NUTRITION IN THE LIFE STAGES
NUTRITION IN SCHOOL-AGE CHILDREN
Topic Outline
● Characteristics of the School-age child
● Growth and Development
● Nutrition Concerns of a School-age child
● Nutrient Allowances
● Feeding problems
● Meeting the Allowance of a School-age child
● Competing influences at school
● Hunger and malnutrition in children
● Other nutrition problems
● Sign of good nutrition
CHARACTERISTICS OF THE SCHOOL-AGE CHILDREN
● School age: The period between 6-12 years old
● Characterized by slow and steady growth
● This decline continues up to the latter part of the
period when there is a gradual increase in need
because reserve are being laid down for demands of
approaching adolescence
● Although physical growth is less remarkable and more
steady, this period shows significant development in
social, cognitive, and emotional areas
● Considerable variation in individual growth and
development may be observed
Weight
● Weight generally increases an average if 2-3 kg per
year until the child is 9-10 years old
● Rate increases, signaling approach of puberty
Height
● Height increments average 6-8cm per year from 2
years of age until acceleration to puberty
● Mid-childhood years are relatively stable compared
to the preschool and adolescent years, with
regards to growth rate and behavior
● After this, it increases in preparation for growth
spurt during puberty
Body mass
● Boys have more lean body mass per cm of height
● Girls tend to gain fat slightly higher rate than boys –
crucial marker and intervention point for childhood
obesity
GROWTH AND DEVELOPMENT
A. Weight and height
● Approximately 2 inches in height and 2 kgs in
weight are added each year
B. Muscle and fat
● Muscles are still prone to injury because of their
immaturity. Both sexes accumulate equal
amounts of body fat relative to eating habits
C. Skeleton
● Ossification is till in progress
OSSIFICATION – the process by which bone is formed in
the body. It is a crucial part of the skeletal system’s
development, growth and maintenance.
D. Gastrointestinal System
● This system matures, thus experiencing fewer
stomach upsets and greater stomach capacity
E. Brain
● Brain growth is essentially complete by age 10 or
12
NUTRITION CONCERNS OF A SCHOOL-AGE CHILD
After 1st year, growth rate slows:
● Dramatic changes in the body continues
Children’s appetite decline markedly around the first birthday:
● After this point, appetite fluctuates
● Child will need and demand more food during
periods of rapid growth
● Food energy intake varies from meal to meal
● Total daily energy intake remains fairly constant
● Inadequate intakes of vitamin E, potassium, and
fiber
● Excessive intakes of sodium and saturated fat
● Need more nutritious foods in proportion to their
weight than do adults because of their growth
and development
● Can be at risk for malnutrition when there’s long
duration of poor appetite, accept limited foods,
dilute diets with nutrient-poor foods
Appropriate eating habits and attitudes toward food should
start from childhood
● Candy, cola, and other concentrated sweets should
be limited
● Preference for sweets is innate
● Children need direction in selecting appropriate foods
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 NUTRIENT ALLOWANCES

A. Recommended Energy Intake

● Allowances decline gradually to
approximately 80-90 kcal/kg for 7-9 age
group and 70-80 kcal/kg for 10-12 age group
● Must be adjusted individually since there are
wide variations in the children’s Physical
Activity

● Minimum of 8% of TER is necessary since

● At 1 year, child needs about 800 kcal/day
● At 6 years: active child needs twice
● At 10 years: active child needs about 2,000
kcal/day
● Physically active children require more
energy
● Inactive children can become obese even
when they eat less food than average
B. Carbohydrates
● Carbohydrate recommendations for children
after 1 year same as adults
D.
● Based on brain’s glucose use
C. Protein
● The child’s protein requirement is relatively
higher in relation to body weight than that of
an adult. An adequate protein intake is
needed to cover the requirements for periods
of rapid growth
E.
● Protein needs increase slightly with age
● Decline as percentage body weight
F.
children are susceptible to recurrent
infections
● Need higher amounts of high biological value
(HBV)
● Approximately 35g of CHON daily is
recommended for 7-9 years old and 45-49g
for 10-12 years old
● Milk, cheese, and/or yogurt may be given 3
servings/day
● Meat, fish, alternatives: 2 servings/day
● Fish should be offered at least twice per
week; oily fish should be offered twice per
week but limited to 4 servings for boys per
week and 2 servings for girls per week
Fat
● Recommended fat intake: 30-40% from ages
1-3 years old
● 25-35% for ages 4-18 years old
● Fat gradually decreases during early
childhood, reaching a minimum at 6 years of
age
Fiber
● Recommendations lower for younger
children with low energy intakes
● Higher for older children with high intakes
Vitamins and Minerals
● 2 most important minerals that may be
limiting at this age: calcium and iron
● Zinc has also notable decrease in school
children – deficiency results to growth failure,
poor appetite, decreased taste acuity and
poor wound healing
● Physicians do not recommend routine
vitamin or mineral supplementation in areas
not fluoridated
● Vitamin and minerals needs increase with
age
● Can be met with balanced diet of nutritious
foods

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 ● Iron-deficiency anemia and low vitamin D
intake major problems
● Supplement may be needed for Vitamin D,
iron, and fluoride
Nutritional risks who may benefit from supplements:
● Children from deprived families
● With poor appetite and poor eating habits
● Consuming vegan diets without dairy
No risk for giving standard multivitamin pills but mega doses
(>10 times RDA) should be avoided
G. Fluids
● Fluid requirement is 4-6 glasses a day
FEEDING PROBLEMS
● Hurried or missed breakfast due to limited
time for eating
● Poorly planned school lunches
● Poor appetite due to school and/or
peer-related stresses
● Poor eating practices due to lack of guidance
in food selection at home or school
MEETING THE FOOD ALLOWANCES OF SCHOOL-AGE
CHILD
● Liberal amounts of body-building, regulating, and
energy-giving foods each meal
● Meals and snacks should include varied foods from
each food group
Competing Influences at School
● Amounts suited to child’s appetite and
needs
● Higher-kcalorie choices more appropriate
for active older children
● Nutritious snacks to provide affitional source of
nutrients
● Well-planned home-packed lunch or school lunch for
children eating their meals in school; school lunches
should furnish at least 1/3 of the child’s daily food
requirements
● Continue on providing milk or foods incorporated with
milk
● Feeding involves nutritious foods and nutruting child’s
self-esteem
Challenge: prepare foods that appeal to child’s
taste and provide needed for nutrients
● Child’s preferences should be treated with
respect
● Avoid power struggles
● Parent chooses what to offer child
● Child chooses whether and how much to
eat
● Be aware of the dangers of choking
● Meal should be preceded by activity
● Children eat better following activity
● Tend to hurry through meal to get to
activity when it follows
● Allow child to help plan and prepare family meals
● Provide nutrient-rich, low-kcalorie snacks
● Parents and caregivers should role model healthy
eating behaviors
● School has important role in food and nutrition
behaviors
School breakfast – federally funded program for
low-income families
● School Lunch
● Designed to provide at least one-third of
recommended amounts for energy,
protein, vitamins A and C, iron and
calcium
● Must include specific number of servings
from each food group
● Short lunch periods and long lines prevent some
students from having enough time to eat
● Availability of competitive foods
● Fast-food restaurants in or near school
● Ala carte choices that are less nutritious
● Snack foods and carbonated beverages from snack
bars or vending machines
HUNGER AND MALNUTRITION IN CHILDREN
● Hunger affect 16 million US children
● Low-income families more likely to be
hungry and malnourished
● Food assistance programs available
● Hunger impairs attention and ability to be productive
● Children who skip breakfast do not make up nutrient
deficits later at meals
NUTRITION PROBLEMS
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A. Iron Deficiency and Behavior
● Iron deficiency impairs attention span and
learning ability
Important roles of iron
- Transports oxygen within cells
- Used to make neurotransmitters
● Deficiency usually not diagnosed until long
after effects on child’s brain
● Iron deficient infants continue to perform
poorly as children even if iron status
improves
B. Other Nutrient Deficiencies
● Nutrient deficiencies often result in
behavioral and physical symptoms
Any departure from normal, healthy
appearance and behavior may indicate
poor nutrition
● Registered dietician, nutritionist, or other
qualified health care professional should
inspect child’s diet
Take steps to correct inadequacies
immediately
C. Lead Poisoning
● Lead poisoning can cause iron deficiency
Iron deficiency weakens body’s defenses
against lead absorption
● Mild lead toxicity has non-specific effects
Diarrhea, irritability, fatigue
● Symptoms of higher levels of exposure
- Reduced cognitive, verbal, and
perceptual abilities
- Learning issues and behavioral
problems
D. Food Allergies
● Allergies affect approximately 4-8% of
children
- Generally diminish with age
- True food allergy occurs when
food proteins elicits immunologic
response
- Involves antigen-antibody
response
● Detecting allergy
- Allergies may or may not
involves symptoms
- Medical testing and food
challenges
● Reactions may occur within minutes or up to
24 hours after exposure to antigen
● Immediate reactions are easiest
for identifying cause
● Delayed reactions more difficult
to pinpoint
● Anaphylactic Shock
● Life threatening condition most
often caused by peanuts and
other allergens
● Prevented by administering
epinephrine after
E. Food Labelling
● Food labels must be identify common
allergens in plain language
● Food producers must prevent
cross-contamination during
production
● Clearly mark foods where
cross-contamination may occur
F. Food Intolerances
● Stomachaches
● Headaches
● Nausea
● Wheezing
● Hives
● Coughs
● Reaction specific to MSG or sulfur
● Enzyme deficiencies (lactose intolerance)
● Psychological aversions
G. Hyperacidity
● Affects behavior and learning in about 11%
of school-aged children
Untreated, interferes with social
development and ability to learn
● Treatment focused on relieving symptoms
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 ● Behavior modification
● Special educational techniques,
counseling
● medication
● Restricting sugar has no proven effect
H. Childhood Obesity
● Number of overweight children increased
dramatically over past three decades
● 32% of US children are
overweight
● 17% of these are obese
Adolescence
● Genetic and environmental factors
● Physical Inactivity
NUTRITION IN ADOLESCENCE
Topic Outline
- Introduction
- Growth and Development
- Nutritional Requirements
- Nutrient Focus
- Eating Behaviors
- Feeding Problems and Suggestions
- Nutrition Related-Problems and Disorders
- Nutrition Counseling for Teens
INTRODUCTION
● Adolescence occurs between 10-19 years old and is
the period in which a child grows up into mature

● Parental obesity
● Physical Health
● Poor diet
● 40% of total energy intake from solid fats and
- High levels of blood lipids
added sugars for children ages 2-18 years old
- High blood pressure
man or woman
● It is also known as the period of transition from
● Psychological development childhood to adulthood

- Emotional issues due to peer Complex Changes occur during adolescence

rejection ● Physical changes increase nutrient needs
● Emotional, intellectual, and social changes makes
● Prevention and treatment of obesity
meeting needs a challenge

- Approach: improve long-term Teenagers make their own food decisions

physical health through ● Food choices profoundly affect health
permanent, healthy lifestyle ● Social pressures impact choices
habits ● Alcohol
- Includes diet and physical ● Dieting
activity
GROWTH AND DEVELOPMENT
SIGNS OF GOOD NUTRITION AMONG SCHOOL-AGE
CHILDREN Dramatic increase in growth rate occurs at onset of
adolescence
a. Well-developed body with normal weight for height ● Profound effect on every organ of body, including
b. Firm and well-developed muscles brain
c. Good posture ● Growth spurt lasts about 2 ½ years
d. Healthy skin, no lesion, and dyspigmentation ● Starts ate age 10-11 for females and age 12-13 for
e. Smooth and glossy hair males
f. Clear eyes
g. Alert facial expression and good disposition
h. Sound sleep Males Females
i. Good digestion and elimination
j. Good appetite Increase lean body mass Larger percentage of body
(muscle, bone) weight from fat

Grow 8 inches taller Grow 6 inches taller

Gain about 45 pounds Gain about 35 pounds

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 NUTRITIONAL REQUIREMENTS
Nutrient needs are determined not by age and sex alone but
the rate of growth as well
Energy
● The makes for both age groups have higher energy
allowance than their female counterparts because of
more intense physical activities and differences in
weight, body size, and body composition
● Bone density at risk if soft drinks displace milk from
diet
● Regular soft drink consumption linked to obesity
● Caffeine in drinks presents problems as well
o Moderate intake of caffeine relatively
harmless
o Greater amounts can result in symptoms
similar to anxiety
EATING FROM HOME

Protein Adolescents eat about 1/3 of meals away from home

● Allowance for males is slightly higher than that for
females among adolescents aged 13-15 years
● A further increase in allowance is made for males
16-19 years but nor for females
● The higher protein allowance for boys in this age
group is due to an increased growth spurt
● Nutritional welfare is enhanced or hindered by their
food choices
● Many fast-food restaurants offer more nutritious
choices
Peers often influence adolescents’ choices
● Adults can make nutritious foods available

Vitamins and Minerals NUTRITION COUNSELING FOR TEENS

● The need for B vitamin increases as energy
requirement becomes higher
● Vitamins A and C are higher among males than
females
● Iron requirement is higher among females to
compensate losses during menstruation
● Must be individualized to accommodate range
contemporary lifestyles
● Start early, start at home (family-based interventions)
● Parental role modeling is critical; parents can either
be positive or negative role models

NUTRIENT IN FOCUS FEEDING PROBLEMS

● Adolescence is characterized by a high level of

Vitamin Description
physical and emotional growth that may result in
Vitamin D Many adolescents do not anxiety and stress
receive enough ● Socio-psychological changes occur and may affect
food and nutrition behavior, e.g., expression of
Iron Iron-deficiency most independence, peer pressure, and concern for body
prevalent among adolescent image
girls ● Tendency to skip meals due to lack of time and/or lack
of appetite, which in turn may be excuses for many
Calcium Need for calcium peaks
other possible reasons
during teens
● Snacking at the expense of regular meals
Crucial time for bone ● Unusual eating patterns, e.g., fad diets
development
FEEDING SUGGESTIONS
Low intake common among
teens ● Eat at least three good meals a day, and never skip
on breakfast
FOOD CHOICES AND EATING HABITS ● Choose snacks wisely, providing not only energy but
protein, vitamins, and minerals as well
Busy lifestyle results in irregular eating habits ● Eat enough of a variety of foods everyday
● Adult role: gatekeeper
o Ensure healthy food available at home NUTRITION-RELATED PROBLEMS AND DISORDERS
● Snacks
o About ¼ of daily energy intake comes from
Disorders Description
snacks
o Can contribute to some of needed nutrients if Iron Deficiency Anemia Risk is higher considering
chosen carefully the need for growth and
Beverage Consumption maintenance of body
● Trend: increased consumption of soft drinks tissues; replacement of iron
losses in menstrual cycle

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 among females

Iodine deficiency disorder Teenagers in endemic

(IDD) regions are at risk

Anorexia Nervosa A state of emaciation that

has been brought on by
voluntary starvation

Bulimia Also known as the “gorge

and purge”, characterized by
enormous consumption of
food and then immediately
purging or eliminating the
food by vomiting or taking
laxatives

Weight disorders Arising from poor eating

habits

Teenage Pregnancy Presents a very high risk for

low infants birth weights

SIGNS OF GOOD NUTRITION

a. Energetic and responsive

b. Normal weight for height, age and body build
c. Shiny and lustrous hair
d. Skin that is smooth, slightly moist and of good color
e. Bright and clear eyes with no fatigue circles under
them
f. Lips are of good color
g. Pink gums with no swelling or bleeding
h. Tongue of good color and without lesions
i. Teeth and straight and without crowding