1. Chapter 10 Toddler and Preschooler Nutrition
Nutrition Through the Life Cycle
Judith E. Brown

2. 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

3. 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

4. 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)

5. 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 (
Table 10.1 lists the objectives for toddlers and preschoolers with results to date

6. 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

7. 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

8. Recumbent Length
The length of toddlers < 24 months are measured in the recumbent position

9. The 2000 CDC Growth Charts Charts are: Monitor for:
Gender specific - one set for girls & one for boys
Age specific - a set for ages birth to 36 months and 2-20 years
Monitor for:
Weight-for-age
Length- or stature-for-age
Weight-for-length or -stature
BMI-for-age

10. The 2000 CDC Growth Charts

11. 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

12. 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

13. Appropriate Measuring Equipment for Young Children

14. 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
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

15. 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)

16. Development of Feeding Skills of Toddlers
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

17. Feeding Behaviors of Toddlers
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

18. 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

20. 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

21. Development of Feeding Skills of Preschool-Age Children
Can use a fork, spoon, & cup
Spills occur less frequently
Foods should be cut into bite-size pieces
Adult supervision still required

22. Feeding Behaviors of Preschool-Age Children
Appetite related to growth
Appetite increases prior to the “spurts” of growth
Include child in meal selection & preparation

23. Meal-preparation Activities of Young Children

24. 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

25. Appetite and Food Intake of Preschool-Age Children
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

26. Temperament differences
Temperament—the behavioral style of the children. Three main temperaments:
40% “easy” temperaments
10% “difficult” temperaments
15% “slow-to-warm-up”
Remaining styles are “intermediate low” to “intermediate high”

27. 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

28. 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

29. 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

30. 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

31. Feeding Relationship

32. 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

33. Nutrient Needs: Protein

34. Vitamins & Minerals
Most toddlers and preschool-age children have adequate vitamin & mineral consumption except for iron, calcium and zinc

35. Common Nutrition Problems
Iron-deficiency anemia
Dental caries
Constipation
Lead poisoning
Food security
Food safety

36. Iron-deficiency Anemia
Seen in 7% of toddlers
May cause delays in cognitive development and behavioral disturbances
Diagnosed by hematocrit and/or hemoglobin concentration

37. 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

38. Dental Caries Prevalence: Causes: Prevention:
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

39. Constipation
Definition: Hard, dry stools associated with painful bowel movements
Causes: “Stool holding” and diet
Prevention: Adequate fiber

40. 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

41. 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

42. Food Safety Young children vulnerable to food poisoning
Food safety practices by FightBAC:
Clean: wash hands & surfaces often
Separate: don’t cross-contaminate
Cook: cook to proper temperature
Chill: refrigerate promptly

43. 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

44. 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”

45. 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

46. 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

47. 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

48. 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

49. 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

50. MyPyramid

51. MyPyramid

52. MyPyramid

53. 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

54. 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 mg (rec 2300 mg)
Table shows the mean % of calories

55. Other Concerns Cross-cultural considerations Vegetarian diets
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

56. Other Concerns Vegetarian diet guidelines
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

57. 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

58. Other Concerns Physical activity recommendations
Children need at least 60 minutes of play activity each day
Suggested activities
Taking a nature walk
Riding a tricycle or bicycle
Walking, skipping, running
Most important—have fun while being active!

59. Nutrition Intervention for Risk Reduction
Model program
Bright Futures in Practice: Nutrition
Public food and nutrition programs
WIC
WIC’s Farmers’ Market Nutrition Program
Head Start and Early Head Start
Supplemental Nutrition Assistance Program (formerly Food Stamps)