8.1 Introduction
It is extremely important for infants, children and adolescents to consume healthy nutrition for growth and development. Research also strongly suggests that nutrition consumed during childhood affects our health during adulthood. Feeding patterns continuously change during the first year and it is important to provide the right types and quantities of food.
Infants double their weight within the first 4-6 months and this is the time that they need breastfeeding. Module 8 will explain important differences between breast and formula milk as well as describe different foods that you can use to wean infants off milk gradually. Please note that although infants begin to eat other foods, milk remains an important part of their diet. Children grow rapidly between the ages of 1 to 5 and they develop full dentition by the age of two years. Hence, they are ready to eat other foods, and this is a good time to provide a wide variety of foods in order to expose them to different tastes, textures and flavours. It is a good idea to minimise excessive amounts of sugary, fatty and salty foods.
Children between the ages of 5 and 12 grow at a rapid rate and require nutritious food that provides adequate energy. Furthermore, they also tend to be affected by their school environments away from their home environments. They need to eat a diet that offers a balance of proteins, carbohydrates and fats in the correct proportions, combined with vitamins and minerals. Adolescence is the time of dissatisfaction and doubt with regard to body image, and teens often resort to extreme dieting. This trend is more commonly observed in girls than boys. There has been a paradigm change from eating traditional meals to snacking several times a day.
Fact
According to news reports in the BBC, only 34% of mothers in the UK breastfed their infants at six months and only 0.5% breastfed at one year. Further reports from the 'Save the Children UK' organisation and World Health Organisation said that aggressive marketing of formula milk was a barrier in feeding infants with breast milk.
Source: www.bbc.com
8.2 Nutritional Requirements for Infants and Children
Proper nutrition is crucial for healthy growth and development of infants from birth until the first year. Positive feeding attitudes, healthy nutrition and a caring approach help infants develop a proactive relationship with food. Infant and childhood nutrition requirements need to be taken seriously because of its significant impact on adult health. Choosing to provide the proper nutrition can help you raise a healthy child, as well as reduce the likelihood of sicknesses during adulthood.
Numerous physiological changes that occur during infancy allow the infant to consume different foods associated with diverse textures, composition and tastes. As the infant slowly grows and the digestive system begins to develop, they are able to shift from swallowing liquids to chewing and biting solid foods. Simultaneously, infants also change from being needed to be fed to feeding themselves. Their feeding patterns undergo significant changes over the first year.
In order to ensure proper growth and development, the infant must be provided with the correct nutrients in the correct quantities. Since infancy is a time of rapid growth, the nutritional requirements needed per pound of body weight are proportionally high compared to other stages of life. Nutritional requirements may vary depending on a number of factors like health conditions, socioeconomic background, diet history and natural appetite. New parents are often confused with contradictory information regarding optimal nutritional requirements and it is important to understand the basics of infant nutrition.
The points described below explain the key characteristics of infant nutrition: Proper nutrition ensures healthy growth and development of the infant. Deficient nutrition can result in developmental abnormalities and vulnerability to disease in later life. Breast milk is extremely crucial for the infant's growth during the first six months or more. Breast milk supplies all the crucial nutrients (proteins, carbohydrates, vitamins and minerals) in the correct proportions and in a form that is easily digestible; in fact, breast milk is known to contain more than 300 components including effective immunological components.
For example, colostrum produced in the first few days after birth helps impart high grade immunity. Breastfeeding provides high levels of immunity from disease. Breastfeeding also helps in the release of hormones including prolactin and oxytocin that help the mother lose weight and bond better with the infant.
Roughly around six months (this may vary from one infant to another), the caregiver should consider introducing certain solid foods, as breast milk alone will no longer be sufficient to satisfy nutritional requirements. You can begin to introduce fruits (banana and papaya, for
example) and vegetables (in mashed form) in the baby's diet. You can also consider giving foods such as cooked or mashed sweet potato, yam, pear, apple and carrots.
Allow the baby to hold and touch foods and do not force-feed them. Be patient and make it fun because mealtimes should not become traumatic for the infant. It is also a good idea to be careful while introducing foods such as eggs, shelfish or cow's milk because some infants may be allergic to these foods. From six months to one year, provide formula milk along with small meals of cooked and mashed food. You may also like to feed the infant with fortified cereals (these usually contain all the required nutrients).
Breast milk contains omega-3 and omega-6 fatty acids that help in the formation of the brain, retina and nervous system. It also contains adequate quantities of oligosaccharides that help improve immunity to pathogens. The infant's birth weight doubles within the first 3-4 months and trebles within the first year. Try and limit the amount of sweetened drinks, as these are the main cause of dental decay in young children. Sugar consumption becomes addictive and the infant may refuse to eat unless the food is sweetened with sugar.
In general, it is also advisable for breastfeeding mothers to avoid alcohol, caffeine (in excess) as well as large helpings of sworddish and marlin, as these fish are known to contain high levels of mercury. Only if the mother is unable to breastfeed for some reason or chooses not to (an option not recommended by experts), then formula milk should be administered to the child. Formula milk manufactured in the UK follows stringent rules regarding the composition and proportion of components.
The two primary types of protein found in most infant milk formula include whey and casein. Among the two, whey protein is digested more easily compared to casein, which is emptied more slowly from the stomach. Breastfed babies usually tend to grow more slowly compared to bottle-fed babies, and experts suggest that this helps protect the infant from a tendency to obesity in later life. The UK Department of Health suggests that the ideal weaning time should begin at six months asthis is when the stores of nutrients like iron begin to run out.
Delayed weaning may also result in reluctance in accepting other forms of food. During early infancy, certain digestive enzymes are still not produced by the body and only small amounts of lipase are secreted by the pancreas.
The following tips provide advice on weaning:
Try providing the baby with different foods with different shapes, colours and textures so the infant is able to experiment. This is likely to promote a non-fussy attitude towards food. Infants need to learn how to move food from the back of the mouth to the front in order to
chew or mash it. During weaning, please remember that infants need at least 400-500 ml of milk on a daily basis. Try providing finger foods like boiled carrots or broccoli that the infant can hold onto; many infants prefer finger foods to mashed foods.
You can also consider giving fruit juices but it is a good idea to dilute it in the ratio of 1:3 (one part juice to three parts water), as juices often contains added acids and sugars. By the age of one, the infant has progressed from being able to imbibe nutrition by sucking on a teat or nipple to being able to chew foods at the family dinner table. The child now displays higher levels of physical activity and expends greater energy.
In general, the energy requirement for the infant is four times greater compared to the energy requirement for an adult. Infants need more proteins per unit of weight and essential amino acids like histidine and taurine. Proteins are important; however, please avoid overloading the infant's diet with protein, as the kidneys are not fully developed and cannot filter out complex molecules easily.
Similarly, fats should ideally comprise about 30%-50% of the energy intake because fats are known to provide a high energy output even in smaller volumes. Carbohydrates comprise 40% of the infant's diet, while lactose is broken down into glucose and galactose.
In addition, infants are able to digest sucrose, which is generally sweeter-tasting compared to lactose; starch is difficult to digest. Food should not be heavily spiced, and added sugars and salt should be avoided. Infants also have a small body surface area and require at least 75 to 100 ml of fluids per kilogram of body weight. In adults, the kidneys are able to reduce water loss when fluid intake is low, but infants do not possess this ability; hence it is important to give them adequate fluids on a daily basis. Solute- dense foods should be avoided.
Breast milk is also low in vitamin K and vitamin D, and breastfeeding mothers are advised to take vitamin D supplements. Infants are usually given vitamin K injections after birth to prevent deficiency. In general, the breast milk secreted towards the end of the feed is more nutritious compared to the milk at the start of the feed.
Infants also need an adequate supply of minerals in their diets. They require calcium, phosphorus, iron and zinc for bone growth, production of red blood cells and improved immunity. However, you must be careful not to provide formula feeds that contain excessive amounts of phosphorous as this inhibits calcium intake.
You can try feeding the following foods to your child between the ages of 6 to 8 months:
-Breast or formula milk
-Iron-fortified semi-liquid cereal
-Pureed fruits, vegetables, meat
-Small amounts of yoghurt
It is best to avoid cow's milk until the age of 1 because it contains high levels of proteins and minerals which can be difficult for the infant's kidneys to digest. In addition, it can be a good idea to introduce one food at a time and keep a food log that makes it easier to identify allergies. Once the infant is over 8 months old, you can also add pureed tofu and pureed legumes. The amount of feed should be typically 1 teaspoon gradually increased to 4 teaspoons over 3-4 feedings. You can try mashed (not pureed) fruits, vegetables, βinger foods (cooked pasta, cereal and well-cooked potato) and small pieces of boneless fish. The infant should be able to pick up the food with their thumb and
forefinger. The quantities should ideally be half a cup of fortified cereal or cheese and 1 cup of mashed vegetables or fruit.
Activity
Estimated time: 5 - 10 minutes
Why are breastfeeding rates still low in the UK?
Do you think that hectic lifestyles and increased stress are factors that have influenced the decision to breastfeed one's baby?
From the age of 10 months to 1 year
At this stage, the infant has more teeth to chew and you can add vegetables and fruit cut into small cubes, teething crackers, small pieces of meat or boneless fish, well-cooked pasta pieces, or combination meals like macaroni and cheese.
Children between the Ages of 1 to 5
At this stage, children make a transition to a diet that contains roughly 35% starch and different types of starches. It is also at this time that children tend to resist eating and may display pickiness or fussiness with respect to eating. It is very important for parents to expose children to different types of food. The behaviour and attitude of parents will affect the behaviour and eating of the child. Be careful while attaching conditions to eating.
For example
If a child is allowed to watch television only when they βinish eating the vegetables, they may begin to regard vegetables as 'punishment food'. Different experiences may drive their preferences and choices with regard to food and eating habits. Key factors will include their peer group at school and their dietary habits and preferences.
Growth during the first five years may occur in spurts and these spurts may often be accompanied by surges in appetite. In addition, the child reaches full dentition by the age of two and is more likely to be inclined to try out new foods after this. However, their appetite remains relatively small and in addition to the three main meals, you may wish to provide small snacks during the day. The snacks should be nutritious and should contribute to total nutritional requirement. Most snacks only contain sugar and water which will tend to stifle appetite, and also cause damage to dentition over time by leading to cavities.
Some nutritious snacks that you could consider giving your children include:
-Dried or fresh fruits
-Dry breakfast cereal
-Vegetables as finger foods (for example, cucumber, carrots, beetroots)
-Sandwiches made from wholemeal bread with nutritious fillings
-Yoghurt
-Fruit based cakes or scones
In addition, children in this age group should drink at least 250 ml of milk every day. You can allow the child to choose between equivalent choices; such as allowing selection between wholemeal sandwiches and fruit. Avoid foods that contain excess salt and sugars as these tastes can be addictive. It is a good idea to avoid excessive amounts of saturated fats such as pies, cakes, pastries and crisps etc.
Children between the Ages of 5 and 12
Children of this age (especially between 5 and 8 years of age) tend to have smaller appetites and cannot eat large quantities at once. However, parents continue to be role models for children within this age group and it is a good idea to keep your guidance firm and consistent with regard to food. Please do not force children to go on 'diets'; you can try including healthy foods by replacing undesirable ones instead.
Diets for school-age children should meet nutritional requirements for growth, development, immunity function and energy without promoting excessive weight gain. Early exposure to healthy eating can help children make right choices in eating. They should ideally eat from all food groups (carbohydrates, proteins and fats), as well as consuming foods that provide vitamins and minerals. Salt intake should be no more 5 to 6g in a day.
Children of the school-going age should be encouraged a healthy breakfast. Breakfast should ideally consist of foods that are nutrient dense, but which release energy slowly in the body. This is different from sugary foods which provide high levels of energy quickly and the energy levels drop down quickly leading to a mid-morning slump. Some examples of foods that satisfy the criteria include eggs, porridge, sweet potatoes and quinoa. In addition to this, it is also important to avoid sugary foods due to their detrimental effect on teeth and increased risk of decay.
Any discussion on nutrition would be incomplete without mentioning that physical fitness plays a crucial role too. Children are spending alarming amounts of hours watching TV, playing computer games, chatting on social media and generally staying indoors. A reduction in physical activity has resulted in significant increase in obesity and body weight.
Research studies indicate that teenage eating habits and behaviours have changed significantly. Teens in the UK tend to eat more processed foods, fewer fruits and vegetables; teenage girls are consuming reduced levels of nutrition, due to a host of eating disorders like bulimia and anorexia.
In addition, there is increasing concern over food choices advertised or propagated by TV and Internet media. There are many more adverts for snacks, fast food chains and diet foods than for fruits and vegetables, for example. In general, teenagers are consuming significantly reduced levels of vitamin D, iron, fibre and folate.
The media has repeatedly portrayed thin bodies as ideal, and popular models and movie stars sport size zero figures which have now been accepted as the ideal body in the minds of thousands of British teens. Teenage is the time of puberty and the body undergoes rapid growth for both girls and boys. Girls gain about 20 cm in height between the ages of 10 and 14 while boys gain about 30 cm between the ages of 13 and 16 years. Girls also gain lean tissue and fat. The period of maximum increase in growth rate usually witnesses a corresponding increase in appetite. This time is usually around 14 years in boys and 12 years in girls.
Fact
In a study of primary children, The Guardian, UK reports that 31.6% of boys and 32.4% of girls in the final year of primary suffer from obesity.
The statistics further indicated that there were higher obesity levels in children in deprived areas compared to affluent suburbs and towns in the UK.
Source: www.theguardian.com
8.3 Important Nutrients for Teenagers.
Here is a closer look at some of the important nutrients that are crucial for teenagers.
Iron
Iron is particularly important for growth and muscle mass as it is used in haemoglobin present in red blood cells. Girls who begin menstruation need higher amounts of iron to replace losses. Statistics in the UK show that approximately 7.5% of teenagers suffer from the iron deficiency anaemia. You may wish to ensure that you add citrus fruits or juices during meals to help increase consumption of vitamin C that aids in the absorption of iron. Girls who eat vegetarian diets are more vulnerable to
iron deficiency compared to meat-eaters.
Calcium
Calcium is required to compensate for the rapid increase in bone mass during puberty. In the absence of calcium, the teenager could be at increased risk of bone loss during adulthood. The best sources of calcium include dairy products (milk, cheese and yoghurt). Although skimmed yoghurt and milk contain the same amount of calcium as their full-fat counterparts, low-fat cheese contains low amounts of calcium. Foods like kale, spinach, cauliβlower, sardines (with bones) are also rich in calcium.
Important points regarding nutritional requirements are summarised below:
Teenagers require added calcium in their diets in order to sustain the growth spurt that occurs during the teenage years. Boys, in general, also may need more protein because they are larger and have increased lean body mass. Anorexia nervosa and bulimia are usually prevalent in British teens between the ages of 15 and 19 years of age. Elimination of dairy products or entire food groups often results nutritional deficiency conditions in later years.
As teenagers grow taller, they may often need to incorporate nutritional adjustments in order to streamline the height-weight ratio. That is why it is extremely important for parents to encourage healthy eating and lifestyle habits. These are likely to stand them in good stead into
adulthood and through to old age. Adequate physical activity can help maintain fitness and increase bone mass.
Peer groups, societal pressures and family habits play crucial roles in teenage eating habits. Although most teens are aware of the consequences of excessive intake of fats and sugars, this may not necessarily translate into action.
School Food Standards
One of the best ways to meet nutritional and energy requirements for teenagers is through school meals. The Department of Education announced a new set of flexible rules for school meals served in British schools across the UK; the new rules make it easier for schools to prepare nutritious, tasty and convenient meals.
School cooks have been satisfied with the new rules and school meals in general now include higher levels of fruits and vegetables than before.
Important points included in the new school food standards in the UK:
-Three different fruits and three different vegetables every week
-One or more portions of vegetables with school meals on a daily basis
-Increased emphasis on wholegrain as opposed to refined carbohydrates
-Increased consumption of water as the drink of choice, and restricted consumption of fruit juices (especially with added sugar)
-Pastries, fried and oily foods to be served no more than twice a week
-The new school meals also promoted consumption of seasonal produce that requires reduced levels of cold storage.
-School children should be able to get fresh foods.
Professor of Diet and Population Health, Susan Jebb suggested that providing flexibility within healthy food choices helped school cooks in the UK prepare better meals. At the same time, school meals have significantly helped promote nutrition, and high school children are learning the basics of healthy eating at the same time.
Activity
Estimated time: 5 minutes
If you have a teenager at home, how would try and get them to eat healthier meals?
Do you think that involving them in cooking and planning meals is a good idea?
8.4 Eating Disorders
Bulimia and Anorexia Nervosa are eating disorders brought about by excessive obsession with weight, usually arising from low self-image.
Teenagers who suffer from anorexia and bulimia often experience mood swings and depression, and often withdraw from friends and family. They develop a negative relationship with food. Such conditions lead to adverse health effects including lowered oestrogen levels, weak bones and amenorrhoea (cessation of menstrual cycles).
MODULE SUMMARY
Growth rate is most rapid during the first year of birth and infants should be ideally fed on breast milk alone for the first four months. Breast milk contains crucial proteins, carbohydrates and fats that the infant needs for energy, growth and immunity. Mothers can consider using formula milk if they are unable to breastfeed. Formula milk is manufactured in accordance with stringent standards and most brands contain whey as a major component. Children between the ages of 1 to 5 are influenced by eating preferences and habits at home.
A second spurt in growth occurs during teenage years between the ages of 12 and 17. Teenaged children need adequate amounts of iron and calcium in their diets to meet growth and energy requirements during this time. Eating disorders and erratic eating preferences that involve elimination of entire food groups may lead to adverse health consequences during adulthood. Two common eating disorders include anorexia and bulimia that arise from low body image and obsession with weight loss.
Teenagers must consume adequate portions of healthy food that provide proteins, carbohydrates, fats, vitamins and minerals in the correct proportions. It also helps to build health by indulging in adequate physical activity.
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