Nutrition during childhood

While peer pressure and TV commercials for junk food can make getting children to eat well seem impossible, there are steps parents can take to instill healthy eating habits without turning mealtimes into a battle zone.

Children who are ill usually have a decreased appetite and limited food intake. Acute viral or bacterial illnesses are often short-lived but may require an increase in fluids, protein or other nutrients.

Because children are growing and developing bones, teeth, muscles, and blood, they need more nutritious food in proportion to their size than do adults. They may be at risk for malnutrition when they have a poor appetite for a long period, eat a limit number of foods, or dilute their diets significantly with nutrient-poor foods.

As the growth rate slows after the first year of life, appetite decreases, which often concerns parents. Children have less interest in food and an increased interest in the world around them. They can develop food jags or periods when foods that were previously liked are refused, or they can request a particular food at every meal. This behavior may be attributable to boredom with the usual foods or may be a means of asserting newly discovered independence.

Parents may have concerns about the adequacy of their child’s diet and be frustrated with their child’s seemingly irrational food behavior. No child can be forced to eat. Parents still retain control over what foods are offered, and they have the opportunity to set limits on inappropriate behaviors. Parents should continue to offer a variety of foods, including the child’s favorite ones, and not make substitutions a routine.

With smaller stomach capacity and variable appetites, preschool children eat best with small servings of food offered four to six times a day. Snacks are as important as meals in contributing to the total daily nutrient intake. Carefully chosen snacks are dense in nutrients and least likely to promote dental caries. Wholesome snacks enjoyed by many young children include fresh fruit, cheese, raw vegetable sticks, milk, fruit juices, wholegrain crackers, dry cereal, and peanut butter sandwiches. Fruit juices, especially apple juice and juice drinks, are an increasingly common beverage for young children, at home and in groups, they frequently replace water and milk in children’s diets. In addition to altering the diet’s nutrient content, excessive intake for fruit juice can result in carbohydrate malabsorption and chronic, nonspecific diarrhea. Excess juice intake by young preschool children may replace the consumption of higher-energy foods and decrease a child’s appetite, resulting in decreased food intake and poor growth. Toddlers should get up to 6 oz fruit juice per day, children and adolescents 6 to 12 oz fruit juice per day. Keep plenty of fruits, vegetables, whole grain snacks, and healthy beverages (water, milk, pure fruit juice) around and easily accessible so kids become used to reaching for healthy snacks instead of empty calorie snacks like soda, chips, or cookies.

Children tend to avoid food with extreme temperatures, and some foods are rejected because of odor rather than taste. Many children will not accept foods that touch each other on the plate, and mixed dishes or casseroles with unidentifiable foods are not popular. Brocken crackers may go uneaten or a sandwich may be refused because it is cut the wrong way.

Young children do not eat well if they are tired. A quiet activity or rest immediately before eating is conducive to a relaxed, enjoyable meal.

The energy needs of healthy children are determined on the basis of basal metabolism, rate of growth, and energy expenditure. Depending on age, size, and activity level, your toddler needs between 1,000-1,400 calories a day. It is perfectly normal for your child to be ravenous one day and shun food the next. Don’t worry if your child’s diet isn’t up to par every day—as long as he or she seems satisfied and is getting a well-rounded diet. Dietary energy must be sufficient to ensure growth and spare protein from being used for energy but not allow excess weight gain. Suggested intake proportions of energy are 45%-65% as carbohydrates, 30%-40% as fat and 5%-20% as protein for 1 to 3 year olds, with carbohydrates the same for 4 to 18 year olds, 25%-35% as fat and 10%-30% as protein.

The need for protein decreases from 1.1 g/kg in early childhood to 0.95 g/kg in late childhood. Children who are most at risk for inadequate protein intake are those on strict vegan diets, with multiple food allergies, or who have limited food selections because of fad diets, behavioral problems, or inadequate access to food.

Children between 1 and 3 years of age are at high risk for iron deficiency anemia. Iron deficiency is one of the most common nutrient disorders of childhood. The rapid growth period of infancy is marked by an increase in hemoglobin and total iron mass. Children with prolonged bottle feeding are at highest risk for iron deficiency. The diet may not be rich in iron-containing foods. Recommended intakes must factor in the absorption rate and quantity of iron in foods, especially those of plant origin. Infants with iron deficiency, tend to score lower on standardized tests of mental development and pay less attention to relevant information needed for problem solving. Many young preschool children do not like meat. Parents should increase the amount of ascorbic acid and meat, fish in their children’s diet.

Calcium is needed for adequate mineralization and maintenance of growing bone in children. Calcium needs are 500 mg/day for 1-3 years old, 800 mg/day for 4-8 years old, 1300 mg/day for those ages 9 to 18 years. Actual need depends on individual absorption rates and dietary factors such as quantities of protein, vitamin D and phosphorus. Because calcium intake has very little influence on the degree of urinary calcium excretion during periods of rapid growth, children need two to four times more calcium per kilogram than adults. Since milk and other dairy products are primary sources of calcium, children who consume limited amounts of these foods are at risk for poor bone mineralization. Until the age of two they should drink whole milk, but older toddlers can usually switch to 2% or skim milk if approved by your pediatrician. If your kids are lactose intolerant or don’t like dairy, incorporate calcium-rich foods like fortified soy products, cereals, and orange juice.

Zinc is essential for growth. A deficiency results in growth failure, poor appetite, decreased taste acuity, and poor wound healing. The best sources of zinc are meats and seafood.

Vitamin D is needed for calcium absorption and deposition of calcium in the bones. Rickets is the bone disease resulting from too little vitamin D. This nutrient is also formed from sunlight exposure on the skin. Vitamin D fortified milk is the primary source of this nutrient. Many breakfast cereals and nondairy milks are fortified with vitamin D.

For toddlers and preschool children the family is the primary influence in the development of food habits. Food attitudes of parents can be strong predictors of food likes and dislikes and diet complexity in children of primary-school age. Contrary to common belief, young children do not have the innate ability to choose a balanced, nutritious diet. They can choose one only when presented with nutritious foods. The parents and other adults provide safe, nutritious, developmentally appropriate food as regular meals and snacks, and the children decide how much, if any, they eat.

One of the biggest challenges for parents is to limit the amount of sugar and salt in their children’s diets.

By encouraging healthy eating habits now, you can make a huge impact on your children’s lifelong relationship with food and give them the best opportunity to grow into healthy, confident adults.

Add physical activity to your child’s day, just as you would add fruit or veggies. To encourage physical activity, play with your kids - throw around a football; go cycling, skating, or swimming, take family walks and hikes, and help your kids find activities they enjoy by showing them different possibilities. The benefits of lifelong exercise are abundant and regular exercise can even help motivate your kids to make healthy food choices.