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)
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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.
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