children

Child and Preadolescent Nutrition

Photo credit: Patricia Prudente

Photo credit: Patricia Prudente

The growth and developmental stage of children ages 5-10 years can be described as middle childhood, or school age. Preadolescence is the developmental and growth stage of children ages 9-11 for girls and ages 10-12 for boys.(1)

 

Nutrition plays an important role in helping to ensure children reach their full potential for growth, development and overall health.(1) Nutrition related problems that can occur during this stage include under-nutrition, and weight issues on both sides of the spectrum. The prevalence of childhood obesity is on the rise, and the beginnings of disordered eating can be present in children at this stage.(1,2,3) Adequate nutrition and establishing healthy eating behaviors are important factors for preventing immediate health problems, and for promoting a healthy lifestyle to avoid chronic disease in the future. Something as simple as eating breakfast daily has been linked to improved performance in school.(4)

 

During middle childhood, there is an increase in muscle strength, stamina, and motor coordination allowing children to participate in dance, sports, and other physical activities.(1)

 

Percent body fat reaches a minimum of 16% in females and 13% in males during this stage.(1) This percent will increase in preparation for the adolescent growth spurt, which typically occurs around age 6. This increase is known as BMI rebound.(5) The increase in body fat that occurs with puberty happens earlier in females than males. In females the increase in body fat is about 19%, and in males it is about 14%.(1) This increase may cause concern, especially in girls, that they are becoming overweight. Be aware that this increase is a normal part of growth and development.(1) It is important to reassure your child that these changes are normal. Take care not to reinforce a preoccupation with size and weight, which can lead to disordered eating behaviors and eating disorders.

 

Cognitively, children in this stage develop a sense of self, and self-efficacy, which is the knowledge of what to do and the ability to do it. They can focus on several parts of a situation at the same time, have cause and effect reasoning, and can classify, reclassify and generalize.(1,6) They also are able to see others’ points of view (they are no longer egocentric as they are during the toddler and preschooler years). Children become more independent and learn their roles within their families, at school, and in their communities. More time is spent with friends, at others’ homes, watching television, on the computer, and using other methods of technology. External influences from the environment begin to play increasingly important roles in all aspects of the child’s life.(1)

 

During childhood, the use of eating utensils is mastered. Involvement in simple food preparation and the assignment of chores related to mealtime (like setting the table) can be important for helping your child develop healthy behaviors around food and nutrition. Children of this age are strongly influenced by the eating behaviors of their parents and older siblings, who can help shape the child’s attitudes towards food and food choices, as well as their food likes and dislikes.(7) Parents are responsible for creating the food environment in the home, the availability of a variety of foods for the child to select from, determining when the child is served, and providing guidance so the child can make healthy food choices when away from home. The child is responsible for how much food she eats.(1,7)

 

Eating meals with the family together is encouraged, as is allowing time for pleasant conversation. Avoiding reprimanding and arguments during mealtime is recommended. There are associations between families eating dinner together and the overall quality of the child’s diet, where children that eat dinner with their families have better dietary intakes of fruit, vegetables, fiber, calcium, folate, iron, B vitamins, and vitamins C and E.(1) Family dinners together can become more challenging as the child gets older and has extracurricular activities to take part in.

 

Because children at this stage spend more time outside of the home, peer influence, and influence of teachers, coaches and others increases and extends to attitudes toward food and food choices.(8) The media also plays an increasingly larger role in shaping your child’s attitudes towards food and food choices.(9)

 

Snacking helps children meet their nutritional needs because they are not able to consume large amounts of food in one sitting at this stage.(1) Giving them access to a variety of foods, nutrition education for helping them make their own food choices, and knowledge of some basic food preparation techniques can allow them to begin to prepare their own breakfasts and snacks.(1)

 

Children have the innate ability to internally control their energy (calories from food) intake, and these internal cues can be altered by external influences, which increase during this stage of childhood development.(1,10) Children of parents who control their child’s eating have a lesser ability to innately respond to their own energy needs, meaning these children lose the ability to respond appropriately to their innate nutritional needs, and their internal controls of hunger and satiety.(1,10) 

 

Parents who experienced difficulty controlling their own intakes may impose more restrictions on their children, and this transfer of unhealthy eating behavior may influence children as early as preschool age.(1,10)  If mom is on a diet, her daughter is likely to follow suit. The preadolescent increase in body fat, especially in young girls, is often seen as the beginning of a weight problem, rather than normal growth and development.

 

Imposing controls and restrictions over dietary intake can actually promote increased intake of ‘forbidden’ or ‘restricted’ foods, and may be a risk factor for developing obesity in the future.(1,10)  Dieting, dietary restrictions and controlling child feedings ignore internal cues of hunger and satiety, and can contribute to the onset of obesity, and the beginning of eating disorders.(1,10 )

 

There is a slow and steady growth rate during this developmental stage, energy needs reflect this, and are based on the individual child’s activity level and body size.(1)

 

Predictors of childhood obesity include having parents that are obese (in particular the mother(11), lower socioeconomic status, early BMI rebound (the normal increase in BMI that happens after BMI decreases to its lowest point, around 6 years of age), and more than 2 hours of screen time (television, computers, etc.) per day.(1,12) With the increased prevalence of overweight and obesity in children comes an increased risk for cardiovascular disease, insulin resistance, metabolic syndrome and type 2 diabetes, chronic conditions that used to be associated only with adults.(1,13)

 

Regular physical activity is important.(13,14) Set a good example for your child by being physically active and joining her in physical play activities. Encourage your children to participate in physical activities at home, at school and with friends, and limit their screen time to less than 2 hours per day.(1) Generally girls are less active than boys, and physical activity decreases with age. Seasons, climates and weather affect a child’s outdoor activity levels, and physical education in schools has decreased.(1)

 

Children are children first. This means that even if your child has special health care needs that change their nutrition, medical and social needs, they can still be expected to become more independent in making food choices, assisting with meal preparation, and participating in mealtime with other family members. Modifications can be made to help your child be successful. Children do not benefit from being treated in a ‘special’ manner when it comes to mealtime, and providing consistency and structure to support a child’s development is important. This structure can include regular meal and snack times, and an increasing responsibility in assisting with food preparation in the home. Energy and nutrient requirements may be higher, lower, or the same for children with special health needs compared to those without such needs, depending on the child’s condition.(1)

  

Need assistance or have questions? Contact me today!

 

References:

  1. Brown J. Nutrition through the Life cycle 4th ed. Belmont, CA: Wadsworth; 2011.

  2. Centers for Disease Control and Prevention. Healthy Schools. Childhood Obesity Facts. Updated January 25, 2017. Available from: https://www.cdc.gov/healthyschools/obesity/facts.htm. Accessed January 4, 2018.

  3. National Eating Disorders Association. Parent Toolkit. Available from: https://www.nationaleatingdisorders.org/sites/default/files/Toolkits/ParentToolkit.pdf. Accessed January 4, 2018.

  4. Adolphus K, Lawton CL, Dye L. The effects of breakfast on behavior and academic performance in children and adolescents. Frontiers in Human Neuroscience. 2013;7:425. doi:10.3389/fnhum.2013.00425.

  5. Dietz WH. Critical periods in childhood for the development of obesity. Am J Clin Nutr. 1994;59(5):955-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/8172099.

  6. Cincinnati Children’s. Cognitive Development. Updated April 2017. Available from: https://www.cincinnatichildrens.org/health/c/cognitive. Accessed January 4, 2018.

  7. Birch L, Savage JS, Ventura A. Influences on the Development of Children’s Eating Behaviours: From Infancy to Adolescence. Canadian journal of dietetic practice and research : a publication of Dietitians of Canada = Revue canadienne de la pratique et de la recherche en dietetique : une publication des Dietetistes du Canada. 2007;68(1):s1-s56.

  8. Salvy SJ, Elmo A, Nitecki LA, Kluczynski MA, Roemmich JN. Influence of parents and friends on children’s and adolescents’ food intake and food selection. Am J Clin Nutr. 2011;93(1):87-92. Available from: http://ajcn.nutrition.org/content/93/1/87.full.

  9. Harris JL, Bargh JA. The Relationship between Television Viewing and Unhealthy Eating: Implications for Children and Media Interventions. Health communication. 2009;24(7):660-673. doi:10.1080/10410230903242267.

  10. Scaglioni S, Arriza C, Vecchi F, Tedeschi S. Determinants of children’s eating behavior. American Society for Nutrition. 2011;94(6):Suppl 2006S-2011S. doi: 10.3945/jcn.110.001685.

  11. Rooney BL, Mathiason MA, Schauberger CW. Predictors of obesity in childhood, adolescence, and adulthood in a birth cohort. Matern Child Health J. 2011;15(8):1166-75. doi: 10.1007/s10995-010-0689-1.

  12. Gable S,  Lutz S. Household, Parent, and Child Contributions to Childhood Obesity. Family Relations. 2000;49: 293–300. doi:10.1111/j.1741-3729.2000.00293.x.

  13. Hills, A.P., King, N.A. & Armstrong, T.P. The Contribution of Physical Activity and Sedentary Behaviours to the Growth and Development of Children and Adolescents. Sports Med. 2007;37:533. doi.org/10.2165/00007256-200737060-00006.

  14. Harsha DW. The benefits of physical activity in childhood. Am J Med Sci. 1995;310(Suppl 1):S109-13. Available from: https://www.ncbi.nlm.nih.gov/pubmed/7503112.

Preschooler Nutrition

Photo credit: Kazuend

Photo credit: Kazuend

Preschool aged children are between 3-5 years old and during this developmental stage there is increased autonomy, broader engagement in social circumstances (attending preschool, playing with friends, and staying with friends or relatives), increased language skills, and a better ability to control behavior.(1)

 

For preschoolers to reach their full growth and developmental potential, adequate intake of energy (calories from food) and nutrients is important. Nutritional deficiency, or under-nutrition, during this time can hinder cognitive development. Providing adequate nutrition in a supportive environment can prevent long-term effects of under-nutrition, like failure to thrive and cognitive impairment.(1)

 

Children of this age continue to refine their gross and fine motor skills. A sense of egocentrism begins where the child may not be able to accept the views of others. They begin to learn to limit behaviors internally rather than relying on demands of parents and caregivers to do so. Control becomes a central theme. Preschool aged children will test their parents’ limits, and may resort to temper tantrums to get their way. Tantrums tend to peak around age 2-4 years. The child wants to become independent, and parents must balance this desire by setting appropriate limits while also letting go (a parallel to adolescence).(1)

 

At this age, children can use a cup, fork and spoon. Using a knife to cut foods may need refinement. Children should be seated at the table for all meals and snacks. Eating may not be as messy as it was during the toddler years, however spills are normal and will occur. Choking may still be a risk, so cutting grapes and meat into smaller bites for example is advised. Adult supervision at mealtime is also important.(1)

 

The child’s rate of growth at this stage remains slow as it is during toddler years, therefore appetite may be small. Growth occurs in spurts and there will be an increase in appetite and food intake before a growth spurt, causing children to gain weight that will be used for the soon to occur growth in height. Thus, the appetite of children at this age can be variable.(1)

 

This is a good age to involve children in food selection and preparation, in that they want to be helpful and please their parents. Taking them to the supermarket, and better yet a farmer’s market, to have them ‘help’ with food selection can provide an opportunity to introduce your child to a variety of fruits and vegetables. Children also can help prepare foods for meals. For example tearing lettuce, rinsing fruit and vegetables, squeezing citrus fruits, stirring batter, peeling eggs, bananas and oranges, or even measuring liquids as they are able are ways they can become involved in meal preparation.(1)

 

A very important cornerstone of nutrition is that young children have the ability to self-regulate food intake. If they are allowed to decide when to eat and when to stop eating without external interference, they will eat as much as they need. Children also have an innate ability to adjust their caloric intake to meet their energy needs.(2) Intake may fluctuate day to day, however it will remain relatively stable over the course of a week. Interfering with a child’s self-regulation of eating by asking them to clean their plate or by using food as a reward is asking the child to over or under eat. While they can self regulate caloric intake, they do need to be guided to select and eat foods that are part of a well balanced diet. This is a time when their food habits and preferences are established. Modeling healthy eating behaviors, and providing your child with healthy foods to select from is important for helping her learn to enjoy a variety of foods that are rich in nutrients to promote overall health and development. Keep in mind that children and their eating behaviors can be influenced by other children and adults, siblings and family members, and by the media.(1,3)

 

Preschool aged children may be described as picky eaters.(4) This can be because eating familiar foods is comforting, or your child may be trying to exert control over this part of her life.  To avoid having the dinning table become a battleground, serve child sized portions in an attractive way. Young children may not like their foods to touch on the plate, or to be mixed together like in salads or casseroles, and they may not enjoy strong tastes (sour or bitter) or spicy foods. It is important not to allow snacking or grazing indiscriminately between meals because this can blunt appetite at mealtime. Children should not be forced to stay at the table until they have eaten a certain amount of food determined by the parent.(1)

 

Children naturally prefer sweet and slightly salty tastes.(1,5)  Children eat foods familiar to them, and this emphasizes the importance of environment in their food choices. Familiarize them with healthy and varied food choices and they will learn to gravitate towards them. With repeated exposure, children will learn to like new foods that are unfamiliar to them. It can take 10-20 or more tries of a new food before a child will take to it. Be patient and persistent, and remember that modeling the behavior you want your child to learn plays an important role in the process. If you eat a variety of foods, you child is more likely to do so as well.(1)

 

Children tend to prefer foods that are energy dense and therefore those higher in sugar and fat.(3) This may be because they have pleasant feelings from eating these foods, such as satiety, or because these foods are associated with special occasions like birthday parties. Keep in mind that foods served on a limited basis or used as rewards become more desirable.  Restricting access to certain foods may increase the desire for them and lead to disordered eating behaviors, and obesity later in life. Remember that children can innately regulate their food and caloric intake, and studies have shown that allowing children this flexibility results in healthier eating behaviors long-term.(1,2)

PRACTICAL APPLICATIONS OF CHILD FEEDING RESEARCH FOR TODDLERS AND PRESCHOOLERS(1)

 

  • Respond appropriately to the child’s hunger and satiety cues

  • Focus on long-term goals of developing healthy self-controls of eating

  • Look beyond concerns regarding the composition and quantity of foods consumed or fears that your child may eat too much and become overweight

  • Trying to control food intake by attaching punishment or reward to eating is not recommended

  • Severely restrict treats is not recommended because this may make such foods even more desirable

  • Model positive eating behaviors, like eating a variety of fruits and vegetables, and help your child develop preferences for a wide variety of foods consistent with a healthy diet and lifestyle

  • It may take repeated exposure to a new food before your child takes to it, this is normal, be patient and persistent

  • Serving appropriate portion sizes is important, and it’s better to keep them smaller and have your child ask for more if she wants it

  • Mealtimes should take place in a positive, secure and happy environment with the family, and with adult supervision

  • Children should not be forced to eat

  • If your child has low interest in eating, long mealtimes (more than 30 minutes), prefers liquids over solids, refuses foods, or needs to be offered foods as if she is younger than her chronological age, feeding problems may be indicated and further evaluation can be helpful

 

Need assistance or have questions? Contact me today!

 

References:

  1. Brown J. Nutrition through the Life cycle 4th ed. Belmont, CA: Wadsworth; 2011.

  2. Fox MK, Devaney B, Reidy K, Razafindrakoto C, Ziegler P. Relationship between portion size and energy intake among infants and toddlers: evidence of self-regulation. J Am Diet Assoc. 2006;106(1 Suppl 1):S77-83. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16376632.

  3. McNally J, Hugh‐Jones S, Caton S, Vereijken C, Weenen H, Hetherington M. Communicating hunger and satiation in the first 2 years of life: a systematic review. Maternal & Child Nutrition. 2016;12(2):205-228. doi:10.1111/mcn.12230.

  4. van der Horst K, Reidy K. Picky eating: Associations with child eating characteristics and food intake. Appetite. 2016;103(1):286-293. doi.org/10.1016/j.appet.2016.04.027.

  5. Mennella JA, Bobowski NK, Reed DR. The Development of Sweet Taste: From Biology to Hedonics. Reviews in endocrine & metabolic disorders. 2016;17(2):171-178. doi:10.1007/s11154-016-9360-5.


Tips for Picky Eaters

Photo credit: Jennifer Brand

Photo credit: Jennifer Brand

Is your child a picky eater?

Did you know it can take multiple introductions of a single food before a taste is developed for it?

It can take 10, 20, 100, or even more tries of a food before it’s accepted. Don’t give up on adding healthy foods just because it didn’t work the first, second, or tenth time.

Baby develops his taste patterns by 9 months old, so you’ve only got a few month to prevent picky eating habits! First solid food introductions (around 6 months old) don’t need to be baby cereals. Think puréed vegetables, fruit and finely chopped meats for protein (well-cooked too, to avoid a choking hazard). Mashed ripe banana, avocado and sweet potato are all nutritious options.

Now I’ll explain this picture. This is my dad. He’s a picky eater. He always has been. When he was a child, if he didn’t like something, my grandma never had him try it again.

I think I finally rubbed off on him. He’s recently eaten kale chips, and Brussels sprouts, and admitted they weren’t horrible!

We went out to dinner, and guess what?! Here’s dad, eating a BBQ chicken sandwich! If you know my dad, you know this is huge (he once told me ketchup is spicy)! He really enjoyed the sandwich. If I can get my dad to eat new foods, I know you can get your child to!

Why is overcoming picky eating important?

Your body runs off of nutrients from foods you eat, when nutrients are missing imbalances develop and symptoms and health problems follow.

Healthy skin for example requires a wide range of nutrients from all food groups and categories of foods. One of the first things I explore with children who have eczema is making sure their diet is rich in these nutrients. We often have to dig deeper to find the root cause, but we always look at nutrition first and this may surprise you, but it’s not about taking more foods out. In fact adding foods back in can help significantly.

Tips for Picky Eaters

 

  1. Remember you are in charge! YOU decide what your little one needs to eat. It’s up to you to make sure his diet contains all the nutrients he needs to grow, develop, repair, function and thrive.

  2. Keep offering the food to your picky eater. He doesn’t have to eat it. Simply exposing your him to it is an important part of the process. It is ok for him to pick up the food, play with it and feel it. This helps him get used to it.

  3. Offer soft foods cut up in small pieces, and cut them smaller than you think may be necessary, avoiding anything that might be a choking hazard.

  4. Give your child a spoon and let him feed himself. Giving him control of the situation may encourage him to eat a few bites.

  5. Wait to offer a new food until your picky eater is truly hungry. If he’s just eaten or snacked, there won’t be much motivation to try something new.

  6. Prepare meals with your picky eater as your co-chef! Give him a few bites of a new food while you are preparing it so he can get familiar with it.

  7. Take your picky eater to a store that gives out samples like Whole Foods or Costco, and you might be surprised at what he’ll try!

  8. Children are very impressionable and are great imitators. They will be more likely to want what you are eating, and to avoid foods you show disgust or lack of interest in when trying.

  9. If you give them healthy foods, they will eat, and learn to enjoy them.

  10. Having separate menus for different family members encourages habits we don’t want, and it’s too much unnecessary work! If your child has celiac disease and can’t eat gluten, to support him the whole family also should follow the same plan (there are lots of naturally gluten free grain options to choose from that aren’t processed gluten free products).

  11. Some children are sensitive to the taste, smell, or texture of different foods. Experiment with different tastes, smells, and textures and if you think your picky eater may have a sensitivity, talking to a professional can help to rule out medical issues that make it hard to swallow or digest certain foods.

What to avoid

  1. Forcing your picky eater to eat, this may make the behavior worse, and leads to an unhealthy relationship with food.

  2. Nagging your picky eater, trying to make a deal with him to have just a bite or two, or that he can have dessert if he eats his vegetables teaches him that there is a reward attached to everything (and this certainly isn’t the case in life). 

Be patient, be persistent, take small steps in the right direction, and you can get your picky eater to come around.

 References

https://parenting.stackexchange.com/questions/7235/how-to-get-a-toddler-to-start-chewing-and-eating-solids

Brown J. Nutrition through the Life cycle 4th ed. Belmont, CA: Wadsworth; 2011.

https://academic.oup.com/ajcn/article/94/suppl_6/2006S/4598037

https://www.sciencedirect.com/science/article/pii/S0195666314001573

https://onlinelibrary.wiley.com/doi/abs/10.1111/apa.12078