13.1: Childhood and Nutrition

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Learning Objectives

Summarize nutritional requirements and dietary recommendations for school-aged children.
Discuss the most important nutrition-related concerns during childhood.

Nutritional needs change as children leave the toddler years. From ages four to eight, school-aged children grow consistently, but at a slower rate than infants and toddlers. They also experience the loss of deciduous, or “baby,” teeth and the arrival of permanent teeth, which typically begins at age six or seven. As new teeth come in, the positioning of the teeth can affect their ability to chew food. Other changes that affect nutrition include the influence of peers on dietary choices and the kinds of foods offered by schools and afterschool programs, which can make up a sizable part of a child’s diet. Food-related problems for young children can include tooth decay, food sensitivities, and malnourishment. Also, excessive weight gain early in life can lead to obesity into adolescence and adulthood. At this life stage, a healthy diet facilitates physical and mental development and helps to maintain health and wellness.

Energy

Children’s energy needs vary, depending on their sex, growth, and level of physical activity. Recommended intakes of macronutrients and most micronutrients are higher relative to body size, compared with nutrient needs during adulthood. Therefore, children should be provided nutrient-dense food at meal- and snack-time. However, it is important not to overfeed children, as this can lead to childhood obesity, which is discussed later in this chapter.

Macronutrients

The Acceptable Macronutrient Distribution Ranges (AMDRs) for children from 4-8 years old are listed in Table \(\PageIndex{1}\). For carbohydrates, the Acceptable Macronutrient Distribution Range (AMDR) is 45–65% of daily calories which is the same AMDR as adults. Carbohydrates high in fiber are important as children should get 25 grams of fiber per day.¹ The AMDR for protein is 10–30% of daily calories. Children have a high need for protein to support muscle growth and development, so it's recommended that children get 0.95 grams protein/kg body weight/day. High levels of essential fatty acids are needed to support growth (although not as high as in infancy and the toddler years). As a result, the AMDR for fat drops to 25–35% of daily calories.

Table \(\PageIndex{1}\): Acceptable Macronutrient Distribution Ranges (AMDRs) for Children Ages 4-8¹
Macronutrient	AMDR
Carbohydrate	45-65% of total calories
Protein	10-30% of total calories
Fat	25-35% of total calories

Micronutrients

Micronutrient needs should be met with foods first. Parents and caregivers should select a variety of foods from each food group to ensure that nutritional requirements are met. Deficiencies in iron, zinc, protein, and vitamin A can result in stunted growth, illness, and limited development. The most common nutrient deficiency in young children is iron. Because children grow rapidly, they require foods that are high in iron, such as lean meats, legumes, fish, poultry, and iron-enriched cereals. Other important micronutrient requirements during childhood include adequate calcium and vitamin D intake. Both are needed to build dense bones and a strong skeleton. Calcium is necessary to achieve peak bone mass. Dairy products are the most common source of calcium for children. However, "milk displacement" (replacing milk with soda or other sugary drinks) typically leads to low calcium intake. According to the American Academy of Pediatrics, children who are consuming less than 32 ounces per day of vitamin D-fortified milk, should receive a vitamin D supplement of 10 micrograms a day.² Table \(\PageIndex{2}\) shows the micronutrient recommendations for children ages 4-8. Note that the recommendations are the same for boys and girls. As we progress through the different stages of the life cycle, there will be some differences between males and females regarding micronutrient needs.

Table \(\PageIndex{2}\): Micronutrient Levels during Childhood¹
Nutrient	Children, Ages 4–8
Vitamin A (mcg)	400
Vitamin B₆ (mg)	0.6
Vitamin B₁₂ (mcg)	1.2
Vitamin C (mg)	25
Vitamin D (mcg)	15
Vitamin E (mg)	7
Vitamin K (mcg)	55
Calcium (mg)	1,000
Folate (mcg)	200
Iron (mg)	10
Magnesium (mg)	130
Niacin (B₃) (mg)	8
Phosphorus (mg)	500
Riboflavin (B₂) (mg)	0.6
Selenium (mcg)	30
Thiamin (B₁) (mg)	0.6
Zinc (mg)	5

Factors Influencing Intake

A number of factors can influence children’s eating habits and attitudes toward food. Family environment, societal trends, taste preferences, and messages in the media all impact the emotions that children develop in relation to their diet. Therefore, it is critical that parents and caregivers direct children toward healthy choices. One way to encourage children to eat healthy foods is to make meal- and snack-time fun and interesting. Parents should include children in food planning and preparation, for example selecting items while grocery shopping or helping to prepare part of a meal, such as making a salad. At this time, parents can also educate children about kitchen safety.

The National School Lunch Program

Beginning with preschool, children consume at least one of their meals in a school setting. Many children receive both breakfast and lunch outside of the home. Therefore, it is important for schools to provide meals that are nutritionally sound. In the United States, more than 30 million children are provided meals by the National School Lunch Program. Participating schools receive cash subsidies and USDA foods for each reimbursable meal they serve. In exchange, the schools must serve lunches that meet federal meal pattern requirements and offer the lunches at a free or reduced price to eligible children.³

Food Allergies and Food Intolerances

The development of food allergies is a concern during the toddler years. This remains an issue for school-aged children. Approximately 8% of children have a food allergy; the most common food allergies in children are to peanuts, milk, and shellfish.⁴ Although nearly any food can trigger an allergic reaction, the following nine foods cause the majority of reactions: milk, egg, peanuts, soy, wheat, tree nuts, shellfish, fish, and sesame.⁵ An allergy occurs when a protein in food triggers an immune response, which results in the release of antibodies, histamine, and other defenders that attack foreign bodies. Possible symptoms include itchy skin, hives, abdominal pain, vomiting, diarrhea, and nausea. Symptoms usually develop within minutes to hours after consuming a food allergen. Anaphylaxis is a life-threatening reaction that results in difficulty breathing, swelling in the mouth and throat, decreased blood pressure, shock, or even death. Milk, eggs, wheat, soy, fish, shellfish, peanuts, and tree nuts are the most likely to trigger this type of response. A dose of the drug epinephrine is often administered via a “pen” to treat a person who goes into anaphylactic shock.

Some children experience a food intolerance, which does not involve an immune response. A food intolerance is marked by unpleasant symptoms (e.g., gas, bloating, diarrhea, stomach pain) that occur after consuming certain foods. Lactose intolerance, though rare in very young children, is one example. Children who suffer from this condition experience an adverse reaction to the lactose in milk products. It is a result of the small intestine’s inability to produce enough of the enzyme lactase, which is produced by the small intestine. Symptoms of lactose intolerance usually affect the GI tract and can include bloating, abdominal pain, gas, nausea, and diarrhea. An intolerance is best managed by making dietary changes and avoiding any foods that trigger the reaction.

Lead Toxicity

There is a danger of lead toxicity, or lead poisoning, among school-aged children. Lead is found in plumbing in old homes, in lead-based paint, and occasionally in the soil. Contaminated food and water can increase exposure and result in hazardous lead levels in the blood. Children under age six are especially vulnerable. They may consume items tainted with lead, such as chipped, lead-based paint. Lead is indestructible, and once it has been ingested it is difficult for the human body to alter or remove it. It can quietly build up in the body for months, or even years, before the onset of symptoms. Lead toxicity can damage the brain and central nervous system, resulting in impaired thinking, reasoning, and perception. Fortunately, lead toxicity is highly preventable. It involves identifying potential hazards, such as lead paint and pipes, and removing them before children are exposed to them.

Key Takeaways

The recommended intakes of macronutrients and micronutrients for children are higher (relative to body size) compared to nutrient needs during adulthood.
Children’s daily energy needs vary depending on their level of physical activity, growth, and sex.
Some food- and nutrition-related problems that can affect school-aged children include micronutrient deficiencies, food allergies, food intolerances, and lead toxicity.

References

Summary Report of the Dietary Reference Intakes. nationalacademies.org. www.nationalacademies.org/our-work/summary-report-of-the-dietary-reference-intakes. Accessed July 13, 2020.
Vitamin D: on the double. healthychildren.org. https://www.healthychildren.org/English/healthy-living/nutrition/Pages/Vitamin-D-On-the-Double.aspx. Accessed July 13, 2020.
The National School Lunch Program. fns-prod.azureedge.net. https://fns-prod.azureedge.net/sites/default/files/resource-files/NSLPFactSheet.pdf. Accessed July 13, 2020.
Allergy Statistics. aaaai.org. www.aaaai.org/about-aaaai/newsroom/allergy-statistics. Accessed July 13, 2020.
Common Allergens. foodallergy.org. https://www.foodallergy.org/living-food-allergies/food-allergy-essentials/common-allergens. Accessed July 13, 2020.