Childhood is a critical time in the growth and development of a person, and is a key stage in the establishment of their physical and mental abilities. There is therefore considerable scientific interest in determining a child’s optimal dietary requirements that will enhance and assist this growth and development. This includes factors such as the quantity, quality, timing, and nutrient components of every meal.
Physical maturation follows the same course for all children, although rates will differ between individuals. Post-natal growth spans three age periods: infancy, which is the first year of life; childhood, which extends from infancy to around 10 years of age; and adolescence, which is defined as between 10 to 18 years of age. Across all developmental stages, changes in body proportions and the mastering of fundamental motor skills are all part of biological maturation. Subsequently, these are also very sensitive to the nutritional status of the individual.
Cognitive development in children involves the maturation of higher mental functions such as attention, memory, learning and perception. During these years, optimal brain development has been shown to be associated with better academic ability (Nyaradi et al. 2013b). If cognitive development is positively influenced by nutrition then, conversely, cognitive development is therefore vulnerable to dietary deficiencies (Benton 2010).
The Effect of Nutritional Deficiencies
Child malnutrition includes under-nutrition and over-nutrition, both of which are deficiency diseases caused by inadequate nutrition (Ge & Chang 2001). During childhood, under-nutrition causes children to have less energy and less interest for learning, which negatively influences cognitive development and academic performance. Under-nutrition will also affect physical growth and maturation, thus affecting growth rate, body weight and ultimately height.
Obesity is a special form of malnutrition, as this type of diet is likely to have low nutrient-density as well as high fat and high carbohydrate content (Tanumihardjo et al. 2007). There is growing concerns of the prevalence of paediatric obesity, as this comes with an increased risk of developing cardiometabolic disease in adolescence and adulthood. Obesity in children also affects confidence and competence during physical activity and thus further compounds proper growth and development.
Evidence suggests that the timing of nutritional deficiencies can also significantly affect growth and development. For example, during the foetal stage, folic acid deficiency between 21 and 28 days after conception predisposes the foetus to a congenital malformation called neural tube defect. The childhood period is also very sensitive to dietary deficiencies, particularly as the brain is undergoing major structural and cognitive maturation.
Role of the Healthcare Professional
Primary healthcare professionals are ideally placed to identify those individuals who are malnourished. In the assessment of child malnutrition, healthcare workers should consider approved anthropometry measures such as growth charts, body mass index, Z-scores, and skin fold thickness. To measure the nutritional state of children, it is recommended to use a range of measures in order to comprehensively understand a child’s nutritional state.
From macronutrients to micronutrients, the healthcare worker needs to effectively and safely advise parents and children about the importance of diet and nutrition. Dietary pattern and quality are obviously both very important, but so are the macronutrient (carbohydrate, protein and fats) ratios and the presence of key micronutrients (vitamins, minerals, etc.). For the latter, important micronutrients include omega-3 fatty acids, vitamins such as vitamin B12, and minerals such as zinc and iron (Nyaradi et al. 2013a).
Skills and Knowledge
All healthcare professionals need a basic understanding of the role of nutrition in growth and development. Healthcare professionals should be encouraged to utilise the tools and resources that are currently available to identify and evaluate malnutrition in children. Once identified, it may be easier to implement changes through dietary interventions rather than wholesale changes.
Early life obesity has far reaching effects on the premature development of other diseases such as osteoporosis, type 2 diabetes, metabolic syndrome, and liver disease (Joliffe & Janssen 2007). The supply of friendly and practical advice that fosters good behaviours in parents and children should help to prevent paediatric obesity. However, engagement needs to be as early as possible to prevent the inevitable obesity trajectory.
Breakfast is also important. A child’s glucose metabolism is higher than an adult’s and the continuous supply of glucose to the brain is more important in children than it is in adults (Chugani 1998). Although there is a lack of studies showing the type, composition and portion size of an optimal breakfast that best benefits cognitive development, a carbohydrate-rich, low-glycaemic index breakfast may facilitate better cognitive performance in school.
Nutrition plays an important role in the growth and development of children, with a healthy diet synergistically enhancing physical and mental abilities. Malnutrition in children is detrimental to the development of their physical growth, cognitive abilities, and psychosocial skills, with multiple downstream effects in the short-term and long-term. Healthcare professionals are ideally placed to have a frank, open, and respectful conversation with parents about child nutrition, and should be encouraged to do so.
- Benton, D 2010, ‘The Influence of Dietary Status on the Cognitive Performance of Children’, Molecular Nutrition and Food Research, vol. 54, no. 4, pp. 457-70, viewed 27 October 2016, https://www.ncbi.nlm.nih.gov/pubmed/20077417
- Chugani, HT 1998, ‘A Critical Period of Brain Development: Studies of Cerebral Glucose Utilization with PET’, Preventive Medicine, vol. 27, no. 2, pp. 184-8, viewed 27 October 2016, https://www.ncbi.nlm.nih.gov/pubmed/9578992
- Ge, KY & Chang, SY 2001, ‘Definition and Measurement of Child Malnutrition’, BES: Biomedical and Environmental Sciences, vol. 14, no. 4 pp. 283-91, viewed 27 October 2016, https://www.ncbi.nlm.nih.gov/pubmed/11862608
- Jolliffe, CJ & Janssen, I 2007, ‘Development of Age-Specific Adolescent Metabolic Syndrome Criteria that are Linked to the Adult Treatment Panel III and International Diabetes Federation Criteria’, Journal of the American College of Cardiology, vol. 49, no. 8, pp. 891-98, viewed 27 October 2016, https://www.ncbi.nlm.nih.gov/pubmed/17320748
- Nyaradi, A, Li, J, Hickling, S, Foster, J & Oddy, WH 2013a, ‘The Role of Nutrition in Children’s Neurocognitive Development, From Pregnancy Through Childhood’, Frontiers in Human Neuroscience, vol. 7, no. 97, viewed 27 October 2016, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3607807/
- Nyaradi, A, Li, J, Hickling, S, Whitehouse, AJ, Foster, JK & Oddy, WH 2013b, ‘Diet in the Early Years of Life Influences Cognitive Outcomes at 10 Years: A Prospective Cohort Study’, Acta Paediatrica, vol. 102, no. 12, pp. 1165-73, viewed 27 October 2016, https://www.ncbi.nlm.nih.gov/pubmed/23879236
- Tanumihardjo, SA, Anderson, C, Kaufer-Horwitz, M, Bode, L, Emenaker, NJ, Haqq, AM, Satia, JA, Silver, HJ & Stadler, DD 2007, ‘Poverty, Obesity, and Malnutrition: An International Perspective Recognizing the Paradox’, Journal of the American Dietetic Association, vol. 107, no. 11, pp. 1966-72, viewed 27 October 2016, https://www.ncbi.nlm.nih.gov/pubmed/17964317