Toddler and Preschooler Nutrition Chapter 10

Key Nutrition Concepts continue to grow and develop Physically Cognitively Emotionally New skills rapidly with time

Key Nutrition Concepts innate ability to self-regulate food intake Parents & caretakers provide nutritious foods 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

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

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

Preschoolers 3 – 4 inches total 5 – 6 pounds per year

Developmental connections to nutrition: toddlers Initial neophobia Exerting independence imitation

Developmental connections: preschoolers Egocentrism Cooperation socially Control – language Start to limit behavior internally

Importance of nutrition status adequate energy & nutrients Undernutrition FTT & cognitive impairment

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

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 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 85-95%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 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

Toddlers Micronutrients: Iron deficient anemia fruits and vegetables Vitamins A, C, E, calcium, iron, zinc Iron deficient anemia

Toddlers Fluid needs: Supplements: 1.3 liters per day fluoride via fluoridated water Supplements ??? If giving supplements, should not exceed 100% RDA for any nutrient

Toddlers Allergies: Vegetarian families: 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

Preschoolers Micronutrients: Vitamins and minerals fruits and vegetables continue to be a concern Vitamins A, C, E, calcium, iron, zinc AI of calcium increases for toddlers RDAs for iron and zinc also increase

Preschoolers Fluid: Supplements: 1.7 liters per day ????? 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

Feeding skills: toddlers 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? 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 Food preference development 40% easy, 10% difficult, 15% slow-to-warm-up Food preference development

Food Preference Development a complex process Influences Genetics Parents Media educators at school *By age 3, the dislike for certain foods has already developed.*

Food Preferences Malnourished children vs Well- Nourished Children

Biological Influence Genetic pre-disposition of tastes Food Neophobia Exposure After-meal results Self-Regulation Developmental Landmarks Cognitive Development

Parental & Familial Influence Economics & Geography Nutrition Knowledge Foods Consumed During Pregnancy Food Modeling Short-Order Cooking Restriction

Implications for Practice 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. Max. 24 oz/day

Lead Exposure 5-10x higher rate of absorption 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: Irritability Loss of appetite Weight loss Sluggishness Abdominal pain Vomiting Constipation Pallor from anemia

Complications of lead contamination 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

Other Concerns Food allergies and intolerance Dietary supplements and herbal remedies Sources of nutrition services