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Chapter 10
Toddler and Preschooler Nutrition
Key Nutrition Concept #1
• Children continue to grow and develop
physically, cognitively, and emotionally
during the toddler and preschool age years,
adding many new skills rapidly with time.
Key Nutrition Concept #2
• Learning to enjoy new foods and
developing feeding skills are important
components of this period of increasing
independence and exploration.
Key Nutrition Concept #3
• Children have an innate ability to selfregulate food intake. Parents and caretakers
need to provide children nutritious foods
and let children decide how much to eat.
Key Nutrition Concept #4
• Parents and caretakers have tremendous
influence on children’s development of
appropriate eating, physical activity and
other health behaviors and habits formed
during the toddler and preschool years.
These lessons are mainly transferred by
example.
Definitions of the Life Cycle
Stage
• Toddlers—1-3 years
– Characterized by rapid increase in gross & fine
motor skills
• Preschool-age children—3-5 years
– Characterized by increasing autonomy, broader
social circumstances, increasing language
skills, & expanding self-control
Importance of Nutrition Status
• During toddler and preschool years,
adequate nutrition is required to achieve full
growth & development
• Undernutrition impairs cognition & ability
to explore environment
Tracking Toddler and
Preschooler Health
• Economic & nutrition status of U.S.
children
– 18% live in poverty (2006)
– 14% have no health insurance
– 33% lived in single-parent families (make them
more likely to live in poverty)
Healthy People 2010
• Healthy People 2010 – objectives for the
nation for improvements in health status by
the year 2010
• Healthy People 2020 is under development
(www.hhs.gov)
• Table 10.1 lists the objectives for toddlers
and preschoolers with results to date
Normal Growth and
Development
• From birth to 1 year, average infant triples
his birthweight
• Toddlers gain 8 oz and grow 0.4 in per
month
• Preschoolers gain 4.4 lb and grow 2.75 in
per year
Monitoring Children’s Growth
• Use calibrated scales & height board
• Toddlers under age 2 years
– Weighed without clothes or diaper
– Determine recumbent length
• Children over age 2 years
– Weighed with light clothing
– Measure stature with no shoes
Recumbent Length
• The length of toddlers
< 24 months are
measured in the
recumbent position
The 2000 CDC Growth Charts
• Charts are:
– Gender specific - one set for girls & one for boys
– Age specific - a set for ages birth to 36 months and 220 years
• Monitor for:
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Weight-for-age
Length- or stature-for-age
Weight-for-length or -stature
BMI-for-age
The 2000 CDC Growth Charts
WHO Growth Standards
• WHO (World Health Organization)
published growth standards for children
from birth to 5 years.
• International growth standards regardless of
ethnicity or socioeconomic status.
• See the “Resources” section at the end of
the chapter or www.who.int/childgrowth
Common Problems with
Measuring & Plotting Growth
Data
• Error in measuring may result in errors in
health status assessment
• Use of calibrated equipment and plotting
accuracy are vital
Appropriate Measuring
Equipment for Young Children
Physiological and Cognitive
Development: Toddlers
• A time of expanding physical and developmental
skills
• Walking begins as a “toddle,” improving in
balance & agility
• Progress by month
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15—crawl upstairs
18—run stiffly
24—walk up stairs one foot at a time
30—alternate feet going up stairs
36—ride a a tricycle
Cognitive Development
of Toddlers
• Toddlers “orbit” around parents
• Transitions from self-centered to more interactive
• Vocabulary expands:
– 10-15 words at 18 months
– 100 at 2 years
– 3-word sentences by 3 years
• Temper tantrums common (the terrible two’s)
Development of Feeding Skills of
Toddlers
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Gross & fine motor development improved
9-10 months—weaning bottle begins
12 to 14 months—completely weaned
12 months—refined pincer
18-24 months—able to use tongue to clean
lips & has developed rotary chewing
• Adult supervision vital to prevent choking
Feeding Behaviors of Toddlers
•
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Rituals in feeding are common
May have strong preferences & dislikes
Food jags common
Serve new foods with familiar foods &
when child is hungry
• Toddlers imitate parents & older siblings
Appetite and Food Intake of
Toddlers
• Slowing growth results in decreased
appetite
• Toddler-sized portions average 1 tablespoon
per year of age
• Nutrient-dense snacks needed but avoid
grazing on sugary foods that limit appetite
for basic foods at meals
Cognitive Development of
Preschool-Age Children
• Egocentric—cannot accept another’s point
of view
• Learning to set limits for himself
• Cooperative & organized group play
• Vocabulary expands to >2000 words
• Begins using complete sentences
Development of Feeding Skills of
Preschool-Age Children
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•
•
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Can use a fork, spoon, & cup
Spills occur less frequently
Foods should be cut into bite-size pieces
Adult supervision still required
Feeding Behaviors of PreschoolAge Children
• Appetite related to growth
• Appetite increases prior to the “spurts” of
growth
• Include child in meal selection &
preparation
Meal-preparation Activities of
Young Children
Innate Ability to Control Energy
Intake & Preschool-Age Children
• Children adjust caloric intake to meet
caloric needs
• Avoid encouraging child to “clean your
plate”
• Healthful eating habits must be learned
Appetite and Food Intake of
Preschool-Age Children
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May prefer familiar foods
Serve child-sized portions
Make foods attractive
Strong-flavored or spicy foods may not be
accepted
• Control amount eaten between meals to
ensure appetite for basic foods
Temperament differences
• Temperament—the behavioral style of the
children. Three main temperaments:
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40% “easy” temperaments
10% “difficult” temperaments
15% “slow-to-warm-up”
Remaining styles are “intermediate low” to
“intermediate high”
Temperament differences
• “Easy”—adapts to regular schedules & accepts
new foods
• “Difficult”—slow to adapt and may be negative
to new foods
• “Slow-to-warm-up”—slow adaptability, negative
to new foods but can learn to accept new foods
• “Intermediate low” to “intermediate high” – a
mixture of behaviors
Food Preference Development,
Appetite, and Satiety
• Prefer sweet & slightly salty, reject sour &
bitter foods
• Eat familiar foods
• May need 8–10 exposures to new foods
before acceptance
• Food intake related to parent’s preferences
Appetite and Satiety
• Consumption of foods high in sugar and/or
fat before meals decreases intake of basic
foods
• Offering large portions increases food
intake and may promote obesity
• Restriction of palatable foods increases
preference for the foods
Feeding Relationship
• Parent or caretaker responsibilities:
– “What” children are offered to eat
– The environment in which food is served
including “when” & “where” foods are offered
• Child’s responsibilities:
– “How much” they eat
– “Whether” they eat a particular meal or snack
Feeding Relationship
Energy Needs
• Dietary Reference Intakes (DRIs) have been
developed
• The reports present a comprehensive set of
reference values for nutrient intakes of
healthy individuals
• Table 10.4 gives the Estimated Energy
Requirements for reference boys and girls
Nutrient Needs: Protein
Vitamins & Minerals
• Most toddlers and preschool-age children
have adequate vitamin & mineral
consumption except for iron, calcium and
zinc
Common Nutrition Problems
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Iron-deficiency anemia
Dental caries
Constipation
Lead poisoning
Food security
Food safety
Iron-deficiency Anemia
• Seen in 7% of toddlers
• May cause delays in
cognitive development
and behavioral
disturbances
• Diagnosed by
hematocrit and/or
hemoglobin
concentration
Iron-deficiency Anemia
• Preventing Iron Deficiency:
– Nutrition-Limit milk consumption to 24 oz/d since
milk is a poor source of iron
– Infants at risk should be tested at 9 to 12 months, 6
months later, and annually from ages 2 to 5
• Intervention for Iron Deficiency
– Iron supplements
– Counseling with parents
– Repeat screening
Dental Caries
• Prevalence:
– 1 in 5 children ages 2 to 4
• Causes:
– Bedtime bottle with juice or milk
– Streptococcus mutans
– Sticky carbohydrate foods
• Prevention:
– Fluoride—supplemental amounts vary by age &
fluoride content of water supply
Constipation
• Definition: Hard, dry stools associated with painful
bowel movements
• Causes: “Stool holding” and diet
• Prevention: Adequate fiber
Lead Poisoning
• Seen in ~2.2% of children ages 1-5
• Low levels of lead exposure linked to
lower IQ & behavioral problems
• High blood lead levels may decrease growth
• Reduce lead poisoning by eliminating
sources of lead
Food Security
• Defined as access at all times to sufficient
supply of safe, nutritious foods
• Insecurity more common in minority
populations
• A concern for growing children since food
insecurity may hinder growth &
development
Food Safety
• Young children vulnerable to food
poisoning
• Food safety practices by FightBAC:
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Clean: wash hands & surfaces often
Separate: don’t cross-contaminate
Cook: cook to proper temperature
Chill: refrigerate promptly
Prevention of Nutrition-Related
Disorders
• Overweight and obesity
• Prevention and treatment of overweight and
obesity
• Nutrition and prevention of cardiovascular
disease
• Vitamin and mineral supplements
• Herbal supplements
Overweight and Obesity
• Of children ages 2-5:
– 10.4% are overweight (BMI/age ≥95%)
– 20.6% are at risk for becoming overweight
(BMI/age ≥ 85%-95%)
• BMI is lowest from ages 4-6 years
• Adiposity rebound—normal increase in BMI that
occurs after BMI declines
• Best treatment is allowing child to “grow into his
or her height”
Prevention of Overweight &
Obesity
• Limit sugar-sweet
beverages
• Encourage fruits &
vegetables
• Limit TV
• Daily breakfast
• Limit fast foods
• Limit portions
• Calcium rich diets
• Diets high in fiber
• Follow the DRI for
carbs, pro & fat
• Promote physical
activity
• Limit energy-dense
foods
Nutrition and Prevention of
Cardiovascular Disease
• Limit dietary saturated fats, trans fat &
cholesterol
• Acceptable total fat intake ranges:
– 2 to 3 years—30 to 35% of calories
– 4 to 18 years—25 to 35% of calories
• For children at high risk of CVD limit
saturated fat to < 7% of calories &
cholesterol to < 200 mg
Vitamin and Mineral
Supplements
• A varied diet provides all vitamins & minerals
needed
• AAP recommends supplements for certain groups
of children:
– From deprived families
– With anorexia, poor appetites or poor diets, or a
dietary program for wt mgmt
– Who consume only a few types of foods
– Vegetarians without dairy products
Herbal Supplements
• Parents who take herbs are likely to give
them to their children
• Advise parents of potential risks of herbal
therapies & the need to closely monitor the
child if given supplements
Dietary and Physical Activity
Recommendations
• Dietary guidelines
– Offer a variety of foods, limiting foods high in
fat & sugar
– 60 minutes of vigorous physical activity each
day
• MyPyramid developed by the USDA for
young children
MyPyramid
MyPyramid
MyPyramid
Recommendations for Intake
• Iron- meats, fortified cereal, dried beans and
peas
• Fiber- fruits, vegetables, whole grains
• Fat- follow food guide pyramid
• Calcium- dairy, canned fish with soft bones,
green leafy vegetables, calcium-fortified
beverages
• Fluids- beverages, foods and sips of water
Recommended vs. Actual Food
Intake
• Dietary intake of children ages 2-5
– Energy exceeded by 31%
– Consistently low “mean” intakes of zinc, folic
acid, Vit D and Vit E
– Total fat is 31% of calories
– Sodium intake is 2150-2400 mg (rec 2300 mg)
– Table 10.10 shows the mean % of calories
Other Concerns
• Cross-cultural considerations
– Build on cultural practices
• Reinforce positive practices
• Attempt change for more benefit
• Vegetarian diets
– Vegan and macrobiotic diet children tend to
have lower growth rates but remain within
normal ranges
Other Concerns
• Vegetarian diet guidelines
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Several meals / day (3 meals, 2-3 snacks)
Avoid excessive bulky foods (i.e. bran)
Include energy dense foods (cheese / avocado)
Fat-30% with omega-3 fatty acids
Sources of Vitamin B12, Vitamin D and
Calcium should be included or supplemented
Other Concerns
• Child-care nutrition standards
– Nearly half of preschool-age children attend a
child care program
– Standards for child care vary by state
– Offer food at intervals not less than 2 hours &
no more 3 hours
Other Concerns
• Physical activity recommendations
– Children need at least 60 minutes of play
activity each day
– Suggested activities
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Taking a nature walk
Riding a tricycle or bicycle
Walking, skipping, running
Most important—have fun while being active!
Nutrition Intervention for Risk
Reduction
• Model program
– Bright Futures in Practice: Nutrition
• Public food and nutrition programs
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WIC
WIC’s Farmers’ Market Nutrition Program
Head Start and Early Head Start
Supplemental Nutrition Assistance Program
(formerly Food Stamps)