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(BQ) Part 1 book “Bright futures nutrition” hass contents: Cultural awareness in nutrition services, early childhood, middle childhood, children and adolescents with special health care needs, diabetes mellitus, eating disorders, human immunodeficiency virus,… and other contents.
Bright Futures Nutrition New from the American Academy of Pediatrics and Bright Futures THIRD EDITION Other great resources from Bright Futures Bright Futures Nutrition, Third Edition Pocket Guide Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition To order these and other pediatrics resources, visit the American Academy of Pediatrics Online Bookstore at AAP Bright Futures NutRItion third edition Editors Katrina Holt, MPH, MS, RD Nancy Wooldridge, MS, RD, LD Mary Story, PhD, RD Denise Sofka, MPH, RD Published by The American Academy of Pediatrics American Academy of Pediatrics Department of Marketing and Publications Staff Maureen DeRosa, MPA Director, Department of Marketing and Publications Mark Grimes Director, Division of Product Development Sandi King, MS Director, Division of Publishing and Production Services Maryjo Reynolds Product Manager, Bright Futures Peg Mulcahy Manager, Graphic Design and Production Kate Larson Manager, Editorial Services Kevin Tuley Director, Division of Marketing and Sales Bright Futures: Nutrition, 3rd Edition Library of Congress Control Number: 2010941756 ISBN: 978-1-58110-554-4 Product Code: BF0037 The recommendations in this publication not indicate an exclusive course of treatment or serve as a standard of care Variations, taking into account individual circumstances, may be appropriate Every effort has been made to ensure that the drug selection and dosage set forth in this text are in accordance with the current recommendations and practice at the time of the publication It is the responsibility of the health care provider to check the package insert of each drug for any change in indications or dosage and for added warnings and precautions The mention of product names in this publication is for informational purposes only and does not imply endorsement by the American Academy of Pediatrics Copyright © 2011 American Academy of Pediatrics All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior permission from the publisher Printed in United States of America This publication has been produced by the American Academy of Pediatrics under its cooperative agreement (U04MC07853) with the US Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB) 10 BRIGHT FUTURES: NUTRITION Table of Contents Bright Futures Children’s Health Charter v Creating a Lifelong Foundation for Healthy Eating vii About Bright Futures: Nutrition ix Bright Futures: Nutrition Vision and Goals xi How This Guide Is Organized xii How This Guide Can Be Used xiii Participants in Bright Futures: Nutrition, Third Edition xv INTRODUCTION Healthy Eating and Physical Activity Nutrition in the Community Cultural Awareness in Nutrition Services 13 NUTRITION SUPERVISION 17 Infancy 19 Early Childhood 51 Middle Childhood 73 Adolescence 93 NUTRITION ISSUES AND CONCERNS 113 Breastfeeding 115 Children and Adolescents With Special Health Care Needs 123 Diabetes Mellitus 131 Eating Disorders .137 Food Allergy .147 Human Immunodeficiency Virus .153 Hyperlipidemia 161 Hypertension 167 Iron-Deficiency Anemia 175 Nutrition in Sports 183 Obesity 193 Pediatric Undernutrition 209 Vegetarian Eating Practices .213 iii Bright FUTURES Oral Health .201 BRIGHT FUTURES: NUTRITION TABLE OF CONTENTS, CONTINUED NUTRITION TOOLS 221 Tool A: Nutrition Questionnaire for Infants 223 Tool B: Nutrition Questionnaire for Children Ages to 10 227 Tool C: Nutrition Questionnaire for Adolescents Ages 11 to 21 233 Tool D: Key Indicators of Nutrition Risk for Children and Adolescents 239 Tool E: Screening for Elevated Blood Lead Levels 245 Tool F: Stages of Change—A Model for Nutrition Counseling .249 Tool G: Strategies for Health Professionals to Promote Healthy Eating Behaviors .251 Tool H: Basics for Handling Food Safely 255 Tool I: Tips for Fostering a Positive Body Image Among Children and Adolescents 257 Tool J: Nutrition Resources 259 Tool K: Federal Nutrition Assistance Programs 265 INDEX 269 Bright FUTURES iv BRIGHT FUTURES: NUTRITION Bright Futures Children’s Health Charter Principles developed by advocates for children have been the foundation for initiatives to improve children’s lives Bright Futures participants have adopted these principles in order to guide their work and meet the unique needs of children and families in the 21st century Every child deserves to be born well, to be physically fit, and to achieve self-responsibility for good health habits Every child and adolescent deserves ready access to coordinated and comprehensive p reventive, health-promoting, therapeutic, and rehabilitative medical, mental health, and oral health care Such care is best provided through a continuing relationship with a primary health professional or team, and ready access to secondary and tertiary levels of care Every child and adolescent deserves a nurturing family and supportive relationships with other s ignificant persons who provide security, positive role models, warmth, love, and unconditional acceptance A child’s health begins with the health of his parents Every child and adolescent deserves to grow and develop in a physically and psychologically safe home and school environment free of undue risk of injury, abuse, violence, and exposure to environmental toxins Every child and adolescent deserves satisfactory housing, good nutrition, a quality education, an adequate family income, a supportive social network, and access to community resources Every child deserves quality child care when her parents are working outside the home Every child and adolescent deserves the opportunity to develop ways to cope with stressful life experiences Every adolescent deserves the opportunity to be prepared for parenthood Every child and adolescent deserves the opportunity to develop positive values and become a responsible citizen in his community Every child and adolescent deserves to experience joy, have high self-esteem, have friends, acquire a sense of efficacy, and believe that she can succeed in life She should help the next generation develop the motivation and habits necessary for similar achievement Bright FUTURES v BRIGHT FUTURES: NUTRITION Creating a Lifelong Foundation for Healthy Eating To meet the challenge of developing nutrition guidelines for infants, children, and adolescents, the Bright Futures team convened a multidisciplinary panel of health professionals, including educators, clinicians, public health officials, and representatives from family organizations The panel focused on key issues What families need to to promote the nutrition status of infants, children, and adolescents? What health professionals and communities need to to become more effective in promoting the nutrition status of infants, children, and adolescents? The goal was to develop nutrition guidelines for the infancy through adolescence developmental periods Nutrition guidelines based on the best available scientific research, professional standards, and expert opinions were developed and sent for review to more than 150 individuals from a variety of health agencies and organizations Bright Futures: Nutrition presents the resulting nutrition guidelines and tools designed for use by a wide array of health professionals, including dietitians, nutritionists, nurses, and physicians The guide can also serve as a practical, educational resource for families and communities Bright Futures: Nutrition emphasizes health promotion, disease prevention, and early recognition of nutrition concerns of infants, children, and adolescents The guide also highlights how partnerships among health professionals, families, and communities can improve the nutrition status of infants, children, and adolescents Bright Futures: Nutrition builds on the nutrition guidelines presented in Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents The nutrition guide is a practical tool for applying concepts and principles essential to nutrition supervision It also supports the Healthy People objectives for the nation and can be used to develop and implement programs and policies for the health and well-being of infants, children, and adolescents Bright Futures: Nutrition represents a vision for the new millennium, a direction for integrating nutrition into health services in the 21st century Together, health professionals, families, and communities can work to improve the nutrition s tatus of our nation’s infants, children, and adolescents and build a foundation for lifelong healthy eating behaviors—a foundation that encourages infants, children, and adolescents to enjoy eating healthy food and encourages children and adolescents to value family meals and feel good about themselves Bright FUTURES vii BRIGHT FUTURES: NUTRITION Nutrition Supervision Adolescence An adolescent’s nutrition and weight status should be evaluated during nutrition supervision visits or as part of health supervision visits (For more information on health supervision, see Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition, listed under Suggested Reading in this chapter.) It is important to remember that nutrition supervision, which includes asking interview questions, conducting screening and assessment, and providing anticipatory guidance, should be used as appropriate and will vary from visit to visit and from adolescent to adolescent Health professionals begin nutrition supervision by selectively asking interview questions about the adolescent’s nutrition status, to invite discussion and build partnerships Use of the questions may vary from visit to visit and from family to family Questions can be modified to match the health professional’s communication style Gathering information can also be accomplished by reviewing a questionnaire filled out by parents and/or the adolescent before the visit (See Tool C: Nutrition Questionnaire for Adolescents Ages 11 to 21.) Additionally, to meet the challenge of providing nutrition supervision to diverse populations, health professionals need to appreciate the variety of cultural traditions related to food and the wide variation in food practices within and among cultural groups (See the Cultural Awareness in Nutrition Services chapter.) Asking interview questions provides a useful starting point for identifying an adolescent’s nutrition concerns Interview Questions Eating Behaviors and Food Choices FOR THE ADOLESCENT ■■ ■■ Bright FUTURES 98 ■■ ■■ Which meals you usually eat each day? How many snacks? How many times a week you eat breakfast? Lunch? Dinner? How often does your family eat meals together? What you usually eat and drink in the morning? Around noon? In the afternoon? In the evening? Between meals? What snacks you usually eat? ■■ ■■ ■■ ■■ ■■ Are there any foods you won’t eat? If there are, which ones? How often you drink milk? What kind of milk you drink (eg, whole milk, reduced fat [2%], low-fat milk [1%], fat-free [skim milk])? What other milk products you like to eat? What fruits and vegetables, including juices, did you eat or drink yesterday? How often you drink soft drinks, energy drinks, or sports drinks? What changes would you like to make in the way you eat? FOR THE PARENT ■■ ■■ ■■ How often does your family eat meals together? Do you have any concerns about your teenager’s eating behaviors? Do you think your teenager eats healthy foods? Why or why not? Food Resources FOR THE ADOLESCENT OR PARENT ■■ ■■ Who usually buys the food for your family? Who prepares it? Are there times when there is not enough food to eat or not enough money to buy food? Weight and Body Image FOR THE ADOLESCENT ■■ ■■ ■■ ■■ ■■ ■■ How you feel about the way you look? Do you think that you weigh too little? Weigh too much? Are just the right weight? Why? How you feel about your weight and height? Are you trying to change your weight? If so, how? How much would you like to weigh? Are you teased about your weight? FOR THE PARENT ■■ How you feel about your teenager’s weight and height? BRIGHT FUTURES: NUTRITION Physical Activity ■■ FOR THE ADOLESCENT ■■ ■■ ■■ ■■ ■■ FOR THE PARENT ■■ ■■ ■■ What type of physical activity does your teenager engage in? How often? How much time does your teenager spend each day watching television or playing computer or video games? Does your teenager have a television in his bedroom? Screening and Assessment Growth and Physical Development ■■ ■■ Measure the adolescent’s height and weight, and plot these on a standard growth chart Deviation from the expected growth pattern (eg, a major change in growth percentiles on the chart) should be evaluated This may be normal or may indicate a nutrition problem (eg, difficulties with eating) Height and weight measurements can be used to indicate nutrition and growth status Changes in weight reflect an adolescent’s shortterm nutrient intake and serve as general indicators of nutrition status and overall health Low height-for-age may reflect long-term, cumulative nutrition or health problems ■■ ■■ ■■ Adolescence ■■ What you to be physically active? How often? How much time you spend being active in a week? What physical activity would you like to that you are not doing now? How can you make time for it? How much time you spend each day watching television and playing computer or video games? What you think you can to be more active? Body mass index (BMI) is used as a screening tool to determine nutrition status and overall health Calculate the adolescent’s BMI by dividing weight by the square of height (kg/m2) or using a BMI wheel or calculator To interpret BMI, plot the adolescent’s BMI and age on a BMI-for-age growth chart to determine the adolescent’s BMI percentile Some adolescents have a high BMI because of a large, lean body mass resulting from physical activity, muscularity, or frame size An elevated skinfold (ie, above the 95th percentile on Centers for Disease Control and Prevention [CDC] growth charts) can confirm excess body fat in adolescents Evaluate the appearance of the adolescent’s skin, hair, teeth, gums, tongue, and eyes Obtain the adolescent’s blood pressure (See the Hypertension chapter.) Assess the adolescent’s risk for familial hyperlipidemia (See the Hyperlipidemia chapter.) Table provides an overview of indicators of height and weight status When an adolescent is outside the healthy weight range, a more indepth assessment may be needed Body mass index serves only as a screening tool and should not be used as a diagnostic tool Stunting ■■ Adolescents whose height-for-age is below the third percentile should be evaluated Stunting reflects a failure to reach optimum height as a result of poor nutrition or poor health.5 However, most adolescents with low heightfor-age are short as a result of genetics, not because their growth is stunted Stunting has been reported in adolescents with severely inadequate energy intake or chronic illnesses The goal is to identify adolescents whose growth is stunted and who may benefit from improved nutrition or treatment of other TABLE INDICATORS OF HEIGHT AND WEIGHT STATUS Anthropometric Variable Cut-Off Values Height-for-age