nutrition

Adolescent Nutrition

Photo credit: A L L E F . V I N I C I U S Δ

Photo credit: A L L E F . V I N I C I U S Δ

Adolescence is the period of life from 11 to 21 years of age. There is profound biological, emotional, social and cognitive development as a child grows into adulthood. During this important stage of development physical, emotional and cognitive maturity is reached, and there is development of personal identity and a value system that is unique and separate from parents and other family members.

 

This can be a challenging time for an adolescent as she struggles for personal independence, yet recognizes the need for economic and emotional family support. Adolescents are also adjusting to their new bodies that have changed in shape, size, and function.(1) Keep these challenges in mind when viewing the adolescent as being difficult or irrational. Your adolescent is dealing with a lot!

 

Because of the dramatic physical growth and development during this stage, there is an increased need for energy (calories from food), protein, vitamins and minerals.(1) Unfortunately at this stage the struggle for independence often leads to health compromising eating behaviors like excessive dieting/caloric restriction and following fad diets, skipping meals, and using unconventional dietary supplements that may cause more harm than good.(2) With guidance, your adolescent can channel their struggle for independence into healthy behaviors like eating a healthy diet, participating in physical activities, and living a healthy lifestyle overall.(1)

 

During early adolescence, puberty occurs. Sexual maturation, increased height and weight, accumulation of skeletal mass and changes in body composition are observed. The age of onset, duration and tempo of these events varies greatly within and between individuals. Because of these differences, nutritional intake and needs should be based on biological growth and development rather than on chronological age. “Tanner Stages” (sexual maturation rating or SMR) is used by health professionals to assess pubertal maturation, regardless of chronological age.(1,3) SMR is based on the development of breasts and pubic hair in females, and on testicular, penile and pubic hair development in males.(1,3) Table 1 demonstrates the Tanner Stages of development in females and males.(4)

 

In females, the first signs of puberty include the development of breast buds and sparse, fine pubic hair around age 8 to 13 years. Menarche occurs 2 to 4 years after the first signs of puberty, and is typically around SMR stage 4.  The average age of menarche is about 12.4 years, but it can occur as early as 9 to 10 years of age, or as late as 17 years of age. Girls that are highly competitive athletes (female athlete triad)5, and those who severely restrict caloric intake to limit body fat may detrimentally delay menarche. In girls, 15 to 25% of final adult height will be gained during puberty, and linear growth spurts cease on average by age 16 years in most females. Some females will have small increases in height until about 19 years of age. Caloric restriction can slow or delay linear growth.(1,6)

 

The first signs of puberty in boys are enlargement of the testes and change in coloring of the scrotum. This occurs typically between the ages of 10.5 to 14.5 years (11.6 years of age is the average). Development of pubic hair is common during SMR stage 2. The average age of spermarche is about 14 years of age in males. Linear growth peaks in velocity in males during SMR stage 4, either coinciding with or following testicular development and the appearance of faint facial hair. On average, peak velocity of linear growth occurs at 14.4 years of age. Linear growth continues throughout adolescence and ceases at about age 21 years in males.(1,6)

 

Up to 50% of ideal adult body weight is gained during adolescence in both females and males. Body composition changes dramatically in females during puberty.  Lean body mass percent decreases, and body fat percent increases. During puberty females can experience a 120% increase in body fat.(7) In order for menarche to occur, 17% body fat is necessary, and then body fat must be at 25% for the development and maintenance of a regular ovulatory cycle.(8) While this gain in body fat in females is normal and required for normal physiologic function, it is often viewed as negative, leading to compromising health behaviors (excessive dieting, restriction, and exercise, and use of diet aids and laxatives for example) that can lead to serious disordered eating and eating disorders.(1)

 

Peak weight in males coincides with the timing of peak linear growth and peak muscle mass development. Adolescent males may gain an average of 20 lbs per year during peak weight gain.(1) Body fat decreases, and by the end of puberty, males on average have about 12% body fat.(1)

 

By age 18, more than 90% of adult skeletal mass has been formed.(1) Adequate nutrition during childhood and adolescence is therefore critical to support optimum bone growth and development, where a variety of dietary nutrients are necessary for building bone tissue.(1)

 

Eating patterns and behaviors of adolescents can be influenced by a variety of factors including peer influence, parental modeling, food preferences, availability, cost, convenience, personal and cultural beliefs, media and body image.(1,9,10,11)

 

During adolescence, there are dramatic biological changes related to puberty that occur.The development of body image and an increased awareness of sexuality become predominant themes. The dramatic changes that take place can lead to the development of poor body image and unfavorable health behaviors, factors that must be addressed by family members and health practitioners when identified.(1)

 

Peer influence is strong during adolescence. The need for adolescents to fit in can affect nutritional intake, either adversely or beneficially.(1,11) Males that are late bloomers may be more prone to use anabolic steroids and other supplements to fit in with their peers that have matured faster, and females that are early bloomers may resort to disordered eating and present with poor body image.(1) Female early bloomers also may be more likely to take part in adult-like behaviors, such as smoking, drinking alcohol, and engaging in sexual intercourse.(1)

 

Talking to your child about the variations in tempo and timing of growth and development, modeling healthful behaviors, and educating them about making healthy nutritional choices can help them navigate this tumultuous time, and develop healthy body image and health related behaviors to last their lifetime.(1)

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Need assistance or have questions? Contact me today!

 

References:

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

  2. Eating disorders in adolescents: Principles of diagnosis and treatment. Paediatrics & Child Health. 1998;3(3):189-192.

  3. Antiretroviral Therapy for HIV Infection in Infants and Children: Towards Universal Access: Recommendations for a Public Health Approach: 2010 Revision. Geneva: World Health Organization; 2010. ANNEX H, SEXUAL MATURITY RATING (TANNER STAGING) IN ADOLESCENTS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK138588/.

  4. Tanner, JM. Growth at adolescence 2nd Edition. Oxford, England: Blackwell Scientific Publications; 1962.

  5. Raj MA, Rogol AD. Female Athlete Triad. [Updated 2017 Feb 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2017 Jun-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430787/.

  6. National Research Council (US) and Institute of Medicine (US) Forum on Adolescence; Kipke MD, editor. Adolescent Development and the Biology of Puberty: Summary of a Workshop on New Research. Washington (DC): National Academies Press (US); 1999. Available from: https://www.ncbi.nlm.nih.gov/books/NBK224695/doi: 10.17226/9634

  7. Frisch R.E. Fatness, Puberty, and Fertility The Effects of Nutrition and Physical Training on Menarche and Ovulation. In: Brooks-Gunn J., Petersen A.C. (eds) Girls at Puberty. Springer, Boston, MA; 1983.

  8. Frisch RE, McArthur JW. Menstrual cycles: fatness as a determinant of minimum weight for height necessary for their maintenance or onset. Science. 1974;185(4155):949-51.

  9. Videon TM, Manning CK. Influences on adolescent eating patterns: the importance of family meals. Journal of Adolescent Health. 2003;32(5):365-373.

  10. Wade TD, Lowes J. Variables associated with disturbed eating habits and overvalued ideas about the personal implications of body shape and weight in a female adolescent population. Int. J. Eat. Disord., 2002;32:39–45. doi:10.1002/eat.10054.

  11. Story M, Neumark-Sztainer D, French S. Individual and Environmental Influences on Adolescent Eating Behaviors. Journal of the American Dietetic Association. 2002;102(3):S40-S51. doi.org/10.1016/S0002-8223(02)90421-9.

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: Providence Doucet

Photo credit: Providence Doucet

Did you know it can take introducing a new food multiple times before it is accepted? Some children (as well as adolescents and even adults) will take to a new food after a couple of introductions, and with others, it may take anywhere between 10 to 20+ introductions! If your child doesn't like a new food the first, or even third time you offer it to him, this isn't a reason to throw in the towel. Eating a variety of whole real foods is important for your child to grow and develop normally, and you CAN get them to eat these foods.

 

Here are some ideas that may help:

 

  1. Keep offering the food you are attempting to get your child to eat. Your child does not have to eat it. Simply exposing your child to it however is an important part of the process. It is ok for your child to pick up the food, play with it and feel it. This allows your child to get used to the food and it is part of the process.

  2. Offer soft foods cut up in small pieces, like a banana. Your child may be more inclined to eat a bite of a soft banana rather than a crunchy cracker. Bananas, cooked peas and carrots, avocado, plain cooked macaroni, etc., are other examples to try. Cut foods smaller than you think may be necessary.

  3. Give your child a spoon and let him feed himself. Letting him have ‘control’ of the situation may encourage him to eat a few bites of the new food.

  4. Wait to offer your child a new food until he is really and truly hungry. If he’s satiated from other foods, there won’t be much motivation to try something new. 

  5. Give you child a few bites of a new food while you are preparing his meal that includes that new food. Let him familiarize himself with it, play with it and try to eat it.

  6. Take him to a store that gives out samples like Whole Foods and Costco (on the weekends) and you might be surprised at what he will try.

  7. Children are very impressionable, and are great imitators. They will be more likely to want what you are eating, so make your own dietary choices wisely.

  8. Do not panic! While it is frustrating to get your child to diversify his dietary intake, if you are anxious during meals, he’ll pick up on it.

 

Your child may simply need the time and freedom to explore eating new foods. Be patient, be persistent, and watch the magic happen.

 

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.