Infancy’s Big Bang: Explosive Growth & Development

in Early Childhood

Robert Murray MD FAAP

Professor of Pediatrics, The Ohio State University

Ohio Chapter, American Academy of Pediatrics

Apis mellifera scutellataKiller Bees

Apis mellifera ligusticaEuropean Honey Bees

Robinson & colleagues

Genes + Experiences = Gene Expression (how we react)

Epigenetics: Which, When, & How Much Protein

Genetics: DNA Makes Protein

Cell

Social experience changesHow our genes work,

which changesHow our body works,

which changesHow we behave,

which changeswho we become

The Epigeneticsof our

“Exposome”

Miller, Jones. Toxicol Sci, 2014; 137:1-2

Epigenetics = Experiences

Diet Quality

Too little/ Nutrient Imbalance/ Too Much

Metabolism ChangesFunction Changes

DEVELOPMENT CHANGES

Body composition Heart & Blood vessels

Appetite and energy control

Tissue Structure and Function Changes

Cells Dysfunction

Tissues Remodel

What Happens to MotherHappens to Baby

Poor diet & inactivity

Under- or over-weight

Blood pressure and blood flow

Corticosteroids

Smoking, alcohol

Physical, mental stress

Toxins, drugs, chemicals

Chronic diseases (inflammation)

Blood sugar

We are born with…Genetic Potential

Ready: Brain cells, the spine, nerves and blood vessels

form and grow during pregnancy

The Big Bang: Birth Experience Information floods the body

all 5 senses

muscles

movement & balance & gravity

Explosive Early Growth

Velocity Linear growth

• 10 in 1st yr

• 4-5 in 2nd yr

• Doubled birth length by 5 yrs

Weight

• Doubled by 4 months

• Tripled by 12 months

• Then 5 lbs / year until 5 yrsGrowth Velocity and Basal Metabolic Rate x AgeSon’kin and Tambovtseva. Bioenergetics, 2012; Chap 5:121-142

Basal Metabolic Rate

The Developing Brain

Brain doubles in size in first yearTriples in size by the third year

Massive synaptic connections (700 per second) Connections stronger with use, but lost if unused

The Child Responds

The Adult Responds

What is this baby doing?

“Play” is Actually Sensory-Motor Learning

Sight, sound, smell, touch & taste

Big and small muscles

Body movements

They practice all their skills

Exploration develops the brain

Babies Seek Novelty

Mealtime is Playtime, Too

Sight

Smell

Taste

Texture

Sound

Eating skills

Explore new flavor combinations

Food preferences*“The magic of everyday moments”

Nutrients Build the Brain Collectively

• Vit B1 – utilize glucose, modulatecognition, language development, neurotransmitter synthesis

• Vit B6, B12, choline, tryptophan, tyrosine, phenylalanine, copper, histidine, threonine –synthesis of neurotransmitters

• Vit B12 – cognition, language, myelination

• Vit C – antioxidant, cognition, memory, myelination

• Vit D – prevents neurodegenerative disease

• Vit E – cell membrane integrity, antioxidant, protection of DHA

• Iron – oxygenation, synthesis of myelin & neurotransmitters, brain development, IQ

• Magnesium – energy and ion regulation, neural plasticity

• Zinc –neuromotor transmission, cell proliferation, taste

• Iodine – (via thyroid) cellular energy metabolism

• Omega 3 PUFA (DNA) – cognition, visual development

• Lutein – macular protection

• Flavonoids – protect & enhance neurons, anti-inflammatory, cognition

Anti-microbial Factors Secretory IgA,

IgM, IgG Lactoferrin Lysozyme Complement C3 Leukocytes Bifidus factor Antiviral mucins,

GAGs

Oligosaccharides

Hormones Feedback inhibitor

of lactation (FIL) Insulin Prolactin Thyroid hormones Corticosteroids,

ACTH Oxytocin Calcitonin Parathyroid

hormone Erythropoietin

Digestive Enzymes Amylase Bile acid-

stimulatingesterase

Bile-stimulatinglipases

Lipoprotein lipase Ribonuclease

Others Casomorphins d-sleep peptides DNA, RNA Long chain

polyunsaturatedfatty acids (LCP)

Carotenoids

Growth Factors Epidermal (EGF) Nerve (NGF) Insulin-like (IGF) Transforming (TGF) Polyamines

Transporters Lactoferrin (Fe) Folate binder Cobalamin binder IgF binder Thyroxine binder Corticosteroid

binder

Cytokines andAnti-InflammatoryFactors Tumor necrosis

factor Interleukins Interferon Prostaglandins a1-anti-chymotrypsin a1-anti-trypsin Platelet-activating

factor: acetyl hydrolase

Breast Milk: Nourishes & Transitions to Life Outside the Uterus

Starting First Foods

Signs of readiness • Around 6 months old

• Head control, sit with support, eat from a spoon

• Interested

Self-feeding is a learned motor skill• Coordinate sensory and fine motor skills

• Match foods to emerging developmental skills

Challenge the infant • New colors, flavors, smells, combinations

• A steady advance in textures

Goals for Complementary Feeding 6-12 months

Augment energy and nutrients

Introduce every type, flavor, texture

Promote a responsive feeding style

Ensure food acceptance

Establish an initial dietary pattern*

A Major Shift

Past:A few foods tightly

sequenced

Today:Diverse foods repeatedly

offered

What is a Dietary Pattern?

“Over the course of any given day, week, or year, individuals consumefoods and beverages in combination – an eating pattern.

It is more than the sum of its parts; it represents the totality of what individuals habitually eat and drink, and these dietary components act synergistically in relation to health"

Dietary Guidelines for Americans, 2015

Mix and Matchthe 5 Food Groups

At every meal & snack

Build upNutrient Dense Foods

in each Food Group

• Fruits• Vegetables• Whole grains• Dairy • Quality proteins

How to Build a Dietary Pattern

The Nutrient- per- Calorie Ratio

6 to12 Months

Milks lay a solid foundation•Infant formula 84%

•Breast milk 22%

Inappropriate cow milk persists

< 12 months = still 14%-20%

NHANES 2005-12 & FITS 2016

Other Foods & BeveragesFoods & Beverages % of infants

Any fruit 82.5%

100% fruit juice 47.7%

Any vegetable 74.2%

White potato 23.9%

Green vegetable 6.6%

Beef 11.3%

Hot dogs, deli 8.8%

Chicken, turkey 28.0%

Eggs 11.0%

Yogurt 15.6%

Snack/dessert/soda* 50.5%

NHANES 2005-2012 on any given recall day

Novel First Foods

IRON

pureed beef

infant cereals scrambled eggs

white & brown rice

hummus

avocado guacamole

yogurt

spinach

PeasDatesCarrotsSweet potatoPastaMango

cheese

Baby-Led Weaning & Food Acceptance

Potential Pros Cons

Babies read their own hunger-satiety signals Dependent on parent nutrition knowledge

Less risk for over eating, excess weight Underweight more common

Encourages food explorations Risk of choking/negative experience

Reported decrease in later picky eating Nutrient adequacy unknown

Castle/Jacobsen, Building Block for Life, 2014; Rapley G. Bably-Led Weaning; Schilling L & Peterson W.; Born to Eat

• Whole, unmodified foods in graspable pieces =

repeated exposures & exploration of new foods

• Spoon feeding = advancing textures 6-12 months

A Critical Transition: 12-24 Months

Food Groups Prevalence

Any fruit/ 100% fruit juice 83% / 47%

Any Vegetable 80%

White Potato 45%

Dark Green veggies 7.5% *

Yellow veggies 17.5%

Beef 33%

Deli meats, hot dogs 27% *

Cereals 72%

Pre-sweetened cereals 30%

Eggs 35% *

Yogurt 25% *

NHANES 2005-12

By the age of 2 yearsthe child will assume

the eating habitsof the family

Toddler’s Pick Up Our Snack Habits

“Snacks” are mini-meals

•91% consume snacks

•33% consume 3 or more snacks/day

•25% of daily energy

•Averages 288 kcal/ day

•Added sugars = 8-10% of kcals

Snack Foods Prevalence

Any sweet-salty snacks 92%

Any desserts 82%

Cakes & Pastries 58%

Ice cream/frozen treats 21%

Regular cookies 30%

Candy 32%

Salty snacks 53%

Sweetened beverages 54%

Muffins, donuts 11%

But also include fiber, Vitamins C, D, E, B12, calcium, iron, zinc, & potassium

What is a “Snack”?

Food type

Portion size

Time of day

Location

Purpose

Younginer et al. Appetite, 2016; 98:35-40

“A small portion of food that is given in-between meals,

frequently with an intention of reducing or preventing hunger

until the next meal time”

“Snacks are Not Real Food”Less preparation or balance needed,

For the enjoyment of the child,Helps me manage my child behavior

Scientists

Parents

26

Percentage Of U.S. Children Consuming Snacks Over A Two-Day Period (1977–2006)

SOURCE Content based on authors’ assessments. NOTE Percentage of children consuming snacks on day 1 of interview, day 2 of interview, or both.

Piernas and Popkin, Health Affairs, 2010; 29:398-404

EveryU.S.

Child &Teen

Snacks

The Holy Trinity of Food Choice

CONVENIEN

CE

VALUE

Snacks can Strengthen a Dietary Pattern

Dairy

• Protein, calcium, Vits D, A, potassium, B vits, phosphorous, magnesium, zinc, niacin

Sweet Potatoes/ Squash

• Carotenoids, Vit C, potassium, fiber

Spinach, kale, watercress

• Vit A,C,K, folate, potassium, mag., iron, phytochemicals

Tomatoes, avocados

• Vit A,C, fiber, phytochemicals

Broccoli, greens, green beans

• Vit C, folate, carotenoids

Rye, wheat, oat grain products

• Whole grain, fiber, B Vitamins

Citrus fruits

• Vit C, fiber, folate, phytochemicals

Blueberries, blackberries

• Vit C, fiber, folate, potassium

Salmon & fatty fish

• Omega-3 fatty acids, protein

Nuts, seeds

• Fiber, protein, MUFA/ PUFA, omega-3 FA (walnuts), vit E (almonds), folate (peanuts)

Pack in Nutrients per Calorie Drewnowski, Fulgoni; Am J Clin Nutr; 1223s, 2014Verger EO et al, J. Nutr. 144: 929–936, 2014

Speed Snacks

Breakfast Powders & Milk130 kcals + non-fat milk = 220 kcalsHigh in potassium, Vit A, C, Calcium, Ironw/ milk it blends carbs, protein, fats

Energy Bars230 kcalsGrains, fruitHigh in potassium, Vit A, Vit C,Calcium, Iron, Vit D, Vit E, fiber,Vit B12, Magnesium, Zinc, etc.Balance: fats, carbs, protein

Foods Paired with Other FoodsSalsaHummusGuacamoleYogurtDipsDressingsCerealsSoupsSmoothies

Yogurt & …90-250 kcalCalcium, Vit DMany Vits & Minerals

Popcorn & 100% Juices100 kcal microwaved +120 kcal fruit juicesWhole grain, fiber, vitamins

Veggies in …Raw with dipsSoupsStewsStock100% Juices w/ fruitsPureed and hidden

A Healthful Diet Pattern•Plant oils

•Fish & seafood

•Lean meats

•Legumes

•Nuts & seeds

•Vegetables

•Fruits

•Dairy & yogurt

•Whole grains

•Wine

Dietary Patterns are PersonalPreferences, experiences, culture

Improvements are incremental

Added Sugars in Children’s Diets NHANES 2007-2010

Soft drinks*; 4.4

Fruit drinks*; 2.7

Sweet Bakery Products; 2.3

Other Desserts; 1.6

Other; 1.4

Candy; 1.4

Ready-to-Eat Cereals; 1.1

Sugars; 0.9

Flavored Milk; 0.8

Coffee, Tea; 0.7

Sport and energy drinks*; 0.5

Breads, Rolls, Tortillas; 0.4

Quick Breads, Bread Prod.; 0.3 Condiments, Sauces;

0.3

Yogurt; 0.2

Dairy Drinks & Substitutes; 0.2

Teaspoon Equivalentsof Added Sugars

NHANES 2007 – 2010, ages 2- 18 yearsBailey et al. Nutrients, 2018; 10 (1)

5 sources =75% Sugars

Soft DrinksFruit Drinks

Grain DessertsOther Desserts

CandyWhy Do We Discourage… * Yogurt* Flavored milks* Sweetened cereals* 100% fruit juice

32

Use Added Sugars

wiselyto promote the consumption of

Nutrient Rich Foods

Snacks, Sweetened Beverages, Added Sugars, and Schools Murray R, Bhatia J and the

COUNCIL ON SCHOOL HEALTH, COMMITTEE ON NUTRITIONPediatrics 2015; 135:3 575-583

Growth & brain development require optimal nutrition

Initial feeding experiences establish the first dietary pattern

Snacks must contribute to an individual’s dietary pattern

Use added sugars wisely to promote nutrient rich foods