Toddler and Preschooler Nutrition

Chapter 10

Key Nutrition Concepts

continue to grow and developPhysicallyCognitivelyEmotionallyNew 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 skillsRapid increases in gross motor skills

Preschool age

3-5 years of age (36 months-5th BD/Begin Kindergarten) increasing autonomybroader social circumstances increasing language skillsexpanding 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 slowsGain 5.5 to 7.5 inches totalgain 9-11 pounds totalHigher energy expended

Preschoolers

3 – 4 inches total 5 – 6 pounds per year

Developmental connections to nutrition: toddlers

Initial neophobiaExerting independenceimitation

Developmental connections: preschoolers

EgocentrismCooperation sociallyControl – languageStart to limit behavior internally

Importance of nutrition status

adequate energy & nutrientsUndernutritionFTT & cognitive impairment

Disparity of nutrition status among racial and ethnic groups

8% of low income children under age of 5 are growth retarded15% of African-American low income

children

8% of white children have iron deficiency anemia

17% of Mexican American children10% of African American children

Normal Growth and Development

The 2000 CDC Growth Chartsbody 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%tileNormal: BMI for age 5-85%tileAt risk of overweight: BMI for age 85-

95%tileOverweight: 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 needsProteinVitamins and minerals

Toddlers

Macronutrients:Estimated energy requirement (EER) is

kcal/day = (89 x weight(kg)-100)+20

DRI 992-1046 kcal30%-40% of total kcal from fat1.1 grams of protein per kg body weight130 g carbohydrates per day 14 grams fiber per 1,000 kcal/day

Toddlers

Micronutrients: fruits and vegetables

Vitamins A, C, E, calcium, iron, zinc

Iron deficient anemia

Toddlers

Fluid needs:1.3 liters per day

Supplements: fluoride via fluoridated waterSupplements ???

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

dietA vegan diet may lack essential vitamins

and minerals

Preschoolers

Macronutrients: Energy – 1642-2279 depending on gender

and ageTotal fat intake should gradually drop to a

level closer to adult fat intake25%-35% of total energy from fat

0.95 grams protein per kg body weight130 grams carbohydrate per day14 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 toddlersRDAs for iron and zinc also increase

Preschoolers

Fluid:1.7 liters per day

Supplements:?????May be recommended when particular food

groups are not eaten regularlySupplements should be appropriate for the

child’s age

Vitamin and mineral supplements

Not strictly necessaryMay be beneficial when entire food

groups are not consumed with regularityShould be age specificMonitor ULAt 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 differences40% easy, 10% difficult, 15% slow-to-warm-

upFood 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

1. Exposure2. Target Children’s Literature3. Learning across the curriculum4. Pregnancy Books5. Family Meals6. Proper Influence

Most common nutrition problems

Iron-deficiency anemiaDental caries

fluorideConstipationLead poisoningFood SecurityFood 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/dayMilk intake – should meet calcium needs

but not replace iron rich foods.Max. 24 oz/day

Lead

Exposure 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 sourcechelation

Dietary and Physical Activity Recommendations

Dietary guidelinesFood 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 programsWICHead Start and Early Head StartFood Stamps

Other Concerns

Food allergies and intoleranceDietary supplements and herbal

remediesSources of nutrition services