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,\tWashington\tDC,\t2009.\nDevelopment\tof\tfeeding\tskills\nAt\tbirth,\tinfants\tcoordinate\tsucking,\tswallowing,\tand\tbreathing,\tand\tare\tprepared\tto\tsuckle\tliquids\nfrom\tthe\tbreast\tor\tbottle\tbut\tare\n\tnot\table\tto\thandle\tfoods\twith\ttexture.\tDuring\tthe\tfirst\tyear,\ttypical
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infants\tdevelop\thead\tcontrol,\tthe\tability\tto\tmove\tinto\tand\tsustain\ta\tsitting\tposture,\tand\tthe\tability\tto\ngrasp,\tfirst\twith\ta\t\npalmar\tgrasp\n\tand\tthen\twith\ta\trefined\t\npincer\tgrasp\n\t(\nFig.\t15.1\n,\t\nB\n).\tThey\tdevelop\nmature\tsucking\tand\trotary\tchewing\tabilities\tand\tprogress\tfrom\tbeing\tfed\tto\tfeeding\tthemselves\nusing\ttheir\tfingers.\tIn\tthe
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] |
using\ttheir\tfingers.\tIn\tthe\n\tsecond\tyear,\tthey\tlearn\tto\tfeed\tthemselves\tindependently\twith\ta\tspoon\n(\nFig.\t15.2\n).
|
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] |
FIG.\t15.1\nDevelopment\tof\tfeeding\tskills\tin\tinfants\tand\ttoddlers.\nA,\n\tThis\t6\tmonth\told\tis\tshowing\thunger\tand\nreadiness\tfor\tthe\tnext\tbite\tby\tleaning\tinto\tthe\tspoon.\t\nB,\n\tThis\t8-month-old\tgirl\tis\tusing\ta\trefined\tpincer\tgrasp\tto\npick\tup\ther\tfood.\t\nC,\n\tThis\t19-month-old\tboy\tis\tbeginning\tto\tuse\this\tspoon\tindependently,\talthough\the\tis\tnot\tyet
|
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] |
FIG.\t15.2\nThis\t2-year-old\tis\tskilled\tat\tself-feeding\tbecause\the\thas\tthe\tability\tto\trotate\this\twrist\tand\nelevate\this\telbow\tto\tkeep\tfood\ton\tthe\tspoon.\nAddition\tof\tsemisolid\tfoods\nDevelopmental\treadiness\tand\tnutrient\tneeds\tare\tthe\tcriteria\tthat\tdetermine\tappropriate\ttimes\tfor
|
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] |
the\taddition\tof\tvarious\tfoods.\tDuring\tthe\tfirst\t4\tmonths\tof\tlife,\tthe\tinfant\tattains\thead\tand\tneck\ncontrol,\tand\toral\n\tmotor\tpatterns\tprogress\tfrom\ta\tsuck\tto\ta\tsuckling\tto\tthe\tbeginnings\tof\ta\tmature\nsucking\tpattern.\tFor\tthe\tfirst\t6\tmonths\tof\tlife,\tbreastmilk\tor\tinfant\tformula\tis\tadequate\tas\tthe\tsole\nsource\tof\tnutrition.\t\nTable\t15.6
|
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source\tof\tnutrition.\t\nTable\t15.6\n\tlists\tdevelopmental\tlandmarks\tand\ttheir\tindications\tfor\tsemisolid\tand\ntable\tfood\tintroduction.
|
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] |
Table\t15.6\nFeeding\tBehaviors:\tDevelopmental\tLandmarks\tDuring\tthe\tFirst\t2\tYears\tof\tLife\nDevelopmental\nLandmarks\nAge\n(MO)\nChange\nIndicated\nExamples\tof\tAppropriate\tFoods\nTongue\tlaterally\ntransfers\tfood\tin\nthe\tmouth\nShows\tvoluntary\nand\nindependent\nmovements\tof\nthe\ttongue\tand\nlips\nSitting\tposture\tcan\nbe\tsustained\nShows\tbeginning\nof\tchewing\nmovements\t(up
|
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0.06683755666017532,
0.06471797823905945,
0.019948642700910568
] |
be\tsustained\nShows\tbeginning\nof\tchewing\nmovements\t(up\nand\tdown\nmovements\tof\nthe\tjaw)\n6\nIntroduction\tof\nsoft,\tmashed\ntable\tfood\nCanned,\tboneless,\tskinless\tfish\tsuch\tas\tchunk\n\tlight\ntuna\tor\tsalmon\t(avoid\talbacore\ttuna\tfor\tmercury\ncontent);\tmashed\tpotatoes;\twell-cooked,\tmashed\nvegetables;\tground\tmeats\tin\tgravy\tand\tsauces;
|
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] |
vegetables;\tground\tmeats\tin\tgravy\tand\tsauces;\nmashed\tbeans\tor\tpieces\tof\ttofu;\tsoft,\tdiced\tfruit\nsuch\tas\tbananas,\tpeaches,\tand\tpears;\tyogurt\nReaches\tfor\tand\ngrasps\tobjects\nwith\tpalmar\ngrasp\nBrings\thand\tto\nmouth\n6-9\nFinger\tfeeding\n(large\tpieces\nof\tfood)\nOven-dried\ttoast,\tteething\tbiscuits\nApproximates\tlips\nto\trim\tof\tthe\ncup\n6-9\nIntroduction\tof
|
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] |
Approximates\tlips\nto\trim\tof\tthe\ncup\n6-9\nIntroduction\tof\ncup\tfor\nsipping\nliquids\nWater,\tbreastmilk,\tor\tinfant\tformula.\tJuice\tand\tcow’s\nmilk\tare\tnot\trecommended\tduring\tthe\tfirst\tyear.\nVoluntarily\nreleases\tfood\n(refined\tdigital\n[pincer]\tgrasp)\n9-12\nFinger\tfeeding\n(small\tpieces\nof\tfood)\nBits\tof\tcottage\tcheese,\tdry\tcereal,\tpeas,\tbeans,\tand
|
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of\tfood)\nBits\tof\tcottage\tcheese,\tdry\tcereal,\tpeas,\tbeans,\tand\nother\tbite-size\tvegetables;\tsmall\tpieces\tof\tmeat\nShows\n\trotary\nchewing\tpattern\n9-12\nIntroduction\tof\nfood\tof\tvaried\ntextures\tfrom\nfamily\tmenu\nWell-cooked,\tchopped\tmeats\tand\tcasseroles;\tcooked\nvegetables\tand\tcanned\tfruit\t(not\tmashed);\ttoast;
|
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] |
vegetables\tand\tcanned\tfruit\t(not\tmashed);\ttoast;\npotatoes;\tmacaroni,\tspaghetti;\tpeeled\tripe\tfruit\nUnderstands\nrelationship\tof\ncontainer\tand\nits\tcontents\n9-12\nBeginning\tof\nself-feeding\n(though\nmessiness\nshould\tbe\nexpected)\nFood\tthat\twhen\tscooped\tadheres\tto\tthe\n\tspoon,\tsuch\nas\tapplesauce,\tcooked\tcereal,\tporridge,\tmashed
|
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] |
spoon,\tsuch\nas\tapplesauce,\tcooked\tcereal,\tporridge,\tmashed\npotatoes,\tcottage\tcheese,\tyogurt\nShows\tincreased\nmovements\tof\nthe\tjaw\nShows\ndevelopment\tof\nulnar\tdeviation\nof\tthe\twrist\n12-18\nMore\tskilled\tat\ncup\tand\nspoon\tfeeding\nChopped\tfibrous\tmeats,\tsuch\tas\troast\tand\tsteak;\traw\nvegetables\tand\tfruit\t(introduced\tgradually)\nWalks\talone\n12-18
|
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vegetables\tand\tfruit\t(introduced\tgradually)\nWalks\talone\n12-18\nMay\tseek\tfood\nand\tobtain\nfood\nindependently\nMixed\ttextures,\n\tfood\tfrom\tthe\tfamily\tmeal;\tfoods\tof\nhigh\tnutritional\tvalue\nNames\tfood,\nexpresses\npreferences;\nprefers\tunmixed\nfoods\nGoes\ton\tfood\tjags\nAppetite\tappears\nto\tdecrease\n18-24\nBalanced\tfood\tchoices,\twith\tchild\tpermitted\tto
|
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0.020666642114520073,
0.03348070755600929,
0.055965930223464966,
0.0710691511631012,
0.008155692368745804
] |
to\tdecrease\n18-24\nBalanced\tfood\tchoices,\twith\tchild\tpermitted\tto\ndevelop\tfood\tpreferences\t(parents\tshould\tnot\tbe\nconcerned\tthat\tthese\tpreferences\twill\tlast\tforever)\nModified\tfrom\tTrahms\tCM,\tPipes\tP:\t\nNutrition\tin\tinfancy\tand\tchildhood\n,\ted\t6,\tNew\tYork,\t1997,\tMcGraw-Hill.
|
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] |
,\ted\t6,\tNew\tYork,\t1997,\tMcGraw-Hill.\nAround\t6\tmonths\tof\tage,\twhen\tthe\tmature\tsucking\tmovement\tis\trefined\tand\tmunching\tmovements\n(up-and-down\tchomping\tmotions)\tbegin,\tthe\tintroduction\tof\tstrained\tor\tpureed\tfoods\tis\tappropriate.\nTo\tsupport\tdevelopmental\tprogress,\tpureed\tfood\tis\toffered\tto\tthe\tinfant\tfrom\ta\tspoon,\tnot\tcombined
|
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] |
with\tformula\tin\ta\tbottle\tand\tnot\tdirectly\tfrom\ta\tsqueezable\tpouch\t(see\n\t\nFig.\t15.1\n,\t\nA\n).\tThe\tsequence\tin\nwhich\tthese\tfoods\tare\tintroduced\tis\tnot\timportant;\thowever,\tit\tis\timportant\tthat\tone\tsingle\tingredient\nfood\t(e.g.,\tpeaches,\tnot\tpeach\tyogurt,\twhich\thas\tmany\tingredients)\tbe\tintroduced\tat\ta\ttime.
|
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] |
Introducing\ta\tsingle\tnew\tfood\tat\ta\ttime\tat\t2-\tto\t7-day\tintervals\tenables\tparents\tto\tidentify\tany
|
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allergic\tresponses\tor\tfood\tintolerances.\tIntroducing\tvegetables\tbefore\tfruits\n\tmay\tincrease\tvegetable\nacceptance.\tFoods\tintroduced\tmay\tvary\tdepending\ton\tcountry\tof\torigin\tand\tculture\tof\tthe\tfamily.\nInfants\tdemonstrate\ttheir\tacceptance\tof\tnew\tfoods\tby\tslowly\tincreasing\tthe\tvariety\tand\tquantity\tof
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solids\tthey\taccept.\tBreastfed\tinfants\tseem\tto\taccept\tgreater\tflavor\tvarieties\tthan\tdo\tformula-fed\ninfants\t(\nHarris\tand\tCoulthard,\t2016\n).\tParents\twho\tthoughtfully\toffer\ta\tvariety\n\tof\tnourishing\tfoods\nare\tmore\tlikely\tto\tprovide\ta\twell-balanced\tdiet\tand\thelp\ttheir\tchildren\tlearn\tto\taccept\tmore\tflavors.
|
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As\toral-motor\tmaturation\tproceeds,\tan\tinfant’s\trotary\tchewing\tability\tdevelops,\tindicating\ta\nreadiness\tfor\tmore\ttextured\tfoods\tsuch\tas\twell-cooked\tmashed\tvegetables,\tcasseroles,\tand\tpasta\nfrom\tthe\tfamily\tmenu.\tLearning\tto\tgrasp—with\tthe\tpalmar\tgrasp,\tthen\twith\tan\tinferior\n\tpincer\tgrasp,
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] |
pincer\tgrasp,\nand\tfinally\twith\tthe\trefined\tpincer\tgrasp—indicates\ta\treadiness\tfor\tfinger\tfoods\tsuch\tas\toven-dried\ntoast\tor\tarrowroot\tbiscuits\t(see\t\nFig.\t15.1\n,\t\nB\n).\t\nTable\t15.6\n\tpresents\trecommendations\tfor\tadding\tfoods\nto\tan\tinfant’s\tdiet.\tFoods\twith\tskins\tor\trinds\tand\tfoods\tthat\tstick\tto\tthe\troof\tof\tthe\tmouth\t(e.g.,\thot
|
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families\tstrictly\toffer\tfinger\tfoods\twhereas\tothers\tchoose\tto\toffer\ta\tcombination\tof\tfinger\tfoods\tand\npurees\tfrom\ta\tspoon.\tWith\tcareful\tattention\tto\tthe\tinfant’s\tdevelopmental\treadiness\tand\tthe\tfood’s\ntexture\tand\tnutrition\tcontent,\tinfants\tfed\twith\tbaby-led\tweaning\tcan\tachieve\tappropriate\tgrowth,\nmeet\tnutrition\tneeds,\tand\tavoid\tchoking\t(
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] |
meet\tnutrition\tneeds,\tand\tavoid\tchoking\t(\nTaylor\tet\tal,\t2017\n).\tSee\t\nBox\t15.2\n\tfor\tmore\ton\tbaby-led\nweaning.\nBox\t15.2\nBaby-Led\tWeaning\nBaby-led\tweaning\tis\ta\tphilosophy\twhich\tpromotes\tinfants\tself-feeding\tall\tcomplementary\tfoods.\nInfants\tappropriate\tfor\tthis\tare\table\tto\tsit\tunassisted,\thave\ta\tpalmar\n\tgrasp,\tand\tbring\tfood\tto\ttheir
|
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] |
grasp,\tand\tbring\tfood\tto\ttheir\nmouth,\twhich\toften\thappens\taround\t6\tmonths\tof\tage.\nSpecial\tattention\tshould\tbe\tpaid\tto\tminimize\tchoking\trisk,\tand\tto\tensure\tthe\tinfant\tmeets\nenergy\tand\tnutrient\tneeds,\tspecifically\tiron.\tSome\tgeneral\tguidelines\tfor\tbaby-led\tweaning\ninclude:\n•
|
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include:\n•\t\nFoods\tshould\tbe\tmashable\tbetween\ttongue\tand\troof\tof\tthe\tmouth\tor\ttough\tenough\tthat\tthey\ndo\tnot\tbreak\toff,\tsuch\tas\tstrips\n\tof\tmeat\n•\t\nDo\tnot\toffer\tfoods\tthat\tform\ta\tcrumb\tin\tmouth\n•\t\nFoods\tshould\tbe\tas\tlong\tas\tinfant’s\tfist,\tat\tleast\ton\tone\tside\n•\t\nInfants\tshould\tbe\tsitting\tupright\tand\talways\tsupervised\n•
|
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•\t\nInfants\tshould\tbe\tsitting\tupright\tand\talways\tsupervised\n•\t\nNever\tplace\tan\tentire\tfood\tinto\tthe\tinfant’s\tmouth.\tInfants\tshould\tcontrol\thow\tmuch\tfood\nthey\tput\tinto\ttheir\tmouth.\n•\t\nOffer\tthe\tfollowing\tfoods\tat\teach\tmeal:\n•\t\nIron-rich\tfood\n•\t\nEnergy-rich\tfood\n•\t\nFruit\tor\n\tvegetable\n•
|
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] |
•\t\nIron-rich\tfood\n•\t\nEnergy-rich\tfood\n•\t\nFruit\tor\n\tvegetable\n•\t\nWhen\tan\tinfant\tis\till,\tincrease\tbreastmilk\tor\tformula\tfeeding\tfrequency\tand\toffer\tfoods\tthat\ninfant\tcan\teasily\teat.\nAlthough\tbaby-led\tweaning\thas\tbeen\tpromoted\tas\tdecreasing\trisk\tof\tchildhood\toverweight
|
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] |
because\tinfants\tlearn\tto\tself-regulate\ttheir\tintakes\tbetter,\tstudies\thave\tnot\tsupported\tthis\tclaim.\nModified\tfrom\tTaylor\tRW,\tWilliams\tSM,\tFangupo\tLJ,\tet\tal:\tEffect\tof\ta\tbaby-led\n\tapproach\tto\tcomplementary\nfeeding\ton\tinfant\tgrowth\tand\toverweight:\ta\trandomized\tclinical\ttrial,\t\nJAMA\n\tPediatr\t171:838–846,\t2017.
|
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] |
JAMA\n\tPediatr\t171:838–846,\t2017.\nDuring\tthe\tlast\tquarter\tof\tthe\tfirst\tyear,\tinfants\tcan\tapproximate\ttheir\tlips\tto\tthe\trim\tof\tthe\tcup\tand\ncan\tdrink\tif\tthe\tcup\tis\theld\tfor\tthem.\tDuring\tthe\tsecond\tyear\tthey\tgain\tthe\tability\tto\trotate\ttheir\nwrists\tand\televate\ttheir\telbows,\tthus\tallowing\tthem\tto\thold\n\tthe\tcup\tthemselves\tand\tmanage\ta\tspoon\n(see
|
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] |
the\tcup\tthemselves\tand\tmanage\ta\tspoon\n(see\t\nFig.\t15.1\n,\t\nC\n).\tThey\tare\tvery\tmessy\teaters\tat\tfirst\t(\nFig.\t15.3\n),\tbut\tby\t2\tyears\tof\tage\tmost\ttypical\nchildren\tskillfully\tfeed\tthemselves\t(see\t\nFig.\t15.2\n).
|
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] |
FIG.\t15.3\nThis\t14-month-old\tgirl\tis\tlearning\tto\tself-feed;\tit’s\tnormal\tto\tbe\tmessy.\nWeaning\tfrom\tbreast\tor\tbottle\tto\tcup\nThe\tintroduction\tof\tsolids\tinto\tan\tinfant’s\tdiet\tbegins\tthe\tweaning\tprocess\tin\twhich\tthe\tinfant\ntransitions\tfrom\ta\tdiet\tof\tonly\tbreastmilk\tor\tformula\tto\ta\tmore\tvaried\tone.\tWeaning\tshould\tproceed
|
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] |
gradually\tand\tbe\tbased\ton\tthe\tinfant’s\trate\tof\tgrowth\tand\tdevelopmental\n\tskills.\tWeaning\tfoods\nshould\tbe\tchosen\tcarefully\tto\tcomplement\tthe\tnutrient\tneeds\tof\tthe\tinfant,\tpromote\tappropriate\nnutrient\tintake,\tand\tmaintain\tgrowth.\nMany\tinfants\tbegin\tthe\tprocess\tof\tweaning\twith\tthe\tintroduction\tof\tthe\tcup\tat\tapproximately\t6\tto\t9
|
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months\tof\tage\tand\tcomplete\tthe\tprocess\twhen\tthey\tare\table\tto\tingest\tan\tadequate\tamount\tof\tmilk\tor\nformula\tfrom\ta\tcup\tat\t18\tto\t24\tmonths\tof\tage.\n\tParents\tof\tinfants\twho\tare\tbreastfed\tmay\tchoose\tto\ntransition\tthe\tinfant\tdirectly\tto\ta\tcup\tor\thave\tan\tintermittent\ttransition\tto\ta\tbottle\tbefore\tthe\tcup\tis\nintroduced.\nEarly\tchildhood\tcaries
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] |
introduced.\nEarly\tchildhood\tcaries\nDental\tcaries\tis\tthe\tmost\tcommon\tchronic\tdisease\tof\tchildhood\t(\nAAP,\t2014c\n).\t\nEarly\tchildhood\ncaries\t(ECC)\n,\tor\t“baby\tbottle\ttooth\tdecay”\tis\ta\tpattern\tof\ttooth\tdecay\tthat\tinvolves\tthe\tupper\nanterior\tand\tsometimes\n\tlower\tposterior\tteeth.\tECC\tis\tcommon\tamong\tinfants\tand\tchildren\twho\tare
|
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] |
allowed\tto\tbathe\ttheir\tteeth\tin\tsugar\t(sucrose\tor\tlactose)\tthroughout\tthe\tday\tand\tnight.\tIf\tinfants\tare\ngiven\tsugar-sweetened\tbeverages\tor\tfruit\tjuice\tin\ta\tbottle\tduring\tthe\tday\tor\tat\tbedtime\tafter\tteeth\nhave\terupted,\tthe\trisk\tof\tdental\tcaries\tincreases\t(see\t\nChapter\t24\n).\nTo\tpromote\tdental\thealth,\tinfants\tshould\tbe\tfed\tand
|
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] |
Chapter\t24\n).\nTo\tpromote\tdental\thealth,\tinfants\tshould\tbe\tfed\tand\n\tburped\tand\tthen\tput\tto\tbed\twithout\tmilk\tor\nfood.\tJuice\tshould\tnot\tbe\tintroduced\tinto\tthe\tdiet\tbefore\t12\tmonths\tof\tage\tunless\tclinically\tindicated.\nJuice\tshould\tbe\tlimited\tto,\tat\tmost,\t4\toz/day\tfor\ttoddlers\t1\tthrough\t3\tyears\tof\tage\tand\tonly\toffered\nfrom\ta\tcup\t(
|
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] |
from\ta\tcup\t(\nHeyman\tand\tAbrams,\t2017\n).\tParents\tand\tcaregivers\tcan\tbe\ttaught\teffective\toral\thealth\npractices\tfor\tinfants,\tnot\tonly\tby\tdentists\tbut\talso\n\tby\tother\tparaprofessionals\t(\nEdelstein,\t2017\n).\nFeeding\tolder\tinfants\nTypically\tdeveloping\tchildren\thave\ta\tnatural\tability\tto\teat.\tThey\teat\tas\tmuch\tas\tthey\tneed,\tthey\tgrow
|
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] |
in\tthe\tway\tthat\tis\tright\tfor\tthem,\tand\tthey\tlearn\tto\teat\tthe\tfoods\ttheir\tparents\teat.\tAs\tinfants\ntransition\ttoward\tfamily\tfood,\tthe\tparent\tis\tresponsible\tfor\twhat\tis\toffered\tand\twhen\tand\twhere\tthey\neat.\tThe\tchild\tis\tresponsible\n\tfor\thow\tmuch\tand\twhether\tto\teat\tthe\tfoods\tthat\tare\toffered.\tThis\tis
|
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for\thow\tmuch\tand\twhether\tto\teat\tthe\tfoods\tthat\tare\toffered.\tThis\tis\nknown\tas\tthe\tdivision\tof\tresponsibility\tin\tfeeding\tproposed\tby\tthe\tSatter\tFeeding\tDynamics\tModel.\nBased\ton\twhat\tthe\tchild\tcan\tdo,\tnot\ton\thow\told\tthey\tare,\tparents\tguide\ttheir\tchildren\tthrough
|
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] |
transitions\tfrom\tnipple\tfeeding\tas\ta\tyoung\tinfant\tto\teventually\teating\ttable\tfoods\tat\tfamily\tmeals\n(\nSatter,\t2000\n).\t\nTable\t15.6\n\thighlights\n\tappropriate\tfeeding\tbased\ton\tdevelopmental\tlandmarks.\nAs\tmaturation\tproceeds\tand\tthe\trate\tof\tgrowth\tslows\tdown,\tinfants’\tinterest\tin\tand\tapproach\tto
|
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food\tchanges.\tBetween\t9\tand\t18\tmonths\tof\tage\tmost\treduce\ttheir\tbreastmilk\tor\tformula\tintake.\tThey\ncan\tbecome\tfinicky\tabout\twhat\tand\thow\tmuch\tthey\teat.\nIn\tthe\tweaning\tstage\tinfants\thave\tto\tlearn\tmany\tskills,\tincluding\tthe\tability\tto\tchew\tand\tswallow
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solid\tfood\tand\tuse\tutensils.\tThey\tlearn\tto\ttolerate\tvarious\ttextures\tand\tflavors\tof\tfood,\teat\twith\ttheir\nfingers,\tand\tthen\tfeed\tthemselves\twith\ta\tutensil.\tVery\tyoung\tchildren\tshould\tbe\tencouraged\tto\tfeed\nthemselves\t(see\t\nClinical\tInsight:\n\tA\tLook\tat\tthe\tFood\tPractices\tof\tInfants\tand\tToddlers\n).\nCLINICAL\tINSIGHT
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] |
•\t\nAssuming\tthat\ta\tvariety\tof\tnutritious\tfoods\tare\toffered\tto\tinfants\tand\ttoddlers,\tparents\tand\ncaregivers\tshould\tencourage\tself-feeding\twithout\tconcern\tfor\tcompromising\tenergy\tintake\nand\tnutrient\tadequacy\t(\nCarruth\tet\tal,\t2004b\n).\n•\t\nParents\tand\tcaregivers\tshould\toffer\ta\tvariety\n\tof\tfruits\tand\tvegetables\tdaily;\tsweets,\tdesserts,
|
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of\tfruits\tand\tvegetables\tdaily;\tsweets,\tdesserts,\nsweetened\tbeverages,\tand\tsalty\tsnacks\tshould\tbe\toffered\tonly\toccasionally.\tBecause\tfamily\nfood\tchoices\tinfluence\tthe\tfoods\toffered\tto\tinfants,\tfamily-based\tapproaches\tto\thealthy\neating\thabits\tshould\tbe\tencouraged\t(\nFox\tet\tal,\t2004\n).\n•
|
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] |
eating\thabits\tshould\tbe\tencouraged\t(\nFox\tet\tal,\t2004\n).\n•\t\nBy\t24\tmonths\tof\tage,\t50%\tof\ttoddlers\twere\tdescribed\tas\tpicky\teaters.\tWhen\toffering\ta\tnew\nfood,\tcaregivers\tmust\n\tbe\twilling\tto\tprovide\t8\tto\t15\trepeated\texposures\tto\tenhance\nacceptance\tof\tthat\tfood\t(\nCarruth\tet\tal,\t2004a\n).\n•
|
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acceptance\tof\tthat\tfood\t(\nCarruth\tet\tal,\t2004a\n).\n•\t\nInfants\tand\ttoddlers\thave\tan\tinnate\tability\tto\tregulate\tenergy\tintake.\tParents\tand\tcaregivers\nshould\tunderstand\tthe\tcues\tof\thunger\tand\tsatiety\tand\trecognize\tthat\tcoercive\tadmonitions\nabout\teating\tmore\tor\tless\tfood\tcan\tinterfere\twith\tthe\tinfant’s\tor\ttoddler’s\tinnate\tability\tto\nregulate
|
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] |
regulate\n\tenergy\tintake\t(\nFox\tet\tal,\t2006\n).\n•\t\nOn\taverage,\tinfants\tand\ttoddlers\twere\tfed\tseven\ttimes\tper\tday,\tand\tthe\tpercentage\tof\nchildren\treported\tto\tbe\teating\tsnacks\tincreased\twith\tage.\tSnack\tchoices\tfor\tinfants\tand\ntoddlers\tcould\tbe\timproved\tby\tdelaying\tthe\tintroduction\tof\tand\tlimiting\tfoods\tthat\thave\ta\tlow
|
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] |
nutrient\tcontent\tand\tare\tenergy\tdense\t(\nSkinner\tet\tal,\t2004\n).\nAt\tthe\tbeginning\tof\ta\tmeal,\n\tchildren\tare\thungry\tand\tshould\tbe\tallowed\tto\tfeed\tthemselves;\twhen\nthey\tbecome\ttired,\tthey\tcan\tbe\thelped\tquietly.\tEmphasis\ton\ttable\tmanners\tand\tthe\tfine\tpoints\tof
|
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] |
eating\tshould\tbe\tdelayed\tuntil\tthey\thave\tthe\tnecessary\tmaturity\tand\tdevelopmental\treadiness\tfor\nsuch\ttraining.\nThe\tfood\tshould\tbe\tin\ta\tform\tthat\tis\teasy\tto\thandle\tand\teat.\tMeat\tshould\tbe\tcut\tinto\tbite-size\npieces.\tPotatoes\tand\tvegetables\n\tshould\tbe\tmashed\tso\tthat\tthey\tcan\tbe\teaten\teasily\twith\ta\tspoon.
|
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] |
should\tbe\tmashed\tso\tthat\tthey\tcan\tbe\teaten\teasily\twith\ta\tspoon.\nRaw\tfruits\tand\tvegetables\tshould\tbe\tin\tsizes\tthat\tcan\tbe\tpicked\tup\teasily.\tIn\taddition,\tthe\tutensils\nshould\tbe\tsmall\tand\tmanageable.\tCups\tshould\tbe\teasy\tto\thold,\tand\tdishes\tshould\tbe\tdesigned\tso\tthat\nthey\tdo\tnot\ttip\tover\teasily.\nType\tof\tfood
|
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they\tdo\tnot\ttip\tover\teasily.\nType\tof\tfood\nIn\tgeneral,\tchildren\tprefer\tsimple,\tuncomplicated\tfoods.\tFood\tfrom\tthe\tfamily\tmeal\tcan\n\tbe\tadapted\nfor\tthe\tchild\tand\tserved\tin\tchild-size\tportions.\tChildren\tyounger\tthan\t6\tyears\tof\tage\tusually\tprefer\nmild-flavored\tfoods.\tBecause\ta\tyoung\tchild’s\tstomach\tis\tsmall,\ta\tsnack\tmay\tbe\trequired\tbetween
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meals.\tChildren\tages\t2\tto\t6\tyears\toften\tprefer\traw\tinstead\tof\tcooked\tvegetables\tand\tfruits.\nInfants\tshould\tbe\toffered\tfoods\tthat\tvary\tin\ttexture\tand\tflavor.\tInfants\twho\tare\taccustomed\tto\nmany\n\tkinds\tof\tfoods\tare\tless\tlikely\tto\tlimit\ttheir\tvariety\tof\tfood\tchoices\tlater.\tTo\tadd\tvariety\tto\tan
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offer\tsmall\nportions\tof\tthese\tfoods\twithout\tcomment,\tinfants\tbecome\tfamiliar\twith\tthem\tand\toften\taccept\tthem.\nIt\tmay\ttake\t8\tto\t15\trepeated\texposures\tbefore\tacceptance\tof\tthe\tfood\t(\nCarruth\tet\tal,\t2004a\n).\tIt\tis\nimportant\tthat\tfruit\tjuice\tdoes\tnot\treplace\tmore\tnutrient-dense\tfoods.\tIf\texcessive\tamounts\tof\tjuice
|
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are\tconsumed,\tchildren\tmay\tfail\tto\tthrive.\nServing\tsize\nThe\tsize\tof\ta\tserving\tof\tfood\n\toffered\tto\ta\tchild\tis\tvery\timportant.\tAt\t1\tyear\tof\tage\tinfants\teat\tone\nthird\tto\tone\thalf\tthe\tamount\tan\tadult\tnormally\tconsumes.\tThis\tproportion\tincreases\tto\tone\thalf\tan
|
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] |
adult\tportion\tby\tthe\ttime\tthe\tchild\treaches\t3\tyears\tof\tage\tand\tincreases\tto\tabout\ttwo\tthirds\tby\t6\nyears\tof\tage.\tYoung\tchildren\tshould\tnot\tbe\tserved\ta\tlarge\tplateful\tof\tfood;\tthe\tsize\tof\tthe\tplate\tand\nthe\tamount\tshould\tbe\tin\tproportion\n\tto\ttheir\tage.\tA\ttablespoon\t(not\ta\theaping\ttablespoon)\tof\teach
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] |
to\ttheir\tage.\tA\ttablespoon\t(not\ta\theaping\ttablespoon)\tof\teach\nfood\tfor\teach\tyear\tof\tage\tis\ta\tgood\tguide\tto\tfollow.\tServing\tless\tfood\tthan\tparents\tthink\tor\thope\twill\nbe\teaten\thelps\tchildren\teat\tsuccessfully\tand\thappily.\tThey\twill\task\tfor\tmore\tfood\tif\ttheir\tappetite\tis
|
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] |
not\tsatisfied.\tAs\tsoon\tas\tthey\tare\table,\tencourage\tyoung\tchildren\tto\tserve\tthemselves.\nForced\tfeeding\nChildren\tshould\tnot\tbe\n\tforced\tto\teat;\tinstead,\tthe\tcause\tfor\tthe\tunwillingness\tto\teat\tshould\tbe\ndetermined.\tA\ttypical,\thealthy\tchild\teats\twithout\tcoaxing.\tChildren\tmay\trefuse\tfood\tbecause\tthey\tare
|
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may\trefuse\tit.\nParents\twho\tsupport\tthe\tdevelopment\tof\tself-feeding\tskills\trespond\tto\tthe\tinfant’s\tneed\tfor\nassistance\tand\toffer\tencouragement\tfor\tself-feeding;\tthey\talso\tallow\tthe\tinfant\tto\tinitiate\tand\tguide\nfeeding\tinteractions\twithout\tpressure\ton\tthe\tinfant\tfor\tneatness\tin\tself-feeding\tor\tamount\tof\tfood\nconsumed.\tIf\ta
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consumed.\tIf\ta\n\tchild\trefuses\tto\teat,\tthe\tfamily\tmeal\tshould\tbe\tcompleted\twithout\tcomment,\tand\tthe\nplate\tshould\tbe\tremoved.\tThis\tprocedure\tis\tusually\tharder\ton\tthe\tparent\tthan\ton\tthe\tchild.\tAt\tthe\nnext\tmealtime,\tthe\tchild\twill\tbe\thungry\tenough\tto\tenjoy\tthe\tfood\tpresented.\nEating\tenvironment
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Eating\tenvironment\nYoung\tchildren\tshould\teat\ttheir\tmeals\tat\tthe\tfamily\ttable;\tit\tgives\tthem\tan\topportunity\tto\tlearn\ttable\nmanners\twhile\n\tenjoying\tmeals\twith\ta\tfamily\tgroup.\tSharing\tthe\tfamily\tfare\tstrengthens\tties\tand\nmakes\tmealtime\tpleasant.\tHowever,\tif\tthe\tfamily\tmeal\tis\tdelayed,\tthe\tchildren\tshould\treceive\ttheir
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] |
child.\tHe\twas\treferred\tto\tsee\ta\tregistered\tdietitian\tnutritionist\t(RDN)\tdue\tto\tparents’\tconcerns\nabout\this\tgrowth\tand\tthat\the\t“isn’t\teating\tenough.”\nAssessment\nArvan\twas\n\tbreastfed\tfrom\tbirth\tuntil\t6\tmonths\tof\tage.\tHis\tmother\tsays\ther\tmilk\tsupply\tdecreased
|
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] |
after\treturning\tto\twork,\tso\tshe\tbegan\tsupplementing\twith\tstandard\tinfant\tformula.\tShe\tsays\tthat\nArvan\twould\tnot\tfinish\ta\tbottle\ton\this\town\tso\thad\tto\tbe\tforce-fed.\nSolids\twere\tintroduced\tat\t6\tmonths\tof\tage.\tArvan’s\tmother\tstarted\twith\tragi\t(finger\tmillet)\nmixed\twith\tformula.\tShe\tsays\tthat\tArvan\twould\teat\tonly
|
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mixed\twith\tformula.\tShe\tsays\tthat\tArvan\twould\teat\tonly\n\ta\tlittle\tbit,\tso\tagain\thad\tto\tbe\tforce-fed\nwith\ta\tlot\tof\tdistractions\tso\the\twould\t“eat\tenough.”\nArvan’s\tmother\tsays\tthat\the\tis\tno\tlonger\tbreastfed,\tand\tthat\tshe\tand\this\tgrandparents\thave\tto\nchase\thim\taround\tthe\thouse\tto\tget\thim\tto\tfinish\ta\tbottle\tof\tformula.\tLately,\tthe\tdistraction\tfeeding
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] |
has\tnot\tbeen\tworking,\tand\tArvan\trefuses\tto\topen\this\tmouth\tafter\tonly\ttaking\ta\tfew\tbites\tof\tfood.\nShe\tsays\n\tthat\tparents\tor\tgrandparents\tfeed\thim\tall\tmeals,\tand\tthat\tshe\therself\twas\tfed\tuntil\tshe\nwas\t3\tyears\tof\tage.\tShe\tsays\tthat\tArvan\toften\twill\ttry\tto\tgrab\tthe\tspoon,\tbut\tthe\tfamily\tdoes\tnot\nlet\thim\tfeed\thimself\tbecause\tit\tcreates\ta\tmess.
|
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] |
let\thim\tfeed\thimself\tbecause\tit\tcreates\ta\tmess.\nArvan’s\tmother\tdescribes\ta\ttypical\tday\tas\tthe\tfollowing.\tShe\tsays\tall\tmeals\ttake\tclose\tto\tan\thour\nand\tinvolve\tdistractions,\tcoaxing,\tand\tsometimes\tforcing:\n7\n\tam:\t8\toz.\tof\tformula\toffered,\tusually\tfinishes\tall\t8\toz.
|
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7\n\tam:\t8\toz.\tof\tformula\toffered,\tusually\tfinishes\tall\t8\toz.\n9\tam:\tParent\tor\tgrandparent\toffers\t2\tidlis\t(lentil\tand\trice\tcake)\tand\t½\tlarge\tbanana.\tArvan\neats\t1\tidli\tand\t¼\tbanana.\n11:30\tam:\t8\toz.\tof\tformula\toffered,\tfinishes\tabout\t6\toz.\nNap\n1:30\tpm:\tParent\tor\tgrandparent\toffers\t½\tcup\tdalia\t(bulgur)\tporridge\twith\tmilk,\tsugar,\tghee
|
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(clarified\tbutter),\tand\tground\tnuts.\tArvan\teats\tabout\t3\ttablespoons.\n3:30\tpm:\t8\toz.\tof\tformula\tof\toffered,\tfinishes\tabout\t6\toz.\n6:00\tpm:\tParent\tor\tgrandparent\toffers\t½\tcup\tvegetable\tkhichadi\t(peas,\tpotatoes,\trice,\tlentils).\nArvan\teats\tabout\t¼\tcup.\n8:00\tpm:\t8\toz.\tof\tformula\toffered,\tfinishes\tabout\t6\toz.
|
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] |
8:00\tpm:\t8\toz.\tof\tformula\toffered,\tfinishes\tabout\t6\toz.\nDiet\tanalysis:\t700\tkcal,\t17\tg\tprotein,\t500\tmg\tcalcium,\t300\tIU\tvitamin\tD,\t11\tmg\tiron\nAnthropometrics:\nWeight\t(without\tclothes\tor\tdiaper):\t9.2\tkg\t(∼50th\tpercentile)\nLength:\t77.0\tcm\t(∼95th\tpercentile)\nWeight-for-length:\tbetween\t10th\tand\t25th\tpercentiles
|
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Weight-for-length:\tbetween\t10th\tand\t25th\tpercentiles\nGrowth\thistory:\tArvan’s\tweight\twas\tfollowing\taround\tthe\t75th\tpercentile\tfrom\tbirth\tuntil\t6\nmonths\tof\tage.\tAt\this\t9-month\twell-child\tvisit,\this\tweight\tpercentile\thad\tdecreased\tto\tabout\nthe\t50th\tpercentile.\tHis\tlength\thas\tconsistently\tfollowed\taround\tthe\t95th\tpercentile\tsince
|
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birth.\tA\tvery\tgradual\tdecrease\n\tin\tweight-for-length\tpercentiles\tfrom\tthe\t25th\tpercentile\tat\nbirth\tis\tnoted.\nSupplements/medications:\tNone\nLaboratories:\tNone\nEstimated\tneeds:\t740\tkcal,\t14\tg\tprotein,\t260\tmg\tcalcium,\t400\tIU\tvitamin\tD,\t11\tmg\tiron\nNutrition\tdiagnostic\tstatements\n•
|
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Nutrition\tdiagnostic\tstatements\n•\t\nInadequate\tenergy\tintake\trelated\tto\tdiscordant\tfeeding\trelationship\tas\tevidenced\tby\thistory\nof\tforce-feeding,\tgradual\tdecline\tin\tweight-for-length\n\tpercentile,\tand\tintakes\tbelow\nestimated\tneeds.\n•\t\nInadequate\tvitamin\tD\trelated\tto\tfood\tand\tnutrition\tknowledge\tdeficit\tabout\tdietary\tsources
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of\tvitamin\tD\tand\tinadequate\tfood\tintake\tas\tevidenced\tby\tvitamin\tD\tintake\tbelow\tthe\tAI\tof\n400\tIU/d.\nIntervention\n•\t\nCommend\tArvan’s\tmother\ton\tproviding\ta\tstructured\tmeal\tschedule\tand\toffering\tnutrition-\nrich,\tage-appropriate\tfoods,\tand\tencourage\ther\n\tto\tcontinue\tdoing\tso.\n•
|
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to\tcontinue\tdoing\tso.\n•\t\nCounsel\tArvan’s\tmother\tabout\ttypical\tinfant\tserving\tsizes\tand\tsuggest\toffering\thim\tsmaller\nportions\tat\tthe\tbeginning\tof\tmeals.\tEncourage\tArvan\tto\tbe\tthe\tone\tto\tdictate\thow\tmuch\tor\nhow\tlittle\the\twill\teat.\n•\t\nExplore\twith\tArvan’s\tmother\tways\tto\thelp\tArvan\tdevelop\this\tself-feeding\tskills\twhile
|
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] |
minimizing\tmess.\tFinger\tfoods,\tdrop-mats,\tremove\tclothes\tduring\tmealtimes,\tetc.\n\tPoint\tout\nthat\tArvan\tis\tasserting\this\tdesire\tto\tfeed\thimself\tby\tgrabbing\tthe\tspoon\tand\trefusing\tto\tbe\nfed\tby\tothers.\n•\t\nEducate\tArvan’s\tmother\tabout\tinfant\thunger\tand\tfullness\tcues\tand\thow\tto\trespect\tthose
|
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16\nNutrition\tin\tchildhood\nBeth\tOgata,\tMS,\tRDN,\tCD,\tCSP,\tSharon\tA.\tFeucht,\tMA,\tRDN,\tCD\nKEY\tTERMS\nadiposity\trebound\ncatch-up\tgrowth\nfailure\tto\tthrive\t(FTT)\nfood\tjags\ngrowth\tchannels\ngrowth\tdeficiency\npediatric\tundernutrition\nprimarily\twasted\nstunted\tgrowth
|
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] |
pediatric\tundernutrition\nprimarily\twasted\nstunted\tgrowth\nThe\tperiod\tthat\tbegins\tafter\tinfancy\tand\tlasts\tuntil\tpuberty\toften\tis\treferred\tto\tas\tthe\tlatent\tor\nquiescent\tperiod\n\tof\tgrowth—a\tcontrast\tto\tthe\tdramatic\tchanges\tthat\toccur\tduring\tinfancy\tand\nadolescence.\tAlthough\tphysical\tgrowth\tmay\tbe\tless\tremarkable\tand\tproceed\tat\ta\tsteadier\tpace\tthan
|
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] |
it\tdid\tduring\tthe\tfirst\tyear,\tthese\tpreschool\tand\telementary\tschool\tyears\tare\ta\ttime\tof\tsignificant\ngrowth\tin\tthe\tsocial,\tcognitive,\tand\temotional\tareas.\nGrowth\tand\tdevelopment\nGrowth\tpatterns\nThe\trate\tof\tgrowth\tslows\n\tconsiderably\tafter\tthe\tfirst\tyear\tof\tlife.\tIncrements\tof\tchange\tare\tsmall
|
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] |
compared\twith\tthose\tof\tinfancy\tand\tadolescence.\tWeight\ttypically\tincreases\tan\taverage\tof\t1.6\tto\t3.9\nkg\t(3½\tlb\tat\tage\t2\tyears\tto\t8\t½\tlb\tfor\tboys\t10\tto\t11\tyears)\tper\tyear\twith\tonly\tslight\tdifferences\nbetween\teach\tsex.\tGirls\tgenerally\tincrease\ttheir\trate\tof\tgain\tbetween\t10\tand\t11\tyears,\twith\tboys\nstarting\tbetween\t11\tand\t12\tyears
|
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] |
starting\tbetween\t11\tand\t12\tyears\n\tof\tage,\tsignaling\tthe\tapproach\tof\tpuberty.\tHeight\tincrease\nincrements\taverage\t5\tto\t9\tcm\t(2\tto\t3½\tinches)\tper\tyear\twith\tlower\tincreases\tin\tlate\tchildhood\tuntil\nthe\tindividual\tgrowth\tspurt\tseen\tin\tpuberty\t(\nCenters\tfor\tDisease\tControl\tand\tPrevention\t[CDC\n2017]
|
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] |
Centers\tfor\tDisease\tControl\tand\tPrevention\t[CDC\n2017]\n).\tWhile\tgrowth\tis\tgenerally\tsteady\tduring\tthe\tpreschool\tand\tschool\tage\tyears,\tit\tcan\tbe\terratic\nin\tindividual\tchildren,\twith\tperiods\tof\tno\n\tgrowth\tfollowed\tby\tgrowth\tspurts.\tThese\tpatterns\tusually\nparallel\tsimilar\tchanges\tin\tappetite\tand\tfood\tintake.\tFor\tparents,\tthese\tperiods\tof\tslower\t(but
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normal)\tgrowth\tand\tdecreased\tappetite\tcan\tcause\tanxiety,\tpotentially\tleading\tto\tmealtime\tstruggles.\nBody\tproportions\tof\tyoung\tchildren\tchange\tsignificantly\tafter\tthe\tfirst\tyear.\tHead\tgrowth\tis\nminimal,\ttrunk\tgrowth\tslows\tsubstantially,\tand\tlimbs\n\tlengthen\tconsiderably,\tall\tof\twhich\tcreate\tmore
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lengthen\tconsiderably,\tall\tof\twhich\tcreate\tmore\nmature\tbody\tproportions.\tWalking\tand\tincreased\tphysical\tactivity\tlead\tto\tthe\tlegs\tstraightening\tand\nincreased\tmuscle\tstrength\tin\tthe\tabdomen\tand\tback.\nThe\tbody\tcomposition\tof\tpreschool\tand\tschool\tage\tchildren\tremains\trelatively\tconstant.\tFat
|
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] |
gradually\tdecreases\tduring\tthe\tearly\tchildhood\tyears,\treaching\ta\tminimum\tbetween\t4\tand\t6\tyears\tof\nage.\tChildren\n\tthen\texperience\tthe\t\nadiposity\trebound\n,\tor\tincrease\tin\tbody\tfatness\tin\tpreparation\tfor\nthe\tpubertal\tgrowth\tspurt.\tEarlier\tadiposity\trebound\t(before\t5\t½\tyears\tof\tage)\thas\tbeen\tassociated\nwith\tincreased\tadult\tbody\tmass\tindex\t(BMI)\t(
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] |
with\tincreased\tadult\tbody\tmass\tindex\t(BMI)\t(\nWilliams\tand\tGoulding,\t2009\n).\tSex\tdifferences\tin\tbody\ncomposition\tbecome\tincreasingly\tapparent:\tboys\thave\tmore\tlean\tbody\tmass\tper\tcentimeter\tof\theight\nthan\tgirls.\tGirls\n\thave\ta\thigher\tpercentage\tof\tweight\tas\tfat\tthan\tboys,\teven\tin\tthe\tpreschool\tyears,\tbut
|
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] |
these\tdifferences\tin\tlean\tbody\tmass\tand\tfat\tdo\tnot\tbecome\tsignificant\tuntil\tadolescence.\nAssessing\tgrowth\nA\tcomplete\tnutrition\tassessment\tincludes\tthe\tcollection\tof\tanthropometric\tdata.\tThis\tincludes\tlength\nor\tstature,\tweight,\tand\tweight-for-length\tor\tBMI,\tall\tof\twhich\tare\tplotted\ton\tthe\trecommended\ngrowth\n\tcharts\t(see\t\nAppendix\t3
|
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] |
growth\n\tcharts\t(see\t\nAppendix\t3\n).\tOther\tmeasurements\tthat\tare\tless\tcommonly\tused\tbut\tthat\tprovide\nestimates\tof\tbody\tcomposition\tinclude\tmid\tupper-arm\tcircumference\tand\ttriceps\tor\tsubscapular\tskin\nfolds.\tCare\tshould\tbe\ttaken\tto\tuse\tstandardized\tequipment\tand\ttechniques\tfor\tobtaining\tand\tplotting
|
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] |
growth\tmeasurements.\tCharts\tdesigned\tfor\tbirth\tto\t24\tmonths\tof\tage\tare\tbased\ton\tlength\nmeasurements\tand\tnude\n\tweights,\twhereas\tcharts\tused\tfor\t2-\tto\t20-year-olds\tare\tbased\ton\tstature\n(standing\theight)\tand\tweight\twith\tlight\tclothing\tand\twithout\tshoes\t(see\t\nChapter\t5\n).
|
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] |
Chapter\t5\n).\nThe\tproportion\tof\tweight\tto\tlength\tor\theight\tis\ta\tcritical\telement\tof\tgrowth\tassessment.\tThis
|
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parameter\tis\tdetermined\tby\tplotting\tthe\tweight-for-length\ton\tthe\tWorld\tHealth\tOrganization\t(WHO)\nbirth\tto\t24-month\tgrowth\tcharts,\tor\tcalculating\n\tBMI\tand\tplotting\tit\ton\tthe\t2-\tto\t20-year-old\tCDC\ngrowth\tcharts.\tGrowth\tmeasurements\tobtained\tat\tregular\tintervals\tprovide\tinformation\tabout\tan
|
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] |
individual’s\tgrowth\tpattern.\tOne-time\tmeasurements\tdo\tnot\tallow\tfor\tinterpretation\tof\tgrowth\tstatus.\nGrowth\tchannels\tare\tnot\twell\testablished\tuntil\tafter\t2\tyears\tof\tage.\tChildren\tgenerally\tmaintain\ttheir\nheights\tand\tweights\tin\tthe\tsame\t\ngrowth\tchannels\n\tduring\n\tthe\tpreschool\tand\tchildhood\tyears,
|
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] |
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