Chapter 12

CHAPTER 12
Nutrition for Normal Growth and
Development

Sharon M. Nickols-Richardson

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Individual Needs of Children

 Growth may be defined as an increase in
body size
 Biologic growth of an organism occurs
through cell multiplication (hyperplasia) and
cell enlargement (hypertrophy)
 Development is the associated process by
which growing tissues and organs take on a
more complex function

Copyright (c) 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 2

Normal Life Cycle Growth Pattern

 Normal human life cycle includes the following
four general stages:
 Infancy
• Growth velocity is rapid during the first year of life
• At 6 months weight has doubled; at 1 year weight has tripled
 Childhood
• The growth rate slows and becomes erratic


Normal Life Cycle Growth Pattern – Cont’d
 Adolescence
• With the beginning of puberty, the second period of growth
acceleration occurs
 Adulthood
• Final stage of a normal life cycle; growth levels off on the
adult plateau


Measuring Childhood Physical Growth
Growth Charts
 Children grow at widely varying individual rates
 A child’s pattern of growth is compared with
percentile growth curves derived from
measurements of large numbers of children
throughout the growth years


Measuring Childhood Physical Growth –
Cont’d

Growth Charts – cont’d
 Two age intervals are presented, with separate
curves for boys and girls:
 Birth to 3 years
 2 to 20 years


Cont’d

Anthropometry
 Monitors a child’s growth, with growth charts and
other clinical standards as points of reference
 A number of methods and measures may be
used


Cont’d

Anthropometry – cont’d
 Body weight and height
 Common general measures of physical growth
 Provide a basic measure of change in body size but give
only a crude index of growth without the finer details of
individual variations in body fat or muscle or bone


Cont’d

Anthropometry – cont’d
 Body circumferences and skinfolds
 Head circumference is a valuable measure in infants
 Skinfold measures are performed with special calipers and
require skill and practice for accuracy


Cont’d
Clinical Signs
 Various clinical signs of optimal growth can
be observed as indicators of a child’s
nutritional status

Laboratory Tests
 Include studies of blood and urine to
determine levels of hemoglobin, vitamins, and
similar substances


Cont’d

Nutritional Analysis
 Provides helpful information for assessing the
adequacy of the diet for meeting growth needs


Motor, Mental, and Psychosocial
Development

Motor Growth and Development
 Gross motor skills develop within the first 18
months of life
 Fine motor skills gradually develop over a longer
period of time


Development – Cont’d

Mental Growth and Development
 Measures of mental growth involve the following:
 Abilities in speech and other forms of communication
 Ability to handle abstract and symbolic material in
thinking



Emotional Growth and Development
 Measured in the capacity for love and affection,
as well as the ability to handle frustration and
anxieties



Social and Cultural Growth and
Development
 Measured as the ability to relate to others and to
participate in group living and cultural activities


Nutritional Requirements
for Growth
Energy Needs
 Intake of a 5-year-old child is spent Total
daily energy as follows:
 Approximately 50% supplies basal metabolic
requirements (BMR)
 Approximately 5% is used in the thermic effect of
food (TEF)


for Growth – Cont’d

Energy Needs – cont’d
 Total daily energy intake of a 5-year-old child is
spent as follows: – cont’d
 Approximately 25% goes toward daily physical activity
 Approximately 12% is needed for tissue growth
 Approximately 8% is lost in the feces


Protein Needs
 First 6 months of life an infant requires 1.52 g
of protein per kilogram per day
 This amount gradually decreases throughout
childhood until adulthood


Essential Fatty Acid Needs
 Linoleic acid is required for the synthesis of
brain and nerve tissue and normal mental
development

Carbohydrate Needs
 Carbohydrates are primary energy source and
are important in sparing protein for its vital role
in tissue formation


Fiber
 Important to satiety and bowel regulation and
affects blood lipid and glucose concentrations



Water Requirements
 Infant’s body content of water is approximately
70% to 75% of total body weight
 A child’s water need is related to energy intake
and urine concentration
 An infant generally drinks a daily amount of
water equivalent to 10% to 15% of body weight



Mineral and Vitamin Needs
 Minerals and vitamins play essential roles in
tissue growth and maintenance and in overall
energy metabolism



Mineral and Vitamin Needs – cont’d
 Calcium is needed for tooth development,
muscle contraction, nerve excitation, blood
coagulation, and heart muscle action
 Iron is essential for hemoglobin formation and
mental and psychomotor development


Stages of Growth
and Development
Psychosocial Development
 The developmental problem at each stage
has a positive ego value and a conflicting
negative counterpart, as follows:
 Infancy: trust versus distrust
 Toddler: autonomy versus shame and doubt
 Preschooler: initiative versus guilt
 School-age child: industry versus inferiority


Stages of Growth
and Development – Cont’d
Psychosocial Development – cont’d
 The developmental problem at each stage
has a positive ego value and a conflicting
negative counterpart, as follows: – cont’d
 Adolescent: identity versus role confusion
 Young adult: intimacy versus isolation
 Adult: generativity versus stagnation
 Older adult: ego integrity versus despair


Infant (Birth to 1 Year)

Nutrition for the Full-Term Infant
 Breast milk or infant formula generally
provides all the nutrients required by a
healthy infant for the first 6 months of life
 Exclusive breast-feeding can be adequate for
the first 12 months of life


Infant (Birth to 1 Year) – Cont’d

Nutrition for the Full-Term Infant – cont’d
 Nearly all infants born in a hospital receive an
injection of vitamin K shortly after birth
 By the age of 6 months, semisolid foods such as
iron-fortified cereals may be added to the diet to
help meet increasing nutritional needs



Psychosocial and Motor Development
 Core psychosocial developmental task during
infancy is the establishment of trust in others
 Feeding is the infant’s primary means of
establishing human relationships



Breast-Feeding
 Ideal food for the human infant is human milk
 Experienced nutritionists and nurses, many of
whom are certified professional lactation
consultants, advise flexibility rather than a
rigid approach to breast-feeding
 Toward the end of the prenatal period, the
breasts secrete a thin, yellowish fluid called
colostrum



Breast-Feeding – cont’d
 Typically by the end of the second week,
mature milk is produced
 Breast milk is produced under the stimulating
influence of the hormone prolactin
 Another pituitary hormone, oxytocin,
stimulates the ejection of the milk (let-down
reflex)



Breast-Feeding – cont’d
 The mother should follow the baby’s lead with
an on-demand schedule
 Feedings are usually about every 2 to 3 hours
in the first few weeks after birth
 A breast-feeding mother needs to be aware
that her infant will likely gain weight more
slowly than bottle-fed infants, but this should
not be a concern



Bottle-Feeding
 A variety of commercial formulas that attempt to
approximate the composition of human milk are
available
 Special formulas have been developed for
infants with allergies, lactose intolerance,
diarrhea, fat malabsorption, or other problems



Bottle-Feeding – cont’d
 For hypoallergenic formulas, all proteins are
completely hydrolyzed to free amino acids
 Use of soy protein–based formulas has been
growing among parents who wish to feed their
infants vegetarian diets



Bottle-Feeding – cont’d
 Any remaining formula should be thrown
away and not refrigerated for reuse
 Most infants are fed on demand versus
scheduled, which works out to be about every
2 to 3 hours
 Only infant formula and water are appropriate
for bottle-feeding; other fluids should not be
used



Breast-Feeding and Formula-Feeding
Combination
 Some women may desire the flexibility of both
breast-feeding and formula-feeding their
infants
 Regular unmodified cow’s milk is not suitable
for infants for several reasons:
 It causes gastrointestinal bleeding
 Its renal solute load is too concentrated for the
infant’s renal system to handle


Breast-Feeding and Formula-Feeding
Combination – cont’d
 Regular unmodified cow’s milk is not suitable
for infants for several reasons: – cont’d
 Early exposure to cow’s milk increases the risk of
developing allergies to milk proteins
 It adversely affects nutritional status



Premature and Small-for-Gestational-Age
Infants
 These infants should be fed breast milk, usually
fortified with additional protein, vitamins, and
minerals
 Formulas developed for the premature infant
may have as much as 30% more protein per
fluid volume, as well as higher amounts of
calcium, zinc, and the B-complex vitamins



Premature and Small-for-Gestational-
Age Infants – cont’d
 Nutrition support of the high-risk infant
requires a team approach:
 Pediatrician
 Nurse
 Dietitian
 Lactation consultant



Beikost: Solid Food Additions
 Beikost feeding begins the transition from a
predominantly liquid diet to a predominantly
solid food diet
 Solid foods should be introduced to an infant no
earlier than 4 to 6 months of age



Beikost: Solid Food Additions – cont’d
 Developmental abilities to use the hands and
fingers are required before self-feeding can be
initiated
 Smaller amounts of food, eaten on a more
frequent basis, may contribute to the pattern of
eating in moderation



 Vegetables, fruits, potato, egg yolk, and
finally meat can be added to the diet in a
gradual sequence
 Two foods require special attention in infant
feeding:
 1. Honey
 2. Fruit juices



 The following two basic principles should guide
the feeding process:
 1. Nutrients are needed, not specific foods
 2. Food is a main basis of early learning


Toddler (1 to 3 Years)

Physical Characteristics and Growth
 The growth rate of children slows after the
first year
 Legs become longer, and the child begins
losing “baby fat”
 Energy demands are lower because of the
decelerated growth rate
 The child has six to eight teeth at the
beginning of the toddler period


Toddler (1 to 3 Years) – Cont’d

 As physical mobility increases with increased
gross and fine motor skill development, the
sense of autonomy and independence grows



Food and Feeding
Energy
 Rises to a range of 1160 to 1680 kcal/day for

boys and 1080 to 1650 kcal/day for girls by
age 3
 From age 1 to 2, some children do not eat as
much as they did in the second half of infancy



Food and Feeding – cont’d
Protein
 The toddler requires about 13 g of protein per

day
 At least half of this protein should be of
animal origin



Minerals
 Calcium and phosphorus are needed for bone
mineralization
 Adequate levels of zinc are necessary to support
protein synthesis and cell division



Vitamins
 Fat-soluble and water-soluble vitamins are

critical to macronutrient utilization and growth
and development



Fiber
 19 g/day is recommended for children age 1

to 3 years

Food Choices
 About 2 to 3 cups of milk daily is sufficient for

the young child’s needs


Preschooler (3 to 6 Years)

 Each child tends to settle into a regular
genetic growth channel as physical growth
continues in spurts
 Mental capacities are developing


Preschooler (3 to 6 Years) – Cont’d

Physical Characteristics and Growth –
cont’d
 13 to 19 g/day of good-quality protein is
needed
 Calcium and iron are needed to support
growth and to build body stores
 A variety of fruits and vegetables should be
provided



 Children are beginning to develop their
superego—the conscience
 This is a period of increasing imitation
 Self-feeding skills increase, and eating takes
on greater social aspects



Food and Feeding
Fruits and Vegetables
 Fruits are usually well liked

 Vegetables usually are the least well liked by

children



Milk, Cheese, Egg, Meat, and Legumes
 It is helpful if children can set their own goals

of quantities of food; portions need to be
relatively small

Grains
 Whole grains provide important fiber


The School-Age Child
(6 to 12 Years)

 During this stage, the rate of growth slows and
body changes occur very gradually
 By now the body type has been established, and
growth rates vary widely


(6 to 12 Years) – Cont’d

 Children have increased cognitive capacity and
the ability to problem solve
 They cooperate in group activities and begin to
experience a sense of adequacy and
accomplishment and sometimes the realities of
competition



Food and Feeding
 The slowed rate of growth during this period
results in a gradual decline in the food
requirement per unit of body weight



School and the Learning Environment
 Breakfast is particularly important for the school-
age child
 Schools should also take a premier role in
promoting lifelong physical activity patterns in
children
 Sound nutrition is especially critical for the child
athlete


The Adolescent

 Final growth spurt of childhood
 Adolescent growth accounts for wide
fluctuations in physical size, metabolic rate,
food needs, and even illness


The Adolescent – Cont’d

 Adolescence is an ambivalent period marked
by stresses and strains
 Emergence of a self-identity is the major
psychosocial developmental task of the
adolescent years
 Pressure for peer group acceptance is strong
 Social tensions and family conflicts are often
created



Food and Feeding
Energy
 The kilocalorie (kcalorie or kcal) needs

increase with the metabolic demands of
growth and energy expenditure



Protein
 Girls require 46 g/day and boys require 52

g/day to sustain daily needs and to maintain
nitrogen reserves



Minerals
 Calcium requirement for all adolescents rises

to 1300 mg/day
 Fluid replacement in any exercise or
performance period is essential



Eating Habits
 Physical and psychosocial pressures
influence adolescent eating behavior
 Two factors combine to increase issues
surrounding nutrition and food intake in
adolescent girls:
 1. Physiologic sex difference
 2. Social and personal tensions


Health Promotion

Children and Adolescents: Seeking
Fitness
 The Dietary Guidelines for Americans 2005
provides direction for the development of a
healthy diet and lifestyle for all persons age 2
years and older


Health Promotion – Cont’d

Weight Management
 Body weight and physical activity are intrinsically
related
 Body fat increases rapidly during the first year of
life and then slows until about age 6



Physical Activity
 Television, computer games, the Internet,
and similar sedentary pastimes are growing
in popularity
 The goal is to have children and adolescents
engage in a minimum of 1 hour of exercise
every day



Helping Children Develop an Active
Lifestyle
 Parents and caregivers, schools, and
communities need to work together to
increase physical activity among children
 Parents and role models should also
demonstrate such behavior


Chapter 12

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