1. Toddler and Preschooler Nutrition
Chapter 10

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

3. Key Nutrition Concepts
innate ability to self-regulate food intake
Parents & caretakers provide nutritious foods
children decide if & how much to eat

4. Key Nutrition Concepts
Parents & caretakers
tremendous influence

5. Toddlers 1-3 years (12-36 months) Increase in fine motor skills
Rapid increases in gross motor skills

6. 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

7. 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

8. Toddlers Rapid growth rate of infancy slows
Gain 5.5 to 7.5 inches total
gain 9-11 pounds total
Higher energy expended

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

10. Developmental connections to nutrition: toddlers
Initial neophobia
Exerting independence
imitation

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

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

13. 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

14. Normal Growth and Development
The 2000 CDC Growth Charts
body mass index (BMI)

15. 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

16. BMI
Predictive of body fat for children over age of 2

17. 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

18. Recumbent length
Not my husband 

19. Head Circumference
Not my baby 

22. Physiological and Cognitive Development
Development of feeding skills
Feeding behaviors
Appetite and food intake
Growth

23. Energy and Nutrient Needs
Energy needs
Protein
Vitamins and minerals

24. Toddlers Macronutrients:
Estimated energy requirement (EER) is kcal/day = (89 x weight(kg)-100)+20
DRI 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

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

26. 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

27. 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

28. Preschoolers Macronutrients:
Energy – 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

29. 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

30. 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

31. 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

32. 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

33. 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

34. 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

35. Mealtime
Is a time for learning
Not a time for battles

36. Other Factors Temperament differences Food preference development
40% easy, 10% difficult, 15% slow-to-warm-up
Food preference development

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

38. Food Preferences
Malnourished children vs Well- Nourished Children

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

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

41. Implications for Practice
Exposure
Target Children’s Literature
Learning across the curriculum
Pregnancy Books
Family Meals
Proper Influence

42. Most common nutrition problems
Iron-deficiency anemia
Dental caries
fluoride
Constipation
Lead poisoning
Food Security
Food Safety

43. Diagnostic levels 1-2 years of age: Hgb<11 g/dl; Hct <32.9%
2-5 years: Hgb <11.1 g/dl; Hct <33%

44. Prevention 7-10 mg iron/day
Milk intake – should meet calcium needs but not replace iron rich foods.
Max. 24 oz/day

45. 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

46. 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

47. 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

48. Treatment
Removal of source
chelation

49. Dietary and Physical Activity Recommendations
Dietary guidelines
Food Guide Pyramid developed by the USDA for young children

50. School-Aged Children

51. Nutrition Intervention for Risk Reduction
Public food and nutrition programs
WIC
Head Start and Early Head Start
Food Stamps

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