NUTRITION

Infancy

Provision of adequate energy and nutrients is needed in the first year of life to support the most rapid growth and development period in a person's life. From birth to six months of age about 108 calories per kilogram per day are needed; by twelve months a baby needs about 100 calories per kilogram per day. Since babies can eat only a small volume of food to support rapid growth, they require nutrient-dense, highly caloric foods. Fat must contribute at least 30 percent of total calories to meet the demands of growth and development. Babies should double their birthweight by four to six months of age and triple it by one year. On average, their length will increase by 50 percent in the first year of life.

Mother's breast milk is the best source of nutrients for a newborn. A full-term infant's digestive system has been specially designed to digest breast milk. Whether by breast or by bottle, feeding on demand is best. Infants can self-regulate their food intake to match their nutritional needs, based upon internal hunger and satiety cues. Parents need to pay attention to their baby's cues and feed them accordingly. If a baby is bottle-fed and signals that he is full by pulling away or easily becoming distracted, consumption of the entire bottle is not necessary.

For the first four to six months, babies should be fed only breast milk or correctly prepared infant formula. Children under the age of twelve months should not have cow's milk. Between four and six months of age, children are usually developmentally ready to try moist, soft foods. To easily identify allergies, one food should be introduced at a time, with a three-day wait before the introduction of another new food. Parents should encourage the child to try new foods, one at a time. During the first year or so, children will learn to chew, swallow, and manipulate finger foods; drink from a cup; and eventually feed themselves. Of course, they will make lots of mess while learning these skills, so patience is important. Bottle-fed infants should be weaned from the bottle by twelve to fourteen months of age. There is no specific time to wean a breast-fed child; the longer a baby is on breast milk, the better it will be for her health and well-being.

Early Childhood

Children tend to be unpredictable, picky eaters during the early childhood phase of growth and development (one to four years of age). Parents should allow the child to explore new foods through touch, smell, and taste. It is normal to offer the child a new food five to ten times before he will try to eat it. A food that a child likes one day may not be one he likes the next day. Children may also eat a lot one day and very little the next. They usually eat just one or two foods per meal. This is normal behavior for a child and parents should not worry that the child is not eating enough. Children's growth rates and energy needs decrease during this period.

Parents should offer their children a variety of foods and act as role models by eating a variety of foods. Parents need to provide a structured, pleasant mealtime environment to help their child develop healthy eating behaviors. Parents are responsible for what, when, and where the child eats; children are responsible for whether they eat and how much they eat. Older preschool children may learn to like new foods more by participating in their preparation. Fat should not be restricted before age two; by age five, children should eat fewer high-fat foods and their total fat intake should not exceed 30 percent of total daily calories. Children under age two should be provided whole milk; after age two lower-fat milk options are appropriate. Parents should encourage the child to eat enough iron-rich foods, such as lean red meat or fortified cereals with juice that contains vitamin C, at the same meal. Daily regular activity is important to build a healthy habit and to balance a child's weight and food intake.

Middle Childhood

During middle childhood, regular food habits should be established. This includes eating three meals and two snacks every day. A variety of foods should be chosen with special attention to foods high in calcium (such as low-fat dairy products and dark green vegetables), and zinc and iron (such as low-fat animal products and fortified breakfast cereal). Over-consumption of foods high in fat (such as whole milk, table spreads, and cooking oil), saturated fat (full-fat dairy products, animal products, and solid cooking fats), and sodium (salt and cheese) need to be avoided. Participation in regular physical activity is important to reduce the risk of obesity and development of chronic disease such as coronary heart disease or hypertension.

During and just before a growth spurt, a child's appetite and food intake will increase. The percentage of body fat in older school-age children increases in preparation for the growth spurt during adolescence. Parents should be aware that a child's body image becomes very important at this time. The increased fat mass that naturally occurs during these periods, particularly among girls, can be alarming unless the family realizes that this is normal development. Some preadolescent children may become concerned that they are overweight and may begin to eat less, therefore compromising their normal growth and development. It can also lay the foundation for future psychological issues, such as eating disorders.

Adolescence

Adolescence is the second most rapid period of growth and development (the first being the first year of life), which leads to increased energy and nutrient needs. Physical activity influences adolescents' growth and body composition as well as their propensity for obesity. Inadequate nutrition can delay sexual maturation, slow or stop linear growth and compromise peak bone mass as well as cognitive development, with the latter possibly affecting learning, concentration, and school performance. Studies continue to show that students achieve higher test scores if they consume a meal before the test. A boy's physical maturation tends to increase his satisfaction with his body because of increased size and muscular development. In contrast, a girl's physical maturation tends to decrease body satisfaction. Reassurance that fat accumulation in the hips, thigh, and buttocks is normal during adolescence will help to allay this anxiety.

Healthy eating habits, such as eating breakfast and not skipping meals, should continue to be promoted. Healthful food choices that are based on the Dietary Guidelines for Americans and the Food Guide Pyramid should be encouraged. Adolescents become more independent and make more of their own food choices. Parents should be encouraged to provide a variety of healthful foods at home and to make family mealtimes a priority.

In the average adolescent's diet, the intake of folate, iron, zinc, calcium, and vitamins A and B6 is inadequate. Consumption of green leafy and dark orange vegetables, whole grains, lean meat and fortified breakfast cereals, and low-fat dairy products will provide these nutrients and should be advocated. Although vitamin and mineral supplements can appear to be an easy solution, these do not provide other nutrients, such as fiber, which are found naturally in food. The best insurance for good health is to eat a variety of foods and enough to meet daily needs. In-take of fat, saturated fat, cholesterol, sodium, and sugar tends to be excessive. Obesity is an increasingly prevalent problem among adolescents and is contributed to by little physical activity and intake of high caloric, low-nutrient foods. Other nutritional concerns include inadequate intake of fruits, vegetables, and calcium-rich foods; excessive intake of soft drinks; unsafe weight loss practices; iron-deficiency anemia in girls; eating disorders; and hyperlipidemia, including high blood cholesterol.

Government Nutrition Assistance Programs

There are several government nutrition assistance programs that are available in health centers or clinics, schools, child-care centers, and licensed day-care homes. These programs assist families in meeting the nutritional needs of their children.

The Supplemental Nutrition Program for Low Income Women, Infants, and Children is a government program that provides nutrition education, vouchers for food, and referral for services for eligible women and children. Eligibility includes having a nutritional risk and an income that is less than the poverty level multiplied by 1.85.

The Child and Adult Care Food Program provides reimbursement to child-care providers—child-care centers and family day-care homes—for each child to have two meals and a snack. The provider must follow menu guidelines and report the menus in order to be reimbursed.

The National School Meal Program (NSMP), which includes lunch, breakfast, and special milk, is offered in almost every school in the country. The lunch provides one-third of a child's daily nutrient requirements; when breakfast is also provided, 40 percent of the requirements are met. If a school does not have a cafeteria, food may be brought in from a central kitchen or at least the special milk program will be available. With the increase of after-school programs, the NSMP is assisting in providing snacks for those programs. In the summer when school is not in session, day camps, recreation centers, and schools can sponsor the Summer Food Program, which provides lunches for children to eligible programs.

The Food Stamp Program was designed to provide coupons or electronic benefits to people with low incomes for the purchase of eligible food items. Income, household size, assets, housing costs, work requirements, and other factors determine eligibility and allotments. A study of data gathered in fiscal year 1998 found that 52.8 percent of all participants were children (age eighteen or younger).

See also: EXERCISE; MALNUTRITION; OBESITY; WOMEN, INFANTS, AND CHILDREN

Bibliography

Clark, Nancy. Nancy Clark's Sports Nutrition Guidebook, 2nd edition. Champaign, IL: Human Kinetics, 1996.

Dietz, William H., and Lorraine Stern, eds. Guide to Your Child's Nutrition: Making Peace at the Table and Building Healthy Eating Habits for Life. New York: Villard, 1989.

"Frequently Asked Questions [about Food Stamps]." In the U.S. Department of Agriculture, Food and Nutrition Service [web site]. Washington, DC, 2001. Available from http://www.fns.usda.gov/fsp/menu/faqs/faqs.htm; INTERNET.

Story, Mary, Katrina Holt, and Denise Sofka, eds. Bright Futures in Practice: Nutrition. Arlington, VA: National Center for Education in Maternal and Child Health, 2000.

U.S. Department of Agriculture, Center for Nutrition Policy and Promotion. Tips for Using the Food Guide Pyramid for Young Children, Two to Six Years Old. Washington, DC: U.S. Department of Agriculture, Center for Nutrition Policy and Promotion, 1999.

"Your Guide to Nutrition and Health Information on Federal Government Websites." Available at http://www.nutrition.gov; INTERNET.

Stacy L. Dubit

Janice Dodds

Nicole B. Knee