Early childhood encompasses infancy and the toddler years, from birth through age three. The remaining part of childhood is when children enter the school from ages four through eight. Several critical physiological and emotional changes take place during the life stage from childhood through adolescence. Children’s attitudes and opinions about food deepen. They begin taking their cues about food preferences from family members and peers, and the larger culture.

Parents also significantly impact their child’s nutritional choices. This time in a child’s life provides parents and other caregivers an opportunity to reinforce good eating habits and introduce new foods into the diet while remaining mindful of their preferences. Parents should also serve as role models for their children, who will often mimic their behavior and eating habits. Parents must continue to help their school-aged children and adolescents establish healthy eating habits and attitudes toward food. Their primary role is to bring a wide variety of health-promoting foods into the home so that their children can make good choices.

Nutritional needs change as children leave the toddler years. From ages four to eight, school-aged children grow consistently but slower than infants and toddlers. They also experience the loss of deciduous, or “baby,” teeth and the arrival of permanent teeth, which typically begins at age six or seven. As new teeth come in, many children have some malocclusion, or malposition, of their teeth, which can affect their ability to chew food. Other changes that affect nutrition include the influence of peers on dietary choices and the kinds of foods offered by schools and afterschool programs, making up a sizable part of a child’s diet. Food-related problems for young children can include tooth decay, food sensitivities, and malnourishment. Also, excessive weight gain early in life can lead to obesity in adolescence and adulthood.

A healthy diet facilitates physical and mental development at this life stage and helps maintain health and wellness. School-aged children experience steady, consistent growth, with an average growth rate of 2–3 inches in height and 4.5–6.5 pounds per year. Besides, the extremities’ growth rate is faster than for the trunk, which results in more adult-like proportions. Long-bone growth stretches muscles and ligaments, which results in many children experiencing “growing pains” at night, in particular.

Energy

Children’s energy needs vary, depending on their growth and level of physical activity. Energy requirements also vary according to gender. Girls ages four to eight require 1,200 to 1,800 calories a day, while boys need 1,200 to 2,000 calories daily, and, depending on their activity level, maybe more. Also, recommended intakes of macronutrients and most micronutrients are higher relative to body size than nutrient needs during adulthood. Therefore, children should be provided nutrient-dense food at meal- and snack time. However, it is important not to overfeed children, leading to childhood obesity, discussed in the next section.

Macronutrients

For carbohydrates, the Acceptable Macronutrient Distribution Range (AMDR) is 45–65 percent of daily calories (which is a recommended daily allowance of 135–195 grams for 1,200 daily calories). Carbohydrates high in fiber should make up the bulk of intake. The AMDR for protein is 10–30 percent of daily calories (30–90 grams for 1,200 daily calories). Children have a high need for protein to support muscle growth and development. High levels of essential fatty acids are needed to support growth (although not as high as in infancy and the toddler years). As a result, the AMDR for fat is 25–35 percent of daily calories (33–47 grams for 1,200 daily calories). Children should get 17–25 grams of fiber per day.

Micronutrients

Micronutrient needs should be met with foods first. Parents and caregivers should select various foods from each food group to meet nutritional requirements. Because children grow rapidly, they require high iron, such as lean meats, legumes, fish, poultry, and iron-enriched cereals. Adequate fluoride is crucial to support strong teeth. One of the essential micronutrient requirements is sufficient calcium and vitamin D intake during childhood. Both are needed to build dense bones and a strong skeleton. Children who do not consume adequate vitamin D should be given a supplement recommended by their pediatrician.

Factors Influencing Intake

Several factors can influence children’s eating habits and attitudes toward food. Family environment, societal trends, taste preferences, and messages in the media all impact children’s emotions with their diet. Television commercials can entice children to consume sugary products, fatty fast foods, excess calories, refined ingredients, and sodium. Therefore, it is critical that parents and caregivers direct children toward healthy choices.

One way to encourage children to eat healthy foods is to make the meal and snack-time fun and interesting. Parents should include children in food planning and preparation, such as selecting items while grocery shopping or preparing part of a meal, like making a salad. At this time, parents can also educate children about kitchen safety. It might be helpful to cut sandwiches, meats, or pancakes into small or interesting shapes. Parents should also offer nutritious desserts, such as fresh fruits, instead of calorie-laden cookies, cakes, salty snacks, and ice cream. Also, studies show that children who eat family meals frequently consume more nutritious foods.

Children and Malnutrition

Malnutrition is a problem many children face in both developing nations and the developed world. Even with the wealth of food in North America, many children grow up malnourished or hungry. The US Census Bureau characterizes households into the following groups:

• food secure
• food insecure without hunger
• food insecure with moderate hunger
• food insecure with severe hunger

Millions of children grow up in food-insecure households with inadequate diets due to available food and food quality. In the United States, about 20 percent of families with children are food insecure to some degree. In half of those, only adults experience food insecurity. In contrast, in the other half, both adults and children are considered food insecure, which means that children do not have access to adequate, nutritious meals at times.^[3]

Growing up in a food-insecure household can lead to many problems. Deficiencies in iron, zinc, protein and vitamin A can result in stunted growth, illness, and limited development. Federal programs, such as the National School Lunch Program, the School Breakfast Program, and Summer Feeding Programs, address the risk of hunger and malnutrition in school-aged children. They help fill the gaps and provide children living in food-insecure households with greater access to nutritious meals.

The National School Lunch Program

Beginning with preschool, children consume at least one of their meals in a school setting. Many children receive both breakfast and lunch outside the home. Therefore, schools need to provide nutritionally sound meals. More than thirty-one million children from low-income families are given meals provided by the National School Lunch Program. This federally-funded program offers low-cost or free lunches to schools and snacks to afterschool facilities. School districts that participate receive subsidies from the US Department of Agriculture (USDA) for every meal they serve. School lunches must meet the 2015 Dietary Guidelines for Americans and need to provide one-third of the RDAs for protein, vitamin A, vitamin C, iron, and calcium. However, local authorities decide what foods to serve and how they are prepared.

The Healthy School Lunch Campaign works to improve the food served to children in school and promote children’s short- and long-term health by educating government officials, school officials, food-service workers, and parents. Sponsored by the Physicians Committee for Responsible Medicine, this organization encourages schools to offer more low-fat, cholesterol-free options in school cafeterias and vending machines.

Food Allergies and Food Intolerance

As discussed previously, the development of food allergies is a concern during the toddler years. Recent studies show that three million children under age eighteen are allergic to at least one food type. This remains an issue for school-aged children.

Some of the most common allergenic foods include peanuts, milk, eggs, soy, wheat, and shellfish. An allergy occurs when a protein in food triggers an immune response, which results in the release of antibodies, histamine, and other defenders that attack foreign bodies. Possible symptoms include itchy skin, hives, abdominal pain, vomiting, diarrhea, and nausea. Symptoms usually develop within minutes to hours after consuming a food allergen. Children can outgrow a food allergy, especially wheat, milk, eggs, or soy allergies.

The Threat of Lead Toxicity

There is a danger of lead toxicity, or lead poisoning, among school-aged children. Lead is found in plumbing in old homes, lead-based paint, and occasionally soil. Contaminated food and water can increase exposure and result in hazardous lead levels in the blood. Children under age six are especially vulnerable. They may consume items tainted with lead, such as chipped, lead-based paint. Another everyday exposure is lead dust in carpets, with the dust flaking off of paint on walls. When children play or roll around on carpets coated with lead, they are in jeopardy. Lead is indestructible, and once it has been ingested, it is difficult for the human body to alter or remove it. It can quietly build up in the body for months, or even years, before the onset of symptoms. Lead toxicity can damage the brain and central nervous system, resulting in impaired thinking, reasoning, and perception.

Treatment for lead poisoning includes removing the child from the source of contamination and extracting lead from the body. Extraction may involve chelation therapy, which binds with lead to be excreted in the urine. Another treatment protocol, EDTA therapy, involves administering a drug called ethylenediaminetetraacetic acid to remove lead from the bloodstream of patients with levels greater than 45 mcg/dL. Fortunately, lead toxicity is highly preventable. It involves identifying potential hazards, such as lead paint and pipes, and removing them before children are exposed to them.