Infant, Child and Adolescent
Nutrition
Dr. Sheila Blank, DNP, RN, LSN
Nutritional Effects on Growth & Development
• Nutrition is the greatest influence on physical growth and
intellectual development
• Adequate nutrition promotes health and prevents illness
Nutritional Needs
• Infancy
– Birth to 6 months
• What to feed
• Breast milk or formula ONLY
– 4-6 months
• What to feed
• Breast milk or formula, PLUS
• Semi-liquid iron-fortified rice cereal, THEN
• Other grain cereals like oats or barley
– 6 – 8 months
• What to feed
• Breast milk or formula, PLUS
• Iron-fortified cereals (rice, barley, oats)
• Pureed or strained fruits (banana, pears, applesauce, peaches)
• Pureed or strained vegetables (avocado, well-cooked carrots, squash, and sweet
potato)
– 8-10 months
• What to feed
Nutritional Needs
• Finger foods (lightly toasted bagels, cut up; small pieces of ripe
banana; well-cooked spiral pasta; teething crackers; low-sugar
O-shaped cereal)
• Small amounts of protein (egg, pureed meats, poultry, and
boneless fish; tofu; well-cooked and mashed beans with soft skins
like lentils, split peas, pintos, black beans)
• Non-citrus juice (apple or pear)
Nutritional Needs
• 10-12 months
– What to feed
• Breast milk or formula PLUS
• Soft pasteurized cheese, yogurt, cottage cheese (but no cows' milk
until age 1)
• Iron-fortified cereals (rice, barley, wheat, oats, mixed cereals)
• Fruit cut into cubes or strips, or mashed
• Bite-size, soft-cooked vegetables (peas, carrots)
• Combo foods (macaroni and cheese, casseroles)
• Protein (egg; pureed or finely ground meats, poultry, and boneless
fish; tofu; well-cooked and mashed beans)
• Finger foods (lightly toasted bread or bagels, small pieces of ripe
banana, spiral pasta, teething crackers, low-sugar O-shaped cereal)
• Non-citrus juice
Growth Measurements
• Anthropometric Measurements
• Height
• Weight
• Basal Metabolic Index (BMI)
• Head circumference
• Chest circumference
• Labs
– Hemoglobin and hematocrit
– Serum glucose, fasting insulin, lipids, lipoproteins
– Liver and renal function studies
Infant and Child Nutrition
• Infants: recommended for 12 months
– Breast milk is most complete, easily digested (20kcal/oz)
– Iron-fortified formulas (20 kcal/oz)
– Premies Breast milk or formula (24 kcal/oz)
– Introduce new foods one at a time, with at least three days in between
to make sure your baby's not allergic.
– Weaning is started at 6months from breast/bottle to sippy cup
– 100 calories/kg/day
• Toddler
– Picky, ritualistic eaters
– Avoid hot dogs, grapes, cherries, peanuts
• Preschooler - Gains 4 to 5 lbs. per year
– Has food preferences and dislikes
– Influence by other’s eating habits
– 90 kcal/kg/day
• School-age: Gains approx. 5 lbs per year
– Steady, slow weigh gain
– Obesity risk in this age group
– Avoid junk foods, empty calories
– 85 kcal/kg/day
• Adolescent: Rapid period of growth
– Girls gain 15-55 lbs
– Boys gain 15-65 lbs
– 60-80 kcal/kg/day
Common Dietary Deficiencies
• Iron
– 25-85% Premies have iron deficiency need supplement
– Iron storage depletes 4-6 months for the infant
– Adolescent females
• Calcium
– Adolescent growth spurts when 40% adult bone mass is added
• Vitamin D
– Supplement breast fed infants for 6 months
– AAP recommends all Infants and children should receive 400 IU
vitamin D daily
• Folic Acid
Food Allergies
• Food intolerances
– Indigestion, flatulence, diarrhea, bloating, abdominal pain upon eating
certain foods
• Food allergy
– Peanut allergy #1 cause
• Incidence has increased last 2 decades
– Milk, shellfish
– RAST diagnostic test to measure IgE antibodies to specific allergens
Challenges
• Colic
• Celiac Disease
• Intolerances
• Financial resources
• Fast foods
• School Vending Machines
• Peer pressure
• Lack of physical activity
• Eating Disorders
OBESITY IN
CHILDREN AND
ADOLESCENTS
Defining Child & Adolescent Obesity
• Overweight-excess body weight for a particular height
from fat, muscle, bone, water, or a combination of these
factors.
• Obesity-excess body fat. BMI at or above 95th percentile
of those same age and sex
• Overweight and obesity are the result of “caloric
imbalance”—too few calories expended for the amount
of calories consumed—and are affected by various
genetic, behavioral, and environmental factors
Categories of Weight Status for children
between 2 and 19 years of age
• On a standard BMI chart, kids ages 2 to 19 fall into one
of four categories:
• underweight: BMI below the 5th percentile
• normal weight: BMI at the 10th and less than the 90th
percentile
• overweight: BMI at the 85th and below 95th percentiles
• obese: BMI at or above 95th percentile
Recommendations
• Eat meals as a family as often as possible
• Limit eating out, especially at fast-food restaurants, and when you do
eat out, teach your child how to make healthier choices
• Adjust portion sizes appropriate for age
• Limit TV and other “screen time” to
• less than 2 hours a day for children older than 2 years and don’t allow
television for children younger than 2 years
• Be sure your child gets enough sleep
• Well-child check ups at least once a year
• Know your child’s BMI
“TRAFFIC LIGHT APPROACH”
by Leonard Epstein, PhD
Classifies foods as RED YELLOW GREEN
• RED- HIGH in calories and sugar or fat
• STOP & THINK before consuming these foods
• YELLOW- lean meats and whole-grain foods that are moderately
high in calories
• SLOW DOWN & THINK about appropriate portion sizes
Traffic light diet- 900-1500 calories per day*
• GREEN- fruits, vegetables, water, and nonfat milk
Family Involvement
• Research studies have demonstrated that interventions that do not include a patient’s parents or
guardians and other family members are less likely to be effective
• Treatment should begin only when the patient’s parents and caregivers are ready to commit to
lifestyle changes, which should involve the whole family
School Involvement
Strategies
• Include healthy eating, physical activity, and body image
education in the school curriculum
• Increasing the amount of physical activity during the
school day
• Serving healthier food in schools
• School Lunch and the Healthy Hunger Free Kids Act of 2010
• Designed to ensure access to healthy foods for children in low-income
families.
• As a result nutrition standards for school meals were updated to require
more whole grains, fruits, vegetables, lean protein, and low-fat dairy
