Nutrition in

Preschool Age
Introduction
• Age period: 1-6 years of age
• Changes occur in children’s rate
of growth and continuing
maturation of fine and gross
motor skills.
• Personality Development:
– influence both the amount
of food they consume
– and foods acceptable to
them
•
• Food habits, likes and dislikes
begin to established.
• Nutrition plays a critical role
in the development and growth
of children.
• Environmental influences and
parental behavior
• May reinforce or
extinguish food
related behaviors.
•
 CHARACTERISTICS OF THE
PRESCHOOL CHILD
• Preschool years:
• Rates of growth decrease and as
a result appetite decrease
• Growth rate slows considerably
from the first year of age.
• Toddlers (1-2 years old)
• Gain only from 2-4 kgs.
each year.
• Preschoolers (3-4 years old)
• have even slower growth
averaging from 1-2 kgs. each year.
•
• From ages 3-5:
• There is a greater increase in height relative
to weight
•
• Each child will grow at his or her own rate as
determined by heredity, state of health and
nutritional adequacy of the diet.
•
• Between ages 1 and 2, children learn to feed
themselves independently .
•
• Development of gross and motor skills:
• Allows them to learn to feed themselves and to prepare
simple foods such as sandwiches and cereal.
• They progress from eating with their hands to using
utensils.
•
• Spilling and messiness characterize the first half of
the second year but by age 2, hand-mouth
coordination has improved and spilling seldom
occurs.
• By 15 months of age, children can
manage the cup, but not expertly.
•
• As the young child matures, self-help
skills become more sophisticated.
•
• By the 18 months to two years, many
toddlers are quite adept at feeding
themselves.
•
• By age 5, children can effectively use
knives and forks.
• Characteristics of toddler:
• Independence and curiosity
•
• Exploration of the environment is due to
the child’s increasing mobility,
manipulation and attempts at various
skills.
•
• Food is one area where they attempt to
show this characteristics.
•
• Preschoolers also learn to understand
language and how to talk and ask about
food.
•
• They learn about the variety of foods and
the way it feels, tastes and smells.
•
• Younger pre-school children:
• interested in how food feels and often
prefer finger feeding and feeding themselves.
•
• Food that provides opportunities for
finger feeding should be provided at
each meal.
•
• They demand independence and refuse help in many
tasks in which they are not skillful such as
self-feeding.
•
• As they become older, they become less interested
in food and more interested in their
environment.
•
• They test and learn the limits of behavior that
are acceptable.
•
• Idiosyncratic food choices are common.
•
• Likes and dislikes may
change from day to day and
week to week.
• However, the child should be allowed to
choose foods they like.
•
• Rituals become part of food preparation
and service.
•
• Appetites are usually erratic and
unpredictable during the preschool
period.
•
• The child may eat voraciously at one
meal and refuse to eat the next.
 NUTRIENT ALLOWANCES
• RDA TABLE FOR Filipino lists
nutrient allowances for
preschool children into 2
categories:
• 1-3
• 4-6
•
• Allowances are based on the
needs of the middle year in
each group (2 and 5), and are
for moderate activity and
average weight.
•
 ENERGY
• Energy requirement must take into
consideration basal metabolism,
rate of growth and activity.
•
• Dietary energy must be sufficient
to ensure growth and spare
protein from being used as a
source of energy.
•
•
• The average energy requirement for basal
metabolism during the first 12-18 months
of life is 55 kcal/kg body weight.
•
• The requirement of the weight specific basis
declines to an adult level of 25-30
kcal/kg.
•
• As children grow older, the level of
calories increases due to larger body size
but the need for energy per unit size
actually decreases.
•
• The contribution of physical activity to
total energy expenditure varies daily and
between each child.
•
• The energy needs of individual children of
the same age, size and sex also varies.
•
• Observation has shown that in malnourished
children the diet is often lacking in
calories and not protein.
•
• Lack of calories in the diet leads to
utilization of protein as source of energy
resulting in protein energy malnutrition
(PEM), or extreme wasting called marasmus .
•
• If calories are adequate but protein intake
is inadequate, this results in condition
called kwashiorkor .
•
 PROTEIN
• It is need for maintenance of tissue, changes in
body composition and synthesis of new tissue.
•
• Protein requirement increases from age 1-6 years.
•
• Protein needs for growth decreases as the rates
of growth decline.
•
• On a weight-specific basis, protein requirement
decreases from the first year of life through
childhood and adolescence.
•
•

• FAO (Food and Agriculture Organization)

• recommends 1.5-2 g protein/kg body weight, 2/3
of which should be of high biological value.
•

• This amount will provide for increase in

skeletal and muscle tissues and protection
against infection.
•
 VITAMINS AND MINERALS
• It is necessary for normal growth and development.
•
• Insufficient intake can cause impaired growth and
result in deficiency diseases.
•
• Vitamins requirements increase during the preschool
age.
•
• The most common Vitamin Deficiency among
preschoolers is Vitamin A, C, riboflavin and
thiamine.
•
• Vitamin A is essential for growth, vision
healthy skin and mucous membrane.
•
• Vitamin D is needed for calcium absorption
and deposition of calcium in the bones.
•
• During childhood, mineral content and
requirements of the body increases.
•
• Most common mineral deficiency is iron,
calcium and zinc.
•
• Iron is needed for growth and development and
formation of hemoglobin.
•
• Full-term infant’s iron stores that
were deposited in fetal life are
generally adequate for body needs up
to 4-6 months of age.
•
• Calcium is needed for optimum
mineralization of bone and prevents
osteoporosis in later life.
•
• Zinc is essential for growth and a
deficiency results in growth failure,
poor appetite, decrease taste acuity
and poor wound healing.
 COMMON NUTRITION PROBLEMS
• The four most common malnutrition
problems in the Philippines are:
•

• 1. Protein-Energy Malnutrition
• 2. Iron deficiency anemia
• 3. Vitamin A deficiency
• 4. Iodine-deficiency Disorder
•

• …other nutrition problems are:

• Obesity
• Dental Caries
•
 Protein - Energy
Malnutrition
• This is due to lack of energy and protein in the
diet.
• Age 1-3 years are vulnerable to PEM that is the
most common and widespread form of
malnutrition
• “major public health problem” causing a high rate
of morbidity among preschool children.
• It is due to a deficiency of protein or of
calories or both.
• “Marasmus” – severe form of PEM manifested by
extreme wasting caused by prolonged
restriction of both energy and protein.
• “Kwashiorkor” – due to a deficiency of CHON but
energy intake is adequate.
•
• Manifestation of PEM is a weight
for height that is below the
reference standard.
•
Iron deficiency anemia
• Anemia – either low hemoglobin or a low hematocrit or
both compared with normal concentrations.
•
• IDA is the most common form of anemia among children
and usually occurs between the ages of 3mos. – 3
years of age.
•
• Lack of iron in the blood results in paleness of the
eye, lips, fingernails, palms and skin, shortness of
breathe and easy fatigability, reduced ability to
learn and irritability.
•
• Anemic children do poorly on vocabulary, reading,
mathematics, problem-solving and psychological tests.
• Lack of dietary iron may be due to the ignorance
of parents on the importance and food sources
of iron, poverty that restricts the amount and
variety of foods available or the difficulty of
providing dietary iron under the best
circumstances.
•
• Treatment of anemia in childhood involves the
therapeutic use of iron salts at level
providing from 30 – 100 mg of iron a day,
usually together with Vitamin C, until
hemoglobin levels have returned to normal
levels.
•
 Vitamin A deficiency
• It results in night blindness, xerophthalmia,
rough dry skin and membranes of nose and
throat, increase susceptibility to
infections, poor growth and blindness in
severe cases.
•
• It is due to low intake of vitamin A from
animal sources and leafy green vegetables
as well as fat, a carrier of fat soluble
vitamins.
•
 Iodine - deficiency
Disorder
• It refers to a group of clinical
entities caused by inadequacy of
dietary iodine that includes goiter,
hot or cold intolerance, mental
retardation, deaf-mutism, difficulty
in standing or walking normally, and
stunting of the limbs of children of
goitrous mother.
•
 Obesity
• Over Nutrition is one of the most
widespread nutrition disorders of
children in developed countries such
as USA.
•
• However in the Philippines, this is not
much of a problem compared with the
lack or deficiency of nutrients and
calories.
•
• Childhood obesity is associated with
hyperinsulinemia,
hypertriglyceridemia and reduced HDL-
cholesterol.
•
• The causes of obesity can be genetic or
familial, metabolic hormonal
abnormality and environmental.
•
• However, it is attributed mostly to
inactivity or sedentary lifestyle and
poor eating habits.
•
• Too much viewing in television in
children is a factor that can lead to
obesity.
•
 Dental Caries
• Diet and nutrition have an important role in
preventing dental caries.
•
• Cariogenicity of a child’s diet is related more
to the frequency of intake of sticky sugar-
containing foods that cling to the teeth than
to the total amount of sugar in the diet.
•
• Preventive dietary practices include
restricting sugary foods to mealtimes,
brushing teeth immediately after eating
sugary foods, and decreasing the practice of
allowing children to go to sleep with a
bottle of containing juice, milk or other
sugar containing fluid.
•
• Dental caries can also be
prevented by flouridation of
water supply and the use of
flouride in toothpastes and
mouthwashes.
•
 NUTRITION ASSESSMENT
• Anthropometric Assessment – The
following measurement should be complete
for a preschool child:
•

– Weight
– Stature
– Head Circumference
– Triceps Skinfold
•
 WEIGHT
• Children who can stand without assistance
are weighed standing on a scsle and
wearing only lightweight undergarments.
•
• Weight should be recorded to the
nearest100g.
•
• Consistency of technique and choice of
weight units are important to avoid
unnecessary sources of error.
•
• Weight for age is a complete index of
height for age and weight for height.
• In preschooler, it is an
indicator of acute
malnutrition.
•
•
 STATURE
• Children between 2-3 years of age can be
measured in recumbent or standing position
depending on their ability to cooperate.
•
• Children older than 3 years should be
measured standing.
•
• To avoid error, the measurers eye should be
level with the headboard.
•

•
• A low height for age is sometimes called growth
stunting that may due to poor nutrition, a high
frequency of infections or both.
•
• Stunting refers to a slowing of skeletal growth
and stature, the end result of a reduce rate of
linear growth.
•
•
 HEAD CIRCUMFERENCE
• It should be measured in children until they
are 36 months of age.
•
• A flexible, non-stretch tape about 0.6 cm is
wide is used.
•
•
 TRICEPS SKIN FOLD
• Thickness is a measurement of a double length
of skin and subcutaneous fat on the back of
the upper arm.
•
• It is useful index of relative fatness of the
body because subcutaneous adipose tissue is
a major component of body fat.
•
• The thickness of the skin and subcutaneous
fat can also be measured with calipers.
•
•
 BIOCHEMICAL ASSESSMENT
• Hgb and Hct determination should be done to
determine the presence of anemia.
•
• Total Serum cholesterol level and LDL
cholesterol may also be assessed using 170
mg/dl as cut off point for total cholesterol
and 110 mg/dl for LDL cholesterol.
 DIETARY ASSESSMENT
• The diet assessment methods used for
adults can be adapted to child.
•
• However, the parent must provide the
information about the child’s meal and
snack pattern, food eaten, how foods were
prepared and other dietary habits.
•
• The most common dietary assessment method
used to determined children’s intake are:
•

• 24 hour food recall

• Food record
• Food frequency
questionnaire
 24 HOUR FOOD RECALL
• This is a method of assessment whereby an
individual is asked to remember
everything eaten during the previous 24
hours.
•
• It is widely used method because it is
easy to administer, in person or by
telephone, and lends itself to large
population studies.
•
• This method is best suited to describing
the intakes of populations, not
individual.
 FOOD RECORD
• This is written record of the amounts of all
foods and liquids consumed during a set time
period, usually 3-7 days, and often includes
information on time, place and situation of
eating.
•
• This method provides detailed information on
foods eaten and methods of preparation.
•
• Accurate records can be obtained if respondents
are highly motivated, literate and well
trained.
 Food frequency
questionnaire
• This is a method of assessment in which
the data collected relate to how
often foods are consumed.
•

• Its advantage are:

•

– It is self administered
– requires only 15-30 minutes to complete
– Can be analyzed at a reasonable cost.
•
• Its limitation is similar to the 24-
hour recall, in that the accurate
reporting depends on memory.
•
• Also, the food list is often limited in
scope and may overlook come foods
commonly eaten by the population.
 FACTORS INFLUENCE
FOOD INTAKE
•
• Family Environment
• Societal Trends
• Media
• Illness or Disease
 FAMILY ENVIRONMENT
•
• The family has the major influence on the food
habits of toddlers and preschoolers.
•
• Families can provide the appropriate role models
and reinforcements that will most likely bring
about desirable food habit changes.
•
• The influence of parents to children’s food behavior
decrease as the amount of time spent in working
outside the home increased.
• One of the basic responsibilities of a parent
or caregiver is to provide nourishing food
that is clean, safe and developmentally
appropriate.
•
• A positive feeding relationship includes
division of responsibility between parents
and children.
•
• Parents provide safe, nutritious food as
regular meals and snacks and children
decide how much, if any, they eat.
•
• Ellen Satter states that “the parent is
responsible for what is offered: the child
is responsible of how much to eat.”
• Feeding and nutrition problems during
childhood may result from
inappropriate parent-child
interactions.
•
• It is possible to set up a home
environment that fosters the
development of desirable eating
patterns in young children.
•
• A positive environment is one in which
sufficient time is set aside to eat,
occasional spills are tolerated and
conversion that includes all family
members are tolerated.
 SOCIAL TRENDS
• There are more mothers now who work or are
employed outside the home.
•
• Therefore, they do not have much time to
prepare meals for their families nor teach
their children about good eating habits.
•
• They often have to rely on others to cook for
them or they either purchase fast foods on
convenience foods.
 MEDIA
• Mass media esp. television affects children’s
request for and attitudes towards food.
•

• TV influences eating habits and the

nutritional status of children in several
ways:
– 1. Tv advertising influences family food
purchase and snaking patterns of children
– 2. the use of food as depicted on TV shows
food being used for many activities other
than to satisfy hunger
– 3. the few overweight children used on tv
suggest that inappropriate used of food have
no impact on health.
– 4. there is a relationship between increased
TV watching and increased snaking.
– 5. TV encourages inactivity and passive use
of leisure time so it is detrimental to
children’s growth and development.
–
– Children spend more time watching TV than
going to school or doing any other
activity.
–
– Parents must set limits on the number of
hours that children watch TV and should
help them interpret food messages seen on
the screen.
–
– They should not be persuaded by their
children to buy non-nutritious foods seen
in TV.
 ILLNESS OR DISEASE
• Children who are ill have decrease appetite
and limited food intake.
•
• Acute illness of short duration may require
increase in fluids, protein and other
nutrients.
•
• Chronic condition may take it more difficult
to obtain nutrients for optimal growth.
•
• Children with illness are more likely to have
behavior problems or family struggles
around food.
 DEVELOPMENT OF FEEDING
PATTERNS
• The goals for the development of food
patterns are as follows:
•

– 1. Children should be able to eat in sufficient

quantities the foods given to them, just as
they take care of their other daily needs.
– 2. children should be able to manage the
feeding process independently and with
dispatch, without either necessary dawdling
or hurried eating.
– 3. Children should try to eat new foods in
small portions the first time they are served
to them to try them again and again until
they like or at least willingly accept them.
FEEDING THE PRESCHOOL CHILD
• Milk : When , What , and How?
Starting at age two, most children can
safely drink reduced-fat milk, including
1% low-fat and 2% reduced-fat.
• That's because your youngster requires less
of the fat and cholesterol concentrated
in full-fat milk than she did during her
first two years.
• That's not to say that you must serve skim
or 1% low-fat or light milk, however.
• Your child may still need the calories that
full-fat dairy products supply.
• Whatever milk you choose, make sure your child
drinks enough to get the calcium required by
growing bones.
• Three-year-olds need 500 milligrams of calcium
a day, the equivalent of about 14 ounces of
milk or fortified soy beverage.
• Four-, five-, and six-year-olds need much more:
800 milligrams of calcium daily, or about 24
ounces of milk or fortified soy beverage.
•
• Table 17-5 (refer to book) shows the right
kinds and amounts of foods to eat
everyday.
•
• This includes energy foods such as rice,
corn, bread, yellow kamote or gabi; and
fats and oils that also gives energy.
•
• Additionally, fats help the body make use
of fat soluble vitamins such as A, D, E
and K.
•
•
• The second are the body building foods such as
milk for growth, strong bones and teeth and
increased resistance to infection; and fish,
meat, poultry, eggs and dried beans for growth,
building firm and strong muscles, giving
energy and helping keep the blood healthy.
•
• The last are the regulating foods consisting of
GLV and yellow vegetables such as malunggay,
kangkong, kamote tops, petsay, carrot and
squash for vitamins and minerals; vitamins C
rich fruits such as papaya, mango, suha, and
dalanghita; and other fruits and vegetables
such as banana, chico, avocado, sitao or
eggplant.