NUTRITIONAL NEEDS OF CHILDREN

Eating is a natural and instinctive behavior usually to gain and save energy. For people, especially children, it is important to have the correct balance of food intake in terms of quality and quantity. This includes foods that are sources of energy, macronutrients, and micronutrients.

Maintaining the proper nutritional needs of a child allows for normal growth and development, as well as maintaining the proper weight. This is especially true for infants, who have higher energy and nutrient needs as they undergo neurocognitive (brain) development.

Malnutrition, which refers to both obesity and undernutrition, is one of the main causes of acquired diseases, such as hypertension, diabetes, and even acquired immunodeficiencies. In children aged 2 to 18 years old, as much as 40% of their diet contains sugars and solid fats. On the other hand, teenagers are unable to meet their total daily water requirements.

Children with nutritional deficiencies are at risk of problems with their immune system, brain development, and overall growth. They are at risk of acquiring health conditions later on in life: these include hypertension, diabetes, heart disease, osteoporosis, iron deficiency, and cancer. Malnourished kids are also at risk of earlier death from these illnesses. Having a proper diet, along with regular physical activity, will help prevent these conditions from developing at an early age.

Energy and Nutrients

When a child eats food, he or she receives nutrients that can be used for energy. Throughout the day, various metabolic processes in the body take place that consume energy. Physical activity and stress, as well as illnesses, take additional stores of energy. Too much or too little energy left causes an imbalance; too much energy left can lead to obesity, while too little can lead to growth problems and even the breakdown of some body tissues to provide energy.

Food mostly provides three main types of macronutrients: fats, carbohydrates, and proteins. Water and micronutrients, such as vitamins and minerals, are also important components of nutrition that are found in various types of food.

Macronutrients

Fat

Fat is the most calorically dense of foods, jam-packed with macronutrients for energy use. In infants, fats are obtained from human and formula milk. For older children, sources of fats include animal products, margarine, and oils. While fats are essential for development of the brain and eyes, it’s best to start limiting fat intake as a child turns 2 years old. For children, it’s easy to eat too much fats, and this could lead to cardiovascular diseases in the future.

Good sources of fats include breast milk and infant formula for infants, and walnut and flaxseed oil for older children. These contain essential fatty acids that are needed for healthy skin and hair, a good immune system, and the absorption of fat-soluble vitamins (A, D, E and K).

Protein

Proteins are the building blocks of the body’s tissues and organs. It is a significant component of our genetic material (DNA and RNA). Proteins are needed for a child to continue growing taller and stronger. Indeed, athletes, male teenagers, and children with select medical illnesses may need more protein intake than the general population. The most common source of protein is meat, but significant amounts may also be acquired from eggs, dairy, legumes, and corn. For infants, human milk and formula also contain protein.

Carbohydrates

Carbohydrates and sugars are also essential to a child’s diet. Glucose, in particular, is the best source of energy for the body. Good sources of carbohydrates are grains, cereals, bread, dairy products, fruits, and vegetables. Like fat, carbohydrates should be taken in moderation. Excess intake can cause problems in the absorption of other essential nutrients, such as vitamins and minerals.

Fiber is a type of carbohydrate that can pass through the intestines without being digested at all. Instead of being another source of energy, fiber is needed for regular and healthy bowel movements. Indirectly, fiber helps regulate the body’s cholesterol and sugar levels, and also prevents the buildup of harmful toxins and potential carcinogens in the intestines.

Micronutrients

While macronutrients are required for the body to store up and use energy, micronutrients are needed to maintain the normal physiologic processes of the body. For example, iodine is needed for proper thyroid function, while folic acid (a type of Vitamin B) helps prevent certain birth defects. In the United States, studies show that children do not have enough iron, calcium, zinc, potassium and vitamin K in their diets; on the other hand, there is too much sodium intake.

In general, vitamins and minerals are found in the following food groups:

• fruits and vegetables (including tofu, nuts and legumes)
• meat (lean meat, fish, chicken, eggs)
• grains (breads, cereals, rice, pasta and corn)
• dairy (milk and cheese)

Vitamins

There are different types of vitamins that cater to different anatomical or physiological areas of the body. These are essential for bone growth and metabolism, the formation of coagulation factors and blood components, proper vision, nerve conduction, synthesis of important fatty acids and neurotransmitters, metabolism of macronutrients, collagen synthesis, and antioxidants. More information on vitamins may be found in the following page: https://myacare.com/blog/vitamin-deficiencies-in-children

Minerals

Like vitamins, minerals are important in maintaining the proper physiologic functions of the body. These include maintaining the proper structure of proteins in the blood, proper immunity and gene expression, muscle contraction, nerve conduction, sufficient fluid absorption from the gut, maintaining the appropriate blood pressure and water content of the body, proper thyroid function, metabolism of macronutrients, dental health, metabolism of toxins, and connective tissue formation. More information on vitamins may be found in the following page: https://myacare.com/blog/micronutrient-deficiencies-in-children[1] 

Water

Water is an important part of nutrition. Found in breast milk, infant formula and in varying amounts in food, water helps with regulating the amount of body heat, which is necessary for most physiologic functions and metabolic processes.

Nutrition At Different Stages of Childhood

Young infants (0-5 months old)

For children who are less than 6 months of age, human milk is the best source of nutrition. If this is unavailable, or there are any contraindications to using human milk, infant formula is a good substitute. Water and food should not be given to babies belonging to this age group.

Older infants (6-12 months old)

When babies turn 6 months old, they can become gradually exposed to soft, finger foods, gradually transitioning to lumpy foods and table foods. Human milk or formula may still be given at this age.

Toddlers (1-3 years old)

During the toddler phase, a child is exposed to new foods, such as bread, cereals, dairy products, fruits, vegetables, and meat. The usual mealtime schedule is divided into three meals and two snacks a day. At this age, kids may start to become picky eaters, refusing either the type of food or the scheduled mealtime. Parents may need to reintroduce the same food multiple times before a child will try to eat it.

While they may still continue drinking human or formula milk, another substitute is whole milk. Healthy fats are essential (and even encouraged) in children 1-2 years old. Sources are coconut oil, salmon, and whole milk, to name a few. On the other hand, foods with large amounts of salt, butter or sugar should be avoided. Most portions should be served in small servings, so the child can easily consume food without the risk of choking. It is recommended to try different flavors and food groups every few days to encourage - not to pressure - them to eat any particular type of food.

Preschool age (4-5 years old)

At 4 to 5 years of age, most children would have settled down with proper mealtimes and table food. Often, they learn to eat what is served alongside the rest of the family members. At this point, it is important to avoid processed, salty and sugary foods or drinks.

School age

School-aged children should have much less fats, sugar and salt in their diet. Encourage them to eat more foods containing fiber, such as cereals, whole-grain breads, seeds, nuts, fruits, and vegetables.

Teens

Big growth spurts happen during the teenage years. This means that there is an increased amount of calories needed per day. Males may need up to 2,800 calories per day, while females will require less at 2,200 calories. Teenagers who are athletes or physically active may need even more. At this stage, complex-carbohydrate foods are preferred, while only 30% of the diet should be from fats, which are still essential. Good protein sources are chicken, turkey, and beef. Because studies show that adolescents do not take in enough of vitamin D, calcium, iron and zinc, a well-balanced diet is advised. Multivitamins and mineral supplements may also be taken to prevent any micronutrient deficiencies.

Summary

Sources of nutrition include energy, macronutrients and micronutrients. These are important for a range of normal bodily functions, including growth, development, and maintenance of metabolic processes.

Macronutrients include carbohydrates, proteins, and fats, while micronutrients are mainly comprised of vitamins and minerals. As children grow, their nutritional needs may vary, but overall a balanced diet between the major food groups is essential for proper growth and development.

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References:

• Kliegman, R.M. et al. (2020). Part V Nutrition. Nelson Textbook of Pediatrics 21st edition. Elsevier.
• American Academy of Pediatrics (Updated 7 Oct 2021). Baby's First Month: Feeding and Nutrition. Caring for Your Baby and Young Child: Birth to Age Five, 7th ed. Taken from: https://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/The-First-Month-Feeding-and-Nutrition.aspx
• American Academy of Pediatrics Committee on Nutrition (Updated 4 Mar 2021). Healthy Food Choices for Your Family. Taken from: https://www.healthychildren.org/English/ages-stages/gradeschool/nutrition/Pages/Making-Healthy-Food-Choices.aspx
• American Academy of Pediatrics. Toddler - Nutrition. Taken from: https://www.healthychildren.org/English/ages-stages/toddler/nutrition/Pages/default.aspx
• American Academy of Pediatrics Section on Obesity (2016). Feeding & Nutrition Tips: 4-to 5-Year-Olds. Taken from: https://www.healthychildren.org/English/ages-stages/preschool/nutrition-fitness/Pages/Feeding-and-Nutrition-Your-4-to-5-Year-Old.aspx
• American Academy of Pediatrics Committee on Nutrition (Updated 1 Mar 2016). A Teenager’s Nutritional Needs. Taken from: https://www.healthychildren.org/English/ages-stages/teen/nutrition/Pages/A-Teenagers-Nutritional-Needs.aspx
• Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion.  Childhood Nutrition Facts. Taken from: https://www.cdc.gov/healthyschools/nutrition/facts.htm

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