Nutrition Management of the School Aged Child

NUTRITION MANAGEMENT OF THE SCHOOL-AGED CHILD

Description
The Regular Diet for the School-Aged Child (6 to 11 years old) includes a wide variety of foods to promote optimal growth and development. Nutrition during this stage should supply adequate nutrients to support physical activity, attain a healthy weight, and ensure that the growth demands of adolescence are met (1). In addition, healthy eating habits and regular participation in physical activity should be established to reduce the risk of chronic disease and achieve optimal physical and cognitive development (1). Foods are provided based on the Food Guide Pyramid and the National Cholesterol Education Program. Three meals per day plus one to three planned snacks are recommended.

Indications
This diet is served when specific dietary modifications are not therapeutically required.

Nutritional Adequacy
The Regular Diet for the School-Aged Child meets the Dietary Reference Intakes (DRIs) for specific ages as outlined in the Statement on Nutritional Adequacy, provided that a variety of foods is consumed. Energy and protein requirements vary with the child’s age, growth rate, and physical activity.

How to Order the Diet
Order as “Pediatric Regular Diet” or “Regular Diet for Age ______.” The patient’s age will be taken into consideration in implementing the diet order. Any specific instructions should be indicated.

Planning the Diet
Energy needs vary with the growth rate, body size, and physical activity of the child. The average energy requirement for children aged 4 to 8 years is 1,742 kcal for boys and 1,642 kcal for girls. For children aged 9 to 11 years, the average daily energy requirement is 2,279 kcal for boys and 2,071 kcal for girls (2). The Institute of Medicine’s Food and Nutrition Board has established acceptable macronutrient distribution ranges for school-aged children. These guidelines indicate that carbohydrates should provide 45% to 65% of total energy, proteins should provide 10% to 30% of total energy, and fat should provide 25% to 35% of total energy (2). The recommended dietary allowance (RDA) for protein is 0.95 g/kg for children aged 4 to 13 years. This RDA is met by children aged 4 to 8 years who consume 19 g of protein per day and children aged 9 to 13 years who consume 34 g of protein per day (2). Dietary reference intakes that limit added sugars, defined as sugars and syrups that are added to food during processing or preparation, have been established (1,2). The daily intake of added sugars should be limited to 25% of the total energy consumed by a child (2). Twenty-five percent is a maximum limit; the recommended amount of added sugar in a healthy diet is 6% to 10% of total energy (1,2). Fruit juices can provide a substantial amount of sugar and energy in the diet of school-aged children. Currently it is recommended that daily fruit juice consumption be limited to 4 to 6 oz for children aged 1 to 6 years and 8 to 12 oz for children and adolescents aged 7 to 18 years (3).

The DRI for calcium in children aged 8 years or younger is 500 mg. The DRI increases to 1,300 mg for children aged 9 years or older (4). The requirement for calcium increases with the growth of lean body mass and the skeleton. The higher DRI for calcium was established because evidence indicates that calcium intakes at this level can increase bone mineral density in children, thus decreasing their risk of developing osteoporosis later in life (1).

Older children (9 to 11 years) will have a natural increase in appetite. Between the ages of 8 and 11 years some children (primarily girls), may be at risk for developing eating disorders due to an overemphasis on body image and low intake (5).

Recommendations from the Dietary Guidelines, National Cholesterol Education Program, and the American Academy of Pediatrics should be applied to the diet of healthy children. These recommendations include an intake of fat between 25 to 35% of total energy, limiting saturated fat to less than 10% of total energy, limiting dietary cholesterol to less than 300 mg/day, and limiting the intake of trans fatty acids (6-8). The recommended daily fiber intake for children aged 6 to 11 years is equal to or greater than the child’s age plus 5 g (9). The DRIs have established adequate intakes of fiber that are higher than the estimated requirements due to the health benefits of fiber. The adequate intake of fiber is 25 g/day for children aged 4 to 8 years, 31 g/day for boys aged 9 to 13 years, and 26 g/day for girls aged 9 to 13 years (2).

Table IE-4: Food Groups and Recommended Portion Sizes for the School-Aged Child (10)

Food Group	Daily Servings	Portion Size
Grains, Breads, Cereals	More than six servings Bread Dry cereal Cooked cereal Noodles Rice Crackers	1 slice 1 oz or ¾ cup ½ cup 4-6 ½ cup 4 to 6
Fruits	Two or more servings Fresh fruit Cooked, canned, or raw (chopped) Juice	1 whole medium ½ cup ½ cup
Vegetables	Three or more servings Cooked, canned, or raw (chopped) Juice	½ cup ¾ cup
Milk	Three servings Milk Yogurt Cheese	1 cup 1 oz 1 oz
Meat	Two to three servings (a total of 5-6 oz/day) Egg Cooked meat Dried beans, peas Peanut butter	1 2-3 oz ½ cup 2 tbsp
Fats, Sweets	As needed to provide energy

See:
OBESITY AND WEIGHT MANAGEMENT

References

Nicklas T, Johnson R for The American Dietetic Association: Dietary guidance for healthy children ages 2 to 11 years. J Am Diet Assoc. 2004;104:660-677.
Institute of Medicine’s Food and Nutrition Board. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids (Macronutrients). Washington, DC: National Academy of Science; 2002.
American Academy of Pediatrics Committee on Nutrition. Policy statement: the use and misuse of fruit juice in pediatrics. Pediatrics. 2001;107:1210-1213.
Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC: National Academy Press; 1997.
Nutrition Management of the School-Age Child. Pediatric Manual of Clinical Dietetics. 2nd ed. Chicago, Ill: American Dietetic Association; 2003.
Nutrition and Your Health: Dietary Guidelines for Americans. Available at: www.ars.usda.gov/ dgac/dgacguidexp.pdf. Accessed on August 8, 2004.
National Cholesterol Education Program. Report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents. Washington, DC: US Dept of Health and Human Services; 1991. NIH publication 91-2732.
American Academy of Pediatrics Committee on Nutrition. Cholesterol in childhood. Pediatrics. 1998;101:141-147.
The American Dietetic Association: Health implications of dietary fiber. J Am Diet Assoc. 2002;102:993-1000.
Dietary Guidelines for Americans 2005. Available at: www.healthierus.gov/dietaryguidelines on January 31, 2005.