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40 Cards in this Set

  • Front
  • Back

Middle Childhood

5-10 years

(school aged)


9-11 for girls; 10-12 for boys

(school aged)

What is unique about school aged children?

  • key time for preparing for physical and emotional demands of adolescent growth spurt
  • Establishing healthy eating behaviours
  • interventions help prevent immediate and long-term health problems
  • Adequate nutrition associated with improved growth and performance

Cognitive Development

  • Achievement of self efficacy...knowledge of what to do and the ability to do it
  • Developing sense of self
  • more independent, learning role in the family
  • peer relationships become more important
  • adequate nutrition associated with improved academic performance

Physiological Development

  • Increased muscular strength, motor coordination and stamina
  • boys generally have more lean tissue than girls
  • adiposity rebound occurs at around 6

Adiposity Rebound

  • In early childhood, body fat reaches a min then increases in relation to body's preparation for adolescent growth spurt
  • Percent body fat reaches a min of 16% in females and 13% in males during this time
  • Adiposity rebound usually occurs before 6 years of age and is associated with increased obesity risk the earlier it occurs
  • Tends to be earlier and greater in females (boys tend to have more lean body mass at this stage)

BMI for 2-5 years

Not consistent because height changes so much during these years:

  • Obese - 99.9th percentile
  • Overweight - 97th percentile
  • Risk of overweight - 85th percentile
  • Wasted - 3rd percentile - both height and weight are low

BMI for 5-19 years

Not consistent because height changes so much during these years:

  • Severely Obese - 99.9th percentile\
  • Obese - 97th percentile
  • Overweight - 85th percentile
  • Wasted - 3rd percentile - both height and weight are low

WHO Growth References

  • weight for age < 3rd percentile: underweight
  • height/length for age < 3rd percentile: stunted
  • weight for length < 3rd percentile: wasted

Energy Needs

  • Vary by activity level and body size
  • Equations are available to estimate intake based on gender, age, height, weight and activity level
  • Protein DRI is 0.95 g/kg body weight for 4-13 year old girls and boys

Acceptable Macronutrient Distribution Range (AMDR)

The range of intake for a particular macronutrient source (protein, fat or carb) expressed as a percentage of total energy, that is associated with reduced risk of chronic disease while providing sufficient amounts of essential nutrients

AMDR for 4-18 years in Canada

Carb: 45-65%

Protein: 10-30%

Fat: 25-35%

Wiggle room: 20%


  • Provides fuel for beneficial bacteria within lower GI tract
  • aids with waste removal from GI tract
  • we cannot breakdown plant components ourselves (done by intestinal enzymes)
  • we cannot obtain energy from this source
  • therefore no AMDR

Fibre recommendations


4-8 - 25 g/d

9-13 - 31 g/d


4-8 - 25 g/d

9-13 - 26 g/d


Recommendations are same for boys and girls

Selected Nutrient Intakes for 9-13 year (study results)

  • high caloric intake
  • low fibre intakes
  • not enough calcium
  • too much sodium
  • not enough fruits and veg

What about Iron?

  • childhood dietary iron and iron status are usually adequate
  • growth has slowed, eating more food
  • Risks for iron deficiency include:

  1. limited access to iron-rich foods
  2. a low iron or other specialized diet (vegan or vegetarian)
  3. medical conditions e.g. malaria or parasitic infections

Toxic Media Environment

91% of all ads are ones that target children

Media and Children's Body Image

  • influenced by peers, environment
  • pressure from media to look a certain way
  • children may develop an unhealthy relationship with food

Body Image and Dieting

  • preoccupation with weight and body size starts early
  • Study of 10-14 year olds in Ont found 29% of girls were currently trying to lose weight and 10% engaged in disordered eating
  • Australian study of 4000 children found 61% of boys and 56% of girls (10-11 yrs) had used weight management strategies in the last 12 months

Body Image and Dieting

  • The normal increase in body fat (adiposity rebound) at this age may be interpreted as the beginning of obesity
  • Parental controls and restriction of "forbidden foods" may increase desire and intake of these foods

Weight Based Stigmas

Exhibits as:

  • Biased attitudes, prejudice and behavioural intentions
  • various forms of discrimination
  • social marginalization, weight-related teasing/bullying
  • can happen in the home via parents, siblings
  • can negatively impact self-esteem

Psychosocial and Behavioral Consequences of Weight related teasing

Increases in:

  • frequent dieting
  • extreme weight control behaviours
  • binge eating
  • depressive symptoms
Decreases in:

  • self esteem
  • body satisfaction

Preventative Measures

  • Limit sugar sweetened beverages
  • Limit TV
  • Limit fast foods
  • Limit portions
  • Limit energy-dense foods
  • Have daily breakfast
  • encourage fruits and vegetables
  • promote calcium rich diets
  • promote diets high in fibre
  • promote physical activity

What seems to work?

  • comb of clinical and school-based multicomponent programs
  • Components: physical activity, parent training/modelling, behaviour counselling, and nutrition education (for children and parents)

Physical Activity Guide for Children 5-17

  • 60 minutes/day of moderate to intense exercise
  • 3+ days/week, intense exercise
  • 3+ days/week, muscle building exercise

How are Canadian Children doing?

  • ~7% children/youth achieve 60+ minutes 6+ days/week
  • Higher level of activity in school aged children compared to preadolescents

School Nutrition

Schools are in a unique position to support healthy eating because:

  • they have a captive audience for educating about healthy eating
  • reach nearly all children
  • venue for both nutrition and education
  • role modeling/social norms: staff, peers
  • may have positive influences on family

Aspects of the School Nutrition Environment

  1. School Food and Beverage Policy
  2. Breakfast/snack programs
  3. Access to off campus vendors
  4. Health Curriculum

Ontario School Food and Beverage Policy

  • Took effect in Sept 2011
  • Nutrition standards for food and beverages sold in elementary/secondary schools applies to: cafeterias, vending machines and tuck shops, events on school property (i.e. bake sales, sports events, etc.), lunch programs

Ontario School Food and Beverage Policy

All food and beverages are fit into one of 3 categories:

  1. Sell most (>80%): nutrient dense, low fat, sugar and sodium
  2. Sell less (<20%): slightly higher fat, sugar and sodium
  3. Not permitted to sell: low nutrient, high fat, sugar and sodium

Ontario School Food and Beverage Policy

  • 10 Event days per year where any food is permitted for sale
  • 20 minutes of physical activity required on top of recess time

Chocolate Milk Controversy

Policy states that schools are NOT allowed to sell milk based drinks with more than 28 grams of sugar

  • 250 ml chocolate milk ~ 26g, so is it okay?
  • Children like it! Good source of calcium, vit D, protein
  • 2 x sugar of white milk
  • no added health benefits
  • normalization of sugary foods

How is the policy doing?

Audited in 2013, visited 3 school boards and ministry found:

  • No monitoring strategy in place
  • secondary school cafeteria sales down 25-45%
  • vending machine sales up to 70-80%
  • many food items NOT compliant
  • majority of students not receiving 20 min daily physical activity

Food/Breakfast Programs

  • Canada has no national breakfast program; education is the jurisdiction of provincial governments
  • district/school level programs may provide "universal" breakfast, lunch or snacks to children - these are run by local groups

Food/Breakfast Programs Examples

In Guelph: Food and Friends - Mission: Initiate, facilitate and support quality, sustainable student nutrition programs

  • supports over 80 breakfast, lunch and snack programs for students in a supportive, nonjudgmental environment
  • Breakfast for Learning
  • Breakfast Clubs of Canada (raise money for local initiatives)

Food/Breakfast Programs

Food and friends program:

  • Snack program: $0.90/child or $171/school
  • Breakfast or lunch: $2.20/child or $418/school
  • 2014-2015 provided food to 14,000 students

Access to Off Campus Vendors

The Canadian Children's Food and Beverage Advertising Initiative:

  • Voluntary, industry-driven program
  • Core principles include: not advertising food or beverage products in elementary schools - pre-kindergarten through Grade 6
  • Potential conflict of interest for food industry giants like: McDonalds, Nestle, PepsiCo, etc.

Ontario Health Curriculum

Healthy Eating, Injury Prevention, substance use and Development and Sexual Health subsections:

  • grade 1: Food groups, hunger
  • grade 2: Food choices, Food Guide
  • Grade 3: Nutrition value, local and cultural foods, environmental impact
  • Grade 4: nutrients, healthy eating

Ontario Health Curriculum

  • Grade 5: Food labels, media effect on choices
  • Grade 6: benefits of healthy foods
  • grade 7: Health issues from food choices
  • Grade 8: Promoting healthy eating