nutrisi pada bayi dan anak (blok nutrisi 2010)

NUTRISI

Oleh:Dian Ramawati, M. Kep., Ns.

Jurusan KeperawatanUniversitas Jenderal Soedirman Purwokerto

Pada Bayi dan Anak

Tujuan Pembelajaran

Mahasiswa mengetahui pengertian nutrisi untuk bayi dan anakMahasiswa mengetahui macam-macam nutrisi untuk bayi dan anakMahasiswa mampu memahami perubahan kebutuhan nutrisi dari usia bayi sampai dengan usia remajaMahasiswa memahami cara menghitung kebutuhan nutrisi pada bayi dan anakMahasiswa memahami strategi pemenuhan kebutuhan nutrisi pada bayi dan anak sesuai dengan tahapan tumbuh kembang, jenis kelamin, dan usia.

Mengapa nutrisi sangat penting?

Memenuhi kebutuhan energi untuk aktivitas sehari-hari

Mempertahan seluruh fungsi organ tubuh

Penting untuk pertumbuhan dan perkembangan

Manfaat terapeutik : pencegahan dan penyembuhan penyakit

Nutrisi Pada Bayi

Pertumbuhan yang cepat pada otak dan sistem tubuh (1 tahun pertama):

– Peningkatan BB 200%

– Peningkatan panjang tubuh 55%

– Peningkatan lingkar kepala 40%

– Berat otak bertambah 2 kali lipat

Nutrisi Bayi Baru Lahir

ASI sampai dengan bayi berusia 6 bulan (rekomendasi internasional), dapat diberikan 10 -12 kali/hari

Susu formula, dapat diberikan sampai dengan 480 ml/hari

Kebutuhan kalori neonatus: 108 kcal/kgBB/hari

Manfaat ASI untuk Bayi

Imunitas alami (>100 komponen).

Menurunkan angka kejadian infeksi telinga, gastroenteritis, penyakit pernafasan dan bakteremia.

Mudah didapatkan dan siap digunakan.

Mengurangi resiko pemberian makan yang berlebihan

Meningkatkan kedekatan ibu dan bayi.

Tahapan kandungan gizi ASI

Kolostrum : 2-4 hari, berwarna kekuningan, kaya akan protein, vitamin, dan Ig A.

ASI transisi : sd. 2 minggu kelahiran, banyak mengandung lemak dan kaya kalori.

ASI matur : mengandung 90% air

Kandungan ASI : lemak, protein, vitamin

Standar Emas Makanan Bayi

Inisiasi Menyusui Dini (IMD) : 1 jam setelah kelahiran

Pemberian ASI eksklusif sd bayi 6 bulan

Pemberian MP-ASI lokal (buatan rumah tangga) selama 90 hari berturut-turut

Mempertahankan pemberian ASI sd. Anak berusia 2 tahun

Kandungan Gizi dalam MP-ASI

Bayi 6-12 bulan : 250 kalori, 6-8 gram protein

Anak usia 12-24 bulan : 450 kalori, 12-15 gram protein

Kebutuhan gizi bayi usia 6-12 bulan : 650 kal dan 16 gram protein

Kebutuhan gizi anak usia 12-24 bulan : 850 kal dan 20 gram protein

Kandungan Gizi ASI

ASI usia bayi 6-12 bln : 400 kal dan 10 gram protein

ASI usia 12-24 bln : 350 kal dan 8 gram protein

(Pedoman umum pemberian MP-ASI lokal tahun 2006, Depkes RI)

Manfaat Pemberian ASI untuk Ibu

Memperlambat proses ovulasi (kehamilan)

Membantu menurunkan berat badan setelah melahirkan

Mencegah perdarahan post partum

Menurunkan resiko terjadinya kanker payudara

Monitoring Pemberian ASI

Kenaikan BB bayi lebih stabil dan konsisten

Keb nutrisi total : 80-100 ml ASI/KgBB

Kapasitas lambung bayi 90 ml

Waktu pemberian ASI setiap 2-3 jam

Setiap pemberian 10-20 menit/setiap sisi payudara

Bayi puas menyusu : hisapan melambat atau tertidur

Susu Formula untuk Bayi

3 bentuk:– Siap diminum – paling mahal, tidak

membutuhkan air .– Konsentrate – Dicampur dengan air (50-50).– Bubuk – Dicampur denan air sesuai aturan.

Komposisi Susu Formula

Kandungan kalori: 20 calories/oz (0.67 calories/cc).Kandungan Protein: rasio of protein nabati dengan kasein 60:40 atau sama dengan ASI.Lemak: paling banyak tersedia ~50% kalori dari lemak jenuh dan asam lemak tak jenuh.Karbohidrat: laktosa, mineral (Ca, Zn, Mg).Mikronutrient: vitamin and mineral yang lebih tinggi dibandingkan ASI.

Susu Formula Khusus

Kedelai: untuk vegetarian, defisiensi laktose, galactosemia.

Tanpa Laktose: bahan dasar susu sapi

Protein hydrolysate: untuk bayi yang mengalami alergi atau tidak dapat mencerna protein

Bayi prematur: terdiri dari protein nabati, susu sapi dan protein serta calcium yang tinggi, 20-50%.

CACFP Meal Pattern Requirements for InfantsBirth through 3 months

4 through 7 months 8 through11 months

Breakfast 4-6 fl. oz. Formula1 or Breast milk2,3

4-8 fl. oz. Formula1 or Breast milk2,3

0-3 Tbsp. Infant cereal1,4

6-8 fl. oz. Formula1 or Breast milk2,3

and2-4 Tbsp. Infant cereal1

and1-4 Tbsp. Fruit or Vegetable or both

Lunch or Supper

4-6 fl. oz. Formula1 or Breast milk2,3

4-8 fl. oz. Formula1 or Breast milk2,3

0-3 Tbsp. Infant cereal1,4

0-3 Tbsp. Fruit or Vegetable or both4

6-8 fl. oz. Formula1 or Breast milk2,3

and2-4 Tbsp. Infant cereal1;and/or1-4 Tbsp. Meat, Fish, Poultry, Egg Yolk, Cooked Dry Beans or peas; or ½ -2oz. Cheese; or 1-4 oz (volume) Cottage Cheese, or 1-4 oz (weight) Cheese Food, or Cheese spread; and1-4 Tbsp. Fruit or Vegetable or both

Supplement(Snack)

4-6 fl. oz. Formula1 or Breast milk2,3

4-6 fl. oz. Formula1 or Breast milk2,3

2-4 fl. oz. Formula1 or Breast milk2,3

or 100% Fruit Juice5; and0-1/2 Bread4,6 or 0-2 Crackers4,6

1 Infant formula and dry infant cereal must be iron-fortified.2 It is recommended that breast milk be served in place of formula from birth through 11 months.3 For some breastfed infants who regularly consume less than the minimum amount of breast milk per feeding, a serving of less than the minimum amount of breast milk may be offered, with additional breast milk offered if the infant is still hungry.4 A serving of this component is required when the infant is developmentally ready to accept it.5 Fruit juice must be full-strength.6 Bread and bread alternates must be made from whole-grain or enriched meal or flour.

Kebutuhan Nutrisi Bayi

Vitamin D : 200 IU per hari (2 bln pertama)

ASI : setiap 2-3 jam diberikan

Finger foods : usia 6-7 bulan

Jus buah : 180 ml/hari

Cereal : usia 4-6 bulan

Susu formula : maks. 960 ml/hari

Buah dan sayur : 6-8 bulan

Daging, ikan, ayam : usia 8-10 bulan

Telur dan keju : 12 bulan

Pemberian makan pada bayi

4-6 bln – rasa baru.

– Berikan bubur susu dengan zat besi.

6-7 bln – duduk dengan bantuan.

– Berikan sayuran dan buah.

8-9 bln – kemampuan motorik halus.

– Berikan makanan camilan dengan protein.

10-12 bln – berdiri, belajar mengambil makanan

– Berikan makanan lunak, ajari makan sendiri.

12-18 bln – peningkatan kemandirian.

– Stop susu dg botol, gunakan sendok dan gelas

18 bln -2 th – pertumbuhan melambat, mjd kurang tertarik dg makanan

– Ajari anak makan sendiri.

2-3 th – asupan bervariasi, mulai memilih makanan.

Developmental Skills

Birth through 5 months:• Suck/swallow reflex• Tongue thrust reflex• Rooting reflex• Gag reflex • Poor control of head,

neck, trunkSERVE LIQUIDS ONLY

•Breastmilk•Infant formula with iron

Developmental Skills,

continued4 months through 7 months:• Tongue thrust and rooting reflexes begin to

disappear • Gag reflex diminishes• Can transfer food from front to back of

tongue to swallow• Begin to see an up-and-down munching

movement of the jaw• Sits with support• Has good head control

ADD SEMISOLID FOODS

•Infant cereal with iron

•Strained vegetables*

•Strained fruit*

•Progress to thicker texture and add in meats*

*may be started later in the age range

Developmental Skills, continued

8 months through 11 months:• Moves food from side-to side in mouth

• Begins to curve lips around rim of cup

• Begins to chew in rotary pattern (diagonal movement of the jaw as food is moved to the side or center of the mouth) ADD MODIFIED TABLE FOODS

•Mashed or diced soft fruit or soft-cooked vegetables•Strained meat/poultry or mashed egg yolk •Mashed cooked beans or peas•Cottage cheese, yogurt, or cheese strips•Crackers or pieces of soft bread•Breastmilk, iron-fortified formula or fruit juice in a cup

Eating and FoodBehaviors of Infants

Caregivers and Parents:Provide the right foods to promote good health.

Decide what to serve and when to introduce new foods.

Determine the kinds and types of food and textures to introduce.

Offer older infants appropriate finger foods when they can enjoy and manage them.

Tips:

Feed infants the foods you want them to love when they get older.

Provide a variety of nutritious foods.

Make mealtime relaxed and enjoyable.

Feeding the Baby for the First YearBabies

Age:When Babies Can: Serve:

Birth through 3 months

Only suck and swallow LIQUIDS ONLYBreastmilkInfant formula with iron

4 months through 7 months

Draw in upper or lower lip as spoon is removed from mouth

Move tongue up and downSit up with supportSwallow semisolid foods

without chokingOpen the mouth when they see

foodDrink form a cup with help, with

spilling

ADD SEMISOLID FOODSInfant cereal with ironStrained vegetables*

Strained fruit*

*may be started later in the age range

8 months through 11 months

Move tongue from side to sideBegin spoon feeding

themselves with a spoonBegin to chew and have some

teethBegin to hold food and use their

fingers to feed themselvesDrink from a cup with help, with

less spilling

ADD MODIFIED TABLE FOODSMashed or diced soft fruitMashed or soft cooked vegetablesStrained meat/poultry or mashed egg

yolkMashed cooked beans or peas

Cottage cheese, yogurt, or cheese stripsCrackers or pieces of soft breadBreastmilk, iron-fortified formula or fruit

juice in a cup

Food Safety and Infant Feeding

Infants are particularly sensitive to food borne disease. Their immature digestive system cannot fight bacteria as well as adults.

•Common symptoms of food borne illness (nausea, vomiting, and diarrhea) can be deadly for the infant.

•To keep it safe, remember the following Infant Food Safety tips . . .

Infant Food Safety Tips:

Wash hands before preparing or feeding foods.Use clean utensils.Transfer baby food to a dish – don’t serve baby from the jar – and discard leftovers from the dish.Refrigerate leftover food in the jar – label with the date and discard 2 days after opening.

Infant Food Safety Tips, continued:

Check that the safety button tin the lid of a baby food jar is down and ”pops” when opened.Discard formula or breastmilk left in a bottle after feeding.Avoid honey for the first year.

Breast Fed Babies in Childcare

Breastfeeding is the best source of food for a baby’s first year of life.

Supporting a breastfeeding mother helps to sustain the duration of breastfeeding.

Safe and sanitary handling is important for breastmilk as well as formula, so . . .

Handle it with care!

Nutrisi Pada Anak (1-6 tahun)

1-2 th: rata-rata tumbuh 12 cm, BB naik 3.5 kg.

Pertumbuhan melambat pada usia 4 tahun.– 6-8 cm/th– 2-4 kg/th

Perkembangan otak bertambah 3 kali lipat pada usia 6 tahun.

CACFP Meal PatternBreakfast

Components Ages 1-2 Ages 3-5 Ages 6-12

Milk

Milk, fluid ½ cup 3/4 cup 1 cup

Vegetables and Fruits

Vegetable(s) and/or fruit(s) or

Full strength fruit or vegetable juice or an equivalent quantity of any combination of the above

¼ cup

¼ cup

½ cup

½ cup

½ cup

½ cup

Grains/Breads

Bread or

Cornbread, biscuits, rolls, muffins, etc., or

Cold dry cereal or

Cooked cereal or

Cooked pasta or noodle products or

Cooked cereal grains or an equivalent quantity of any combination of grains/breads

½ slice

½ serving

¼ cup or 1/3 oz

¼ cup

¼ cup

¼ cup

½ slice

½ serving

1/3 cup or ½ oz

¼ cup

¼ cup

¼ cup

1 slice

1 serving

3/4 cup or 1oz.

½ cup

½ cup

½ cup

CACFP Meal Pattern: Lunch and Supper

Components Ages 1-2 Ages 3-5 Ages 6-12Milk

Milk, fluid ½ cup 3/4 cup 1 cup

Vegetables and Fruits

Vegetable(s) and/or fruit(s), 2 or more ¼ cup total ½ cup total ¾ cup total

Grains/Breads

Bread or

Cornbread, biscuits, rolls, muffins, etc., or

Cooked pasta or noodle products or

Cooked cereal grains or an equivalent quantity of any combination of breads/grains

½ slice

½ serving

¼ cup

¼ cup

½ slice

½ serving

¼ cup

¼ cup

1 slice

1 serving

½ cup

½ cup

Meat and Meat Alternates

Lean meat, poultry, or fish or

Cheese or

Eggs or

Cooked dry beans or peas or

Peanut butter or soy nut butter or

Other nut or seed butters or

Peanuts or soy nuts or tree nuts or seeds* or

Yogurt, plain, or sweetened and flavored or an equivalent quantity of any combination of the above meat and meat alternates

1 oz

1 oz

1 egg

¼ cup

2 tbsp.

½ oz = 50%

4 oz

1 ½ oz

1 ½ oz

1 egg

3/8 cup

3 tbsp.

½ oz = 50%

6 oz

2 oz

2 oz

1 egg

½ cup

4 tbsp.

1 oz = 50%

8 oz

CACFP Meal Pattern: SnackComponents (Choose any 2 components) Ages 1-2 Ages 3-5 Ages 6-12

Milk

Milk, fluid ½ cup ½ cup 1 cup

Vegetables and Fruits

Vegetable(s) and/or fruit(s), or

Full-strength fruit or vegetable juice or and equivalent quantity of any combination of the above

½ cup

½ cup

½ cup

½ cup

¾ cup

¾ cup

Grains/Breads

Bread or

Cornbread, biscuits, rolls, muffins, etc., or

Cold dry cereal or

Cooked cereal or

Cooked pasta or noodle products or

an equivalent quantity of any combination of grains/breads

½ slice

½ serving

¼ cup or 1/3 oz

¼ cup

¼ cup

½ slice

½ serving

1/3 cup or ½ oz

¼ cup

¼ cup

1 slice

1 serving

¾ cup or 1 oz

½ cup

½ cup

Meat and Meat Alternates

Lean meat, poultry, or fish or

Cheese or

Eggs or

Cooked dry beans or peas or

Peanut butter or soy nut butter or

Other nut or seed butters or

Peanuts or soy nuts or tree nuts or seeds* or

Yogurt, plain, or sweetened and flavored or an equivalent quantity of any combination of the above meat and meat alternates

½ oz

½ oz

½ egg

1/8 cup

1 tbsp.

½ oz

2 oz or ¼ cup

½ oz

½ oz

½ egg

1/8 cup

1 tbsp.

½ oz

2 oz or ¼ cup

1 oz

1 oz

1 egg

¼ cup

2 tbsp.

1 oz

4 oz or ½ cup

Developing Healthy Habits

Offer a variety of healthy foods and snacks.Encourage fruit and vegetable intake.No junk food snacking.Limit intake of juices ( 4 oz per day).Increase intake of water (no soda).Encourage low fat dairy products (3-4 servings/ day).Make fun physical activity a habit.Limit TV to no more than 1 to 2 hours per day.Track growth and development carefully.Be a good role model.

Developmental Skills

ONE-YEAR-OLD CHILDRENThey may grow less quickly than during infancy. They may eat less, but they tend to eat frequently throughout the day. They get better at feeding themselves, although spills should still be expected. They drink from a cup with help.

How Children Grow and Develop

At 1 year old– Teething occurs – Playing consists of imitating others– One-year-olds use and understand the

words “me,” “mine,” and “no”– They recognize their names – They can make two to three word sentences

Developmental Skills, continued .....

Two-year olds can:Fold napkinsScrub fruits and vegetablesWipe tablesSnap fresh beansTear lettuce and salad greensBreak bread for stuffing

How Children Grow and Develop

At 2 years old– Two-year-olds have a high energy level– They develop skills including walking,

running, and eye-hand coordination– They are curious and want to do things for

themselves– 2-year-olds still use sucking, mouthing,

and tasting to explore – Children can speak in two to five

word sentences

Developmental Skills, continued

Three-year olds can:Pour liquids into a batterMix muffin batterShake a milk drinkSpread peanut butter on breadCrack hard cooked eggs

Eating and Food Behaviors

of ToddlersTips:

Don’t serve large

amounts of juice.

Offer sweet and

sugary foods only

rarely.

Caregivers and Parents:Know that appetite ups and downs are normal and usually relate to growth.

Allow children to stop eating when they indicate they are full

Know that now is the time when food preferences are being firmly established.

Realize that children are usually willing to try new foods.

Feeding Responsibility: Caregivers & Parents

Select and buy foods, including new foodsChoose meal and snack timesPrepare & present the food attractivelyExpect a standard of behavior at the tableMake mealtime pleasantSet a good example

Feeding Responsibility: Child

Decides what foods they will eat

Determines how much they will eat

Chooses whether or not they will eat

Transitional Feeding/Eating

How do you handle the transition between infant and toddler on the CACFP meal pattern?

Serving Meals Family-Style

Introducing Family-Style Meals Provide a table and play dinnerware so the children

can practice. Show the children the proper way to set the table.

Practice proper table etiquette; emphasize using “please” and “thank you”.

Keep food safety in mind (if the cup falls on the floor, it must be washed).

Remember these tips:

Children enjoy helping with "grown up" activities. Let them assist with each of the four components of family-style meals as it will boost their self-esteem. The four components are:

•Table setting

•Self-serve

•Food preparation

•Cleanup

Begin with something simple like table setting. Then allow children to help with a small snack, and always encourage them to clean up after themselves.

Family Style Meals

Food SafetyFood Safety

NutritionNutrition Child Development

Family Style Meals

FOOD SAFETY

Handwashing Keep Foods Safe to Eat

Hot Foods HOT/Cold Foods COLD

Introducing New Foods

Introducing New Foods

Think about timing

Be positive

Keep trying

Tip:

Did you know that children

may need to

encounter a new food 12 times

before they actually eat

it?

Child Development

Family Style Meals

How Children Grow and Develop

Between 3 and 5 years of age– Preschoolers enjoy art, pretend and music

and dramatic play.– Children begin to use a fork or spoon well. – As they get older, sharing toys and

belongings becomes easier.– Attention spans continue to

grow with the child’s age.

Eating and Food Behaviorsof Preschoolers

Caregivers and Parents:Realize that erratic eating habits are normal.

Provide healthy meals and snacks in order to build a strong foundation for a lifetime of good eating habits.

Tips:

Preschoolers enjoy learning abut

food.

With proper supervision, they can help prepare simple meals and

snacks.

Books, videos, storytelling and

discussion groups are excellent ways

to teach good nutrition!

Allow input on what is served.

A Closer Look at Eating Habits

Eating Habits are formed in early childhood.

Good eating habits do not just happen, they must be learned.

Childcare Providers Support

Positive Eating Habits by:

Successful introduction of new

foods.

Encouraging favorable attitudes

toward food.

Encouraging good eating habits.

Encouraging Favorable Food Attitudes

and Good Eating Habits

Be sensitive to children’s needs.Help children feel ready to eat.Get children interested and involved.Make eating a pleasure.Foster positive feelings.Check out the

Mealtime Memo on Feeding Toddlers

Food Matching GameActivity

Nutrients are Needed for Growth and Development

Nutrition is the process by which our bodies take in and use food.

The best way to ensure good nutrition is to choose a variety of foods.

Check out the Mealtime Memo on Nutrition & Cognitive Development!

Nutrients Needed for Growth and Development

Carbohydrates– Supply energy 4

kcal per gram (90 kcal/KgBB or 1800 cal/day)

– Provide fiber if whole grain

– Made up of 2 types

• Complex• Simple

Proteins– Supply 4 kcal per

gram (13-19 g/day)

– Build and repair body tissue

– Help antibodies fight infection

Nutrients Needed for Growth and Development

Fats– Supply 9 kcal per gram (< 30% daily

intake)– Carry fat-soluble vitamins A, D, E, and K– Provide a feeling of fullness since fats

take longer to digest

– Tips About Fat• Serve reduced- or low-fat milk to

preschoolers, ages 2 and older.• Do not restrict all fats in children’s diets.

Nutrients Needed for Growth and Development

Vitamins– Needed by body in

small amounts– Help release

energy from nutrients

Minerals– Needed in small

amounts– Help in making

strong bones and teeth & healthy red blood cells

Water (100 ml/KgBB/day)– Essential for life– Is part of every

living cell– Helps maintain

body temperature– Is the medium for

metabolism– Transports

nutrients and body substances

– Acts as a lubricant

What is a Portion Size?

Nutrient Contributions from MyPyramid

“Empty” Calories

Protein, Iron, Phosphorous, and Zinc

Fiber, Potassium, and Vitamins A&C

Complex Carbohydrates, Fiber, Iron, Thiamin, and Niacin

Fiber, Potassium, and Vitamins A&C

Calcium, Protein, some B-vitamins, and Vitamins A&D

Keeping a Daily Record of Meals

TIP

Be sure to record menu

components in your log each

day!

Nutrition Education Why?

To get children involved in activities with food and eating.

To encourage them to try new food.

To help them establish a lifetime of good eating behavior.

Check out the Mealtime Memo on Preventing Obesity Part I!

Nutrition Education

How? Plan activities that match children’s

abilities and interests (developmentally appropriate).

Build on what a child already knows. When?

– Plan simple activities before trying harder ones.

The Parent FactorEstablish regular communication with parents on activities, progress, and how they can support healthy eating concepts at home.

Take a look at the Mealtime

Memo on Preventing

Obesity Part II!

“DEVELOPMENTALLY APPROPRIATE!”

For all Ages and Stages

Child Development

Children make decisionsChildren socializeLearn to listen to internal cuesPractice daily living skills

Child Development

NutritionNutrition

Family Style Meals

Nutrition Nutrition

Must follow the meal patternMust put all foods on the tableChildren can try new foodsChildren learn to enjoy a variety of foods

Skills for Serving Self

SKILLS FOR SERVING SELF

Hold and physically pass bowls or pitchers Make sure someone receives them.Judge space for bowls or pitchers.Efficiently use serving utensils.

SKILLS FOR SERVING SELF

•Teachers direct table conversations and model behavior.

•Children wait their turn.

•Children balance serving containers

•Children spoon food from a serving dish without using fingers.

Adolescent Growth Spurt

Physiological growth stage (Tanner staging) rather than chronological age, is the best indicator for establishing requirements or evaluating intake.

Females: 11-14 years:

– Grow 8.4 - 9.0 cm/year.

– Girls deposit more total body fat.

Males: 13-16 years:

– Grow 9.5 - 10.3 cm/year.

– Boys deposit more muscle mass.

– Boys tend to gain more weight at a faster rate and skeletal growth continues longer than girls.

Obesity in Childhood and Adolescents

>20% of children/adolescents are overweight.

Increased by 50-100% over last 20-30 years:

– More sedentary lifestyle and behavior (TV/video games).

Prevalence increasing more rapidly among African-Americans.

Obese children and adolescents become obese adults.

Recent reports indicate 8-45% of newly diagnosed pediatric pts with diabetes are diagnosed with type 2.

Obesity:Health Consequences

Cardiovascular disease risk

Type 2 diabetes (epidemic)

Hypertension

Orthopedic

Sleep apnea

Gall bladder disease/steatohepatitis

Psychosocial problems

Pediatric ObesityEtiology and Treatment

Etiology:

– Genetic predisposition: 80% risk if both parents obese

– Environment

– Dietary intake

– Physical activity / sedentary activity

Treatment:

– Multidisciplinary and comprehensive

– Formal behavior modification

– Family-based

Eating Disorders in Adolescents

An estimated 20% of teens engage in some type of abnormal eating.

5% of high schools girls have been diagnosed with an eating disorder.

Adolescents are frequent users of OTC diet pills.

Multiple factors contribute: thin “ideal” , family pressure, exhibiting body control.

Disease Prevention Developing Healthy Eating Habits

Discourage dieting and obsession with weight.Pack healthy lunch at least twice a week.Limit fast food eating out.Encourage a balanced diet.5 servings of fruits/vegetables a day.Encourage low fat dairy products (3-4 / day).Prepare meals that kids and teens enjoy.Encourage teens to learn to cook healthy food.Teach kids and teens label reading.Be a role model.

TABEL Z-SCORE

Tabel Z-Score untuk status gizi anak Indonesia (WHO, 2005)

Tabel Z-Score berdasarkan buku bagan MTBS 2008.

What Is BMI?

• Body mass index (BMI) = weight (kg)/height (m)Body mass index (BMI) = weight (kg)/height (m)22

• BMI is an effective screening tool; it is not a BMI is an effective screening tool; it is not a diagnostic tooldiagnostic tool

• For children, BMI is age and gender specific, so For children, BMI is age and gender specific, so BMI-for-age is the measure usedBMI-for-age is the measure used

• Body mass index (BMI) = weight (kg)/height (m)Body mass index (BMI) = weight (kg)/height (m)22

• BMI is an effective screening tool; it is not a BMI is an effective screening tool; it is not a diagnostic tooldiagnostic tool

• For children, BMI is age and gender specific, so For children, BMI is age and gender specific, so BMI-for-age is the measure usedBMI-for-age is the measure used

For Children, BMI Changes with Age

Boys: 2 to 20 years

BMI BMI

BMI BMI

Example: 95th Percentile

Age BMI 2 yrs 19.3 4 yrs 17.8 9 yrs 21.013 yrs 25.1

BMI-for-Age Cut offs

> 95th percentile Overweight

85th to < 95th Risk of overweight percentile

< 5th percentile Underweight

Calculating BMI with the Metric System

Formula: weight (kg)/[height (m)]2

Calculation: [weight (kg)/ height (cm)/

height (cm)] x 10,000

Example: A child’s weight=16.9 kg and height=105.4 cm

BMI = [16.9 kg / 105.4 cm / 105.4 cm] x 10,000 = 15.2

Disease Prevention Developing Healthy Eating Habits

Discourage dieting and obsession with weight.Pack healthy lunch at least twice a week.Limit fast food eating out.Encourage a balanced diet.5 servings of fruits/vegetables a day.Encourage low fat dairy products (3-4 / day).Prepare meals that kids and teens enjoy.Encourage teens to learn to cook healthy food.Teach kids and teens label reading.Be a role model.

Nutritional Concerns in Childhood and Adolescents

Malnutrition and poverty.

Growth spurt-onset of menses for girls-changes in body size/image.

Food fads, vitamins, athletes.

Eating disorders: anorexia and bulimia nervosa.

Overweight and obesity.

Hyperlipidemia and heart disease.

Bone mineralization and osteoporosis.

Thank You! Any Questions?