The
feeding of children is an extremely complicated topic that certainly cannot
be dealt with in a brief article. The problems obviously vary according
to age and include breast-feeding, weaning, nutrition in the following
months and years with the changes in life and feeding habits relating to
its frequency, or lack of, in the home and then kindergarten.
The early school years and
sports activities bring further changes and different nutritional demands,
as does puberty and its pattern of hormone changes; until the growing-up
phase stops, it is a continuous modification of life habits and nutritional
needs.
Relationships within the
family and with the outside world can condition the eating behavior and
often thinness, obesity or normality is the fruit of this. In such a variegated
scenario I should therefore prefer to make some observations, dwelling
upon a few points and referring the reader to various texts for further
detailed information.
There is still a lot of
fret these days over the child who eats little, and much less concern for
the child who eats too much. If a limited food supply can lead over time
to various shortages (insufficient protein, calcium, iron and other nutrients)
and therefore to an unfulfilled realization of the genetic potential of
the growing child. The other side of the coin is that a food intake that
is well above the child's needs leads firstly to overweight and then, in
most cases, to manifest obesity.
We should keep in mind that
excessive feeding in the first two years of life can cause, not only an
increase in adipose cellular volume, but also in the number of these cells;
as adults, therefore, one will have a greater predisposition to obesity
and greater difficulty in finding and maintaining one's “proper” body weight.In
order to avoid such harm, it is necessary to control the balance and supply
of calories in the serving size and to adjust the life-style, above all
to fight against sedentariness.
Children should not be “couch
potatoes”, sitting for too many hours in front of the television, but should
participate more in active games, get used to using the stairs instead
of the elevator, walking to relatively nearby destinations (as the school
or gym might be); in these ways the quantity of food will not need to be
reduced so much, thereby ensuring a good supply of all the nutrients.
We must remember is that
for a correct nutrition, all the food elements need to be present according
to certain proportions: the glucides ought to supply between 55-65% of
the total calorie intake; lipids 25-30%; protides 15%. These proportions
vary according to age, though.
Furthermore, it is fundamentally
important to ensure good hydration by introducing, besides water: fresh
fruit, vegetables and soups. In this way the feeling of having had one's
fill (satiety) will be more easily arrived at, with a smaller number of
calories.
But, in practice, how many
calories should be introduced at the various stages of infancy, childhood
and teens?The energy requirement differs in relation to age and weight
(see Table 1, taken from
the 1996 “LARN” review)
In relation to this data,
I would suggest a daily menu valid for children aged between 2 and 10 years,
where the distribution of the meals throughout the day is appropriate for
all, whereas the quantities obviously vary according to the age groups.
Breakfast and snacks:
350-500 g. of milk, essential
as a source of calcium (if milk is not particularly liked, it can be substituted
with yogurt or cheese), 30-40 g. bread or 20 g. dry-toast slices with 20
g. jelly, or a dessert slice or a small snack.
Lunch and dinner:
First course:
alternate 50 g. pasta with
vegetable or legume soup.
Second course:
70-80 g. meat or fish that
may be substituted by ham or liver or an egg.
Side-dish:
cooked or raw vegetables
(until two or three years old, it is better to serve the vegetables cooked
and sieved).
a little bread: about 30
g.
fruit.
This goes for children and
teenagers that would have a weight pattern or in any case to prevent overweight.
When there is already the
presence of excessive weight, the conduct to be followed is thus: reduce
the calorie intake and seek to increase physical activities. But in the
growing individual it is also very important to determine the skeletal
age and, when possible, the final height projection.
Such data is obtained through
radiography of the left wrist and examining the growing cartilage (TANNER
TW2 RUS; BAYLEY-PINNEAU; ROCHE). Knowing the presumed final stature, one
will then be able to calculate the optimum weight for the end of the growth
period.
Therefore, following-up
the individual over time, the weight will have to be kept stable or he/she
made to lose a little whilst the height is physiologically increasing,
for the correct height/weight ratio to be achieved.
To calculate the ideal weight
for the different heights for males and females, the two monograms included
below may be used (Graph 1 taken from the “LARN” review, 1996).
We must keep in mind that
overweight and obesity create serious problems for children and teenagers
so that they often remain isolated, not participating in group games, etc.
This also occurs because
it takes extra physical effort to play a sport. Being overweight is not
just an esthetic problem, but a condition that fosters various changes
in all organs and systems.
In the osteoarticular system,
for instance. Moreover it provokes or aggravates some bone distortions
such as: flattening, valgoid condition, and scoliosis; it also promotes
the beginnings of degeneration and wear of cartilage in the joints and
therefore predisposes the onset of arthrosis.
Then, at puberty, obesity
modifies the neuroendocrine regulation of gonadal function. Indeed, in
girls, there can be menstrual cycle disorders with oligomenorrhea or amenorrhea
and the presence of hirsutism. In fact, the clinical picture is seen to
improve by correcting the obesity. In males, there can be hypogonadism.
Therefore, control the calorie
intake and consumption increase, proposing team sports or a sport that
the family can join in on, like bicycle-riding on Sundays or walks in the
park where children can run freely, because movement encourages the fixation
of calcium in the bones and counters hypercholesterolemia in subjects predisposed
to this.
And so, what is to be said
about the kids who eat too little?It is necessary for a careful study to
be made of their behavior.
At times the refusal of
food is in fact caused by the need to assert their own personality in confrontation
with the adults. In this case, instead of being imposed, the food should
simply be offered, complying as much as possible with tastes and timetables
and without rigid schemes.
At other times, there are
organic reasons behind the lack of appetite, for example iron deficiency
may be the cause of the appetite loss as well as the effect of an insufficient
intake. In this case pharmaceutical help is in order, with vitamin preparations
that also contain mineral salts.
Malnutrition due to excess
is a problem in our Society; however, we should not overlook malnutrition
due to want, particularly in regard to the lack of some nutrients, that
can present itself even with a diet that is adequate from the point of
view of calorie content. It is therefore important for the physician to
pay particular attention to patients who are still growing, who represent
one of the most vulnerable groups.
Whether due to excess or
want, malnutrition can affect our children's physical and mental development
and the problem calls for the maximum attention from all those who are
in a position to have influence, especially family members and physicians.
Advisable weight progressions
for Italian children and
adolescents (3-17 years old)
N.B.: If the weight
relating to the height of a child or teenager falls between the two lines,
the energy requirement can be calculated using the observed weight. In
all other cases it is appropriate to use the advisable weight figure.
Maria Teresa Strumendo
Nutrizionista dell'età
evolutiva
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Italian
Mensile di scienza medica e attualita`
