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The dietary intake of infants, children and adolescents should not only maintain the current body weight but should be adequate enough to support their normal growth and development.1 A healthy diet is the one which meets the energy requirements and supplies essential macro and micronutrients for supporting the functioning of all vital processes.1 Growth during infancy is rapid. During this period, the requirements for energy and nutrients are highest relative to body size when compared with other growth periods. Also, this period is critical for neurocognitive development.1
The table below shows the major physical and cognitive milestones in normal children2:
|Age||Physical Skills||Cognitive skills|
|2 years||Jumps with both feet, throws the ball overhead, Can dress itself under supervision and can use zippers, buckles, and buttons||Has the understanding of how to avoid simple obstacles like stoves and stairs etc.|
|3 years||Most children can stand on one foot for 5 seconds. They can also hop on one foot and can broad-jump as well||Can count up to 3, can tell its age, first and last name, can answer simple questions|
|4–5 years||Most children can hop and balance on one foot, can do forward heal-toe walking, and can catch the bounced ball||Can count 5–10 objects, asks questions, has a vocabulary of more than 200 words, understands the concepts of opposite and consecutive|
|6–11 years||The complex gross and fine motor and perceptual skills are improved through practice and refinement||Thinking becomes logical and rational, concrete operational thinking develops|
|12–17 years||Rapid growth and development of sexual organs as well as secondary sex characteristics||Develop formal operational thinking during early adolescence which becomes well developed during the latter part of adolescence|
Inadequate nutrition during infancy, childhood or adolescence can restrict growth, weaken immunity and increase the incidence of infections and diseases.1 Undernutrition can begin with conception itself due to maternal undernutrition. This may lead to the delivery of low birth-weight babies. In India, although <1% preschool children suffer from severe forms of protein energy malnutrition (PEM), sub-clinical undernourishment is prevalent in almost half of <5-year-old children with symptoms such as underweight, stunting and wasting.3 Poor or insufficient diet can also cause catabolism of body tissues and failure to provide energy substrate. Continuous undernutrition during the childhood years leads to short stature in adults.3
Effect on the nervous system
The central nervous system (CNS) is most susceptible to nutritional impact during the period starting from 3rd trimester of pregnancy until 2 years of age.4
Diet has a dual role in cognitive development4:
Both intrauterine and extra-uterine malnutrition have a great impact on brain function as well as brain structure composition. The adverse effects of malnutrition on the brain during early life include: decrease in brain cells, number of synapses, dendritic arborisation and myelin production, leading to smaller brain size and changes in neurotransmitter systems. The hippocampus, cerebellum and neocortex are the most affected brain parts.4
All these changes are associated with4:
A nutritionally adequate and balanced diet is crucial to prevent the above mentioned physical and psychological ill-effects and for the optimum growth, development and boosting of the immune function in children.3 The overall nutritional requirements for growing children are briefly discussed below.3
Carbohydrates: A major energy source for all cells are carbohydrates which are the primary source of energy for erythrocytes and the CNS.1 They should provide 45% to 65% of total calories in a diet. Complex instead of simple carbohydrates should contribute to a greater extent in the diet. A higher intake of simple sugars in children can displace essential macro- and micronutrients, thereby increasing the risk of nutrient deficiencies. Fruits are a good source of simple carbohydrate and are also rich sources of vitamins and fibre. Whole fruits instead of fruits juices should preferably be given to children.1,5
Protein: Protein energy malnutrition hampers brain, immune system and intestinal mucosal functions.1 Protein requirement is greater for infants and growing children than for adults.3 It is important that all the essential amino acids be provided through dietary intake.1 For children who are vegetarians or vegans, a variety of food sources including legumes and corn should be incorporated to meet the requirement of essential amino acids. Breast milk is considered the optimal source of proteins for infants.1For children and adolescents, milk is an important source of good quality proteins in addition to other animal and vegetables food sources.3 Overall, for children around 10% to 35% of total calories should come from proteins.
Fats: In addition to being energy dense, fats provide essential fatty acids and have important structural and functional roles.1 Fatty acids are needed for nervous system myelination in children younger than 2 years of age.5 Cholesterol moieties act as precursors for cell membranes, hormones, and bile acids. Fats also facilitate absorption of fat-soluble vitamins. These functions of fats are important for neurological and ocular development.1For children younger than 2 years, 25% to 40% of total calories should come from fat, and for older children 10% to 35% calories should come from fat.
Calcium: During childhood and adolescence, adequate calcium intake is important for bone health during growing years as well as later years of life. Milk and dairy products are a good source of calcium.3,5 Although recommended dietary allowances for calcium are about 600 to 800 mg/d, higher calcium intakes during adolescence helps to achieve peak bone mass.3 For children who do not consume adequate milk products, calcium requirements can be met through other sources such as tofu, green leafy vegetables, ragi, sesame seeds and calcium-fortified food products.5
Iron: Iron deficiency is very common among children and is associated with anemia and neurocognitive deficits. Iron present in animal food sources is more bioavailable than that present in plant sources.1 Vitamin C rich foods promote the absorption of iron in the body.3
Vitamin A: Vitamin A is an important micronutrient as it is required for clear vision in dim light, and maintenance of the integrity of epithelial tissues. It also plays a role in maintaining resistance against common infections.3 Yellow, orange and dark green fruits and vegetables are rich sources of beta-carotene, which is the precursor of retinol.1,3
Vitamin D: Vitamin D is critcial for calcium and bone metabolism, and its adequeate intake is important for long-term bone health. In infants vitamin D deficiency can cause rickets and very severe deficiency can also lead to hypocalcemic seizures.5 Breastfeeding, darker skin, little sun exposure and fat malabsorption are the risk factors for Vitamin D deficiency. Breastfed infants and children who do not get at least 400 IU of vitamin D through diet should receive Vitamin D supplement.5
The Indian Council of Medical Research (ICMR) recommended dietary allowances of macronutrients and important micronutrients for infants, children and adolescents are listed below:
Recommended Dietary Allowances3
|Infants||0-6 months||92 kcal/kg/d||1.16 g/kg/d||–||500||46 µg/kg/d||–||–|
|6–12 months||80 kcal/kg/d||1.69 g/kg/d||19||350||2800|
The universally accepted definition of dietary fibers “Dietary fiber is a type of carbohydrate that cannot be digested by our bodies enzymes”. Fiber is a very important non-nutrient. Foods rich in fiber improves satiety as it needs more clearing than other foods and it absorbs water and swells
By:- Dr. Anuradha Khadilkar and Dr. Vaman Khadilkar HCJMRI, Jehangir Hospital, Pune
Calcium and vitamin D are critical for musculosketal health. One of the main actions of Vitamin D is for the absorption of calcium. The calcium that is absorbed is deposited in bones;
Dual protein combinations containing a blend of soy and dairy proteins (whey and casein) have sufficient essential amino acid content, various digestion rates and longer aminoacidemia compared to single protein isolates to offer unique advantage to health.
It is a well known fact that children are a vulnerable segment of population and also very susceptible to morbidity due to infections. Various short term and long term health outcomes are associated with under-nutrition such as impaired immune
Optimal nutrition intake is necessary for normal brain development.1 According to the UNICEF, the years from conception through birth till the age of eight years is a critical period for complete and healthy cognitive, emotional and physical growth of children.
Dr. Meghna Chawla DNB (Paediatrics), Fellowship in Paediatric Endocrinology (UK) Consultant Paediatric and Adolescent Endocrinologist, Ruby Hall Clinic, Pune Assistant Professor and In-charge, Paediatric Endocrine Clinic, SKN Medical College, Maharashtra
Children and adolescents form the backbone of future generations and their health and nutrition play a significant role in human resource development. In modern times, children in developing countries are exposed to poverty, unstimulating home environments, malnutrition
The information and references in this article are intended solely for the general information and do not constitute legal or other professional advice on any subject matter. The information contained herein is correct as the date of this document to the best of our knowledge. We suggest that you evaluate any recommendations and suggestions independently. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as referred in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended that require medical treatment under a doctor's care.The content of this article is not intended to offer personal medical advice, diagnose health problems or for treatment purposes. It is not a substitute for professional medical advice. Please consult your health care provider for any advice on medications. These articles have been created and curated by Signutra’s medical team and are property of the Company. Copyright of these articles vests with Company.