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decisions,\tlarger\tportion\tsizes,\tand\tdecreased\tphysical\tactivity.\tIn\taddition,\tAmerican\tchildren\tsnack\nthree\ttimes\ta\tday,\twith\tchips,\tcandy,\tand\tother\tlow-nutrient\tfoods\tproviding\tmore\tthan\t27%\tof\ttheir\ndaily\tenergy\tintake;\tthis\tcontributes\t168\tkcal\tper\tday\t(\nPiernas\tand\tPopkin,\t2010\n).\tMany\tof\tthe\trisk
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Piernas\tand\tPopkin,\t2010\n).\tMany\tof\tthe\trisk\nfactors\tfor\tobesity\tare\tmore\tprevalent\tamong\tchildren\tfrom\tracial/ethnic\tminorities\tand\tfamilies\twith\nlower\tsocioeconomic\tstatus.\nInactivity\tplays\ta\tmajor\trole\tin\tobesity\tdevelopment,\twhether\tit\tresults\tfrom\tscreen\ttime,\tlimited
|
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opportunities\tfor\tphysical\tactivity,\tor\tsafety\tconcerns\tthat\tprevent\tchildren\tfrom\tenjoying\tfree\tplay\noutdoors.\tAlthough\tincreased\ttelevision\tviewing\n\tand\tcomputer\tand\thandheld\tgame\tuse\thave\tbeen\nassociated\twith\tchildhood\toverweight,\ta\treview\tsuggests\tthat\tthe\tgreater\trisk\tof\toverweight\tis\nrelated\tto\ttelevision\tviewing\tplus\ta\tlow\tactivity\tlevel\t(
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related\tto\ttelevision\tviewing\tplus\ta\tlow\tactivity\tlevel\t(\nRitchie\tet\tal,\t2005\n).\tThe\tneed\tto\tuse\nautomobiles\tfor\tshort\ttrips\tlimits\tchildren’s\topportunities\tto\twalk\tto\tlocal\tdestinations,\ta\nphenomenon\tparticularly\trelevant\tto\tchildren\tin\tthe\tsuburbs.\nObesity
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] |
phenomenon\tparticularly\trelevant\tto\tchildren\tin\tthe\tsuburbs.\nObesity\n\tin\tchildhood\tis\tnot\ta\tbenign\tcondition,\tdespite\tthe\tpopular\tbelief\tthat\toverweight\tchildren\nwill\toutgrow\ttheir\tcondition.\tThe\tlonger\ta\tchild\thas\tbeen\toverweight,\tthe\tmore\tlikely\tthe\tchild\tis\tto
|
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] |
be\toverweight\tor\tobese\tduring\tadolescence\tand\tadulthood.\tConsequences\tof\toverweight\tin\tchildhood\ninclude\tpsychosocial\tdifficulties\tsuch\tas\tdiscrimination,\ta\tnegative\tself-image,\tdepression,\tand\ndecreased\n\tsocialization.\tMany\toverweight\tchildren\thave\tone\tor\tmore\tcardiovascular\trisk\tfactors\tsuch\nas\thyperlipidemia,\thypertension,\tor\thyperinsulinemia\t(
|
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] |
as\thyperlipidemia,\thypertension,\tor\thyperinsulinemia\t(\nDaniels,\t2009\n).\tAn\teven\tmore\tdramatic\thealth\nconsequence\tof\toverweight\tis\tthe\trapid\tincrease\tin\tthe\tincidence\tof\ttype\t2\tdiabetes\tin\tchildren\tand\nadolescents,\twhich\thas\ta\tserious\teffect\ton\tadult\thealth,\tdevelopment\tof\tother\tchronic\tdiseases,\tand\nhealth\n\tcare\tcosts\t(see\t\nChapter\t30\n).
|
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] |
health\n\tcare\tcosts\t(see\t\nChapter\t30\n).\nThe\tAAP\thas\tdeveloped\tguidelines\tfor\toverweight\tscreening\tand\tassessment\tfor\tchildren\tfrom\tage
|
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] |
2\tthrough\tadolescence\t(\nBarlow\tand\tCommittee,\t2007\n).\tIn\taddition\tto\tgrowth\tparameters,\tother\nimportant\tinformation\tincludes\tdietary\tintake\tand\tpatterns,\tprevious\tgrowth\tpatterns,\tfamily\thistory,\nphysical\tactivity,\tand\tfamily\tinteractions.\tThe\tU.S.\tPreventive\tServices\tTask\n\tForce\t(USPSTF)
|
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Force\t(USPSTF)\nrecommends\tobesity\tscreening\tfor\tchildren\tand\tadolescents\t6\tyears\tand\tolder\tand\treferral\tto\ncomprehensive,\tintensive\tbehavioral\tintervention\ttreatment\tprograms,\tif\tappropriate\t(\nGrossman\tet\nal,\t2017\n).\nA\t2010\tpaper\tdescribed\ta\tlower\tprevalence\tof\tobesity\tamong\tchildren\twho\twere\texposed\tto\tthe
|
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] |
following\troutines:\tregularly\teating\tthe\tevening\tmeal\tas\ta\tfamily,\tobtaining\tadequate\tnight-time\nsleep,\tand\thaving\tlimited\tscreen-viewing\ttime\t(\nAnderson\tand\tWhitaker,\t2010\n).\tInterventions\tfor\nobesity\tin\tchildren\thave\thad\tlimited\teffect\ton\tthe\tchildhood\tobesity\tproblem,\tespecially\tfor\tblack,
|
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] |
Hispanic,\tand\tNative\tAmerican\tpopulations.\tSuccess\tis\tmost\tlikely\tto\tresult\tfrom\tprograms\tthat\ninclude\tcomprehensive\tbehavioral\tcomponents\tsuch\tas\tfamily\tinvolvement,\tdietary\tmodifications,\nnutrition\tinformation,\n\tphysical\tactivity,\tand\tbehavioral\tstrategies\t(\nBarlow\tand\tCommittee,\t2007\n).
|
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0.09984718263149261,
0.06851557642221451,
0.08626505732536316,
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] |
Barlow\tand\tCommittee,\t2007\n).\nIncorporating\tbehavioral\tintervention\tin\tobesity\ttreatment\timproves\toutcomes\tand\tis\tmost\teffective\nwith\ta\tteam\tapproach.\tDepending\ton\tthe\tchild,\tgoals\tfor\tweight\tchange\tmay\tinclude\ta\tdecrease\tin\nthe\trate\tof\tweight\tgain,\tmaintenance\tof\tweight,\tor,\tin\tsevere\tcases,\tgradual\tweight\tloss\t(see\t\nChapter\n20
|
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] |
Chapter\n20\n).\tAn\tindividualized\tapproach\n\tshould\tbe\ttailored\tto\teach\tchild,\twith\tminimum\tuse\tof\trestrictive\ndiets\tor\tmedication,\texcept\tif\tthere\tare\tother\tsignificant\tdiseases\tand\tno\tother\toptions.\nIntervention\tstrategies\trequire\tfamily\tinvolvement\tand\tsupport.\tIncorporating\tmotivational
|
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] |
interviewing\tand\tstages\tof\tchange\ttheory\tinto\tthe\tcomprehensive\tprogram\twill\tlikely\tbe\tmore\nsuccessful\t(see\t\nChapter\t13\n).\tChanges\tto\taddress\toverweight\n\tshould\tinclude\tthe\tchild’s\tinput,\twith\nchoices\tand\tplans\tthat\tmodify\tthe\tfamily’s\tfood\tand\tactivity\tenvironment,\tnot\tjust\tthe\tchild’s.
|
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] |
Adequate\tenergy\tand\tother\tnutrients\tare\tneeded\tto\tensure\tmaintenance\tof\theight\tgain\tvelocity\tand\nnutrient\tstores.\tThe\thazards\tof\ttreating\toverweight\tchildren\ttoo\taggressively\tinclude\talternate\nperiods\tof\tundereating\tand\tovereating,\tfeelings\tof\tfailure\tin\tmeeting\n\texternal\texpectations,\tignoring
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external\texpectations,\tignoring\ninternal\tcues\tfor\tappetite\tand\tsatiation,\tfeelings\tof\tdeprivation\tand\tisolation,\tan\tincreased\trisk\tfor\neating\tdisorders,\tand\ta\tpoor\tor\tan\tincreasingly\tpoor\tself-image.\nSome\tchildren\twith\tspecial\thealth\tcare\tneeds,\tsuch\tas\tthose\twith\tDown\tsyndrome,\tPrader-Willi
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] |
syndrome,\tshort\tstature,\tand\tlimited\tmobility,\tare\tat\tincreased\trisk\tfor\tbeing\toverweight.\tTheir\tsize,\nlevel\tof\tactivity,\tand\tdevelopmental\tstatus\tmust\tbe\tconsidered\twhen\testimating\tenergy\tintake\tand\nproviding\tdietary\tguidance\tto\ttheir\tfamilies\t(see\t\nChapter\t43\n).
|
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] |
providing\tdietary\tguidance\tto\ttheir\tfamilies\t(see\t\nChapter\t43\n).\nPrevention\tof\tchildhood\tobesity\tis\tan\timportant\tpublic\thealth\tpriority\tin\tthe\tUnited\tStates.\tThe\nIOM\thas\tpublished\trecommendations\tthat\ttarget\tfamilies,\thealth\tcare\tprofessionals,\tindustry,\nschools,\tand\tcommunities\t(\nIOM,\t2012\n).\tThe\trecommendations
|
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schools,\tand\tcommunities\t(\nIOM,\t2012\n).\tThe\trecommendations\n\tinclude\tschools\t(improved\tnutritional\nquality\tof\tfood\tsold\tand\tserved,\tincreased\tphysical\tactivity,\twellness\teducation),\tindustry\t(improved\nnutrition\tinformation\tfor\tconsumers,\tclear\tmedia\tmessages),\thealth\tcare\tprofessionals\t(tracking
|
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] |
limit\tthe\tsale\tof\tcompetitive\tfoods\tand\nbeverages\t(foods\tsold\toutside\tthe\tschool\tmeal\tprograms)\tare\tassociated\twith\tchanges\tin\nconsumption\tand\tavailability\tof\tfoods.\tMore\tresearch\tis\tneeded\tto\tunderstand\tlong-term\thealth\neffects\tof\tthese\tpolicies\t(\nChriqui\tet\tal,\t2014\n).\tMore\tresearch\talso\tis\tneeded\tto\tdevelop\teffective
|
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] |
).\tMore\tresearch\talso\tis\tneeded\tto\tdevelop\teffective\nprevention\tstrategies\tthat\taddress\tthe\tneeds\tof\tdiverse\tpopulations.\nFamilies\n\tare\tessential\tfor\tmodeling\tfood\tchoices,\thealthy\teating,\tand\tleisure\tactivities\tfor\ttheir\nchildren.\tParents\tinfluence\tchildren’s\tenvironment\tby\tchoosing\tnutrient-rich\tfoods,\thaving\tfamily
|
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] |
meals\t(including\tbreakfast),\toffering\tregular\tsnacks,\tand\tspending\ttime\ttogether\tin\tphysical\tactivity,\nall\tof\twhich\tcan\tbe\tcritical\tin\toverweight\tprevention.\tReducing\tsedentary\tbehaviors\tcan\tincrease\nenergy\texpenditure\n\tand\treduce\tprompts\tto\teat;\tthe\tAAP\trecommends\tlimiting\tscreen\ttime\tto\tno\nmore\tthan\t2\thours\tper\tday\t(\nAAP,\t2016
|
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] |
more\tthan\t2\thours\tper\tday\t(\nAAP,\t2016\n).\tParents\texerting\ttoo\tmuch\tcontrol\tover\ttheir\tchild’s\tfood\nintake\tor\tpromoting\ta\trestrictive\tdiet\tmay\tcause\tchildren\tto\tbe\tless\table\tto\tself-regulate\tand\tmore\nlikely\tto\tovereat\twhen\tthe\topportunity\tis\tavailable\t(\nRitchie\tet\tal,\t2005\n).\tHealth\tprofessionals\tshould\nsupport\tpositive\tparenting
|
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] |
).\tHealth\tprofessionals\tshould\nsupport\tpositive\tparenting\n\twithin\tthe\tchild’s\tdevelopmental\tlevel.\nUnderweight\tand\tfailure\tto\tthrive\nWeight\tloss,\tlack\tof\tweight\tgain,\tor\t\nfailure\tto\tthrive\t(FTT)\n\tcan\tbe\tcaused\tby\tan\tacute\tor\tchronic\nillness,\ta\trestricted\tdiet,\ta\tpoor\tappetite\t(resulting\tfrom\tconstipation,\tmedication,\tor\tother\tissues),
|
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feeding\tproblems,\tneglect,\tor\ta\tsimple\tlack\tof\tfood.\tSome\texperts\tprefer\tthe\tterms\t\npediatric\nundernutrition\n\tor\t\ngrowth\tdeficiency\n.\tInfants\tand\ttoddlers\tare\tmost\tat\trisk\tfor\tpoor\tgrowth,\toften\nas\ta\tresult\tof\tprematurity,\tmedical\tconditions,\tdevelopmental\tdelays,\tinadequate\tparenting,\tor\ta
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combination\tof\tthese.\tDietary\tpractices\talso\tcan\tcontribute\tto\tpoor\tgrowth,\tincluding\tfood\nrestrictions\tin\tpreschool\tchildren\tstemming\tfrom\tparents’\tconcerns\tabout\tobesity,\tatherosclerosis,\tor\nother\tpotential\thealth\tproblems.\nA\tcareful\n\tassessment\tis\tcritical\tand\tmust\tinclude\tthe\tsocial\tand\temotional\tenvironment\tof\tthe\tchild
|
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and\tany\tphysical\tfindings.\tIf\tneglect\tis\tdocumented\tto\tbe\ta\tcontributing\tfactor,\thealth\tprofessionals\nare\tobligated\tto\treport\tthe\tcase\tto\tthe\tlocal\tchild\tprotective\tservices.\tBecause\tof\tthe\tcomplexity\tof\ngrowth\tfailure,\tan\tinterdisciplinary\tteam\tis\tideal\tfor\tassessments\tand\tinterventions.\nThe\tprovision\tof
|
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The\tprovision\tof\n\tadequate\tenergy\tand\tother\tnutrients\tand\tnutrition\teducation\tshould\tbe\tone\tpart\tof\nan\toverall\tinterdisciplinary\tplan\tto\tassist\tchildren\tand\ttheir\tfamilies.\tAttempts\tshould\tbe\tmade\tto\nincrease\tchildren’s\tappetites\tand\tmodify\tthe\tenvironment\tto\tensure\toptimal\tintake.\tFrequent\tsmall
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meals\tand\tsnacks\tshould\tbe\toffered\tat\tregular\ttimes,\tusing\tdevelopmentally\tappropriate,\tnutrient-\ndense\tfoods.\tThis\toptimizes\n\tthe\tsmaller\tstomach\tcapacity\tof\tthe\tyoung\tchild\tand\tprovides\tstructure\nand\tpredictability\tfor\tthe\teating\tenvironment.\tFamilies\tshould\treceive\tsupport\tfor\tpositive\tparent-
|
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child\tinteractions,\twith\trespect\tfor\tthe\tdivision\tof\tresponsibility\tin\tfeeding\tand\tavoidance\tof\tany\npressure\tor\tcoercion\ton\tthe\tchild’s\teating.\tSevere\tmalnutrition\tmay\trequire\tcarefully\tplanned\ninterventions\tand\tclose\tmonitoring\n\tto\tprevent\trefeeding\tsyndrome.
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interventions\tand\tclose\tmonitoring\n\tto\tprevent\trefeeding\tsyndrome.\nChronic\tconstipation\tcan\tresult\tin\tpoor\tappetite,\tdiminished\tintake,\tand\tFTT.\tEnsuring\tadequate\nfluid\tand\tfiber\tintake\tcan\thelp\trelieve\tconstipation,\timprove\tappetite,\tand\teventually\tpromote\tweight
|
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] |
gain.\tBecause\tthe\tfiber\tintake\tof\tchildren\tis\toften\tlow,\tespecially\tin\tchildren\twho\tare\tpicky\teaters,\nfiber\tintake\talways\tshould\tbe\taddressed\tin\tthe\tevaluation.\tFiber\n\tcan\tbe\tincreased\tby\tadding\nlegumes,\tfruits\t(especially\tdried\tfruits),\tvegetables,\thigh-fiber\tbreakfast\tcereals,\tbran\tmuffins,\tor\tall\nof\tthese\tto\tthe\tdiet.\nIron\tdeficiency
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of\tthese\tto\tthe\tdiet.\nIron\tdeficiency\nIron\tdeficiency\tis\tone\tof\tthe\tmost\tcommon\tnutrient\tdisorders\tof\tchildhood.\tThe\thighest\tprevalence\tof\nanemia\tin\tchildren\toccurs\tin\tthose\tyounger\tthan\t2\tyears\tof\tage\t(\nGupta\tet\tal,\t2017\n).\tIron\tdeficiency\tis\nless\tof\ta\tproblem\n\tamong\tolder\tpreschool\tand\tschool\tage\tchildren.
|
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less\tof\ta\tproblem\n\tamong\tolder\tpreschool\tand\tschool\tage\tchildren.\nInfants\twith\tiron\tdeficiency,\twith\tor\twithout\tanemia,\ttend\tto\tscore\tlower\ton\tstandardized\ttests\tof\nmental\tdevelopment\tand\tpay\tless\tattention\tto\trelevant\tinformation\tneeded\tfor\tproblem\tsolving.
|
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Poorer\tcognitive\tperformance\tand\tdelayed\tpsychomotor\tdevelopment\thave\tbeen\treported\tin\tinfants\nand\tpreschool\tchildren\twith\tiron\tdeficiency.\tDeficiency\tcan\n\thave\tlong-term\tconsequences,\tas\ndemonstrated\tby\tpoorer\tperformance\ton\tdevelopmental\ttests\tin\tlate\tchildhood\tand\tearly\tadolescence\n(\nLozoff\tet\tal,\t2007
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(\nLozoff\tet\tal,\t2007\n).\tIron\tintake\tshould\tbe\tconsidered\tduring\tassessments\tof\tindividual\tdiets\tand\tin\npolicy\tdecisions\tintended\tto\taddress\tthe\tnutrition\tneeds\tof\tlow-income,\thigh-risk\tchildren.\nIn\taddition\tto\tgrowth\tand\tthe\tincreased\tphysiologic\tneed\tfor\tiron,\tdietary\n\tfactors\talso\tplay\ta\trole.
|
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] |
factors\talso\tplay\ta\trole.\nFor\texample,\ta\t1-year-old\tchild\twho\tcontinues\tto\tconsume\ta\tlarge\tquantity\tof\tmilk\tand\texcludes\nother\tfoods\tmay\tdevelop\tanemia.\tSome\tyoung\tpreschool\tchildren\tdo\tnot\teat\tmuch\tmeat,\tso\tmost\tof\ntheir\tiron\tis\tconsumed\tin\tthe\tnonheme\tform\tfrom\tfortified\tcereals,\twhich\tis\tabsorbed\tless\tefficiently\n(see\t\nChapter\t31\n).
|
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] |
(see\t\nChapter\t31\n).\nDental\tcaries\nNutrition\tand\teating\thabits\tare\timportant\n\tfactors\taffecting\toral\thealth.\tAn\toptimal\tnutrient\tintake\tis\nneeded\tto\tproduce\tstrong\tteeth\tand\thealthy\tgums.\tThe\tcomposition\tof\tthe\tdiet\tand\tan\tindividual’s\neating\thabits\t(e.g.,\tdietary\tcarbohydrate\tintake,\teating\tfrequency)\tare\tsignificant\tfactors\tin\tthe
|
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] |
development\tof\tdental\tcaries\t(see\t\nChapter\t24\n).\nAllergies\nFood\tallergies\tduring\tinfancy\tand\tchildhood\tare\tmore\tlikely\twhen\ta\tchild\thas\ta\n\tfamily\thistory\tof\nallergies.\tAllergic\tsymptoms\tare\tseen\tmost\toften\tas\trespiratory\tor\tgastrointestinal\tresponses\tas\twell
|
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] |
as\tskin\tresponses\tbut\tmay\tinclude\tfatigue,\tlethargy,\tand\tbehavior\tchanges.\tThere\tcan\tbe\tconfusion\nabout\tthe\tdefinitions\tof\t\nfood\tallergy\n,\t\nfood\tintolerance\n,\tand\t\nfood\tsensitivity\n,\tand\tsome\ttests\tfor\tfood\nallergies\tare\tunspecific\tand\tequivocal.\tSee\t\nChapter\t25\n\tfor\tmanagement\tof\tfood\n\tallergies\tin\tchildren.
|
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] |
Chapter\t25\n\tfor\tmanagement\tof\tfood\n\tallergies\tin\tchildren.\nAttention-deficit/hyperactivity\tdisorder\t(ADHD)\tand\tautism\tspectrum\tdisorder\nADHD\tand\tAutism\tSpectrum\tDisorder\tare\ttwo\tcommon\tneurological\tdisorders\tof\tchildhood\tthat\naffect\tbehavior,\tsocialization,\tand\tcommunication.\tBoth\tcan\taffect\teating\tbehaviors\tand\tnutrient
|
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] |
intake\twhich\tcan\tmanifest\tas\tfood\taversions,\thypersensitivity\tto\ttextures\tand\tflavors,\tand\tinadequate\nintake.\n\tSee\t\nChapter\t43\n\tfor\tmore\tdetails\tabout\tassessment\tand\tMNT\tfor\tthese\tconditions.\nPreventing\tchronic\tdisease\nThe\troots\tof\tchronic\tadult\tdiseases\tsuch\tas\theart\tdisease,\tcancer,\tdiabetes,\tand\tobesity\tare\toften
|
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] |
based\tin\tchildhood—a\tphenomenon\tthat\tis\tparticularly\trelevant\tto\tthe\tincreasing\trate\tof\tobesity-\nrelated\tdiseases\tsuch\tas\ttype\t2\tdiabetes.\tTo\thelp\tdecrease\tthe\tprevalence\tof\tchronic\tconditions\n\tin\nAmericans,\tgovernment\tand\tnonprofit\tagencies\thave\tbeen\tpromoting\thealthy\teating\thabits\tfor
|
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] |
children.\tTheir\trecommendations\tinclude\tthe\tDietary\tGuidelines\tfor\tAmericans,\tthe\tUSDA\tMyPlate,\nthe\tNational\tCholesterol\tEducation\tProgram\t(NCEP),\tand\tthe\tNational\tCancer\tInstitute\tDietary\nGuidelines\t(see\t\nChapter\t10\n).\nCardiovascular\thealth\nCompared\twith\ttheir\tcounterparts\tin\tmany\tother\tcountries,\tAmerican\n\tchildren\tand\tadolescents\thave
|
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0.04188033938407898,
0.0622989721596241,
0.10326273739337921,
0.07219989597797394,
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] |
children\tand\tadolescents\thave\nhigher\tblood\tcholesterol\tlevels\tand\thigher\tintakes\tof\tsaturated\tfatty\tacids\tand\tcholesterol.\tEarly\ncoronary\tatherosclerosis\tbegins\tin\tchildhood\tand\tadolescence.\tRisk\tfactors\tinclude\tfamily\thistory,\nbreastfeeding\tand\tperinatal\tfactors,\tnutrition\tand\tdiet,\tphysical\tactivity,\ttobacco\texposure,
|
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] |
hypertension,\thyper-\tand\tdyslipidemia,\toverweight\tand\tobesity,\tand\tdiabetes.\n\tThese\twere\texplored\nby\tan\texpert\tpanel\t(\nNational\tHeart\tLung\tand\tBlood\tInstitute,\t2011\n);\tselected\trecommendations\twith\nnutrition\timplications\tare\tbriefly\tsummarized\tas\tfollows:
|
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] |
nutrition\timplications\tare\tbriefly\tsummarized\tas\tfollows:\nFor\tmost\thealthy\tchildren\tlimiting\ttotal\tfat\tto\t30%\tof\ttotal\tenergy,\tsaturated\tfat\tto\t7%\tto\t10%,\tand\ndietary\tcholesterol\tto\t300\tmg/day\tis\trecommended.\tA\tbalanced\tenergy\tintake,\tincreased\tintake\tof\nfruits\tand\tvegetables,
|
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] |
fruits\tand\tvegetables,\n\tand\tlimiting\t“extra\tcalories”\tto\t5%\tto\t15%\ttotal\tintake\talso\tis\trecommended\nfor\tmost\tchildren.\tFiber\tintake\tof\tat\tleast\t“age\t+\t5\tgrams”\t(e.g.,\tfor\ta\t4-year-old,\t4\t+\t5\t=\t9\tg\tper\nday)\tor\t14\tg\tfiber/1000\tkilocalories\tis\tsuggested.\nFor\tchildren\twith\tdyslipidemia,\twho\tare\toverweight\tor\tobese,\tor\twho\thave\t“risk\tfactor\tclustering”
|
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] |
and\tBlood\tInstitute,\t2011\n).\tThis\tis\ta\tDASH-style\tpattern\twith\temphasis\ton\tfat-free/low-fat\tdairy\tand\nincreased\tintake\tof\tfruits\tand\tvegetables.\nFor\tall\tchildren,\tthe\tapproach\tto\tmodifying\trisk\tfactors,\tespecially\trelated\tto\tdietary\tfat\tintake,\nshould\tbe\tindividualized\t(see\t\nChapter\t32\n).\nCalcium\tand\tbone\thealth
|
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] |
should\tbe\tindividualized\t(see\t\nChapter\t32\n).\nCalcium\tand\tbone\thealth\nOsteoporosis\tprevention\tbegins\tearly\tby\tmaximizing\tcalcium\tretention\tand\tbone\tdensity\tduring\nchildhood\tand\tadolescence,\twhen\tbones\tare\tgrowing\trapidly\tand\tare\tmost\tsensitive\tto\tdiet\tand\tthe\nimportant\teffects\tof\tphysical\tactivity\t(see\t\nChapter\t23
|
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important\teffects\tof\tphysical\tactivity\t(see\t\nChapter\t23\n).\tHowever,\tmean\tdietary\tintakes\tof\tcalcium\tare\nlower\tthan\tthe\tAI,\twith\t20%\tto\t30%\tof\tpubertal\tgirls\thaving\tintakes\tless\tthan\n\t500\tmg/day.\tOne\nlongitudinal\tstudy\tof\twhite\tchildren\tfrom\tinfancy\tto\t8\tyears\tof\tage\tfound\tthat\tbone\tmineral\tcontent
|
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0.11422260105609894,
0.06417887657880783,
0.02765250764787197,
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] |
was\tpositively\tcorrelated\twith\tintake\tof\tprotein\tand\tseveral\tminerals,\tsuggesting\tthat\tmany\tnutrients\nare\trelated\tto\tbone\thealth\tin\tchildren\t(\nBounds\tet\tal,\t2005\n).\tBecause\tfood\tconsumption\tsurveys\tshow\nthat\tchildren\tare\tdrinking\tmore\tsoft\tdrinks\tand\tnoncitrus\tjuices\tand\tless\tmilk,\n\teducation\tis\tneeded\tto
|
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] |
education\tis\tneeded\tto\nencourage\tyoung\tpeople\tto\tconsume\tan\tappropriate\tamount\tof\tcalcium\tfrom\tfood\tsources\tand\npossibly\tsupplements\t(see\t\nAppendix\t39\n).\nFiber\nEducation\tabout\tdietary\tfiber\tand\tdisease\tprevention\thas\tmainly\tbeen\tfocused\ton\tadults,\tand\tonly
|
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limited\tinformation\tis\tavailable\ton\tthe\tdietary\tfiber\tintake\tof\tchildren.\tDietary\tfiber\tis\tneeded\tfor\nhealth\tand\tnormal\tlaxation\tin\tchildren.\n\tNational\tsurvey\tdata\tindicate\tthat\tpreschool\tchildren\nconsume\ta\tmean\tof\t11\tto\t12\tg/day\tof\tdietary\tfiber;\tschool\tage\tchildren\tconsume\tapproximately\t14\tto\n15\tg/day\t(\nUSDA,\t2014
|
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15\tg/day\t(\nUSDA,\t2014\n).\tThis\tis\tlower\tthan\tthe\tDRI\tfor\tchildren,\twhich\tis\tbased\ton\tthe\tsame\t14\ng/1000\tkcal\tas\tadults\tbecause\tof\tlack\tof\tscientific\tevidence\tfor\tthe\tpediatric\tpopulation\t(\nOtten\tet\tal,\n2006\n).\tGenerally,\thigher\tfiber\tintakes\tare\tassociated\n\twith\tmore\tnutrient-dense\tdiets\tin\tyoung\nchildren\t(\nKranz\tet\tal,\t2012\n;
|
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children\t(\nKranz\tet\tal,\t2012\n;\t\nPapanikolaou\tet\tal,\t2017\n).\nThe\tgut\tmicrobiome\nThe\tgut\tmicrobiome\tis\tan\temerging\ttopic\tin\tnutrition,\tincluding\tpediatric\tnutrition.\tIt\tis\tclear\tthat\ndietary\tand\tother\tfactors\taffect\tthe\tnumber\tand\ttype\tof\tbacteria\tthat\tcolonize\tthe\tgut.\tFactors\tthat
|
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] |
can\taffect\tthe\tgut\tmicrobial\tcommunity\tinclude\tdietary\tfiber,\tprebiotics,\n\tprobiotics,\tand\tthe\tuse\tof\nantibiotic\tmedication\t(see\t\nChapter\t1\n).\nThe\tgut\tbacteria\tprofile\tseems\tto\tbe\tassociated\twith\tshort-\tand\tlong-term\thealth\toutcomes.\tIn\naddition\tto\teffects\ton\tGI\tdisorders,\tresearch\tcontinues\tto\texplore\tthe\trelationship\tbetween\tthe\tgut
|
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] |
microbiome\tand\tshort-\tand\tlong-term\thealth\toutcomes,\tincluding\tobesity,\tdigestive\tdisorders,\ninflammation,\tand\tcancers\t(\nPeregrin,\t2013\n).\nPhysical\tactivity\nChildren\tshould\tbe\tphysically\tactive\teach\tday,\tincluding\tplay\tas\twell\tas\tstructured\tactivities,
|
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depending\ton\tage\tand\tdevelopmental\tlevel.\tDecreased\tlevels\tof\tphysical\tactivity\tare\tstill\tseen\tin\tone\nthird\tof\tchildren\t4\tto\t11\tyears\tof\tage,\twith\talmost\ttwo\tthirds\tof\tthe\tsame\tgroup\thaving\thigh\tscreen\ntime\t(\nAnderson\tet\tal,\t2008\n).\tRegular\tphysical\tactivity\thelps\tcontrol\texcess\tweight\n\tgain\tand\timproves
|
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0.043329041451215744,
0.02963874116539955,
0.047660358250141144,
-0.015107255429029465
] |
gain\tand\timproves\nmusculoseketal\thealth\tand\tfitness\tand\tcomponents\tof\tcardiovascular\thealth\t(\nJanssen\tand\tLeblanc,\n2010\n).\tPhysical\tactivity\tmay\talso\timprove\tthe\tchild’s\tmental\thealth,\tblood\tpressure,\tand\tlipid\tprofile\n(\nJanssen\tand\tLeblanc,\t2010\n).\nCurrent\tphysical\tactivity\trecommendations\tfor\tthose\tages\t6\tthrough\t17\tyears\tof\tage\tare\t60
|
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] |
minutes\tor\tmore\tof\tphysical\tactivity\tevery\tday\twith\tthe\tmajority\n\tat\ta\tmoderate\tor\tvigorous\taerobic\nintensity.\tChildren\tand\tadolescents\tshould\tdo\tvigorous\tintensity\tactivity\tat\tleast\t3\tdays\tper\tweek\tand\ninclude\tmuscle-strengthening\tand\tbone-strengthening\tactivity\ton\tat\tleast\t3\tdays\tper\tweek.
|
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] |
Information\tregarding\tactivities\tthat\twill\tmeet\tthese\trecommendations\tand\tare\tappropriate\tfor\nchildren\tis\tavailable\t(\nU.S.\tDepartment\tof\tHealth\tand\tHuman\tServices\t[USDHHS],\t2008\n).\tStrategies\nto\tincrease\tactivity\tin\tpreschool\tand\tchildcare\tsettings,\tschools,\tand\tthe\tcommunity\tinclude\tmore
|
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] |
activity\tbreaks,\tincreased\ttime\toutside,\tand\timproved\twalking/biking\tpath\tinfrastructure\t(\nUSDHHS,\n2012\n).\tScreen\ttime\t(active\tgames,\texercise\tor\tdance\tvideos,\tor\tTV\texercise\tprograms)\tcan\tbe\ta\nbeneficial\tsource\tof\tactivity\tfor\tyouth.\tThree\tin\t10\tyouth\tages\t9\tto\t18\tengaged\tin\tat\tleast\t1\n\thour\tof
|
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] |
hour\tof\nactive\tscreen\ttime\tweekdays,\tand\t4\tin\t10\tyouth\tdid\tthe\tsame\ton\tweekends\t(\nWethington\tet\tal,\t2013\n).\nMyPlate’s\t\nEat\tSmart\tto\tPlay\tHard\n\tmaterials\tpromote\tthe\trecommendation\tfor\t60\tminutes\tof\tphysical\nactivity\teach\tday\t(\nFig.\t16.6\n).\tThe\tDietary\tGuidelines\tfor\tAmericans\tand\tMyPlate\talso\thave\tbeen\napplied\tto\tchildren\tand\ttheir\tparents.
|
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] |
FIG.\t16.6\nEat\tsmart\tto\tplay\thard.\n\t\nSource:\n\t(From\tUnited\tStates\tDepartment\tof\tAgriculture:\t\nEat\tSmart\tto\tPlay\tHard\n\t(website):\n\t\nhttp://www.fns.usda.gov/sites/default/files/eatsmartminiposter.pdf\n,\t2012.)\nCLINICAL\tCASE\tSTUDY\nBrian\tis\ta\t7-year,\t4-month-old\twhite\tmale\twho\tgained\t15\tpounds\tduring\tthe\tpast\tschool\tyear.\tHis
|
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] |
17\nNutrition\tin\tadolescence\nNicole\tLarson,\tPhD,\tMPH,\tRDN,\tLD,\tTashara\tM.\tLeak,\tPhD,\tRDN,\tJamie\tS.\tStang,\tPhD,\tMPH,\tRDN\nKEY\tTERMS\nadolescence\nbody\timage\ndisordered\teating\ngrowth\tspurt\ngynecologic\tage\nmenarche\npeak\theight\tgain\tvelocity\nphysiologic\tanemia\tof\tgrowth\npubarche\npuberty\nsexual\tmaturity\trating\t(SMR)\nTanner\tstaging\nthelarche\nAdolescence
|
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sexual\tmaturity\trating\t(SMR)\nTanner\tstaging\nthelarche\nAdolescence\n\tis\tone\tof\tthe\tmost\n\texciting\tyet\tchallenging\tperiods\tin\thuman\tdevelopment.\tGenerally\nthought\tof\tas\tthe\tperiod\tof\tlife\tthat\toccurs\tbetween\t12\tand\t21\tyears\tof\tage,\tadolescence\tis\ta\tperiod\tof
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] |
and\tparents.\tBecause\tall\tof\tthese\tchanges\thave\ta\tdirect\teffect\ton\tthe\tnutrient\tneeds\tand\tdietary\nbehaviors\tof\tadolescents,\tit\tis\timportant\n\tthat\thealth\tcare\tproviders\tdevelop\ta\tfull\tunderstanding\tof\thow\nthese\tdevelopmental\tchanges\tof\tadolescence\tcan\taffect\tnutritional\tstatus.\nGrowth\tand\tdevelopment\nPuberty
|
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Growth\tand\tdevelopment\nPuberty\n\tis\tthe\tperiod\tof\trapid\tgrowth\tand\tdevelopment\tduring\twhich\ta\tchild\tphysically\tdevelops\tinto\tan\nadult\tand\tbecomes\tcapable\tof\treproduction.\tIt\tis\tinitiated\tby\tthe\tincreased\tproduction\tof\treproductive\nhormones\tsuch\tas\testrogen,\n\tprogesterone,\tand\ttestosterone\tand\tis\tcharacterized\tby\tthe\toutward
|
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progesterone,\tand\ttestosterone\tand\tis\tcharacterized\tby\tthe\toutward\nappearance\tof\tsecondary\tsexual\tcharacteristics,\tsuch\tas\tbreast\tdevelopment\tin\tfemales\tand\tthe\nappearance\tof\tfacial\thair\tin\tmales.\nPsychological\tchanges\nThe\tphysical\tgrowth\tof\tpuberty\ttransforms\tthe\tteen\tbody\tinto\tan\tadult-like\tform,\tleading\tadults\tto
|
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] |
believe\tthat\tadolescent\tdevelopment\tis\tcomplete.\tHowever,\tthe\tsocial\tand\temotional\n\tdevelopment\tof\nadolescence\tlags\tbehind.\tThe\tmismatch\tbetween\thow\tteens\tlook\tand\thow\tthey\tact\tmay\tlead\tadults\tto\ndeduce\tthat\tadolescents\tare\t“not\tacting\ttheir\tage.”\tThe\trebellion\tthat\tis\tassociated\twith\tthe\tteen\tyears
|
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] |
is\tactually\tthe\tmanifestation\tof\ttheir\tsearch\tfor\tindependence\tand\ta\tsense\tof\tautonomy.\tFood\tcan\tbe,\nand\toften\tis,\tused\tas\ta\tmeans\tof\texerting\tautonomy.\tAdolescents\tmay\tchoose\n\tto\tbecome\tvegetarian\tas\ta\nway\tto\tdifferentiate\tthemselves\tfrom\ttheir\tmeat-eating\tparents\tor\tto\texpress\ttheir\tmoral\tand\tethical
|
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0.024633781984448433,
0.06396345049142838,
0.07943431288003922,
0.042661167681217194,
0.002441562945023179
] |
response.\tCognitive\tability,\tincluding\tabstract\treasoning,\texpands\tduring\tadolescence;\thowever,\tteens\nare\tmore\tlikely\tto\tbase\tdecisions\ton\temotional\tas\topposed\tto\trational\tcontexts\t(\nSteinberg,\t2016\n).\nPsychosocial\tdevelopment\tcan\taffect\thealth\tand\tnutritional\tstatus\tin\tmany\tways,\tincluding\tthe\nfollowing:\n•\t\nPreoccupation\twith
|
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] |
following:\n•\t\nPreoccupation\twith\n\tbody\tsize,\tbody\tshape,\tand\t\nbody\timage\n\t(the\tmental\tself-concept\tand\nperception\tof\tpersonal\tbody\tsize),\tresulting\tfrom\tthe\trapid\tgrowth\tand\tdevelopment\tthat\thas\noccurred,\tmay\tlead\tto\tdieting\tand\tpossibly\tdisordered\teating\tbehaviors\n•
|
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•\t\nDiminishing\ttrust\tand\trespect\tfor\tadults\tas\tauthority\tfigures,\tincluding\tnutrition\tand\thealth
|
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professionals\n•\t\nStrong\tinfluence\tof\tpeers\tand\tsocial\tmedia,\tespecially\n\taround\tareas\tof\tbody\timage\tand\nappearance,\twith\tthe\tinfluence\tof\ta\tfew\tselect\tpeers\tbecoming\tmore\timportant\tthan\tthat\tof\nlarge\tgroups\tas\tadulthood\tapproaches\n•\t\nMore\tpronounced\tsocial,\temotional,\tand\tfinancial\tindependence,\tleading\tto\tincreased
|
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independent\tdecision\tmaking\trelated\tto\tfood\tand\tbeverage\tintake\n•\t\nSignificant\tcognitive\tdevelopment\tas\tabstract\treasoning\tis\tnearly\tcomplete\tand\tegocentrism\ndecreases;\thowever,\tteens\tmay\tstill\trevert\tto\tless\tcomplex\tthinking\tpatterns\twhen\tthey\tare\nstressed\n•
|
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stressed\n•\t\nDevelopment\tof\tfuture\torientation,\twhich\tis\trequired\tto\tunderstand\tthe\tlink\tbetween\tcurrent\nbehavior\tand\tchronic\thealth\trisks\n•\t\nDevelopment\tof\tsocial,\temotional,\tfinancial,\tand\tphysical\tindependence\tfrom\tfamily\tas\tteens\nleave\thome\tto\tattend\tcollege\tor\tseek\temployment\n•\t\nDevelopment\tof\ta\tcore
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0.0473586842417717,
0.04695933684706688,
0.05677398666739464,
-0.013640337623655796
] |
influencing\thealth\tbehavior\tchange.\tAlthough\tmany\tadolescents\tare\tconcerned\twith\ttheir\tphysical\nappearance,\tit\tis\timportant\tto\taddress\tthis\ttopic\twith\tcaution\tand\tsensitivity\tso\tas\tnot\tto\treinforce\nnegative\tbiases\tor\tincrease\n\ta\tsense\tof\tshame.\nSexual\tmaturity\nSexual\tmaturity\trating\t(SMR)\n,\talso\tknown\tas\t\nTanner\tstaging
|
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] |
Sexual\tmaturity\trating\t(SMR)\n,\talso\tknown\tas\t\nTanner\tstaging\n,\tis\tused\tto\tassess\tclinically\tthe\tdegree\nof\tsexual\tmaturation\tduring\tpuberty\t(\nTanner,\t1962\n).\tAmong\tmales\tSMR\tis\tbased\ton\tgenital\tand\tpubic\nhair\tdevelopment\t(\nFig.\t17.1\n\tand\t\nTable\t17.1\n).\tAmong\tfemales\tSMR\tis\tassessed\tby\tbreast\tand\tpubic\thair
|
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] |
Table\t17.1\n).\tAmong\tfemales\tSMR\tis\tassessed\tby\tbreast\tand\tpubic\thair\ndevelopment.\tSMR\tis\tmeasured\tthrough\ta\tseries\tof\tfive\tstages,\n\twith\tstage\t1\tmarking\tprepubertal\ndevelopment\tand\tstage\t5\tmarking\tthe\tcompletion\tof\tphysical\tgrowth\tand\tdevelopment\t(see\t\nAppendix\t4\n).
|
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] |
Appendix\t4\n).\nThe\tfive\tstages\tof\tSMR\tcorrelate\twith\tother\tmarkers\tof\tgrowth\tand\tdevelopment\tduring\tpuberty,\tsuch\nas\talterations\tin\theight,\tweight,\tbody\tcomposition,\tand\tendocrine\tfunctioning.\tA\tthorough\nunderstanding\tof\tthe\trelationship\tbetween\tphysical\tgrowth\tand\tdevelopment\n\tand\tSMR\tenables\thealth
|
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] |
and\tSMR\tenables\thealth\ncare\tprofessionals\tto\tassess\tan\tadolescent’s\tpotential\tfor\tfuture\tgrowth.\nFIG.\t17.1\nSequence\tof\tevents\tduring\tpuberty\tin\tfemales\t\n(upper\tchart)\n\tand\tmales\t\n(lower\tchart)\n.\tBreast,\tgenitalia,\nand\tpubic\thair\tdevelopment\tare\tnumbered\t2\tto\t5\tbased\ton\tthe\tTanner\tdevelopmental\tstages.\n\t\nSource:\n\t(From\tMarshall
|
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] |
Source:\n\t(From\tMarshall\nWA,\tTanner\tJM:\tVariations\tin\tthe\tpattern\tof\tpubertal\tchanges\tin\tmales,\t\nArch\tDis\tChild\n\t45:13,\t1970.)
|
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] |
TABLE\t17.1\nRatings\tof\tSexual\tMaturation\n*\nPubic\tHair\nGenitalia\nCorresponding\tChanges\nMales\nStage\t1\nNone\nPrepubertal\nStage\t2\nSmall\tamount\tat\touter\tedges\nof\tpubis,\tslight\tdarkening\nBeginning\tpenile\nenlargement\nTestes\tenlarged\tto\t5-mL\nvolume\nScrotum\treddened\tand\nchanged\tin\ttexture\nIncreased\tsweat\tgland\tactivity\nStage\t3\nCovers\tpubis\nPenis\tlonger
|
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] |
Increased\tsweat\tgland\tactivity\nStage\t3\nCovers\tpubis\nPenis\tlonger\nTestes\tenlarged\tto\t8-10\nmL\nScrotum\tenlarged\nVoice\tchanges\nFaint\tmustache\n\tand\tfacial\thair\nAxillary\thair\nBeginning\tof\tpeak\theight\tgain\nvelocity\t(growth\tspurt\tof\t6-8\ninches)\nStage\t4\nAdult\ttype,\tdoes\tnot\textend\nto\tthighs\nPenis\twider\tand\tlonger\nTestes\tenlarged\tto\t12\tmL
|
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0.013698858208954334,
0.05783762410283089,
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0.06344695389270782,
0.014021234586834908
] |
to\tthighs\nPenis\twider\tand\tlonger\nTestes\tenlarged\tto\t12\tmL\nScrotal\tskin\tdarker\nEnd\tof\tpeak\theight\tgain\tvelocity\nMore\tfacial\thair\nDarker\thair\ton\tlegs\nVoice\tdeeper\nPossibly\tsevere\tacne\nStage\t5\nAdult\ttype,\tspreads\tto\tthighs\nAdult\tpenis\nTestes\tenlarged\tto\n\t15\tmL\nSignificantly\tincreased\tmuscle\tmass\nFemales\nStage\t1\nNone\nNo\tchange\tfrom\tchildhood\nStage\t2
|
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] |
Females\nStage\t1\nNone\nNo\tchange\tfrom\tchildhood\nStage\t2\nSmall\tamount,\tdowny,\ton\nmedial\tlabia\nBreast\tbuds\nIncreased\tsweat\tgland\tactivity\nBeginning\tof\tpeak\theight\tgain\nvelocity\t(growth\tspurt\tof\t3-5\ninches)\nStage\t3\nIncreased,\tdarker,\tcurly\nLarger,\tbut\tno\tseparation\tof\nthe\tnipple\tand\tthe\tareola\nEnd\tof\tpeak\theight\tgain\tvelocity\nBeginning\tof\tacne
|
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] |
End\tof\tpeak\theight\tgain\tvelocity\nBeginning\tof\tacne\nAxillary\thair\nStage\t4\nMore\tabundant,\tcoarse\ntexture\nLarger\nAreola\tand\tnipple\tform\nsecondary\tmound\nPossibly\tsevere\tacne\nMenarche\tbegins\nStage\t5\nAdult,\tspreads\tto\tmedial\nthighs\nAdult\tdistribution\tof\tbreast\ntissue,\tcontinuous\toutline\nIncreased\tfat\tand\tmuscle\tmass\n*\nSee\t\nAppendix\t4\n.
|
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] |
Increased\tfat\tand\tmuscle\tmass\n*\nSee\t\nAppendix\t4\n.\nModified\tfrom\tTanner\tJM:\t\nGrowth\tat\tadolescence\n,\ted\t2,\tOxford,\t1962,\tBlackwell\tScientific\tPublications.\nThe\ttiming\tof\tpubertal\tdevelopment\tis\tdependent\ton\tgender,\tethnic/racial\tbackground,\tand\tbetween
|
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