Hey everybody, Dr. O here. Welcome back to chapter 16. This is life-cycle nutrition on infancy, childhood, and adolescence. So we just covered pregnancy and lactation. You'll see some overlap here because the infants are the ones consuming the breast milk, of course, or formula. And then we'll move through and then we'll look at another section on life-cycle nutrition into aging as we get older. Alright, so this is obviously a critically important time because this is when you see the majority of the brain development. So the infant is growing more rapidly than any other time in their life and the brain is definitely growing more rapidly than any other time in their life. When an infant in the first few weeks of their life, over 90%, maybe 94%, 95% of the energy they're consuming is going into brain development. You're never going to see a number that high. Again, because obviously the body is growing so rapidly. So if a baby puts on a pound, that's a huge deal. An adult can put on a pound with one day of bad food choices. So super important time and just critical periods of development. And like I've mentioned, I give presentations on malnutrition in the brain and I plan on doing a video presentation of that sometime for you. But the choices that are made, choices is a bad term when you're dealing with malnourished children because of starvation. Maybe there aren't any food choices. But the food, right, you are what you eat. The building blocks that you use and the calories that you consume early in life go into developing the brain. And if the brain doesn't develop properly in those first thousand days from conception to the end of the second year of life, those changes are permanent.  So these are critically important periods in development. So that's why we're going to really focus in on that. And then as a kid gets older, these things clearly still important. Nutrition is important for everyone.  All right, then something we'll cover just briefly here, especially when talking about breast milk. Remember that in the first three years of a child's life is when their microbiome, which is the gut microbes that live in us, is when the microbiome develops into the adult microbiome. So that will be with you the rest of your life as well. You're not actually just a human.  You're somewhere in the ballpark of half human and half microbial. And the microbiome that you develop will play an impact in your future health. We don't know exactly how much, but directionally we do know that your microbiome impacts your risks of chronic diseases and things like diabetes and obesity. And it impacts digestion of your food, the modulation of your immune system, all these cool things. So not only, so if you have a kid, right, not only are you giving them the human part of them the best chance of success by focusing on nutrition and other lifestyle factors when they're young, you're also helping their microbiome develop into the best microbiome that it can be. So pretty cool topic covered way more in microbiology, but I like to sprinkle it in here too. Okay, let's dive in. In what way does the presentation of foods in early years affect the food choices we make as adults? Do you know anyone who is considered a picky eater as a child? Are they still? Why do you think that is?  But the presentation of foods does appear to make a difference, right?  But, you know, forcing a child to eat a food that they don't want to eat makes them less likely to want it not more. So I'm totally cool with finding ways to maybe hide vegetables or things that a child may not like in their food. You know, you can you can add, you know, vegetables to fruit smoothies or vegetables to like muffin recipes, these kind of things. I'm totally fine with doing that. While you slowly try to get a child to make better food choices, you know, but yeah, forcing them just doesn't doesn't appear to work very well at all. Now, I don't you don't let the child totally control meals or things like that either. There has to be a you have to draw a line somewhere in my opinion. But you want to make consuming healthy foods a positive thing, much more than a negative thing. And the earlier you start those things and the order that you add these foods all makes a difference. We'll cover that. We'll cover that this chapter. But the presentation does matter. The experience kids have with food matters. And it probably for most people does matter forever.  I've never met anyone that loves vegetables more. But his entire life, I mean, he was forced, he was made to consume vegetables, and it just became his became a habit like he had to consume vegetables at every meal when he was a kid and he fell in love with them and he's still to this day. He's older than me. Still to this day loves consuming vegetables. Then there are people that, you know, revolted against consuming vegetables because they were forced. So every situation is different. Every kid is different. But you do you have to you have to learn how to navigate food choices when it comes to your children.  And it's very, very difficult. So and I think how you handle that is different for every single kid. But can a picky eater become less picky? I certainly think so. I was a picky eater. But I don't know, I wasn't really a picky eater, but I wasn't exposed to a lot of things like I like literally just found out a few years ago that my mom had never had a blueberry.  Like we just had we were from a small town. There wasn't a grocery store, right? So we we had more maybe more limited food choices. You know, the food the food that we could only food we could buy in town came from a bar, wherever you could buy like packaged sandwiches and pizzas and stuff. And then we of course, we would go to the store. But we just we kind of just had certain foods we ate and most of my life I was like that and I and I still can be like that I don't I don't need a lot of variety. I'm totally fine just kind of consuming the same things over and over.  So I wasn't a picky eater so much I could eat anything.  So it's not that I'm a picky eater, but I just I always had limited food choices. But there are things that I eat now that I never would eat when I was younger. So I think you can you can learn to like things like things like Brussels sprouts, hated Brussels sprouts. Now I really like them, right? So learning better ways to prepare them and then also just, you know, getting used to consuming them just, you know, in general, when I didn't like a lot of greens when I was growing up. Now I consume heaps of them. And for a while I forced myself to do it and now I look forward to it and and part of it is that I enjoy how they taste and part of it is I know that I should eat them and part of them is I feel better when I do. Right?  And I notice if I keep if I if I consume more greens that I feel better, right? I perform better physically, I perform better mentally. So those those are the main reasons that I started to eat those kind of foods and then I just learned to love them. All right, so lots and lots to think about there with you know, especially if you have your own kids or think about your experience as a young kid. But trust me, if you don't have kids yet and you do in the future, you will learn how important this this tightrope between forcing a kid to eat something and and helping them fall in love with themselves will be will be things I never would have understood until I was a parent, like most things associated with parenting. All right, learning objectives list some of the components of breast milk and describe the appropriate foods for infants during the first year of life. So one of my favorite discussions because since I also teach microbiology, breast milk is a huge, huge deal for me because of its impacts on the microbiome and its impact on the immunity that the child develops or has. Explain how children's appetites and nutrient needs reflect their stage of growth and why iron deficiency and obesity are often concerns during childhood. So iron deficiency also linked to microbiology. So we'll come back to that. Describe some of the challenges in meeting the nutrient needs of adolescents. And let's dive in nutrition during infancy. So you see your energy and nutrient needs. Notice those first couple years. You see that the the weight is shooting up. So obviously if you're growing, the more you're growing, the more your nutrient needs are. Just like if I'm trying to put on five pounds of muscle, I have to consume a lot more calories than if I'm trying to lose five pounds of fat because you know gaining versus losing versus maintaining. So same thing when you're young. So a baby, let's say a baby's seven pounds at birth, what you see here, by the end of the first year they're 21 pounds. So they tripled in size. Then in that second year they gained around 10 pounds. So they gained, what was that, 14 pounds the first year tripling in size. And then they gained another, what was I say, another seven pounds or so. No, no, another 10 pounds a second year, but was only a third of their body size. So you see that relatively speaking, that growth is going to be slowing down. And that first year, especially the first six months, is when you see the most rapid growth by far. All right. What else about that? So that's who we just talked about. The first six months being the most rapid growth and you have the second six months. Carbohydrate needs, calorie needs, you know, a huge deal is the brain. I mentioned this earlier, but when a baby is a few days old, a few weeks old, almost 100% of the calories they're consuming are going into brain development because the brain is growing so rapidly. Most of your brain development occurs in those first seven years, but the huge majority of it occurs even in the earliest half of that. All right. So carbs and fat, both fuel sources, both sources of calories for building a human, for building a brain. Fat provides most of the energy and breast milk and formula because again, a kid is, we're talking about just basic growth and development here. I'm sorry, I have to pause this. I'm getting a call. Okay. Sorry about that. We should be back in action here. So carbs and fat are the fuel sources. I lost track of where I was, but oh, it's fats, primary fuel source because they, yeah, they need a lot of energy, but they're not exercising. So they're not really moving. So they don't need energy super, super quickly, relatively speaking. And then protein is going to be the building block for building all these tissues, right? Your brain has got a lot of fat in it though and a lot of water, but protein is still the primary building block in the human body. If you don't have protein, then you just can't grow. All right. Knowledge check one, relative to body weight, how does an infant's needs for nutrients compare with adults? You can pause it and try to answer that question. And it is C. Infants need roughly double that of an adult. The younger the infant, the greater the percentage of body weight is water. So not only do we need a lot of energy, but water super important. Breast milk usually provides enough of this nutrient. Rapid losses lead to dehydration, which is life threatening. Breast milk and formula usually provide enough water. If the temperature is very high so the baby be sweating a lot, supplemental water may be needed. Bombing and diarrhea cause rapid losses that may require special treatment. So I think about it. Diarrhea is a life-threatening condition, excessive vomiting, life-threatening condition when it comes to babies, especially the youngest young and the oldest old basically. So babies, you know, they're made of a lot of water, but they don't have a lot of water to lose. So diarrhea can lead to dangerous life threatening dehydration much more quickly in an infant than an adult, but then elderly people, they've lost a lot of their body water, so they don't have as much to tap into. So we think about things like dehydration, way more life-threatening in really, really young babies and then really old, elderly people because of those reasons. So make, obviously with young kids, if you can, the key is to keep them from being in a hot human environment where they'd be sweating a lot. But if they are, if they need to be, then make sure they're staying hydrated just like anybody else. All right, so breast milk. We covered this in the last video on lactation, but breast milk has the most significant effect on infant nutrition are the milk the infant receives and the age of which complementary foods are introduced. So, I mean, I believe that there's no condemnation for me ever, but there are reasons that breast milk is superior to formula, but I know there are countless reasons why formula is needed. There, you know, we think about it, they've got the world's changed a lot, right? So most of human history, every human, every baby was breastfed and if a mother couldn't breastfeed their child and there were wet nurses and other people that would. So you think about living in tribal situations and things like that. So really all children were breastfed and then or and consume breast milk, but now that isn't always possible. I know with Oliver with my son, you know, our goal was to breast, you know, for Oliver to consume breast milk as all and then part of his diet for a couple of years. You know, that was grand plans, right? But my wife had to go back to work because we can't afford to survive without two incomes like most families now in the United States and globally. So when she went back to work, she did everything she could. She tried herbal supplements. She was chugging water, eat as much as she could. She couldn't continue to produce the breast milk. So so he was really only breastfed for eight or 10 weeks. And that wasn't what we wanted, right? And then he had he had some ear infections and things that he might not have had. But that's just reality. I know people that can breastfeed their children for for 27 months like the World Health Organization World Health Organization recommends plus have extra to donate to hospitals and other people can try to breastfeed and within two or three days, they can't. So it's so there again, there's no condemnation. But if if breast milk is an option, I think it's a superior option from a nutritional and a microbiological standpoint.  My brain seems to work pretty good, you know. So just to just keep just keep that in mind. If it's if it's an option, I would weigh that that option, weigh that choice, you know, very heavily. But if it's not an option, then you do the best you can, which is all parents all parents can do in all situations. All right, so the length of exclusive breastfeeding.  Introduction of complementary foods, we'll look, we'll look at those. We'll look at those as we go into a few slides in here. The frequency and duration of feedings about eight to 12 feedings per day for the first few weeks, because again, they were just just growing so rapidly. All right, well, I'll come back to all the reasons why breast milk is is a powerful food. You see a couple of the big ones here, though. The primary carbohydrate in breast milk is is lactose, which enhances calcium absorption and it's digested very efficiently by especially by babies, right? So you think about lactose intolerance, very few babies are lactose intolerant. So normally when we're born, we generate, we have the lactase genes that generate a bunch of the enzyme lactase to break down lactose. But then as we get older, for most of human history, all humans lost the ability to do that.  So until 10,000 years ago, all humans were lactose intolerant. Then mutations, I think 10,000 years ago in northern Europe and 7,000 years ago in Africa, you see these mutations start to accumulate that led to lactase persistence. So a mutation that said, that told these genes keep staying on, keep producing lactose. So some human beings can consume lactose their entire life. But most people struggle with certain levels of or some or any lactose at some point in their life because tolerating lactose is not easy as an adult. But that's not the case in babies in most situations. Now Oliver, we ended up finding that he was lactose intolerant. He was having a lot of trouble. They once he was he was fine with the breast milk. But then after that, he was having trouble with different formulas. We tried multiple formulas. And then finally made the switch. We ended up making the switch. I mean, we're talking months and months into his life now. But we made the switch from from formula to raw dairy because and I know a lot of people don't don't agree with that. And that's fine. But we made the decision that we would rather try something like that than keep trying these formulas that are basically made of corn syrup and vegetable oil, right? So we decided that, yes, there's risk to consuming dairy that's not been pasteurized, but it also has the enzyme lack lactase in it. But there's also risks to building a brain out of syrup and and vegetable oil. So that's that's what we decided. And it worked out great. You know, he's he's he's he thrived on it. And trust me, I trust me. I looked at the microbiology reports from the from the from the organic farm. I saw their operation. You know, I know that they they they did more micro they did I think twice as much microbiological testing as the state required and they never had a positive sample. So I felt really confident I wouldn't I wouldn't make a decision like that without being thorough, like I am with most things. But but yeah, it was kind of neat. But so breast milk has this lactose, but that's generally fine for most babies. Then there are oligosaccharides that are present in breast milk. So saccharides means means sugar. So oligosaccharides you have like your monosaccharides, which are the small ones like like sucrose. And then you have your polysaccharides like starch and fiber. Aligo means few. So oligosaccharides are these like medium chain carbohydrates. And they're present in breast milk. There's actually hundreds of different ones. They're called HMOs, human milk oligosaccharides. We know about at least 200 of them. We have more than any other species that has been studied. And these oligosaccharides you see here that there there's not much in formula and there's hundreds of different kinds and there's way more about 10 percent of the calories that mom needs to make breast milk goes into producing these oligosaccharides. But they're not for your baby. That's the interesting thing, right? It's an example of how we rely on our microbiome and we've co-evolved with them. So it protects from infection because it does. It builds your microbiome. The oligosaccharides will feed the good bacteria in your baby's gut and help their microbiome develop. And while that's happening those good microbes will lower the pH and they'll take up space and they'll crowd out the bad microbes. So the oligosaccharides feed the good microbes that crowd out the bad microbes and that's why breast milk can protect from infection in ways that formula can't. Breast milk places less stress on infants' immature kidneys to excrete urea because it's lower in protein. It's high enough to build a human but not excessively high. That's one of the main reasons why young children aren't supposed to consume cow's milk. It's got a lot more protein than they need. DHA, so DHA is one of your fish oils, they call them, but you can get it from algae as well and your body can make it. The conversion is pretty poor but your body can make it. So DHA is decoza, hexanoic acid, so it'll be one of the two fish oils, EPA and DHA and they come from your essential fatty acids. Now I think that DHA itself should be classified as essential because since the conversion is so poor you might be able to convert I don't know one and a half, two percent of your EPA into DHA. It's much better to consume it. So DHA is very important for brain development. There's lots of DHA in the brain as you can see here. It improves cognitive function. So I strongly recommend that babies are getting formula or something that has DHA in it. If you are vegan, then you can buy algae based DHA and then instead of getting it from fish. All right. So what are some of the other really important nutrients needed for growth? You'll see here that the exception is vitamin D. So breastfed infants are supposed to be supplemented with vitamin D. We always use the Carlson's vitamin D drops and just not a brand placement but that's what we used. Iron in only small amounts, which sounds bad, but it's enough iron for growth. You don't want to see excessive amounts of iron. Iron is one of the most important nutrients that pathogenic bacteria need. So having too much iron can be a problem. So you want to make sure it's like when you're sick, your iron levels will drop and your liver is trying to store it to take it away from pathogenic bacteria. So controlling iron levels is a big deal. Pathogenic bacteria have proteins that are designed to harvest and steal iron from us. So you can see there's basically a war going on over iron when you're infected. And this is why some studies show and this is not medical advice. Some studies show that if you're supplementing with iron because of iron deficiency anemia or these kind of things, while you're actively battling an infection, you may not want to be dosing with high amounts of iron. So no medical advice. Talk to your doctor about that but something to consider.  So iron, good, iron, great, but you don't want too much iron and that's why there's not a tremendous amount of it in breast milk but it's very bioavailable. So the little bit that is there is usually is very useful. All right, so calcium that promotes bone growth. Think about how rapidly the skeleton is growing in a baby as they triple in size that first year. Routinely prescribes supplements so the ones they maybe have in trouble getting if you're consuming breast milk, vitamin D is the big one and then iron if needed and fluoride because fluoride for bones and teeth and are you using fluoridated water or not? You know, generally they recommend with formula, you know, not. But yeah, so you say so fluoride to be something to, I guess, talk to your doctor about there. My personal stance is that fluoride is it's prime and this is not my personal stance. This is the largest position paper ever done on this topic has shown that the majority of the benefit coming from fluoride is topically. So actually directly adding it to your teeth. So fluoridated dental products and fluoride mouth rinses, those are the things that I generally favor. OK, recommend that intakes of an infant and adult compared on the basis of body weight. You just want to see that some of those purple lines are really long. So we're comparing pound per pound, a 20 year old male, 160 pounder, which the green lines, compared to a five month old infant that weighs 10% as much. And you'll see that some of these things are off the chart. Needs for zinc are real high, which makes sense because zinc is important for growth and development and cell and cell differentiation. Notice that iron, I'm just writing in the bottom, sorry, notice that iron needs are pretty low. They don't have a lot of blood yet. The majority of the iron we use, iron has lots of functions, but iron is needed to make, you know, in hemoglobin to carry iron, so, you know, or to carry oxygen, sorry. I've got 23 trillion red blood cells, a baby doesn't have anywhere near that much. So iron needs aren't super high yet. Iodine off the charts, iodine is critically important for thyroid hormone, which regulates metabolism and growth, also critically important for brain development. That's why you see that huge need for iodine. Let's see, calcium needs are up because you're not maintaining a skeleton, you're building a skeleton. B12, remember, cell differentiation, DNA replication, you got lots of growth going on. Other B vitamins for the same reason. Ah, let's see here. Vitamin C, pretty high because vitamin C is needed. You might be thinking colds and flus and stuff, but no, vitamin C is needed for collagen formation. And collagen is the most numerous protein in your body. So you're building a human. It takes a lot of protein. Vitamin C is needed to make collagen. Let's see, vitamin D. I see vitamin D recommendations for an infant are almost seven times greater per pound of body weight than those for an adult male. It's just, it's needed for calcium absorption, needed for gene regulation, all sorts of things, you know, training, modulation of the immune system, et cetera, et cetera. All right, then you see at the top there, protein needs pound per pound or higher. Energy needs are almost double per pound. Protective factors in breast milk. So I mentioned a few of these. You see immunological protection. So we've talked about the antibodies that, so I'll just read what it says and then kind of explain it my way, but offer protection in the upper respiratory tract and the gastrointestinal tract by inhibiting pathogen attachment to the mucosa and protecting against invasive infections may stimulate the infants immune system. So not only do these antibodies protect because all five classes of antibodies, so you learn about them in A and P, but IgG, IgA, IgM, IgE, and IgD, all five classes of antibodies pass into breast milk. So the way the system works is, baby's immune system sucks, this is to be honest. It's not developed, it's not activated yet.  Mom is exposed and responds by making antibodies and then donates those antibodies to the baby. So every time a baby is being breastfed, they're being given a antibody therapy, just like you'd be giving someone an anti-toxin or something like that. So it's a form of passive, natural passive immunity. So not only is mom's immune system directly protecting the baby with every meal, but you see that there are some other benefits that they help with keeping pathogens out of the mucous membranes and those kinds of things as well. Notice on the left hand side, it says colostrum, so all breast milk has antibodies in it, but colostrum, those first few doses of breast milk are extremely high in these immune protective factors. So they're giving baby a fresh start and then also helping with the development of the microbiome. Baphytus factors, those would be so second point there, favor the growth of the friendly or good bacteria, lactobacillus baphytus in the infant's digestive tract so that other harmful bacteria cannot become established. We talked about that. So breast milk is a probiotic, it actually has living organisms, but then it's also a prebiotic, meaning it feeds the good bacteria. So as the good bacteria grow and take over, they crowd out the bad bacteria. Growth factors, you have epidermal growth factor which regulates cell growth, proliferation and differentiation, obviously lots of growth going on. Transforming growth factor beta or TGF beta, inhibits inflammatory bowel diseases, supports a healthy epithelial barrier so you want a nice, great barrier in your intestines, keeping the bad things out. Lactadirin inhibits pathogen attachment to the intestinal mucosa, so that's obviously a good thing, keeping kids from getting gut infections. Lactoferrin prevents bacteria from getting the iron needed to grow, so we talked about this war, this war over iron. So the pathogenic bacteria are trying to steal iron, lactoferrin is binding it up to keep it from happening. Helps absorb iron into the infant's bloodstream, kills some bacteria directly and inhibits viral activity. Lysozyme, this is in all of our body, our adult secretions do, but lysozyme directly kills bacteria by assisting this compound lactoferrin. So lysozyme, you can take lysozyme out of egg white and you can use it as an antibacterial, not saying to use it clinically, but in a lab, we do those kind of things where you can see that the lysozyme has antimicrobial properties. Then we've already talked about the oligosaccharides. They help to establish and maintain the growth of desired bacteria in the gastrointestinal tract. They inhibit pathogen attachment to the intestinal mucosa, so this would be those 200 HMOs, human milk oligosaccharides, that breast milk has and then there's only, that this is where, honestly, if you look at these things, they all matter, but to me, the antibodies and the oligosaccharides are two things that really definitely can't be replaced by a formula, at least at this time. They're working on formulas that produce, that have some of these oligosaccharides, but they'll never have all 200 in this variety. So protective factors, we have allergy and disease protection. We're talking, to me, the allergy thing is creating that good barrier. If you have a good intestinal barrier that keeps all these foreign things out of your body, that can be immunogenic, meaning that your immune system can respond and react to them. So that's so that everywhere you see where it supports a healthy gut barrier or keeps the bad things away from this gut barrier, that's what seems to reduce the risk of allergies and that's why kids that are breastfed are less likely to have allergies. Breast milk banks, so if you can't produce enough breast milk, then there are ways to get it. Knowledge check, so feel free to pause this and try to answer these questions. Breastfed infants have lower incidence of allergic reactions, just explained why. Breastfeeding reduces the risk of sudden infant death syndrome or SIDS, as well as cardiovascular disease and adulthood. I think the microbiome thing is a big thing there. Some research suggests breastfeeding helps prevent obesity, same thing. It seems to, you know, the microbiome can have a big impact on how inflamed your body gets and inflammation can make you more likely to be obese. Your microbiome determines basically what percent of calories you digest and absorb from your food so all these things can matter. Breast milk may also benefit intelligence, but more research is needed, so let's think about that. Lots of studies, observational studies, have shown that children that are breastfed have higher IQs. So you can make that leap that breast milk increases IQ and getting DHA, getting increased IQ, things like that. That's the whole correlation versus causation thing, though, because children that are breastfed are generally more likely, you see higher socioeconomic status. Children that are breastfed, there's probably a lot of other positive factors that are going on. Like if a child can't be breastfed because both parents are working and they're in a poverty situation, all those things are gonna impact IQ and intelligence level and these types of things. So it's not black and white. Breast milk, yes, no breast milk, no. But it's part of it. I think it's part of it, we just can't say. Like I said, more research is needed to know how much of that benefit is directly from the breast milk. Infant formula, so if you can't produce enough breast milk or you can't consume breast milk, then we have lots and lots of formulas. Formula composition, from a nutritional standpoint, it's trying to make it as similar to breast milk as possible. It's just not, you can't do those other things. You can't add those other compounds, at least yet. Someday, who knows what formula might become, but I do believe that in most situations, breast milk is still superior, but you never know if that's gonna be true forever. All right, the risk of formula feeding, the no protective antibodies. So again, when you're breastfed, you're being basically given an immune therapy every time you drink breast milk and that's not the case with formula. Formulation standards, they are developed by the American Academy of Pediatrics, so obviously a really good group to look into those kind of things. And there are lots of special formulas. You think you just got your typical formula, but there's tons of special formulas. So special formulas for infants with specific conditions, premature babies, inherited diseases, so this is where you work with your pediatrician. You work with your doctor. Should I just consume a standard formula or is there a better one? That's what we did when we were trying to figure out what was wrong with Oliver. They just continued to prescribe different formulas and we tried them all and we finally tried something else. Some formulas may be inappropriate, again, depending on the situation. So make sure you work with your doctor there and then nursing bottle tooth decay, that's just, that can be an issue. So here's a comparison of breast milk. As you see on the left-hand side, breast milk versus the recommended adult diet, notice that it's lower in carb, higher in fat, and much lower in protein. So babies need protein, but they're so small. They don't need as much protein as you think because they're primarily building their nervous system, which takes a lot of fat. So that's why a baby needs a higher fat, lower protein, and then they're not physically active. Yet they can't even move, so a lower carb diet. That's why you look at this huge difference. So just remember, in general, an infant's diet would be lower protein, higher fat, lower carb, than a typical adult diet. And you see that in the composition of breast milk. Then on the right-hand side, comparing breast milk to formula, they're actually pretty close. Formula's got a little bit more protein, a little bit more carbs. But then notice cow's milk is very high in protein, which is why the recommendation is to avoid it for the first year of life because it is lower carb, and, but mainly because it's higher protein is the biggest negative there. Remember why, right?  Knowledge check three, so pause this and see if you can answer these. Formula manufacturers attempt to copy the composition of breast milk. A formula is given that should be iron fortified, just because the iron that's in breast milk is more bioavailable. Formula does not provide protective antibodies. We talked about why, mom has to make those. Safe preparation of formula includes using water free from contamination, so water containing lead is a major source of poisoning among infants. That's why you buy, generally people buy special formula water or things like that. The last thing I want to be doing, remember, I told you about a couple of videos ago, I told you about the little things matter video on YouTube that I always share with students because small amounts of lead can have a tremendous impact on IQ and intelligence potentials, things like that. Special needs of preterm infants, so if a baby's born too soon, I mean they're not done incubating, right? They're not done, you're supposed to be growing for those nine months in your mother's womb, so a preterm or premature baby has incomplete fetal development, they are not ready. To be honest, even a baby born at nine months is not ready, right? Look at how many animals you see like a giraffe comes out and it's running in a couple hours, right? We're nothing like that. We have to be born, even if you're carried to term, you were born way too early. It's the price we pay for having our huge brains, right? So we basically, we have to be born when our bodies aren't ready because if we were in our mother's womb until our brains and bodies were ready to take care, you know, somewhat to take care of ourselves, like with a lot of animals, then we would be too large to exit the birth canal. So even if you're carried to term, you were born incompletely developed, which is why we lay there and do nothing for so long. But if you're premature, that's even more the case. So incomplete fetal development, the leading cause of infant deaths, obviously, and then they often have a low birth weight, almost guaranteed unless they were going to be a really large baby and then we're born preterm. Benefits of the third trimester for the infant, we just taught, I mean, this is where you're being stitched together. This is where you're being built and it's a critically important time for growth and development. Preterm breast milk differs from term breast milk because again, mom wasn't ready, right? This whole, this process, this developmental process takes the full nine months for mom and child. So sometimes preterm infants are given special supplements. You gotta work with your doctor or those kind of stuff. All right, excuse me, introducing cow's milk. Not advised before the age of one. You got the protein concerns and things like that. Cow's milk is a poor source of iron. So if a baby needs to use cow's milk, keep that in mind, because remember, formulas are fortified with iron and breast milk has a really, really bioavailable form of iron, so something to consider if cow's milk is needed. Children age one to two, so this transition, so a gradual transition from breast milk or formula to reduce fat cow's milk. Recent change in recommendations from whole milk to reduce fat milk because of evidence that atherosclerosis begins in a childhood. So this is a tricky one, but so they're talking about lowering the saturated fat intake of a baby, of a child's diet because of atherosclerosis concerns. But remember that kids are still growing a tremendous amount in this year from one to two. Be careful not to have them consuming too few calories and too little fat.  I get that, and a child's cholesterol levels are gonna be really low at this time. But just keep that in mind. I just, I shudder a little bit when I think about putting kids on restrictive diets because I would, honestly, I'd rather them have a little bit more calories and a little bit more fat and make sure they got, they eat out every ounce of development that they can, but I do understand this, that we now know that the atherosclerosis, the process where our arteries harden that lead to atherosclerosis and all the things that come with heart disease and stuff, it does, the process begins soon, early. But this transition from age one to age two is still a really tricky time to be restricting diets. Introducing first foods. So when to begin? Start complementary foods between the ages of four and six months, like we mentioned earlier. Because of food allergies, you want to introduce single ingredient foods one at a time. That way you can figure out if a kid, I wrote the list down to make sure I didn't skip any of them, but if a kid has any sort of allergies. So you don't just start giving them a whole bunch of different foods because if they develop problems, you won't know what ingredient did it. So what are the most common ones to cause issues? Cows milk, eggs, peanuts, tree nuts, soy, fish and wheat. So your best is rice though. So if you start with, rice is basically a hypoallergenic food. So rice based foods are a really good thing to start with if you're introducing foods. But then if you're introducing things like fruits and vegetables one at a time and then monitor for any things that look like allergies or food intolerances. Choice of infant foods that you use to provide variety, balance and moderation from the diet like any other good diet. Good sources of iron, zinc and vitamin C. That's why you see a lot of like your baby's snack foods and things there. A lot of times they're often four to five of these types of things. Suggested that infants exposed to fruits before vegetables may develop a preference for sweets. I believe that as a parent, that you should definitely start if you're using like the Gerber's and you're you're purating vegetables, a fruit, you should definitely start with vegetables. Get kids really used to eating vegetables. I know you can't wait to see them eat the banana or things like that. As an adult, I would still eat a Gerber banana, baby food now. But the problem is, you know, it's like once you give kids chicken nugget, they're gonna want them forever, right? Once you give kids candy or soda, they love those things because they cause these explosions in our brain, right? So I recommend keeping kids on vegetables as long as possible because once you add fruits, they are going to prefer them. Not every kid, I get that. And I'm just basing this on the research I've seen but also just my experience as a parent. I recommend vegetables first and then adding fruits in later. Introducing first foods again. Foods to omit, concentrated sweets that contain no nutrients to support growth. So kids don't need empty calories, right? They shouldn't be drinking coax in their sippy cups and junk food, right? Because that's all that is as calories. There's no nutrients. You still want them eating nutrient dense foods. Issues with vegetarian diets. So a newborn is a lacto-vegetarian because they're obviously getting a lot of lactose. They're getting a lot of milk from Mother's Milk. Beyond six months, greater challenge to meet nutrient needs. Vegan diets can lead to deficiencies. So yeah, and I agree with that wholeheartedly. I mentioned earlier that I don't believe children should be on really restrictive diets just like I wouldn't recommend a kid being on a carnivore diet or a keto diet. I really wouldn't recommend them being on a vegetarian diet but if they are, then it should be very well balanced because you've got to make sure they're getting calories. You got to make sure the nutrients they're getting are being absorbed and you got to make sure there aren't nutrient deficiencies. So this is, you have to take this seriously. It has to be a properly formulated, well thought out vegetarian diet or there are concerns. All right, foods at one year. We talked about cow's milk and the replacement of iron-rich food sources. So as you start to add in new foods, make sure they're replacing the nutrients that they're costing you from what you used to eat. Infant development and recommendations, you can read through this whole thing. This is not a developmental physiology or developmental psychology class but we'll look at the food things on the sides here. So you can read the rest of it, just pause this or look at your PowerPoints. But foods introduced into the diet. So you see zero to four months. It should be just breast milk or infant formula. Four to six months. Begin iron-fortified cereal mixes, especially your rice-based ones with breast milk formula or water. So you're not completely, honestly, breast milk should continue consuming it for as long as you can, I guess I would say. But so you start to introduce foods. Doesn't mean that you're no longer breastfeeding or using formula. Begin pureed meats, legumes, vegetables and fruit. So limiting the fruits early on, I think personally. Six to eight months. Begin textured vegetables and fruit. And notice they say vegetables and fruit, not fruits and vegetables. Eight to 10 months. Begin breads and cereals from the table. Begin yogurt. Begin pieces of soft cooked vegetables and fruit from the table. Gradually begin finely cut meats, fish, casseroles, cheese, eggs and mashed legumes. And then 10 to 12 months. Add some variety and gradually increase portion sizes. So you see there that obviously portion sizes for infants and young children are smaller than those for an adult. For example, a grain serving might be a half a slice of bread instead of one slice or a quarter cup of rice instead of a half a cup. All right, so again, you can read the rest of this but all I really want you to focus on is the foods we introduce because this is a nutrition course and that's what we're talking about. Meal times with toddlers. So feeding guidelines. Discourage unacceptable behavior. I mean like any other time when you're guiding a toddler. Let toddlers explore and enjoy foods. You want this to be a good experience. I mentioned that earlier that like the next point don't force food on children. It's you know, I get it. You want kids to consume really nutritious foods but you need them to be a part of it. You need them to want to do it or else they may revolt against it and it could actually backfire. So you want what's best for your kid but forcing them to eat foods and clear their plate and these kind of things absolutely could backfire on you. But you have to know your kid. Every kid's going to be different. Every situation's going to be different. You have to draw a line somewhere, right? Or else kids are going to be eating tablespoons of sugar for lunch. But yeah, let the toddler explore and enjoy foods. Give them a variety to try. Focus on the healthiest ones that they love and then maybe hide some other ones in their food. Get them to try other things occasionally and then hopefully they'll continue to like more and more good foods. I like this next point. Provide nutritious foods. Let the child choose which ones and how much. This is something that I do think matters. If a kid, that's how you go to the farmers market at the grocery store, if a kid gets to choose so like what produce they're going to consume, like, okay, we're going to have something green. What should we have? If they choose it and they play a role in choosing it and preparing it and serving it maybe, then they are more likely to eat it because they're part of it. Or like we have the garden, right? So when our kids play a role in growing the food, trust me, way more likely to eat it, right? Oliver's way more likely to eat a radish that he picked out of our garden than he would be if we just plop some vegetables in front of him. So I think those are important things. Limit sweets, that's the case in all times of our lives, but the kids are growing so fast they can't afford to be eating a bunch of empty calories that don't offer the nutrition needed to grow a healthy human. But all that being said, don't turn the dining table into a battleground. And this is where it's really hard. Like you have to decide you're going to draw a line right here, right? Like we are kids, Oliver will eat something green with supper, right? And then his main snack is going to be fruit. These kind of things are like rules that we have, but we have to know where to draw the line, where to push the gas, where to tap on the brakes, where, when to give in, when to just hide produce in his diet and things like that. So we have just, we have rules about every meal has to have some protein, every meal or, you know, later in the day like our lunch and our supper, there is going to be produce. And then as I said, our primary snacks are going to be fruit. Those are like our non-negotiables. And then the rest of it is just discouraging on acceptable behavior around food and then making him a part of these food choices so that he's more likely to eat healthy. And explaining why too, I think that's really important. Obviously he's seven now when a kid's a toddler you can't do that. But so you kind of, you have to play a bigger role here. But I spent a lot of time talking to Oliver about why we want to eat a certain way so that we feel better and we grow big and strong and all these kinds of things. And I think so you can, you can work with your kids in these situations. All right, nutrition during childhoods. Now the kid's getting older.  So our height and weight changes, we talked about those first couple of years how rapidly someone's growing. I showed you that chart that it tapers off, but there still should be some relatively steady growth. Abilities change as children age. We know that. I mean the whole thing, what is, maybe you don't know this. I didn't know this till probably Oliver was born, but the reason they're called toddlers is because they toddle. So toddling is like this cautious forced walking that kids do when they're first learning how to do it. That's called toddling. And that's where the term toddler came from. So clearly abilities change. When a baby's first born, basically they have their muscles, they have their nerves. They're not fully developed, but the nerves are not myelinated. They're not covered with insulation that makes the wiring work better. So in that basically that myelination process kind of starts at the top and works down.  And then once the wiring is done, then a kid can start sitting, standing, walking, running, all that. Then they become much harder to take care of. They're easy to take care of when they just lay there. Body composition and shape changes. You know, your skeleton's getting bigger. You know, hopefully getting more muscle, maybe a little bit less fat, et cetera. And that depends on the age and all those things. All right, so energy and nutrient needs. Appetite diminishes around one year of age. Food intakes coincide with growth patterns. So if a kid, I mean we noticed this like with Oliver, if all of a sudden he seems to be much hungry than usual, we're assuming that a growth spurt is coming. So basically kids are relatively good at regulating their food intake versus their needs. So if a kid is eating less, they're probably not growing as much. And if they really want to eat more, then they're getting ready to grow or they're in the middle of a growth spurt. So energy intakes vary from meal to meal. Like with us, I mean, what have they been doing? If it's lunchtime and they've been sitting around all day, their energy needs are gonna be a lot different than if they've been running and playing all day. Oliver's been spending our, we have this cheap inflatable pool in the backyard and he has been spending hours out there because it's been so hot. But then suppertime, he is just completely, you know, unbelievably hungry. But it totally makes sense. He's constantly moving for three or four hours at a time between meals. So energy needs are gonna vary based on growth, physical activity. And then vegan diets, we talked about difficulty meeting energy needs because there's lower, less calorie dense foods, less bioavailable, more fiber, et cetera. All right. As a kid gets older, let's see you've got, when a kid is, where did I put that number? I had to write it down. An active six year old. So in the ballpark of where Oliver is now needs about 1600 calories a day. Just so you understand kind of ballpark. The reason I wanted to bring up that number is because when we talk about adults and weight loss and you hear these common numbers, especially with smaller females of 1200 calorie a day diets to lose weight. But just think about that. An active six year old needs 1600 calories a day. So if you're on a really restricted 1200 calorie a day diet, I mean, that's pretty limited.  All right.  Let's go through some of these nutrient needs. Carbohydrate recommendations are the same for children older than one year and adults. So I just, you know, the carb intake is gonna be important. Now that the kids are getting more physically active, they're gonna rely on a higher percentage of their calories coming from carbs. Fiber recommendations for younger children with low energy intakes are less than older ones. So again, fiber intake is based on how many calories you're consuming, right? There's, you know, 10 grams of fiber for 1400 calories. But then if a kid has a lower energy intake, you know, you don't need as much fiber and you wouldn't want as much either because you wanna make sure that you're absorbing all the nutrients. Remember that high fiber diets do limit mineral absorption, for example. Fat and fatty acids. So the DRI, remember your dietary reference intakes, the DRI committee recommendation is 30 to 40% of fat for a one to three year old, then it drops to 25 to 35% for four to 18 year olds. I agree with those numbers because again, rapid brain development, early in life, brain and nervous system rely heavily on fat. So I do recommend a higher fat diet for younger kids. And then as you get older, those numbers drop to adult levels. Discussion question one, when it comes to protein recommendations, what should be considered before making those recommendations? So think about that. Like total calorie needs, total protein requirements increase slightly with age. However, when looking at the child's body weight, the protein requirement declines. So you need more protein as you get older, but as a percent of your size, you don't need as much and that's because you're not growing as much. You need less, so you need less protein to maintain a state of nitrogen balance, which is what happens with maintenance than to be in a state of positive nitrogen balance, which is needed for growth. So the more rapidly you're growing, whether it's a growth spurt as a child or you're building muscle as a bodybuilder, the more rapidly you're growing muscle or body proteins, the more protein you need in your diet. Maintaining nitrogen balance, protein quality and added needs of growth should be considered before making recommendations. The needs for most vitamins and minerals are met by a balanced diet. So if you're eating a good, healthy whole food diet, that's why I said, you don't generally have to worry too much about individual vitamins and minerals except for some exceptions, except for some exceptions. All right, planning children's meals, variety. You see the old, the choose my plate here from the government, variety of foods from each food group with varieties important for lots of reasons, making sure you're getting, meeting all nutrient needs without getting too much of some things. Amount suited to appetite and needs. So just, you know, knowing your child, knowing their activity levels and making sure they're getting a well balanced diet. Hunger and malnutrition in children. This is the biggest deal. You know, we have this issue with poverty, extremely low income families, greater risk of hunger and malnutrition, which makes sense, right?  So if you don't have enough money to buy food, then there's not going to be as much food to eat. So definitely this does track with socioeconomic status. Interestingly, we've talked about the link between poverty and obesity before because a low income family, if they do eat foods or they're gonna eat foods that are usually really high in calories and not very nutritious. I was thinking about this the other day. I saw like a 48 pack of Pop Tarts at the store and I think it was $10 and something. So a two pack of Pop Tarts, I don't know, would that be less than a dollar, I think.  So let's say for 50 cents you get, you can get a meal, right? But that meal has 370 calories, almost all carbs and like two, I don't know, maybe two grams of protein. I don't know the nutritional facts of a Pop Tart. But you're talking about two grams of protein. Yes, you can eat breakfast for 50 cents, but that's not enough protein to build a human being. But if you're eating like eggs and yogurt or making smoothies, I make a smoothie that probably cost me $6 every time I make it. So I get it, I get the link between poverty and obesity. The foods that you eat when money is tight are generally high in calories, high in sugar, high in unhealthy fats, but low in protein, low in vitamins, low in minerals. That's if you're just making poor food choices. If you don't have food at all, it's a whole different story. In that talk I gave on malnutrition of the brain, I say that I always talk about how I don't want my son's brain built out of corn syrup, but a brain built out of corn syrup is better than a brain built out of nothing. So meal skipping and academic performance, that obviously a huge deal. If you're not properly fueled, your brain's not properly fueled and you need your brain to be fueled to function just like you need your car's engine to have fuel to function. So the benefits of breakfast consumption, they're without a doubt. Iron deficiency in behavior, behavior, attention span and learning ability, all can be impacted by low iron levels. Iron is needed to carry oxygen. So again, you need oxygen for your brain to function too. Testing for iron status, the effects of dietary, deficiency, sorry, occur before blood effects occur. So you've got to look for those kind of things. We've covered that already. Look for iron storage and iron transport. Those things will be impacted before your actual hemoglobin levels drop down.  The malnutrition lead connection, we've already covered this too because this is one of those contaminant metals we covered in the mineral section. Malnourished children are vulnerable to lead toxicity. So like you see here, low intakes of certain nutrients increase the risk of lead toxicity. So if you're deficient in calcium, zinc, vitamin C, vitamin D and iron, then you're gonna actually, the damage of being exposed to lead is gonna be higher. And then commonalities between iron deficiency and lead toxicity. So again, if you're deficient in these nutrients, you're more likely to have lead toxicity. And then here, sadly, lower socioeconomic status, you're more likely to live in old houses that might or like look at the Flint, Michigan situation where iron plumbing or lead based plumbing, sorry, or old houses that have lead based paint. As you see here, the paint is chipping off and this old lead based paint is chipping off and this kid is going to eat it. Kids put everything in their mouth. So the malnutrition lead connection is a very real and lead has a tremendous impact on IQ. Hyperactivity and hyperbehavior. The cause of hyperactivity is unknown. ADD, attention deficit disorder, ADHD, attention deficit hyperactivity disorder. Characteristics, trouble sleeping, inability to sit still, impulsivity, difficulty paying attention. The trick is like all kids to some extent have that. The key is when does it become a problem? When is it physiological? When is it pathological? Science does not support sugar and hyperactivity. So you think, you always think about nutrition textbooks, always talk about the birthday party. Kids are running around, you know, being hyper. Well, it's like they're with their friends, they're at a birthday party. That's when those things would happen. So it's a correlation between high sugar meals and hyperactivity, linked to things like birthday parties and fun events like that. The causal link has not been made. I can't say there isn't one, but it certainly has not been supported. So I would say at this point, we'd say it isn't supported, right? Some evidence suggests food additives may exacerbate symptoms. This would be like some of your artificial food colors, I think some of the red ones and different ones, but this would be where, you know, if you have a kid that's having these kind of issues and putting them on a diet that's free of artificial colorings and flavorings would be a smart move, just at least for a while to see if it helps. Knowledge check four. The excited behavior exhibited at a birthday party is an example of hyperactivity. That is false. The excitement exhibited by a child at a birthday party is markedly different from true hyperactivity. Characteristics of hyperactivity include trouble sleeping, inability to sit still, impulsivity and difficulty paying attention. So it'd be, you know, again, a kid is kind of supposed to be hyperactive at a birthday party. Food allergies and intolerances. So let's look at the, first of all, the difference. Food allergies are in true allergies. Your immune system responds to a food. A food intolerance is a gastrointestinal issue.  You're gonna have gas, bloating, diarrhea, those kind of things, upset stomach. A food allergy is if you consume something like a milk protein allergy, you consume the milk proteins and your immune system responds to it. All right, the prevalence of true food allergies in children tended to diminish with age. I listed off the allergenic foods earlier. True food allergy is an immunologic response to a food. So you can have swelling, hives, you can have symptoms, mental fog, all sorts of issues because it's your immune system. So the symptoms can be anywhere. A food intolerance, the symptoms are in the GI tract. All right, the reaction may be immediate or delayed. That's why anytime you're adding foods, you only add one at a time for a few days. And even as an adult, if you're doing what's called an elimination provocation diet to see if you have a food allergy or intolerances, you remove a bunch of foods that could cause problems and you only add one new one in. And I recommend only adding one new one every two, three or four days and then add another one and another one. The reason you have to wait at least two days but I recommend three, maybe even four is because you can have a delayed reaction. So if you add milk back to your diet or child's diet today and you add eggs back in two days and then the next day you have a problem, you still actually don't know, was it a delayed reaction from the milk or was it a more immediate reaction from the eggs?  Anaphylchic shock would be the worst situation where a kid is so, or anyone is so allergic that you have this huge immune response that we have a whole page coming up on that in a moment. Detecting food allergies, you have antibody tests that you can do, treatments, there are desensitization reactions, those kinds of things. The antibody testing, not the most trustworthy thing, I mean, I'm not saying not to do them, but not the most accurate test I've ever seen for sure. And so there can be some issues there. That's why to me, the perfect thing to do, get the testing, consider the treatments, work with your doctor and all those kinds of things. But to me, I trust an elimination provocation diet more than I trust allergy testing. What I mean by that is, if you think a food is causing a problem, then you take it out for a while and see if you feel better, slowly add it back, see if you feel worse. So I kind of like to let, you know, I think that's a good way to do it without the testing, but nothing wrong with the testing, but just don't treat the test results as gospel, because I've seen too many case reports where the allergy testing was just not showing the reality. So yeah, elimination provocation diets are pretty cool.  I've done this, you know, I have autoimmune diseases, so I've been told by all sorts of people to avoid eggs, for example. So twice in my life, I went six full months without consuming eggs and saw no improvements in symptoms or lab values, as far as like inflammatory markers, those kind of things. So six months without eggs, no improvement noted. Adding eggs back in, nothing got worse. So I know that a typical person with autoimmune conditions is supposed to avoid eggs and maybe there is some unknown, yet unseen mechanism why I should avoid eggs, but I've tried twice and so I eliminated them. That's called an elimination diet because you remove things. Elimination provocation, so I provoked my body by adding them back in and nothing happened, nothing got better, nothing got worse. So in my opinion, the elimination provocation diet has told me that eggs are not a problem for me. Just an example. All right, so worst case scenario with food allergies is anaphylactic shock. So what happens here, usually when you think about shock, we're talking about like hypovolemic shock, which means you're losing blood internally or externally. You bleed so much that you go into hypovolemic shock.  Well, anaphylactic shock is, it is still a form of shock, but what happens is your airways constricts, you have bronchoconstriction, your airways tighten down so you're not getting enough oxygen. But the key thing here is you have vasodilation. So your blood vessels all pop open and we don't have enough blood in our body for blood to go everywhere, right? Blood moves to our gut, well, away from our muscles when we eat. Blood moves to our muscles away from our gut when we exercise. So blood has to move to different parts of the body depending on what you're doing.  So that's what anaphylactic shock is.  So you go into shock. So you're not losing blood, but your body is in a situation where it would need more blood than you have and that's why you go into shock. All right, so the most common causes, peanuts, tree nuts, milk, eggs, and so on, I gave you the list earlier, soy and stuff. So peanuts and tree nuts are really, really big ones, which is why you see that schools are now peanut and tree nut free zones. Symptoms of impending anaphylactic shock, tingling sensation in the mouth, swelling of the tongue and throat, irritated reddened eyes, difficulty breathing from the bronchoconstriction, hives, swelling, rashes, vomiting, or abdominal cramps, diarrhea, drop in blood pressure because you've got too little blood to go through all the pipes and a loss of consciousness. So these things are happening if they're mild, maybe an antihistamine would work, but if they're really severe, then you need an epinephrine injection. So epinephrine is the other name of adrenaline. So what adrenaline does is it stimulates your body's fight or flight response, which causes bronchodilation. So remember the anaphylactic shock closed your airways, epinephrine opens them back up, and then it stimulates vasoconstriction. The anaphylactic shock caused your blood vessels to dilate, the epinephrine causes them to constrict. All right, food labeling, because if you're allergic to something, you have to know if it's in your food. The eight most common allergy-causing foods would have to be warnings on there, may contain this, made in the factory that may contain this, those kind of things. Possible new technological solutions, especially when it comes to cross-contamination. So food intolerances, I mentioned, are different. Reactions to chemicals in food, symptoms without antibody production. So it's not your immune system, it's your gastrointestinal system that's responding. I don't know, so I guess I'm kind of like sugar alcohol intolerant. If I have maltitol, for example, one of the sugar alcohols, I have a terrible problem. I'm not gonna share any more information, but that would be an intolerance. It's not my immune system. It is my GI tract that responds negatively, probably because of my microbiome. All right, childhood obesity. A diet and physical inactivity are the two strongest environmental factors. Shocker, same thing in adults. We're consuming too many calories and burning too few. Characteristic physical traits, if they begin puberty earlier, that's because fat is estrogenic. So fat basically produces these estrogenic compounds. Fat also has an enzyme called aromatase that converts testosterone into estrogen. So you see in both males and females, you can see estrogen levels higher if you have a lot of extra adiposity or fat tissue. So they do because of these hormonal signals, they begin puberty earlier. They stop growing, and that could be because of leptin and other things too, but they stop growing at a shorter height than their peers because if you start puberty earlier, you generally end it earlier, or at least stop growing earlier. Have greater bone and muscle mass makes sense, you're carrying a larger body around. Physical health, look at things like blood lipid profile. Maybe they already have high triglycerides, high cholesterol, signs of fatty liver disease, all terrible things for anyone to have, but especially a child. Type two diabetes and respiratory diseases, they're linked to all the inflammation and high blood sugar, et cetera. Psychological development, you have emotional and social problems, no doubt.  I was no older than 10 the first time I started going on starvation diets. No one, you know, you don't want to be obese. And it does come with a lot of issues that take a long time to deal with for sure. So there's a mental and emotional and social and psychological price to pay for obesity as much as there is other physical health issues. All right, 32% of kids, between the, I had to write this down, 32% of kids between the ages of two and 19 are overweight or obese. So we're in that number's climbing. One of the big issues when it comes to prevention before adolescence is key. Yeah, I tell it to Oliver all the time. I tell him, listen, I have to work really hard to get healthy because I let myself get unhealthy. The best thing to do is to not let that happen, right? To stay healthy, right? My stepson has lost like 90 pounds and I've lost over 100 pounds. So we've done great, but we had to do a lot of extra work to get healthier, to lose the excess weight. So not prevention is the key. So prevention before adolescence is key with diet and physical activity, not being overly restrictive, but being smart about it. I'm much more look for ways to try to keep Oliver active than I do to restrict his diet. So I told you that his snacks need to be based around high fiber produce and protein, but we don't restrict very much but we wanna keep him active. We have him in his ninja classes. We got a trampoline in the backyard, get him swimming in the pool. We take him to the park, bike rides, walks, everything. So we are constantly looking for ways to keep him active.  He's always been real high on the growth charts and stuff. So something to be consider. Just keeping him happy, keeping him active, having him do things he enjoys, trying new sports. So we focus more on the physical activity side of things. All right, treatment must consider many aspects of the problem. Improve long-term physical health through permanent healthy lifestyle habits. Absolutely, we're trying to, again, trying to teach him to be a physically active person. And one of the big things there is television. So I wrote some stats down here. TV, kids the age of two to five, you should limit their television consumption to one hour a day. Kids over five, no more than two hours. So it's really, it's like the last time they spend in front of screens, the more time they can do all those things I just mentioned. Successful approaches are multi-dimensional, no doubt, focusing on diet, yes, physical activity, yes, behavioral change, all those things. Psychological support, behavioral changes, potentially drugs and surgery, that would be with clear obesity. With drugs and surgery, the risk of staying the body weight you are has to be higher than the risk of the drugs or the surgery. And that's why you only see those in pretty extreme situations. The goal is to reduce the body mass index or just maintain weight as a child grows taller and then the focus on physical activity, like I mentioned. All right, here's a little activity you can try. Use the chart to determine the weight status of a 13-year-old boy with a BMI of 24. So you can pause this and do this, but so you go to, we look at boys, right? So boys are on the left, girls on the right. So 13, but right here, we go up to a BMI of 24 and it puts us right there. I hope they can see my little pointer there. And that puts him in the overweight 85th percentile. If his BMI was one point higher, he would be in the obese range. To determine the weight status of children and adolescents, follow the steps, select the appropriate chart. We did that. Locate the age, we did that. Look at the BMI, we did that. Note the color of the chart where the age and BMI lines intersect and use the key to determine the weight status. And we did follow the curved line to the right to find the percentile. So the 13-year-old boy with a BMI of 24 is considered overweight and then we have to, I didn't do that part though, so you go to the 24, 13, you follow that. So we in between the 85th and 95th percentile. All right, meal time at home. Honor your children's preferences. That doesn't mean french fries and chicken nuggets every meal, but getting them involved in what produce they eat and their protein sources and that, I think it's a really good idea. They typically say they like colorful foods but tend to choose bland colors, interesting. Tend to prefer raw overcooked when it comes to veggies and those kind of things. But again, know your kid and honor their preferences. So we make meals, we build meals around the healthiest things that we know Oliver will eat, you know, for him, right? We sometimes we eat different things than he does. Oftentimes we do. But what's the healthiest meal that we know he'll eat and then we continue to introduce things like, you know, you have to have some green and all this kind of stuff. All right, encourage learning to participation. I mentioned this several times now, include children and meal planning and preparation. So he gets to choose like the flavor of yogurt. He gets to choose the fruits he wants to eat. He gets to choose the vegetables we cook, et cetera, et cetera. You know, he gets to help with those things, not always. Avoid power struggles. When forced to try new foods, kids are less likely to try those foods again. So you've got to introduce a lot of foods and then hopefully they learn to love them but force feeding kids liver, for example, will make them less likely to want to consume it, not more. Usually, again, got to know your kid. Every situation is unique. Recommended meal time behaviors, choking prevention. So adults should be present when children is eating and make sense. They should be, you know, eating real small bites, et cetera.  Mindful eating is the best way to eat an appropriate amount of food. Snacking, limit access to concentrated sweets, so be candies and stuff, so does. Preference for sweets is innate. We love, our brains love sugar because sugar used to be hard to find but now it isn't. So yeah, so our big thing is for snacks, we've got fruit and then we have, we actually do a lot of nuts and cheese and craisans. He loves craisans, so nuts and cheese and craisans, packs. We have those are great. I feel way better about him eating those snacks than candy or chips. Dental considerations, preventing dental carries or cavities, behaviors to encourage, brush and floss after meals.  So brushing and flossing after meals will remove it. So even a high sugar meal, you can rinse those things away. So brush or rinse after eating snacks.   Select crisp or fibrous food frequently and less sticky foods like we mentioned. Roll models for both physical and emotional growth. I believe wholeheartedly in that my son needs to see me brushing my teeth and using my water pick and using my rinse and he needs to see me rinsing my mouth out and doing this. So my son is going to follow my, what I do way more than what I say and that's why I have to, I explain to him why I exercise. I explain to him why I eat the way I do. I show him these things because I'm trying to practice what I preach. All right, nutrition at school. School meals are administrated by the U.S. Department of Agriculture. We have the school breakfast program, national school lunch program, nutritional adequacy. So a third of recommended intakes for the dietary guidelines. So they're basically assuming that a kid's gonna have breakfast, lunch and dinner. So the school lunch program has to meet a third of their nutritional needs for the day hoping they get those needs met at the other two meals. And then the school breakfast program should be the same thing. So if a kid is having breakfast and lunch at school then two thirds of their recommended intakes should be met. And then we're talking about the dietary guidelines for Americans as far as what intakes we're talking about. Educational benefits to breakfast and nutritious food totally makes sense. A well-fueled engine is gonna function better. Child and adult care food program, so the CACFP, another example. Competing influences the school.  Short lunch periods and long waiting lines. So a lot of times Oliver, if we pack his lunch he'll bring half of it home because he ate as much as he could in the limited time he had. And we're not talking about intricate meals that can take a ton of time to consume. He literally didn't have time to finish his lunch. So we, and we see that because he doesn't throw in the trash. I don't know why. He puts it back in his lunchbox and we see it when he brings it home. Competing foods. So I remember that when I was in high school. Yeah, you can have, you know, you got a salad bar. That's great. But I can get a slice of pizza right there and I can go get Skittles and a Mountain Dew over here. So those competing foods are a big problem especially when children or young adults have their own money. Federal legislations such as wellness policies, things like having healthy alternatives and bending machines are great but if there's only alternatives then the skills are still there, you know. I don't know how big of an impact it has. All right, nutrition during adolescence. Needs are grading, greater during adolescence. I mean, they're larger so calories are gonna go up but they vary widely depending on activity levels. So factors influencing energy needs are they in a growth spurt or not? How much lean mass do they have? How physically active they are. Right, if a kid, if it's a larger muscular kid that's competing in multiple sports, their needs are gonna be a lot different than someone that isn't. Differences between boys and girls that has to do with lean mass mainly. Obesity during adolescence, serious, obviously a problem. We talked about, I gave you the numbers before, 32% of kids between the ages of two and 19 are overweight or obese. Vitamins and minerals, the RDAs or AIs for most vitamins increase because your needs go up because you're larger. Vitamin D deficiencies are a big problem especially if kids aren't outside during the summer, et cetera. Iron, differences between boys and girls. During growth spurt, you need more iron and then once men are key, what's the first menstrual cycle kicks in? Girls are gonna need more than boys. Calcium, reaching peak bone mass, especially important between age girls because they're the ones that are going to be post-menopausal women that are more likely to have osteoporosis. So that's why they're more vulnerable. But peak bone mass, we talked about this before but I don't know, between the ages of 14, 18, early 20s, somewhere in that ballpark is when you reach your peak bone mass depending on you and your hormones. The reason the peak bone mass is so important is you are gonna lose bone mass as you get older. So the higher that peak, the more bone loss you can afford to lose before you develop osteopenia and osteoporosis. And if you started a high enough peak, hopefully you never get there. It's an equation of where was the peak, how long do you live, and all those kind of factors. All right, now let's check, so you can pause and look at these. Male growth spurts, there are differences. This shows you that sex hormones are critically important when it comes to body fat.   It lasts two and a half years and begins the age 12 to 13. So a female growth spurt starts earlier, begins at age 10 to 11. Still lasts two and a half years. So the length of time is the same but they start earlier and end earlier. So females are gonna start growing earlier and they'll end growing earlier but the increase in fat stores.  So a young male when they go through puberty will come out of puberty with a lower body fat level. When a young female goes through puberty, she will come out of that growth spurt with a higher body fat level. More body fat in the mammary regions and below the waist what's called genitofamoral fat. Changes in body composition become apparent. Lean tissue increases in males, principally muscle and bone. Males grow eight inches versus six inches for females. Males gain approximately 45 pounds compared to 35 pounds for females. So you see that the sex hormones play a big role there. Food choices and health habits. The benefits of eating meals with families, I mean just again for role modeling more than anything.  A skipping breakfast we said was not good. Eating fast food, occasionally, right? We talk to our kids a lot about what a treat is. Right, if you have a treat every day it's not a treat, it's part of your diet. So treats are supposed to be the exception, not the rule. Parental gatekeepers control type and availability of food. This is like not only that, it's not just what you put down at the tables but what snacks are available. Right, if we have treat-like snacks we put them in places where the kids can't get them because we are the gatekeepers. So Oliver can go grab a piece of fruit if he wants and he can grab the nut and cheese and craze in packs. We keep in the refrigerator for him but like the occasional treat type stuff we have to control that and that's, I get it. Of course the kid's gonna want those kind of things. Snacks are 25% of an average teenager's daily food intake so it goes up when kids have a lot more power or say over what they eat, they have their own money then you're gonna see fast food consumption go up, snacking go up because we can control what Oliver, the seven year old, eats in the house and he's almost always in the house. We can't control what Tom, you know, what he eats in here as much because he's gone, he has his own car, has his own money, et cetera. Soft drinks, to me they're a big no-no I mean for young kids especially. And peer influence, I mean that's, I remember when I was a teenager, like almost every day me and my friends would go to the pizza place or the fast food places as part of what we did, part of our socializing. All right, summary, did we do what we were supposed to do? List some of the components of breast milk and describe the appropriate foods for infants during the first year of life. Life check, explain how children's appetites and nutrient needs reflect their stage of growth and why iron deficiency and obesity are often concerns during childhood. Check, describe some of the challenges in meeting the nutrient needs of adolescents. I think we've done a great job here. So a lot of good stuff here. I hope this helps. Have a wonderful day, be blessed.