Promoting Good Nutrition for Children

Good nutrition is only one aspect of the positive life style that promotes sustainable physical, mental, and social well-being. But the diets and life styles learnt in childhood are likely to influence adult life and

Table 4 Vitamin deficiency problems that may occur in childhood Vitamin Condition

Vitamin A - retinol, carotene Xerophthalmia

Vitamin B-i - thiamine Beriberi

Vitamin B2 - riboflavin Anemia

Vitamin B3 - niacin Pellagra

Vitamin B6 - pyridoxine Convulsions

Vitamin B12 - cyanocobalamin Pernicious megaloblastic anemia

Subacute combined degeneration of the spinal cord

Folic acid Anemia

Growth faltering

Vitamin C - ascorbic acid Scurvy

Vitamin D - calciferol Rickets

Vitamin E - tocopherol Hemolytic anemia

Neurological degeneration

Features

Minor: night blindness

Major: total destruction of eye and blindness

Nutritional stunting

Increased infection; severe infection

Mental changes: apathy, irritability, depression

Cardiac failure

Peripheral neuritis

Hypochromic, microcytic anemia

Dry skin; seborrhoeic dermatitis in skinfolds; angular stomatitis;

raw red tongue Cracked, dry, peeling, or blistering light-sensitive dermatitis Apathy, depression, confusion Diarrhea

Unusual except in inborn errors of metabolism involving pyridoxine

Peripheral neuritis

Convulsions

Anemia

Megaloblastic macrocytic anemia

Anesthesia and loss of position sense and motor weakness in limbs Encephalopathy Megaloblastic anemia

Folic acid deficiency may develop whenever there is rapid growth. It may also cause impaired catch up growth or growth faltering

Bleeding, bruising with painful bleeding subperiosteally

Anemia

Osteoporosis

Painful deformity of weight-bearing bones with bowed legs; swollen ends to shafts of long bones and ribs giving Harrison's sulcus at attachment of diaphragm to lower ribs and 'rickety rosary' effect; bossed skull Poor growth and increased infection Rarely, hypocalcemic tetany

Unusual except in fat malabsorption conditions such as cystic fibrosis and abetalipoproteinemia Loss of sensation and motor power in limbs similar to that with vitamin B12 deficiency

Table 5 Mineral deficiencies that can occur in childhood

Mineral

Condition

Features

Iron

Anemia

Hypochromic, microcytic anemia

Impaired growth

Role of iron, as separate from anemia, in relation to poor growth not clear.

Impaired cognition

Likewise role of iron independent of anemia in impaired cognition not clear

Iodine

Cretinism

Severity of iodine deficiency and age at which it occurs affect the damage caused

Stunting

The younger the child the more likely there is permanent neurological damage

Goiter

Goiter common when growth rapid in early life and at adolescence

Zinc

Loss of taste

Anorexia

Growth impairment

Zinc deficiency is associated with growth faltering and delayed maturation

Gastrointestinal effects

Acute diarrhea may be more likely to persist when there is zinc deficiency

Selenium

Keshan disease

Cardiomyopathy which may be precipitated by associated deficiency of vitamin E or perhaps by Coxsackie virus infection

Kachin-Beck syndrome

Osteoarthritis affecting particularly lower limbs

Copper

Anemia

Microcytic hypochromic anemia

Poor bone mineralization

Osteoporosis

Calcium

Rickets-like syndrome

Very low calcium diets can be associated with rickets-like condition but more usual for associated vitamin D deficiency as well

Magnesium

Often silent deficiency

Deficiency is very unusual except in severe malnutrition when it is universal Occasionally magnesium deficient convulsions

Table 6 Principles of good nutrition in childhood

Policy

Practice

Feed children appropriate to their developmental skills

Encourage recognition of satiety and hunger

Encourage varied nutrient intake

Achieve nutrient needs by varied diet

Aim for diet that will protect as far as possible against chronic noncommunicable diseases as adult

Maintain active life style

Progress diet from soft mushy weaning diet to increasingly lumpy and then chewable foods

Encourage biting and chewing

Encourage new foods, textures, and tastes

Organize regular meals and snacks

Eat as a family where possible

Eat away from activities such as watching television

Avoid snacking whilst occupied with television or computer or other absorbing activity

Home prepared foods when possible so nutrient content is recognized

Vary diet and recognize that children may not accept new foods on first tasting

If possible use other members of the family to show how specific foods are enjoyable

Plan for an energy-dense staple, protein source, micronutrient source at each meal

Aim for about 500 ml of milk or formula daily to provide a good calcium source

Provide a source of vitamin C at each meal

Aim towards five small portions of fruit and vegetable/day and gradually increase portion sizes

(e.g., from few segments of an orange work up to a whole orange as the child's appetite grows) Work towards recommendations for a healthy adult diet as child matures but avoid high fiber, low-fat diets in early childhood

Encourage activity both outside and inside the home Encourage children to take part in household chores

Encourage children to take an interest in and understand food preparation and food choice should optimize opportunities for health and social well being throughout life.

It is unlikely that the Western world, with its working mothers and busy parents, can return to a society where all meals are consumed as families. Eating and socializing over meals are nevertheless important for child development since they may encourage children to recognize satiety during the time spent eating. Further, the communication and stimulation that should take place during family meals develops children's social skills. Even when family meals are not practical, eating should be organized, and to some extent formalized, preferably away from distractions such as television, which may detract from awareness of the quantity of food consumed. Snacking should be at specific times rather than an activity that happens because food is available or because there is nothing else to do. Table 6 outlines some of the principles to be followed when trying to develop good eating and nutritional habits in childhood.

A healthy diet needs to be accompanied by plenty of exercise, out of doors whenever possible. Young children are naturally extremely active and should be encouraged to explore and develop their physical skills under supervision. Sedentary interests, particularly watching television, should occupy only a very small portion of the day although as children grow older, homework, which is usually fairly sedentary, inevitably occupies part of the after school hours. At home children can be kept active helping around the house, playing games, and pursuing varied hobbies. Overcoming sedentariness may involve parents as well as children, but that should be good for parents' health also.

Eating and drinking opportunities at school can run counter to the good nutritional practices parents may be pursuing. For example, in schools, water dispensers could replace those selling carbonated drinks although drinks sales are often significant sources of revenue for schools. Many countries now have guidelines, such as making fruit available at lunch, for healthy eating programs in schools. Nevertheless, diet is only one, admittedly important, area for action when developing life styles that should sustain normal nutrition throughout the life cycle.

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