Music This is a course about you. So, what are we going to learn about you today? There is actually one time in your life when you need to triple your weight in one year. You need to eat like a sumo wrestler. For this kind of diet, parents need special advice for their own little champions. Music Hello. I am Professor Karen Hastings and welcome to the Science of Human Nutrition. This is Lesson Number 24, "Diet of Little Champions." Let's start with a few reminders. First, your notebook and your pencil. Have it handy because we will be giving you some extremely important dietary information when it comes to raising children. Two, if you're going to tape today's Lesson, it is time to start your VCR now.

And remember, if for some reason you have a malfunction or you need to review the tape again, your packet contains complete information on how to borrow the tapes from either the Library or the Learning Assistance Center on the Honolulu Community College campus. And, finally, pull out your Syllabus. Check the assignment dates, the exam dates and finally, the assigned readings. Remember, in order to understand the material being presented by our guest, it is best to have read the material first. Music Now, let's review what was said in our last Lesson, Number 23, "Eating Expectantly," which was nutrition for pregnancy and lactation. We covered the major risk factors of pregnancy, nutritional needs during pregnancy, common nutrition related complaints of pregnancy, and lactation. Music

Today's lesson, the "Diet of Little Champions," will cover the growth of infants, the nutrient needs of infants, the growth of children one to five, and the nutrient needs of children one to five. Music Bringing a brand new baby home from the hospital is met with a great deal of joy, excitement and anticipation. But also, there is a great deal of apprehension, because now, you are responsiœble for feeding this brand new baby that has absolutely, positively no way of communicating to you. Today I have asked two very special guests to come and share their expertise in this very important area, nutrition from birth through the first five years. Our two guests are Robyn Wong, who holds a masters degree in public health and is a registered dietitian. She works with children with special needs. And with her, I have Debbie Wong, who also has an MPH and is a registered dietitian. She works at the Zero to Three Hawaii Project. So their careers are centered on children in this particular age group. I am sure that they will have a lot of very practical advice to share with you in this Lesson. Now, let's start with the physical size of an infant. As you probably know some babies come home from the hospital weighing, average, 7, 8, 9 pounds, 10 pounds. In fact, some babies come home from the hospital weighing 11 pounds. These are big ones. Other babies are much smaller than this, some even down to maybe two or three pounds. What difference does size actually make in the nutritional needs of children? "Well, when we're talking about premature infants, we're talking about infants that were born either five weeks early or under the weight of 5 1/2 pounds. And because they were born earlier, they're small. They have limited body stores and they also have systems that may be immature, not fully developed. So, their need for protein and Calories are going to be higher than the needs, the requirements for a term infant, and they also are going to have higher needs for certain other nutrients like Vitamin E, Vitamin C, folic acid, iron, calcium and phosphorus." What are some of the ways that they will be able to get these needs? "They have specially made premature formulas, if the infant is going to be bottle fed. If the infant has, is successful at being breast fed, they also have special powders that can be added to breast milk to fortify or increase the nutritional value of the breast milk."

I have another question about this. Let's say the baby's not premature baby, but the baby just happens to be small, maybe not as much muscle or not as much fat, what kind of advice might we have with this one? "Sometimes when they're small like that they could have problems with sucking and swallowing. The coordination of their feeding, they just would have a harder time drinking formula either at the breast or the bottle." Oh, I see. Well, I think we should say maybe at this point that a baby should double, this is correct, I think, should double its weight at six months and triple its weight at the end of the year. Correct? It's length should expand by about one and a half lengths. So, when we look at growth charts, we are looking for this tripling and this one and a half times. What if a baby doesn't do that, it fails to thrive? What might cause that failure to thrive in babies? "There are a lot of different reasons that this could happen. Some of them are medically related, if the child had cleft lip and palate, they would, again, have difficulty with sucking and swallowing. Or if a child had a severe cardiac defect, again, they would have difficulty in consuming an adequate amount of Calories. Infants that are frequently ill will also, during these episodes, not be able to consume adequate nutrients and Calories, and again, they will not grow and gain weight at the rate of a healthy baby. Other problems that we have come across would be where the mother maybe, did not dilute the formula properly, maybe she added a little too much water, the formula was very dilute. Some other kind of reasons could be that the family has inadequate finances to purchase formula, foods, and again, there's this large area of psychosocial kind of problems--families that are homeless. It would be helpful, I think, in the case of failure to thrive to be able to observe the child feeding in their natural environment, meaning, at home or in school or something like that." Well, I feel a little bit bad to bring this one up because it's such a tragic, sad thing, but on the other hand, I think we also have, you might correct me, if I'm wrong, we have instances where we have actually have starvation. Maybe they don't have enough money. Sometimes it's intentional. The parents just neglect the child, so the child isn't fed, and some children even develop illnesses that prevent them from thriving. Is this not correct? Like maybe they would become sick during that particular period, so they're just not particularly able to thrive. I have something else that kind of goes along with this. Here's a bottle of wine, and I'm reading from the label here.

It says, "According to the Surgeon General, women should not drink alcoholic beverag"es during pregnancy because of the risk of birth defects." What's that all about? "Well, basically, it's a matter of we don't know how much is too much for a mother to drink during pregnancy. Fetal alcohol syndrome is a syndrome where there is growth retardation, either prenatally and/or postnatally, where their weight, their length and their head circumference fall below the tenth percentile. They also end up with damage to their central nervous system, where they have neurological abnormalities, developmental delays and some mental retardation, as well as some physical problems where they have a facial change, where they have microcephaly which is a small head, and also they have different facial disfigurations where they have a poorly developed philtrum here. They might have a thin upper lip and a flattening of the face. Basically why we recommend no alcohol for mothers that are going through pregnancy is that there are several factors that can affect the effect of the alcohol on the baby in utero. So, that include things like what other drugs that the mother might be using. It can also be her nutritional status, what she might be consuming during her alcohol consumption. Not only how much she drinks, but when she drinks.

Usually the most severe damage occurs if she drinks during the first eight weeks of pregnancy. Also, we have to consider the baby's genetic susceptibility to the effects of the alcohol, itself, so to keep it safe, we say no alcohol during pregnancy." You know, I have noticed that there are a few studies, though I don't have the exact number, that are suggesting that perhaps the alcohol consumption of the father during conception might also play a role in this. Do you have any information on that? "They have some information saying that basically it may result in slow sperm, but that's about it. There's nothing really that's been found to say that the alcohoƒl consumption of the father can have that much of an effect, or any effect at all." That's interesting, I did want to clear that up. You briefly mentioned some other drugs, and I know I do get this question. I don't know whether I should say frequently, but at least I do receive this question from my students. They ask about drugs like simple things like marijuana. They ask about cocaine. They ask about heroin. What are some of the things that we might expect with the development of an infant with, if drugs of those sorts have been consumed? "Generally those babies will have some neurological damage, so they will have some growth retardation. They tend to be very irritable babies. That makes it very difficult for them to feed. So that can compound the problem of their growth. They also tend to have a high tone, so that tends to use up a quite a lot of energy as well. So they do tend to be smaller babies. Very, very difficult to "manage for a mother. We can try to get them to feed, but it is very difficult to get them to grow." I think I should redefine or at least remind the students about another term. We have been talking about alcohol and different drugs and these are what we call teratogens, and these are substances that cause physical defects in the embryo.

So all of these substances would fit into that particular category. Music If you look at a length and weight chart for a child, what you will notice is that there is extremely rapid growth during those first few months of life. In fact, if you take a look at this bar graph, you will notice that during the first three months of a baby's life, that the baby actually has more demand for food or nutrients, I guess I should say, more demand for nutrients per pound than an adult male does. Now, understand what I just said. More demand for nutrients per pound, per pound, than an adult male. That's not the total amount. This particular one shows just the first three months and in all instances, it does exceed the needs of a male. So this bring us to the very, very important topic, nutrient and food needs for infants. I can't emphasize the importance of this particular topic enough. Debbie, let's start with the very beginning. What point should we consider if we are trying to decide whether to breast feed or bottle feed, right from the start? "Well, there are several factors we need to consider when we're advising a mother. Of course, the first thing is nutrition. Although formula now is fairly similar nutritionally to breast milk, we cannot duplicate the immunological components that are found in breast milk. We just can't put that in formula. Another thing we have to consider is the sucking ability of the infant. It's much easier for a child to suck from a bottle than it is from the breast. So, sometimes if an infant has a weak suck, we may actually have to go back onto a bottle, because it's just too frustrating for the mother and for the infant. We have to consider if there's a family history of allergies. In that instance, if it seems like the family, the father, the mother, aunties, brothers, sisters seem to have a lot of allergies, we would probably strongly advise them to breast feed because there is less of a risk of allergies. We have to consider the status of the mother. Whether she's returning to work. It makes it a little difficult to breast feed. The age of the other children, if there's another one year old, two year old child who's making demands on the mother. She may not have as much time for the infant and may require help in feeding. In which instance we may recommend a bottle. Another thing we have to consider is support of other family members. Is she taking care of the other kids by herself? Is she taking care of this child by herself?

Oftentimes in Hawaii we're rather lucky because we do have multifamily dwellings. So sometimes we can rely on the grandma to help out with the other kids so that mom can have more time with the infant and she may be able to breast feed. Another thing to consider is financial status of the family. It is cheaper to breast feed. Formula can be quite expensive." Not if the the mother eats caviar. Ha, ha, ha, Oh, well, we gotta take that into account I was just checking. Actually another point I think we might bring up is the fact that if the mother is like a drug addict or an alcoholic, this would not be wise for her to breast feed, would it not? "In that particular instance, she'd probably be in rehab, we hope, as well, and also it brings up another point is that if the mother is HIV positive, we do not recommend breast feeding." Oh, that's also a good point. Well, what are some of the things that can be passed on in breast milk to the child? "Alcohol can be pƒassed on. Pretty well, any of the drugs that the mother takes, as well as." That's over the counter drugs as well as. "Yes." I know that's kind of and important point, because I think a lot of people think, that when we say drugs we mean cocaine or alcohol, or marijuana, but when in reality aspirin, any kind of even prescribed drugs can be passed on. "Even with antibiotics, for example, can cause a bad taste to the milk and the baby actually may end up rejecting the milk." What about chocolate? "I've never really heard all that much about chocolate. We could only hope. Ha, ha, ha." Now, now the reason I brought it up is because now and then, actually pretty often, someone will mention to me that anytime they eat chocolate that their baby ends up having diarrhea or reaction to the chocolate. And so I wondered if you had run into any.. "I'm not too sure about that one." Well, no, I don't have any documented proof. There are some. The point, I think, is there are some substances, even, that we don't have identified on a list that a baby might possibly react to. So, if you're the mother breast feeding, and every time you eat a chocolate bar your baby reacts, clue number one is, don't eat the chocolate bar. Try something else. "Something else to consider are trace minerals as well. If the mother is exposed to lead, for example, there is a possibility that it may be passed on to the baby through the breast milk." It's easy to become exposed to lead too. "In certain parts of Hawaii, yes." Like, can you give us an example?

For example, if in the Kalihi area, with the old lead pipes in some of the dwellings there. We had a family where they were living in a boat off Sand Island, so they may have been near the factories. It may have actually been in the air and the mother got exposed and passed it on to the baby. In those particular instances, or if the mother drinks some wa¹ter that comes out of some other containers that may contain lead." Wow, that's very interesting information. You know, Robyn, I have a question for you, and this is one that I think is on every parent's mind. And that is, what are the supplement needs as far as micronutrients are concerned for breast fed and formula fed children, infants? "Well all infants, whether they're breast fed or bottle fed are going to receive an intramuscular dose of Vitamin K." You mean I get one of those shots? "All babies." Oh, that's just so mean. "This is to prevent something called hemorrhagic disease of the new born." What is hemorrhagic disease? "That's bleeding, so the Vitamin K helps the blood clotting. So this would mean like, say if an infant were, did not receive Vitamin K and they had bleeding, they would keep bleeding and it could become a very dangerous situation. So by giving them the Vitamin K just at at the start, you will ƒprevent this from ever being a problem." Now I think we should back track a second. It crosses my mind, the students might have forgotten that new born babies come with no bacteria in their stomachs to produce Vitamin K, is that not the cause of this? "Right." So. "So then once they receive this dose of Vitamin K then their gut starts to make their own, make Vitamin K on its own." I'm sorry to interrupt you, but go on. "No that's fine. And then as far as other supplements, the American Academy of Pediatrics does recommend that breast fed infants receive a supplement of Vitamin D. As far as bottle fed infants under the age of six months, they do not, oh, under the age of six months, who are drinking iron fortified formula, they do not need a supplement of vitamins or minerals, and as far as infants over the age of six months, if they're eating a good variety of both solid foods and drinking infant formula, they, too, do not need a supplement of vitamins or minerals. The one exception to this, I think particularly this is of importance in Hawaii, is fluoride. We do not have fluoride in our water supply. The fluoride, the military bases do have fluoride in their water. And fluoride helps infants and children as far as making their teeth really strong and resistant to cavities and other kinds of dental concerns.

So, fluoride is recommended." For both groups, right? "Right." Well, we could move to the military bases, but they could get crowded, so I guess we better stick to the fluoride supplement, right? OK. Commercial baby food has become available only since the late 1940s when it was introduced and that means that I didn't have it, folks. I just didn't. And they were very clever when they introduced it. They implied that babies, it meant the babies were eager to eat, they were intellectually and physically advanced. That the baby would sleep through the night. Many things were done in the world of advertising to encourage mothers to introduce solids at a very early age. Debbie, how do we know when a baby's actually ready for solids? "Well, usually in between the ages of four to six months, they should be able to sit up and swallow fairly easily without gagging or choking. And this is also a good time to introduce a different texture to the infant. So what we do is we start with an iron enriched rice cereal and we start with rice as opposed to wheat or a mixed cereal in the event of allergies. Because rice tends to be less of an allergen than wheat is. It's important when you introduce the solid to make it as nonthreatening and as pleasant an experience as possible because eating is not just nutrition, it's a pleasant social experience with the family and with friends. And as you start to introduce the foods, what you will do is gradually the formula will start to decrease or the breast milk will start to de¡crease as the solids start to increase. It's kind of preparing the baby to eat like an adult." Well, I think we should prepare the parent for that first spoonful. And what happens when that first spoonful goes in? "It usually comes out." That's right, it comes right back out all over you, so you can't get by with like plopping the food on the baby and having him absorb it. No, you have to put it pretty far back and you have to plan on having some spit all over you. "Well, you start very small. You start with, you know, a teaspoon of rice cereal and see how they handle that, and you can make it actually fairly thin to see how they tolerate it." How do you make it thin? "You just add more formula. You follow the instructions on the box. It usually says to add water or formula." Right. The reason I ask you elaborate on that is because a lot of parents aren't sure. You say, "Make it thin." They say, "Well what do I do, how do I geÃt this thin?" But adding...something they're already familiar with. "The directions are pretty explicit on the box of cereal." Oh, OK. So I don't have to worry about that, right? "No." OK.

When we take a look at milk intakes from birth on, can we put that in perspective, how much they should consume and when to add solids? "OK. First you're looking at, I'll go through say, the first six months before we, say we add solids about six months. So you're looking at the beginning about 18 to 24 ounces. So that comes out to maybe 2 1/2 cups let's say about 2 1/2 cups a day of formula and the frequency of that will depend on the baby. So, let's start the day. And then you look it about two months, 22 to 28 ounces, two to three months, 25 to 32 ounces, and then three to four months, 28 to 32 ounces. From four to six months it increases a little bit from 28 to 40 ounces, but then you'll see it start to decrease because we'll start to increase the solids. So, from the six months to the 12 months, then you're looking at about 24 to 32 ounces of formula. Of course, we can't gauge that with breast milk." Well, let's, can we go over the exact introduction of solids into the diet of the baby? "Sure." You mentioned that and I would like to cover the exact introduction. "OK. Well, from, of course, birth to four months you're looking at strictly breast milk or infant formula and you can add water as needed, especially in Hawaii, especially in the hot summer months you do want to give them some water. From about four to six months, then you're looking at giving infant cereal by spoon and again we're talking about varying the consistency. You can either thicken it by adding more cereal or you can dilute it by adding a little bit more water or formula. And then at about five to seven months you're adding first strained vegetables and then the strained fruit. We add straine'd vegetables first because there's a risk that they will reject the vegetables once they've tasted the sweetness of the fruit. So we try to introduce the vegetables first. And then from six to eight months we start introducing the strained meats and chicken and turkey, that sort of thing and the egg yolk. Fruit juice can be introduced at this time. I generally don't recommend it, I just get them to keep drinking water because I do find through my experience that they may reject the formula or the milk in preference of the fruit juice. And then at about 8 to 12 months, the teeth will start to come out. The baby will start mouthing their toys and things so you will look at possibly giving them finally chopped or minced table foods and finger foods at that time, the crackers and things. And then by one year of age, then, you start to wean them off the formula or the breast milk and introduce cow's milk, and at that time, you can also introduce the whole e"gg."

Yeah, I think a couple of things I want to add to this. The formula, as I understand it, is iron fortified formula because babies do not have iron in milk and it's Vitamin C fortified juice rather than just regular old juice, right? No orange juice like I had when I was a child. "Well, the orange juice, itself, the reason we don't usually recommend is that there's a risk of allergies with oranges." Right, that's what I was afraid of. What factor should be consider when we're choosing between commercial or homemade baby food, Robyn? "Well, they both could be very nutritious. I think if families were to purchase the ready made food in the jars, if they purchased the plain foods, like say, single ingredient foods like vegetables and the fruits, those are fine. They don't have any sugar or salt added. Those foods that are like the fruit desserts and those cobbler kinds of things, they do have sugar added to them. The finger kind of snack foods, they look like little sausages, they do have salt added to them, so those are not recommended. So if a family stuck to just plain single ingredients foods like strained beef, strained chicken, strained peas or something like that, those would be fine. The chunky foods also, the chunky and the toddler kinds of foods also do have salt added to them. Homemade foods, I think, are very good. You could have much more variety as far as introducing things like zucchini and broccoli, things that aren't readily available in jars." Well, you know, when I was a baby, my mother used to say a fat baby was a healthy baby. And she would put pictures of me with whoever if they were skinnier, she'd tell me how healthy I was. Is a fat baby a healthy baby? "I have problems with this question, but I think I figured out a way to answer it. If the obesity was a problem to where the child had problems sitting, later on walking, they did all these kinds of th ings late, yes, then I think a fat baby is not a healthy baby. If it's a chubby baby who is kind of just gone through a period of time where they gained a lot of weight, but is very active, as far as when I look at their diet, they're consuming, you know, not excessive amounts of formula or breast milk or solids, then I think that chubby baby is a healthy baby." Debbie, one quick question. Who should decide how much a baby should eat? "Basically, the baby. The baby is the best judge of whether or not he or she is hungry and whether or not he or she has had enough."

Let's summarize the information that we've covered on infants so that we'll be able to move from toddlers to the elementary years which will be coming up. Basically we have found out their needs are the same as adults. They have the same kind of foods that they need. You just covered that. They need safe, manageable appealing and appropriate for the age kind of foods. What are those, Debbie? "Well, you're looking at about say 12 months of age when I mentioned they should progress to soft, chopped foods. They do have a controlled sustained bite which they can use to eat a cookie, a soft cookie. But they probably lack the teeth and the biting power to take on something like a much harder cookie. They probably also don't have the oral control to take on foods that may have a skin that they require breaking. For example, the grape. So you're looking at trying to avoid things that require a skin breakage unless you break that for them. Things that are hard to chew, like hard cookies, like nuts, and things that may be a little sticky, like peanut butter that they can't maneuver around in their mouths. So at the age of one you want to avoid those particular kinds of foods. Plus, if you do give them those foods, they may try to eat it, but you can imagine how difficult it is to try to eat this food and how frustrating it is &endash;and the child will give up and that can actually lead to undernutrition, because the child will give up trying to eat. So, then as they get a little bit older their skills pick up and you can progress their textures appropriately." Oh, yes, I guess it's good to mention the next one. To progress meat and meat alternates regularly for iron, because, of course, they would be able to consume those. Those are very important. We also need to promote calcium rich foods, and finally, moderation and not restriction is a very important rule to follow. Music When we are growing from birth through those first five years of our lives, the preschool years, we are in what we call a period of very rapid growth and earlier in the Lesson I demonstrated to you that very, very rapid growth in that first year of life. The child is physically growing. The child is emotionally growing, and the child is mentally growing.

Now, some of the things that we need to accomplish with nutrition is that it must be a healthy diet. We should be giving our children a very well balanced diet. It is important during those years that we make eating a very, very pleasant experience. And we need to begin to help the baby develop self responsibility about food. This responsibility with food starts at a very young age. And let's start by trying to determine what is normal at what stage and how we can make transitions between these stages. So, Robyn, what are some of the physical development things that are happening at this particular time? "Well, as we had mentioned earlier, the first year of life is a period of very rapid growth and weight gains. During this time an infant will increase his weight by 200%. His length will increase by 55% as well as his head circumference. The average weight gain during that first year of life is about 15 pounds. During years, two to four, the average weight gain is about five to six poundsÀ a year. And from four to six years of age, the weight gain slows and it's about five pounds a year for boys and four pounds a year for girls. And girls do start to put on more adipose tissue and this happens at around the age of two years and continues on. As far as them putting on lean body mass, for both boys and girls, the rate is about the same." In other words, we start to get fat at that very young age. "Start to put on more adipose tissue." Oh, how discouraging. I knew something happened way back them. Well, when a baby is first born, they really have no physical skills, like they can't pick things up. They're totally at the mercy of the caregiver. They hope that somebody will hold them, will cuddle them, will take care of them, will nurture them until they're able to move their muscles. What are some of the things that happen as far as the development of this coordination is concerned? So they can go from somebody being totally at the mercy of the caregiver to someone who's independent? "At birth, I'm answering this in relation to feeding kinds of issues, at birth the infant pretty much is capable of sucking and swallowing, so formulas or breast milk is very appropriate.

As Debbie had mentioned earlier, at around the age of four to six months, the infant's able to sit up on his own. He loses what's called the tongue thrust. The tongue thrust is kind of like a reflex that he had where pretty much everything that you would put in his mouth, if he was under the age of four months, he'd push it back out with his tongue. He loses that reflex around the age of four months, and it becomes easier to start to feed him solids. At around the age of eight months, he begins to show good, he's able to close his lips around a spoon and makes, again makes the feeding process much easier. At around the age of nine months, his real capability to start chewing begins. And around the age o»f 11 months he starts to be able to use a cup with assistance of mom or dad or the caregiver held the cup and tipped it. The infant is able to take sips from a cup. And around the age of 12 months he should pretty much be eating a variety of different kinds of finger foods." Oh, isn't that the time when they always want a cracker? "Uhum." And you have to be very careful because if you let them eat crackers, they won't eat anything else? "Right, and I guess the other issue is finger feeding or any kind of feeding when the child is again feeding himself is you need to always be there because even if the food is very, very safe, there's always that possibility that the infant may choke and you need to be right there. So, his meal times and snack times should always be supervised." Oh, that's a good point, supervision at all times, because I know I see small children when they first are able to pick things up and eat them, that they want to ªdo it all the time because it's like, "Look at me, I'm grown up, I can do what you can do." So it's a very interesting time. There is also a great deal of psychosocial development that occurs in those first five years. What are some of the things that a parent could expect in raising a child in this psychosocial area, Debbie? "Well, I find one of the biggest changes that occurs is when the child learns how to walk. Because that just opens up a whole new world to them. And they're more interested in learning about their environment than sitting down and eating a meal. It's just too boring for them. Also as they get a little bit older, around, say around two, the terrible twos sit in, they start to become more independent. They begin to assert themselves. They are busy trying to explore different avenues.

So, they aren't interested in eating, or they might be interested in only one thing. It's really important at that time as parents not to do what we call short order cooking. And we find that with parents, they'll see that the child doesn't want to eat the meals that they prepared for them and so they'll go and make them something else, and you can keep doing this until the kid finally gets what he wants, which isn't really a habit we want to set for our kids. I always say that when these kids grow up, I pity their spouses. So, you want to be able to encourage them to eat what you prepared for them. It's their choice as to whether or not they'e going to eat it, but you made it for them, its nutritious, and you know, just give it to them and see if they'll eat it. And also as they start to become a little older, say around three to five, they become a little more coordinated. They like to have more say in what they do. So what you can do, is you can have them more involved in meal preparation. So they can do something simply putting cold vegetables on thÅeir plate, or as they get a little bit older, they may even be able to help you chop up some things, you know, with your supervision, of course. But, even giving them a choice, which vegetable are we going to have tonight. Do you want the peas, or do you want the carrots. And sometimes that's enough to try to encourage them to eat." Well, isn't this also the time when the babies, you know, they want to become independent, and you set the food down and you nicely cut the meat and all the vegetables and everything. And the next thing you know the child says, "I can do that myself, leave me alone." So you know you let the child cut the vegetables, they're very happy. The next day you set the food down and all of a sudden the child starts crying and says, "Aren't you going to cut this for me?" You say, "Well, no, you can do that." And he says, "You don't love me anymore." Isn't that sort of what happens at that time? "Well, that does happÀen. It's again, you know, their going back and forth. They like to be an adult sometimes, but sometimes it's much more comfortable to be a kid, and quite convenient, I think. Ha, ha, ha." It makes me wonder why I ever gave the idea up. "Well, there are benefits of being an adult." Well, OK. Well, on a serious note, I think we could say that at least this is a sign that the child is becoming more responsible and hopefully will eventually be able to learn to choose the right food, too. Music

Let's start now by specifically talking about the child's food environment and what are the different factors that play a role in this because this relates very directly to the food the child consumes and in the end, the nutrients that the child actually receives. We need to discuss things like the availability of foods. Children tend to eat what's available, whatever their parents have taught them to eat. We talked about this very early on in the cours"e. We also know that people have an inborn desire for sweetness, and a few minutes ago Debbie mentioned to you that you should feed vegetables before you feed fruits because fruits are sweet, and that inborn desire for sweetness will win out. We also have to take into account things like individual variability. One child likes food A, another child likes food B. Culture makes a big difference. We have working mothers. The role of working mothers that may or may not make a difference. We have some studies on this. The ability of a child to fix his own food plays a role in this, microwave ovens, peer influence, television. Sitting and watching television makes a difference because we have a lot of commercials that advertise processed food. In fact, I'd like to show you the Saturday morning television pyramid. If you will notice by looking at this Pyramid, it's much different than the pyramid that you usually look at. The Saturday morning pyramid haÀs a very small portion for bread, cereal, rice and pasta, a tinny, tiny portion for milk, cheese and yogurt. Another tinny, tiny portion for meat, poultry, fish dried beans, eggs and nuts. Fruits and vegetables have totally disappeared from the Saturday morning pyramid, and fats oils and sweets are very, very big on the Saturday morning pyramid. In other words, what we call foods of low nutrient density. So, Robyn, what effect does all of this have on children? "Well, as far as the effects of working moms, in this one study they found that the quality of the diets of children whether the mom worked or not, was not significantly different. So this is very reassuring, I think, for working moms. As far as TV, I have a couple of comments about that. One is that there's a positive correlation with the amount of hours a child watches TV, and the problem of obesity. The other is, as far as, like you had mentioned, these commercials are promoting foods that are high in fat and high in sugar. In Hawaii, I wanted to mention, that there is a condition, well there's a condition called baby bottle tooth decay, that's where a child stays on the bottle for long period of time, drinks juice or milk or sweetened kinds of fluids out of the bottle, and there's a tendency for their front teeth to decay to the point where they may need to be removed or have caps on them." I want to stop you a second.

This is a really important problem in Hawaii. Unusually high, is this not true? "Right." And that actually happens way back in that first year of life. "Right." Is that correct "So, as far as. I'll come up with some recommendations to address this problem, but to give you some idea of how significant the problem is in Hawaii, nationwide 5% of the children had baby bottle tooth decay. Whereas Hawaii children, 16% of them had baby bottle tooth decay. So we have three times the national ratøe for this problem. And as far as decayed, missing and filled teeth, this would be, again, a reflection of the dental health of our children. Whether a child between the ages of six to eight years had decayed one or more decayed, missing or filled teeth, in the United States the rate is 53%. Whereas in Hawaii it's 97%, meaning 97% of the children six to eight years of age had at least one or more decayed, missing or filled teeth. So to address this problem, one of the things I would suggest is that infants go to bed with a bottle of water versus formula or juice or something like that. And that we try to get them off the bottle anywhere between 12 to 18 months of age, and also that we encourage supplements of fluoride for those children, infants and children who are not living on a military base." You know, I have heard that one of the reasons we have such a high incidence of the nursing bottle syndrome or the cavities is that mÆothers put the children to bed sucking on, actually, kool aid. Do you have any knowledge of this particular habit or practice? "I think that's one of the major contributors, I think. Things like all those syrup drinks, things like." Like what syrup drinks, specifically? "Like Malolo syrup, I don't know what." Or the fruit punch....OK, I see what you're saying. "Also things like passion orange drink, guava drink, a lot of the fruit drinks that people think that they're juices, but they're drinks and they have a lot of sugar added to them. So, again, and as far as juices, even unsweetened fruit juices, I think, there's, you know, children don't need much juice at all. So it's best that we, again, promote the use of water in the bottle, use fluoride, get them to brush their teeth. The parents can start wiping their teeth as soon as the first tooth starts to appear." That would be a good idea. Well, another thing, with the Saturday morning» television, which we are going to talk about, I guess, obesity is connected with it, but also I think some of the studies indicate that children who watch all of the different television things tend to have a higher cholesterol in their blood than other children. Is that not correct? "I'm not sure. I didn't, that's not familiar to me as far as being correlated with the hours, the number of hours that they've been watching TV." Well, a recent study came out that did indicate that there seemed to be a correlation between hours of television and a high blood cholesterol. Let's talk a little bit about the division of responsibility.

Whose job is it to decide what to give a child. That's the question, "What to give a child?" When to feed the child and how much. Those are always bones of contention. "Well, first of all, it's the parents responsibility to provide nutritious foods because a child can't determine whether or not a food is nutritious. Secondly, it's their responsibility to provide it in the form that the child can eat. So, obviously, you're not going to give a T-bone steak to a 1 1/2 year old. And thirdly, they're to provide it at regular intervals so that the child does receive a constant supply of nutrition throughout the day. It is, however, the child's responsibility, as it is with anybody, as to how much the child is going to eat, and whether or not they're even going to eat it. And that actually lifts a whole weight load of responsibility off the parents." You know, I did read an interesting study, it's been a few years back, but they had studied parents, to determine whether the parents thought their child ate enough food. And interestingly enough, something like 90% of the parents didn't think their children had eaten enough, when in reality, at least 50% of the kids had eaten enough. So, parents are really and truly concerned that their children do eat enough, and get enough food, I believe. "Well, the best thing, actually, and we always tell parents this, is to look at the growth chart, see how well their child's growing. And if the child seems to be growing well, at a pretty steady rate, then obviously the child is getting enough to eat." I think another point we're talking about growth charts is to point out that you should compare the child's growth against itself, not necessarily compared against the growth of Jane down the street, and Suzie across the street, and Joe back across the alley. What you're really looking at is the growth rate of your own child. Which brings us to another thing. What are some of the things that we need to keep in mind, Robyn, about changes that occur as we age as children, as far as our nutrient needs and nutritional status is concerned. "Well, during periods of rapid growth, so that would be infancy, childhood, adolescent, the child, their nutritional needs aregoing to be much higher, nutritional needs as well as energy needs. They are more physically active. If we compare that then with adults, the energy expenditure of children is going to be much higher. So their energy needs really based on their weight, is going to be much higher than an adult.

One of the things that I'd like to address is about fat, and infants and children under the age of two should not have a fat restriction. I think sometimes parents think that they are on a low fat diet, and it would be a good thing to also put their children on fat restricted diets. This is fine for children over the age of two, but it's really not recommended for children under the age of two. And as far as anemia, I think a long time ago, it used to be a more prevalent problem, and since the use of iron fortified formulas and supplementing breast fed babies with iron, the incidence of anemia among infants has gone down significantly." Those two points are v&emdash;ery, very important. No fat restriction below the age of two. Many people don't understand that. And another thing, iron deficiency anemia has actually decreased because of iron fortified formula. There's one last thing I think we might mention here, and that is the fact that the total food needs of the child slowly begin to increase in age. And what is the rule of thumb about, what's a serving size? "It will vary. I think with young children if you needed to have some kind of ballpark idea, generally it would be one tablespoon of food per age of the child. So, say if it was a child's eating lunch, and he's two years old, then you'd probably want to serve him around two tablespoons or more of vegetables, two tablespoons of fruit and some kind of meat or other high protein food." OK. Another question that we have a lot of problem with, and its, I'm not sure what the statistics are at this point, but it's the "O" word, I call it these days, obesity. Now, some sources indicate that obesity is running at about 25%, at least obesity and overweight children, but what is alarming about it is it seems to be increasing at a very rapid rate. In fact, I've seen some newspapers call it, an epidemic. I've seen some newspapers say as many as 50% of our children are overweight, or are obese.

So, Debbie, what are some of the problems as far as obesity is concerned? "Well, there are some psychosocial problems with the child as they're growing up. Our society has been brought up to believe that we should all look the same, that we should all be slim and beautiful and so on. And there are a lot of feelings of inferiority as far as obesity is concerned. If they get a lot of teasing. Kids don't like to be set apart from other children, so they get those sort of problems. There are some physical problems as they get older. Mobility becomes a problem. You just aren't able to play sports as well as some other kids might be able to. You may not be able to run as fast. You know, there's problems as far as possibility, you know, leading into obesity as an adult and the problems linked with that. The risk of cardiovascular disease, the risk of diabetes, hypertension." Do you have anything to add to that? "I think respiratory problems could be another fear of complication of being overweight to the point where they could actually have sleep apnea. In the middle of the night they could stop breathing because they're so obese." So, Robyn, what kind of advice would you give a parent dealing with this problem? I think this problem is really difficult to deal with because you want the child to eat, you don't want the child to be obese, you really have their best interest at heart, but what kind of advice do you give a parent? I guess medically I would suggest that the child be checked, assessed for his hyperlipidemia and abnormal glucose metabolism. 

One of the main things, though, that I think we'd like to stress is that we don't want to put these kids on what's called, diets. It gives a very negative connotation to meal time, to eating, to snacking and we don't want to do that. We still want to make sure that eating is a pleasant experience. We would make sure that we would encourage physical activity and try to avoid a sedentary lifestyle. So the child who spends a lot of hours in front of the TV or playing Ninentendo, those are the kind of kids that we'd like to get up and out and playing. The parents, we feel, should be responsible for choosing and preparing foods that are healthy and nutritious. The child, again, I think we had mentioned this earlier, determines how much they will be eating. I think a couple of other things we'd like to mention and we've mentioned them earlier is that the meal time should be scheduled and so should the snack times, and that again, with young children you want to supervise their meal times and their snack times. You don't want to let them have free range of the refrigerator, the freezer, the microwave at meal time, or snack time." Oh, heck, free range is fun. That brings us to one more question that I would like to ask you about, Debbie. What are the guidelines that we need to follow when we are feeding children? "Oh, we're looking at say, for milk, and milk products, things like milk and yogurt and cheese, about four times a day. But we're looking at small servings. So we're looking at about a half a cup to three quarters of a cup for one serving. So one to one and one half ounces of cheese, OK, per serving. You're looking at protein foods like meat, fish, chicken, eggs, that sort of thing, two to three times a day. But you think, two to three times a day, that's an awful lot. You're looking at a serving size being only about an ounce. An ounce is half a chicken drumstick or one chicken wing. OK, so i"t's pretty small.

For fruits and vegetables, you're looking at least four servings a day. One serving being something with Vitamin A, another one being with Vitamin C, and then the complex carbohydrates are your starches. Things like rice, noodles, even saimin occasionally, bread, that sort of thing, and that's a small serving as well. A serving of rice is a quarter cup of cooked rice. That's a very small amount. And then two to three times a day a serving of some sort of fat, just a teaspoon is one serving. So you're looking at probably a total of about a tablespoon of fat. You can incorporate those into snacks as well. We're not saying to put this all into three meals a day, because the parent will look at this and go, six servings of bread a day, I don't think I can do that. But that's where the snacks come in. So you're looking at probably three meals a day and then maybe a morning, afternoon and even an evening snack, where you can make it a 'slice a bread with a piece cheese melted on top of it. And there you've already gotten your serving of starch and a serving of milk." Well, actually that's a very good point because 15 to 20% of their diet actually comes from snacks, so if you include the pyramid things, it makes it much, much simpler. How do you get kids to try something new? "Oh, if I had that answer, I think I'd quit and be a millionaire. But, it's really impossible to try to force a child to eat. You can just imagine how it can be. All you can do is to try to present the food to him or her in the most non-threatening way, and in small amounts. It is important to give small amounts so that they don't feel threatened. They'll look at this and be just totally overwhelmed. OK. If they refused to eat it, you can try to reintroduce it in a few days. You can try to involve them in the food preparation. Sometimes peer pressure is wonderful. We do find that sometimes kids will not eat wdell, and then you send them off to preschool. And they'll eat whatever the other kids are eating, just because they want to be just like them." Well, what about food jagswhen you mentioned preschool? Food jags is another problem. It's more that, it usually happens around the time the kid's around two years of age. They're starting to explore. They're learning a bunch of new things. They're learning what something is, becoming more familiar with it, hanging on to it. Then going on to something else. So, they'll want a food that they like, it's comfortable, say peanut butter. All they want is peanut butter sandwiches. And then after a while they get tired of it. If you don't, don't make too much of an issue of it, you know. You can give it to them. They'll eventually move on to some other food. And, fortunately, for the most part I've founçd that fairly nutritious food, plenty go into these food jags." What about supplements, Robyn? "Generally, we as nutritionists, and also the American Academy of Pediatrics do not recommend routine supplementation for normal healthy infants and children.

The American Academy of Pediatrics did identify for us groups which they felt could get nutritional risk who might benefit from supplements. And this would include children who are living in homes where they may be abused and neglected, children who have anorexia, children with, who are consuming vegetarian diets that do not have dairy products and also pregnant teens." Well, that is absolutely fabulous information. I sincerely wish to thank our two guests today, Debbie Wong and Robyn Wong, who have given us some food for thought as we prepare a "Diet of Little Champions." Music Let's recap what we covered in today's Lesson. We Ñdiscussed the growth patterns of infants, explaining to you the very rapid growth in the first year, and another very important condition called fetal alcohol syndrome. We discussed the nutrient needs of infants, and how these nutrient needs could be met with food. We discussed the growth patterns of children one through five and the nutrient needs of children one through five, including things like food jags. A few reminders. Check your exam dates, your assignment dates and read your material for the next class. For the Science of Human Nutrition, this is Professor Karen Hastings, and "Debbie Wong," and "Robyn Wong." Thanks for watching.

Music And now, ladies and gentlemen, it's time for the Wheel of Misfortune, featuring our own and very lovely, Miss Karen. (Wheel turning.) It's yellow. Your child says the best thing about TV dinners is the TV. (Laughter.) Music