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Pediatric Nutrition
Understanding USDA Organic Definitions, Labeling, and Regulations
Table of Contents
Free Topics
About
Athlete Development
Basic Physiology/Homeostasis
Conclusion
Diagnosis
Fat-Soluble Vitamins
Flowchart - Enteral Tube Feeding Algorithm
Flowchart - Flow Diagram for the Management of Malnutrition
Mineral Needs by Age Group
Nutritional Requirements for Iron
Physiological and Developmental Considerations
Preface
Prevention
Therapy for Type 2 Diabetes and Prediabetes
I. Nutrient-Gene Interactions
1. Nutrition for the 21st Century-Integrating Nutrigenetics, Nutrigenomics, and Microbiomics
1. Nutrition for the 21st Century-Integrating Nutrigenetics, Nutrigenomics, and Microbiomics
Influence of Diet on the Genome
Influence of Genetic Sequence Variants on Dietary Needs
References
The Future of Nutrition-Precision Nutrition and Utilization of Systems Biology Approaches
II. Feeding the Infant
2. Development of Gastrointestinal Function
2. Development of Gastrointestinal Function
Development of the Gastrointestinal Tract
Development of the Intestinal Epithelium
Developmental Disorders
Dietary Carbohydrates
Dietary Fats
Dietary Protein
Human Milk
Infant Intestinal Microbiota
Infant Nutrient Assimilation
Micronutrients
References
3. Breastfeeding
3. Breastfeeding
Breastfeeding and Safe Sleep
Conclusions
Contraindications to Breastfeeding
Duration of Breastfeeding
How to Support Breastfeeding
Human Milk: Composition, Nutrients, and Bioactive Factors
Nutrition of the Lactating Mother
Recent Epidemiology
References
Special Situations, Including Preterm Infants
The Pediatrician's Role in Breastfeeding Support
4. Formula Feeding of Term Infants
Follow-up Formulas
Formula Composition and Labeling
General Considerations and Historical Perspective
Infant Formula Allergy-Related Issues
Manufacturers' Information for Product Composition and Other Resources
Newer Ingredients
References
Safe Handling, Preparation, and Storage of Infant Formula
Uses of Infant Formulas
5. Nutritional Needs of the Preterm Infant
5. Nutritional Needs of the Preterm Infant
Commercial Formulas for Preterm Infants
Conclusion
Enteral Nutrition
Feeding the Preterm Infant After Discharge
Growth Rate Standards
Human Milk
Methods of Enteral Feeding
Parenteral Nutrition
References
Specific Nutrient Recommendations
Transition From Parenteral to Enteral Nutrition
6. Complementary Feeding
6. Complementary Feeding
AAP Recommendations for Food Allergy Prevention Through Diet
Nutritional Considerations
Physiological and Developmental Considerations
References
Summary: How to Guide Complementary Feeding
III. Feeding the Child and Adolescent
10. The Global Burden of Pediatric Undernutrition and Malnutrition
Definitions of Undernutrition
Environmental Enteric Dysfunction, the Microbiome, and Malnutrition
Management of Moderate Acute Malnutrition
Management of Severe Acute Malnutrition
Micronutrient Deficiencies in Children
Nutrition in Humanitarian Crises
Public and Individual Health Relevance of Undernutrition
References
Undernutrition in Low- and Middle-Income Countries
11. Nutritional Aspects of Vegetarian Diets
Conclusion
Emerging Evidence: Soy, Cow Milk, and Allergens
Nutritional Considerations
Overview of Vegetarian Diets
References
Safety and Adequacy of Vegetarian Diets for Children: A Review of the Research
Summary Recommendations and Resources
Vegetarian Diets for Life Stage and Special Populations
12. Sports Nutrition
12. Sports Nutrition
Athlete Development
Body Weight and Body Composition in Young Athletes
Fuels for Activity
Performance-Enhancing Substances
References
Resources
Vegetarian and Vegan Athletes
Where to Get Further Assistance
13. Fast Foods and Fad Diets, Including Herbal Products and Botanicals
13. Fast Foods and Fad Diets, Including Herbal Products and Botanicals
Advertising/Marketing
Botanical Complementary and Integrative Therapy for Weight Loss
Changes in the Fast Food Environment During the COVID-19 Pandemic
Effect of the Macroenvironment
Fad Diets
Fast Food Summary-Going Forward
Herbal Products and Botanicals
Policy That Affects Fast Food Offerings
References
Specific Fad Diets
The Fast Food Environment
Where Do People Learn About Fad Diets?
7. Feeding the Young Child
7. Feeding the Young Child
Elementary School-Aged Children
Food Parenting in the Context of Food Insecurity
Nutrient Needs and Eating Patterns
Preschool-Aged Children
References
The Role of Anticipatory Guidance in Promoting Healthy Eating Behaviors
Toddlerhood
8. Adolescent Nutrition
8. Adolescent Nutrition
Assessing and Maintaining Adequate Nutrition in Adolescents
Dietary Reference Intakes
Factors Influencing the Nutritional Needs of Adolescents
Nutrition Concerns During Adolescence
Nutritional Concerns for Adolescent Bone Health
Nutritional Considerations During Pregnancy
References
9. Nutrition in School, Preschool, and Child Care
9. Nutrition in School, Preschool, and Child Care
Food Allergies in the School Environment
Food Safety
Nutrition Standards in Preschool and Child Care
Participation in School Meals
References
School Meal Standards, Nutrient Intake, and Plate Waste
Special Dietary Needs Within the School Environment
Standards for Food Sold in Competition to School Meals
The Basis for New School Nutrition Standards
The Complex Business of School Food Service50
The Healthy, Hunger-Free Kids Act of 2010
The Legacy of School Meals
The Nutritional Effectiveness of the School Meal Programs
The Role of a Pediatrician in the School Nutrition Environment
The Summer Food Service Program
The US Nutrition Safety Net
IV. Micronutrients and Macronutrients
14. Protein
14. Protein
Assessment of Protein Nutritional Status
Effects of Insufficient and Excessive Protein Intake
Factors Affecting Dietary Protein Requirements
Methods for Determining Protein and Amino Acid Requirements
Protein Quality
Protein Requirements
Recommended Dietary Intake for Protein and Amino Acids
References
15. Carbohydrate and Dietary Fiber
Absorption of Monosaccharides
Current Dietary Recommendations
Digestion of Disaccharides and Starches
Fiber
Glycemic Index
Lactose
Metabolism of Glucose
Overview
Potential Adverse Effects of Fiber Intake
Potential Benefits of Fiber Intake
References
Special Carbohydrate Diets and Supplements
Starches
16. Fats and Fatty Acids
16. Fats and Fatty Acids
Cholesterol
Complex Lipids and the Milk Fat Globule Membrane
Essential Fatty Acids
Fat and Fatty Acid Terminology
Fat Digestion and Absorption
Long-Chain Polyunsaturated Fatty Acids
Metabolically Dispensable Fatty Acids
References
Total Fat Intake in Infant and Child Nutrition
17. Calcium, Phosphorus, and Magnesium
Basic Physiology/Homeostasis
Calcium Requirements
Dietary Sources: Calcium
Dietary Sources: Magnesium
Dietary Sources: Phosphorus
Magnesium Requirements
Mineral Needs by Age Group
Phosphorus Requirements
References
18. Iron
18. Iron
Iron Metabolism
Iron Therapy
Nutritional Requirements for Iron
References
Screening for ID and IDA
Summary
19. Trace Elements
19. Trace Elements
Copper
Iodine
Manganese
Other Trace Elements
References
Selenium
Zinc
20. Vitamins
20. Vitamins
Fat-Soluble Vitamins
References
Water-Soluble Vitamins
V. Nutrient Delivery Systems
21. Parenteral Nutrition in Children and Adolescents
21. Parenteral Nutrition in Children and Adolescents
Implementing the PN Prescription
Important Considerations Before Initiating Parenteral Nutrition
Long-Term Management
Monitoring
References
Writing the Parenteral Nutrition Prescription
22. Enteral Feeding for Nutritional Support in Children and Adolescents
22. Enteral Feeding for Nutritional Support in Children and Adolescents
Blenderized Formulas
Conclusion
Definition
Enteral Formula Selection for Children 1 to 13 Years of Age: Standard Formulas
Enteral Formulas for Use in Children Older Than 13 Years: Standard Formulas
Extensively Hydrolyzed and Amino-Acid-Based Formulas
Formula Concentration and Supplementation With Use of Modular Components
Indications
Initiation
Monitoring
Note of Caution
Oral Supplements
References
Transition to Tube Feeding
Tube Feeding: Routes and Complications
When and How to Transition Feeding
VI. Nutrition in Acute and Chronic Illness
23. Assessment of Nutritional Status in Children and Adolescents
23. Assessment of Nutritional Status in Children and Adolescents
Biochemical Testing
Clinical History
Conclusion
Dietary Intake Assessment
Growth Assessment
Nutritional Assessment Through the Measurement of Body Composition
Nutrition-Focused Physical Examination
References
24. Feeding and Swallowing Disorders in Infants and Children
Development of Oral Feeding Skills
Introduction to Feeding Problems
References
Summary and Conclusion
Therapeutic Strategies for Feeding and Swallowing Disorders
Variations With Feeding Difficulties and Practices During Childhood
25. Malnutrition/Undernutrition/Failure to Thrive
25. Malnutrition/Undernutrition/Failure to Thrive
Definition
Epidemiology
Evaluation
Long-Term Outcomes
References
Short-Term Outcomes
Summary
Treatment
26. Nutrition and Pediatric Diarrheal Disease
26. Nutrition and Pediatric Diarrheal Disease
Common Concerns About Oral Rehydration Solutions in the United States
Definitions and Pathophysiology
Differential Diagnosis of Persistent Diarrhea
Early, Appropriate Feeding
Evaluation of the Infant and Child With Persistent Diarrhea
Oral Therapy for Diarrhea
Persistent Diarrheal Disease
Physiologic Principles
References
Summary
The Search for a More Effective Oral Rehydration Solution
27. Nutrition in Children with Inborn Errors of Metabolism
27. Nutrition in Children with Inborn Errors of Metabolism
Conclusion
Emergency Therapy for a Suspected or Known Inborn Error of Metabolism
Evaluation for Inborn Errors of Metabolism
Inheritance
Newborn Screening for Inborn Errors of Metabolism
Nutritional Therapy Using Medical Foods
Other Nutritional Therapies
Other Therapeutic Modalities
References
28. Nutrition Therapy for Children and Adolescents with Type 1 and Type 2 Diabetes
28. Nutrition Therapy for Children and Adolescents with Type 1 and Type 2 Diabetes
Background: Diabetes Mellitus in Children and Adolescents
Guidelines for Medical Nutritional Management of Type 1 and Type 2 Diabetes in Youth
Nutritional Deficits Among Youth With Diabetes
References
Special Situations and Chronic Diseases Associated With Diabetes in Children
Summary
Therapy for Type 2 Diabetes and Prediabetes
29. Nutrition in Children with Dyslipidemia
29. Nutrition in Children with Dyslipidemia
Genetic Dyslipidemias
Lipoproteins
Prevalence and Classification of Dyslipidemia
Prevention of Atherosclerosis and Optimization of Lipids With a Heart-Healthy Lifestyle and Diet
References
Secondary Forms of Dyslipidemia
Summary
Treatment
30. Pediatric Obesity
30. Pediatric Obesity
Assessment
Comorbidities of Obesity
Epidemiology of Pediatric Obesity
Factors Influencing Pediatric Obesity Throughout the Life Cycle
Genetics
Pathophysiology
Prevention of Childhood Obesity
References
Resources
Treatment of Pediatric Obesity
31. Food Allergy in Children
31. Food Allergy in Children
Clinical Disorders
Diagnosis
Food Allergens
Medical Management
Natural History
Pathophysiology
Prevalence
Prevention
References
Summary
Treatment
32. Nutritional Support of Children with Developmental Disabilities
32. Nutritional Support of Children with Developmental Disabilities
Assessment
Conclusion
Diagnostic Studies for Consideration Based on History/Physical Examination
Growth History/Assessment
Opportunities for Intervention
References
33. Nutrition of Children Who Are Critically Ill
33. Nutrition of Children Who Are Critically Ill
Carbohydrate and Lipid Metabolism
Energy Requirement During Critical Illness
Immunonutrition
Malnutrition and Metabolic Reserves
Micronutrients
Nutrient Delivery in the Pediatric Intensive Care Unit: Challenges
Protein Metabolism
References
Summary
34. Eating Disorders in Children and Adolescents
34. Eating Disorders in Children and Adolescents
Assessment
Clinical Features
Conclusions
References
Treatment
35. Nutrition for Children with Sickle Cell Disease and Thalassemia
35. Nutrition for Children with Sickle Cell Disease and Thalassemia
Conclusions
Macronutrient Intake, Requirements, and Energy Expenditure
Nutritional Guidelines for Sickle Cell Disease and Thalassemia
References
Specific Micronutrient Deficiencies
Unique Nutritional Situations
36. Nutritional Management of Children with Kidney Disease
36. Nutritional Management of Children with Kidney Disease
Conclusion
Enteral Nutrition and Fluid Provision
Nutrition in Chronic Kidney Disease
Nutrition Therapy for Acute Kidney Injury
Nutritional Assessment in Kidney Disease
Nutritional Considerations in Specific Kidney Conditions
References
37. Nutritional Management of Children with Cancer
Background
Nutrition Assessment
Nutritional Intervention
References
Treatment-Related Nutritional Considerations in Pediatric Oncology
38. Nutrition in Management of Chronic Autoimmune Inflammatory Bowel Diseases in Children
38. Nutrition in Management of Chronic Autoimmune Inflammatory Bowel Diseases in Children
Gluten-Related Disorders
Growth Impairment
Inflammatory Bowel Disease
Monitoring of Nutritional Status (See Chapter 23: Assessment of Nutritional Status in Children and Adolescents)
Nutritional Therapy for Inflammatory Bowel Disease
Psychosocial Effect of Nutritional Interventions in the Care of Children With Inflammatory Bowel Disease
References
Summary
39. Nutrition in Children with Liver Disease
39. Nutrition in Children with Liver Disease
Macronutrient Metabolism and Considerations
Micronutrient and Vitamin Considerations
Nutritional Assessment of the Child With Liver Disease
References
Special Considerations
Specific Disease States
40. Cardiac Disease
40. Cardiac Disease
Management
References
Summary
Undernutrition in Congenital Heart Disease
41. Nutrition in Children with Short Bowel Syndrome
Background
Complications
Intestinal Adaptation
Intestinal Physiology
Medical Therapies
Nutritional Assessment
Nutritional Management
References
Summary
42. Nutrition in Cystic Fibrosis
42. Nutrition in Cystic Fibrosis
Age-Specific Guidelines for Nutritional Management
Conclusions
Importance of Nutrition in Cystic Fibrosis
Nutrition Intervention for Poor Growth and Malnutrition
Nutritional Care
Overview of Therapy
Pathogenesis of Poor Weight Gain in Cystic Fibrosis
References
Role of the Pediatrician
43. Nutrition and Oral Health in Children
43. Nutrition and Oral Health in Children
Conclusions
Dental and Oral Associations With Chronic Diseases
Nutritional Choices and Dental Disease
References
VII. Nutrition and Public Health
44. Sustainability, Organic Foods, GMOs, and Food Safety
44. Sustainability, Organic Foods, GMOs, and Food Safety
Environmental Contamination
Environmental Effect and Sustainability
Genetically Modified Organisms and Regulation of Bioengineering
Nutrition and Health Aspects of Organic Food
Organic Foods
Practical Considerations for Pediatric Practice
References
Summary Points for Educating Families
Understanding USDA Organic Definitions, Labeling, and Regulations
45. Preventing Food Insecurity-Available Community Nutrition Programs
45. Preventing Food Insecurity-Available Community Nutrition Programs
Conclusion
Food Distribution Programs
Health and Nutrition Agencies: A Nutrition Resource to Provide Services and Identify Qualified Providers
Innovation
Nutrition Services Provided Through International, Federal, State, and Local Health and Nutrition Agencies
Other Federal Agencies Providing Nutrition Services to Improve Pediatric Health and Well-Being
References
Where to Seek Nutrition Assistance
46. Federal Regulation of Foods and Infant Formulas, Including New Ingredients: Food Additives and Substancesa Generally Recognized As Safe
46. Federal Regulation of Foods and Infant Formulas, Including New Ingredients: Food Additives and Substancesa Generally Recognized As Safe
Biotechnology in the Development of New Food Substances-Bioengineered Foods
Conclusions
Exempt Infant Formulas
Federal Regulation of Substances Added to Food
Labeling
References
Regulation of Infant Formula
Regulation of Other Substances of Interest in Pediatric Nutrition
47. Federal Regulation of Food Labeling
47. Federal Regulation of Food Labeling
Bioengineered Food Disclosure
Conclusion
Front-of-Package Nutrition Rating Systems and Symbols
Ingredient Labeling
Nutrition Claims
Nutrition Facts Panels for Infants Younger Than 12 Months and Children Between 1 and 3 Years of Age
Package Dating
References
The Nutrition Facts Panel
48. Food Safety: Infectious Disease
48. Food Safety: Infectious Disease
Clinical Manifestations
Epidemiology of Foodborne Disease
Food Safety and Prevention of Foodborne Illness
Laboratory Testing
Management
References
Surveillance for Foodborne Diseases
49. Food Safety: Pesticides, Industrial Chemicals, Toxins, Antimicrobial Preservatives, Irradiation, and Food Contact Substances
49. Food Safety: Pesticides, Industrial Chemicals, Toxins, Antimicrobial Preservatives, Irradiation, and Food Contact Substances
Antimicrobial Preservatives
Chemical Byproducts From Food Processing
Conclusion
Food Irradiation
Food-Contact Substances
References
Sources of Chemical Substances of Concern for Food Safety
Toxins
US Food Safety Regulations Including Ingredients and Contaminants Advertently or Inadvertently Added to Food
Appendices
Appendix A-1. Composition of Human Milk
Appendix A-2. Maternal Status and Human Milk
Appendix A-2. Maternal Status and Human Milk
References
Appendix B. Infant Formula Act Regulations and Expert Recommendations for Term Us Infant Formulasa
Appendix B. Infant Formula Act Regulations and Expert Recommendations for Term Us Infant Formulasa
Appendix C. Increasing the Caloric Density of Infant Formula
Appendix D-1. Dietary Reference Intakes: Recommended Intakes for Individuals
Appendix D-2. Dietary Reference Intakes: Tolerable Ul
References
Appendix E. Selected Nutrient Content of Foods From USDA National Nutrient Database
Appendix E-1. Dietary Fiber: Food Sources Ranked by Approximate Amounts of Dietary Fiber and Energy per Standard Food Portions and per 100 g of Foods
Appendix E-2. Approximate Calcium Contents of Servings of Some Common Food That Are Good Sources of Calciuma
Appendix E-3. Approximate Iron Content of Servings of Some Common Food That Are Good Sources of Irona
Appendix E-4. Approximate Zinc Content of Common Household Portions of Selected Foodsa
Appendix E-5. Approximate Sodium Content of Foods, mg per Servinga
Appendix E-6. Approximate Saturated and Polyunsaturated Fat and Cholesterol Content of Common Foodsa
Appendix F. Growth Charts
Front Matter
Preface
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