21.3 Nutrition from Infancy to School Age: Growth, Feeding Patterns, Problems, and School Programs
Key Takeaways
Birth weight typically doubles by about 4-6 months and triples by 12 months, while length increases by about 50% in the first year.
WHO advises 2-3 complementary meals a day at 6-8 months and 3-4 meals plus 1-2 snacks at 9-23 months, with texture progressing from mashed to family foods.
Honey should not be given before 12 months because of infant botulism risk, and cow's milk should not replace breast milk before 12 months.
In Satter's division of responsibility, parents decide what, when, and where food is offered, and the child decides whether and how much to eat.
Under DepEd Order 13 s. 2017, green foods should always be available in school canteens, yellow foods are served carefully, and red foods are not sold.
The table of specifications asks examinees to summarize growth and development at each life stage, relate nutrients to growth, select meal patterns, explain risk factors and health problems, and apply feeding principles to individuals and groups. Infant and young child feeding policy and the Milk Code are covered in the IYCF section.
Growth and Development Milestones
| Age | Growth | Feeding development |
|---|---|---|
| 0-6 months | Weight doubles by about 4-6 months | Suckling and rooting reflexes; exclusive breastfeeding |
| 6-8 months | Rapid growth continues | Sits with support; mashed and pureed foods |
| 9-11 months | Weight about triples by 12 months; length up about 50% | Pincer grasp; finely chopped foods and finger foods |
| 12-23 months | Growth slows; appetite falls | Family foods; drinks from a cup; self-feeding |
| 2-5 years | Steady growth of about 2 kg and 6-8 cm a year | Food preferences form; food jags and neophobia |
| 6-12 years | Slow, steady growth; prepubertal spurt in girls first | Eats independently; influenced by peers and school |
Infant Feeding
- Exclusive breastfeeding for 6 months, then continued breastfeeding to 2 years or beyond.
- Infant formula only when breastfeeding is not possible, prepared exactly as instructed with safe water.
- No water, juice, honey, or other foods before 6 months for exclusively breastfed infants.
- Vitamin K at birth and vitamin A from 6 months under DOH programs.
Complementary feeding (WHO guiding principles for the breastfed child):
| Age | Texture | Meals per day | Approximate energy from complementary foods |
|---|---|---|---|
| 6-8 months | Mashed, pureed, thick porridge | 2-3 meals, plus 1-2 snacks as desired | About 200 kcal/day |
| 9-11 months | Finely chopped, mashed, finger foods | 3-4 meals plus 1-2 snacks | About 300 kcal/day |
| 12-23 months | Family foods, chopped as needed | 3-4 meals plus 1-2 snacks | About 550 kcal/day |
Start with 2-3 tablespoons and increase gradually. Include animal-source foods daily (egg, fish, chicken liver), vegetables and fruits, and add a little oil for energy. Responsive feeding: feed slowly and patiently, encourage but do not force, and respond to hunger and fullness cues. Avoid: honey before 12 months (botulism), added salt and sugar, sweetened drinks, and cow's milk as the main drink before 12 months.
Toddlers and Preschool Children (1-5 years)
PDRI 2015 energy: 1,000 kcal (boys) and 920 kcal (girls) at 1-2 years; 1,350 and 1,260 kcal at 3-5 years.
Typical eating behaviors:
- Food neophobia: fear of new foods; offering a new food 8-15 times often leads to acceptance.
- Food jags: wanting the same food repeatedly.
- Smaller, irregular appetite as growth slows.
Satter's division of responsibility: the parent decides what, when, and where food is offered; the child decides whether and how much to eat. Pressuring, bribing, or using food as a reward backfires.
Common problems and prevention:
| Problem | Prevention |
|---|---|
| Iron deficiency anemia | Iron-rich foods; limit milk to avoid displacing foods |
| Dental caries | Avoid bottles at bedtime and frequent sweets; brush teeth |
| Choking | Avoid whole grapes, nuts, hard candy, round hotdog slices; supervise eating |
| Stunting and wasting | Adequate diet, growth monitoring, illness management |
| Overweight | Limit sugary drinks and snacks; active play; limit screen time |
| Picky eating | Regular meal times, family meals, small portions, role modeling |
School-Age Children (6-12 years)
PDRI 2015 energy: 1,600 kcal (boys) and 1,470 kcal (girls) at 6-9 years; 2,060 and 1,980 kcal at 10-12 years.
Nutrition concerns: skipping breakfast (linked to poorer attention), unhealthy snacks and drinks around schools, rising overweight, anemia, and wasting in poor households.
Planning a healthy baon (packed meal):
- Rice or bread (go), egg, fish, chicken, or tokwa (grow), and vegetables and fruit (glow)
- Water instead of sweetened drinks
- Food kept safe: packed hot or cool, eaten within a few hours
School nutrition programs: the School-Based Feeding Program for undernourished learners (RA 11037), deworming, Gulayan sa Paaralan, nutrition education, and healthy canteens.
DepEd Order 13 s. 2017 (Healthy Food and Beverage Choices in Schools and in DepEd Offices):
| Category | Description | Examples | Canteen rule |
|---|---|---|---|
| Green | Eat most: nutritious, low in fat, sugar, and salt | Rice, boiled root crops, fresh fruits, vegetables, milk, safe water | Should always be available |
| Yellow | Eat moderately: some added fat, sugar, or salt | Fried rice, pancakes, 100% fruit juice | Served carefully and in moderation |
| Red | Eat less: high in fat, sugar, or salt | Soft drinks, sweetened juices, candies, chips, deep-fried foods, instant noodles | Not sold or served in school canteens |
Feeding Groups of Children
When planning meals for child development centers or school feeding, follow menu cycles that meet a set share of needs, use local and seasonal foods, follow food safety rules, and involve parents. Weigh children at the start and end of feeding to measure progress.
An infant weighed 3.0 kg at birth. About how much should the infant weigh at 12 months if growing normally?
About 9.0 kg
About 6.0 kg
About 4.5 kg
About 12.0 kg
A mother complains that her 3-year-old refuses vegetables and eats only small amounts. Which advice follows Satter's division of responsibility?
Promise dessert only after the vegetables are finished
Cook only the foods the child prefers
Offer vegetables regularly at set meals and let the child decide how much to eat
Make the child stay at the table until every bite on the plate is completely finished
Under DepEd Order 13 s. 2017, how should a school canteen treat soft drinks and chips?
Sell them freely as green-category items
Sell them only on Fridays
Sell them in small portions as yellow-category items
Not sell or serve them, because they are red-category items
Sections you finish are checked off in the contents.