Nutritional Requirements

Compared to adults, small children need more nutrients in proportion to their body weight. As bones, muscles, teeth, and blood volume are develop-

Dan Glickman

Former U.S. Secretary of Agriculture Dan Glickman promotes federal food programs at a daycare center while the children behind him enjoy lunch.

[Photograph by Mike Derer. AP/Wide World Photos. Reproduced by permission.]

Former U.S. Secretary of Agriculture Dan Glickman promotes federal food programs at a daycare center while the children behind him enjoy lunch.

[Photograph by Mike Derer. AP/Wide World Photos. Reproduced by permission.]

ing, nutrient intake needs to be adequate to support this process, and also to keep up with the growing child's increasing activity. A challenge also arises when growth spurts alternate with periods of no growth or slowed growth.

The Dietary Reference Intakes (DRIs), which include the Recommended Dietary Allowances (RDAs) and Adequate Intakes (AIs), should serve as a guide to prevent deficiencies in this age group. However, most of the levels set for preschoolers and toddlers are based on values established for infants and adults. In addition, the DRIs include a built-in margin of safety that exceeds the requirements for most children in the United States. Therefore, an intake that is less than that specified in the DRIs is not necessarily a reason for concern. For parents, a more practical approach to ensuring proper nutrient intake is to use the Food Guide Pyramid for Young Children, devised by the U.S. Department of Agriculture (USDA).0

Most people do not follow the requirements specified in these guides. Although severe nutrient deficiencies are rare in the United States, calcium, iron, zinc, vitamin B6, folic acid, and vitamin A are the nutrients most likely to be low in children as a result of poor dietary habits. Ensuring that children eat the recommended number of servings from each of the food groups in the pyramid is the best way to be certain that all nutritional requirements are met. A good rule of thumb for serving sizes is one tablespoon per year of age.

Energy and Protein Needs. Basal metabolic rate, growth, and physical activity all affect a child's daily energy. Regardless of the total intake, the composition should resemble the following: 50 to 60 percent of calories from carbohydrates, 25 to 35 percent of calories from fat, and 10 to

Dietary Reference Intakes: set of guidelines for nutrient intake

Recommended Dietary Allowances:

nutrient intake recommended to promote health adequate intake: nutrient intake that appears to maintain the state of health calcium: mineral essential for bones and teeth iron: nutrient needed for red blood cell formation zinc: mineral necessary for many enzyme processes basal metabolic rate: rate of energy consumption by the body during a period of no activity calorie: unit of food energy carbohydrate: food molecule made of carbon, hydrogen, and oxygen, including sugars and starches fat: type of food molecule rich in carbon and hydrogen, with high energy content

RECOMMENDED DIETARY ALLOWANCES FOR ENERGY AND PROTEIN FOR CHILDREN.

Kilocalories

Grams of protein

Age (years)

daily per kg per cm daily per kg

1,300 102 14.4

16 24

malnutrition: chronic lack of sufficient nutrients to maintain health vegan: person who consumes no animal products, including milk and honey diet: the total daily food intake, or the types of foods eaten allergy: immune system reaction against substances that are otherwise harmless hemoglobin: the iron-containing molecule in red blood cells that carries oxygen oxygen: O2, atmospheric gas required by all animals anemia: low level of red blood cells in the blood phosphorus: element essential in forming the mineral portion of bone vitamin D: nutrient needed for calcium uptake and therefore proper bone formation temperate zone: region of the world between the tropics and the arctic or Antarctic

SOURCE: Mahan L. Kathleen and Escott-Stump, Sylvia, eds. (2000). Krause's Food, Nutrition & Diet Therapy, 10th ed. Philadelphia, PA: W. B. Saunders Company.

15 percent of calories from protein (see accompanying table.) It should be remembered, however, that this is simply an estimate, and intake may need to be adjusted to suit each child.

Protein is a vital dietary component for preschoolers and toddlers, as it is needed for optimal growth. Enough protein should be consumed every day to allow for proper development. Protein deficiencies are rare in the United States, since most U.S. children consume plenty of protein each day. When protein malnutrition does occur, it is usually seen in those from low-income homes, those who follow a strict vegan diet excluding all animal sources, and those with multiple food allergies.

Vitamin and mineral needs. Iron is a vital component of hemoglobin, the carrier of oxygen in the blood. As a young child grows, blood volume increases, and so does the need for iron. Preschoolers and toddlers typically eat less iron-rich foods than they did in infancy. In addition, the iron that children get is usually non-heme iron (from plant sources), which has a lower availability than heme iron (from animal sources). As a result, children up to three years of age are at high risk for iron-deficiency anemia. The RDA for iron for both toddlers and preschoolers is ten milligrams (mg) per day.

Calcium is needed for bone and teeth mineralization and maintenance. The amount of calcium a child needs is determined in part by the consumption of other nutrients, such as protein, phosphorus and vitamin D, as well as the child's rate of growth. During this period of development, children need two to four times as much calcium per kilogram of body weight as adults do. The AI for toddlers is 500 mg/day, while for preschoolers it is 800 mg/day. Since dairy foods are the primary source of calcium, children who do not consume enough dairy or have an aversion to dairy products may be at risk for calcium deficiency.

The body can produce vitamin D in the skin in response to sun exposure. The amount of vitamin D needed daily thus depends mainly on how much time a child spends outside and on geographical location. The RDA for children living in tropical areas is between zero and 2.5 micrograms (^g) per day, depending on the amount of sun exposure. For those living in temperate zones, the RDA increases to 10 mc/day. Vitamin D-fortified milk is the best source.

Zinc is essential for proper development. It is needed for wound healing, proper sense of taste, proper growth, and normal appetite. Preschoolers and toddlers are sometimes at risk for marginal zinc deficiencies because the best sources are meats and seafoods, foods they may not eat regularly. The recommended intake of zinc is 10 mg/day.

Vitamin and mineral supplements are popular with more than 50 percent of parents of preschoolers and toddlers. Most use a multivitamin/ mineral supplement with iron. Parents should be aware, however, that such supplements do not necessarily fulfill the needs for marginal or deficient nutrients. For example, although calcium is often a nutrient that is low in children, most multivitamin/mineral supplements do not include it, or include it in very low doses. The American Academy of Pediatrics does not support routine supplementation for normal, healthy kids. Although there is no harm in giving children a standard children's supplement, megadoses should always be avoided, and caution should be used when supplementing the fat-soluble vitamins (vitamins A, D, E, and K).

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