toddler & preschooler nutrition
TRANSCRIPT
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Leny Budhi Harti
TODDLER &PRESCHOOLER
NUTRITION
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CONTENT
1. Overveiw of toddler & preschooler
2. Normal growth development
3. Physiological and cognitive development
4. Energy and nutrient needs (Dietary and physicalactivity recomendation)
5. Common nutritional problems
6. Prevention of nutrition-releted problems
7. Growth assessment
8. Feeding problem
9. Nutrition related condition
10.Food allergies and intolerance
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Overveiw of Toddler &Preschooler
Toddlers aregenerally definedas children betweenthe ages of 1 and 3
years
This stage ofdevelopment ischaracterized by arapid increase ingross & fine motorskills
Preschool-agechildren arebetween 3 and 5
years of age.Characterized byincreasing languageskill, staying with
friends an relatives,and expending theirability to controlbehavior
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Normal Growth Development
Berat badan
Tinggi badan
Status gizi
Nafsu makan
Toddler terjadipeningkatan BB 0,23kg/bln dan TB 1 cm/ bln
Preschool terjadipeningkatan BB 2 kg/thndan TB 7 cm/thn
Mengalami penurunan nafsu makanStatus gizi dapat diketahui melaluimetode : IMT for age ataumenggunakan the 2000 CDC growthchart
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An explosion in the development of new skill happens duringthe toddler years
Gross motor skill such as sitting and climbing developrapidly at this age
Age(months)
Gross motor skill
15 Crawl up stairs
18 Run stiffly
24 Jump in a place
30 Advance to going up stair by alternatingtheir feet
36 Ready for tricycles
Physiological and CognitiveDevelopment
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Children become increasingly mobile andindependent with improvement in grossmotor skills
Toddler have no sence of dengeroussituations children are especiallyvulnerable to accidental injuries andingestion of harmful substance
Physiological and CognitiveDevelopment
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Cognitive Development inToddler
Processes the ability to explore the environment andto develop new relationship
Fears for certain situations : darkness, wind, rain,&lound sounds
Social development : imitating others (parents,caretakers) children begin to learn about familyscultur
Dramatic development of language skills :
18 mo : children have 10 15 words
24 mo : children have 100 words
36 mo : children use 3 word sentences
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Development of Feeding Skillsin Toddler
Gross and fine motor development during toddleryears enhances childrens ability to chew foods ofdifferent textures and to self-feed
Between 12-18 mo
toddler are able to movethe tongue from side to side, learn to chew foodwith rotary, use the tongue to clean the lips,handle meats, raw fruits and vegetables amdmultiple texture of food.
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Feeding Behaviors of Toddlers
To circumvent food jags, parents can serve newfoods along with familiar foods.
New foods are better accepted if they are servedwhen the child is hungry, and if she sees othermembers of family eating these foods.
Toddler are great immitators, which includesimitating the eating behavior of others
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Cognitive Development ofPreschool-Age Children
Language develop rapidly during the preschoolyears and is an important indicator of both
cognitive and emotional development. Between
age 2 and 5, childrens vocabularies increase from 50to 100 words to more than 2000 words, and their
labguage progressess from two-to-three-wordsentences to complete sentences
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Development of Feeding Skills & Innate Ability toControl Energy Intake
The preschool-age child can use a fork and aspoon and uses a cup well
An important principle of nutrition for young
children and one with direct application tochild feeding is childrens ability to selfregulate food intake
Although children can self-regulate caloricintake, no inborn mechanism direct them toselect and consume a well-balanced diet
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Children learn healthful eating habits
Preschool children continue to learn
about food and food habits byobserving their parents, caretakers,peers, and siblings, and they begin tobe influenced by what they see on TV
Development of Feeding Skills & Innate Ability toControl Energy Intake
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Energy andNutrient
Needs
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EnergyKebutuhan energi untuk usia13 35 bulan :
1. 100 kkal/kg DBW
2. EER : (89 x berat badan) 80
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Kebutuhan energi untuk anak usia 3 8 tahun (EER)
Boys : 108.8 (61.9 x age (y)) + PA x {(26.7 xweight (kg) + (903 x height (m)}
Girls : 155.3 (30.8 x age (y)) + PA x {(10.0 xweight (kg) + (934 x height (m)}
Usia 4 6 tahun : 90 kkal/kg DBW
Energy
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Physical Activity
PAL PA
Boys Girls
Sedentary 1,00 1,00
Low active 1,13 1,16
Active 1,26 1,31
Very active 1,42 1,56
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Protein
Berdasarkan AKG di atas, prosentasekebutuhan protein untuk anak usia 1 3thn dan 4 6 tahun adalah 10% dari
total kebutuhan energi
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Berdasarkan ADA, 2004. Kebutuhanprotein untuk anak usia 1 3 tahunsebesar 1.1 g/kg BB dan menurun 0.95g/kg BB untuk anak usia 4 -8 tahun dan 9 13 tahun
Atau 5 20% dari kebutuhan energi
50% merupakan protein yang bernilai
biologis tinggi
Protein
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LemakBerdasarkan ADA, 2004. Kebutuhanlemak untuk anak usia 1 3 tahunsebesar 30 40% dari total energi
Untuk anak usia 4 18 tahun sebesar25 35% dari total energi
Kurangi sumber lemak yang berasal
dari lemak jenuh dan trans fatty acid
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KarbohidratBerdasarkan ADA, 2004 kebutuhankarbohidrat sebesar 45 65% daritotal energi
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Cairan
Kenutuhan cairan : 50 60 ml/ kg BB
Cairan berasal dari air putih, jus
buah, susu, dan sayuran
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Serat
Berdasarkan ADA, 2004, Kebutuhan seratadalah sebagai berikut :
1. Untuk usia 1 3 tahun : 19 gram/day.
2. Untuk usia 4 8 tahun : 25 gram/ day
Serat berasal daribuah, sayur dan biji-bjian.serat dapat digunakan untuk
mencegah terjadinya konstipasi
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Vitamin dan Mineral
Kebutuhan vitamin dan mineraldapat merujuk pada AKG
Vitamin dan mineral dapatberasal dari buah,sayur, laukhewani dan nabati serta biji-bijian
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Nutrition Guidance
Prinsip makanan untuk anak baduta dan preschool :
1. Kalori diberikan tinggi untuk menyediakan energi yangcukup, agar protein tidak digunakan sebagai sumber energi
2. Protein diberikan tinggi untuk menunjang pertumbuhan danmengganti sel-sel yang rusak
3. Lemak diberikan cukup untuk menyediakan alat transportvitamin larut lemak
4. Vitamin dan mineral cukup untuk menunjang prosesmetabolisme tubuh
5. Cairan dan serat cukup melancarkan defekasi
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Syarat :
1. Mudah cerna
2. Tekstur makanan tidak terlalu keras agar tidak
merusak gigi geligi3. Suhu makanan tidak terlalu panas dan dingin
4. Mengurangi makanan yang manis-manis dapatmenekan nafsu makan
5. Menu dipilih yang disukai anak
6. Disajikan dengan penampilan menarik
7. Hindari cemilan yang terlalu banyak
Nutrition Guidance
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Contoh Menu
Untuk anak usia 12 bulan :
Waktu Menu BM Berat(g)
Penukar Energi
pagi Bubur kuahsemur ayamdan sayur
Beras 25 110
Ayam 9
Wortel 25
Kacangmerah
5
minyak 1,25
Selingan Rotipanggang
Roti 35
Selai 5
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Untuk Anak usia > 13tahun
Sore :
Nasi lembek
Ungkep hati ayam
Bola tempe saus kuning
Cah oyong dan wortel
Contoh Menu
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Untuk anak usia 3 6tahun
Siang :
Nasi
Ayam goreng kremes
Perkedel tahu kukus
Sayur sup kacang merah
Buh semangka
Contoh Menu
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Common Nutritional Problems
1. Iron deficiencyanemia
2. Dental caries3. Constipation
4. Food security
5. Food safety
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Iron Deficiency Anemia Increase iron
requirentment Inadequate iron
absorption Inadequate iron intake
Decrease iron stores
Iron deficiency
Iron depletion
Iron deficiensy anemiasymptoms
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Treatment : supplementation with irondrops at a dose 3 mg/kg per day perlu dilakukan skreening pada 4
minggu setelah diberikan intervensiPerlu dilakukan pemeriksaan kadah Hbdan hematokrit setiap 6 bulan
Jika Hb dan hematokrit setelah 4minggu perlu pemeriksaan lebihlanjut
Iron Deficiency Anemia
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Dental CariesPenyebab :
Kebiasaan minumsusu/jus dengan botol
diwaktu tidurBahan makanansumber KH streptococcus mutan
mengasilkan asamyang dapat merusakgigi
Treatment :
Suplementation
Flouride :
6 mo 3 y : 0,25 g
3 6 y : 0,5 g
Kelebihanfluorosis
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Constipation
Diet providing adequate total fiber for age:
o 1 3 y : 19 g/day
o 4 8 y : 25 g/day
Some of the best food sources of fiber : whole grain
breads, cereals, legumes, fruit and vegetables
Too much fiber should avoid diarrhea, decreaseenergy dense food, decrease bioavailability ofsome vitamin and mineral (Fe, Ca)
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Food Security
Food security is particularly importantfor young children because of their highnutrient needs for growth and
developmentYoung children are a vulnerable groupbecause they must depend on theirparents to supply them with adequateaccess to food
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Food Safety
Young children are especially vulnerableto food poisoning because they canbecome ill from smaller doses of organism
Key foodborn pathogens include : Campylobacte
Salmonella
E. Choli
Listeria monocytogenes
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Contamination of food products can occurat any point along the way fromproduction to consumption.
One major food safety education program:
o Clean : wash hands and sufaces often
o
Separate : dont cross contaminano Cook : cook to proper temperature
o Chill : refrigerate promptly
Food Safety
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Prevention of Nutrition-ReletedProblems
1. Prevention and treatment ofoverweight and obesity
2. Prevention of cardiovascular
disease
3. Vitamin and mineral supplements
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Prevention and Treatment ofOverweight and Obesity
Prevention is the best approach for overweight andobesity
Parenting techniquea such as finding reasons topraise the childs behavior, but never using food as a
reward, foster the development of healthy eatingbehaviors in children and help them to self-regulatefood intake
Example of behavior changes of lifestyle :
o physical activity
o Not caloric dense
o Offering nutrient dense
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Prevention of cardiovasculardisease
Children with familial hyperlipidemia and obese children LDLcholesterol
High intake of saturated fat, trans fatty acids LDL cholesterolin children
DRI for fat :1 - 3 y : 30 40% dari total
energi4 18 : 25 35% dari total
energi
Children need toscreeningperiodicly
Pencegahan
Jika kadar LDL tinggi membatasi jumlah lemak, lemakjenuh 7% dari total kalori, kolesterol tidak lebih dari 200mg/day
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Vitamin and MineralSupplements
Anak yang mengkonsumsi makanan yangbervariasi tidak memerlukan suplementasi,karena kebutuhan zat gizi dapat terpenuhi darimakanan
Menurut The American Academy of Pediatrics ,beberapa kondisi yang membutuhkansuplementasi vitamin dan mineral :
Anorexia
Anak yang menjalani fat diet
vegetarian
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Growth Assessment
The need for nutrition services isidentified by answer to these sorts ofquestions :
1. Is the child growth on track?
2. Is his or her diet adequate
3. Are the childs feeding or eating skills
appropriate for the childs age4. Does the diagnosis affect nutritional needs?
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1. Berat badan
2. Tinggi badan
3. Status gizi
IMT for age, CDC4. Intake zat gizi recall 3 x 24 jam
5. Kebiasaan makan FFQ
Growth Assessment
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Feeding Problem
1. Behavior feeding problem
2. Excessive fluid intake
3. Feeding problems and food safety4. Feeding problem from disabilities
involving neuromuscular control
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Behavior Feeding Problem &Excessive fluidintake
Behavioral disorder that affect nutritionalstatus are autism and attention-focusingproblems, such as ADHD
The child refuses to eat many foods andis rigid in what he will eat
When he is not given food he likes, herefuse to eat all foods he prefer drinkrather than eat food kelebihan intakecairan
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Nutrition Related Condition
1. Failure to Thrive (FTT)
2. Diarrhea and Caliac Disease
3. Autism
4. Pulmonary problems
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Failure to Thrive (FTT)
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Diarrhea and Caliac Disease
Diare pada anak biasanya disebabkan karenakelebihan mengkonsumsi jus yang mengandungsorbitol atau sukrosa
Caliac disease : terjadi pada orang yang sensitifterhadap gluten, komponen dari wheat, rye,barley
Caliac disease diare
Jika anak menderita caliac disease
hindarimakanan yang mengandung gluten seperti :tepung, roti, pasta, dll
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Autism
No scientifically proven diet is nowrecommended for prevention ortreatment of autism
A gluten free and casein free diet is wellknown to families who educatethemselves on internet
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Pulmonary Problem
Breathing problems increase nutritionalneeds, lower interest in eating, slow growthrate
Feeding difficulties have several causes in atoddler :
1. The normal progression of feeding skills isinterrupted
2. Medication & their side effect highnutritional needs
3. Interrupted sleep and fatigue
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Dietary recommendation :
o Small, frequent meals with foods that areconcentrated sources of calories
o
Easy to eato Nutritional suplement : pediasure, vitamin and
mineral
Pulmonary Problem
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Food Allergies and Intolerance
Food allergies anaphylaxis
Example food allergies that mayresult in anaphylaxis : milk, eggs,wheat, peanuts, walnuts, soy, fish
Strict and complete avoidance of
food that causes tha allergies isrequired.
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Pertanyaan
1. Berapakah BB ideal anak?
2. Bagaimana status gizinya?
3. Bagaimana pendapat anda tentangkeiasaan makan anak tersebut?
4. Berapakah kebutuhan energi dan zat
gizi nya sehari?5. Buatlah menu sehari untuk anak
tersebut!
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References1. Brown, Judith E. Nutrition Through the Life Cycle. Second Edition.
Thomson. Unted State of America.2005
2. Mahan, L.K; Stump, S.E; 2004; Krauses Food & Nutrition Therapy11th ed; Sanders Elsevier; St. Louis, Missouri
3. Leonberg, L. Beth. 2008. ADA Pocket Guide to Pediatric NutritionAssessment. Unites State of America
4. Stump, Sylvia Escott. 2008. Nutrition and Diagnosis Related Care.Lippincott Wiliams & Wilkins. Philadelphia
5. Soetjiningsih. 1995. Tumbuh Kembang Anak. EGC : Jakarta
6. Kaswari, S. Rum Teguh , dkk. 2009. Buku Panduan Studi Kasus danPraktikum Nutrition in the Life Cycle. Universitas Brawijaya Malang
7. Kurniasih, Dedeh. 2010. Sehat & Bugar Berkat Gizi Seimbang.Kompas Gramedia: Jakarta
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TERIMA KASIH