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281
Chapter 16 – Life Cycle Nutrition: Infancy, Childhood, and Adolescence
Learning Objectives
After completing Chapter 16, the student will be able to:
16.1 List some of the immune factors in breast milk and describe the appropriate foods for infants during the
first year of life.
a. Describe growth patterns of infants and demonstrate the ability to use growth charts.
b. Identify nutritional and other health benefits of breast feeding.
c. Discuss the factors used in the selection of an infant formula.
d. Discuss the appropriate age and procedure used for the introduction of cow’s milk and solids into an
Assignments and Other Instructional Materials
The following ready-to-use assignments are available in this chapter of the instructor’s manual:
• New! Case Study 16-1: Vegan Diets for Children
• Case Study 16-2: Childhood Obesity
• Worksheet 16-1: Infant Feeding Review (Internet Exercise)
1
• Worksheet 16-2: How to Rate Your Food Behaviors
• New! Worksheet 16-3: Chapter 16 Crossword Puzzle
2
• New! Critical thinking questions with answers
Lecture Presentation Outline
3
Key to instructor resource annotations (shown to the right of or below outline topics):
TRA = Transparency acetates: 13e = 13th edition, 12e = 12th edition, 11e = 11th edition, 10e = 10th edition
Website = Available for download from book companion website: HN = student handout
IM = Included in this instructor’s manual: CS = case study, WS = worksheet, CA = classroom activity
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I. Nutrition during Infancy IM WS 16-1
A. Energy and Nutrient Needs
1. Energy Intake and Activity 10e TRA 159, 161
a. Weight doubles the first five months, triples by one year (Figure 16-1)
2. Energy Nutrients (Figure 16-2) 13e TRA 18
3. Vitamins and Minerals
4. Water
a. Higher percentage of water compared to adults
b. Found outside the cells and easily lost
c. Dehydration from diarrhea and vomiting is a concern
B. Breast Milk
1. Frequency and Duration of Breastfeeding
2. Energy Nutrients (Figure 16-3)
3. Vitamins
4. Minerals
5. Supplements
a. Vitamin D, iron, and fluoride during first year
b. A single dose of vitamin K
6. Immunological Protection
a. Colostrum
7. Allergy and Disease Protection
8. Other Potential Benefits
a. May protect against obesity
b. Indications of positive effect on later intelligence
9. Breast Milk Banks
a. Donated milk
283
C. Infant Formula (Figure 16-4)
1. No cow’s milk in first year of life
2. Infant Formula Composition
3. Risks of Formula Feeding
4. Infant Formula Standards
5. Special Formulas
6. Inappropriate Formulas
7. Nursing Bottle Tooth Decay (Figure 16-5)
a. Can be caused by formula, milk, or juice
b. Prolonged exposure to formula when sleeping
c. Upper and lower teeth may be affected by decay
D. Special Needs of Preterm Infants
1. Limited nutrient stores
2. Physical and metabolic immaturity
3. Reduced-fat cow’s milk gradually introduced between 2 & 5 years of age
F. Introducing Solid Foods
1. When to Begin
a. 4-6 months
b. Timing varies from infant to infant depending on growth rates, activities, and environmental
conditions
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
4. Foods to Provide Iron
5. Foods to Provide Vitamin C
a. Vegetables first, then fruits (suggestion; not evidence based)
b. Set limits on fruit juice consumption (4-6 oz./day)
6. Foods to Omit
a. Concentrated sweets
7. Vegetarian Diets during Infancy IM CS 16-1
a. Rice milk
8. Foods at 1 Year (Figure 16-6)
a. 2-2 ½ cups cow’s milk
1. Discourage unacceptable behavior
2. Let toddlers explore and enjoy food
3. Don’t force foods
4. Let children choose among nutritious foods
5. Limit sweets
6. Make mealtimes pleasant
II. Nutrition during Childhood IM CA 16-1, 16-2
A. Energy and Nutrient Needs
1. Energy Intake and Activity (Figure 16-7)
a. Needs vary widely
b. Energy requirements:
1. 1 year: 800 kcalories
2. 6 years: 1,600 kcalories
3. 10 years: 2,000 kcalories
2. Carbohydrate and Fiber
3. Fat and Fatty Acids
4. Protein
5. Vitamins and Minerals
a. Needs increase with age
b. Balanced diet meets all needs except iron
c. Iron-fortified foods are important
d. Vitamin D supplements may be needed
6. Supplements
7. Planning Children’s Meals (Figure 16-8) 13e TRA 19
a. Variety of foods from each food group
b. Proper portion sizes
285
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 Website HN 13-1, 13-2
1. Malnourished children are more vulnerable to lead poisoning
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
1. Detecting Food Allergy
2. Anaphylactic Shock
a. Life-threatening food allergy reaction
3. Food Labeling
4. Food Intolerances
a. Adverse reactions
b. Symptoms without antibody production
c. Tolerance level
F. Childhood Obesity (Figures 16-9 & 16-10) 13e TRA 20; 10e TRA 162; IM CS 16-2
1. Genetic and Environmental Factors IM CA 16-3
a. Parental obesity is a risk factor
2. Growth
286
3. Physical Health
4. Psychological Development
a. Emotional and social problems
b. Stereotypes and discrimination
5. Prevention and Treatment of Obesity
6. Diet
7. Physical Activity
8. Psychological Support
9. Behavioral Changes
10. Drugs
a. Long-term impact on growth and development are unknown
b. Only approved drug for children is orlistat
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
3. Avoiding Power Struggles
4. Choking Prevention
a. Be alert to foods that are common causes of choking
b. Make sure children are sitting, not running or in danger of falling, when eating
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
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H. Nutrition at School
1. Meals at School
a. Breakfast and lunch at a reasonable cost
III. Nutrition during Adolescence IM CA 16-5
A. Growth and Development
1. Growth speeds up and continues for about 2 ½ years
2. Gender differences
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
a. Needs for all vitamins increase
b. Vitamin D needs special attention
3. Iron
4. Calcium
a. Crucial time for peak bone mass
b. Increase milk and milk products
c. Low calcium intakes and physical inactivity may cause problems with osteoporosis in later life
C. Food Choices and Health Habits IM WS 16-2
1. Snacks
2. Beverages
a. Soft drinks replace fruit juices and milk
b. Caffeine may be an issue
3. Eating Away from Home
4. Peer Influence – Peer influence is strong when making nutritional choices
1. On the increase in recent years
2. Risk factors include obesity, sedentary lifestyle, and family history
288
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
1. Active children have better lipid profiles
1. Moderation, Not Deprivation
2. Diet First, Drugs Later – Treat problems with diet first, then drugs
E. Smoking
1. Increases risk for heart disease
2. Half of teens who continue to smoke will die of smoking-related causes
Case Studies
4
Case Study 16-1: Vegan Diets for Children
Frank and Jan W. are the proud parents of Jesse, an 18-month-old child who has been breastfed from birth. Jesse
was 7 pounds 1 ounce at birth and at her last check up she weighed 20 pounds. Jesse’s mom breastfeeds her in the
morning and before putting her to bed at night. During the day, Jesse drinks juice and water from a cup. Jesse’s
parents have been feeding her a vegan diet since her birth, citing a strong family history of heart disease as their
reason for this choice. Jesse’s current diet includes a variety of chopped fruit, vegetables, cereal, mashed beans, and
soy-based cheeses. Both parents want the best for their child and are carefully considering whether to continue her
current diet restrictions.
1. Using the “How to” feature on page 507, plot Jesse’s birth weight and her current weight for age. What might
this information indicate to Jesse’s parents?
2. What impact might a vegan diet have on Jesse’s nutritional status and development that her parents should
consider?
3. What components of a Jesse’s diet may contribute to her low rate of weight gain? Explain.
4. In view of her current diet, what nutrition strategies might Jesse’s parents consider to improve her weight gain?
Give specific examples.
5. As Jesse is weaned from breast milk, what vegan foods might be added to her diet to prevent nutrient
deficiencies?
6. Using the meal plan in Figure 16-6 as a guide, show how Jesse’s parents might provide a child-friendly and
balanced diet that contains no animal foods.
289
Answer Key
1. Jesse’s birthweight was at the 25th percentile. Her current weight is at the 3rd percentile for her age. Jesse’s
dramatic change from the 25th to the 3rd percentile weight-for-age indicates a slowed rate of weight gain and
may be cause for concern.
Case Study 16-2: Childhood Obesity
Ryan is a 6-year-old elementary school student. At his last well child exam, his measured height was 46 inches and
his weight was 60 pounds. His pediatrician is concerned that Ryan has gained an excessive amount of weight over
the past year. His usual diet consists of sweetened cereal with whole milk and fruit juice for breakfast and a juice
drink and crackers for his mid-morning snack. During the week, Ryan buys his lunch at school; his favorite menu
items are pizza and tacos. His mother states that she started a new job this past year, which requires that Ryan attend
an after-school program until 5:30 or 6 in the evening. He receives a snack there, usually an 8-ounce box of fruit
juice and crackers. Ryan’s parents report that Ryan is “always hungry” and they will often stop for his favorite
chicken nuggets, fries, and a soda on late evenings when the family is too tired to cook. Ryan likes to play video
games and has a computer and television in his room. His father complains that he spends more time in his room
than playing outside. Ryan’s mother is overweight and his father is of normal weight, although he states he was
overweight as a child. The family has discussed getting more exercise on the weekends but are not sure how to add
this to their busy schedules.
1. Calculate Ryan’s body mass index (BMI) and use this to evaluate his weight status using information in Figure
16-10.
2. From information in this chapter, what are some factors that may have contributed to Ryan’s excess weight gain
over the past year?
3. Considering his age and the information in this chapter, what would be a reasonable weight-management goal
for Ryan?
4. Using the recommendations in Table 16-7, what strategies would you suggest that Ryan and his parents
incorporate into their current lifestyle?
5. Based on his usual intake, identify at least 2 or 3 nutrients likely to be deficient in Ryan’s diet. What major food
groups provide these nutrients?
6. Assuming his current level of activity, what are Ryan’s estimated daily kcalorie needs according to Table 16-5?
Using that calorie level and the guidelines in Table 16-4, plan a balanced daily menu for Ryan that includes 3
meals and 2 snacks..
Answer Key
1. BMI = 60 pounds 703 ÷ 46 inches ÷ 46 inches = 19.9. Ryan’s BMI for his age and sex is greater than the 95th
percentile, which indicates obesity.
290
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: Devise Games for Kids
5
Key concept: Childhood nutrition education Class size: Any
Instructions: Have students devise games and game boards for teaching children nutrition facts. These games can be
used in dentists’ and pediatricians’ waiting rooms. For example, students may design a set of cards with a nutrition
fact on each one. The object would be for the kids to turn up two matching cards.
Classroom Activity 16-2: 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.
Classroom Activity 16-3: Assess Nutrition Information Presented on TV
6
Key concept: Effects of advertising on children’s food habits Class size: Any
Instructions: Have students view 2 ½ hours of prime time children’s television (cartoons). Instruct them to count the
total number of ads and categorize them by types (food versus other). Food ads should be further categorized into
nutrient-dense and “empty-kcalorie” food ads. Have students determine the percentage of ads for food items and
assess the quality of nutrition information conveyed by the ads.
14.
• Powell LM, Schermbeck RM, Szczypka G, Chaloupka FJ, Braunschweig CL. Trends in the nutritional content
of television food advertisements seen by children in the United States: analyses by age, food categories, and
companies. Arch Pediatr Adolesc Med. 2011 Dec;165(12):1078-86. Epub 2011 Aug 1.
• Mink M, Evans A, Moore CG, Calderon KS, Deger S. Nutritional imbalance endorsed by televised food
advertisements. J Am Diet Assoc. 2010 Jun;110(6):904-10.
• Batada A, Seitz MD, Wootan MG, Story M. Nine out of 10 food advertisements shown during Saturday
morning children's television programming are for foods high in fat, sodium, or added sugars, or low in
nutrients. J Am Diet Assoc. 2008 Apr;108(4):673-8.
• Kelly B, Smith B, King L, Flood V, Bauman A. Television food advertising to children: the extent and nature of
exposure. Public Health Nutr. 2007 Nov;10(11):1234-40. Epub 2007 Mar 5.
• Batada A, Wootan MG. Nickelodeon markets nutrition-poor foods to children. Am J Prev Med. 2007
Jul;33(1):48-50.
291
Classroom Activity 16-4: Vending Machine Survey
7
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
Deteriorating lead-based paint, lead-contaminated dust, and lead-contaminated residential soil
Study Card 16 Answer Key
1. Infant formula may be used to feed an infant from birth to one year, to wean an infant after less than a year of
breastfeeding, or to substitute for breastfeeding on occasion. All formula-fed infants should be given iron-
292
7. Some common nutrition problems in children include iron deficiency, food allergies and intolerances, and
obesity. Providing children with a balanced diet of primarily nutrient-dense foods and beverages, such as one
planned using the USDA intake patterns and including foods rich in each micronutrient (including iron) is a
8. A child with any of several nutrient deficiencies may be irritable, aggressive, and disagreeable, or sad and
withdrawn. Both short-term and long-term hunger exert negative effects on behavior and health. Short-term
hunger, such as when a child misses a meal, impairs the child’s ability to pay attention and be productive.
Hungry children are irritable, apathetic, and uninterested in their environment. Long-term hunger impairs
9. A true food allergy occurs when fractions of a food protein or other large molecule are absorbed into the blood
and elicit an immunologic response. The body’s immune system reacts to these large food molecules as it does
to other antigens—by producing antibodies, histamines, or other defensive agents. This may result in symptoms
10. Overweight children have the potential of becoming obese adults with all the social, economic, and medical
ramifications that often accompany obesity. They have additional problems, too, arising from differences in
their growth, physical health, and psychological development. Overweight children display a blood lipid profile
indicating that atherosclerosis is beginning to develop—high levels of total cholesterol, triglycerides, and LDL
cholesterol. They also tend to have high blood pressure; in fact, obesity is a leading cause of pediatric
11. Honor children’s preferences by offering easy-to-eat vegetables raw or slightly undercooked; serving food
warm, not hot; and keeping flavors mild and textures smooth. Allow children to help plan and prepare the
12. In an effort to help reduce disease risk, all government-funded meals served at schools must follow the Dietary
Guidelines for Americans. School lunches offer a variety of food choices and help children meet at least one-
16. In general, nutrient needs rise throughout childhood, peak in adolescence, and then level off or even diminish as
the teen becomes an adult. Boys’ energy needs may be especially high; they typically grow faster than girls and
develop a greater proportion of lean body mass. The RDA (or AI) for most vitamins increases during the
17. Adolescents who frequently eat meals with their families eat more fruits, vegetables, grains, and calcium-rich
foods, and drink fewer soft drinks, than those who seldom eat with their families. Compared with those who
Critical Thinking Questions
8
1. Explain why infants require more energy per unit of body weight than adults.
2. Explain how breast milk provides immunological protection for the newborn.
3. What strategies can be implemented to prevent the occurrence of nursing bottle tooth decay in infants?
4. Describe how solid foods should be introduced to prevent reactions to potential allergens in the diet.
5. Describe the difference between food allergy and food intolerance. What methods can be used to increase food
safety related to these two health concerns?
6. What competing factors influence a student’s food selections?
Answer Key
1. Even though adults weigh more than infants, infants require more energy per pound of body weight. Infants
294
2. The constituent parts of breast milk contribute to immunological protection for the newborn, as breast milk
contains antibodies, essential fatty acids, and other metabolic compounds that attack bacteria prototypes.
3. Infants should not be put to bed with either a formula or juice bottle as this will lead to accumulation on dental
4. Single food items should be introduced over a period of a few days to determine if there is any potential allergic
reaction. If foods are not introduced this way, and a reaction is observed, it may prove difficult to isolate the
5. Food allergy involves the development of antibodies based on an antigen-triggered response. The food allergy
response may intensify over time with subsequent exposures to the trigger item. Food intolerance does not
6. Students who attend school are subject to a variety of competing factors that influence their individual food
choices. Economics plays a role in what students are able to select from school cafeterias. Additionally, students
IM Worksheet Answer Key
Worksheet 16-1: Infant Feeding Review (Internet Exercise)
Worksheet 16-2: How to Rate Your Food Behaviors
Worksheet 16-3: Chapter 16 Crossword Puzzle
295
Worksheet 16-1: Infant Feeding Review (Internet Exercise)
1. Which of the following behaviors is a reliable indicator that your baby is ready to eat solid foods?
a. The infant drinks less than 32 ounces per day.
b. The birth weight of the infant has tripled.
c. Your infant is interested in the foods that you are eating more than the food that he/she is eating.
d. Your baby asks for solid foods by name.
2. You should use a bottle to provide juice to infants after 6 months of age.
3. Salt should not be added to an infant's food.
4. The amount of fat in a baby's diet should be limited.
5. Honey should not be given to infants.
6. Shellfish should be avoided in the first year as it causes diarrhea.
a. True
b. False
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Worksheet 16-2: How to Rate Your Food Behaviors
Fill out the following table with respect to your own observations about food behaviors.
Question
True
False
2. When I go into a restaurant, I have a definite idea of what I
want to eat.
4. I can remember everything that I ate yesterday in terms of
amounts and food products.
6. When I go to the supermarket I become hungry as I walk up
and down the aisles.
8. I prepare all of the food that I eat during the week.
10. I am aware of the amount of kcalories in the foods I eat on a
daily basis.
297
Worksheet 16-3: Chapter 16 Crossword Puzzle
1
2
3
4
5
6
7
8
9
10
11
12
Across:
Down:
5. Primary source of protein in most infant formulas
10. Limiting _____ is important for the prevention of
chronic diseases such as diabetes and heart disease.
12. _____ provide about one-fourth of adolescents’
daily energy intake.
1. At 4-6 months an infant may start eating _____.
3. Primary carbohydrate in breast milk or infant
formula
6. At least _____ minutes of daily physical activity is
recommended for children.
9. Energy-yielding nutrient that provides the majority
of kcalories in breast milk or infant formula
