Children and Adolescents: Nutrition Issues, Services and

Programs

Dr. Dina Qahwaji

Children and adolescence

Good health is fundamental to growth, development and well-being of all children and adolescence

Protect them from chronic disease as adult This group is dependent and at high risk of

nutritional and health problem

Dr. Dina Qahwaji

Factors interact to shape food choice in young children

Nutrition attitudes and knowledge of parents and child-care providers

Economic and social status of the family Birth order of the child Peers, media and advertising Source of food (home, day care and fast-

foods restaurants)

Dr. Dina Qahwaji

Healthy People 2010

Objective: understanding and improving health Through physical activity, nutrition and dental

care Decrease overweight and obesity rate

The proportion of students who participate in physical activity declined from 42% in 1991 to 29% in 1999. And incidence of diabetes as well as overweight & obesity increased

Dr. Dina Qahwaji

Healthy People 2010 recommended steps

Promote the beginning of behaviour therapy for overweight children before puberty

Educate children and their families about health benefits of PA and weight reduction

Dr. Dina Qahwaji

Healthy People 2010 recommended steps

Encourage schools for health-promoting ways

Demonstrate to school that regularly PE during the school day can ↑ academic achievement

Develop ways to increase PA among children with disabilities

Dr. Dina Qahwaji

What are children and adolescence actually eating?

Children are failing to meet recommendation guideline by not consuming enough fruit and vegetables and by eating too much food high in fat and salts

Eating habit is changed since last 2 decade The USDA’s Centre for Nutrition Policy and Promotion

uses the Healthy Eating Index (HEI) as an indicator of diet quality

It provides an overall picture of the variety and quantity of food people choose to eat

Dr. Dina Qahwaji

What are children and adolescence actually eating?

Effect of family status, children from poor families’ are more likely to have a diet rated as poor or needs improvement

Diet from childhood to adolescence ↓ dietary quality ↓ consumption of vegetables, fruits & milk ↑ consumption of soda drink

Dr. Dina Qahwaji

A Healthy Eating Report Card for Children aged 2-9

Source: Centre for Nutrition Policy and Promotion, USDA, 2001

Childhood Obesity Eating practices influence a child’s physical

growth During the past 2 decades:

The lack of good nutrition habits and physical inactivity, has lead to an epidemic of overweight children and adolescents

Percentage of overweight children has nearly doubled Percentage of overweight adolescents has tripled Associated with chronic diseases, Type 2 diabetes, high

blood lipids and hypertension

Dr. Dina Qahwaji

Childhood obesity and early development of chronic diseases

Overweight children are at risk for CVD, insulin resistance, Type 2 diabetes, and other serious health problems

Overweight children and adolescents more likely to become overweight and obese adults

60% of overweight children shown to have at least one CVD risk factors

Dr. Dina Qahwaji

Other Nutrition-Related Problems

Under-nutrition Iron deficiency anaemia Dental caries High blood cholesterol

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Nutrition standards for child-care programs

Three guiding principles set the tone of the nutrition section of the standards:

Food should help to meet the child’s daily nutritional needs and reflect individual and cultural differences.

A nutrition specialist or food service expert is a central member of the facility’s planning team

To prevent food-borne illness, suitable equipment and food handling are essential

Dr. Dina Qahwaji

General Recommendations

Meal plans: ⅓ of RDAs should be met if the child present 4-7

hours per day, ½ - ⅔ of RDAs should be met for a child present 8 hours or more per day.

Meals and snacks with a variety of nutritious. Attention should be given to cultural food

patterns, appetizing colours and qualities.

Dr. Dina Qahwaji

General Recommendations Preparation and food service: Salt, fat and sugar should be kept to a minimum. Fruits, vegetables and whole-grain foods should be

promoted.

Nutrition guidance: Registered dietitians should employed to review

and guide a quality program.

Dr. Dina Qahwaji

General Recommendations

Nutrition education and training: Education for children and parents Parents can serve as instructors and facilitators

Physical and emotional environment: Positive, enjoyable interaction among children and

adults is preferred

Dr. Dina Qahwaji

Child Nutrition Programs: National School Lunch Program

NSLP is the Nation's second largest food and nutrition assistance program. It operated in over 95,000 public and nonprofit private schools (grades K-12) and provided low-cost or free lunches to over 30 million children daily

Free lunches are available to children in households with incomes at or below 130 % of poverty

Dr. Dina Qahwaji

School cafeterias served more than 5 billion lunches, more than half of them free or at a reduced price. The NSLP also provided more than 180 million afterschool snacks in 2007. The cost to USDA of providing lunches and snacks was $8.7 billions

Meals must meet nutritional standards and stay within the budget

Calories must be enough to meet nutritional needs

Dr. Dina Qahwaji

Child Nutrition Programs: School Breakfast Program

Founded by the Child Nutrition Act of 1966, SBP like NSLP, provides nutritional meals to students at participating schools (and to children in a few housing child care institutions).

Eligible students receive free or reduced-price breakfasts

Dr. Dina Qahwaji

The number of schools participating in the SBP ↑ in 1990

Growing by 9% annually between 1989 and 1995

The number of participating schools has continued to increase

In 2007, 79,950 schools participated in the SBP, up from 78,017 in 2006

Dr. Dina Qahwaji

In 1989, 3.7 million students participated in the program on a given school day, and a total of 658 million breakfasts were served

In 2007, 10.1 million students participated in the program daily, 4 % more than the previous year

1.7 billion breakfasts served, 71 % were free and another 10 % were provided at reduced price

Dr. Dina Qahwaji

Child Nutrition Programs: Child and Adult Care Food Program

CACFP provides meals and snacks to children at family day care homes, child care centers, homeless protects, and after-school programs, and to adults at adult day care centers

In 2007, more than 3 million children and 103,603 adults received CACFP meals and snacks on an average day. Total cost to USDA for CACFP in 2007 was $2.2 billion

Dr. Dina Qahwaji

Meals and snacks provided through CACFP important to working parents, improving day care quality and making day care more possible

It give refunds for family child care homes participating in the CACFP, with higher refunds for homes serving primarily low-income children

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Child Nutrition Programs: USDA Fruit and Vegetable Program

The Program makes fruit and vegetable snacks available at no cost to all children in participating schools

The program began in 2002 as a pilot program in a small number of schools

It has become a permanent program that was expanded to cover selected schools in all 50 States, as part of the 2008 Farm Bill

Dr. Dina Qahwaji

USDA's Economic Research Service evaluated the pilot based on: Analyses of administrative school records School reports Site visits to schools Focus groups and interviews with school staff

and parents

Dr. Dina Qahwaji

Most schools participating in the pilot considered the program doing well and strongly supported its continuation

Pilot sites chosen to represent a mix of large and small; rural, suburban, and urban; and elementary, middle, and high schools

Schools included students from different ethnic backgrounds and family income levels, based on the proportion of students qualified as eligible for free and reduced-price lunches

Dr. Dina Qahwaji

Nutrition Intervention for Risk-Reduction: Model Program

Bright Futures: Aim of Program: To further trusting relationships between the child, health professional, the family, and the community to promote best health for the child

The guideline are developmentally based and address the physical, mental, and social devolvement of children and their families

Nutrition supervision guideline are given for each group, interview, questionnaire, screening, assessment, counselling are provided

Dr. Dina Qahwaji

Bright Futures

Nutrition is based on: Nutrition must be added into the lives of

infants, children, adolescents, and families Good nutrition requires balance An element of joy increase nutrition, health,

and well-being

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Head Start and Early Head StartUS Dept of Health & Human Services Complete child development programs

serving children from Birth to 5 Pregnant women Their families 1 million children participate Nutrition services are part of provision

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Head Start and Early Head Start The overall goals is to increase readiness

for school of children from low-income families

Work on education and early childhood development, medical, dental and mental health services, nutrition services and parent education

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Food Stamps USDA Administered Designed for low income adults to buy food Average monthly benefit per person was $79 in

2002 which is enough to help family pay for portion of the food they need

It’s now progressing from stamps to electronic cards

Participants in the program is associated with increase intake of number of nutrients

Dr. Dina Qahwaji

Other federal program Summer Food Service Program

Provide meal to children from poor area when school is not in session

Federal government provide financial assistance to program where 50% of participants children are from family’s income lower than 185% of the poverty level

Important source of food for many children from food-insecure families

Dr. Dina Qahwaji

Other federal program

Team Nutrition USDA’S Food and Nutrition Services Aim to improve children’s lifelong eating &

physical activity level Partnership of public and private organization

interested in improving the health of children

Dr. Dina Qahwaji

Impact of child nutrition programs on children’s diets

Promoted healthful eating habits and contributed to the quality of children’s overall diets

Have positive effect on children’s consumption of milk, fruit, vegetables and some vitamins and minerals

Improve the quality and nutritional value of school meals

Dr. Dina Qahwaji

Key points shared by all nutrition and health program

Know and Identify the problem within specific target group

Have good educational background about the target group

To focus on health problem’s related behaviour to be change

Chose most suitable way to help change the behaviour to protect or by reducing health problem