Nutritional Requirements in Growing Children

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Nutritional Requirements

Nearly 1 in 3 children are overweight or obese. Despite parents focusing on the health of their kids, many are still confused when it comes to what kids eat. How much does the child require? Is the child getting enough calcium? Enough iron? Or too much fat?

According to Dr. Ratnav Ratan, a renowned pediatric orthopedic doctor in Gurgaon, whether it is a toddler or a teen, nutrition is essential to children’s physical and mental development. Here is what children need — no matter what the age.

Nutrient Requirements in Babies

Some of the nutrients babies require to develop and stay healthy include:

  • Calcium: Helps develop stronger bones and teeth.
  • Fat: Produces energy, helps the brain to grow, keeps skin and hair healthy, and prevent infections.
  • Folate: Assist cells to divide.
  • Iron: Builds blood cells, and helps the brain develop. Breast-fed babies should get iron supplements.
  • Protein and carbohydrates: They provide fuel and energy for growth.
  • Zinc: Helps the cells grow and to repair themselves

The baby also needs vitamins which include:

  • Vitamin A: Keeps skin, vision, hair, and the immune system healthy.
  • Vitamin B1 (thiamine): Helps the body process food into energy.
  • Vitamin B2 (riboflavin): Helps the body convert food into energy, and prevents cells from damage.
  •  Vitamin B3 (niacin): Helps the body convert food into energy and use protein and fats.
  •  Vitamin C: Protection against infections, builds up bones and muscles and helps wounds cure.
  •  Vitamin D: Helps the body take calcium from food, and keeps teeth and bones healthy. Breast-fed babies may require a D supplement.
  •  Vitamin E: Prevents cells from damage, and strengthens the immune system.

Nutrition for kids and adolescents is based on the same rules as nutrition for adults. Everyone requires the same kinds of nutrients such as vitamins, carbohydrates, minerals, protein and fat. However, children require different amounts of specific nutrients at different growth ages.

Nutrient Requirements in Toddlers 

Toddlers grow in spurts, also their appetites come and go in spurts. So they may eat a lot one day and then not eat anything the next. It is normal, and as long as the child is given a healthy selection, they will get what they need. Calcium, the body’s building block, is required to develop strong, healthy bones and teeth. 

Fibre is another important focus. The kids might want to stick to the bland, beige, starchy diet (think chicken nuggets, fries, macaroni). However, this is really the time to encourage fruits, vegetables, whole grains, and beans, which all provide fibre. 

Nutrient Requirements in Grade Schoolers 

It is not uncommon for a 6- or 7-year-old to suddenly change to being a vegetarian; because they understand animals and where food comes from. This does not mean the child will not get ample amounts of protein.

Animal tissue is not the only place to get protein. Rice, beans, milk, eggs and peanut butter all have protein. So, if the child goes “no-meat” for a week or for life, he or she will get sufficient amounts of protein.

Nutrient Requirements in Preteens and Teens

As puberty kicks in, young people need more calories to support the many changes they will experience. Unfortunately, for some, those extra calories come from fast food with little nutritional value.

Some adolescents go the other way and restrict calories, fats, or carbs. Parents have to be aware of changes in their child’s eating patterns. They can make family dinners a priority at least once or twice a week.

Just like calories, calcium requirements are high. Calcium is more crucial than ever during the preteen and teen years. It is because the majority of bone mass is formed during this time.

Encouraging kids to have milk products or other calcium-rich options should help them get more calcium.

The child’s gender may play a role in whether he or she needs more of a specific nutrient. For instance, teenage girls require more iron than their male counterparts. It is to replace what is lost during menstruation, and males need slightly more protein than girls.

Normal growth in children

It is the child’s growth rate that is the crucial factor to consider when evaluating if a child is growing and developing typically.

If the child is following the growth curve, then they are likely growing normally. Keep in mind that some children can move up or down on their growth curves when they are 6–18 months old.

If the child is not losing weight or having any other symptoms like persistent diarrhoea, vomiting or poor appetite, then it is normal to move up or down on the growth percentiles. Older children stick to their growth curves reasonably close.

How to reach child’s growth chart

Daily Nutrition Chart

Regular measurements of the child’s weight, height, and head circumference and plotting them on a growth chart. It is an excellent method to check if the child is growing normally. A paediatrician will use such measurements to assess a child’s growth.

Normal growth rates for boys and girls

 Guidelines for the younger child’s growth rates for weight include:

  • 2 weeks: Regains birth weight and then gains about 0.6 kg a month
  • 3 months: Gains almost 0.4 kg pound a month
  • 5 months:  Birth weight doubles
  • 1 year:  Birth weight triples and then gains almost 0.22 kg a month
  • 2 years: Birth weight quadruples and then gains about 1 -2 kg a year
  • 9–10 years: Raised weight gain as puberty arrives, often about 4 kg a year

In addition to monitoring the child for less growth or failure to thrive, it is essential to ensure that the child is not becoming overweight.

Height growth rates

Guidelines for a younger child’s growth rates for height are the following:

  • 0–12 months: Grows almost 10 inches (25 cm)
  • 1–2 years: Grows nearly 5 inches (13 cm)
  • 2–3 years: Grows almost 3 1/2 inches a year many children will double their birth height by 3–4 years of age
  • 3 years to puberty: Grows about 2 inches (5 cm) a year

One can utilize the child’s height to try and predict how long they will be when they grow up.

Growth spurts 

According to a 2017 research in Scientific Reports, there are three distinct phases of development in a child’s life:

  • Phase 1: Instantly decelerating infant growth that lasts until about three years of age
  • Phase 2: Childhood phase with steady height raises
  • Phase 3: Adolescent growth spurt until the adult height is approached

The toddler is in a constant stage of growth until the age of 3. However, the growth — which happens swiftly in the baby stage — will slow down a little in toddlerhood.

One can picture the development like an upside-down triangle, with a considerable amount of growth happening in infancy and then a little slow down until the age of three.

3 ways to build strong bones in children

Kids with strong bones have a good chance of preventing bone weakness later on in life. The parents can help by ensuring that the kids get the 3 critical ingredients for healthy bones. A pediatric orthopedic may recommend these as well:

  • Calcium 
  • Vitamin D
  • Exercise

 Give kids high-calcium foods

Calcium is a mineral and is commonly known for building healthy bones. It is present in dairy products, some nuts, beans and seeds, and leafy green vegetables. It can also be added to foods like cereal or orange juice.

Motivate kids to consume high-calcium foods:

If the child consumes dairy, a doctor or dietitian can say how much to serve depending on age. Younger kids may require 2–3 servings of low-fat dairy every day, while older kids may need 4 servings.

Replace common foods with high-calcium versions. One can consider purchasing calcium-fortified orange juice instead of regular juice or almond butter instead of peanut butter.

Give kids a vitamin D supplement

Vitamin D (sometimes labelled vitamin D3) assists the body to absorb calcium. Many kids do not eat foods that contain vitamin D. They can instead consume a vitamin D supplement if they do not get an adequate amount in their diet. 

Even babies require taking vitamin D unless they are drinking at least 32 ounces of formula each day. A doctor or a dietitian can confirm how much vitamin D the child needs and the best way to get it.

Encourage kids to exercise

A child’s muscles get stronger the more they utilize them. The same is valid for bones. Weight-bearing activities like running, jumping, walking, and climbing are suitable for growing bones. They use the force of muscles and gravity to provide pressure on the bones. The pressure helps the body build stronger bones.

Activities such as riding a bike and swimming do not provide this weight-bearing pressure. They are suitable for overall body health, but kids need to do some weight-bearing exercise.

Everyone requires an adequate amount of calcium, vitamin D, and exercise. However, these are really good for kids, mainly when they are growing during the preteen and teen years. 

Problems in children due to nutritional deficiency

Some of the common problems that children face due to nutritional deficiency include:

Growth faltering (failure to thrive)

 The problem includes failure to meet expected potential in growth and different aspects of wellbeing. Treatment for such issues depends on the cause. However, general treatment includes:

  • Feeding advice from a paediatrician
  • Raising the nutrient density of foods. Choosing more nutrient-dense foods or adding one food to another can increase the nutrient content of the food. It includes milk and cheese to mashed potato
  • Refer to specialists, in case of severe hampering in a child’s growth

Iron deficiency anaemia

Iron deficiencies can also occur if a child does not get sufficient amounts of iron from their diet. Symptoms of deficiency involve tiredness and poor appetite.

Preventive measures involve:

  • Inclusion of solids within six months of age involving iron-fortified cereal and different iron-containing foods
  • Prevent whole cow’s milk for 12 months after birth, utilize iron-fortified infant formula if not breast-feeding
  • Promote iron-rich foods with foods having vitamin C to enhance absorption
  • Iron-fortified follow-on formula can be useful after 1 year if ‘at risk’

Even though a child can take iron supplements, it may cause nausea and constipation. So, it is better to promote a healthy diet which includes iron-rich foods.

Vitamin D-deficient rickets

A deficiency of vitamin D in a growing child can cause a condition known as rickets. In this condition:

  • Skull bones become soft
  • Epiphyseal swelling (particularly at wrists)
  • An enlarged costochondral junction where the ribs articulate with the sternum (rickety rosary)
  • Tibial bowing (bow legs)
  • Delayed dentition

Using Vitamin D-fortified formula milk or 7.5–10µg/day supplement in children’s vitamin drops can prevent rickets.

Treatment for rickets includes:

  • 25–125µg/day Vitamin D until alkaline phosphatase is normal, then 10µg/day
  • Exposure to sunlight
  • Good consumption of calcium

Nutrient deficiency and growth faltering due to not enough consumption of food is possible. Refer the child to a paediatric dietitian if this is suspected.

All kids need a lifestyle that assists in building healthy bones. For increasing a child’s bone strength and density, a diet rich in vitamin D, calcium and protein is recommended. Also, safe physical activity is useful during the growing years.

Dr. Ratnav Ratan
Dr. Ratnav Ratan
Pediatric Orthopedist and Sports Medicine specialist​

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