AAFS 3334: HUMAN NUTRITION
LECTURER: DR. KOO HUI CHIN
TITLE: NUTRITION FOR INFANTS, CHILDREN AND ADOLESCENTS
PROGRAMME: DIPLOMA IN FOOD SCIENCE (YEAR 2 SEM 3)
TUTORIAL GROUP: DFN 2 NN1
NAME ID NUMBER
LIAN YONG LIANG 16WLD04987
LEE VOON YEE 16WLD04754
CHU HUI XIN 16WLD04189
ANG NI JING 16WLD05068
CHUAH JI ZIN 16WLD01141
DICKSON TEE DICK SENG 16WLD02667
CHAI JOE YEN 16WLD00660
INFANT
Growth chart
CDC
2057400325120BOYS
00BOYS

1924050187325GIRLS
00GIRLS

IOTF

WHO

Carbohydrates
60-95g/day. It used to provide body with source of fuel and energy to carry out dairy activities and exercise. Carbohydrates also used to ensure the efficiency of infant brain, heart, nervous, digestive and immune system work correctly. Examples of food products such as breakfast cereals, vegetable and fruits, wholemeal bread and so on.Protein
1.5g/kg/day. Protein important for infant’s growth and development. Difference stage of infant take in difference food products. For instance, 6 to 8 months with chopped meats and mashed beans. 8 to 10 months, mashed egg yolk, cottage cheese and yogurt. 10 to 12 months, protein-rich foods, or food products in soft and small pieces. Baby should eat protein every day because baby body does not store protein as the way it stores fats and carbohydrates.
Fat
30-31g/day. Fat need to provide energy in a concentrated form and in quantities with which their stomach can cope. Infant need sufficient amount of omega 3 and omega 6. Fat helps in constituents of cell membranes and important to development of eyes and nervous system.

Mineral and vitamin
Iron: only last first 4 to 6 months in infant’s body. Infant should take in 11mg/ day at 7 to 12 months. Iron as essential nutrient for haemoglobin, where red blood cell transport oxygen throughout body. Iron rich food help to prevent anemia.

Vitamin A: 400mcg/day. It important for cell growth, eye development, infection resistance, bone growth and red blood cell production.Vitamin C: 40mg/day. It important for tissue repair and collagen production, improve iron absorption to prevent scurvy.

Vitamin D: 400IU/40= 10mcg/day. Lack of vitamin D cause to get bone disorder and rickets. Infant could get enough vitamin D from the sunlight.

Breast milk
Breast milk contain carbohydrate, protein and fat with 39%, 6% and 55% respectively. Breast milk has higher nutrient and more benefit compared to formula milk. Breast milk important for infant’s growth and development especially first month of life. It also used to strengthen immune system and respiratory system in infant. The fat such as cholesterol in breast milk support the nerve tissue in infant to faster their brain development. Breast milk always convenient and ready to eat.Breast feeding
Mother will burn extra calories when breast feeding, which will lose pregnancy weight faster. Breastfeeding will release hormone oxytocin, help uterus return to its pre-pregnancy size and reduce the uterine bleeding after birth. WHO stated that exclusive breastfeeding for 6 months, then continued breastfeeding combined with solid food for 2 years.

Increase the breastmilk
Mother should consume at least 1,800 calories in a day and drink at least 6 glasses of fluid such as mineral water, milk or juices while lactating. Moreover, mother should always take a good rest. Sleep well when the baby is sleeping and relax when free. A reasonably well-balanced diet is important for a mother. Food products that contain Galactagogue such as herbs, prescription, medication and so on should having more to increase the milk supply. The duration of feeding should exchange each side after 10 to 20minutes.
Infant formula
Infant formula is a substitute for breast milk for feeding infants and the composition of the infant formula is attempts to copy breast milk composition.

Composition of the infant formula
Caloric density
Protein content such as whey and casein
Fat such as saturated and polyunsaturated fatty acid
Carbohydrates such as lactose
Micronutrients
Type of the infant formula
Milk-based formula
Milk based formula is prepared from cow`s milk with added vegetable oil, vitamins, iron and minerals. This is suitable for most healthy full-term infant.

Soy-based formula
Soy-based formula is soy protein with added vegetable oils (fat calories) and corn syrup or sucrose (for carbohydrate). This kind of milk is very suitable for the infant who are lactose intolerance or who are allergic to the whole protein in cow milk and milk based formula.

Low sodium formula
This kind of milk is suitable for the infant who are needs to restrict intake of salt.

`Predigested’ protein formula
This kind of milk formula is suitable for the infant who are cannot digest or are allergic to intact protein.

Lactose free formula
Lactose free formula is suitable for the infant who are lactose intolerance and for children who are recovery from infectious diarrhea and gastroenteritis.

Free amino acids
Pre-term infants
Suitable for the premature infant.

Pre-term follow up
FEEDING SKILL DEVELOPMENT
4-6 months
Baby will feed in semi-reclined position
Visually recognizes bottle or breast
Uses hands to pat bottle/breast during feeding
Begins to eat puree/smooth creamy foods by sucking food from a spoon
Child will swallow strained foods
6-8 months
Eating in more upright position
Tongue can lateralized/move toward cheeks
Mouthing and munching spoon, toys and biter biscuits
Holds own bottle
Drinking from a cup held for child
Eating mushed, soft table foods
Drooling less except for teething
Bite and released observed
Move food around in mouth using tongue, bites and chew toys
8-12 months
Sitting upright during meals
Biting and chewing food voluntary
Eating finger foods with purees meats
Developing a rotary chew pattern
Finger feeds self
Holds spoons during meals
12-18 months
Eating table foods, but meat chopped very small
Lips closed during chewing
Appetide decrease, may refuse food
Scoops food with spoon, bring food to mouth
18-24 months
Chewing with rotary jaw movements
Distinguish between food and non-food item
Give up bottles
Give empty bowl or dish to an adult
Plays with foods
Develop clear food preferences
CHILDREN
ENERGY NEEDED FOR CHILDREN
Age Gender Sedentary Moderately active Active
2-3 Male or female 1000 1000 1000
4-8 Male
Female 1200-1400
1200-1400 1400-1600
1400-1600 1600-2000
1400-1800
9-13 Male
Female 1600-2000
1400-1600 1800-2200
1600-2000 2000-2600
1800-2200
Calories need for children in different age and in different physical activity

NUTRIENTS NEED
For children, both boys and girls need to consume 50-55% of carbohydrate. For fats, at the age of 1-3 years old, children need to take in 30-40% of calories from fat. During 4-18 years old, children need to take in 25-35% of calories from fat. For protein, at the age of three, 10-30% of calories must come from protein. Other than that, the needs for protein will increase gradually with age. For children, there is no needs to take in supplement. However, food that are iron fortified should be consume.
EATING HABIT
Food jag is a common eating habit found in children. It is when a child will only eat selected food item, meal after meal. If this continue for a long period, it will lead to nutrients deficiency. Parents should offer a wide variety of food to the children. Other than that, gradually stop the children from the food they select but do not force them.
DISEASE – CROUPS
Although children tends to be sick or infected with several disease, most parents know how to react and counter them when they are sick. However, the knowledge on croups that is the second most familiar source of respiratory distress in the earliest decade of life are quite less compare to other disease. Croup indicates an infection in the upper airway, which interfere the breathing and result in a unique barking cough. It was seen more frequent in boys more than girls and also young kids between 6 months and the age of three compared to infants, older children and adolescents.

REMEDIES FOR CROUPS
Moisten the air. Although there is no research proven from this practice, we trust that humid air aids in child’s breathing. Humidifier or sit with the child in a bathroom filled with steam produce by running hot water from the shower can moisten the air. Eat honey, turmeric or ginger helps in relieves the symptoms too.

ADOLESCENT
Table 3
Nutrients of concern in the average diet of US adolescents
Nutrient intakes Females Males
Lower than recommended intakes Vitamins ?
?
?
? ?
?
Folate
Vitamin A
Vitamin E
Vitamin B6 Minerals
Calcium
Iron
Zinc
Magnesium ?
?
?
? ?
?
Other
Fiber ? ?
Higher than recommended intakes Total fat
Saturated fat
Sodium
Cholesterol
Total sugars ?
?
?
?
?
?
?
?
Source: data from 1-3
Energy (kcal/day)
Females Kcal Males Kcal
9-13yrs 2071 9-13yrs 2279
14-18yrs 2368 14-18yrs 3152
19-30yrs 2403 19-30yrs 3067
RDA for vitamins in adolescents
Vitamins Age (yrs) Females Males
Vitamin A 9-13 600ug/d 600ug/d
14-18 700ug/d 800ug/d
Vitamin E 9-13 11mg/d 11mg/d
14-18 15mg/d 15mg/d
Vitamin C 9-13 45mg/d 45mg/d
14-18 65mg/d 65mg/d
Folate 9-13 300ug/d 300ug/d
14-18 400ug/d 400ug/d
Source: data from reports from the Institute of Medicine, Food and Nutrition Board, Standing Committee on the Scientific Evaluation of Dietary Reference Intakes,3-7 © by the National Academy of Sciences, courtesy of the National Academies Press, Washington DC.

Recommended caloric (kcal) and protein intake for adolescents
Age (yrs) Calories (kcal)
Kcal/day Kcal/cm
Females
11-14
15-18
19-24 2200
2200
2200 14.0
13.5
13.4
Males
11-14
15-18
19-24 2500
3000
2900 15.9
17.0
16.4
Age (yrs) Protein (g)
g/day g/cm
Females
11-14
15-18
19-24 46
44
46 0.29
0.27
0.28
Females
11-14
15-18
19-24 45
59
58 0.29
0.34
0.33
Source: data from Gong EJ, Heard FP. Diet, Nutrition and adolescence. In: Shils ME, Olson JA, Shike M, eds. Modern nutrition in health and disease. 8th Edition. Philadelphia, PA: Lea ; Febiger, 1994; and 1989 Recommended Daily Allowances, 10th Edition of the RDAs, Food and Nutrition Board, Commission on Life Sciences. Washington, DC: National Academy Press; 1989.
Carbohydrates
Primary source of dietary energy
;50% of total daily calories in carbohydrates, no more than 10-25% from sweeteners
Fat
For normal growth and development
;30% of calories from fat, with no more than 10% from saturated fat
Protein
Maintain lean body mass
Highest protein requirement for females in the 11-14 age range and for males in the 15-18 age range
Inadequate intake will leads to reduction in linear growth, delay in sexual maturation and reduction accumulations of lean body mass
Recommended protein intake is based on age, gender and height
Calcium
Adequate intake for age 9-18 years is 1300g/d and 1000mg/d for 19-30 years
Inadequate intake will leads to low peak bone mass and osteoporosis
Zinc
For growth and sexual maturation
Recommended Dietary Allowance
Age (yrs) Intake (Mg/day)
9-13 8mg/d
14-18 (males) 11mg/d
14-18 (females) 9mg/d

Zinc deficiency have been found in 18-33% of female adolescents
Fiber
For bowel function and prevent chronic disease
Recommended Dietary Allowance
Age (yrs) Intake (g/day)
14-18 (males) 15g/d
14-18 (females) 12g/d
EATING DISORDERS
The average age of eating disorders takes place during adolescent’s period. There are a few examples of eating disorders that will happen in adolescent, which are the anorexia nervosa and bulimia nervosa. This two types of eating disorders are the most occur in the adolescent’s age.
Anorexia Nervosa is an eating disorder characterized by weight loss, fear of gaining weight and extremely strong desire to be thin. This characteristics will cause the individual to restrict food intake. (Attia 2010) Besides that, Bulimia Nervosa is another type of eating disorder which characterized by a cycle of bingeing and compensatory behaviours such as self-induced vomiting. (National Eating Disorder Association, NEDA n.d.) These behaviour can affect the digestive system of the individual.
FACTOR THAT LEAD TO DISORDERED EATING IN ADOLESCENT PERIOD
What are the factors that may lead to the eating disorders happen in adolescents? The possible factors are the body image concerns from the adolescents which they highly concern and care about the body shape and etc. (Nestle n.d.) Besides that, anxiety and loneliness will cause the adolescents become disordered eating such as refusal to eat or excessive eating. (Nestle n.d.)
Difficulty in managing relationships such as family relationship and friendships. (Nestle n.d.) The lack of caring and understanding from the family and friends may cause the individual becomes disordered eating. Furthermore, low self-esteem and stress from the environments also are the factors leading to disordered eating. (Nestle n.d.) This is because the society environment have the concept of thin person is more gorgeous, thus the adolescents will have low self-esteem if they are not as thin as the standard and cause disordered eating.
OBESITY IN ADOLESCENT’S PERIOD
There are more than 20 % of children and adolescents are overweight. The obesity of children and adolescents can be measured by age and gender specific normograms for BMI. (Raj et al. 2010) The BMI that equal to or exceeding the age and gender specific 95th percentile are defined as obese. (Raj et al. 2010)
The reasons that can cause the obesity happen in adolescents are the adolescents nowadays having more sedentary lifestyle and behaviours. (Raj et al. 2010) The lack of physical activities and excessive calories can cause the accumulation of fat. The adolescent also consume less fruits and vegetables in the meal but having higher intake of total and saturated fat in the meal increase the risk of adolescents’ obesity. (Raj et al. 2010)
DIABETES IN ADOLESCENT
There are increasing of prevalence of type 2 diabetes mellitus in children and adolescents around the world. (Reinehr 2013) The development of type 2 diabetes is resulting from the insulin resistance which the insulin does not work properly. (National diabetes services scheme 2015) The adolescents and children most at risk of developing type 2 diabetes are overweight or obese adolescents and children, blood relatives with type 2 diabetes, and signs of insulin resistance diagnosed by the doctor. (National diabetes services scheme 2015) The type 2 diabetes can potentially cause long-term complication such as heart disease, kidney disease and limb amputations.
OESTEOPOROSIS
Bone mineralization peaks in teenagers and young adult periods which maximizing the bone mineralization can reduce the risk of adult osteoporosis. Osteoporosis is a type of disease that characterized by too little bone formation and excessive bone loss. (National Institutes of Health Osteoporosis and Related Bone Diseases National Resource Center 2015) This disease is rare in children and adolescent but prevention of adult osteoporosis can be carried out in children and adolescents stage. Thus, high intake of calcium, phosphorus and vitamin D can increase the bone mineralization in the adolescents and prevents the osteoporosis occur in the adult stage. Milk, dairy products and fish are some of the foods that contain calcium and phosphorus. Besides, more physical activities in the outdoor can help to strengthen the bone and increase the vitamin D intake.
ANEMIA
Anemia is a condition characterized by reduction in the red blood cells (erythrocytes) or haemoglobin (Hb) concentration. (Tesfaye et al. 2015) Adolescents are at high risk of iron deficiency and iron deficiency anemia due to the rapid pubertal growth with sharp increase in lean body mass, blood volume and red blood cells mass which require high amount of iron. (Tesfaye et al. 2015)
Adolescents should consume foods that contains iron, folate and vitamin B12 such as whole grains, lean meats and legumes to prevent the anemia to happen. (Tesfaye et al. 2015) The female adolescents should consume more high iron foods or iron fortified food because they require more iron than male adolescents for the menstruation support.
HEALTHY LIFESTYLE IN ADOLESCENTS AND TEENAGERS
A healthy lifestyle in adolescents is important and critical for the prevention of health problems in adulthood, for countries future health and ability to develop. (WHO 2017) There are a few tips of healthy lifestyle for the adolescents (WHO 2017):
Adolescents consume high iron foods or iron-fortified food and food that contains folate to prevent anemia.
Reducing the marketing foods that high in saturated food, trans-fatty acids, free sugar and salts
Do not have cigarette smoking habits
Avoids drinking alcohol in adolescents’ period
Be positive thinking
Having about 60 minutes of moderate to vigorous physical activities daily
Adolescents can find parents to guide you during choosing food so that the foods that chosen are healthy.
DIFFERENCES
INFANT
Asian Differences Foreigners
47.5 Average size(cm) 49.5
Brown/black color Eyes color wide variety of color
Black color Hair color Brown/golden color
More on formula milk Food More on breastmilk
CHILDREN
Asian Differences Foreigners
slower Rate of increasing height and weight faster
shorter Height higher
Full black/brown color hair Full brown/golden color
More on education
More stress Personal Happiness More on leisure activities
Less stress
ADOLESCENT
Asian Differences Foreigners
>12 Puberty age 10-11
shorter Height higher
Rice
Noodle Food Noodle
Burger
High protein food
Less freedom Freedom More freedom
REFERENCE
Candice L. Bjornson, David W. Johnson, 2013, “Croup in children”, volume 185(15), pg1317–1323.

Medlineplus, nd, “Food Jag” viewed in 5/4/2018 (https://medlineplus.gov/ency/article/002425.htm)
Nestle, n.d., ‘Adolescent food habits’, viewed 2/4/2018, <https://www.nestle.com.au/nhw/nutrition-for-everyone/familylife/adolescentfoodhabits>
National diabetes service scheme, 2015, ‘Type 2 Diabetes in Children ; Adolescents’, viewed 2/4/2018, <https://www.ndss.com.au/type-2-diabetes-in-children-adolescents-information-sheet>
Reinehr, T, 2013, ‘Type 2 diabetes mellitus in children and adolescents’, World Journal of Diabetes, vol. 4, no. 6, pp. 270-281
National Institutes of Health Osteoporosis and Related Bone Diseases National Resource Center, 2015, ‘Juvenile Osteoporosis’, viewed 2/4/2018, <https://www.bones.nih.gov/health-info/bone/bone-health/juvenile/juvenile-osteoporosis>
World Health Organization, WHO, 2017, ‘Adolescents: health risks and solutions’, viewed 2/4/2018, <http://www.who.int/mediacentre/factsheets/fs345/en/>
Tesfaye, M, Yemane, T, Adisu, W, Asres, Y & Gedefaw, L, 2015, ‘Anemia and iron deficiency among school adolescents: burden, severity, and determinant factors in southwest Ethiopia’, Adolescent Health, Medicine and Therapeutics, vol. 6, pp. 189-196
Raj, M & Kumar, RK, 2010, ‘Obesity in children ; adolescents’, Indian Journal of Medical Research, vol. 132, no.5, pp. 598-607
Attia, E, 2010, “Anorexia Nervosa: Current Status and Future Directions”. Annual Review of Medicine. Vol. 61, no. 1 pp. 425–435.

National Eating Disorder Association, NEDA, n.d., ‘Bulimia Nervosa’, viewed 2/4/2018, < https://www.nationaleatingdisorders.org/learn/by-eating-disorder/bulimia>
Lino M, Gerrior SA, Basiotis P, Anand RS., 1999, ‘Report card on the diet quality of children’. Fam Econ Nutr Rev pp:78-80.
Gleason P, Suitor C, 2001, ‘Dietary intake and its relationship with school meal participation.’ Special nutrition programs; report no. CN-01-CD1. Alexandria, VA: US Department of Agriculture, Food and Nutrition Service, viewed 5/4/18 http://www.fns.usda.gov/oane/MENU/Published/CNP/cnp.htm
Munoz K, Krebs-Smith S, Ballard-Barbash R, Cleveland L, 1997, Food intakes of US children and adolescents compared with recommendations.
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