National Monitoring in Public Health Nutrition

2007 Australian National Children's Nutrition and Physical Activity Survey

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This number represents Click here or below to see national data. Since the NSDUH report, a "mixed" method approach has been implemented for all detailed tables to improve the accuracy of SEs and to better reflect the effects of poststratification on the variance of total estimates. In epidemiological studies, incidence is defined as the number of new cases of a disease occurring within a specific period of time. Corresponding percentages among adults with a past year MDE were

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Although adults aged 26 or older were more likely than people in other age groups to have used prescription drugs in the past year, young adults were more likely than youths and adults aged 26 or older to have misused prescription psychotherapeutic drugs in this period. In addition, youths were more likely than adults aged 26 or older to have misused stimulants in the past year. However, similar percentages of youths and adults aged 26 or older misused prescription pain relievers, tranquilizers, and sedatives in the past year.

Among youths aged 12 to 17, 3. These percentages correspond to , youths who misused prescription pain relievers, , who misused prescription tranquilizers, , who misused prescription stimulants, and , who misused prescription sedatives.

Percentages of young adults aged 18 to 25 who misused specific categories of prescription psychotherapeutic drugs were 8.

These percentages correspond to 3. Among adults aged 26 or older, 4. These percentages correspond to 8. In particular, males aged 12 or older were more likely than their female counterparts to have misused any prescription psychotherapeutic drug in the past year 7.

Males also were more likely than females to have misused prescription pain relievers 5. However, males were less likely than females to have misused prescription sedatives in the past year 0. In , percentages of non-Hispanics and Hispanics aged 12 or older were similar for the misuse in the past year of any prescription psychotherapeutic drug 7.

However, non-Hispanics were more likely than Hispanics to have misused prescription stimulants in the past year 2. The misuse of any prescription psychotherapeutic drug in the past year among individuals aged 12 or older in ranged from 3. The misuse of prescription pain relievers in the past year ranged from 1. The misuse of prescription tranquilizers in the past year ranged from 0. The misuse of prescription stimulants in the past year ranged from 0. Estimates for the misuse of prescription sedatives in the past year among racial groups were below 1.

Among individuals aged 12 or older in , 7. Most people who used prescription psychotherapeutic drugs in the past year did not misuse them. For example, the NSDUH asks respondents aged 12 or older about their past year use of alcohol, tobacco, and several illicit drugs: Except for data that are collected on the use of alcohol in combination with the misuse of prescription drugs in the past month not included in this report , NSDUH does not assess whether respondents misused prescription drugs and used other substances at the same time.

This section provides estimates of past year prescription drug misuse among people who used other substances in that period, such as the percentage of past year alcohol users who misused prescription drugs in the past year. In , the following numbers of people aged 12 or older used other substances at least once in the past year regardless of whether they misused prescription drugs in the past year:.

Among the estimated The large majority of past year heroin users aged 12 or older also misused prescription psychotherapeutic drugs in the past year About a quarter Among past year heroin users aged 12 or older, Compared with the estimate of 2. In addition, more than 1 in 4 past year users of Ecstasy In , the misuse of prescription sedatives in the past year among people aged 12 or older who used other substances in that period was not as pronounced as the misuse of pain relievers, tranquilizers, or stimulants.

In comparison, the percentages of users of other substances who misused sedatives in the past year ranged from 0. Adults are defined as having AMI if they had any mental, behavioral, or emotional disorder in the past year that met the Diagnostic and Statistical Manual of Mental Disorders , 4th edition DSM-IV , criteria excluding developmental disorders and substance use disorders.

This number who misused prescription psychotherapeutic drugs in the past year corresponds to In comparison, among adults who did not have a mental illness in the past year, 5. Among adults in who had AMI in the past year, about 1 in 9 These percentages correspond to 4.

About 1 in 10 adults with SMI 9. Adults in who did not have a mental illness in the past year were less likely than adults with AMI or SMI to have misused prescription drugs in each of the four psychotherapeutic categories in the past year. Among adults in who did not have a mental illness in the past year, 3.

MDE is defined for both adults and adolescents using the diagnostic criteria from DSM-IV, although there are separate criteria for adults and youths. However, some wordings to the questions for adolescents were designed to make them more developmentally appropriate for youths. Data are presented separately for adults and adolescents because of the different wording of questions for adults and adolescents.

This number of adults who misused prescription psychotherapeutic drugs represents Adults who did not have an MDE in the past year were less likely than adults who had a past year MDE to misuse prescription psychotherapeutic drugs in the past year 6.

Corresponding percentages among adults with a past year MDE were Adults in who did not have an MDE in the past year were less likely than adults who had an MDE to misuse prescription drugs in each of the psychotherapeutic categories in the past year.

Specifically, among adults who did not have an MDE in the past year, 4. In , an estimated 3. This number represents Among adolescents who did not have an MDE in the past year, 4. These numbers correspond to 7. Adolescents in who did not have an MDE in the past year were less likely than their counterparts who had an MDE to misuse prescription drugs in each of the psychotherapeutic categories in the past year.

Among adolescents who did not have an MDE in the past year, 3. NSDUH respondents aged 18 or older were asked if at any time during the past 12 months they had thought seriously about trying to kill themselves. This section provides estimates of the misuse of prescription drugs among adults who had serious thoughts of suicide in the past year. However, NSDUH does not assess whether respondents misused prescription drugs while they were having serious thoughts of suicide.

Among adults who did not have serious thoughts of suicide in the past year, 6. Among adults who had serious thoughts of suicide in the past year, these numbers represent Adults who did not have serious thoughts of suicide in the past year were less likely than those who had serious thoughts of suicide to have misused prescription drugs in each of the psychotherapeutic categories in the past year.

Among adults who did not have serious thoughts of suicide in the past year, 4. As noted previously, NSDUH respondents in were asked to identify the specific prescription pain relievers, tranquilizers, stimulants, and sedatives that they used in the past year.

The remainder of this section presents estimates for the misuse of specific subtypes of prescription drugs in the past year. Individuals who misused alprazolam products represented 1. The number of people who misused amphetamine products in the past year represented 1.

In contrast to the 2. The number of people who misused zolpidem products in the past year represented 0. An estimated , people aged 12 or older, or 0. Respondents in the NSDUH who reported misuse of any of the four categories of prescription psychotherapeutic drugs in the past year were asked to recall the last prescription drug in that category that they misused in the past year.

For the first time in NSDUH, respondents were asked to report their reasons for misusing the prescription drug that last time. Respondents who reported more than one reason for misusing the last prescription drug were asked to report the main reason for misuse. If respondents reported only one reason for misusing their last prescription drug in a given psychotherapeutic category, then that reason was their main reason for misuse.

Except for "to relieve physical pain," the same reasons were presented for tranquilizers and sedatives; the first reason that was presented for these two psychotherapeutic categories was "to relax or relieve tension. In addition, respondents could report "some other reason" for their misuse of a particular psychotherapeutic drug and then specify a reason that applied to another psychotherapeutic category.

For example, respondents could specify that they also misused their last tranquilizer to relieve physical pain i.

Among people aged 12 or older in who misused prescription pain relievers in the past year, the most commonly reported reason for their last misuse of a pain reliever was to relieve physical pain Even if the reason for misuse was to relieve physical pain, use without a prescription of one's own or use at a higher dosage or more often than prescribed still constituted misuse.

Other commonly reported reasons for the last misuse among people who misused pain relievers in the past year were to feel good or get high Less common reasons among past year misusers of pain relievers included to help with sleep 4. Among people aged 12 or older in who misused prescription tranquilizers in the past year, the most common reasons for misuse the last time were to relax or relieve tension However, these individuals misused tranquilizers to achieve the effect for which tranquilizers are prescribed.

Even if the reason for misuse was a reason for which tranquilizers are prescribed, use without a prescription, more often than prescribed, or at higher dosages than prescribed still constituted misuse. Less common reasons for misuse included experimenting to see what the drug was like 6.

In , the most commonly reported main reasons for the misuse of stimulants among people aged 12 or older who misused stimulants in the past year were to help be alert or stay awake Less commonly reported reasons for the last misuse of prescription stimulants among past year misusers were to experiment to see what the drug was like 5. Among people aged 12 or older in who misused prescription sedatives in the past year, the most common reason for the last misuse was to help with sleep Even if people took sedatives to help them sleep, this use constituted misuse if people took them without a prescription, more often than prescribed, or at higher dosages than prescribed.

Other reasons for the last misuse among people who misused sedatives in the past year were to relax or relieve tension Less commonly reported reasons included to help with feelings or emotions 3. If NSDUH respondents in reported that they misused a specific prescription psychotherapeutic drug e. The NSDUH measures whether an individual first misused all prescription drugs in a given psychotherapeutic category within the past 12 months i.

By definition, people who initiated the misuse of any psychotherapeutic drug within a category in the past 12 months will have had their first misuse at their current age or the year before their current age. For this reason, estimates are not included for the past year initiation of misuse for any prescription psychotherapeutic drug. Unlike previous sections, this section focuses on the number of people who were recent initiates for the misuse of drugs in specific categories of prescription psychotherapeutic drugs rather than on percentages.

Information on the number of recent initiates can be useful to policymakers and program planners for anticipating future needs for health services both in the short term and in the longer term. However, care should be taken in interpreting apparent differences in the estimated numbers of initiates across population subgroups because some of these differences could reflect differences in the size of the respective subgroups.

This section also presents the average age at first misuse for prescription drugs among recent initiates of prescription drugs in a given psychotherapeutic category. Although the numbers of initiates are shown for initiates aged 12 or older as well as by age group, the average ages at first misuse in this report are limited to past year initiates aged 12 to 49 to avoid extreme values from older initiates influencing the averages.

In , there were 2. The average ages at first misuse in among recent initiates aged 12 to 49 were Historically, the number of past year initiates for the misuse of pain relievers has been second only to marijuana among illicit drugs. This number of recent initiates includes 0. In , approximately , adolescents aged 12 to 17 1.

This averages to approximately 1, adolescents each day who initiated the misuse of pain relievers. There were , young adults aged 18 to 25 1. These numbers average to about 1, young adults and about 3, adults aged 26 or older each day who initiated the misuse of pain relievers. In , approximately , adolescents aged 12 to 17 0. Each day, therefore, about adolescents, 1, young adults, and 2, adults aged 26 or older initiated the misuse of tranquilizers. In , the estimated 1.

These numbers of initiates include , females aged 12 or older 0. Approximately , adolescents aged 12 to 17 1. Thus, about adolescents per day, 1, young adults per day, and 1, adults aged 26 or older per day initiated the misuse of stimulants.

In , the approximately , people aged 12 or older who misused sedatives for the first time within the past year average to about 1, initiates per day for misuse of sedatives. About , females aged 12 or older 0. In , approximately 46, adolescents aged 12 to 17 0. Thus, about adolescents, young adults, and adults aged 26 or older initiated the misuse of sedatives each day in NSDUH includes a series of questions to estimate the percentage of the population aged 12 or older who had substance use disorders SUDs in the past 12 months.

Respondents were asked questions about prescription drug use disorders if they reported misuse of prescription drugs in the past 12 months.

Because of the creation of a new section in the interview for methamphetamine see the "Introduction" , SUDs for prescription stimulants in do not include methamphetamine. In and earlier years, SUD estimates for prescription stimulants included data from respondents who used methamphetamine in the past year.

Instead, new questions were added to the survey in that ask about SUD symptoms that respondents specifically attributed to their use of methamphetamine in the past year, separate from SUD symptoms that were associated with the misuse of prescription stimulants. This number of people who had a prescription drug use disorder represents 1.

An estimated , adolescents aged 12 to 17 in 0. Among young adults aged 18 to 25, about , had a prescription drug use disorder in the past year 2. In , an estimated 2. This number represents 0. Approximately , young adults aged 18 to 25 and 1. These numbers represent 1. An estimated 77, adolescents aged 12 to 17 in 0. Approximately , young adults aged 18 to 25 0. About 38, adolescents aged 12 to 17 in 0.

Approximately , young adults aged 18 to 25 and , adults aged 26 or older in had a stimulant use disorder in the past year. These numbers represent 0. An estimated 26, adolescents aged 12 to 17 0. Approximately 22, young adults aged 18 to 25 and , adults aged 26 or older in had a sedative use disorder in the past year. NSDUH respondents who used alcohol or illicit drugs in their lifetime are asked whether they ever received substance use treatment i.

Substance use treatment refers to treatment received for illicit drug or alcohol use or for medical problems associated with the use of illicit drugs or alcohol. This includes treatment received in the past year at any location, such as a hospital inpatient , rehabilitation facility outpatient or inpatient , mental health center, emergency room, private doctor's office, prison or jail, or a self-help group, such as Alcoholics Anonymous or Narcotics Anonymous.

Respondents who reported receiving substance use treatment in the past year had the opportunity to indicate the specific substances for which they received treatment during their most recent e.

Data on the substances for which people received their most recent treatment are not mutually exclusive because respondents could indicate that they received treatment for their use of more than one substance. The , people who received treatment for the misuse of pain relievers during their most recent treatment in the past year represent An estimated , people aged 12 or older received treatment for tranquilizer misuse during their most recent treatment in the past year 8. This section presents information for how all people aged 12 or older who misused prescription pain relievers in the past year obtained these pain relievers the last time they misused them.

This section also discusses how past year misusers of pain relievers obtained pain relievers the last time they misused them according to approximately increasing levels of problem misuse. More than half About one third of people who misused pain relievers in the past year About 1 in 20 people who misused pain relievers in the past year 4.

Another way of understanding the misuse of prescription pain relievers is to examine whether the sources for the most recently misused prescription pain relievers vary by the type of misuser of pain relievers.

These user types were defined in terms of approximately increasing levels of misuse. Specifically, past year misusers of pain relievers were categorized into the following mutually exclusive groups: As noted previously, individuals who misused pain relievers in the past year were defined as having a pain reliever use disorder in the past year based on criteria specified in DSM-IV. Obtaining pain relievers from a friend or relative was the most common source for both past year initiates This source was followed by obtaining pain relievers through prescription s or health care providers, which was reported by In comparison, the most common source for past year misusers with a pain reliever use disorder was through prescription s or health care providers Past year misusers with a pain reliever use disorder also were more likely than misusers in the other two groups to have obtained their last prescription pain relievers from a drug dealer or other stranger More than 1 in 8 past year misusers with a pain reliever use disorder Past year misusers with a pain reliever use disorder also were less likely to obtain their last pain relievers from a friend or relative for free A number of changes were made to the NSDUH questionnaire and data collection procedures to collect new information and to address current substance use and mental health policy and research needs.

As noted in the section at the beginning of the report titled "Notable Questionnaire Changes for the NSDUH," these changes included the redesign of the prescription drug questions.

Collecting more detailed information on use, misuse, and recent initiation of a comprehensive set of specific prescription drugs was determined to be more useful for policy and research purposes, in part because of public health concerns about increases in addiction, overdoses, and deaths involving prescription drugs. This section provides a brief summary of enhancements to the NSDUH prescription drug questions and some analyses that are now possible with these new prescription drug data.

Notable limitations are also summarized. Several enhancements or improvements were made to the prescription drug questions in the NSDUH, as described below. The definition of misuse was changed to focus on specific behaviors that constitute misuse and to incorporate more ways in which people misuse prescription drugs, including overuse of medication despite having a prescription. The definition of misuse before included a behavior i. Also, use "for the experience or feeling" that a drug caused could be misinterpreted by respondents to apply to use of prescribed medications for their intended effects e.

Because of the focus of the NSDUH questions on the past year reference period for the use and misuse of specific prescription drugs i. Decisions to add specific prescription drugs to the questionnaire were based on a number of factors, including identification of recently approved prescription drugs that were not included in the NSDUH questionnaire for the last major redesign in , changes in prescribing practices e.

In turn, prescription drugs that are no longer available in the United States were removed from the questionnaire, despite some of these having been commonly misused drugs in the past e. In particular, more than half of the stimulants and sedatives in the questionnaire had been discontinued or were no longer legally available in the United States and were therefore not included in the questionnaire.

Keeping a set of measures in the survey that have undergone little or no change over time permits the measurement of trends. However, presenting respondents with a less relevant set of prescription drugs erodes the validity of the trend data for prescription drug misuse, even if the NSDUH questions remain unchanged. Because the NSDUH questionnaire includes subsequent questions on misuse, it is now possible to estimate the percentages of past year users of different categories of psychotherapeutic drugs who reported misuse.

Although not a focus of this report, it also is possible with these data to estimate the number of people who used their own medication only as directed by a doctor by subtracting the number of people who reported misuse from the number who reported any use. Note that people who reported any use of a specific medication and also reported misuse of the same medication are counted as misusers because they misused a medication at least once in the past year.

However, it is not possible to differentiate respondents whose only use in the past year involved misuse from those who used a given medication as directed and who also misused the same medication at some other time in the past year. The prescription drug redesign allows for prescription drug use and misuse to be grouped by chemically related prescription drugs e.

Data on specific prescription drugs also can allow drugs to be categorized according to whether the active ingredient is intended to be released fairly rapidly into a person's system i. Because extended-release prescription drugs typically contain a higher dosage of the active ingredient than their immediate-release counterparts, tampering with extended-release medications e. However, taking a large number of pills for an immediate-release drug could have the same potentially dangerous effect.

Thus, understanding patterns of misuse of immediate-release and extended-release prescription drugs can inform decisionmaking about prescribing practices e. NSDUH now asks respondents to report whether they misused prescription drugs in the following ways:. Although data from these questions were not presented in this report, these questions can be used to assess whether drugs in certain prescription psychotherapeutic categories are more likely to be misused in specific ways compared with other categories of prescription drugs or if ways of misuse vary by respondent characteristics e.

In addition, it would be useful to understand the ways in which people misused prescription drugs in combination with their motivations for misuse see below. NSDUH now asks respondents who misused prescription drugs in a given category in the past year to report why they misused prescription drugs for their last episode of misuse. The specific reasons for misuse are listed below, along with the prescription drug categories to which these reasons applied:. Analyzing data on motivations for misuse according to the ways in which prescription drugs are being misused and how people obtained prescription drugs will be useful for identifying a richer set of social determinants and other risk factors that ultimately could be used by policymakers, researchers, and health care providers in the development of more focused prevention efforts and treatment interventions.

Although the previously described enhancements to the NSDUH prescription drug questions will provide a richer set of data for researchers and policymakers, there also are some important limitations to note that are associated with the changes to these questions. Because of the changes that were described previously, the estimates from the NSDUH for all prescription drug measures are not comparable with corresponding estimates that existed in prior survey years, including estimates of misuse, past year initiation of prescription drug misuse, and prescription drug use disorders.

The changes in the way that lifetime prescription drug misuse was measured appear to have affected the reporting of lifetime misuse of prescription drugs. In particular, the redesigned questions provided fewer questions and cues to aid respondents in recalling whether they misused any prescription psychotherapeutic drug in a given category more than 12 months prior to the interview date.

With the increase in questions asking about specific prescription drugs that were used in the past year, there were fewer questions asking about lifetime use of specific prescription drugs. The redesigned questions also did not provide examples of prescription drugs that were no longer available by prescription in the United States but may have been historically important e.

As a consequence, respondents who did not misuse prescription drugs in the past year but who did so in their lifetime may have underreported lifetime misuse in compared with the situation in prior years. Therefore, both lifetime prescription drug use and misuse measures are not reported for Prior to , NSDUH respondents who reported that they misused one or more specific prescription psychotherapeutic drugs in a given category in their lifetime were asked to report how old they were when they first misused any prescription drug in that category.

This question sequence i. This questioning sequence remained the same in for all substances except for prescription drugs. For prescription drugs, questions about the first time that respondents misused prescription drugs were limited to the specific prescription drugs that respondents misused in the past 12 months. Specifically, if NSDUH respondents reported that they misused a particular prescription psychotherapeutic drug in the past 12 months, they were asked to report their age when they first misused it.

Because initiation data in the NSDUH were not collected for respondents who reported lifetime but not past year misuse, an additional issue for the redesigned prescription drug questions is that limited data are available for establishing the temporal sequence of initiation for misuse of prescription drugs relative to the initiation of use for other substances.

For example, if a respondent initiated use of heroin in the past year and reported misuse of prescription pain relievers more than 12 months prior to being interviewed, information was not available in on the period of time between the initiation of the misuse of pain relievers and the first use of heroin. As noted in the preceding section, there is evidence of underreporting of lifetime but not past year misuse of prescription drugs compared with prior years.

This potential underreporting of lifetime misuse also has two effects on estimates in for initiation of prescription drug misuse. First, underreporting of lifetime misuse would increase the estimated size of the population who are defined as being "at risk" for initiation; respondents who initiated use or misuse of a substance more than 12 months ago can no longer be "at risk" for initiation in the past 12 months.

Second, the potential for respondents to underreport lifetime misuse has affected the estimation of past year initiation of misuse for any prescription psychotherapeutic drug i. If a respondent was defined as being a past year initiate for misuse of one category of prescription drugs e. Likewise, respondents who underreported lifetime but not past year misuse of prescription drugs could be misclassified as initiating the use or misuse of any illicit drug in the past year. Therefore, estimates for are still reported for past year initiation for the individual prescription drug categories i.

However, estimates in are no longer reported for the initiation of misuse of any prescription psychotherapeutic drug or any illicit drug in the past year. Further studies are needed to evaluate how this underreporting has affected the estimates for these aggregate initiation measures. Prescription drug use and misuse in the United States: Key substance use and mental health indicators in the United States: Some of these estimated numbers are not included in figures or tables in the report but may be found in the detailed tables for the NSDUH available at http: Misuse of prescription drugs: Prevalence, correlates, and comorbidity of nonmedical prescription drug use and drug use disorders in the United States: Journal of Clinical Psychiatry, 67 , Nonmedical use of prescription opioids: Motive and ubiquity issues.

Journal of Pain, 9 , Although some people in the general population of the United States are outside of the civilian, noninstitutionalized population, information from the U.

See the following reference: In particular, Tables A. Center for Behavioral Health Statistics and Quality. Methodological summary and definitions. Implications for data users. National Survey on Drug Use and Health: See endnote 7 for the reference. Because respondents were allowed to choose more than one racial group, a "two or more races" category is presented that includes persons who reported more than one category among the seven basic groups listed in the survey question white, black or African American, American Indian or Alaska Native, Native Hawaiian, Other Pacific Islander, Asian, Other.

The category "Hispanic or Latino" includes Hispanics of any race. Also, more detailed categories describing specific subgroups were obtained from survey respondents if they reported either Asian race or Hispanic ethnicity. Office of Management and Budget. Revisions to the standards for the classification of federal data on race and ethnicity.

Federal Register, 62 , These regions consist of the following groups of states, including the District of Columbia:. For this purpose, counties are grouped based on the rural-urban continuum codes.

These codes are updated approximately every 10 years and are available at http: See the following references:. Rural-urban continuum codes for metro and non-metro counties , Staff Report No. Department of Agriculture, Economic Research Service. Revised definitions of metropolitan statistical areas, new definitions of micropolitan statistical areas and combined statistical areas, and guidance on uses of the statistical definitions of these areas OMB Bulletin No.

Other prescription pain relievers could include products that are similar to the specific pain relievers that were listed previously. Other prescription tranquilizers could include products that are similar to the specific tranquilizers that were listed previously.

Other prescription stimulants could include products that are similar to the specific stimulants that were listed previously. Since , methamphetamine has not been included as a prescription stimulant. Other prescription sedatives could include products that are similar to the specific sedatives that were listed previously. Adults were first asked whether they ever had a period in their lifetime lasting several days or longer when any of the following was true for most of the day: Adults who reported any of these problems were asked further questions about having an MDE in their lifetime, including whether they had at least five of nine symptoms in the same 2-week period in their lifetime; at least one of the symptoms needed to be having a depressed mood or loss of interest or pleasure in daily activities.

Those who had lifetime MDE were asked if they had a period of time in the past 12 months when they felt depressed or lost interest or pleasure in daily activities for 2 weeks or longer, and they reported that they had some of their other lifetime MDE symptoms in the past 12 months. These adults were defined as having past year MDE. Adolescents who reported any of these problems were asked further questions about having an MDE in their lifetime, including whether they had at least five of nine symptoms in the same 2-week period in their lifetime; at least one of the symptoms needed to be having a depressed mood or loss of interest or pleasure in daily activities.

Unlike in the questions for adults, adolescents who reported gaining weight without trying were asked if this occurred because they were growing. Formula and milk promote growth of bacteria, yeast, and fungi 2. Bottles, bottle caps, and nipples that are reused should be washed and sanitized to avoid contamination from previous feedings. Excessive boiling of latex bottle nipples will damage them. Additional Resource Feeding Infants: How to clean, sanitize, and store infant feeding items.

Updated April 11, How to safely clean baby bottles. Published February 16, However, recommendations on the introduction of complementary foods provided to caregivers of infants should take into account:. For infants who are exclusively breastfed, the amount of certain nutrients in the body - such as iron and zinc - begins to decrease after 6 months of age.

The first food introduced should be a single-ingredient food that is served in a small portion for 2 to 7 days 3. Gradually increase variety and portion of foods, one at a time, as tolerated by the infant 4. These include sitting up with minimal support, proper head control, ability to chew well, or grabbing food from the plate.

Additionally, infants will lose the tongue-thrusting reflex and begin acting hungry after formula feeding or breastfeeding 3. Early introduction of age-appropriate solid food and fruit juice interferes with the intake of human milk or iron-fortified formula that the infant needs for growth. Age-appropriate solid foods given before an infant is developmentally ready may be associated with allergies and digestive problems 5.

Age-appropriate solid foods, such as meat and fortified cereals, are needed beginning at 6 months of age to make up for any potential losses in zinc and iron during exclusive breastfeeding 3. Typically, low levels of vitamin D are transferred to infants via breast milk, warranting the recommendation that breastfed or partially breastfed infants receive a minimum daily intake of IU of vitamin D supplementation beginning soon after birth 6. Additionally, for infants who are exclusively formula fed or given a combination of formula and human milk, evidence for introducing complementary foods in a specific order has not been established.

Child and Adult Care Food Program: Infant Nutrition and Feeding. US Department of Agriculture; American Academy of Pediatrics. Updated November 21, Infant and young child feeding. Vitamin D3 supplementation during pregnancy and lactation improves vitamin D status of the mother-infant dyad.

J Obstet Gynecol Neonatal Nurs. All jars of baby food should be washed with soap and warm water and rinsed with clean, running warm water before opening. All commercially packaged baby food should be served from a dish and spoon, not directly from a factory-sealed container or jar 1. A dish should be cleaned and sanitized before use to reduce the likelihood of surface contamination. If left out, all food should be discarded after 2 hours 4.

The portion of the food that is touched by a utensil should be consumed or discarded. Any food brought from home should not be served to other children. This will prevent cross contamination and reinforce the policy that food sent to the facility is for the designated child only. Unused portions in opened factory-sealed baby food containers or food brought in containers prepared at home should be stored in the refrigerator and discarded if not consumed after 24 hours of storage.

Feeding of age-appropriate solid foods in a bottle to a child is often associated with premature feeding ie, when the infant is not developmentally ready for solid foods 5,6. Published February 22, US Department of Agriculture. Food Safety and Inspection Service Web site. Baby food and infant formula. Effects of early nutritional interventions on the development of atopic disease in infants and children: WIC Works Web site. Modified October 31, Flavored milks contain higher amounts of added sugars and should not be served.

Water should not be offered to children during mealtimes; instead, offer water throughout the day. Early care and education settings should check with state regulators about the timing between meals.

State agencies may require any institution or facility to allow a specific amount of time to elapse between meal services or require that meal services not exceed a specified duration 2. Following CACFP guidelines ensures that all children enrolled receive a greater variety of vegetables and fruits and more whole grains and less added sugar and saturated fat during their meals while in care 3. Even during periods of slower growth, children must continue to eat nutritious foods. Picky or selective eating is common among toddlers.

Over time, with consistent exposure, toddlers are more likely to accept new foods 4. Independent Child Care Centers: The facility should serve toddlers and preschoolers small, age-appropriate portions. The facility should permit children to have one or more additional servings of nutritious foods that are low in fat, sugar, and sodium as required to meet the caloric needs of the individual child. Young children should learn what appropriate portion size is by being served plates, bowls, and cups that are developmentally and age appropriate.

Usually a reasonable amount of additional food is prepared to respond to any spills or to children requesting a second serving. Children should continue to be exposed to new foods, textures, and tastes throughout infancy, toddlerhood, and preschool.

Children should not be required or forced to eat any specific food items. A child will not eat the same amount each day because appetites vary and food jags are common 2. Eating habits established in infancy and early childhood may contribute to optimal eating patterns later in life.

The quality of snacks for young and school-aged children is especially important, and small, frequent feedings are recommended to achieve the total desired daily intake. Strong evidence supports that larger plates, bowls, and cups, when paired with sustained long-term exposure of oversized portions, promote overeating 3.

Allowing children to decide how much to eat, through family-style dining, may also help promote self-regulation in children 3. Preschool children's sensitivity to teacher-served portion size is linked to age related differences in leftovers.

How to improve eating behavior during early childhood. Pediatric Gastroenterol Hepatol Nutr. An explanatory framework of teachers' perceptions of a positive mealtime environment in a preschool setting. All of which are developmentally appropriate for young children to feed themselves. Children can also use their fingers for self-feeding. Children in group care should be provided with opportunities to serve and eat a variety of food for themselves. As children enter the second year after birth, they are interested in doing things for themselves.

Self-feeding appropriately separates the responsibilities of adults and children. To allow for the proper development of motor skills and eating habits, children need to be allowed to practice feeding themselves as early as 9 months of age 3,4.

Children will continue to self-feed using their fingers even after mastering the use of a utensil. J Pediatr Gastroenterol Nutr. Williamson C, Beatty C. Weaning and childhood nutrition. American Academy of Pediatrics Committee on Nutrition.

Elk Grove Village, IL: American Academy of Pediatrics; Children between 12 and 24 months of age can be served whole pasteurized milk 1. Milk provides many nutrients that are essential for the growth and development of young children. The fat content in whole milk is critical for brain development as well as satiety in children 12 to 24 months of age 3. For those children whom overweight or obesity is a concern or who have a family history of obesity, dyslipidemia, or early cardiovascular disease, the primary health care provider may request low-fat or nonfat milk 2.

Some early care and education programs have children between the ages of 18 months and 3 years in one classroom. To avoid errors in serving inappropriate milk, programs can use individual milk pitchers clearly labeled for each type of milk being served. Prevention of cardiovascular disease in pediatric populations. Demos Medical Publishing; Children attending facilities for 2 or more hours after school need at least 1 snack.

Breakfast, or a morning snack, is recommended for all children enrolled in an early care and education facility or in school. Depending on age and length of time in care, snacks should occur 2 hours after a scheduled meal. State agencies may require any institution or facility to allow a specific amount of time to elapse between meal services or require that meal services not exceed a specified duration 1,2. Early childhood is a time of rapid growth that increases the need for energy and essential nutrients to support optimal growth 2.

Food intake may vary considerably because this is a time when children express strong food likes and dislikes. The CACFP requirements ensure that children in child care centers for longer than 8 hours common in military child development centers, for example are given the appropriate number of meals and snacks to meet individual caloric and nutrient needs 1.

Programs serving children during the summer months can find the recommendations of the Summer Food Service Program at https: Family style meal service, with the serving platters, bowls, and pitchers on the table so all present can serve themselves, should be encouraged, except for infants and very young children who require an adult to feed them. A separate utensil should be used for serving. Children should not handle foods that they will not be consuming. The adults should encourage, but not force, the children to help themselves to all food components offered at the meal.

When eating meals with children, the adult s should eat items that meet nutrition standards. The adult s should encourage social interaction and conversation, using vocabulary related to the concepts of color, shape, size, quantity, number, temperature of food, and events of the day.

Extra assistance and time should be provided for slow eaters. Eating should be an enjoyable experience at the facility and at home. Special accommodations should be made for children who cannot have the food that is being served.

Children who need limited portion sizes should be taught and monitored. One adult should not feed more than one infant or three children who need adult assistance with feeding at the same time.

When eating, children should be within sight of an adult at all times. Both older children and staff should be actively involved in serving food and other mealtime activities, such as setting and cleaning the table. Staff should supervise and assist children with appropriate handwashing procedures before and after meals and sanitizing of eating surfaces and utensils to prevent cross contamination.

Experiences with new foods can include tasting and swallowing but also include engagement of all senses seeing, smelling, speaking, etc. Children should be seated when eating. Children should not be allowed to continue to feed themselves or continue to be assisted with feeding themselves if they begin to fall asleep while eating.

The nutrition plan encompasses:. Potentially hazardous and perishable foods should be refrigerated and all foods should be protected against contamination. The facility should have a nutrition plan that integrates the introduction of food and feeding experiences with facility activities and home feeding.

The plan should include opportunities for children to develop the knowledge and skills necessary to make appropriate food choices. The children should have the opportunity to feel the textures and learn the different colors, sizes, and shapes of foods and the nutritional benefits of eating healthy foods. Children should also be taught about appropriate portion sizes. The teaching should be evident at mealtimes and during curricular activities, and emphasize the pleasure of eating.

The key to identifying a qualified nutrition professional is seeking a record of training in pediatric nutrition normal nutrition, nutrition for children with special health care needs, dietary modifications and experience and competency in basic food service systems. Early care and education programs should create and implement written program plans addressing the physical, oral, mental, nutritional, and social and emotional health, physical activity, and safety aspects of each formally structured activity documented in the written curriculum.

These plans should include daily opportunities to learn health habits that prevent infection and significant injuries and health habits that support healthful eating, nutrition education, physical activity, and sleep. Awareness of healthy and safe behaviors, including good nutrition, physical activity, and sleep habits, should be an integral part of the overall program. Young children learn better through experiencing an activity and observing behavior than through didactic methods 1.

There may be a reciprocal relationship between learning and play so that play experiences are closely related to learning 2. Children can accept and follow rules, routines, and guidelines about health and safety when their personal experience helps them to understand why these rules were created. National guidelines for children birth to age 5 years encourage their engagement in daily physical activity that promotes movement, motor skills, and the foundations of health-related fitness 3.

Physical activity is important to overall health and to overweight and obesity prevention 4. Healthy sleep habits e. Shorter sleep duration is associated with increased risk for being overweight at ages 9 to 12 years.

Bedtime in preschool-aged children and risk for adolescent obesity. Sleep duration and obesity in children: J Paediatr Child Health. Longitudinal impact of sleep on overweight and obesity in children and adolescents: J Epidemiol Community Health. Later emotional and behavioral problems associated with sleep problems in toddlers: US Government Printing Office; Effects of a physical activity intervention in preschool children. Med Sci Sports Exerc.

Curr Dir Psychol Sci. Int J Early Years Educ. Early Childhood Obesity Prevention Policies: Goals, Recommendations, and Potential Actions. Institute of Medicine; The importance of healthy sleep habits should be incorporated into obesity prevention programming. Informal programs should be implemented during teachable moments throughout the year.

One goal of a facility is to provide a positive environment for the entire family. Periodically providing families records of the food eaten and progress in physical activities by their children will help families coordinate home food preparation, nutrition, and physical activity with what is provided at the early care and education facility.

Education should be helpful and culturally relevant and incorporate the use of locally produced food. Subchapter B—the administration for children and families, Head Start program. Poor toddler-age sleep schedules predict school-age behavioral disorders in a longitudinal survey. Sleep health literacy in Head Start families and staff: The facility should have food handling, feeding, and nutrition policies and plans under the direction of the administration that address the following items and assigns responsibility for each:.

For sample policies see the Nemours Health and Prevention Services guide on best practices for healthy eating at http: Children should have ample opportunity to do moderate to vigorous activities, such as running, climbing, dancing, skipping, and jumping, to the extent of their abilities.

All children, birth to 6 years of age, should participate daily in:. Two to 3 occasions of active play outdoors, weather permitting see Standard 3. Playing Outdoors for appropriate weather conditions.

Continuous opportunities to develop and practice age-appropriate gross motor and movement skills. The total time allotted for outdoor play and moderate to vigorous indoor or outdoor physical activity can be adjusted for the age group and weather conditions.

Infants birth—12 months of age should be taken outside 2 to 3 times per day, as tolerated. Toddlers 12 — 35 months and preschoolers 3—6 years should be allowed 60 to 90 total minutes of outdoor play 1.

These outdoor times can be curtailed somewhat during adverse weather conditions in which children may still play safely outdoors for shorter periods, but the time of indoor activity should increase so the total amount of exercise remains the same. Toddlers should be allowed 60 to 90 minutes per 8-hour day for moderate to vigorous physical activity, including running.

Preschoolers should be allowed 90 to minutes per 8-hour day for moderate to vigorous physical activity, including running 1,2. Infants should have supervised tummy time every day when they are awake. Place toys in a circle around the infant. Lie on your back and place the infant on your chest. Opportunities to actively enjoy physical activity should be incorporated into part-time programs by prorating these recommendations accordingly eg, 20 minutes of outdoor play for every 3 hours in the facility.

However, children with out-of-control behavior may need 5 minutes or fewer to calm themselves or settle down before resuming cooperative play or activities.

Infants should not be seated for more than 15 minutes at a time, except during meals or naps 5. Infant equipment, such as swings, stationary activity centers, infant seats eg, bouncers , and molded seats, should only be used for short periods, if used at all. A least-restrictive environment should be encouraged at all times 7.

Children can accumulate opportunities for activity over the course of several shorter segments of at least 10 minutes each 9. Children learn through play, developing gross motor, socioemotional, and cognitive skills. During outdoor play, children learn about their environment, science, and nature Toddlers and preschoolers generally accumulate moderate to vigorous physical activity over the course of the day in very short bursts 15—30 seconds 5.

Children may be able to learn better during or immediately after these types of short bursts of physical activity, due to improved attention and focus Tummy time prepares infants to be able to slide on their bellies and crawl.

As infants grow older and stronger they will need more time on their tummies to build their own strength 3. Childhood obesity prevalence, for children 2 to 5 years old, has steadily decreased from Incorporating government food programs, physical activities, and wellness education into child care centers has been associated with these decreases Physical activity habits learned early in life may track into adolescence and adulthood, supporting the importance for children to learn lifelong healthy physical activity habits while in the early care and education program Predicting adult obesity from childhood obesity: In addition, re-orientation training of the staff is carried out every year.

The data collected, using standardized pre-tested questionnaires, includes: Nutrition monitoring is the measurement of the changes in the nutritional status of a population or a specific group of individuals over time WHO, The paucity of reliable and comparable data from all parts of the country is a definite obstacle towards a realistic and disaggregated problem definition.

This calls for a nation-wide monitoring system. To achieve this, it is necessary to restructure and strengthen the existing National Nutrition Monitoring Bureau NNMB and to develop a mechanism for generating nationwide disaggregated data. National Nutrition Policy, Govt. The National and State governments have been implementing a number of poverty alleviation programmes for the overall socioeconomic development of the community and several nutrition interventions to mitigate the problem of undernutrition.

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