Toddler & Preschooler Nutrition

7/30/2019 Toddler & Preschooler Nutrition

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Leny Budhi Harti

TODDLER &PRESCHOOLER

NUTRITION


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CONTENT

1. Overveiw of toddler & preschooler

2. Normal growth development

3. Physiological and cognitive development

4. Energy and nutrient needs (Dietary and physicalactivity recomendation)

5. Common nutritional problems

6. Prevention of nutrition-releted problems

7. Growth assessment

8. Feeding problem

9. Nutrition related condition

10.Food allergies and intolerance


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Overveiw of Toddler &Preschooler

Toddlers aregenerally definedas children betweenthe ages of 1 and 3

years

This stage ofdevelopment ischaracterized by arapid increase ingross & fine motorskills

Preschool-agechildren arebetween 3 and 5

years of age.Characterized byincreasing languageskill, staying with

friends an relatives,and expending theirability to controlbehavior


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Normal Growth Development

Berat badan

Tinggi badan

Status gizi

Nafsu makan

Toddler terjadipeningkatan BB 0,23kg/bln dan TB 1 cm/ bln

Preschool terjadipeningkatan BB 2 kg/thndan TB 7 cm/thn

Mengalami penurunan nafsu makanStatus gizi dapat diketahui melaluimetode : IMT for age ataumenggunakan the 2000 CDC growthchart


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An explosion in the development of new skill happens duringthe toddler years

Gross motor skill such as sitting and climbing developrapidly at this age

Age(months)

Gross motor skill

15 Crawl up stairs

18 Run stiffly

24 Jump in a place

30 Advance to going up stair by alternatingtheir feet

36 Ready for tricycles

Physiological and CognitiveDevelopment


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Children become increasingly mobile andindependent with improvement in grossmotor skills

Toddler have no sence of dengeroussituations children are especiallyvulnerable to accidental injuries andingestion of harmful substance

Physiological and CognitiveDevelopment


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Cognitive Development inToddler

Processes the ability to explore the environment andto develop new relationship

Fears for certain situations : darkness, wind, rain,&lound sounds

Social development : imitating others (parents,caretakers) children begin to learn about familyscultur

Dramatic development of language skills :

18 mo : children have 10 15 words

24 mo : children have 100 words

36 mo : children use 3 word sentences


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Development of Feeding Skillsin Toddler

Gross and fine motor development during toddleryears enhances childrens ability to chew foods ofdifferent textures and to self-feed

Between 12-18 mo

toddler are able to movethe tongue from side to side, learn to chew foodwith rotary, use the tongue to clean the lips,handle meats, raw fruits and vegetables amdmultiple texture of food.


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Feeding Behaviors of Toddlers

To circumvent food jags, parents can serve newfoods along with familiar foods.

New foods are better accepted if they are servedwhen the child is hungry, and if she sees othermembers of family eating these foods.

Toddler are great immitators, which includesimitating the eating behavior of others


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Cognitive Development ofPreschool-Age Children

Language develop rapidly during the preschoolyears and is an important indicator of both

cognitive and emotional development. Between

age 2 and 5, childrens vocabularies increase from 50to 100 words to more than 2000 words, and their

labguage progressess from two-to-three-wordsentences to complete sentences


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Development of Feeding Skills & Innate Ability toControl Energy Intake

The preschool-age child can use a fork and aspoon and uses a cup well

An important principle of nutrition for young

children and one with direct application tochild feeding is childrens ability to selfregulate food intake

Although children can self-regulate caloricintake, no inborn mechanism direct them toselect and consume a well-balanced diet


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Children learn healthful eating habits

Preschool children continue to learn

about food and food habits byobserving their parents, caretakers,peers, and siblings, and they begin tobe influenced by what they see on TV

Development of Feeding Skills & Innate Ability toControl Energy Intake


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Energy andNutrient

Needs


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EnergyKebutuhan energi untuk usia13 35 bulan :

1. 100 kkal/kg DBW

2. EER : (89 x berat badan) 80


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Kebutuhan energi untuk anak usia 3 8 tahun (EER)

Boys : 108.8 (61.9 x age (y)) + PA x {(26.7 xweight (kg) + (903 x height (m)}

Girls : 155.3 (30.8 x age (y)) + PA x {(10.0 xweight (kg) + (934 x height (m)}

Usia 4 6 tahun : 90 kkal/kg DBW

Energy


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Physical Activity

PAL PA

Boys Girls

Sedentary 1,00 1,00

Low active 1,13 1,16

Active 1,26 1,31

Very active 1,42 1,56


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Protein

Berdasarkan AKG di atas, prosentasekebutuhan protein untuk anak usia 1 3thn dan 4 6 tahun adalah 10% dari

total kebutuhan energi


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Berdasarkan ADA, 2004. Kebutuhanprotein untuk anak usia 1 3 tahunsebesar 1.1 g/kg BB dan menurun 0.95g/kg BB untuk anak usia 4 -8 tahun dan 9 13 tahun

Atau 5 20% dari kebutuhan energi

50% merupakan protein yang bernilai

biologis tinggi

Protein


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LemakBerdasarkan ADA, 2004. Kebutuhanlemak untuk anak usia 1 3 tahunsebesar 30 40% dari total energi

Untuk anak usia 4 18 tahun sebesar25 35% dari total energi

Kurangi sumber lemak yang berasal

dari lemak jenuh dan trans fatty acid


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KarbohidratBerdasarkan ADA, 2004 kebutuhankarbohidrat sebesar 45 65% daritotal energi


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Cairan

Kenutuhan cairan : 50 60 ml/ kg BB

Cairan berasal dari air putih, jus

buah, susu, dan sayuran


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Serat

Berdasarkan ADA, 2004, Kebutuhan seratadalah sebagai berikut :

1. Untuk usia 1 3 tahun : 19 gram/day.

2. Untuk usia 4 8 tahun : 25 gram/ day

Serat berasal daribuah, sayur dan biji-bjian.serat dapat digunakan untuk

mencegah terjadinya konstipasi


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Vitamin dan Mineral

Kebutuhan vitamin dan mineraldapat merujuk pada AKG

Vitamin dan mineral dapatberasal dari buah,sayur, laukhewani dan nabati serta biji-bijian
http://var/www/apps/conversion/tmp/scratch_2/AKG2004.pdfhttp://var/www/apps/conversion/tmp/scratch_2/AKG2004.pdf


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Nutrition Guidance

Prinsip makanan untuk anak baduta dan preschool :

1. Kalori diberikan tinggi untuk menyediakan energi yangcukup, agar protein tidak digunakan sebagai sumber energi

2. Protein diberikan tinggi untuk menunjang pertumbuhan danmengganti sel-sel yang rusak

3. Lemak diberikan cukup untuk menyediakan alat transportvitamin larut lemak

4. Vitamin dan mineral cukup untuk menunjang prosesmetabolisme tubuh

5. Cairan dan serat cukup melancarkan defekasi


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Syarat :

1. Mudah cerna

2. Tekstur makanan tidak terlalu keras agar tidak

merusak gigi geligi3. Suhu makanan tidak terlalu panas dan dingin

4. Mengurangi makanan yang manis-manis dapatmenekan nafsu makan

5. Menu dipilih yang disukai anak

6. Disajikan dengan penampilan menarik

7. Hindari cemilan yang terlalu banyak

Nutrition Guidance


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Contoh Menu

Untuk anak usia 12 bulan :

Waktu Menu BM Berat(g)

Penukar Energi

pagi Bubur kuahsemur ayamdan sayur

Beras 25 110

Ayam 9

Wortel 25

Kacangmerah

5

minyak 1,25

Selingan Rotipanggang

Roti 35

Selai 5


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Untuk Anak usia > 13tahun

Sore :

Nasi lembek

Ungkep hati ayam

Bola tempe saus kuning

Cah oyong dan wortel

Contoh Menu


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Untuk anak usia 3 6tahun

Siang :

Nasi

Ayam goreng kremes

Perkedel tahu kukus

Sayur sup kacang merah

Buh semangka

Contoh Menu


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Common Nutritional Problems

1. Iron deficiencyanemia

2. Dental caries3. Constipation

4. Food security

5. Food safety


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Iron Deficiency Anemia Increase iron

requirentment Inadequate iron

absorption Inadequate iron intake

Decrease iron stores

Iron deficiency

Iron depletion

Iron deficiensy anemiasymptoms


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Treatment : supplementation with irondrops at a dose 3 mg/kg per day perlu dilakukan skreening pada 4

minggu setelah diberikan intervensiPerlu dilakukan pemeriksaan kadah Hbdan hematokrit setiap 6 bulan

Jika Hb dan hematokrit setelah 4minggu perlu pemeriksaan lebihlanjut

Iron Deficiency Anemia


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Dental CariesPenyebab :

Kebiasaan minumsusu/jus dengan botol

diwaktu tidurBahan makanansumber KH streptococcus mutan

mengasilkan asamyang dapat merusakgigi

Treatment :

Suplementation

Flouride :

6 mo 3 y : 0,25 g

3 6 y : 0,5 g

Kelebihanfluorosis


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Constipation

Diet providing adequate total fiber for age:

o 1 3 y : 19 g/day

o 4 8 y : 25 g/day

Some of the best food sources of fiber : whole grain

breads, cereals, legumes, fruit and vegetables

Too much fiber should avoid diarrhea, decreaseenergy dense food, decrease bioavailability ofsome vitamin and mineral (Fe, Ca)


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Food Security

Food security is particularly importantfor young children because of their highnutrient needs for growth and

developmentYoung children are a vulnerable groupbecause they must depend on theirparents to supply them with adequateaccess to food


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Food Safety

Young children are especially vulnerableto food poisoning because they canbecome ill from smaller doses of organism

Key foodborn pathogens include : Campylobacte

Salmonella

E. Choli

Listeria monocytogenes


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Contamination of food products can occurat any point along the way fromproduction to consumption.

One major food safety education program:

o Clean : wash hands and sufaces often

o

Separate : dont cross contaminano Cook : cook to proper temperature

o Chill : refrigerate promptly

Food Safety


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Prevention of Nutrition-ReletedProblems

1. Prevention and treatment ofoverweight and obesity

2. Prevention of cardiovascular

disease

3. Vitamin and mineral supplements


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Prevention and Treatment ofOverweight and Obesity

Prevention is the best approach for overweight andobesity

Parenting techniquea such as finding reasons topraise the childs behavior, but never using food as a

reward, foster the development of healthy eatingbehaviors in children and help them to self-regulatefood intake

Example of behavior changes of lifestyle :

o physical activity

o Not caloric dense

o Offering nutrient dense


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Prevention of cardiovasculardisease

Children with familial hyperlipidemia and obese children LDLcholesterol

High intake of saturated fat, trans fatty acids LDL cholesterolin children

DRI for fat :1 - 3 y : 30 40% dari total

energi4 18 : 25 35% dari total

energi

Children need toscreeningperiodicly

Pencegahan

Jika kadar LDL tinggi membatasi jumlah lemak, lemakjenuh 7% dari total kalori, kolesterol tidak lebih dari 200mg/day


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Vitamin and MineralSupplements

Anak yang mengkonsumsi makanan yangbervariasi tidak memerlukan suplementasi,karena kebutuhan zat gizi dapat terpenuhi darimakanan

Menurut The American Academy of Pediatrics ,beberapa kondisi yang membutuhkansuplementasi vitamin dan mineral :

Anorexia

Anak yang menjalani fat diet

vegetarian


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Growth Assessment

The need for nutrition services isidentified by answer to these sorts ofquestions :

1. Is the child growth on track?

2. Is his or her diet adequate

3. Are the childs feeding or eating skills

appropriate for the childs age4. Does the diagnosis affect nutritional needs?


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1. Berat badan

2. Tinggi badan

3. Status gizi

IMT for age, CDC4. Intake zat gizi recall 3 x 24 jam

5. Kebiasaan makan FFQ

Growth Assessment


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Feeding Problem

1. Behavior feeding problem

2. Excessive fluid intake

3. Feeding problems and food safety4. Feeding problem from disabilities

involving neuromuscular control


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Behavior Feeding Problem &Excessive fluidintake

Behavioral disorder that affect nutritionalstatus are autism and attention-focusingproblems, such as ADHD

The child refuses to eat many foods andis rigid in what he will eat

When he is not given food he likes, herefuse to eat all foods he prefer drinkrather than eat food kelebihan intakecairan


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Nutrition Related Condition

1. Failure to Thrive (FTT)

2. Diarrhea and Caliac Disease

3. Autism

4. Pulmonary problems


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Failure to Thrive (FTT)


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Diarrhea and Caliac Disease

Diare pada anak biasanya disebabkan karenakelebihan mengkonsumsi jus yang mengandungsorbitol atau sukrosa

Caliac disease : terjadi pada orang yang sensitifterhadap gluten, komponen dari wheat, rye,barley

Caliac disease diare

Jika anak menderita caliac disease

hindarimakanan yang mengandung gluten seperti :tepung, roti, pasta, dll


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Autism

No scientifically proven diet is nowrecommended for prevention ortreatment of autism

A gluten free and casein free diet is wellknown to families who educatethemselves on internet


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Pulmonary Problem

Breathing problems increase nutritionalneeds, lower interest in eating, slow growthrate

Feeding difficulties have several causes in atoddler :

1. The normal progression of feeding skills isinterrupted

2. Medication & their side effect highnutritional needs

3. Interrupted sleep and fatigue


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Dietary recommendation :

o Small, frequent meals with foods that areconcentrated sources of calories

o

Easy to eato Nutritional suplement : pediasure, vitamin and

mineral

Pulmonary Problem


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Food Allergies and Intolerance

Food allergies anaphylaxis

Example food allergies that mayresult in anaphylaxis : milk, eggs,wheat, peanuts, walnuts, soy, fish

Strict and complete avoidance of

food that causes tha allergies isrequired.


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Pertanyaan

1. Berapakah BB ideal anak?

2. Bagaimana status gizinya?

3. Bagaimana pendapat anda tentangkeiasaan makan anak tersebut?

4. Berapakah kebutuhan energi dan zat

gizi nya sehari?5. Buatlah menu sehari untuk anak

tersebut!


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References1. Brown, Judith E. Nutrition Through the Life Cycle. Second Edition.

Thomson. Unted State of America.2005

2. Mahan, L.K; Stump, S.E; 2004; Krauses Food & Nutrition Therapy11th ed; Sanders Elsevier; St. Louis, Missouri

3. Leonberg, L. Beth. 2008. ADA Pocket Guide to Pediatric NutritionAssessment. Unites State of America

4. Stump, Sylvia Escott. 2008. Nutrition and Diagnosis Related Care.Lippincott Wiliams & Wilkins. Philadelphia

5. Soetjiningsih. 1995. Tumbuh Kembang Anak. EGC : Jakarta

6. Kaswari, S. Rum Teguh , dkk. 2009. Buku Panduan Studi Kasus danPraktikum Nutrition in the Life Cycle. Universitas Brawijaya Malang

7. Kurniasih, Dedeh. 2010. Sehat & Bugar Berkat Gizi Seimbang.Kompas Gramedia: Jakarta


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Toddler & Preschooler Nutrition