking in protein and other nutrients. 4. Overnutrition is more prevalent in North America. C. Effect of Undernutrition on Growth 1. Effects depend on severity, timing, and duration of nutrition insult 2. Growth is single best indicator of nutritional status a. Gains in weight reflect growth in short term. b. Gains in height reflect growth over long term. 3. Correcting nutritional deficiency may not correct stunted growth or development because hormonal and other conditions change over time D. Using Growth Charts 1. Growth charts from the National Center for Health Statistics are available for children ages 2 to 20 (see Fig. 15-1) 2. 10th percentile means a child is smaller than 90 out of 100 children. 3. BMI percentiles assess appropriate weight in children over 2 years 4. In 2006, WHO released new growth standards for children a. Based on data from children raised under optimal conditions for growth and development (e.g., adequate prenatal care, followed recommended child feeding practices, had adequate health care, no maternal tobacco use) b. CDC recommends using these from birth through 2 years of age 5. By 3 years of age, children usually track along a steady percentile throughout growth; deviations may signal a medical or nutritional problem 6. Preterm babies may catch up (move up in percentiles) during infancy and early childhood. 7. BMI is preferred growth chart for children and adolescents. a. A child between the 85th and 95th percentile for BMI-for-age is considered overweight. b. A child above the 95th percentile for BMI-for-age is considered obese c. Table 15-1 lists weight classifications for children, ages 2 to 20. E. Adipose Tissue Growth 1. Effects of overfeeding in infancy are speculative 2. Reduction of energy intake will affect growth of other organ systems (especially brain and nervous system) 3. It is unwise to restrict calorie and fat intake before age 2 4. Fat intake recommendations a. Ages 1–3: 30 to 40% total kcal b. Older children and teens: 25 to 35% total kcal F. Failure to Thrive 1. Inadequate growth 2. May have physical cause a. Poor oral cavity development b. Problems with breastfeeding c. Infections d. Heart irregularities e. Chronic diarrhea f. Celiac disease 3. Other causes a. Poor infant–parent interaction b. Misinformation or inexperience c. Poverty or food insecurity 4. Must identify true cause and treat 5. Long-term consequences a. Poor physical growth b. Impaired mental development c. Behavioral problems 15.2 Infant Nutritional Needs A. Calories 1. 0–3 months: (89 x wt. in kg) + 75 2. 4–6 months: (89 x wt. in kg) + 44 3. 7–12 months: (89 x wt. in kg) –78 4. Human milk and formula are high in fat and provide about 640 kilocalories/quart. 5. Table 15-2 lists the EERs for infants and toddlers B. Carbohydrate 1. 0–6 months: 60 g/d 2. 7–12 months: 95 g/d 3. These goals are easily met by proper diet. 4. No AI for fiber C. Protein 1. 0–6 months: 9 g/d 2. 7–12 months: 14 g/d 3. These goals are easily met by breast milk or formula. 4. In North America, deficiencies are rare but sometimes occur with watered down formula or elimination diet to detect allergies. D. Fat 1. 30 g/day with 15% (~5 g) of total kilocalories as essential fatty acids 2. Essential fatty acids (DHA and AA) are vital to the development of the eyes and nervous system. 3. Restriction of fat intake is not advised for children under 2 years of age. E. Vitamins of Special Interest 1. Vitamin K given by injection to all newborns 2. Breastfed infants need 400 IU/d of vitamin D 3. Vitamin B-12 supplement if breastfeeding mother is vegan F. Minerals of Special Interest 1. Iron a. Stores generally depleted by age 4 to 6 months (sooner if mother was iron deficient during pregnancy) b. Infants > 6 months need dietary iron source c. Deficiency can lead to poor mental development d. Iron-fortified formula is recommended for formula-fed infants e. Breastfed infants need solid foods to supply extra iron; physicians may prescribe liquid iron supplements 2. Fluoride a. Supplement after 6 months of age for breastfed infants as well as formula-fed infants if household water supply is not fluoridated b. To avoid risk of fluorosis (i.e., mottling of teeth), use of fluoridated bottled water is not recommended 3. Iodide and zinc needs generally met if energy needs met G. Water 1. 700–800 ml (3 c) needed per day a. Human milk and formula usually meet this need b. More required in hot, humid weather or with vomiting, diarrhea, fever 2. Excessive fluid can be harmful, especially to the brain a. Limit supplemental fluids to 4 ounces per day b. Consult physician to determine if additional fluid is needed 3. Infant dehydration a. Early signs 1) >6 hours without wet diaper 2) Dark yellow or strong-smelling urine 3) Unusual lethargy 4) Dry mouth and lips 5) Absence of tears when crying b. Severe signs 1) Sunken eyes or fontanel 2) Cold, splotchy hands and feet 3) Excessive tiredness and fussiness c. Treatment 1) Fluid replacement formula that contains electrolytes 2) May require hospitalization 15.3 Guidelines for Infant Feeding A. Breast Milk Is the Best Milk 1. Human milk uniquely meets needs of infant (see Table 15-3) 2. Maternal diet and nutritional status impacts breastmilk composition (i.e., diet rich in AA and DHA will provide breastmilk also rich in the fatty acids) 3. Breast milk provides a. 55% total calories as fat; fat composition changes within each feeding b. 35 to 40% total calories from carbohydrate c. 10% total calories from protein; easily digestible proteins 4. Micronutrient needs met with breastmilk except a. Vitamin D; AAP recommends supplementation of 400 IU until dietary intake adequate b. Supplement B-12 if vegan, history of bariatric surgery, pernicious anemia c. Iron supplementation rarely needed 5. Flavors of mother's diet transferred to milk; affect eating behaviors later in life 6. Supports natural ability of infant/child to self-regulate food intake B. Formula Feeding for Infants 1. Formula composition (see Table 15-3) a. Strict federal guidelines for nutrient composition and quality b. Carbohydrate: generally lactose or sucrose c. Protein: heat-treated protein from cow's milk d. Fat: vegetable oils e. Specialized formulas 1) Soybean-based for intolerance of lactose or cow’s milk proteins 2) Predigested (hydrolyzed) protein: protein easier to digest 3) Others available f. Transition formulas for older infants, consult physician before use 1) Lower in fat than human milk or formula 2) Higher in iron than cow's milk 3) Reduced cost and better flavor 2. Formula preparation a. Use clean bottles and mixing utensils b. Mix formula with clean, cool water as hot water may contain more lead from pipes c. For infants up to 6 months of age, pediatricians commonly recommend boiling (then cooling) water to be used in formula preparation as well as sterilizing bottles and utensils by immersion in boiling water d. Boiled, cooled well-water is acceptable if it has been tested for contaminants (e.g., nitrates) e. Prepared formula can be kept in refrigerator for 1 day f. Do not use microwave to heat as hot spots can occur g. Discard formula left over from a feeding—contaminated by saliva bacteria and enzymes h. American Dental Association does not recommend using bottles nursery water for formula preparation to avoid mottling from high fluoride content C. Feeding Technique 1. Burp infants during feeding every 1 to 2 ounces or every 10 minutes 2. Burp again at end of feeding 3. Stop feeding when infant indicates he/she is full a. Turning head away b. Inattentive c. Falling asleep d. Becoming playful e. Breastfed infants usually full after 20 minutes D. Expanding the Infant’s Mealtime Choices 1. By about 6 months, infants are ready to begin eating solids 2. By 1 year, infants consume a variety of meats, grains, fruits, and vegetables 3. Table 15-4 illustrates a sample daily menu for a 1-year-old child 4. Respond to infant cues of hunger and satiety 5. Recognizing the infant’s readiness for solid foods a. Nutritional need 1) Until 6 months, nutrient needs met by breast milk or formula 2) Other nutrients and additional kilocalories needed after 6 months 3) Iron stores depleted by 6 months b. Physiological capabilities of infant 1) Ability to digest starch after 3 months 2) Kidney function limited until 4 to 6 weeks c. Physical ability of infant to eat solid foods 1) Tongue thrust control 2) Head and neck control 3) Ability to sit with support d. Allergy prevention 1) First 4 to 5 months, absorption of whole proteins possible 2) Early introduction of some foods may increase risk for food allergies (e.g., cow's milk, egg whites) 3) American Academy of Pediatrics recommends no solids until 6 months and no cow's milk until 1 year 6. Foods to match needs and developmental abilities during the first year a. 100% of Daily Values E. Reduce Lead Poisoning 1. Sources of lead exposure a. Contamination of water b. Inhalation of lead dust c. Contamination of dietary supplements d. Storage of foods in lead-containing vessels 2. Long-term effects of exposure in childhood a. Intellectual and behavioral impairments b. Increased risk for chronic diseases in adulthood 3. Nutritional strategies to reduce risks of lead poisoning a. Reduce lead consumption 1) Use only cold water for drinking and food preparation 2) Use bottled water if supply is contaminated 3) Balanced meal plan, including whole grains, lean meats, and low-fat dairy products b. Reduce lead absorption 1) Regular meals 2) Moderate fat intake 3) Adequate iron and calcium c. Reduce harmful effects of absorbed lead 1) Adequate zinc 2) Adequate thiamin 3) Adequate vitamin E F. Overcome Constipation with Lifestyle Changes 1. Can be associated with more serious condition 2. Causes a. Inactivity b. Lack of fiber in the diet c. Refusal to eliminate leading to fecal impaction 3. Eat more dietary fiber (e.g., fruits, vegetables, whole-grain breads and cereals, and beans) 4. Goal per day varies with age a. 1–3 years: 19 g/d b. 4–8 years: 25 g/d c. 9–13 years: 31 g/d for boys and 25 g/d for girls 5. Substituting cow's milk with soy sometimes helps 6. Drink more fluids a. Toddlers: 4 cups per day b. Older children: 5 cups per day G. Plan Vegetarians Diets Appropriately 1. Nutritional risks include a. Iron deficiency b. Vitamin B-12 deficiency c. Vitamin D deficiency d. Low caloric intake secondary to bulky diet 2. Vegan counseling should focus on protein, vitamin B-12, iron, zinc, vitamin D, and calcium from oils, nuts, seeds, fortified cereals, and fortified soy milk H. Promote Good Oral Health 1. Begin oral hygiene when teeth appear 2. Seek early pediatric dental care 3. Drink fluoridated water 4. Use small amounts of fluoridated toothpaste twice daily 5. Snack in moderation 6. Avoid sticky, high-sugar snacks 7. If gum is desired, chew sugarless gum I. Links Between Autism and Nutrition 1. Autism spectrum disorder (ASD) includes a range of problems with social interaction, verbal and nonverbal communication, and/or unusual, repetitive, or limited activities and interests 2. Occurs in 1/68 children; more prevalent in boys 3. Often associated with GI disorders (e.g., diarrhea, constipation, or reflux disease), which may impair nutrient absorption 4. Feeding problems may be related to developmental impairments 5. Altered absorption/metabolism of nutrients may increase dietary needs 6. Many nutrient-based theories under study for treatment of autism a. Gluten-free, casein-free diet 1) Eliminates wheat, barley, rye, and milk products 2) Food proteins may affect neurotransmitter synthesis 3) Ensure adequate protein, calcium, vitamin D, folic acid, and other B vitamins 4) Clinical evidence for support is limited b. Supplementation 1) Probiotics 2) Vitamin B-6 (0.6 mg/kg/d) 3) Magnesium (6.0 mg/kg/d) 4) Omega-3 fatty acids (up to 800 mg/d) 15.5 School-Age Children: Nutrition Concerns A. Overview 1. Generally, nutritional concerns and goals are the same as preschoolers, but peers, media, and desire for independence influence food intake 2. Improvement needed with regard to fruit, vegetable, whole grain, and dairy choices a. 40% of school children ate no vegetables on a given day b. 20% of school children ate no fruit on a given day c. Less than 20% girls consume adequate calcium 3. Emphasis on iron, zinc, and calcium intake is needed 4. Reduction in consumption of sugared soft drinks is advised 5. Number of servings increases as energy needs increase 6. Figure 15-3 presents how to use MyPlate to build a healthy meal for children B. Reversing Trends for Overweight and Obesity 1. In the US, 1/3 of school-age children are overweight or obese; prevalence is increasing especially in minority populations 2. Effects a. Ridicule b. Embarrassment c. Possible depression d. Short stature e. Cardiovascular disease f. Type 2 diabetes g. Hypertension h. 40% of obese children become obese adults i. 80% of obese adolescents become obese adults 3. Potential causes a. Heredity b. Inactivity 1) Increased screen time (average 7 hours per day) 2) Only 50% children get recommended 60 minutes exercise per day 3) Lack of safe play areas c. Diet 1) Excessive snacking 2) Overreliance on fast food 3) Abundant supply of high-calorie food choices 4) Excessive consumption of sugared soft drinks 4. Treatment a. 60 minutes or more of planned physical activity per day 1) Caregivers are role models 2) Age-appropriate activities 3) Make it fun and social b. Moderate energy intake 1) Limit energy-dense foods 2) Focus on nutrient-dense foods 3) Small changes 4) Health professionals should be versed in cultural food preferences c. Change habits to maintain weight during growing years d. Weight-loss medications may be needed 1) Sibutramine 2) Orlistat e. Bariatric surgery for morbid obesity C. Early Signs of Cardiovascular Disease 1. CVD begins early in life 2. One in 5 youths between 12 and 19 years of age has abnormal lipid levels. 3. Risk factors a. Overweight b. High blood pressure c. Smoking d. Diabetes e. Family history of CVD (or unknown history) 4. AAP recommends universal blood lipid screening for all children ages 9 to 11 5. At-risk children should begin cholesterol screening between age 2 and 10; repeat every 3–5 years 6. Therapy a. Weight management through dietary modification (based on the Dietary Guidelines and MyPlate ) and increased physical activity b. May require medications to lower cholesterol D. Type 2 Diabetes Among Youth 1. Primarily due to obesity coupled with inactivity 2. Blood glucose screening for at-risk children every 2 years starting at age 10 3. AAP released guidelines for management of type 2 diabetes in children in 2013 a. Guide glucose monitoring, use of medications, weight management, and physical activity b. Dietary strategy 1) Regular schedule of meals and snacks 2) Education on portion control 3) Limiting sweetened beverages 4) Limiting high fat foods, snacks and fast foods 5) Incorporate fruits, vegetables, low-fat or fat-free dairy c. Physical activity: engage in moderate or vigorous intensity physical activity for at least 60 minutes per day. 4. Medications may be necessary E. Start the Day with Breakfast 1. Fortified ready-to-eat breakfast cereal is greatest source of iron, vitamin A, and folic acid for children ages 2–18 2. Children who eat breakfast are more likely to meet their daily nutritional needs than children who do not eat breakfast 3. No need to limit choices to traditional breakfast items F. Choose Healthy Fats 1. Include a variety of foods from each food group 2. Overemphasis on fat-reduced diets during childhood is linked to disordered eating habits 3. Fat consumption trends among school-age children a. Excess saturated fat b. Deficient intake of omega-3 fatty acids 4. Recommendations a. Offer baked or broiled protein sources b. Choose leaner cuts of meat c. Trim visible fat, remove skin d. Include two servings of fish per week e. Encourage moderation in fat and sugar intake with snacks f. Emphasize fruit, vegetables, whole grain, and low-fat dairy products G. Select Appropriate Beverages 1. Sugar-sweetened beverages account for about 200 empty kcal/day for school-age children a. Rise in sweetened beverage consumption associated with rise in childhood obesity b. Linked to increased inflammation and worsened blood lipids 2. Children should drink water and low-fat or fat-free milk as primary beverage choices 3. Limit fruit juice to 4 to 6 oz per day for young children or 8 to 12 oz per day for older children. H. Promote Sound Nutrition in Schools 1. USDA Team Nutrition Initiative supports child nutrition programs with education materials that promote health food choices and physical activity (www.teamnutrition.usda.gov) 2. Healthy Hunger-Free Kids Act (2010) a. Extended funding for the National School Lunch Program, School Breakfast Program, and other federal nutrition programs. b. New standards for school breakfast and lunch stipulate how many servings of fruits, vegetables, and whole grains are offered; replace whole milk with skim or 1% milk c. New standards for the quality of competitive foods sold on school campuses; sets calorie limits on snacks and restricts the levels of saturated fat and sodium in foods that can be sold to students d. Goal: reduce prevalence of childhood overweight and obesity 3. 1/3 total daily calories are eaten at school during the week 15.6 Teenage Years: Nutrition Concerns A. Overview 1. Rapid growth spurt a. Girls: 10 to 13 years of age b. Boys: 12 to 15 years of age 2. Height gains a. Girls: gain 10 inches b. Boys: gain 12 inches 3. Body composition a. Girls gain fat and lean tissue b. Boys gain mostly lean tissue 4. During growth spurts, teenagers eat more a. Girls: 1800–2400 kcal/day b. Boys: 2200–3200 kcal/day 5. Choose nutritious food to meet nutrient needs 6. Using MyPlate can provide the basis for meeting the nutrient needs 7. Fruit and vegetable intake is inadequate a. 1/4 high school students regularly consume at least 5 servings per day b. Low consumption correlates with inadequate intakes of vitamins A, C, E, folate, magnesium, calcium, phosphorus, and vitamin D c. Intakes of saturated fat, cholesterol, sodium, and sugars thus exceed the recommendations set by AHA, increasing risk for obesity and CVD 8. Childhood obesity a. Ages 12 to 19: 18.4% obese b. Black females and Hispanic males at highest risk c. Increased risk for type 2 diabetes, hypertension, cardiovascular diseases, sleep apnea, joint problems. 9. Calcium and vitamin D a. Soft drinks replace milk as preferred beverage among children b. Less than 10% girls and 25% boys meet recommendations for calcium intake c. Calcium requirements for 14 to 18 year old girls and boys are 1300 mg per day d. Consume three servings per day from the dairy group e. One out of 5 children is deficient in vitamin D 10. Iron a. 10% teenagers have low iron stores or iron-deficiency anemia b. Iron-deficiency anemia adverse effects 1) Fatigue 2) Decreased concentration and ability to learn 3) Reduced physical performance 4) Reduced academic performance c. Adolescent females at greater risk of iron deficiency due to heavy menstrual flow and poor diet B. Break the Fast-Food Habit 1. 40% youth eat our at fast food restaurants on any given day 2. Average fast food trip yields a. 300 extra calories b. 14 additional grams of fat c. 400 additional mg of sodium 3. Small changes can make significant difference (i.e., lean meat, healthy sides, limited condiments) 4. Portion control is important; avoid supersized options C. Curb Caffeine Intake 1. 30% adolescents report consuming energy beverages 2. Caffeine content is not required on energy drink labels 3. AAP advises limiting caffeine intake in children to 100 mg per day a. Soft drinks contain 25 mg per serving b. Energy drinks contain 100–200 mg per serving c. Coffee and tea contains about 100 mg per serving d. Chocolate and some candies also contain caffeine 4. Negative effects of caffeine in children includes a. GI distress b. Sleep disturbances c. Anxiety d. Increased blood pressure e. Irregular heartbeat f. Disturbances in growth and learning g. Poisoning and death in extreme cases D. Choosing Vegetarian Diets 1. Should be monitored for nutritional adequacy a. Energy and protein b. Iron, Vitamin B12, calcium, and vitamin D 2. Some cite ethical reasons for choosing vegetarian E. Alcohol Abuse Among Teens 1. National Youth Risk Behavior Survey demonstrates that: a. 20% of teenagers have tried alcohol at the age of 13. b. 70% of teens report drinking alcohol at least once c. 22% of teens report binge-drinking 2. Alcohol use beginning in adolescence has severe consequences a. Body and brain development is affected by alcohol b. 1 in 10 teenagers admit to drinking and driving c. Contributes to accidental injuries and deaths, drowning, falls, and burns d. Alcohol abuse in adolescence is predictor of abuse in adulthood e. Poor nutritional status f. Weight gain from empty calories g. Increased risk for obesity related diseases, such as hypertension and cardiovascular disease Nutrition and Your Health: Food Allergies and Intolerances A. Food Allergies: Symptoms and Mechanism 1. Characteristics a. Occur more frequently in females b. Occur most frequently during infancy and young adulthood 2. Symptoms of food allergies a. Skin: itching, tingling, redness, hives, and swelling b. Gastrointestinal tract: nausea, vomiting, diarrhea, intestinal gas, bloating, pain, constipation, and indigestion c. Respiratory tract: runny nose, wheezing, congestion, and difficulty breathing d. Cardiovascular system: low blood pressure and rapid heart rate 3. Anaphylaxis: severe allergic response involving low blood pressure, respiratory distress, GI distress 4. Inappropriate immune response a. Immune system identifies food protein as antigen and mounts an immune response b. Early introduction of solid foods may trigger food allergies (“leaky” gut) c. Hygiene hypothesis: overuse of antibiotics and antimicrobial products removes common challenges to developing immune system; become sensitized to harmless antigens 5. Possible link between low levels of vitamin D and food allergies B. Testing for a Food Allergy 1. See Table 15-8 for assessment strategies for food allergies 2. Requires skilled physician 3. Record history of symptoms, duration, and family history 4. Elimination diet 5. Food challenge (if anaphylaxis not a symptom) 6. RAST test to determine presence of antibodies to certain foods 7. Blood tests to estimate antibody concentration C. Living with Food Allergies 1. Avoidance 2. 80% of children outgrow food allergies before age 3 3. Some food allergens can be consumed in small doses or are destroyed by cooking 4. Food Allergen Labeling and Consumer Protection Act (2006) mandates identification of major food allergens in food products 5. Work with an RD to ensure adequate nutrient intake when avoiding sources of food allergens 6. Strategies under study: a. Treatment with antibodies to increase the threshold at which an allergic response occurs b. Immunotherapy: exposes allergic individuals to small but progressively increasing amount of food allergens to build a tolerance c. Vaccines d. Genetically engineered foods D. Preventing Food Allergies 1. Feed only breast milk or infant formula before 4 months of age (many experts recommend waiting until 6 months of age to introduce solid foods) 2. Delaying the introduction of highly allergenic foods beyond 6-months of age is no longer advised by the AAP or NIAID, even for infants with a family history of food allergies 3. Mothers who are pregnant or breastfeeding should not restrict allergenic foods 4. Formula-fed infants are at greater risk for developing food allergies than those infants breastfed 5. Hydrolyzed infant formulas may prevent the development of allergies in infants E. Food Intolerances 1. Adverse reactions not involving allergic mechanism 2. Common causes: a. Constituents of certain foods (e.g., red wine, tomatoes, pineapples) b. Certain synthetic compounds added to foods (e.g., sulfites, food coloring agents, MSG) c. Food contaminants d. Toxic contaminants e. Deficiencies in digestive enzymes 3. Treatment: avoidance or consume smaller amounts BEST PRACTICES: TEACHING STRATEGIES, DEMONSTRATIONS, ACTIVITIES, ASSIGNMENTS, AND MORE 1. Assign students the Rate Your Plate activity, "Getting Young Bill to Eat.” Use it as a basis for a discussion of typical problems infants, toddlers, and children have with eating. Discuss strategies for overcoming these problems and promoting good eating habits. 2. Present case studies of an infant, a toddler, and a child with typical eating problems. Duplicate these case studies. Divide the class into small groups. Assign a group leader and give him/her a copy of the studies. Have each group come up with strategies for solving the eating problems in each case. Take one case at a time and let each group leader present the strategies determined by each group. Make a list of these on the blackboard. This would be a good critical thinking activity. 3. Have students bring examples of how certain packaged foods are expressly marketed to young children. Ask them to evaluate the nutritional value of these foods. 4. Have students visit a supermarket to survey the availability of foods for infants. Ask them to compare various brands based on cost and quality. They could compare ingredients using the order given on the label, serving size, and cost. Include fruits, vegetables, meats, mixed dishes, cereals, juices, and dessert items. 5. Assign students the task of planning a menu for a 7–12 year old child and a teenager using the Dietary Guidelines for Americans. 6. Have students visit a local pharmacy to determine the content and cost of nutrient supplements for infants, preschool children, and school-age children. What products contain fluoride and how can they be obtained? Do any of the supplements have vitamin and mineral levels above 150% of the Daily Value US RDA? Are generic brands cheaper than commercial brands? By how much? Are they similar in nutrient content or not? Which one would they pick if they had a child? Have them discuss their answers in class. 7. Ask a representative of the WIC Program to come and discuss the program with the class. 8. Have students compile a 3-day menu of the meals typically eaten in the family they grew up in. Ask them to evaluate the nutrition of those food choices. Have them use the family menu to create a shopping list and visit a grocery store to determine the cost for purchasing the ingredients. They can also look for substitutions and ways to make these same meals more nutritious. Instructor Manual for Wardlaw's Contemporary Nutrition Anne M. Smith , Angela L. Collene 9780078021374, 9781260092189

Document Details

Related Documents

person
Lucas Hernandez View profile
Close

Send listing report

highlight_off

You already reported this listing

The report is private and won't be shared with the owner

rotate_right
Close
rotate_right
Close

Send Message

image
Close

My favorites

image
Close

Application Form

image
Notifications visibility rotate_right Clear all Close close
image
image
arrow_left
arrow_right