CHAPTER 14 NUTRITIONAL REQUIREMENTS DURING GROWTH AND DEVELOPMENT AND EATING HABITS AFFECTING ORAL HEALTH Copyright © 2015, 2010, 2005, 1998 by Saunders,

CHAPTER 14 CHAPTER 14

NUTRITIONAL REQUIREMENTS NUTRITIONAL REQUIREMENTS DURING GROWTH AND DURING GROWTH AND

DEVELOPMENT AND EATING DEVELOPMENT AND EATING HABITS AFFECTING ORAL HABITS AFFECTING ORAL

HEALTHHEALTH

Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 2

Infants: OverviewFeeding patterns in first 2 years of life create

environment for optimal development of genetically determined factors contributing to orofacial development and swallowing patterns

GrowthBirth weight doubles in 4 months (from 7.5 to 15 lb)By 1 year it triples Length or height increases 50% by age 1


Infants: Nutritional RequirementsEnergy requirements are much higher per pound

or kilogram of weight than for an adult 95 to 83 kcal/kg/day between 3 and 12 months of age,

respectively, vs. 29 to 37 kcal/kg/day for adultsInfants have a higher resting metabolic rate

Protein recommendationsAI =1.52 g/kg daily from birth to 6 months of age AI =1.2 g/kg for infants over 6 months of age This translates to about 9.1 to 11 g/day Should not exceed 20% of daily caloric intake due to

immature renal function


Infants: Breast Milk

Living cellsHormonesActive enzymes (e.g.,

lipase to aid in fat digestion)

AntibodiesLow mineral content;

ideal for immature infant kidneys

Long-chain fatty acids needed for brain and retina development

High cholesterol countBy 6 months of age, need

addition of iron-rich foods or supplements

By 2 months, supplement with vitamin D

Optimal source of nutrition for infants;Optimal source of nutrition for infants;

incredibly complex and contains:incredibly complex and contains:


Infants: Artificial Baby MilkDespite strict standards for infant formula, it

cannot duplicate human breast milkNonfat cow’s milk is the basis for most infant formulas

Provides 20 kcal/ozMost have been modified to include DHA for

brain and retinal developmentAPA provides guidelines for electrolyte, mineral,

and vitamin contentADA recommends use of fluoride-free

water to reconstitute powder formulas


Infants: Artificial Baby MilkAlternative artificial baby milk

Soy-based formulas used for infants with cow’s milk allergy Most common reason for use is relief of perceived formula

intolerance (spitting, vomiting, fussiness) or symptoms of colic although clinical studies do not indicate a benefit

Formulas for infants with special nutritional requirements Preterm infants Metabolic problems (e.g., phenylketonuria)

Formulas discontinued at age 1; whole milk provided until age 2


Infants: Feeding PracticesInfants typically eat six times/day at 4-hour

intervalsOral and neuromuscular development

Suckling encourages maximum development of the genetically defined jaw and chin Breastfed infants less likely to develop malocclusion—high

premaxilla, abnormal alveolar ridges, and palate and posterior cross-bite

Infants breastfed for a year require 40% less orthodontia than bottle-fed infants

Sucking from a bottle or on a pacifier, thumb, or fingers may result in narrower upper and lower dental arches


Infants: Feeding PracticesSuckling is replaced with sucking by 4 months of age

Sucking motion becomes developed enough to eat and handle semisolid foods from a spoon at 4 to 6 months

At about 6 to 8 months of age, develop the ability to receive food and perform a chewing motion

When infant can chew, variety of texture is mandatory to prepare infant to accept unfamiliar foods later in life Unless textured foods are offered, development of oral

musculature may be slow or delayed and affect speech


Infants: Feeding PracticesIntroducing foods

4 to 6 months First foods introduced are usually cereals made of

rice, oat, or barley Should be presented to the infant with a spoon Formula intake should remain around 32 oz daily Fruit juice provides no nutritional benefit for infants

less than 6 months old


Infants: Feeding Practices

Introducing foods6 months

4 to 6 oz of fruit juice diluted with equal portions of water can be introduced in a cup

Because of possible food allergy, only one new food should be introduced at a time

Order of introduction: vegetables, meats, and fruits Sweet foods are preferred so offer other foods first

Junior-type foods with a few lumps are introduced to initiate some chewing

Fluoride supplements recommended for children in areas without fluoridated water


Oral Health Concerns of Early Childhood

Nutritional deficiency during tooth development affects:Tooth sizeTooth formationTime of tooth eruptionSusceptibility to caries

Mild to moderate malnutrition during first year of life associated with increased caries in primary and permanent teeth

From Bath-Balogh M, Fehrenbach MJ: Illustrated From Bath-Balogh M, Fehrenbach MJ: Illustrated Dental Embryology, Histology, and Anatomy, ed 3. St. Dental Embryology, Histology, and Anatomy, ed 3. St.

Louis: Saunders, 2011.Louis: Saunders, 2011.


Infant Oral CareGeneral oral hygiene guidelines

Infant’s gingiva should be cleaned daily with gauze; soft infant toothbrush and water or infant tooth cleaner to remove plaque biofilm

When teeth begin to erupt, parents should continue brushing teeth with soft infant toothbrush using fluoride-free toothpaste

AAPD recommends first dental visit by age 1When child is able to expectorate (usually 2 to 3 years

old), pea-sized amount of fluoride toothpaste can be used


Infant Oral Care

Feeding issues affecting oral healthAt-will nighttime breastfeeding should be discontinued

once teeth eruptInfants and toddlers should not be given a bottle at

bedtimeToddlers should be weaned from the bottle by 14 monthsInfants and toddlers should begin drinking from a cup as

soon as they can sit up and hold it A sippy cup between meals with juice, soda, or other sweetened

liquid places the child at risk for caries


Early Childhood CariesEarly childhood caries (ECC)

Presence of one or more decayed, missing (due to caries), or filled tooth surfaces in any primary tooth in child less than age 6

Severe early childhood caries (SECC)Rampant decay usually associated with

inappropriate feeding practicesChildren with SECC weigh less than their

ideal weight for height, and their weight

for age is frequently below 10th percentile

From Swartz MH: Textbook of From Swartz MH: Textbook of Physical Diagnosis, ed 7. Physical Diagnosis, ed 7.

Philadelphia: Saunders, 2014.Philadelphia: Saunders, 2014.


ECC: Contributing Factors

Infection with Streptococcus mutans from caregiver

Addition of frequent or prolonged exposure to a fermentable carbohydrate will inoculate S. mutansA bottle at bedtime and frequent daytime

bottles or habitual use of a no-spill training cup increase caries risk

Prevention starts before birth with guidance to parents

From Bath-Balogh M, Fehrenbach MJ: From Bath-Balogh M, Fehrenbach MJ: Illustrated Dental Embryology, Histology, Illustrated Dental Embryology, Histology, and Anatomy, ed 3. St. Louis: Saunders, and Anatomy, ed 3. St. Louis: Saunders,

2011.2011.


Cleft Palate and LipMalformation in which parts of the upper lip or

palate fail to grow togetherApproximately 1 out of 1000 infants born with cleft lip

with or without cleft palateDrugs, heredity, or nutrient deficiencies (namely folic

acid) may cause this malformation

Infants born with cleft palates are at high risk of developmental delays, including motor skills

Increased rates of dental abnormalities, including supernumerary, missing, or malformed teeth


Cleft Palate and LipFeeding can be major issue since

presence of the cleft prevents negative pressure needed for sucking Extra feeding time is necessary to

ensure adequate nutritionSpecial feeding devices needed when

feeding time exceeds 1 hourOther feeding issues include nasal

regurgitation, excessive air intake, and frequent burping

Spoon feeding introduced as soon as possible

From Bath-Balogh M, Fehrenbach MJ: From Bath-Balogh M, Fehrenbach MJ: Illustrated Dental Embryology, Histology, Illustrated Dental Embryology, Histology, and Anatomy, ed 3. St. Louis: Saunders, and Anatomy, ed 3. St. Louis: Saunders,

2011.2011.


MyPlate & MyPyramid MyPlate & MyPyramid for Kids emphasize for Kids emphasize variety, moderation, variety, moderation, and balance in food and balance in food choices choices

Focus on importance Focus on importance of making consistent of making consistent smart food choicessmart food choices

Dietary Recommendations and Guidelines for Growth: Children

Older Than 2 Years


MyPlate for Kids: Key Messages for Parents

Set a good example Offer a variety of foodsStart with small portionsHelp them know when

they’ve had enoughFollow a meal and snack

scheduleMake mealtime a family

time

Cope with a picky eaterHelp them try new foodsMake food funEncourage 60 minutes of physical

activity dailyDietary fiber

intake = age of child + 5 g/day


Toddlers and Preschool Children: Overview

GrowthGrow approximately 2 to 3 inches/year and gain

around 5 lb/year Half of adult height achieved by 2½ to 3 years of age

Nutrient requirementsMost often deficient: iron, zinc, calcium, and vitamin DCaloric needs: 1000 kcal + 100 kcal per year of ageChoose nutrient-dense foods to meet growth needs


Toddlers: 1 to 3 Years OldSome finger foods should be provided at every mealToddlers can manipulate a cup by age 18 monthsProvide regularity with meals and snacksOffer small amounts of food several times per dayServing size is dependent on appetiteFood jags are common; continue to offer

well-balanced meals; let children choose

from what is offeredPrevent choking by closely supervising

children while they’re eating


Preschool Children: 4 to 6 Years Old

Independent in feeding themselvesCutting fruits and vegetables into small

pieces increases acceptancePrefer foods separate rather than mixedParents need to model appropriate eating behaviorsSnacks important to ensure adequate nutrient intakeEasy-to-chew foods more readily acceptedMay need 8 to 15 exposures to new food before

acceptance


ADD/ADHA

Promote a nutritionally well-balanced, high-protein diet

Limit added sugarsAdd more complex carbohydratesRestriction of synthetic food color additives

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Children with Special NeedsMastication and swallowing problems are commonBruxism is common in cerebral palsy and Down

syndromeChildren with cerebral palsy, Down syndrome, and

intellectual disabilities likely to have abnormal sensory input and muscle tone

Difficulties with sucking, swallowing, spoon-feeding skills with semisolid or solid foods, chewing, and independent feeding are common

Tongue thrust associated with many of these conditions jeopardizes nutritional status


School-Age Children: 7 to 12 Years Old

Only 22% of all children consume 3 servings of vegetables daily

Food habits and intake may suffer because children do not take time for meals

Although bakery products, soft drinks, candy, and chips are favorites, nutritious snacks are preferable


School-Age Children: 7 to 12 Years Old

Dental cariesPrevalence of caries in the permanent teeth

of youths ages 6 to 11 years decreased from 25% in 1988–1994 to 21% in 1999–2004

Some racial, ethnic, and lower socioeconomic groups have more treated and untreated caries

Caries rate is reduced 60% when 1 ppm fluoride in drinking water is present during tooth formation

Application of sealants aids in reducing caries riskFood selection and patterns of consumption affect

caries risk, so nutritious foods should be encouraged


AdolescentsGrowth and nutrient requirements

Because of major biological, social, psychological, and cognitive changes; 17% of teens at nutritional risk

Growth of long bones, secondary sexual maturation, and fat and muscle deposition lead to increased nutrient requirements Calcium, vitamin D, and iron especially important

Only 9% of girls and 31% of boys between ages 14 and 18 get the recommended daily amount of calcium


AdolescentsInfluential factors on eating habits

External factors Family Peer pressure Mass media Economic and sociocultural factors

Internal factors Physiological needs Body image and self-concept Food preferences Personal values/beliefs toward health and nutrition


Adolescents: Food Choices

Favorite food choices among adolescents:Carbonated beverages,

sports/energy drinks Soda consumption

increased from 16 oz/day to 28 oz/day between 1977 and 1999

Orange and apple juice From 1977 to 2001, fruit

drink consumption from 1.8% to 3.4%

Flavored milkSteak, hamburgers,

chicken Pizza and spaghettiChipsFrench friesIce creamCandy (sour,

hard, chewy)Snack cakes


Adolescents: Food ChoicesAdolescents have more access to food outside the

home and experiment more with food selectionsAbout 25% of kilocalories come from high-calorie,

low-nutrient foods, which results in:Excessive intake of sodium, sugar, and fatInadequate fiberFrequent snacking and skipping meals, especially

breakfastEating in a hurryReliance on convenience and fast foods


Adolescents: Oral HealthAcademy of General Dentistry notes increase in

soda consumption has boosted caries rate in teens, which is approaching levels before fluoridation

AAPD warns of the following potential health problems as a result of high intake of sweetened drinks: Overweight attributable to additional caloric intakeDisplacement of milk consumption, resulting in calcium

deficiency with an attendant risk of osteoporosis and fractures

Dental caries and potential enamel erosion


Adolescents: Nutritional Counseling

Adolescents can frequently be motivated by responsibility, collaboration, fear of failure, and respect for the counselorNegotiation and reflective listening can enhance

their critical thinking skillsPresent nutrition and oral health

information in terms relevant to teen

lifestyles and personal interests (athletic performance, appearance)


HEALTH APPLICATIONChildhood & Adolescent Obesity

Discuss factors impacting/causing the obesity epidemic

Consider physiological/psychosocial complications leading to negative health consequences

Discuss social discrimination related to obesityConsider strategies and rationales for WHY

prevention is so importantDiscuss goal setting for obese children for weight

maintenance or reduction

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CHAPTER 14 NUTRITIONAL REQUIREMENTS DURING GROWTH AND DEVELOPMENT AND EATING HABITS AFFECTING ORAL HEALTH Copyright © 2015, 2010, 2005, 1998 by Saunders,