Chapter 16

Life Cycle
Nutrition: Infancy,
Childhood, and
Adolescence
 Nutrition during Infancy

• Infant growth during first

year
– Reflects nutrient intake
– Birth weight changes
– Infant’s length
 Energy Nutrients (1 of 2)
1. Relative to body weight, an infant’s Answer:
1. Double
need for most nutrients are more 2. Water; breastmilk;
dehydration
than ____ those of adults.
2. The younger the infant, the greater
Explanation:
the percentage of body weight is Breastmilk and formula
_____. ______ usually provides usually provide enough
water. If the temperature
enough of this nutrient. Rapid losses is very high,
supplemental water may
lead to _____, which is life- be needed. Vomiting
threatening. and diarrhea cause
rapid losses that may
require special
treatment.
 Energy Nutrients (2 of 2)
• First six months versus
second six months
• Carbohydrates
– Brain size
• Fat
– Most of the energy in breast
milk and formula
• Protein
– Building material of body
tissues
– Failure to thrive
Recommended Intakes for Infant and an Adult
Compared on the Basis of Body Weight
 Breast Milk (1 of 2)

1. The main carbohydrate in breast Answer:

1. Lactose; calcium
milk is _____. This enhances _____ 2. Formula; infection
absorption. 3. Less. Breastmilk
places less stress on
2. Oligosaccharides are present in the infant’s immature
kidneys to excrete
breast milk. They are only present in urea
trace amounts in _____. These
protect the infant from ______.
3. The amount of protein in breast milk
is greater/less than cow’s milk.
Explain.
 Breast Milk (2 of 2)
1. Research shows DHA improves _____ Answer:
1. Cognitive; arachidonic
function. Most formulas are fortified with acid
both DHA and ______ (2 words). 2. D
3. Iron; bioavailability
2. Breast milk provides ample vitamins for 4. K; D
growth, with the exception of Vitamin
__.
3. With regards to minerals, ___ is present
only in small amounts. However, the
______ is high.
4. Vitamin __ is given at birth. Liquid
vitamin __ is routinely prescribed to
breastfed babies under 6 months.
Percentages of Energy-Yielding
Nutrients in Two Diets Compared
 Immunological Protection
• Immunological
protection
– Most valuable during
first year
▪ Unprepared immune
system
– Colostrum
– Bifidus factors
– Other protective factors
 Allergy and Disease Protection
1. Breastfed infants have lower Answer:
1. Allergic
incidence of _____ reactions. 2. SIDS (sudden infant
2. Breast feeding reduces the risk of death syndrome)
3. Obesity
____, as well as cardiovascular
disease in adulthood.
Explanation:
3. Some research suggests breast Breastmilk may also
feeding helps prevent _____. benefit intelligence, but
more research is needed.
 Breast Milk Banks
• Donation of breast milk
• Screening
• Life-saving solution for fragile infants
• FDA recommendations
Infant Formula
1. Formula manufacturers attempt to
copy the _____ of breast milk. If
formula is given it should be ___-
fortified.
2. Formula does not provide protective
______.
3. Safe preparation of formula includes
using water free from _______.
Water containing _____ is a major
source of poisoning among infants.

Answer:
1. Composition; iron
2. Antibodies
3. Contamination; lead
Special Needs of Preterm Infants
• Preterm or premature
– Incomplete fetal development
– Leading cause of infant deaths
– Often low birth weight infants
▪ Benefits of third trimester for
infant
– Preterm breast milk differs
from term breast milk
▪ Supplements
 Introducing Cow’s Milk
• Not advised before age one
• Cow’s milk: a poor source of iron
• Children one-year old
– At least two thirds of energy coming from food
– Reduced or low-fat cow’s milk
▪ Supply ~30 percent of calories from fat
– Two-years old
▪ Transition to fat-free cow’s milk
▪ Avoid excessive restriction of fat
 Introducing First Foods
1. Exclusive breast feeing is Answer:
recommended until __ months. Often 1. 6; developmentally; 4
to 6
infants are ______ ready to receive 2. Nutrients
solids at __ to __ months. 3. Allergies; 3 to 5

2. The purpose of solids is to supply

needed _____ not adequately available Explanation:
Food allergies have
in breast milk or formula. increased in the United
3. To identify potential ______, experts States and new
guidelines recommend
advise introducing foods one at a time. early introduction of
They recommend waiting __ to __ days peanut-based foods (4–
11 months, rather than
before introducing another food. 12–36 months).
 Infant Development and
Recommended Foods (1 of 2)
Appropriate Foods Added to
Age (mo) Feeding Skill
the Diet
0–4 Turns head toward any object that brushes Feed breast milk or infant
cheek. formula.
Initially swallows using back of tongue;
gradually begins to swallow using front of
tongue as well.
Strong reflex to push food out (extrusion)
during first 2 to 3 months.
4–6 Extrusion reflex diminishes, and the ability to Begin iron-fortified cereal mixed
swallow nonliquid foods develops. with breast milk, formula, or
Indicates desire for food by opening mouth water.
and leaning forward. Begin pureed meats, legumes,
Indicates satiety or disinterest by turning away vegetables, and fruits.
and leaning back.
Sits erect with support at 6 months.
Begins chewing action.
Brings hand to mouth.
Grasps objects with palm of hand.
 Infant Development and
Recommended Foods (2 of 2)
6–8 Able to self-feed finger foods. Begin textured vegetables and fruits.
Develops pincer (finger to thumb) grasp. Begin unsweetened, diluted fruit juices
Begins to drink from cup. from cup.
8–10 Begins to hold own bottle. Begin breads and cereals from table.
Reaches for and grabs food and spoon. Begin yogurt.
Sits unsupported. Begin pieces of soft, cooked vegetables
and fruit from table.
Gradually begin finely cut meats, fish,
casseroles, cheese, eggs,
and mashed legumes.
10–12 Begins to master spoon, but still spills some. Add variety.
Gradually increase portion sizes.a

aPortion sizes for infants and young children are smaller than those for an adult. For
example, a grain serving might be ½ slice of bread instead of 1 slice, or ¼ cup rice
instead of ½ cup.
SOURCE: Adapted in part from Committee on Nutrition, American Academy of
Pediatrics, Pediatric Nutrition, 7th ed., ed. R. E. Kleinman (Elk Grove Village, Ill.:
American Academy of Pediatrics, 2014), pp. 113–142.
 Choice of Infant Foods
Match these With these Answer:
a → c; g b→b
a) Iron-fortified a) Beneficial to give with c → a; d d→f
cereal e→e
iron-containing foods
b) Breast milk or b) Insufficient iron for
iron-fortified infants >4 to 6 months Explanation:
formula “Desserts” provide no
c) Contribute significant nutrients to support
c) Vitamin C iron infant growth, and
contribute additional
d) Inappropriate d) Best sources are fruits calories that promote
for infants and vegetables obesity. Limiting fruit
juices in young children
e) Zinc e) Best sources are meat, is recommended. Honey
poultry, seafood, eggs and corn syrup pose the
risk of botulism to
f) Honey and corn syrup infants.

g) Poor bioavailability
 Vegetarian Diets
• Newborn is lacto-vegetarian
• Beyond six months
– Greater challenge to meet
nutrient needs
– Vegan diets
▪ Deficiencies
– Well-balanced vegetarian
diet
• Foods at one year
– Cow’s milk
▪ Displacement of iron-rich
food sources
Sample Meal Plan for a One-Year-
Old (1 of 2)
Sample Menu
1 scrambled egg
Breakfast 1 slice whole-wheat toast
½ c reduced-fat milk
½ c yogurt
Morning snack
¼ c fruita
½ grilled cheese sandwich: 1 slice
whole-wheat bread with ½ slice
Lunch cheese
½ c vegetablesb (steamed carrots)
¼ c 100% fruit juice (diluted)
aInclude citrus fruits, melons, and berries.
bInclude dark-green, leafy, and deep-yellow vegetables.
Sample Meal Plan for a One-Year-
Old (2 of 2)

½ c fruita
Afternoon snack
½ c toasted oat cereal

1 oz chopped meat or
¼ c well-cooked mashed legumes
Dinner ½ c rice or pasta
½ c vegetablesb (chopped broccoli)
½ c reduced-fat milk

NOTE: This sample menu provides about 1000 kcalories.

aInclude citrus fruits, melons, and berries.

bInclude dark-green, leafy, and deep-yellow vegetables.

 Mealtimes with Toddlers
• Feeding guidelines
– Discourage unacceptable
behavior
– Let children explore and enjoy
foods
– Don’t force food on children
– Provide nutritious foods
▪ Child chooses which ones and
how much
– Limit sweets
– Don’t turn dining table into
battleground
 Body Shape Changes
• Annual growth
– Height and weight
• Abilities change as children age
• Body composition and shape changes
 Appetite and Energy Intake
• Appetites diminish around one year of age
– Food intakes coincide with growth patterns
• Energy intakes vary from meal to meal
– Energy needs vary widely
– Growth and physical activity
– Difficulty meeting energy needs
▪ Vegan diet
 Fat, Fiber, and Carbohydrate
Recommendations
• Carbohydrate and fiber recommendations
– Same for children and adults
– Fiber recommendations
• Fat and fatty acids
– DRI Committee recommendation
▪ 30 to 40 percent for 1 to 3 year olds
▪ 25 to 35 percent for 4 to 18 year olds
 Protein and Vitamin
Recommendations (1 of 2)
1. Like total calorie needs, total protein
Answer:
requirements _____ slightly with age. 1. Increase; declines
However, when looking at the child’s 2. Maintaining nitrogen
balance, protein
body weight, the protein requirement quality, added needs
_____. of growth
3. Can
2. What three points do protein
recommendations need to consider?
Explanation:
3. The needs for most vitamins and Protein needs are well
minerals can/cannot be met by a covered by typical U.S.
diets and well-planned
balanced diet. vegetarian diets.
 Protein and Vitamin
Recommendations (2 of 2)
1. Vitamin and mineral supplements Answer:
1. Are not
are/are not routinely recommended 2. Vitamin D, iron, and
for infants and children to help fluoride are exceptions

them meet their requirements.

2. Explain any exceptions.
 Planning Children’s Meals

• Variety of foods from each

food group
– Amounts suited to appetite
and needs
• MyPlate online resources
• Quality of children’s diets
– 2–6 years old
– 2–11 years old
– Caregivers role
Recommended Daily Amounts from
Each Food Group

Food Group 1000 kcal 1200 kcal 1400 kcal 1600 kcal 1800 kcal
Fruits 1c 1c 1½ c 1½ c 1½ c
Vegetables 1c 1½ c 1½ c 2c 2½ c
Grains 3 oz 4 oz 5 oz 5 oz 6 oz
Protein foods 2 oz 3 oz 4 oz 5 oz 5 oz
Milk 2c 2½ c 2½ c 3c 3c
Hunger and Malnutrition in Children

• Very low-income families

• Short and long-term
negative effects
– Benefits of breakfast
consumption
• Iron-deficiency and behavior
– Behavior, attention span,
learning ability
– Testing for iron status
▪ Effects of deficiency occur
before blood effects occur
The Malnutrition-Lead Connection
• Malnourished children and
lead poisoning
• Low intakes of calcium,
zinc, vitamins C and D, and
iron increase risk of lead
poisoning
• Commonalities between
iron deficiency and lead
toxicity
• Side effects of lead
poisoning
 Hyperactivity

The excited behavior exhibited at Answer:

b
a birthday party is an example of
hyperactivity.
Explanation:
a) True This behavior is markedly
different from true
b) False hyperactivity.
Hyperactivity and “Hyper” Behavior
Answer:
1. The cause of hyperactivity is 1. Unknown
known/unknown. 2. Trouble sleeping,
cannot sit still,
2. List four characteristics of impulsivity, difficulty
paying attention
hyperactivity. 3. Does not support
4. Additives
3. Scientific evidence supports/does
not support eliminating sugar from Explanation:
the diet with relation to Nutrient deficiencies are
known to cause
hyperactivity. behavioral problems.
Food additives include
4. Limited evidence suggests food artificial colors. The FDA
_____ may exacerbate symptoms. determined evidence is
lacking.
 Food Allergy
• Prevalence of true food allergies in children
– Tend to diminish with age
– Reasons
• True food allergy
– Immunologic response to food
– Reaction may be immediate or delayed
• Detecting food allergies
– Testing for antibodies
– Treatment
 Anaphylactic Shock
• Most common causes
• Symptoms of impending
anaphylactic shock
• Epinephrine injections
• Food labeling of common
allergens
– New technology solutions
• Food intolerance
– Reactions to chemicals in
foods
– Symptoms without antibodies
 Childhood Obesity (1 of 2)
1. Children and adolescents at or over
Answer:
the ____ percentile are considered 1. 85th
overweight. 2. 95th
3. 97th; 35
2. Children and adolescents over the ___ 4. 32

percentile are considered obese.

3. Severe obesity in childhood is defined Explanation:
For older adolescents, a
as a BMI at the ___ percentile, or a BMI at the 95th
BMI of >____, whichever is lower. percentile is higher than
a BMI of 30, the adult
4. In the 2- to 19-year age category, cutoff point. Obesity is
therefore defined as a
approximately ___ percent are BMI at the 95th
overweight or obese. percentile, or over BMI
30, whichever is lower.
 Childhood Obesity (2 of 2)
• Influenced by genetic and
environmental factors
– Parent obesity status
– Diet and physical inactivity
(television)
– Eating out
– Parents as role models
– Added sugars
▪ Advertising
Determine Weight Status for
Children and Adsolescents
 Obesity and Growth
• Characteristic physical traits
– Begin puberty earlier, stop growing at a shorter height
than peers
– Greater bone and muscle mass
• Physical health
– Blood lipid profile
– Type 2 diabetes and respiratory diseases
• Psychological development
– Emotional and social problems
 Prevention and Treatment of
Childhood Obesity
• Prevent obesity from birth
– Early treatment, before
adolescence
• Treatment to improve long-term
health
– Permanent healthy lifestyle
habits
– Successful approaches
▪ Diet, physical activity,
psychological support, behavior
changes
• Goal: improve BMI
– Maintain weight as child grows
 Recommended Behaviors to
Prevent Obesity (1 of 2)
The following healthy habits are recommended for
children 2 to 18 years of age to help prevent childhood
obesity:
• Limit or avoid consumption of sugar-sweetened
beverages, such as soft drinks and fruit-flavored
punches.
• Eat the recommended amounts of fruits and vegetables
every day.
• Learn to eat age-appropriate portions of foods.
• Eat foods low in energy density such as those high in
fiber and/or water and modest in fat.
• Eat a nutritious breakfast every day.
 Recommended Behaviors to
Prevent Obesity (2 of 2)
• Eat foods rich in calcium every day.
• Choose a dietary pattern balanced in recommended
proportions for carbohydrate, fat, and protein.
• Eat foods high in fiber every day.
• Eat together as a family as often as possible.
• Limit the frequency of restaurant meals.
• Limit television watching or other screen time to no
more than 2 hours per day and do not have
televisions or computers in bedrooms.
• Engage in at least 60 minutes of moderate to
vigorous physical activity every day.
 Mealtimes at Home (1 of 2)
1. Children influence family food Answer:
1. Consumer
choices. Parents can use this as an 2. Raw; peers
3. Prepare
opportunity to teach _____ skills.
2. Children prefer cooked/raw
vegetables. Children are more likely
to eat foods they ordinarily reject if
they see their ____ eating them.
3. When children help _____ family
meals it provides an enjoyable
experience and encourages them
to try the food.
 Mealtimes at Home (2 of 2)
Answer:
1. Coercing, or rewarding children to 1. Less
try new foods means they are 2. Restricted
3. Beginning
more/less likely to try them again.
2. When a child’s favorite food is
Explanation:
____, they are more likely to want Children enjoy food
it. shapes and giving foods
silly names.
3. Allowing children to sample a small Parents should allow
their child to decide on
amount of a new food at the _____ their own if, and how
much they will eat. Avoid
of a meal increases acceptance. making an “issue” out of
this.
Recommended Mealtime Behaviors
• Choking prevention
– Adult should be present
when child is eating
• Playing first
– More attentive during meal
times
• Snacking
– Limit access to sweets
▪ Preference for sweets is
innate
 Dental Considerations
• Preventing dental caries
– Encourage
▪ Brush and floss after meals, brush or rinse after eating
snacks
▪ Avoid sticky foods
▪ Select crisp or fibrous food frequently
• Role models
– Children prefer foods other family members enjoy
▪ Eat together
– Physical and emotional growth
 Nutrition at School
• Nutrition standards for childcare programs
• School meals administered by USDA
– School Breakfast Program and National School Lunch
Program
– Meet 1/3 of recommended intakes
– Dietary Guidelines for Americans
• School performance and health benefits
• Child and Adult Care Food Program (CACFP)
Competing Influences at School

• Short lunch periods

and long waiting
lines
• Competing foods
• Legislation
– USDA’s Smart
Snack
▪ Healthier options
 Nutrition during Adolescence
Match these With these Answer:
a → b; c; d
a) Male growth a) Begins age 10 to 11 b → a; c; e

spurt b) Increased lean

Explanation:
b) Female tissue Changes in body
growth spurt c) Lasts 2.5 years composition become
apparent. Lean tissue
d) Begins age 12 to increases in males,
principally muscle and
13 bone. Males grow 8
inches vs 6 inches for
e) Increased fat stores females. Males gain
approximately 45
pounds, compared to 35
pounds for females.
Energy and Nutrient Needs During
Adolescence
• Needs are great
– Can vary greatly
– Factors influencing energy
needs
– Differences between girls and
boys
• Obesity during adolescence
• Vitamins
– RDA (or AI) for most vitamins
increase
– Vitamin D deficiencies
 Calcium and Iron Needs
• Iron
– Differences between boys and
girls
– Growth spurt
• Calcium
– Peak bone mass
– Teenage girls most vulnerable
 Food Choices
1. Teenagers who often help prepare Answer:
1. Family
and eat _____ meals, have a higher 2. Breakfast; fast
3. Nutritious
diet quality than those who don’t. 4. 25
5. Soft
2. Teenagers who skip ____ may gain
weight. They may also eat more Explanation:
___ food, also increasing weight Peer opinions and actions
may affect food and behavior
gain. choices.

3. Parents should provide _____,

convenient foods.
4. Snacks provide about __ percent of
a teenager’s daily energy intake.
5. ____ drinks can affect bone density.
 Highlight 16

Childhood
Obesity and
Early
Development of
Chronic
Diseases
 Introduction
• Large number of U.S.
children diagnosed with
obesity and serious “adult
diseases”
– Type 2 diabetes
– Hypertension
▪ Risk for cardiovascular
disease in adulthood
• Role of genetics
– “Permissive” rather than
“determining” role
 Early Development of Type 2
Diabetes
Answer:
1. _____ is the most important risk 1. Obesity
factor for type 2 diabetes. 2. Insulin-resistant; high
blood cholesterol and
2. Cells become ______-______. high blood pressure
3. Weight
This produces a cluster of
symptoms including:
Explanation:
3. Prevention and treatment of type Sedentary behaviors
and family history
2 diabetes depends on ____ increase the likelihood of
management. type 2 diabetes.
Atherosclerosis and
early development of
heart disease occurs as
a result of the symptoms
stated in Q2.
 Early Development of Heart
Disease
• Symptoms rarely appear before age 30
– Disease process begins much earlier
• Atherosclerosis
– Progressive thickening with plaque
▪ May eventually block flow of blood to heart
▪ Development of fatty streaks
– Is not inevitable
The Formation of Plaques in
Atherosclerosis
 Blood Cholesterol
• Differences begin to emerge in childhood
• Tends to rise with increase in dietary saturated fat
intakes
• Obesity
– LDL increases
– HDL decreases
• Selective screening of children and adolescents
– Early atherosclerotic lesions are reversible
 Blood Pressure and Physical
Activity
• High blood pressure may signal underlying disease
and can develop in early life
• Controlling hypertension
• Blood lipids and physical activity
– Impacts into adulthood
• Physical inactivity in youth often leads to physical
inactivity in later years
 Dietary Recommendations for
Children
• Variety of foods and maintain
healthy weight
• Limit fat and cholesterol
– Restaurant choices
• Moderation, not deprivation
– Balance meals
– Establish healthy habits
– Avoid extremes
• Diet first, drugs later
 Smoking
• Most adult smokers began before age 18
• Death from smoking-related causes
• Immediate health consequences of smoking
– Shortness of breath
– Bad breath
• Adult heart disease is a pediatric problem
– Intervention