Chapter 12 Growth and Development Issues in Promoting Good Health

Chapter 12Chapter 12

Growth and Development Issues in Promoting Good Health

2Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.

Learning ObjectivesLearning Objectives

Describe nutritional needs of children and Describe nutritional needs of children and adolescents.adolescents.

Assess a child’s nutritional needs based Assess a child’s nutritional needs based on growth charts.on growth charts.

Describe methods to promote optimal Describe methods to promote optimal nutritional intake.nutritional intake.

Describe assessment and intervention Describe assessment and intervention strategies for common childhood health strategies for common childhood health concerns.concerns.

Apply knowledge of the nutrient needs to Apply knowledge of the nutrient needs to the meal environment.the meal environment.

•2


Development: Ability of Development: Ability of Body Parts to FunctionBody Parts to Function

Nutritionally poor-quality diet can impair cognitive Nutritionally poor-quality diet can impair cognitive function and neurologic developmentfunction and neurologic development Milk intake associated with increased cognitionsMilk intake associated with increased cognitions Nerve function requires B vitamins, vitamins C, E, K, Nerve function requires B vitamins, vitamins C, E, K,

and iodine and iodine (Bourre, 2006) (Bourre, 2006)

Poor nutritional intake of CHO can have Poor nutritional intake of CHO can have short-term deficits in cognitionshort-term deficits in cognition Breakfast leads to improved mental performance in Breakfast leads to improved mental performance in

schoolschool Children with poor school performance found less likely Children with poor school performance found less likely

to eat high-protein foods, have less vitamins and to eat high-protein foods, have less vitamins and minerals in diet, and higher sugar and fat intake minerals in diet, and higher sugar and fat intake (Fu et al., (Fu et al., 2007)2007)


Bone Growth: Best Bone Growth: Best Barometer of Nutritional StatusBarometer of Nutritional Status

Bone, as healthy, living tissue, needs a Bone, as healthy, living tissue, needs a variety of nutrients for growthvariety of nutrients for growth

It may generally be said that a child who It may generally be said that a child who follows the growth curve for height is follows the growth curve for height is meeting nutrient needsmeeting nutrient needs

Chronic inadequate protein, kilocalories, Chronic inadequate protein, kilocalories, vitamins, and minerals will stunt growthvitamins, and minerals will stunt growth


Stunted GrowthStunted Growth

Stunting is shown with Nigerian children, born in the same month in the same village, who have genetically similar parents. (Photo courtesy of Michael Latham, Division of Nutritional Sciences, Cornell University, Ithaca, NY, and David Morley, Institute of Child Health, London, England.)


Growth ChartsGrowth Charts

http://www.cdc.gov/growthcharts/ Based on percentiles (e.g., if child is 75th Based on percentiles (e.g., if child is 75th

percentile for height, this means 25 children of the percentile for height, this means 25 children of the same age and gender are taller and 75 are same age and gender are taller and 75 are shorter)shorter)

Most important is that the child “follows the curve”Most important is that the child “follows the curve” Body mass index for children calculated same as Body mass index for children calculated same as

for adults but ideal numbers based on percentilesfor adults but ideal numbers based on percentiles Optimal:Optimal:

55thth – 95 – 95thth percentile (under 2 years old) percentile (under 2 years old) Over 2 years oldOver 2 years old

• BMI <5BMI <5thth percentile = underweight percentile = underweight• BMI <25BMI <25thth percentile = risk for underweight percentile = risk for underweight• BMI >85BMI >85thth percentile = risk for overweight percentile = risk for overweight• BMI >95BMI >95thth percentile = overweight percentile = overweight


Kilocalorie Needs Kilocalorie Needs During ChildhoodDuring Childhood

80 kcal/kg BW for prepubescent children80 kcal/kg BW for prepubescent children 45 kcal/kg BW for active adolescent males45 kcal/kg BW for active adolescent males 38 kcal/kg BW for active adolescent 38 kcal/kg BW for active adolescent

femalesfemales 30 kcal/kg BW for non-active adolescents30 kcal/kg BW for non-active adolescents

Needs based on level of activity, Needs based on level of activity, chronological age and individual growth chronological age and individual growth raterate


Fluid Needs for ChildrenFluid Needs for Children

The Adequate Intake (AI) is about 2.5 The Adequate Intake (AI) is about 2.5 liters/day for older children; see DRI liters/day for older children; see DRI

A child with constipation should be A child with constipation should be assessed for fluid intakeassessed for fluid intake

Athletic children need to have fluid goals Athletic children need to have fluid goals determined by weight changesdetermined by weight changes


Toddler Feeding GuidesToddler Feeding Guides

Young children like plain, simple foods; avoid Young children like plain, simple foods; avoid mixturesmixtures

Rule of thumb: 1 tbsp of each food per serving for Rule of thumb: 1 tbsp of each food per serving for each year of ageeach year of age

Provide cups with handles; “sippy” cups avoid Provide cups with handles; “sippy” cups avoid spillsspills

Promote “one-taste” rule, but avoid food battlesPromote “one-taste” rule, but avoid food battles Provide structured choices (e.g., “Would you like Provide structured choices (e.g., “Would you like

carrots on this side of the plate or the other carrots on this side of the plate or the other side?”)side?”)

Age + 5 for fiber goalAge + 5 for fiber goal


Picky EatersPicky Eaters

Tastes are learned; research shows a food has Tastes are learned; research shows a food has to be tried 10 times before acceptanceto be tried 10 times before acceptance

Offer a new food with well-liked foods Offer a new food with well-liked foods (e.g., offer broccoli with macaroni and cheese)(e.g., offer broccoli with macaroni and cheese)

Practice patiencePractice patience May be related to tactile defensiveness; May be related to tactile defensiveness;

speech-language pathologist may be helpfulspeech-language pathologist may be helpful Avoid authoritarian approach since related to Avoid authoritarian approach since related to

poor vegetable intakepoor vegetable intake


Preschool AgePreschool Age

Encourage food diversity by involving child in food Encourage food diversity by involving child in food shopping and preparation; help children identify shopping and preparation; help children identify foods by looking at food labelsfoods by looking at food labels

Make eating fun; read Make eating fun; read Green Eggs and Ham,Green Eggs and Ham, sing sing “Popeye the Sailor Man”“Popeye the Sailor Man”

Avoid using food bribesAvoid using food bribes Food jags are common, with same foods desired Food jags are common, with same foods desired

for several weeks at a timefor several weeks at a time Exposure to a variety of foods before age 4 Exposure to a variety of foods before age 4

encourages the child to continue acceptance of encourages the child to continue acceptance of these foods when olderthese foods when older


Early School YearsEarly School Years

Encourage breakfast for enhanced school Encourage breakfast for enhanced school performanceperformance

Help children learn about good nutrition through Help children learn about good nutrition through the MyPyramid Food Guidance System. Ask the MyPyramid Food Guidance System. Ask “What food group is cantaloupe in?”“What food group is cantaloupe in?”

Promote concept of “All foods can fit”Promote concept of “All foods can fit”——avoid avoid labeling foods “bad” and “good”; use Pyramid labeling foods “bad” and “good”; use Pyramid conceptconcept

Remember parent role, “Provide nutritious food in Remember parent role, “Provide nutritious food in a pleasant environment,” and child’s role, a pleasant environment,” and child’s role, “Choose what, when, and how much to eat” (per “Choose what, when, and how much to eat” (per Ellyn Satter, RD)Ellyn Satter, RD)


Adolescent YearsAdolescent Years

Recognize that body fat increase precedes Recognize that body fat increase precedes pubertypuberty

Remember parent role: have a variety of foods Remember parent role: have a variety of foods available for choices teen can make (e.g., available for choices teen can make (e.g., popcorn, pretzels, and fruits instead of chips and popcorn, pretzels, and fruits instead of chips and cookies only)cookies only)

Help teen pack foods for delayed meals, such as Help teen pack foods for delayed meals, such as when sports events delay dinnerwhen sports events delay dinner

Teens need high kilocalorie, protein, and calcium Teens need high kilocalorie, protein, and calcium and vitamin D intake for good growthand vitamin D intake for good growth

Help teens in decision making for food purchasesHelp teens in decision making for food purchases


Help Prevent Childhood ObesityHelp Prevent Childhood Obesity

Discourage excess television and computer useDiscourage excess television and computer use Encourage physical activityEncourage physical activity Promote high-fiber foods for satiety and Promote high-fiber foods for satiety and

encouragement of bone growth from minerals, encouragement of bone growth from minerals, especially magnesiumespecially magnesium

Promote appropriate milk and water intake; Promote appropriate milk and water intake; discourage sweet beveragesdiscourage sweet beverages——juice diluted with juice diluted with mostly seltzer is a healthy alternative to soda popmostly seltzer is a healthy alternative to soda pop

Encourage children to eat fruit rather than drink itEncourage children to eat fruit rather than drink it


Provide Nonfood RewardsProvide Nonfood Rewards

PraisePraise HugsHugs Talking and telling storiesTalking and telling stories Give flowersGive flowers Give stickersGive stickers


Childhood Issues Childhood Issues Related to Poor Weight GainRelated to Poor Weight Gain

Celiac disease: an immune-type response Celiac disease: an immune-type response among those with genetic predisposition to among those with genetic predisposition to gliadin protein as found in gluten portion of gliadin protein as found in gluten portion of certain grains: wheat, barley, and ryecertain grains: wheat, barley, and rye Can result in diarrhea, poor growth, Can result in diarrhea, poor growth,

osteoporosis, iron-deficiency anemia osteoporosis, iron-deficiency anemia Cystic fibrosis: defect in sodium and Cystic fibrosis: defect in sodium and

chloride transportchloride transport Results in thick mucous secretionsResults in thick mucous secretions Treatment: pancreatic enzymes, high-fat andTreatment: pancreatic enzymes, high-fat and

high-kilocalorie diet, fat-soluble vitamin high-kilocalorie diet, fat-soluble vitamin supplementation, EFAs, calciumsupplementation, EFAs, calcium


Anemia and Iron-DeficiencyAnemia and Iron-Deficiency

Generally due to periods of rapid growth Generally due to periods of rapid growth (early childhood and adolescence)(early childhood and adolescence)

Preference for low-iron foods contributesPreference for low-iron foods contributes Possible malabsorption due to parasites Possible malabsorption due to parasites

from lack of hand-washing after outdoor from lack of hand-washing after outdoor playing or due to celiac diseaseplaying or due to celiac disease

Adolescent girls high-risk with menstrual Adolescent girls high-risk with menstrual losses and rapid growthlosses and rapid growth


Critical ThinkingCritical Thinking Joey and Andrea were at the pediatrician’s office with their young son Nick

and were voicing concerns about his lack of growth. The nurse practitioner noted positive interaction between the child and his parents and with her. A review of Nick’s usual food intake suggested a good nutritional intake. She then reviewed his chart: Dominic Luis B____; age: 4 years, today’s height: 38 inches; weight: 33 lb; birth length: 20.5 inches; birth weight: 8 lb 10 oz; history of chronic anemia treated with FeSO4, history diarrhea. She decided to run some laboratory tests—a B12 level and TTG antibody screen—especially given his Italian heritage.

Using growth charts found in Appendix 10, determine whether there have been changes in growth percentiles from Nick’s birth to his current age. Describe his growth based on the percentiles.

What is Nick’s BMI percentile? What are possible reasons for the parental concern about Nick’s perceived

lack of growth? What are the reasons for the laboratory tests ordered? If the tests come back positive for TTG antibodies, what course of action is

advised?


Baby-Bottle Tooth DecayBaby-Bottle Tooth Decay

Examples of baby-bottle tooth decay. (Courtesy of Ferguson F, Department of Children’s Dentistry, School of Dental Medicine, SUNY at Stony Brook, Stony Brook, NY.)


Food AllergiesFood Allergies

Top 8 allergenic foods make up about 90% of Top 8 allergenic foods make up about 90% of food allergiesfood allergies MilkMilk EggsEggs PeanutsPeanuts Tree nuts (such as almonds, cashews, walnuts)Tree nuts (such as almonds, cashews, walnuts) Fish (such as bass, cod, flounder)Fish (such as bass, cod, flounder) Shellfish (such as crab, lobster, shrimp)Shellfish (such as crab, lobster, shrimp) SoySoy WheatWheat

Ensure positive nutritional intake to support Ensure positive nutritional intake to support growth and development needs; refer to RD as growth and development needs; refer to RD as neededneeded

Increase intake of foods high in vitamin E and Increase intake of foods high in vitamin E and carotenoids for possible reduced sensitivitycarotenoids for possible reduced sensitivity

Children tend to outgrow food allergiesChildren tend to outgrow food allergies


Asthma: An Asthma: An Inflammatory ConditionInflammatory Condition

Avoid food allergens as neededAvoid food allergens as needed Eggs, milk, soy, peanut, wheat, fishEggs, milk, soy, peanut, wheat, fish Refer to RD if food restrictions are followedRefer to RD if food restrictions are followed

Provide foods high in magnesium and zinc Provide foods high in magnesium and zinc or supplements with 100% DRIor supplements with 100% DRI Vitamin C and magnesium levels associated Vitamin C and magnesium levels associated

with asthma in adultswith asthma in adults Consider omega-3 fats for anti-Consider omega-3 fats for anti-

inflammatory functionsinflammatory functions


Childhood ConstipationChildhood Constipation

Generally result of inadequate fluids and Generally result of inadequate fluids and fiberfiber

General treatmentGeneral treatment Increase fluids, fiber, exerciseIncrease fluids, fiber, exercise

Use caution with laxativesUse caution with laxatives Epsom salts can provide excessive amount of Epsom salts can provide excessive amount of

magnesium for children and have been linkedmagnesium for children and have been linkedwith toxicity for this populationwith toxicity for this population

Avoid laxative abuse, because peristalsis of GIAvoid laxative abuse, because peristalsis of GItract can be seriously impairedtract can be seriously impaired


Attention Deficit Hyperactivity Attention Deficit Hyperactivity Disorder (ADHD)Disorder (ADHD)

Conflicting research on whether Conflicting research on whether restrictions of sugar or food additives helprestrictions of sugar or food additives help

Newer research indicates magnesium Newer research indicates magnesium deficiency may be a cause, with good deficiency may be a cause, with good response to supplementation notedresponse to supplementation noted Do not exceed DRI for childrenDo not exceed DRI for children


Autism: Sensory Deficits with Autism: Sensory Deficits with Reduced Social InteractionReduced Social Interaction

Child exhibits strong need to maintain routines Child exhibits strong need to maintain routines and avoidance of anything newand avoidance of anything new Acceptance of new foods is extremely gradualAcceptance of new foods is extremely gradual

Diagnosis made in:Diagnosis made in: 1 in 2500 children in the 1980s 1 in 2500 children in the 1980s 1 in 300 in the mid-1990s1 in 300 in the mid-1990s Now estimated 1 in 200 children Now estimated 1 in 200 children (Liptak et al., 2008)(Liptak et al., 2008)

Possible role of gliadin protein as found in gluten Possible role of gliadin protein as found in gluten and casein (milk protein)and casein (milk protein) Any restrictive diet necessitates supervision by an RDAny restrictive diet necessitates supervision by an RD


New Insights into New Insights into AutismAutism

Low mineral status: magnesium Low mineral status: magnesium (Strambi et al., 2006)(Strambi et al., 2006), , iodine, potassium, lithium with high zinc levels iodine, potassium, lithium with high zinc levels (Adams et al., 2006)(Adams et al., 2006)

Rise in rate coincided with folate fortification of Rise in rate coincided with folate fortification of food supply in the 1990s to reduce incidence of food supply in the 1990s to reduce incidence of neural tube defects. However, children born with neural tube defects. However, children born with autism may have a variant enzyme with high autism may have a variant enzyme with high folate needs (previously may have been folate needs (previously may have been miscarried prior to folate fortification); increased miscarried prior to folate fortification); increased folate intake throughout life for such children may folate intake throughout life for such children may reduce incidence of autism reduce incidence of autism (Rogers, 2008)(Rogers, 2008)


Preventing Eating DisordersPreventing Eating Disorders

Do not discuss weight around children of Do not discuss weight around children of any ageany age

Promote positive self-esteem in childrenPromote positive self-esteem in children Do not restrict food intake or label foods Do not restrict food intake or label foods

“good” and “bad” “good” and “bad” ““All foods can fit”All foods can fit” Encourage and respect children’s ability to Encourage and respect children’s ability to

recognize their hunger and satiety cues and recognize their hunger and satiety cues and feelingsfeelings


Recognizing Eating DisordersRecognizing Eating Disorders

Anorexia nervosa: food restricting (may be Anorexia nervosa: food restricting (may be masked as vegetarian diet or complaints of masked as vegetarian diet or complaints of GI discomfort)GI discomfort)

Bulimia: purging with vomiting and/or Bulimia: purging with vomiting and/or laxative abuselaxative abuse

Bulimorexia: combination of anorexia and Bulimorexia: combination of anorexia and bulimiabulimia


Anorexia Nervosa IndicatorsAnorexia Nervosa Indicators

Weight loss of at least 25% of original body Weight loss of at least 25% of original body weightweight

Bizarre eating habits (cutting food into extremely Bizarre eating habits (cutting food into extremely tiny pieces or having food rituals)tiny pieces or having food rituals)

Compulsive exercise habitsCompulsive exercise habits Amenorrhea (lack of menstrual cycle) among girlsAmenorrhea (lack of menstrual cycle) among girls Disturbed body image with irrational, intense fear Disturbed body image with irrational, intense fear

of becoming obese and refusal to maintain of becoming obese and refusal to maintain appropriate body weightappropriate body weight

Underlying low self-esteemUnderlying low self-esteem Need to gain control in life that feels out of controlNeed to gain control in life that feels out of control


Other Physical Indicators Other Physical Indicators of Anorexia Nervosaof Anorexia Nervosa

Abnormally dry skin and reduced secretionsAbnormally dry skin and reduced secretions Fine hair covering the bodyFine hair covering the body Poor hair growthPoor hair growth Yellowing of the skin with hyperpigmentationYellowing of the skin with hyperpigmentation Acne and inflammatory skin condition or dandruffAcne and inflammatory skin condition or dandruff Coldness of the extremities with bluish Coldness of the extremities with bluish

discolorationdiscoloration Impaired wound healingImpaired wound healing EdemaEdema ScurvyScurvy Pellagra: 4 Ds: diarrhea, dermatitis, dementia, Pellagra: 4 Ds: diarrhea, dermatitis, dementia,

and death (provide vitamin Band death (provide vitamin B33 if risk of pellagra) if risk of pellagra)


Bulimia: Purging BehaviorBulimia: Purging Behavior

Dehydration, dry mouth caused by Dehydration, dry mouth caused by vomiting and/or laxative abusevomiting and/or laxative abuse

Dental erosion from purgingDental erosion from purging——dental dental professionals play key role in identifying professionals play key role in identifying bulimiabulimia


Dental ErosionDental Erosion

Bulimia-induced dental erosion. (From Sapp JP, Eversole LR, Wysocki GW: Contemporary oral and maxillofacial pathology, ed 2, St Louis, 2004, Mosby.)


Developmental DisabilityDevelopmental Disability

Severe, chronic disability that occurs before age 22Severe, chronic disability that occurs before age 22 Mental retardation, Autism, Cerebral palsy, Epilepsy, Mental retardation, Autism, Cerebral palsy, Epilepsy,

Down syndrome, Prader-Willi syndromeDown syndrome, Prader-Willi syndrome Nutritional needs may be altered because of medications, Nutritional needs may be altered because of medications,

hypermetabolism, or hypometabolism related to excess hypermetabolism, or hypometabolism related to excess movements or poor muscle tonemovements or poor muscle tone

Eating problems may occur from anatomic defectsEating problems may occur from anatomic defectsand malformations such as cleft palateand malformations such as cleft palate

Eating problems may result from neuromuscular Eating problems may result from neuromuscular dysfunctiondysfunction

• Hyperactive gag reflex, tongue thrust, poor Hyperactive gag reflex, tongue thrust, poor lip closure, inability to chew and swallow,lip closure, inability to chew and swallow,inability to eat independentlyinability to eat independently


Study GuideStudy Guide What is the best barometer of nutritional status in

children? What does a growth percentile mean? When reading growth charts what is the most important

thing to consider? According to BMI for children, what is the ideal range? What are calorie needs for children based on? Be able to identify food related issues for toddlers,

preschoolers, early school years and adolescents How many times might a picky eater need to be exposed

to a food before accepting it? What is iron deficiency anemia usually due to? What is tooth decay in babies often caused by? What mineral deficiency is thought to be related to ADHD?


Study Guide (continued)Study Guide (continued) How can a parent help prevent childhood obesity? What are the top 8 allergenic foods What is childhood constipation generally caused by? What protein is thought to affect autism and what 2 foods

are often restricted to avoid this protein? What B vitamin may need to be increased in autistic

children? How can a parent help prevent eating disorders in their

children? Indicators of anorexia Differences between anorexia, bulemia and bulemorexia How may nutrition be affected by development disability?

Documents

Chapter 12 Growth and Development Issues in Promoting Good Health