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Department of Health and Human Services, 2010). Of these calories, 45% to 65% should come from carbohydrates, 10% to 30% from protein, and 25% to 35% from fat (U.S. Department ofAgriculture and U.S. Department of Health and Human Services, 2010). The 4- to 8-year-old child needs 800 to 1,000 mg of calcium, while the 9- to 13-year-old needs 1,300 mg of calcium for maintenance of growth and good nutrition (Krebs, Primark, & Haemer, 2011). Calcium is needed for the development of strong bones and teeth. Milk, yogurt, and cheese provide protein, vitamins, and minerals and are an excellent source of calcium. Meats, poultry, fish, and eggs provide protein, vitamins, and minerals. Promoting Healthy Eating Habits School-age children should choose culturally appropriate foods and snacks from the U.S. Department of Agriculture’s MyPyramid (Fig. 6.9). MyPyramid.gov offers many tools for the child to use including development of personalized goals and menus, online dieting and physical activity assessment tools, games, activities, and tips for parents. School-age children need to limit intake of fat and processed sugars. A prudent diet limits the use of fatty meats, high-fat dairy products, eggs, and hydrogenated shortenings and promotes the consumption of fish and the substitution of polyunsaturated vegetable oils and margarines. The American Heart Association has endorsed a diet for school-age children that includes the recommendations listed in Box 6.3. Preventing the Development of Overweight and Obesity The National Health and Nutrition Examination Survey (NHANES) found that more and more children are overweight. Over the past three decades the number of overweight children and adolescents more than tripled. Thirty percent of 6- to 11-year-olds are overweight or at risk for overweight (NationalAssociation of Pediatric Nurse Practitioners, 2006). Overweight is classified as a body mass index (BMI) greater than 85% and obese is classified as a BMI greater than 95% (Krebs et al., 2011; U.S. Department of Agriculture and U.S. Department of Health and Human Services, 2010) (see Healthy People 2020). BOX 6.3 AMERICAN HEART ASSOCIATION’S DIET RECOMMENDATIONS FOR SCHOOL-AGE CHILDREN • A high-quality protein with every meal • Milk with added vitamin D and other low-fat dairy products • Vegetables high in vitamin A • Fruits high in vitamin C • Whole-grain or enriched breads or cereals • Vegetable oils high in polyunsaturated fats • Meats (4 servings per week of 4 ounces each) • Fish (1-2 times per week) • Poultry (1-2 times per week) • Dark green, leafy, or deep yellow vegetables (at least 4 times per week) • Eggs (4 times per week) Adapted from American Heart Association, Gidding, S. S., Dennison, B. A., Birch, L. L., Daniels, S. R., Gilman, M. W., et al. (2006). Dietary recommendations for children and adolescents: A guide for practitioners. Pediatrics, 7 77(2), 544-559. HEALTHY PEOPLE 2020 Obesity occurs when the intake of calories and food exceeds the expenditures. Some factors linked to causing obesity include family role modeling, lack of exercise, unstructured meals, consumption of sugar-sweetened beverages, large portion sizes, television viewing, and video gaming as well as cultural, genetic, environmental, and socioeconomic factors. Some factors that influence lack of exercise include the decreased number of days that schoolsystems offer physical education programs and recess. Also, some children live in unsafe neighborhoods or in a community that lacks sidewalks or parks and have no safe place to play outside; therefore, they spend time doing sedentary activities such as watching TV or playing video or computer games (U.S. Department ofAgriculture and U.S. Department of Health and Human Services, 2010). Obese children are at risk for cardiovascular diseases such as high cholesterol and hypertension, type 2 (non-insulin-dependent) diabetes, respiratory complications such as obstructive sleep apnea, mental health issues such as depression, anxiety and eating disorders, and orthopedic problems (Krebs et al., 2011; U.S. Department ofAgriculture and U.S. Department of Health and Human Services, 2010). When parents do not have knowledge of nutrition, do not monitor snacks or meals, and have unstructured meals, habits are established that lead to obesity Obesity occurs when the intake of calories and food exceeds the expenditures. Some factors linked to causing obesity include family role modeling, lack of exercise, unstructured meals, consumption of sugar-sweetened beverages, large portion sizes, television viewing, and video gaming as well as cultural, genetic, environmental, and socioeconomic factors. Some factors that influence lack of exercise include the decreased number of days that schoolsystems offer physical education programs and recess. Also, some children live in unsafe neighborhoods or in a community that lacks sidewalks or parks and have no safe place to play outside; therefore, they spend time doing sedentary activities such as watching TV or playing video or computer games (U.S. Department ofAgriculture and U.S. Department of Health and Human Services, 2010). Obese children are at risk for cardiovascular diseases such as high cholesterol and hypertension, type 2 (non-insulin-dependent) diabetes, respiratory complications such as obstructive
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