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Toddler and Preschooler Nutrition
Chapter 10
Key Nutrition Concepts

continue to grow and develop
Physically
 Cognitively
 Emotionally
 New skills rapidly with time
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Key Nutrition Concepts

innate ability to self-regulate food intake
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Parents & caretakers provide nutritious
foods
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children decide if & how much to eat
Key Nutrition Concepts

Parents & caretakers

tremendous influence
Toddlers
1-3 years (12-36 months)
 Increase in fine motor skills
 Rapid increases in gross motor skills
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Preschool age

3-5 years of age (36 months-5th
BD/Begin Kindergarten)
increasing autonomy
 broader social circumstances
 increasing language skills
 expanding self-control of behavior
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Physical growth

Decrease in rate
 Body proportions change – head growth is
minimal ; trunk & limbs lengthen
 Fat proportions decrease
 Catch-up growth can occur c adequate TX
Toddlers
Rapid growth rate of infancy slows
 Gain 5.5 to 7.5 inches total
 gain 9-11 pounds total
 Higher energy expended
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Preschoolers
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3 – 4 inches total
5 – 6 pounds per year
Developmental connections to
nutrition: toddlers
Initial neophobia
 Exerting independence
 imitation
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Developmental connections:
preschoolers
Egocentrism
 Cooperation socially
 Control –
 language
 Start to limit behavior internally
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Importance of nutrition status
adequate energy & nutrients
 Undernutrition
 FTT & cognitive impairment
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Disparity of nutrition status among
racial and ethnic groups

8% of low income children under age of
5 are growth retarded

15% of African-American low income
children

8% of white children have iron deficiency
anemia
17% of Mexican American children
 10% of African American children
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Normal Growth and
Development

The 2000 CDC Growth Charts

body mass index (BMI)
2000 CDC Growth charts
Birth to 36 months: weight/age; length for
age; head circumference for age; weight
for length
 2-20 years: weight for age; stature for
age; body mass index

BMI
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Predictive of body fat for children over
age of 2
Interpreting the BMI
Underweight: BMI/age <5%tile
 Normal: BMI for age 5-85%tile
 At risk of overweight: BMI for age 8595%tile
 Overweight: BMI for age>95%tile

Recumbent length

Not my husband 
Head Circumference

Not my baby 
Physiological and Cognitive
Development

Development of feeding skills

Feeding behaviors
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Appetite and food intake

Growth
Energy and Nutrient Needs
Energy needs
 Protein
 Vitamins and minerals

Toddlers
Macronutrients:

Estimated energy requirement (EER) is
kcal/day = (89 x weight(kg)-100)+20
DRI 992-1046 kcal
 30%-40% of total kcal from fat
 1.1 grams of protein per kg body weight
 130 g carbohydrates per day
 14 grams fiber per 1,000 kcal/day
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Toddlers
Micronutrients:

fruits and vegetables
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Vitamins A, C, E, calcium, iron, zinc
Iron deficient anemia
Toddlers
Fluid

needs:
1.3 liters per day
Supplements:
fluoride via fluoridated water
 Supplements ???


If giving supplements, should not exceed 100%
RDA for any nutrient
Toddlers
Allergies:
watch for food allergies
 introduce one new food at a time

Vegetarian
families:
including eggs and dairy can be a healthful
diet
 A vegan diet may lack essential vitamins
and minerals

Preschoolers
Macronutrients:
Energy – 1642-2279 depending on gender
and age
 Total fat intake should gradually drop to a
level closer to adult fat intake


25%-35% of total energy from fat
0.95 grams protein per kg body weight
 130 grams carbohydrate per day
 14 grams fiber per 1,000 kcal
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Preschoolers
Micronutrients:
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Vitamins and minerals
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fruits and vegetables continue to be a concern
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Vitamins A, C, E, calcium, iron, zinc
AI of calcium increases for toddlers
 RDAs for iron and zinc also increase

Preschoolers
Fluid:

1.7 liters per day
Supplements:
?????
 May be recommended when particular food
groups are not eaten regularly
 Supplements should be appropriate for the
child’s age

Vitamin and mineral supplements
Not strictly necessary
 May be beneficial when entire food
groups are not consumed with regularity
 Should be age specific
 Monitor UL
 At risk children: abused or neglected;
anorexia; fad diets; vegan diet
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Feeding skills: toddlers
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Weaning
Ability to chew and
self feed
“I do it”
Prefer to eat with
hands
Can use cups and
spoons

Food jags: strong
food preferences
and dislikes
 Food refusals
 Natural to have
decreased interest in
food
Feeding skills: Preschoolers

Skilled with fork,
spoon, cup
 Tolerates most
textures of foods
 Must be careful of
choking hazards
 Messy eating is not
the norm

Growth
variable….appetite
and intake increase
prior to growth spurt
 Desire to help and
please
 May be picky –
exerting control,
comforted by familiar
foods
How much food intake?


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Toddlers – 1 T food per
year of age
Caregivers tend to
overestimate portion
sizes
Important to establish
regular (yet flexible)
patterns
Avoid uncontrolled
grazing




Serve child sized
portions
Avoid mixing foods
together
Again, regular but
flexible patterns
Avoid uncontrolled
grazing
Mealtime

Is a time for learning

Not a time for battles
Other Factors

Temperament differences
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40% easy, 10% difficult, 15% slow-to-warmup
Food preference development
Food Preference Development
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a complex process
 Influences
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Genetics
Parents
Media
educators at school
*By age 3, the dislike for certain foods has already
developed.*
Food Preferences
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Malnourished children vs Well- Nourished
Children
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Biological Influence
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Genetic predisposition of tastes
Food Neophobia
Exposure
After-meal results
Self-Regulation
Developmental
Landmarks
Cognitive
Development
Parental & Familial Influence
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Economics &
Geography
Nutrition Knowledge
Foods Consumed
During Pregnancy
Food Modeling
Short-Order Cooking
Restriction
Implications for Practice
1.
2.
3.
4.
5.
6.
Exposure
Target Children’s Literature
Learning across the curriculum
Pregnancy Books
Family Meals
Proper Influence
Most common nutrition problems
Iron-deficiency anemia
 Dental caries


fluoride
Constipation
 Lead poisoning
 Food Security
 Food Safety

Diagnostic levels
1-2 years of age: Hgb<11 g/dl; Hct
<32.9%
 2-5 years: Hgb <11.1 g/dl; Hct <33%

Prevention
7-10 mg iron/day
 Milk intake – should meet calcium needs
but not replace iron rich foods.
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Max. 24 oz/day
Lead
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Exposure

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
old paint, pieces of metal, lead pipes leaching into
water ;soil; imported canned foods; household dust;
5-10x higher rate of absorption
Other nutrient deficiencies exacerbate


vitamin c, iron, calcium, Vitamin D, zinc
3x more likely to have elevated lead levels
The signs and symptoms of lead poisoning in
children are nonspecific and may include:
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Irritability
Loss of appetite
Weight loss
Sluggishness
Abdominal pain
Vomiting
Constipation
Pallor from anemia
Complications of lead contamination
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Nervous system and kidney damage
Learning disabilities
Speech, language and behavior problems
Poor muscle coordination
Decreased muscle and bone growth
Hearing damage
Treatment
Removal of source
 chelation

Dietary and Physical Activity
Recommendations
Dietary guidelines
 Food Guide Pyramid developed by the
USDA for young children

School-Aged Children
http://www.letsmove.gov/kids-state-dinner
Nutrition Intervention for Risk
Reduction

Public food and nutrition programs
WIC
 Head Start and Early Head Start
 Food Stamps
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Other Concerns
Food allergies and intolerance
 Dietary supplements and herbal
remedies
 Sources of nutrition services
