School Age Children

Question 1

Age of school children

Answer 1

• Middle Childhood: 5 to 9 year olds
  Preadolescence: 9 to 11 year old girls & 10 to 12 year old boys

Question 2

Growth of school aged children

Answer 2

growth is lower than earlier stages and occurs in spurts
* gain average 3 to 3.5 kg and 6 cm per year

Question 3

What is the gain in fat mass called and when does it occur?

Answer 3

rebound adiposity around ~6-7 years
* normal increase in BMI
* greater increase in fat mass for girls
* early rebound adiposity associated with obesity

Question 4

How is growth monitored?

Answer 4

WHO growth charts
monitor using weight for age (until 10 years of age) and height for age; BMI for age

Question 5

What factors would be considered optimal for growth in these age groups?

Answer 5

• physical activity/ movement
• Sleep
• Quality nutrition

Question 6

Motor Skill Development

Answer 6

• improved motor coordination
• ability to perform more complex pattern movements
• increasing muscular strength
• physical activity contributing more to energy expenditur (highly variable)

Question 7

Feeding and Food Skills

Answer 7

• mastered the use of utensils
• should be involved with food preparation and chores related to meals
• ready to learn about simple nutrition facts and relate to food they are eating

Question 8

How should this aged learn about nutrition?

Answer 8

“this food helps make you strong”
* Not complex
* not related to chronic disease or body weight
* not “good” or “bad” foods

Question 9

Cognitive and Social Development

Answer 9

• decreased engocentricism
• more rational cause/effect reasoning, but concrete thinking (Can relate consequences to action)
• development of sense of self and self- efficacy
• increasing importance of peer relationships
• greater independence
• promotion of autonomy

Question 10

Eating Behaviours

Answer 10

• eat more away from home
• some independance on food choice
• influence of family vs. peers
• environmental influences (culture of school, activites, what is available)
• marketing of foods (beyond advertising too)

Question 11

Diet Quality

Answer 11

Based on following recommendations in Eating Well with Canada’s Food Guide most require improvement or have a poor quality diet.

Question 12

How are energy intakes determined?

Answer 12

Energy needs for maintenance, growth and activity
Estimated Energy Expenditure:
* separate formula boys and girls
* different formula for 3-8 years and 9-18 years
* weight, height, age, and physical activity level (variable)

Question 13

Stats of obesity

Answer 13

Canadian Health Measures Survey (2009 to 2011):
* 5 to 11 year olds: 19.7% overweight
* 13.1% obese
* ~1.5% underweight

Question 14

Canadian 24-hr movement guidelines for 5-17 years

Answer 14

SIT
* Limit sitting for extended period
* No more than 2 hours of recreational screen time

UNINTERRUPTED SLEEP
* 5 to 13 years: 9 to 11 hours
* Consistent bed and wake-up times

STEP (LIGHT ACTIVITY)
* Several hours, structured and unstructured

SWEAT (MODERATE TO VIGOROUS)
* At least 60 mins
* Vigorous activities, muscle and bone strengthening at least 3 days/week

Question 15

Macronutrient Recommendations

Answer 15

Question 16

fibre intake

Answer 16

Median intake fibre: below AI boys and girls 4-13yrs

Canadian Community Health Survey (CCHS) 2.2 (2011)

Question 17

AMDRs

Answer 17

Question 18

fat intake stats

Answer 18

• 9-13 years female: 6.5% fat intake below, 11% above
• 9-13 years male: 12% fat intake above

Question 19

Micronutrients of Concern

Answer 19

Reflects intake of ultra-processed foods
Intake less than EAR 9 to 13 year olds:
* Iron: <3%
* Calcium: 44-67%
* Vitamin D: 84-93%%
* Vitamin A: 12-22%
* Magnesium and Zinc: 10-25% girls

• Sodium: 80-97% had intake above UL
• Potassium: median intake below AI

Lower range: males; Higher range: females

Question 20

Goals for School-Age Children

Answer 20

• adequate, but not excessive, energy and nutrient intake
• support normal development (growth, motor, cognitive and social)
• encourage healthy eating patterns and behaviors (family strongest influence still)
• support self-regulation of energy intake

Question 21

Division of Responsibility in Feeding

Answer 21

• Parents decide: What foods are offered & when and where to eat
• Children decide: Whether or not they eat & how much they eat

Question 22

How to Feed a School-Age Child

Answer 22

• role modeling
• foods available and accessible (chopped up veg and fruit)
• food preparation
• consistent eating schedule (Need to know when they can expect to eat)
• meals at table without distractions
• selecting foods and serving size from what
  is offered themselves (encourage internal cues)

Question 23

What parental control practices that can have negative impact?

Answer 23

• pressure to eat
• restriction for weight
• threats and bribes
• intrusive control ⤄ permissive feeding
• prompt to eat
• rules and limits
• redirection and negotiation

Question 24

Body Image

Answer 24

Children senstive to cues from parents and friends so rebound adopisty can be misconstrued and may start to trigger negative body images.
* severe restriction of ‘unhealthy’ foods and/or focus on weight can increase risk of disordered eating in children

Question 25

Healthy Foods to feed school aged children

Answer 25

* variety (all food groups, different foods within groups) * unprocessed or minimally processed emphasized * processed in moderation; ultra-processed not needed

Question 26

What regulates energy intake?

Answer 26

**INTERNAL CUES**: The hypothalamus is the control centre of hunger and satiety via signals from the nervous system, hormones, and blood nutrient levels * **hunger**: low glucose, ghrelin, other hormones * **satiety**: stretching in GI tract, CCK, leptin, other hormones

Question 27

What are External Cues?

Answer 27

Anything that can influence consumption other than feelings of hunger and satiety and can interfere with internal cues * sight, smell, taste of foods * Advertising * Habits, social situations * Portion sizes * Parental and peer modeling * Pressure or incentives to eat more * Using food as a reward * Food often equates with love or acceptance

Question 28

Regulation of Energy Intake in Toddlers and Pre-schoolers

Answer 28

6 day food records in 2 to 5 years reveal large variability in energy from individual meals (33%), lower variability in daily energy (10%) * responsive to internal cues: energy intake variability, eat more if lower energy density * but sensitive to external cues: praise, rewards, portion sizes, peers

Question 29

Fat Substitution Study in 2-5 year olds

Answer 29

Ate more CHO to compensate for calories they weren’t getting in fat * meals can be variable but children are good at regulating overall intake

Question 30

Influence of internal vs. external cues

Answer 30

Children will rely on internal cues but can be overrun by external cues which can lead to more food consumption * yogurt study - encouraging taste * drink study - praise/ reward * peer modelling

Question 31

Yogurt study

Answer 31

external cues ate more high density Based on study: Adjustments with different energy density and use of internal vs external cues (convo about fullness vs. food) * yogurt – same amount with one high kcal and the other low kcal * offered an ad lib snack (unlimited amount) after yogurt * influence of internal vs external cues

Question 32

Praise and reward (Drink study) on energy intake regulation

Answer 32

Reward does not always encourage to eat more food creates an inadvertent side effect it seems like Children (3 to 5 years) offered novel drink * Praise if drink +/- offered more and encouraged * Movie ticket if drink +/- offered more and encouraged * Controls – got drink and movie ticket Offered drink again Consume less second time if praise or movie with or without encouragement to drink more the first time

Question 33

How does modelling as an external cue effect regulation?

Answer 33

Food preferences determined – children who didn’t like vegetable (target) mixed with peers who did and saw that peers influenced each other in both ways, so will accept and try new foods with peers * Evaluated frequency of choosing non-preferred food, and overall consumption of non-preferred food and children who did not like vegetables increased intake of that vegetables

Question 34

Why is assessing appetite important?

Answer 34

assessment of appetite important in understanding regulation of food intake * appetite: subjective sensations of hunger, satiety, motivation to eat

Question 35

Appetite Assessment in Older Children and Adults

Answer 35

visual analog scales are most commonly used to assess appetite for these ages

Question 36

Assessing appetite in young children

Answer 36

Developed a picture-based assessment for use in young children where they can point to pictures where they feel most hungry (board games, video games, walking dog etc.) * Before the age of ~8 years, not able to complete visual analog scales usually either starving or extremely hungry so hard to assess level of hunger and satiety. | Around peri-willer syndrome - part of this is ravenous hunger

Question 37

Reccomendations around exposure to allergenic foods

Answer 37

Introduce “allergenic” food earlier * Purposeful early feeding of peanut is a reversal from the 2000 AAP recommendations that suggested high-risk infants avoid peanut to age 3 years.