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Copy of Pediatric Nutrition

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Amanda R

on 22 July 2015

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Transcript of Copy of Pediatric Nutrition

Formula Feeding
Breast and Formula Feeding Concerns
Iron deficiency anemia
United States Management of Iron Deficiency Anemia
1mg/kg/day of iron supplements for breastfed babies greater than 6 months
Iron fortified formulas
WIC program to increase iron rich food choices
Nutritional classes are more readily available at health departments and are required for WIC recipients
Yearly health checks--- 24 hour food recall
Mexico's Management of Iron Deficiency Anemia
Greater incidence of iron deficiency anemia (17% compared to 6% in the U.S.) due to prolonged bottle feeding

Management includes:
Breast is Best!
Breastfeeding in Mexico
Breastfeeding in the United States

Often shorter duration of breastfeeding than the Unites States related to:
A belief called
, which means if a breastfeeding mother witnesses a frightening or emotionally disturbing event her breast milk becomes tainted
Concern over infant not filling up or being satisfied with breast milk alone resulting in excessive supplementation/overfeeding
If mother is ill, she believes her breast milk will pass on the illness
Breastfeeding rates have continue to rise in the United States with 79% of infants being breastfed at birth and 49% still being breastfed past 6 months of age in 2011
Breastfeeding viewed as "natural" and the best nutritional support for infants
Formula Feeding in Mexico
Prolonged bottle feeding leads to greater nutritional problems
Formula Feeding in the United States

Nutritional Deficits
Health is not valued until sickness comes - Thomas Fuller
Diabetes Mellitus Type II
Iron Deficiency Anemia
Wednesday, May 6, 2015
Vol XCIII, No. 311
Nutritional Health Concerns
How Are Nutritional Concerns Managed?
Pediatric Diet & Nutrition

What Can We Educate All Patients On?
Who Are We?
Culture of Healthcare
NURS 7600
Amanda Ray
Jennifer Rossingol
Ednie Brisson
Candice Choi
Antony Mwangi
United States

Label Reading Practice!
United States and Mexico
Ages 0-18
United States Views on Diet and Nutrition
Mexico's Views on Diet and Nutrition
United States


Why is Nutrition Important?
Energy for daily living
Maintenance of all body functions
Vital for growth and development
Therapeutic benefits
The dietary guidelines for Americans encourages individuals to eat a healthy diet focusing on foods and beverages that help achieve and maintain a healthy weight and prevent chronic diseases.
Grains: 6-11 servings
Vegetables: 3-5 servings
Fruit: 2-4 servings
Dairy : 2-3 servings
Meats: 5-7 oz
Discretionary fat: use sparingly
Added Sugars: use sparingly

Daily Recommendations
Mexico uses the "Plate of Good Eating" (El Plato del Bien Comer). This plate is divided into thirds with vegetables and fruits as one third, cereals as one third, and legumes and animal products as the final one third.
Mexico's recommendations include eating "many" vegetables and fruits, "enough" cereals, and "few" animal products

Descriptive words are used rather than specific serving recommendations
Actively advocating for better food options in the school systems
Decreasing portion sizes of school lunches
Limiting sugar offered at school
Offering baked chips rather than fried
Some schools are banning soft drinks
Offering more fruits and vegetables
Promoting breastfeeding for 1st 6 months
Promoting use of iron-fortified formula and foods

According to the CDC, childhood obesity (6-12 years) has doubled and adolescent obesity (12-19 years) has quadrupled over the past 30 years
The percentage of obese children increased from 7% to 18% from 1980 to 2012 making one third of children overweight or obese
Affects 1 in 6 children born in the U.S.
Iron-deficiency Anemia

United States

More children are packing school lunches with less nutritious food options
Social media and video games are becoming more common
Parents are more willing to give children tablets and games to keep busy rather than engage in physical activity
The "busy" lifestyle lessens the opportunities for families to be physically active together
The Rising Epidemic!
United States
Limiting access to sugary snacks and sodas in schools
Healthier food options for school lunches
Encouraging physical activity
Student access to wellness center
Let's Move! Campaign
WIC program to increase choices of nutritional food items as well as iron fortified infant formula
Iron drops prescribes to infants that are iron deficient
Yearly health exams look at weight, glucose, as well as iron levels
Chronic Kidney Disease Initiative to promote kidney health and decrease DM incidence
National Diabetes Prevention Program

Increased frequency in children and adolescents (age <18) in the past 3 decades
DM Type II among youths in the U.S. accounts for
of all new-onset diabetes case patients
Higher prevalence seen among children
10-19 years
old and in certain ethnic groups: Hispanic, American Indians, Asian-Pacific Islander, and African-American children
Strongly linked to overweight/obesity trends, familial history, diet, physical activity, and the environment.

Obesity has tripled in Mexican children over the past 3 decades
Mexico has higher obesity rates in children ages 5-11 than any other country
Approximately 25% of children and 33% of teens are overweight or obese
1 in every 5 newborns are greater than 4kg
The prevalence of overweight boys aged 6-11 increased from 13 to 27% and from 10% to 20% in girls aged 6-11 in 1999 to 2010
The greatest contributing factor to the current increase of DM Type II in Mexican children
Other Contributing Factors to Health Concerns
United States
Food Insecurity: Problem of availability and access to food (10% of all Mexicans suffer from inadequate food access)
Excessive amount of sugar
Low rates of physical activity
Socioeconomic status
Cultural traditions: Introducing solid foods early
The importance of physical activity and encouraging children to stay active
Involve the entire family
Buy "quick," but healthy foods for those busy days
Establish daily meal and snack times
Plan sensible portions: Use the food pyramid
DM Type II is considered a public health problem in Mexico
One of the top 2 causes of death killing 70,000 people per year
Number one cause of blindness in Mexico
Prevalence increased to 9.2% in 2013 from 4.2% in 2000
Diagnoses of type II diabetes in Mexican adolescents reported to be 0.68% or approximately 155,000 individuals in 2012
Diabetes risk factors are more common in Mexican children than American children
Strongly linked to obesity, which is also becoming more common in Mexican children
Affects 2.4 million U.S. children
12% incidence at 12 months of age and up to 15% toddlers (1-3 years)
Studies demonstrate association between IDA and later cognitive and behavioral deficits
The world's most common single nutrient deficiency
At higher risk for IDA than the U.S due to increased risk factors associated with IDA
28.9% of children less than 2 years of age have anemia with 42.1% attributed to iron deficiency
The prevalence of IDA in Mexican children is approximately 4% higher than in American children
Contributing Factors

Exclusive breastfeeding without iron supplementation
Early, excessive, or prolonged intake of cows milk
Children that are "picky" eaters
Green leafy vegetables being replaced with sugary foods
Higher rates of low birth weight and premature infants
Early menarche
Rapid growth during puberty
Contributing Factors
Prolonged bottle feeding with unfortified formula
Cows milk being offered earlier rather than iron fortified formula
A belief called "susto," which means if a breastfeeding mother witnesses a frightening or disturbing event her breast milk becomes tainted
Concern of infant not filling up or being satisfied with breast milk
If mother is ill she believes the illness will pass on through her milk
Early introduction of solid foods as early as 2 to 3 months is common as well as giving sugar water
Low rates of iron supplementation
Baker, R., & Greer, F. (2010). Clinical Report - Diagnosis and Prevention of Iron Deficiency and Iron-Deficiency Anemia in Infants and Young Children (0-3 Years of Age).
, 126(5), 1040-1050. doi:10.1542/peds2010-2576

Centers for Disease Control and Prevention (2015). Child obesity facts. Retreived from http://www.cdc.gov/healthyyouth/obesity/facts.htm

Escarce, J., Morales, L., & Rumbaut, R. (2006). The health status and health behaviors of hispanics. National Research Council (US) Panel on Hispanics in the United States. Washington (DC): National Academies Press (US).

Federación Mexicana de Diabetes (2012). Diabetes en números. Retrieved from http://www.fmdiabetes.org/fmd/pag/diabe¬tes_numeros.php

García-Guerra, A., Montalvo-Velarde, I., Ramírez-Silva C., Rivera, J., Shamah-Levy, Villalpando, S., & Zambrano, N. (2010). Vitamins a, and c and folate status in Mexican children under 12 years and women 12-49 years: a probabilistic national survey. Salud Pública de México, 45(Suppl. 4), 508-519. Retrieved from http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0036- 36342003001000007&lng=en&tlng=en. 10.1590/S0036-36342003001000007.
Keast, D.R., Fulgoni, V.L., Nicklas, T.A., & O'Neil, C.E. (2013). Food sources of energy and nutrients among children in the united states: National health and nutrition examination survey 2003-3006. Nutrients, 5 (1), 283-301. doi:http://dx.doi.org.ezproxy.gsu.edu/10.3390/nu5010283

National Institute of Health. (2013). Nutritional Quality of foods and beverages on child-care center menus in Mexico. Public Health Nutrition, 16. http://dx.doi.org/10.1017/S1368980012004387

Position of the American Dietetic Association: Individual-, Family-, School-, and Community-Based Interventions for Pediatric Overweight. (2006). Journal of the American Dietetic Association, 106(6), 925-945. doi:10.1016/j.jada.2006.03.001

Ramos, T.L. & Ortiz, A.V.M. (2014). Epidemiología, diagnóstico y tratamiento de la Diabetes Mellitus tipo 2 en niños y adolescentes. Temas de Ciencia y Tecnología 18 (54) 3-10. Retrieved from http://www.utm.mx/edi_anteriores/temas54/

References Continued...
USDA Foreign Agricultural Service; Global Agricultural Information Network. (2010). Food security and nutrition in mexico. (GAIN Report No. MX0043). Retrieved from http://gain.fas.usda.gov/Recent%20GAIN%20Publications/Food%20Security%20and%20Nutrition%20in%20Mexico_Mexico_Mexico_7-9-2010.pdf

Vargas, L., Jiménez-Cruz, A., & Bacardí-Gascón, M. (2013). Unhealthy and Healthy Food Consumption Inside and Outside of the School by Pre-school and Elementary School Mexican Children in Tijuana, Mexico. Journal Of Community Health, 38(6), 1166-1174. doi:10.1007/s10900-013-9729-2

Young, J. (2009). Clinical Pediatrics in the Mexican Community. Contemporary Pediatrics, 26(2). 30-33.

References Continued...
Nutritional Survey in U.S.
National Health and Nutrition Examination Survey (NHANES) conducted from 2003-2006 analyzed nutrient sources in children age 2-18 years old on a single 24-hr recall
Results suggest many foods/food groupings consumed by children are energy dense and nutrient poor.
is made up mostly of
cereals and milk
(sweetened or unsweetened), while
vegetables and animal products
(i.e., poultry meat or beef) are
virtually absent
Usually, the mother both decides the

menu and prepares it. In more than half of the cases,
fruit and vegetables are consumed just once a week
, while
soft drinks are regularly
included for a
third of children
Surveyed children acknowledged the availability of fruit, vegetables and potable water in their households, and sometimes
consumed them when struck by hunger
. However, some of them also admitted to
eating candies and soft drinks when hungry
(Hospital Infantil de Mexico Federico Gomez, 2009).
Nutritional Survey in Mexico
Too much sugar?

An interview of a woman who has lived In Mexico for 20 years was recently conducted.

She stated,

"Because of a lack of money and food, people go for more energy-intense foods. These are often high in sugar or fat. People drink Coca Cola as if it was water in order to have the energy to carry on - and so many of the foods are rich in carbs, are full of cheese or are fried."
Availability of food: Growing chain of fast food restaurants
Food Marketing: Less nutritious food items are advertised to children through television and video games
Busy lifestyle of parents contributes to preparing the "fastest" meals, oftentimes sugary foods
More meals prepared away from home
Increase in media use/screen time
Limited opportunity for activity during the workday
Limited time for daily physical education and recess in schools
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