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Chapter 16 – Life Cycle Nutrition: Infancy, Childhood, and Adolescence
Learning Objectives
After completing Chapter 16, the student will be able to:
1. Describe growth patterns of infants and demonstrate the ability to use growth charts.
2. Identify nutritional and other health benefits of breast feeding.
3. Discuss the factors used in the selection of an infant formula.
4. Discuss the appropriate age and procedure used for the introduction of cow’s milk and solids into an infant’s
diet.
Assignments and Other Instructional Materials
The following ready-to-use assignments are available in this chapter of the instructor’s manual:
• New! Case study
Other instructional materials in this chapter of the instructor’s manual include:
• Answer key for How To (pp. 530, 547) activities
• Classroom activities
• Worksheet answer keys (as appropriate)
Lecture Presentation Outline3
“Of special interest to…” symbol key: = Hot Topic = Personal Health
= Health Care Professionals = Science Majors
Key to instructor resource annotations (shown to the right of or below outline topics):
PL = Available on Power Lecture DVD-ROM (ISBN 0538797592): V = video
TRA = Transparency acetates: 12e TRA = 12th edition, 11e TRA = 11th edition, 10e TRA = 10th edition
1 Worksheets 16-1 and 16-3 contributed by Daryle Wane.
2 Contributed by Mary A. Wyandt, Ph.D., CHES
3 Contributed by Melissa Langone.
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I. Nutrition during Infancy IM CI 16.1, 16.4
The first year of life is a time of rapid growth and development. Breast milk or iron-fortified formula is the
primary food the first year with gradual introduction of solids beginning at four to six months of age. Preterm
infants have very special nutrient needs. Mealtimes with toddlers should be a pleasant and relaxed environment.
A. Energy and Nutrient Needs IM CI 16.6
1. Energy Intake and Activity 10e TRA 159, 161
a. Weight doubles the first five months, triples by one year.
2. Energy Nutrients 10e TRA 160
3. Vitamins and Minerals
a. More than double the needs of an adult in proportion to weight.
b. Vitamin A, vitamin C, vitamin D, and iodine are especially high.
4. Water
a. Higher percentage of water compared to adults.
B. Breast Milk
1. Frequency and Duration of Breastfeeding
2. Energy Nutrients
3. Vitamins
a. Vitamin D content is low.
b. Vitamin D supplementation is recommended by AAP for breastfed infants.
4. Minerals
5. Supplements
6. Immunological Protection
a. Colostrum, the first secretions from the breast, provides antibodies and white blood cells.
b. Bifidus factors allow for the growth of normal flora.
c. Breast milk also contains growth factors and lipase enzymes.
7. Allergy and Disease Protection
a. Fewer allergies than formula-fed babies.
b. Lower blood pressure as adults.
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C. Infant Formula
1. Infants can be weaned to formula or other appropriate foods when breastfeeding is ended.
2. Infant Formula Composition IM CI 16.2
3. Risks of Formula Feeding
4. Infant Formula Standards
5. Special Formulas
6. Inappropriate Formulas
7. Nursing Bottle Tooth Decay
a. Can be caused by formula, milk, or juice.
D. Special Needs of Preterm Infants
1. Limited nutrient stores.
2. Physical and metabolic immaturity.
E. Introducing Cow’s Milk
1. No cow’s milk the first year; contains the protein casein and may cause intestinal bleeding and anemia
in the first year of life.
F. Introducing Solid Foods
1. When to Begin
a. 4-6 months.
2. Food Allergies
a. Introduce single-ingredient foods, one at a time.
3. Choice of Infant Foods
a. Should be provided with variety, balance, and moderation.
b. Palatable and nutritious.
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4. Foods to Provide Iron IM CI 16.3
5. Foods to Provide Vitamin C
6. Foods to Omit
a. Concentrated sweets.
7. Vegetarian Diets during Infancy
a. Rice milk is inappropriate for infants and toddlers.
8. Foods at One Year
a. 2-3 cups cow’s milk.
b. Be careful of milk anemia when milk is consumed excessively.
c. Balance and variety from all food groups.
d. Drink liquids from a cup, not a bottle.
G. Mealtimes with Toddlers
1. Discourage unacceptable behavior.
II. Nutrition during Childhood IM CA 16–2, 16-3
Energy needs, nutrient needs, and appetites during childhood vary because of growth and physical activity.
Hunger and nutrient deficiencies affect behavior. Nutrition concerns at this age include lead poisoning, high
energy, sugar and fat intakes, iron deficiency, caffeine consumption, food allergies, and food intolerances.
Adults and schools need to provide children with nutrient-dense foods.
A. Energy and Nutrient Needs
1. Energy Intake and Activity
a. Needs vary widely because of growth and physical activity.
b. Energy requirements:
1. 1 year: 800 kcalories.
d. Vegans may have difficulty in meeting energy needs.
2. Carbohydrate and Fiber
3. Fat and Fatty Acids
a. Children 1-3 years should have 30-40% of energy from fat.
4. Protein
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5. Vitamins and Minerals PL V “New Vitamin D Guidelines”
6. Supplements
a. Should rely on foods.
b. Supplements not needed.
7. Planning Children’s Meals 12e TRA 21; PL V “Food Pyramid for Children”; IM CI 16.5, 16.7
B. Hunger and Malnutrition in Children
1. Hunger and Behavior
2. Iron Deficiency and Behavior
3. Other Nutrient Deficiencies and Behavior
a. Marginal malnutrition may affect behavior.
b. Also affects personal appearance.
C. The Malnutrition-Lead Connection
1. Malnourished children are more vulnerable to lead poisoning.
2. Anemia caused by lead may be mistaken for an iron problem.
D. Hyperactivity and “Hyper” Behavior
1. Hyperactivity
a. Interferes with social development and academic behavior.
2. Misbehaving
a. Need consistent care.
b. Should receive regular hours of sleep, regular mealtimes, and regular outdoor activity.
E. Food Allergy and Intolerance PL V “Peanut Allergy: Hope for a Cure”
1. Detecting Food Allergy
a. Immunologic response with the production of antibodies, histamines, and other defensive agents.
2. Anaphylactic Shock
a. Life-threatening food allergy reaction.
b. Foods may include eggs, milk, soy, peanuts, tree nuts, wheat, fish, and shellfish.
3. Food Labeling
a. Eight common allergens must appear on a food label.
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b. If cross-contamination is possible, this must be stated on the label.
4. Food Intolerances
a. Adverse reactions to foods like stomachaches, headaches, rapid pulse rate, nausea, wheezing,
F. Childhood Obesity 10e TRA 162; IM CI 16.8
1. Genetic and Environmental Factors PL V “Eating Out: Food Mapping”; IM CA 16-4
a. Parental obesity is a risk factor. Parents act as role models.
2. Growth
3. Physical Health
4. Psychological Development
5. Prevention and Treatment of Obesity
PL V “Fighting Childhood Obesity in Schools,” “Food Fight,” “Help for an Obese Girl,” “Doctors and
Childhood Obesity”
a. Integrated approach with diet, physical activity, psychological support, and behavioral changes.
b. Begin early treatment – before adolescence.
6. Diet PL V “Fast-Food Kids’ Meals”
a. Reduce rate of weight gain, rather than attempt weight loss.
b. Strategies
1. Limit sugar-sweetened beverages.
2. Eat fruits and vegetables every day.
12. Engage in at least 60 minutes of activity per day.
7. Physical Activity
8. Psychological Support
a. Weight-loss programs with parental involvement.
b. Positive influence on eating behaviors.
9. Behavioral Changes
10. Drugs
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a. Long-term impact on growth and development are unknown.
b. Two approved for children are orlistat and sibutramine.
11. Surgery – May result in significant weight loss and decrease disease risk.
G. Mealtimes at Home – with parents as gatekeepers
1. Honoring Children’s Preferences
2. Learning through Participation Website HN 16-1
a. Help plan meals.
b. Assist with food preparation.
3. Avoiding Power Struggles
4. Choking Prevention
5. Playing First
6. Snacking
a. Teach how to snack.
b. Limit access to concentrated sweets.
7. Preventing Dental Caries
a. Brush and floss after meals.
8. Serving as Role Models
a. Children learn through imitation of parents, older siblings, and care givers.
b. Help children to develop positive attitudes toward food and eating.
H. Nutrition at School IM CI 16.9
1. Meals at School
a. Breakfast and lunch at a reasonable cost.
2. Competing Influences at School IM CA 16-5
a. Short lunch periods and long lines.
III. Nutrition During Adolescence IM CA 16–6, CI 16.7
Another rapid state of growth occurs during adolescence. Nutrient needs rise, and iron and calcium are
especially important. Busy lifestyles make it challenging to meet nutrient needs and develop healthy habits.
Peer pressure is significant among adolescents.
A. Growth and Development
1. Growth speeds up and continues for about 2 ½ years.
2. Gender differences
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B. Energy and Nutrient Needs
1. Energy Intake and Activity
a. Needs vary depending on rate of growth, gender, body composition, and physical activity.
2. Vitamins
3. Iron
4. Calcium
a. Crucial time for peak bone mass.
C. Food Choices and Health Habits IM WS 16-1
1. Snacks
a. Provide ¼ of daily energy intake.
b. Favorite snacks are often high in fat and sodium and low in fiber.
2. Beverages
3. Eating Away from Home
a. 1/3 of meals are consumed away from home.
b. Influence of fast-food restaurants.
4. Peer influence is strong when making nutritional choices.
5. Drug Abuse
a. Use money to buy drugs, not food.
6. Alcohol Abuse
7. Smoking
a. Eases feelings of hunger.
b. Lower vitamin and fiber intakes.
c. Increases needs for vitamin C.
d. Need antioxidant fruits and vegetables to reduce cancer risk.
8. Smokeless tobacco has many drawbacks including cancer of the mouth.
IV. Highlight: Childhood Obesity and the Early Development of Chronic Diseases
Nutrition and health education programs during childhood and adolescence are effective when combined with
heart-healthy meals at home and school, fitness activities, and parental involvement. Cardiovascular disease
(CVD) damages the heart.
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3. Insulin resistance.
B. Early Development of Heart Disease
1. Atherosclerosis 10e TRA 168
a. Is often a part of cardiovascular disease.
2. Blood Cholesterol
a. Tends to rise as dietary saturated fat increases.
2. Blood Pressure
a. May be a sign of underlying disease.
b. More common in obese children.
C. Physical Activity
1. Active children have better lipid profiles.
2. Habits developed at this age are carried into later life.
D. Dietary Recommendations for Children
1. Moderation, Not Deprivation
1. Increases risk for heart disease.
2. Half of teens who continue to smoke will die of smoking-related causes.
Case Study4
Ryan is a 6-year-old elementary school student. At his last well child exam, he measured 46 inches tall and weighed
60 pounds with an excessive increase in his weight gain over the past year. His usual diet consists of sweetened
cereal with juice and whole milk for breakfast and juice drink and crackers for mid-morning snack. Most school
days, he buys school lunch; his favorite menu items are pizza and tacos. His mother states that she started a new job
this past year so Ryan has begun to go to an after-school program until 5:30 or 6 in the evening. He gets a snack
exercise on the weekends but have not come up with a plan they can agree on.
1. Calculate Ryan’s body mass index (BMI) and evaluate his weight status using information in Figure 16-10.
2. From information in this chapter, what are some factors that may contribute to Ryan’s excess weight gain?
3. Considering his age, what would be an initial goal to manage Ryan’s weight?
4. Using the recommendations in Table 16-7, what practical advice could you give Ryan and his parents that they
could incorporate into their current lifestyle?
5. Based on his usual intake, identify at least 2 or 3 nutrients likely deficient in Ryan’s diet. What major food
groups provide these nutrients?
6. Using the guidelines in Table 16-4, plan a daily menu for Ryan that includes 3 meals and 2 snacks and provides
approximately 1400 kcalories per day.
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Answer Key:
1. BMI = 60 pounds x 703 ÷ 46 inches ÷ 46 inches = 19.9; BMI on graph for age and sex >95th percentile,
indicates obesity.
Suggested Classroom Activities
This chapter provides a lot of information about a variety of subjects. Instructors may want to emphasize particular
sections of the chapter and elaborate on them in response to student interest.
Classroom Activity 16-1: Chapter Opening Quiz
Objective: Introduction to chapter Class size: Any
Instructions: As a way of introducing any new chapter, give a quiz to the class. This is a quiz designed to be
projected overhead. For details, please see Chapter 1, Classroom Activity 1–7.
Classroom Activity 16-3: Nutrition Pursuit
Key concept: Childhood nutrition education Class size: Any
Instructions: Construct a game of nutrition pursuit similar to that of “Trivial Pursuit.” This has been used with great
success in reinforcing nutrition information.
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Classroom Activity 16-5: Vending Machine Survey7
Key concept: Nutritional value of foods in vending machines Class size: Any
Instructions: Have students conduct a community-wide survey of foods in vending machines in public places and
comment on their nutritional value.
How To “Try It” Activities Answer Key
How to Plot Measures on a Growth Chart
50th percentile
How to Protect against Lead Toxicity
As of Oct. 28, 2009: deteriorating lead-based paint, lead-contaminated dust, and lead-contaminated residential soil
Critical Thinking Questions8
These questions will also be posted to the book’s website so that students can complete them online and e–mail their
answers to you.
1. A patient you are seeing is a new mother whose infant is having some troubles “latching on” to her breast for
breastfeeding. She is considering opting for formula to feed her baby. What information might you provide her
that would encourage her to pursue the breastfeeding approach further?
Answer: A mother should be able to choose between breastfeeding or formula feeding; however, there are
several reasons why breastfeeding is the preferred option. The RD should try to approach this patient by
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2. As the infant grows throughout the first year of life, many milestones are reached. The infant also progresses
through a series of milestones with their nutrient intake. Discuss nutrient intake milestones throughout the first
year of life for the child who is premature or who has developmental delays.
Answer: The progression of introduction of solid foods to an infant within the first year of life, beyond breast
milk or formula, is based on their physiological development or maturation of their GI system as well as their
gag reflex and the strength of the body to sit erect.
3. As Chapter 16 points out, children between the ages of one and adolescence grow considerably over this time
period. The body is actively developing and strengthening into what will someday be the individual’s final adult
body. Clearly, this is a very important time to teach children about good nutrition and exercise. Some adults are
so afraid of obesity that they feed their young infant/child fat–free everything, while others apparently have no
restrictions on their child’s diet. How might you approach raising a nutritionally intelligent, healthy, and happy
child and adolescent given today’s stresses of two career families, fast-food options, and sedentary lifestyles?