Nutrition: child growth and development

School-Aged Child Nutrition

Helpful feeding information for your school-aged child:

School-aged children (ages 6 to 12) continue to need healthy foods and nutritious snacks. They have a consistent but slow rate of growth and usually eat four to five times a day (including snacks). Many food habits, likes, and dislikes are established during this time. Family, friends, and the media (especially TV) influence their food choices and eating habits. School-aged children are often willing to eat a wider variety of foods than their younger siblings. Eating healthy after-school snacks are important, as these snacks may contribute up to one-third of the total calorie intake for the day. School-aged children have developed more advanced feeding skills, are better at feeding skills, and are able to help with meal preparation.

The following are some helpful mealtime hints for school-aged children:

• Always serve breakfast, even if it has to be "on the run." Some ideas for a quick, healthy breakfast include the following:
  • fruit
  • milk
  • bagel
  • cheese toast
  • cereal
  • peanut butter sandwich
• Take advantage of big appetites after school by serving healthy snacks such as the following:
  • fruit
  • vegetables and dip
  • yogurt
  • turkey or chicken sandwich
  • cheese and crackers
  • milk and cereal
• Set good examples for eating habits.
• Allow children to help with meal planning and preparation.
• Serve meals at the table, instead of in front of the television, to avoid distractions.

Healthy food choices:

The food guide pyramid is a guideline to help you and your child eat a healthy diet. The food guide pyramid can help you and your child eat a variety of foods while encouraging the right amount of calories and fat.

The United States Department of Agriculture (USDA) and the US Department of Health and Human Services have prepared the following food pyramid to guide parents in selecting foods for children 2 years and older.

The Food Pyramid is divided into six colored bands representing the five food groups plus oils:

• Orange represents grains: Make half the grains consumed each day whole grains. Whole-grain foods include oatmeal, whole-wheat flour, whole cornmeal, brown rice, and whole-wheat bread. Check the food label on processed foods - the words “whole” or “whole grain” should be listed before the specific grain in the product.
• Green represents vegetables: Vary your vegetables. Choose a variety of vegetables, including dark green- and orange-colored kinds, legumes (peas and beans), starchy vegetables, and other vegetables.
• Red represents fruits: Focus on fruits. Any fruit or 100 percent fruit juice counts as part of the fruit group. Fruits may be fresh, canned, frozen, or dried, and may be whole, cut-up, or pureed.
• Yellow represents oils: Know the limits on fats, sugars, and salt (sodium). Make most of your fat sources from fish, nuts, and vegetable oils. Limit solid fats like butter, stick margarine, shortening, and lard, as well as foods that contain these.
• Blue represents milk: Get your calcium-rich foods. Milk and milk products contain calcium and vitamin D, both important ingredients in building and maintaining bone tissue. Use low-fat or fat-free milk after the age of two years. However, during the first year of life, infants should be fed breast milk or iron-fortified formula. Whole cow’s milk may be introduced after an infant’s first birthday, but lower-fat or skim milk should not be used until the child is at least two years old.
• Purple represents meat and beans: Go lean on protein. Choose low fat or lean meats and poultry. Vary your protein routine - choose more fish, nuts, seeds, peas, and beans.

Activity is also represented on the pyramid by the steps and the person climbing them, as a reminder of the importance of daily physical activity.

According to the Dietary Guidelines for Americans 2005 (the most recent guidelines), a decrease in energy intake of 50 to 100 calories per day for children who are gaining excess fat can reduce the rate at which they gain weight. With this reduction in energy intake, they will grow into a healthy weight as they age. Help your child to find higher-calorie foods that can be cut from his/her daily intake.

Nutrition and activity tips

• Try to control when and where food is eaten by your children by providing regular daily meal times with social interaction and demonstration of healthy eating behaviors.
• Involve children in the selection and preparation of foods and teach them to make healthy choices by providing opportunities to select foods based on their nutritional value.
• For children in general, reported dietary intakes of the following are low enough to be of concern by the USDA: vitamin E, calcium, magnesium, potassium, and fiber. Select foods with these nutrients when possible.
• Most Americans need to reduce the amount of calories they consume. When it comes to weight control, calories do count. Controlling portion sizes and eating non-processed foods helps limit calorie intake and increase nutrients.
• Parents are encouraged to provide recommended serving sizes for children.
• Parents are encouraged to limit children’s video, television watching, and computer use to less than two hours daily and replace the sedentary activities with activities that require more movement.
• Children and adolescents need at least 60 minutes of moderate to vigorous physical activity on most days for maintenance of good health and fitness and for healthy weight during growth.
• To prevent dehydration, encourage children to drink fluid regularly during physical activity and drink several glasses of water or other fluid after the physical activity is completed.

To find more information about the Dietary Guidelines for Americans 2005 and to determine the appropriate dietary recommendations for your child’s age, sex, and physical activity level, visit the Online Resources page for the links to the Food Pyramid and 2005 Dietary Guidelines sites. Please note that the Food Pyramid is designed for persons over the age of two who do not have chronic health conditions.

Always consult your child’s physician regarding his/her healthy diet and exercise requirements.

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Child development

Children represent the future, and ensuring their healthy growth and development ought to be a prime concern of all societies. Children are particularly vulnerable to malnutrition and infectious diseases, many of which can be effectively prevented or treated.

Children are our future, numbering over 2.3 billion worldwide (aged 0-19) and representing boundless potential. Child survival and development hinge on basic needs to support life; among these, a safe, healthy and clean environment is fundamental.

Children are exposed to serious health risks from environmental hazards. Over 40% of the global burden of disease attributed to environmental factors falls on children below five years of age, who account for only about 10% of the world's population. Environmental risk factors often act in concert, and their effects are exacerbated by adverse social and economic conditions, particularly conflict, poverty and malnutrition. There is new knowledge about the special susceptibility of children to environmental risks: action needs to be taken to allow them to grow up and develop in good health, and to contribute to economic and social development.

• Each year, at least three million children under the age of five die due to environment-related diseases.
• Acute respiratory infections annually kill an estimated two million children under the age of five. As much as 60 percent of acute respiratory infections worldwide are related to environmental conditions.
• Diarrhoeal diseases claim the lives of nearly two million children every year. Eighty to 90 percent of these diarrhoea cases are related to environmental conditions, in particular, contaminated water and inadequate sanitation.
• Nearly one million children under the age of five died of malaria in 1998. Up to 90 percent of malaria cases are attributed to environmental factors

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Child maltreatment

Child maltreatment, sometimes referred to as child abuse and neglect, includes all forms of physical and emotional ill-treatment, sexual abuse, neglect, and exploitation that results in actual or potential harm to the child’s health, development or dignity. Within this broad definition, five subtypes can be distinguished – physical abuse; sexual abuse; neglect and negligent treatment; emotional abuse; and exploitation.

As part of the ongoing WHO Global Campaign for Violence Prevention, and as its contribution to follow up on the UN Secretary General's Study on Violence Against Children, WHO has scaled up its child maltreatment prevention activities. WHO has a threefold stake in the prevention of violence against children.

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Chemical risks in food

The contamination of food by chemical hazards is a worldwide public health concern and is a leading cause of trade problems internationally. Contamination may occur through environmental pollution of the air, water and soil, such as the case with toxic metals, PCBs and dioxins, or through the intentional use of various chemicals, such as pesticides, animal drugs and other agrochemicals.

Food additives and contaminants resulting from food manufacturing and processing can also adversely affect health. Since 1976, WHO has implemented the Global Environment Monitoring System - Food Contamination Monitoring and Assessment Programme (GEMS/Food), which has informed governments, the Codex Alimentarius Commission and other relevant institutions, as well as the public, on levels and trends of contaminants in food, their contribution to total human exposure, and significance with regard to public health and trade.

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Arsenic in drinking water

Arsenic may be found in water which has flowed through arsenic-rich rocks. Severe health effects have been observed in populations drinking arsenic-rich water over long periods in countries world-wide.

Source

• Arsenic is widely distributed throughout the earth's crust.
• Arsenic is introduced into water through the dissolution of minerals and ores, and concentrations in groundwater in some areas are elevated as a result of erosion from local rocks.
• Industrial effluents also contribute arsenic to water in some areas.
• Arsenic is also used commercially e.g. in alloying agents and wood preservatives.
• Combustion of fossil fuels is a source of arsenic in the environment through disperse atmospheric deposition.
• Inorganic arsenic can occur in the environment in several forms but in natural waters, and thus in drinking-water, it is mostly found as trivalent arsenite (As(III)) or pentavalent arsenate (As (V)). Organic arsenic species, abundant in seafood, are very much less harmful to health, and are readily eliminated by the body.
• Drinking-water poses the greatest threat to public health from arsenic. Exposure at work and mining and industrial emissions may also be significant locally.

Effects

• Chronic arsenic poisoning, as occurs after long-term exposure through drinking- water is very different to acute poisoning. Immediate symptoms on an acute poisoning typically include vomiting, oesophageal and abdominal pain, and bloody "rice water" diarrhoea. Chelation therapy may be effective in acute poisoning but should not be used against long-term poisoning.
• The symptoms and signs that arsenic causes, appear to differ between individuals, population groups and geographic areas. Thus, there is no universal definition of the disease caused by arsenic. This complicates the assessment of the burden on health of arsenic. Similarly, there is no method to identify those cases of internal cancer that were caused by arsenic from cancers induced by other factors.
• Long-term exposure to arsenic via drinking-water causes cancer of the skin, lungs, urinary bladder, and kidney, as well as other skin changes such as pigmentation changes and thickening (hyperkeratosis).
• Increased risks of lung and bladder cancer and of arsenic-associated skin lesions have been observed at drinking-water arsenic concentrations of less than 0.05 mg/L.
• Absorption of arsenic through the skin is minimal and thus hand-washing, bathing, laundry, etc. with water containing arsenic do not pose human health risk.
• Following long-term exposure, the first changes are usually observed in the skin: pigmentation changes, and then hyperkeratosis. Cancer is a late phenomenon, and usually takes more than 10 years to develop.
• The relationship between arsenic exposure and other health effects is not clear-cut. For example, some studies have reported hypertensive and cardiovascular disease, diabetes and reproductive effects.
• Exposure to arsenic via drinking-water has been shown to cause a severe disease of blood vessels leading to gangrene in China (Province of Taiwan), known as 'black foot disease'. This disease has not been observed in other parts of the world, and it is possible that malnutrition contributes to its development. However, studies in several countries have demonstrated that arsenic causes other, less severe forms of peripheral vascular disease.
• According to some estimates, arsenic in drinking-water will cause 200,000 -- 270,000 deaths from cancer in Bangladesh alone (NRC, 1998; Smith, et al, 2000).

Measurement

• Accurate measurement of arsenic in drinking-water at levels relevant to health requires laboratory analysis, using sophisticated and expensive techniques and facilities as well as trained staff not easily available or affordable in many parts of the world.
• Analytical quality control and external validation remain problematic.
• Field test kits can detect high levels of arsenic but are typically unreliable at lower concentrations of concern for human health. Reliability of field methods is yet to be fully evaluated.

Prevention and control

The most important remedial action is prevention of further exposure by providing safe drinking- water. The cost and difficulty of reducing arsenic in drinking-water increases as the targeted concentration lowers. It varies with the arsenic concentration in the source water, the chemical matrix of the water including interfering solutes, availability of alternative sources of low arsenic water, mitigation technologies, amount of water to be treated, etc.

Control of arsenic is more complex where drinking-water is obtained from many individual sources (such as hand-pumps and wells) as is common in rural areas. Low arsenic water is only needed for drinking and cooking. Arsenic-rich water can be used safely for laundry and bathing. Discrimination between high-arsenic and low-arsenic sources by painting the hand-pumps (e.g. red and green) can be an effective and low cost means to rapidly reduce exposure to arsenic when accompanied by effective health education.

Alternative low-arsenic sources such as rain water and treated surface water may be available and appropriate in some circumstances. Where low arsenic water is not available, it is necessary to remove arsenic from drinking-water:

• The technology for arsenic removal for piped water supply is moderately costly and requires technical expertise. It is inapplicable in some urban areas of developing countries and in most rural areas world-wide.
• New types of treatment technologies, including co-precipitation, ion exchange and activated alumina filtration are being field-tested.
• There are no proven technologies for the removal of arsenic at water collection points such as wells, hand-pumps and springs.
• Simple technologies for household removal of arsenic from water are few and have to be adapted to, and proven sustainable in each different setting.
• Some studies have reported preliminary successes in using packets of chemicals for household treatment. Some mixtures combine arsenic removal with disinfection. One example, developed by the WHO/PAHO Pan American Center of Sanitary Engineering and Environmental Sciences in Lima, Peru (CEPIS), has proven successful in Latin America.

Chemical safety

Chemical Safety is achieved by undertaking all activities involving chemicals in such a way as to ensure the safety of human health and the environment. It covers all chemicals, natural and manufactured, and the full range of exposure situations from the natural presence of chemicals in the environment to their extraction or synthesis, industrial production, transport use and disposal.

Chemical safety has many scientific and technical components. Among these are toxicology, ecotoxicology and the process of chemical risk assessment which requires a detailed knowledge of exposure and of biological effects.

Dioxins and their effects on human health

Background

Dioxins are environmental pollutants. They have the dubious distinction of belonging to the “dirty dozen” - a group of dangerous chemicals known as persistent organic pollutants. Dioxins are of concern because of their highly toxic potential. Experiments have shown they affect a number of organs and systems. Once dioxins have entered the body, they endure a long time because of their chemical stability and their ability to be absorbed by fat tissue, where they are then stored in the body. Their half-life in the body is estimated to be seven to eleven years. In the environment, dioxins tend to accumulate in the food chain. The higher in the animal food chain one goes, the higher is the concentration of dioxins.

The chemical name for dioxin is: 2,3,7,8- tetrachlorodibenzo para dioxin (TCDD). The name ‘dioxins’ is often used for the family of structurally and chemically related polychlorinated dibenzo para dioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs). Certain dioxin-like polychlorinated biphenyls (PCBs) with similar toxic properties are also included under the term “dioxins”. Some 419 types of dioxin-related compounds have been identified but only about 30 of these are considered to have significant toxicity, with TCDD being the most toxic.

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Asthma

Asthma is a chronic disease characterized by recurrent attacks of breathlessness and wheezing, which vary in severity and frequency from person to person. During an asthma attack, the lining of the bronchial tubes swells, causing the airways to narrow and reducing the flow of air into and out of the lungs.

The causes of asthma are not completely understood. However, risk factors for developing asthma include inhaling asthma “triggers”, such as allergens, tobacco smoke and chemical irritants. Asthma cannot be cured, but appropriate management can control the disorder and enable people to enjoy a good quality of life.

Key facts

Facts about asthma

Reducing the asthma burden

The causes

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