P O C K E T G U I D E - American Academy of Pediatrics

1 THIRD EDITION. POCKET GUIDE. Bright Futures Nutrition THIRD EDITION. POCKET GUIDE. Katrina Holt, MPH, MS, RD. Editor Published by American Academy of Pediatrics American Academy of Pediatrics Department of Marketing and Publications Staff Maureen DeRosa, MPA. Director, Department of Marketing and Publications Mark Grimes Director, Division of Product Development Sandi King, MS. Director, Division of Publishing and Production Services Maryjo Reynolds Product Manager, Bright Futures Peg Mulcahy Manager, Graphic Design and Production Kate Larson Manager, Editorial Services Kevin Tuley Director, Division of Marketing and Sales Bright Futures: Nutrition, 3rd Edition Pocket Guide Library of Congress Control Number: 2010917945.

2 ISBN: 978-1-58110-555-1. Product Code: BF0038. The recommendations in this publication do not indicate an exclusive course of treatment or serve as a standard of care. Variations, taking into account individual circumstances, may be appropriate. Every effort has been made to ensure that the drug selection and dosage set forth in this text are in accordance with the current recommendations and practice at the time of the publication. It is the responsibility of the health care provider to check the package insert of each drug for any change in indications or dosage and for added warnings and precautions. The mention of product names in this publication is for informational purposes only and does not imply endorsement by the American Academy of Pediatrics .

3 Copyright 2011 American Academy of Pediatrics . All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior permission from the publisher. Printed in United States of America This publication has been produced by the American Academy of Pediatrics under its cooperative agreement (U04MC07853) with the US Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). 1 2 3 4 5 6 7 8 9 10. Table of Contents Bright Futures: Nutrition Building Bright Futures: vii Bright Futures: Nutrition Vision and viii About Bright Futures: ix Nutrition Supervision Infancy (Prenatal Age 11 Months).

4 3. Early Childhood (Ages 1 4).. 25. Middle Childhood (Ages 5 10).. 37. Adolescence (Ages 11 21).. 45. Nutrition Tools Key Indicators of Nutrition Risk for Children and 55. Strategies for Health Professionals to Promote Healthy Eating 64. Tips for Fostering a Positive Body Image Among Children and 70 iii Basics for Handling Food 71. Bright FUTURES. Federal Nutrition Assistance 74. Bright Futures: Nutrition v Bright FUTURES. Building Bright Futures: Nutrition B right Futures: Nutrition is offered in the spirit of health promotion. This comprehensive guide is based on 3. critical principles consistent with the Bright Futures con . and the balance of cultural norms and secular trends.

5 Bright Futures: Nutrition describes ways in which food and nutrition can be balanced for good health. ceptual framework A sense of joy of is fundamental to the effective integration 1. Nutrition must be integrated into the lives of infants, of healthy nutrition into people's lives. The contributors to children, adolescents, and families. Bright Futures: Nutrition value the sense of wonder and joy 2. Good nutrition requires balance. in infants, children, adolescents, families, and communities. 3. An element of joy enhances nutrition, health, and Nutrition planning and preparing and sharing food are seen well-being. as happy events that bring people together the infant at the Bright Futures: Nutrition weaves nutrition principles into all mother's breast, the family at the dinner table, and the com- aspects of daily life.

6 It incorporates a clear understanding that munity at the clam bake. food availability, family and cultural customs, and external Bright Futures: Nutrition provides a thorough overview of social pressures (eg, those created by the media) all influ- nutrition supervision during infancy, early childhood, middle ence infants, children's, and adolescents' eating behaviors. childhood, and adolescence. We hope that the guide's empha- Integrating good nutrition into the lives of infants, children, sis on nutritional integration, balance, and joy will improve and adolescents requires effort in many settings: the home, the lives of infants, children, adolescents, and their families.

7 Child care facilities, the school system, and the community. vii Balance is central to good nutrition and good health: the balance of calories, protein, fat, carbohydrates, vitamins, and Bright FUTURES. minerals in the diet; the balance of dependence and indepen- dence between the parent and the infant, child, or adolescent;. Bright Futures: Nutrition Vision and Goals The vision and goals of Bright Futures: Nutrition are to Improve the nutrition status of infants, children, and adolescents. Identify desired health and nutrition outcomes that result from positive nutrition status. Set guidelines to help health professionals promote the nutrition status of infants, children, and adolescents.

8 Encourage partnerships among health professionals, families, and communities to promote the nutrition status of infants, children, and adolescents. Describe the roles of health professionals in delivering nutrition services within the community. Identify opportunities for coordination and collaboration between health professionals and the community. viii Bright FUTURES. About Bright Futures: Nutrition A Developmental and Contextual Approach Bright Futures: Nutrition recommends that food and eating be viewed as both health-enhancing and pleasurable. Food Bright Futures: Nutrition represents a developmental and con- provides more than just energy and sustenance.

9 It holds innu- textual approach for helping infants, children, and adolescents merable symbolic, emotional, social, and personal meanings. develop positive attitudes toward food and practice healthy Food is connected with nurturing, family, culture, tradition, eating behaviors. and celebration. Promoting positive attitudes toward food The developmental approach, which is based on the unique and healthy eating behaviors in infants, children, and ado- social and psychological characteristics of each developmen- lescents involves recognizing the multiple meanings of food tal period, is critical for understanding infants, children's, and creating an environment that encourages the enjoyment and adolescents' attitudes toward food and for encouraging of food.

10 Family meals are emphasized because they help build healthy eating behaviors. on family strengths and promote unity, social bonds, and The contextual approach emphasizes the promotion of posi- good communication. tive attitudes toward food and healthy eating behaviors by Partnerships Among Health Professionals, Families, providing infants, children, adolescents, and their fami- and Communities lies with consistent nutrition messages. Consistency, com- bined with flexibility, is essential for handling the challenges Encouraging healthy eating behaviors in infants, children, and of infancy and early childhood. During middle childhood adolescents is a shared responsibility.