To develop their optimal potential it is vital that children are provided with nutritionally sound diet. Diet and exercise pattern during childhood and adolescence may spell the difference between health and risk of disease in later years. Different stages of life cycle dictates different nutrients needs.
Important nutritional considerations in first stage of life:
In first 12 months of life a baby will triple its weight and increase its length 50 %. These gain in weight and height are the primary indices of nutritional status and their accurate measure at regular intervals are compared with standard growth charts. These measurements are important tools for monitoring a child’s progress particularly during the first 6 to 12 months of life.Breast feeding on demand remains the ideal form of feeding for healthy babies. Human milk provides optimum nutrition for growth and development. The first 4 – 6 months are period of very rapid growth, particularly for the brain. Amino acid and fatty acid composition of breast milk is ideally suited to meet these needs. Breast milk also contains anti-bacterial and anti-inflammatory agents including immunoglobulin which have important role to play in boosting immune function. The colostrum is produced by the mammary gland during first few days after birth. It is rich in protein and has high levels of minerals and vitamins. Colostrum also contains antibodies, anti-inflammatory factors, growth factors, enzymes and hormones which are beneficial for growth and development.
Breast feeding is strongly advocated for physiological, psychological and emotional reasons. There is no reason why breast feeding should not continue for as long as it is nutritionally satisfactory for mother and child up to 2 years. However, with changing lifestyle and availability of commercially prepared formula, approved infant formula can also be used under strict hygienic conditions. The infant formulae attempt to mimic as far as possible the composition of human milk and their use must comply with guidelines laid down by the World Health Organization (WHO). Formula fed infant also need to be demand fed and the formula must be made exactly according to the manufacturer’s instructions for optimal growth. Special attention has to be taken to sterilize all the feeding equipment to reduce the potential risk of contamination because formula fed babies do not have same degree of immunological protection as breast fed babies.
When should solid food be introduced?
Introduction of complementary solid food is usually a gradual process over several weeks or months of starting, at about 6 months of age. The exact timing is determined by the individual infant mother and reflects the fact that breast milk will suffice in those first months but will no longer be able to provide adequate nutrition by itself as the baby grows. The introduction of complementary food by about six months is important to ensure normal chewing and speech development. The quality, number and variety of solid food can be increased gradually at a pace that will be generally dictated by the child. Cereals are generally the first food that are introduced into the infants diet (mixed with a little breast milk or formula) with purees (food in the form of thick liquid made by crushing fruit and cooked vegetables in small amount of water).
By exclusive breast feeding up to 4 to 6 months of age, the likelihood of developing allergies is minimized. Foods that are more likely to cause allergic reaction in sensitive children such as egg whites and fish are generally introduced after 12 months of age. With present changes in lifestyle, commonly available baby food plays a growing role in the diet of children and should therefore meet strict standards of quality and safety. The convenience and variety of food available make them a good option to use to complement the home prepared food. Commercial baby food are prepared from fresh fruits, vegetables and meat with no added preservatives and must meet very strict standards. An important consideration in the first year of life is the amount of iron supplied in the diet. Iron deficiency anemia is routinely screened for during pregnancy. The use of an iron-fortified formula or cereal and the provision of iron-rich such as meat can also help to prevent the problem.
Important nutritional considerations for toddlers (1- 3 years of age):
During these years, a child begins to take his/ her own unique personality and choosing food to eat. Although the child is still growing, the rate of growth is slower than in the first 12 months of life. At the end of the third year of age, girls and boys will have achieved about 50 percent of their adult height.
During this period a child becomes able to drink through a straw and eat with spoon. The provision of variety of food will allow the child to choose from a range of food with differing tastes, textures and colors to help satisfy their appetite. The most important factor is to meet energy needs with a wide variety of foods. Food intake will be influenced by family eating pattern and peers. Early food experiences may have important effects on food likes and dislikes and eating pattern in later life. Meal time should not be rushed and a relaxed approach to feeding will pave the way for healthy attitudes to food.
Important nutritional considerations for school going children:
After four years of age, a child’s energy needs per kilogram of body weight are decreasing but the actual amount of energy required increases as the child gets older. From 5 years to adolescence there is a period of slow but steady growth. Dietary intake of some children may be less than recommended for iron, calcium and vitamins. Although in most cases, deficiency is unlikely as long as the energy and protein intakes are adequate and a variety of food including fruits and vegetables are eaten.
Regular meals and healthy snacks that include carbohydrate rich foods, fruits and vegetables, dairy products, lean meat, fish, poultry, eggs and nuts contribute to proper growth and development. Children need to drink plenty of fluid, especially if it is hot or they are physically active. Water is obviously a good source of liquid and supplies fluid without calories. Variety is important in children’s diet other sources of fluid such as milk and milk drinks and fruit juice can also be chosen to provide needed fluid.
Important nutritional considerations for adolescents:
The nutritional requirement of young people are influenced primarily by the growth that occurs at puberty. The peak of growth is generally between 11 and 15 years for girls and 13 and 16 years for boys. The nutrient needs of individual teenagers differ greatly and food intake can vary enormously from day to day. So that deficient or excessive intakes in one day can be compensated on the next. In this period of life, several nutrients at greater deficiency including iron and calcium.
Iron: Among adolescents, iron deficiency anemia is one of the most common diet related deficiency diseases. Adolescents are particularly susceptible to iron deficiency anemia because of their increased blood volume and muscle mass during growth and development. This rises the need of iron for building up hemoglobin, the red pigment in the blood that carries oxygen and for the related protein; myoglobin in muscle. The increase in lean body mass (LBM) is more important in adolescent boys than girls. In pre-adolescent years, LBM is about the same for both sex. Once adolescent starts, however, the boy undergoes a more rapid accumulation of LBM for each additional kilogram of body weight gained during growth. The final LBM maximum value becomes double to that of girls. Other factors contributing to elevated iron needs are increased body weight and beginning of menstruation for girls. All these factors should be taken into account when assessing iron needs in this group of age.
Another important consideration during adolescence is increase in intake of iron rich food such as lean meat, fish, beans, dark green vegetables, nuts and iron fortified cereals and other grains. Iron from animal food is much better absorbed than iron from non-animal sources. Adolescents following vegetarian diet are therefore at increased risk of iron-deficiency. However, vitamin C from fruits and vegetables and animal protein assist in the good absorption of iron.
Calcium: the skeleton accounts for at least 99 % of the body stores of calcium and the gain in skeletal weight is most rapid during the adolescent growth. About 45 % of the adult skeletal mass is formed during adolescence, although its growth continues well beyond the adolescent period and into the third decade. All the calcium for the growth of the skeleton must be derived from the diet. The largest gains are made in early adolescence between about 10- 14 years in girls and 12 – 16 years in boys.
During peak adolescent growth, calcium retention is on average of about 200 mg/day in girls and 300 mg/day in boys. The efficiency of calcium absorption is around 30 %. Therefore, it is important that the diet supplies an adequate calcium intake to help built the dense bones as possible. The achievements of peak bone mass during childhood and adolescence is crucial to reduce the risk of osteoporosis in later years. By eating several servings of dairy products such as milk, yogurt and cheese, the recommended calcium intake can be achieved.
Along with calcium, good dietary supply of other vitamins (vitamin D) and minerals (phosphorous) are needed for building up bones. Physical activities is also essential, particularly weight bearing exercise which provides the stimulus to build and retain bone in the body. Activities such as cycling, gymnastics, dancing, ball games and supervised weight training for at least 30 – 60 minutes a day, three to five times a week can help build bone mass and density. Making the right dietary and lifestyle choices early in life will help young people adopt health promoting behaviors that they can follow throughout their life.
Name : Pratiksha Shrestha
Ms. Shrestha holds masters degree in food engineering and bioprocess technology from Asian Institute of Technology (AIT) Thailand. She is currently working for Government of Nepal at Department of Food Technology and Quality Control (DFTQC), Kathmandu. She is also a teaching faculty in College of Applied food and Dairy Technology (CAFODAT) affiliated to Purbanchal university, Nepal.