John W.L. Puntis discusses nutritional assessments, feeding histories, growth, malnutrition and nutritional interventions.
Nutritional and metabolic factors during sensitive, limited periods of early human development have a long-term programming effect on health, well-being and performance in later age, extending into adulthood and old age. Hence, optimal nutrition during pregnancy, lactation and infancy is of particular importance.
The evidence for early programming effects arise form in vitro experiments, animal models, retro- and prospective epidemiological studies, and first controlled intervention trials.
With these models and experiments it is expected that obstetric and pediatrics medicine will achieve a much greater future role for prevention of long-term disease risks in the population.
Thus, the important effects on health of early nutrition programming, such as understanding the protective effects of breastfeeding on later health outcomes compared to formula feeding is relevant to public health on a population basis. This justifies major investments into research and improvement of practice.
The age range of 1 to approximately 12 years
includes very different phases of development.
With increasing motor skills, toddlers, some of
whom are still partly breastfed, continue to feed
themselves with an increasing variety of foods as
part of the family diet.
Food preferences developed
in the first year of life tend to persist but are
modified under the influence of parents, siblings
and play mates. Pre-school and school children
increase both the frequency and variety of social
contacts outside the home and thereby food and
meal choices  .
A healthy diet for children should be devised
on the basis of both scientific and practical considerations.
Obesity develops during periods of positive
energy balance resulting from inadequate low regular physical activity and
inadequately high calorie intake. Treatment of obesity in children can be
performed on the basis of a behavioral- based training program aiming at
reducing sedentary behaviors, increasing physical activity and improving energy
Successful dietary measures are reducing the intake of energy-dense
foods, foods with added sugar, and increasing the proportion of foods with high
fiber content. Eating and physical activity behavior of an individual child is
strongly influenced by environmental and social factors which also need to be
changed in order to achieve long-term success. Therefore, treatment will have
only limited success in an environment where adequate physical activity is
inhibited and the consumption of high energy food is stimulated.
the inclusion of parents is also important for long-term success.
The microbiota of a newborn is acquired from
the mother at birth and develops rapidly thereafter.
It is initially strongly dependent on the mother’s
microbiota, mode of delivery and birth environment . The microbiota of the mother is
determined by genetic and environmental factors.
Stress and dietary habits during later pregnancy
have a significant impact on the microbiota
at delivery, thus influencing the quality and
quantity of first colonizers of the newborn. Subsequently,
feeding practices (formula or breastfed)
and the infant’s home environment influence
the succession microbiota at the genus and
species level, as well as species composition and
numbers of bacteria.
deficiency and anemia are the most widespread human deficiencies and
produce reduced productivity and learning. Children also commonly
develop overt deficiencies of only certain vitamins and minerals.
Endemic deficiencies of vitamin A and zinc are associated with
greater infectious morbidity in children. Infant formulas, enteral
feeding and parenteral infusion with improper formulation have caused
deficiencies of vitamin E, zinc, copper, selenium, molybdenum and
chromium, as well as chloride. Eating disorders, clinical illness
and iatrogenic causes are the bases of micronutrient deficiencies in
clinical pediatrics. The combination of addressing the underlying
causes and providing prudent supplementation with vitamins and/or
minerals is essential to resolving micronutrient malnutrition. It is
therefore important for the practitioner to recognize the signs and
symptoms and appropriate interpretation of hematological, biochemical
and functional indices of vitamin and mineral deficiencies in order
to prescribe appropriate treatment.