CHILDHOOD NUTRITION

BY
DR. K. S. Abbasi
IFNS. PMAS-AAUR
Peculiar Features
 Early childhood encompasses infancy and the toddler years, from
birth through age three. The remaining part of childhood is the period
from ages 4-8 and is the time when children enter school.
 A number of critical physiological and emotional changes take place
during this life stage. For example, a child’s limbs lengthen steadily,
while the growth of other body parts begins to slow down. By age
10, the skull and the brain have grown to near-adult size
 Emotional and psychological changes occur as well. Children’s
attitudes and opinions about food deepen. They not only begin taking
their sign about food preferences from family members, but also
from peers and the larger culture. All of these factors should impact
the nutritional choices parents make for their children. This time in a
child’s life provides an opportunity for parents and other caregivers
to reinforce good eating habits and to introduce new foods into the
diet.
Childhood is divided into four phases:
 Infancy: Up to 12 months.
 Toddlers: 1–3 years old, Growth rate is high, but slower
than infancy. At Age 2: Gain 3–5 pounds, 3–5 inches
 Preschoolers: 3–5 years old, Need same nutrients as
adults, but have lower energy needs, Smaller appetites,
Smaller stomachs.
 School-Aged Children: Ages 6–12 years, not fully grown,
each year, gain about 7 pounds and 2.5 inches, Compared
to toddlers and preschoolers they do not eat as many times
per day, tend to be less hungry (maintain blood glucose
longer), Can eat more food at each sitting, can impact
healthy development through dietary choices, continue to
develop habits based on modeling adult behaviors.
INFANCY
The term "infant" is typically applied to young children under
one year of age; however, definitions may vary and may include
children up to two years of age. When a human child learns to
walk, the term "toddler" may be used instead.
• In the first year, babies learn to focus their vision, reach out,
explore, and learn about the things that are around them.
Cognitive, or brain development means the learning process of
memory, language, thinking, and reasoning.

INFANT NUTRITION:
“Infant nutrition is the description of the dietary needs of
infants. A diet lacking essential calories, minerals, vitamins, or
fluids is considered inadequate. Breast milk provides the best
nutrition for these vital first months of growth when compared to
infant formula.”
 Ounces per
Age Solid foods
feeding

0.5 oz. in the first

Up to 2 weeks of life No
days, then 1–3 oz.
2 weeks to 2 months 2–4 oz. No
2–4 months 4-6 oz. No

Possibly, if your baby can hold

their head up and is at least 13
4–6 months 4–8 oz.
pounds. But you don’t need to
introduce solid foods yet.

Yes. Start with soft foods, like

one-grain cereals and pureed
vegetables, meats, and fruits,
progressing to mashed and well-
6–12 months 8 oz.
chopped finger foods. Give your
baby one new food at a time.
Continue supplementing with
breast or formula feedings.
 Good nutrition is essential for the growth and
development that occurs during an infant’s first year
of life.
 When developing infants are fed the appropriate
types and amounts of foods, their health is promoted,
 Nutrient needs of infants reflect rates of growth,
energy expended in activity, basal metabolic needs,
and the interaction of the nutrients consumed.
 Balance studies have defined minimum acceptable
levels of intakes for a few nutrients, but for most
nutrients the suggested intakes have been
extrapolated from the intakes of normal, thriving
infants consuming human milk
Recommendations for infants are from the Dietary Reference Intakes
(DRI), National Academy of Medicine, AAP and the Academy of
Nutrition and Dietetics:
–
Energy:

 108 kcal/kg/day from birth to 6 months

 98 kcal/kg/day from 6 to 12 months

Factors that influence caloric needs:

 Weight and growth rate
 Sleep/wake cycle
 Temperature and climate
 Physical activity
 Metabolic response to food
 Health status/recovery from illness
 The equation for total energy
expenditure (TEE) for infants is
as follows:
TEE (kcal/day) = 89 x weight
TOTAL ENERGY of infant (kg) – 100
EXPENDITURE
 0-3 months (89 x weight of infant in
kg – 100) + 175
 4-6 months (89 x weight of infant in
kg – 100) + 56
 7-12 months (89 x weight of infant
in kg – 100) + 22
Proteins:

 Necessary for formation of new cells

 It is needed for tissue replacement, deposition of lean body mass, and
growth.
 Generally, Newborn needs more protein per unit of weight than adult

2.2 g/kg/day from birth to 6 months

1.6 g/kg/day from 6 to 12 months

 Infants require a larger percentage of total amino acids as essential

amino acids than do adults. Histidine seems to be an essential amino
acid for infants, but not for adults, and tyrosine, cysteine, and taurine
may be essential for premature infants
 Protein needs are similar to that of energy but are also influenced by
body composition
Fats:
 The current recommendation for infants younger than
1 year of age is to consume a minimum of 30 g of fat
per day. This quantity is present in a normal intake of
human milk and infant formulas
 Infants need cholesterol for gonads and brain
development
 Breast milk contains short-chain and medium-chain
fatty acids (in addition to the long-chain) – Easier to
digest and utilize than long-chain fatty acid
 Human milk contains the essential fatty acids linoleic
acid and alpha-linolenic acid, as well as the longer-
chain derivatives arachidonic acid and
docosahexaenoic acid
Water:
 The water requirement for infants is determined by the amount lost from the
skin and lungs and in the feces and urine, in addition to a small amount needed
for growth.
 The recommended total water intake for infants, based on the DRIs, is 0.7
L/day for infants up to 6 months and 0.8 L/day for infants 6 to 12 months of
age.

Body weight Fluid

requirements

0-10kg 700 ml/kg

11-20kg 1000ml+50ml/kg for
each Kg
Greater than 20 kg 1500ml+20ml/kg for
each kg
Minerals
1.Calcium
Breast-fed infants retain approximately two thirds of their calcium intake.
 The AI for infants 0 to 6 months of age is 200 mg/day
 For infants 6 to 12 months of age the AI is 260 mg/day
2.Fluoride
The importance of fluoride in preventing dental caries. The tolerable upper intake level
for fluoride has been set at:
 0.7 mg/day for infants up to 6 months and
 0.9 mg/day for infants 6 to 12 months of age.
3.Iron
Full-term infants are considered to have adequate stores of iron for growth up to a
doubling of their birth weight. Recommended intakes of iron increase according to age,
growth rate,
 For breast-fed term infants, the AAP recommends iron supplementation of 1
mg/kg/day starting at 4 months of age
4.Zinc
Newborn infants are immediately dependent on a dietary source of zinc. Zinc is better
absorbed from human milk than from infant formula. Human milk and infant formulas
provide adequate zinc (0.3 to 0.5 mg/100 kcal) for the first year of life.
Vitamins
1.Vitamin B12
Milk from lactating mothers who follow a strict vegan diet may be deficient in vitamin
B12, especially if the mother followed the regimen for a long time before and during
her pregnancy.
2. Vitamin D
The vitamin D content of breast milk is correlated directly to the vitamin D status of
the mother.
 Current RDA for vitamin D for lactating mothers is 600 IU per day, and
 The tolerable upper limit is 4000 IU per day.
 Coupled with the AAP’s recommendation to keep all infants under the age of 6
months out of direct sunlight,
3. Vitamin K
The AI for infants is
 2 mcg/day during the first 6 months
 2.5 mcg/day during the second 6 months of life
Deficiency may result in bleeding or hemorrhagic disease of the newborn. This
condition is more common in breast-fed infants than in other infants because human
milk contains only 2.5 mcg/l of vitamin K, whereas cow’s milk–based formulas
contain approximately 20 times this amount.
 GENERAL STEPS
1. Start Solids
That's the recommended time to introduce solid foods. But it's not just about age.
Before starting solids, your baby should be able to sit up (with support), turn his head
away, and make chewing motions. He should also be past the reflex that makes him spit
out anything including liquids.
2. Keep Going With Breast Milk or Formula
Babies usually don't eat a lot of solid foods right away. So think of solids as something
you're adding to your baby's diet, not as a replacement for breast milk or formula.
Remember, you're introducing solid foods, not totally changing your baby's diet or
eliminating milk. That will happen gradually.
3. Cereals:
Try a single-grain, iron-fortified infant cereal with a neutral to no flavor. It also will be
a bit easier to notice any food allergies than with a cereal made from several grains.
You may want to mix it with formula or breast milk to get a runny consistency at first,
so it's not a drastic change for your baby. Gradually thicken it more until your baby gets
used to the new texture.
4. Start Fruits and Vegetables, One at a Time:
Fruits, vegetables, grains, and even pureed meats can all be on the menu for your baby.
You may want to introduce them one at a time to see how your little one reacts to the
flavor and texture and to make sure no allergies develop. If your baby won't eat them at
first, try again later.
Babies need to reject a food at least 5 to 10 times on different occasions before you
can truly say they don't like the food. Tell your pediatrician if you think your baby
might have any food allergies to any new foods tried.
Use soft baby food from a jar, or soften foods by heating and/or pureeing them.
Put just enough on the spoon for your baby to swallow easily. Don't force feed the
food.

5. Avoid Milk
Most pediatricians say you should wait until after your baby's first birthday to start
offering cow's milk. That's because nutritionally it doesn't measure up to Mother's
milk or have the nutritional value of specially developed formulas.

6. FINGER FOODS:
Around 9 months or so, your baby will be able to pick up small pieces of soft table
food to eat. You'll still need to spoon-feed for a while, and continue formula or
breast milk. Some great "finger foods" include ripe banana pieces, cooked chunks
of carrots, cottage cheese, well-cooked pasta, dry cereal, and scrambled eggs.
Avoid choking hazards like hard candy, chips, raw vegetables, grapes or raisins,
hard cheese, and whole hot dogs.
 GENERAL DIETARY GUIDELINES:
Diet Guidelines: 0 - 12 Months

Breast feeding with appropriate supplementation is the preferred method for

feeding infants 0-12 months old (1). Iron-fortified formulas are recommended if
the child is not breast fed or requires supplemental formula in addition to breast
milk.

 Breast feeding is the preferred method of feeding during the first year of life
and
 that whole cow's milk may be introduced after six months of age if adequate
supplementary feedings are given .
 When the infants are consuming one third of their calories from a balanced
mixture of iron fortified cereals, vegetables, fruits and other foods providing
adequate sources of both iron and Vitamin C it is considered adequate
supplementary feeding.
 Reduced fat content milk is not recommended during infancy.
FEEDING OPTIONS
Breast feeding is the feeding of an infant or
young child with breast milk directly from
female human breasts (i.e., via lactation) not
from a baby bottle or other container.
Exclusive breastfeeding for about 6 month and
To continue for at least the second year
 TYPES OF BREAST MILK

• Colostrum/Early Milk:
It is produced in the late stage of
pregnancy till 4 days after delivery; and is
rich in antibodies.

• Transitional Milk:
It produced from day 4 – 10 is
lower in protein in comparison to
Colostrum.

• Mature milk:
It is produced from approximately
ten days after delivery up until the
termination of the breastfeeding.
 KIND IN PROTEIN FATS (g) COMPOSITION OF
CARBOHY CALORIES
100 ML (g) BREAST
DRATESMILK
(g) (KCAL)
•

Colostrum 7.5 2 4.5 150

Transitive 2.5 3.5 5.5-6.6 60-80

Mature 1.1-15 3.5-4.5 7 65-70

 ADVANTAGES OF BREAST FEEDING:
A diet lacking essential calories, minerals, vitamins, or fluids is
considered inadequate.
• Breast milk provides the best nutrition for these vital first months of
growth when compared to infant formula. For example, breastfeeding
aids in preventing anemia, obesity, and sudden infant death
syndrome; and it promotes digestive health, immunity, intelligence,
and dental development.
• The American Academy of Pediatrics recommends exclusively feeding
an infant breast milk, or iron fortified formula, for the first six months
of life and continuing for one year or longer as desired by infant and
mother.
• Infants are usually not introduced to solid foods until four to six
months of age. Historically, breastfeeding infants was the only option
for nutrition otherwise the infant would perish.
• Breastfeeding is rarely contraindicated, but is not recommended for
mothers being treated for cancer, those with active tuberculosis, HIV,
substance abuse, or leukemia. Clinicians can be consulted to determine
Immunological:
Breastfed babies are at lower risk of infection.
Nutritional:
Easy to digest, optimal blend of nutrients, low risk
of contamination.
Psycho/social:
Bonding, pain relief, maternal confidence
&empowerment.
Financial:
Milk is always available: shorter hospital stay.
Optimal nutrition for human infant
 Correct nutrient composition – macro/micronutrients
 Nutritionally complete until 6 months
INDICATIONS FOR ARTIFICIAL FEEDING

Artificial feeding of a baby with food other than

mother's milk. It includes use of cow’s milk, buffalo’s
milk or commercially available dried whole milk.

POSSIBLE INDICATIONS
 Death or absence of mother
 Prolonged maternal illness
 Failure of breastmilk production
 Mothers who have active TB and HIV mothers
 Working mothers
 The baby is adopted and the mother has adopted the baby for lactating
 TYPES OF FORMULAE
Milk-based formulas
 Prepared from cow milk with added vegetable oils, vitamins, minerals,
and iron.
 These formulas are suitable for most healthy full-term infants.
Soy-based formulas
 Made from soy protein with added vegetable oils (for fat calories)
and corn syrup and/or sucrose (for carbohydrate).
 These formulas are suitable for infants who cannot tolerate the lactose
in most milk-based formulas or who are allergic to the whole protein in
cow milk and milk-based formulas.
Special formulas
 For low birth weight (LBW) infants
 Low sodium formulas for infants that need to restrict salt intake,
 “Predigested" protein formulas for infants who cannot tolerate or are
allergic to the whole proteins (casein and whey) in cow milk and milk-
based formulas.
ADVANTAGES
 If you bottle feed your baby, they may sleep for longer between feeds.
 We can ask someone else to feed your baby, such as your partner or a
family member, if you need to take a break.
 Like breastfeeding, bottle feeding enables a strong bond and a sense of
closeness to develop between the baby and parent.
 Formula milk has added vitamin K
 If you are bottle feeding your baby, you know exactly how much milk
your baby has had.
 •Your social life does not need to be curtailed. You can resume your
normal life.
DISADVANTAGES
• More diarrhea and respiratory infections
• Persistent diarrhea
• Malnutrition Vitamin A deficiency
• More allergy and milk intolerance
• Increased risk of some chronic diseases
• Lower scores on intelligence tests.( Poor IQ)
Complementary feeding or weaning is the process of giving an infant
other foods and liquids along with breast milk after the age of 6 months
as breast milk alone is no longer sufficient to meet the nutritional
requirements of growing baby. It is the process by which the infant
gradually becomes accustomed to adult diet.

WHY AT SIX MONTH?

• Infant’s intestinal tract develops immunologically with defense

mechanisms to protect the infant from foreign proteins.
• The infant’s ability to digest and absorb proteins, fats, and
carbohydrates, other than those in breast milk increases rapidly.

• The infant’s kidneys develop the ability to excrete the waste products.
• The infant develops the neuromuscular mechanisms needed for
recognizing and accepting variation n the taste and color of food
COMPLEMENTARY FOODS ATTRIBUTES

1.Weaning food should be liquid at first, then semi solid and solid
food to be introduced gradually.
2. Clean, fresh and hygienic, so that no infection can occurs.
3. Easy to prepare at home with the available food items and not
costly.
4. Easily digestible, easily acceptable and palatable for infants.
5. High in energy density and low in bulk viscosity and contains
all nutrients necessary for the baby.
6. Based on cultural practice and traditional beliefs.
7. Well – balanced, nourishing and suitable for the infant.
 PRINCIPLES OF WEANING
During introduction of weaning foods following principles to be
remembered:-
1.Weaning foods should provide extra requirement as per need of the
baby
2. Initially small amount should be given then increase gradually in
course of a week
3.New food to be placed over the tongue of the baby to get the taste of
food and to feel the consistency
4. A single weaning food is added at a time.
5. Weaning should be started between 5 to 6 months of age but
breastfeeding to be continued up to 2 yrs. of age.
6. Additional food can be given in the day time. Initially it can be given
once, then twice or thrice.
7.New foods should be given when the infant is hungry, but never force
the child to take the feeds.
8. Delayed weaning result in malnutrition and growth failure.
9.Observe the problems related to weaning process.
 COMPLEMENTARY FEEDING AGE
4 to 6 months
 Weaning to be initiated with fruit juice.
 Within one to two weeks new food to be introduced with suji, biscuit socked with
milk, vegetable soup, mashed banana, mashed vegetable.
 Each food should be given with one or two teaspoon at first for 3 to 6 times per day.

6 to 9 months
Food item to be given at this period include soft mixture of rice and dal, khichri, pulses,
mashed and boiled potato, bread or roti soaked with milk or dal, mashed fruits, egg
yolk, curd.
Amount of food should increase gradually.

9 to 12 months
More variety of household food can be added.
Fish, meat, chicken can be introduced.
Food need not to be mashed but should be soft and well cooked.

12 to 18 months
The child can take all kind of cooked food.
The amount and frequency should increase gradually
ADVANTAGES OF CF
 It prevents malnutrition
 It prevents deficiency diseases, e.g. anemia
Promotes growth.

DISADVANTAGES OF CF
 It may lead to diarrhea, if the food is preparing an unhygienic way.
 Negligence in choosing nutritious weaning food can lead to either
calorie, protein, vitamin or mineral deficiencies

RISK OF STARTING CF LATE OR EARLIER

Reduce breast milk production or intake.
Contribute to increased rates of infant mortality and morbidity..
Increase the risk of mothers becoming pregnant.
Interfere with iron absorption.
Reject foods when they are introduced at a later age
.Consume an inadequate variety & amount of food to meet their
nutritional needs
TODDLERS
During this second year of life, growth slows down. Your toddler may
gain about 5 pounds (2.27 kg) and grow about 4 or 5 inches (10 to 12
cm). By 2 years, children have reached about half of their adult height
and 90% of adult head size. Boys tend to weigh about a pound more than
girls but average about the same height.
Age Weight Height
2 yrs 27.5 lb (12.5 kg) 34.2" (86.8 cm)
3 yrs 31.0 lb (14.0 kg) 37.5" (95.2 cm)

4 yrs 36.0 lb (16.3 kg) 40.3" (102.3 cm)

• During the toddler years, your child will continue change

dramatically in the following five main areas of development:
physical, cognitive, emotional and social, language, and sensory
and motor skills.
NUTRITIONAL NEEDS OF TODDLERS:
CALORIES:
Starting at age 1, toddlers need around 1,000 calories, increasing with age and
activity level to around 1,200 calories/day. Reaching 4 years old, they will
need about 1,500 calories/day. There really is no reason to count calories to
ensure adequate intake if she is adequately gaining weight and staying steady
on her growth curve.
Consider these nutrient-dense foods:
CARBOHYDRATES: Their brain is growing at an astronomical rate and
needs a high amount of carbohydrate to function. Children from the age of 1
need 130 grams of carbohydrates a day. If 130 grams sounds like a lot, it is
(for a little one). Carbohydrates provide the major source of energy that we
need to live, grow and thrive. Every part of our body uses it for energy;
without it, we couldn’t survive. Carbohydrates should provide 50-60% of the
energy a child needs from food.
PROTEIN: Children age 1-3 only need 13 grams of protein/day.
Choose seafood, lean meat and poultry, eggs, beans, peas, soy products,
and unsalted nuts and seeds.
FIBER: Children age 1-3 need a minimum of 19 grams of fiber a day. If you
incorporate healthy carbohydrates like listed above, there should be no
problem in reaching this goal. Remember, whole foods, not processed, have
the most fiber.
SODIUM: We all need sodium to live! Toddlers age 1-3 NEED at least 1 g/day to keep
their body functioning as it should. Sodium is an electrolyte and works to maintain
blood pressure, muscle contractions and nerve function. Sodium is not evil!
IRON; Meals provided to children age 1-3 should provide 7 mg of iron per day.
People are concerned about iron intake, and rightly so, iron-deficiency is the most
prevalent nutrition deficiency in the U.S. and Canada. As children progress from the
highly absorbable iron in breastmilk and iron fortified formula to cow’s milk, a poor
source of iron will cause deficiency. Some iron rich foods are
Organ meats (liver, giblets), 3 oz 5.2-9.9
Fortified instant cooked cereals , 1 packet 4.9-8.1
Soybeans, mature, cooked, ½ cup 4.4
Pumpkin & squash seeds, roasted, 1 oz 4.2
White beans, canned, ½ cup 3.9
Lentils, cooked, ½ cup 3.3
Spinach, cooked from fresh, ½ cup 3.2
WATER: Children age 1-3 need 1.3 liters/day (45 US fluid ounces) of water coming
from water itself, the water in milk, and the water contained in food. From the age
6-12 months, babies can be offered water in small cup, from a straw or sippie cup
during meals and throughout the day. By the time baby reaches 1 year, they will
drink a good amount of water.
VITAMINS:
• Thiamine (B1) (mcg) 600.0
• Riboflavin (B2) (mcg) 600.0
• Vitamin B6 (mcg) 600.0
• Vitamin B12 (mcg) 1.2
• Vitamin C (mg) 25.0
• Vitamin A (mcg) 400.0
• Vitamin D (mcg) 5.0
• Vitamin E (mg) 7.0
• Vitamin K (mcg) 55.0
MINERALS:
• Calcium (mg) 800.0
• Folate (mcg) 200.0
• Iron (mg) 10.0
• Magnesium (mg) 130.0
• Niacin (B3) (mg) 8.0
• Phosphorus (mg) 500.0
• Selenium (mcg) 30.0
• Zinc (mg) 5.0
FOOD GROUPS
• Fruits
Fruits are the rich source of micronutrients. Encourage your child to eat a
variety of fresh, canned, frozen or dried fruits rather than fruit juice. If
your child drinks juice, make sure it's 100 percent juice without added
sugars and limit his or her servings.
Keep in mind that one-quarter cup of dried fruit counts as one cup-
equivalent of fruit. When consumed in excess, dried fruits can contribute
extra calories.
• Vegetables. Serve a variety of fresh, canned, frozen or dried vegetables.
Aim to provide a variety of vegetables, including dark green, red and
orange, beans and peas, starchy and others, each week. When selecting
canned or frozen vegetables, look for options lower in sodium.
• Grains. Choose whole grains, such as whole-wheat bread, oatmeal,
popcorn, quinoa, or brown or wild rice. Limit refined grains such as
white bread, pasta and rice.
• Dairy. Encourage your child to eat and drink fat-free or low-fat dairy
products, such as milk, yogurt, cheese or fortified soy beverages.
GENERAL CONSIDERATIONS

• Eating habits form early in the life, Children will adapt to foods
offered to them
• A variety of food should be offered to young children, child
may need to be exposed to a new food at least 10 times before
accepting it
• Division of responsibility for Parents (What, when, and where
food is offered), for child (Whether or not to eat, and how
much)
• Aim to limit your child's calories from added sugar & saturated
and trans fats.
• “Cleaning the plate” may encourage overeating
• Avoid choking hazards (Offer bite-sized pieces of food)
• Limit availability of hot dogs, nuts or seeds, hard candy or
gum, raw vegetables.
PRE SCHOOL CHILDRENS
• Children of the age 3 to 5 years are Pre school children.
GROWTH:
• Child’s body should continue to lose baby fat and gain muscle during
this time, giving her a stronger and more mature appearance. Her arms
and legs will become more slender and her upper body more narrow
and tapered.
• In general, a preschooler’s growth gradually will begin to slow this
year and in the subsequent ones from about a 5-pound (2.3-kg) gain
and about a 3 1⁄2 inch (8.9 cm) increase in height during the third year,
and then decreasing to about 4 1⁄2 pounds or 2 kg, and 2 1⁄2 inches or
6.4 cm during the fifth.

DEVELOPMENT:
• Your child’s face also will mature during these years. The length of her
skull will increase slightly, and the lower jaw will become more
pronounced. At the same time, the upper jaw will widen to make room
for her permanent teeth. As a result, her face actually will become
larger and her features more distinct.
GENERAL NUTRITION HABITS:
"Preschoolers can eat what the rest of the family eats,“

• That's provided family meals feature a variety of healthy foods, in

moderation.
• Depending on his or her age, an active preschooler's energy needs rival
those of some grown women. While there's no need to track a
youngster's calorie consumption, it is important to make calories count.
• A young child's eating plan should consist mostly of healthy foods,
such as lean meats, poultry, seafood, eggs, and legumes; whole grains,
such as whole-wheat bread and cereals; at least two servings of dairy
foods daily; and fresh or lightly processed fruits and vegetables.
• Make Time for Meals
• Regular family meals provide opportunities for good nutrition, and
much more. Dining together encourages proper table manners and
fosters language development and conversational skills.
NUTRITIONAL REQUIREMENTS:
Calories; 1400 kcal/day (M), 1200 kcal/day (F) estimates are based on a sedentary
lifestyle. Increased physical activity will require additional calories: by 0-200 kcal/d if
moderately physically active; and by 200–400 kcal/d if very physically active.
Carbohydrates: 45-65 % kcal
Proteins: 10-30% kcal
Fats: 25-35% kcal
Minerals: (mg)
• Calcium 1000
• Iron 10
• Magnesium 130
• Phosphorus 500
• Potassium 3800
• Zinc 1900
Vitamins: (mg)
• Vit A 400
• Vit D 600
• Vit C 7
• Vit E 25
• Calcium, the body's building block, is needed to develop strong,
healthy bones and teeth. Children may not believe or care that milk
"does a body good," but it is the best source of much-needed calcium.
Still, there's hope for the milk-allergic, lactose-intolerant, or those who
just don't like milk.
• Lactose-free milk, soy milk, tofu, sardines, and calcium-fortified
orange juices, cereals, waffles, and oatmeal are some calcium-filled
options. In some cases, pediatricians may recommend calcium
supplements.
• Fiber is another important focus. Toddlers start to say "no" more and
preschoolers can be especially opinionated about what they eat. The
kids may want to stick to the bland, beige, starchy diet (think chicken
nuggets, fries, macaroni), but this is really the time to encourage fruits,
vegetables, whole grains, and beans, which all provide fiber. Not only
does fiber prevent heart disease and other conditions, but it also helps
aid digestion and prevents constipation, something you and your child
will be thankful for.
 FOOD GROUPS
Grain Group - at least 6 servings each day (10-30%)
• 1 slice of bread
• 4-6 crackers
• ½ cup cooked rice, pasta, or cereal
Fruit & Vegetable Group - at least 5 servings each day
• ½ cup cooked, canned, or chopped raw
• ½ - 1 small fruit/vegetable
• ½ cup juice
Milk Group - at least 3 servings each day
• ¾ cup milk or yogurt
• ¾ ounce of cheese
Meat Group - 2 servings each day
• 1-3 tablespoons lean meat, chicken, fish
• 4-5 tablespoons dry beans and peas
• 1 egg
Oil & Fat Group - 3-4 servings each day
• 1 teaspoon margarine, butter, oils
 GENERAL RECOMMENDATIONS
Good snacks for preschooler?
• Animal crackers, dry cereal, graham crackers, toast, air-popped popcorn
• Raw vegetables cut up in strips
• Fresh fruit cut up for finger food, canned fruit, dried fruit
• Cheese, cottage cheese, string cheese, yogurt, frozen yogurt, milk (plain or flavored), pudding
• Peanut butter, hard-boiled eggs, lean lunch meat slices such as turkey, chicken, or ham, tuna.
Additional tips:
• Set a good example of healthy eating for your child.
• Plan regular meals and snacks and give kids enough time to eat.
• Plan a quiet time before meals and snacks. Kids eat better when they are relaxed.
• Don't use food as a reward.
• Involve your children in making the food.
• Use child-size plates, cups, forks, and spoons.
Encourage a Healthy Weight
Your child is still young, but it's not too early to help him achieve a healthy weight. Respecting a
preschooler's ability to decide how much to eat and when is central to that effort. An American
Journal of Clinical Nutrition study suggests how capable children are of regulating their intake –
and how adults can interfere with that innate ability..
It's normal to become concerned when a child continues to choose the same limited diet. While
you're waiting for your child to snap out of his eating rut, put your mind at ease by offering a
daily multivitamin appropriate for your child's age.
Multivitamins fill in small nutrient gaps in a picky eater's diet, particularly for iron -- a nutrient
that's critical to a child's brain development, immune system and energy level.
 SAMPLE MENU FOR PRE SCHOOLERS:
Breakfast:
Mini mushroom omelettes or breakfast cups
Strawberries and banana slices
Milk
Lunch:
carrot soup
100% whole wheat unsalted crackers or pita bread
Raw vegetables (carrots, celery sticks, red pepper slices) with salad
Milk
Afternoon Snack:
Apple slices with nut butter or cheddar cheese
Dinner:
Mini meatballs
Whole wheat pasta with tomato and vegetable pasta sauce
Milk
Bedtime Snack:
Granola and fruit bites
SCHOOL AGED CHILDREN
 SCHOOL-AGED CHILDREN (ages 6–12 years)
• Not fully grown, each year, gain about 7 pounds and 2.5 inches.
• Compared to toddlers and preschoolers they do not eat as many times per day, tend to
be less hungry (maintain blood glucose longer).
• Can eat more food at each sitting, can impact healthy development through dietary
choices, continue to develop habits based on modeling adult behaviors.
• Children require regular meals and snacks to give them the energy and nutrients they
need to grow and fight off illness.
• Eating family meals together will encourage them to enjoy a variety of foods.
Snacking all day in place of meals, usually results in eating an unbalanced diet.
FOOD GROUPS
Cereals, potatoes, rice and pasta: These are all carbohydrate foods which give
children slow release energy. Try and choose the low sugar varieties of breakfast
cereals such as Weetabix, Shredded Wheat, Ready Brek or Shreddies and add dried
fruit rather than sugar. Choose unrefined higher fibre types of bread and pasta such as
whole meal and granary bread, whole wheat pasta and brown rice. Children should aim
to have a carbohydrate source at each meal time plus sometimes as snacks in between
meals too.
Meat, fish and alternatives: These are all protein foods which are important for
helping children to grow and repair muscles. Try and include a variety of different
protein containing foods such as lean meats, fish, baked beans, eggs, pulses, peas and
lentils. Children should aim to have protein at least twice a day.
Milk and dairy foods: These are all calcium containing foods and are
important in a child’s diet to support bone and teeth development. Children
over 5 years old should be offered either semi skimmed or skimmed milk, and
should aim to have dairy foods three times a day. Soya products which are
calcium enriched are suitable alternatives for those who cannot tolerate or do
not wish to eat dairy products.
Fruit and vegetables:
Fruit and vegetables provide lots of vitamins and minerals which are important
for fighting off illnesses; they also contain fibre which helps to maintain
regular bowel movements and prevent constipation.
Fruit and vegetables can be included as part of a meal, chopped up and as a
snack or as fruit juice or smoothies. Children should aim for at least 5 portions
of fruit and vegetables every day. Fruit and vegetables can also help to keep
our skin supple and prevent spots!
A portion is equal to:
1. medium sized banana, apple, orange, peach
2. small fruits e.g. plums, apricots, satsumas
3. Handful of grapes, cherries, strawberries
4 tablespoons of cooked vegetables or fruit small salads.
 GENERAL NUTRITIONAL REQUIREMENTS
CARBOHYDRATES:
Depending on your age, sex, activity level, and overall health, your carbohydrate
requirements will vary. Accordingly, 45 to 65 percent of your daily calories should
come from carbohydrates. That’s equal to about 225 to 325 grams of carbs if you take
2,000 calories a day.
1.Draw an imaginary vertical line down the middle of your plate. Then draw a
horizontal line across one half, so your plate is divided into three sections.
2.Fill the big section with non-starchy vegetables, such as spinach, carrots, lettuce,
green cabbage, or mushrooms.
3.Fill one of the small sections with starchy vegetables, such as potatoes or winter
squash, or grains, such as whole grain pasta or brown rice. Legumes, such as black
peas or pinto beans, are also great options.
4.Fill the other small section with protein. For example, you might choose low-fat
options, such as skinless chicken or turkey, salmon or catfish, or lean cuts of beef.
5.Add a small serving of fruit or low-fat dairy on the side.
6.Choose foods that contain healthy fats such as olive oil, avocados, seeds, and nuts.
7.Enjoy a low-calorie drink, such as water, unsweetened tea, or coffee.
STARCHY FOODS: Cereals, grains, bread and bread products, Corn, potatoes,
pumpkin, winter squash, green peas, dried beans
FIBROUS FOODS: Fruits, vegetables, whole grains, nuts, seeds, legumes
PROTEINS:
Ten percent to 30 percent of your calorie intake should come from protein,
says the National Academies of Sciences, Engineering and Medicine,:
For younger children, it breaks down by age: Children ages 4 to 9 need 19
grams of protein each day. Those between ages 9 and 13 need 34 grams.
For adolescents, ages 14 to 18, it varies by gender: Boys need 52 grams and
girls need 46 grams.
RISK OF EXCESSIVE PROTEIN:
Instead of helping, adding extra protein from supplements to your child’s diet
can cause long-term health problems, including:

• Weight gain — Excess protein means excess calories. If a child can’t burn the
calories off, the body stores them as fat.

• Organ damage — High protein levels can cause kidney stones and make the
kidneys work harder to filter out waste products. A high-protein diet wears the
kidneys out over time, and contributes to dehydration. Processing protein also
creates nitrogen in the liver. High levels of nitrogen make it harder for the
body to process waste and toxins. High levels of nitrogen also can decrease
the body’s ability to break down nutrients.

• Issues for children with weakened immune systems — Protein supplements

aren’t regulated by the Food and Drug Administration (FDA), Ms. Schnee
says. Many products don’t label all their ingredients, so you don’t know
exactly what your child is consuming. Many protein powders contain
stimulants or substances that can take a toll on your child’s immune system.
 TYPICAL DAY’S MENU
Breakfast:
Breakfast cereal with milk
Glass fruit juice
2 slices toast with spread
Mid-morning snack:
Portion fruit/chopped fruit salad pieces
Lunch:
Wholemeal bread sandwich
Salad
Yogurt
Fruit
Mid-afternoon snack:
Piece of malt loaf or crumpet
Evening meal:
Family meal e.g. spaghetti bolognaise or roast dinner
Sugarfree jelly or low sugar custard and fruit
Bedtime snack:
Plain biscuit and glass of milk or water
 Childhood Food Preferences
 Parents have strong influence over children’s food
preferences, children model after adult behaviors, both
healthy and unhealthy, Including young children in food
shopping, menu planning, and meal preparation can
encourage variety in their food consumption.
 Picky eating and “food jags” are common in young
children
Picky eating (not wanting to try new food), Food jags
(tendency to eat only a small selection of food). Very
common and normal, but also temporary, Can be
identified through a food diary, Long-term jags increase
risk of nutrient deficiency.
Solutions include: offering a variety of food items within
the preferred food type, gradual start of weaning.
CLINICAL INDICATIONS
 Child Obesity
 Body Mass Index (BMI) is the measurement tool used to
determine weight status
 A Condition of a child’s having too much body weight for
his or her height.
 Causes includes: genetics, environment, excess caloric
intake, inadequate exercise, obese parents, prenatal over
nutrition.
 Food sources: Regular soda, candy bars, potato chips Many
of these products are sold within school buildings through
vending machines or the cafeteria Also available in most
convenience stores and shopping centers. Should typically
be replaced through healthy options such as milk, water, or
fresh fruits and vegetables.
 Child Obesity:
 High sugar and high-fat foods are often preferred by
school-aged children. This could lead to an excess
kilocalorie intake.
 These preferences are formed by overexposure to television
advertisements featuring appealing characters or famous
spokes people. Modeling of parent or sibling eating
behavior.
 Low levels of exercise occur in school-aged children due to
increased “screen time” – exposure to a television,
computer, or video games Less access to physical
education in schools Increased use of a car for
transportation.
 Type II diabetes – a disease typically diagnosed in adults
very likely to occur in obese children.
 Child Obesity Prevention
 American Academy of Pediatrics recommendations
 Parents must ensure their children receive adequate
nutrients without excess kilocalories.
 A variety of healthy food must be offered to children
“Screen time” must be limited to two hours or less per day
 Weight maintenance allows for healthy growth.
 Increased physical activity should be encouraged.
 Be physically active every day
 Choose healthier foods from each group
 Eat foods from every food group every day
 Dental Hygiene
 Streptococcus mutans is responsible for dental caries.
 42% of children and adolescents (6–19 years) have at least
one cavity or filling.
 School-aged children are susceptible to dental caries, but
sometimes do not practice good oral hygiene.
 American Dental Association recommends
 Regular brushing and flossing
 Consuming a balanced diet in accordance with the
Dietary Guidelines for Americans
 Limiting consumption of high-sugar foods such as soda,
fruit juice, or milk
Food Allergies
 Development of food allergies is a concern during the toddler years.
This remains an issue for school-aged children.
 An allergy occurs when a protein in food triggers an immune
response, which results in the release of antibodies, histamine, and
other defenders that attack foreign bodies.
 Possible symptoms include itchy skin, hives, abdominal pain,
vomiting, diarrhea, and nausea.
 Some of the most common allergenic foods include peanuts, milk,
eggs, soy, wheat, and shellfish.
 Anaphylaxis is a life-threatening reaction that results in difficulty
breathing, swelling in the mouth and throat, decreased blood
pressure, shock, or even death. Milk, eggs, wheat, soybeans, fish,
shellfish, peanuts, and tree nuts are the most likely to trigger this type
of response. A dose of the drug epinephrine is often administered via
a “pen” to treat a person who goes into anaphylactic shock.
Food Intolerance
 Children experience a food intolerance, which does not
involve an immune response. A food intolerance is marked
by unpleasant symptoms that occur after consuming certain
foods.
Lactose intolerance is one example. Children who suffer
from this condition experience an adverse reaction to the
lactose in milk products. It is a result of the small
intestine’s inability to produce enough of the enzyme
lactase for the digestion of lactose sugar.
 Lactose intolerance usually affect the GI tract may leads to
bloating, abdominal pain, gas, nausea, and diarrhea.
 An intolerance is best managed by making dietary changes
and avoiding any foods that trigger the reaction by the use
of lactose free milk, fermented milk products etc.
Food Toxicity
 Lead toxicity, or lead poisoning is also prevalent in school-aged
children. Lead is found in plumbing in old homes, in lead-based
paint, and occasionally in soil. Contaminated food and water can
increase exposure and results in hazardous lead levels in the blood.
 Children under age six are especially vulnerable. They may consume
items tainted with lead, such as chipped, lead-based paint. Another
common exposure is lead dust in carpets, with the dust flaking off of
paint on walls. When children play or roll around on carpets coated
with lead, they are in jeopardy. Lead is indestructible, and once it has
been ingested it is difficult for the human body to alter or remove it.
 Lead toxicity can damage the brain and central nervous system,
resulting in impaired thinking, reasoning, and perception
 Treatment for lead poisoning includes removing the child from the
source of contamination and extracting lead from the body through
ethylene diamine tetraacetic acid if it exceeds 45 mcg/dL of blood
stream.
HEALTHY LIFESTYLE TIPS:
• Start the day with a healthy breakfast. It refuels the body and provides
energy for the day. Let kids help plan and prepare 1 meal each week.
• Eat together as a family as often as possible.
• Take time eating, and chew slowly. It takes 20 minutes for the brain to tell
the body that you are full.
• Eat more vegetables and fresh fruits. Aim for a total of 2 cups of fruit and 2
1/2 cups of vegetables each day.
• Eat more whole grains. Examples include oats, brown rice, rye, and whole-
wheat pasta. Try to eat at least 3 ounces of whole grains each day.
• Drink plenty of fluids. Choose water, low-fat or nonfat milk, and low-
calorie beverages.
• School-aged children are susceptible to dental caries, but sometimes do not
practice good oral hygiene. 42% of children and adolescents (6–19 years)
have at least one cavity or fillings. American Dental Association
recommends:
• Regular brushing and flossing
• Consuming a balanced diet
•Limiting consumption of high-sugar foods such as soda, fruit juice, or milk
 CHILDHOOD GROWTH ASSESSMENTS

 Growth chart is used by pediatrics and other health care

providers to follow a child’s growth over time.
 Growth charts have constructed by observing the growth of
large number of normal children over time.
 The height, the weight and head circumference of a child can
be compared to the expected parameters of children of the
same age and sex to determine whether the child is growing
appropriately.
 Growth charts are also used to predict expected adult height
and weight of a child.
 A decrease in growth velocity may such as inflammatory
bowel disease.
 Growth chart for boys and girls are different
 1 foot is equal to 30.5 cms
 1 Kg is equal to 2.2 pounds.
 BOY AGE LENGHT WEIGHT HEAD
CIRCUMFER
ENCE

1 MONTH 54.6 cm 4.5 kg 37 cm

2 MONTH 58.2 cm 5.6 kg 39 cm

Length and
weight
4 MONTH 64 cm 7 kg 41 cm
according to
age for
6 MONTH 68 cm 8 kg 43 cm
boys
9 MONTH 72 cm 9 kg 45 cm By WHO

1 YEAR 76 cm 9.6 kg 46 cm
 GIRL AGE LENGHT WEIGHT HEAD
CIRCUMFERENCE

1 MONTH 54 cm 4.2 kg 37 cm

2 MONTH 57 cm 5.1 kg 38 cm

Length and
4 MONTH 62 cm 6.3 kg 40 cm
weight
according to
6 MONTH 65.5 cm 7.3 kg 42 cm
age for
girls
9 MONTH 70 cm 8.2 kg 44 cm
By WHO
1 YEAR 74 cm 9 kg 45 cm
Nutritional Interventions Programs
Breakfast program
 Eating breakfast may be associated with healthy body weight among
children and adolescents
 Many schools with the National School Lunch Program also offer a
school breakfast
 Eating breakfast may benefit cognitive function including memory,
academic performance, school attendance, psychosocial function,
mood.
National School Lunch Program (NSLP)
 Serves nutritious, low-cost or free lunches to 30.5 million school-
aged children each day
 NSLP nutrient guidelines have specific recommendations
establishing regarding minimum and maximum intakes.
 Quick Review
 Toddlers grow at a slower rate than infants, and have smaller appetites
 Frequent, small meals may be needed to provide adequate kilocalories,
macronutrients, calcium, iron, and vitamin D.
 Appropriate beverages include water, milk, and 100% fruit juice.
 Small portion sizes should be encouraged, while “cleaning the plate” should
be discouraged.
 A variety of foods should be offered, and parents should serve as role models
for healthy eating.
 “Food jags” are normal and usually temporary.
 Rates of overweight and obesity are increasing among school-aged children
 Risk of type 2 diabetes increases in obese individuals
 Limiting excess kilocalorie intake from high-sugar or high-fat foods can help
prevent obesity
 Engaging in physical activity and reducing “screen time” is necessary to
maintain a healthy body weight
 My Pyramid for Kids provides information about healthy eating patterns
 Schools may provide nutritious breakfast and lunch meals
 Parents must continue to serve as role models for healthy behavior.