Chapter 10 &
ADA Position Paper
Toddler and Preschooler
Nutrition
Key Concepts
• Grow and develop physically,
cognitively, and emotionally,
adding many new skills rapidly
• Learning to enjoy new foods and
developing feeding skills
• Increasing independence and
exploration.
Key Concepts
• Children have an innate ability to
self-regulate food intake.
– We provide what and when they eat
– They determine how much
• Influence
– development of appropriate eating
– physical activity
– Lead by example
Life Cycle Stage
• Toddlers— 1-3 years
– rapid increase in gross & fine motor
skills
• Preschool-age children—3-5
years
– increasing autonomy
– parallel play & play with others
– increasing language skills
– expanding self-control
Importance of Nutrition
• Adequate nutrition for full growth
and development
• Undernutrition impairs growth,
cognition & ability to explore
environment
• Of US Children
– 18% live in poverty (2006)
– 33% had no parent w/ full-time
year-round employment
– 14% have no health insurance
– 33% live in single-parent families:
more likely to live in poverty
Normal Growth and
Development
• 0 - 1 year: triple birthweight
• Toddlers: gain 8 oz/mo & grows
0.4 in/mo
• Preschoolers: gain 4.4 lb/yr &
grow 2.75 in/yr
• Accurate assessments are essential
– Errors in measure = errors in health
assessment
Length vs. Stature
• Recumbent length ?
• Toddler-sized portions
– 1 tablespoon per year of age per food
• Nutrient-dense snacks needed
• Limit grazing
Preschool-Age
Cognitive
• Egocentric
• Learning to set limits for himself
• Cooperative & organized group
play
• Vocabulary expands to >2000
words
• Complete sentences
Preschool
Feeding Skills
• Can use a fork, spoon, & cup
• Cut food into bite-size pieces
• Adult supervision still required
• Appetite still related to growth
– Increases prior to growth ―spurts‖
– ―Clean you plate‖?
• Include child in meal choices &
preparation
Meal-preparation
Activities of Young
Children
Preschool
Feeding Behaviors
• They learn healthy eating
– May prefer familiar foods
– Appropriate portion sizes
– Make foods attractive & fun
Making food an issue….don’t
• May need 8–10 exposures to new
foods before acceptance
• Adult responsibilities:
– ―What‖, ―when‖ & ―where‖
• Child’s responsibilities:
– ―How much?‖
– ―Whether?‖
• Restriction of palatable foods
increases preference for the foods
Energy Needs
• 13-36 mos:
EER = (89 x wt [kg] – 100) + 20
• > 36 mos:
– EER based on activity level, gender,
age ht & wt
Protein Needs
Vitamins & Minerals
• Most toddlers and preschool-age
children have adequate vitamin &
mineral consumption except for iron,
calcium and zinc
Nutrition-related
Problems
• Iron-deficiency anemia
• Dental caries
• Constipation
• Food security & safety
• Weight
• Cardiovascular disease
• Dietary supplements
• PA
Iron-deficiency Anemia
• Preventing Iron Deficiency:
– Limit milk consumption to 24 oz/d
• milk is a poor source of iron
– Iron-rich foods
• Nutrition Intervention:
– Prescription iron supplements
– Counseling with parents
Dental Caries
• Prevalence:
– 1 in 5 children ages 2 to 4
• Causes:
– Bedtime bottle with juice or milk
– Sticky carbohydrate foods
• Prevention:
– Fluoridated water & toothpaste
– Possible fluoride supplements
Constipation
• Definition: Painful, hard, dry
stools
• Etiology: ―Stool holding‖ and diet
• Prevention: Adequate fiber
Food Security & Food
Safety
• Security = access at all times to
sufficient supply of safe, nutritious
foods
– may hinder growth & development
• Safety: especially vulnerable to
foodborne illnesses
• Food safety practices by
FightBAC:
– Clean: wash hands & surfaces often
– Separate: don’t cross-contaminate
– Cook: cook to proper temperature
– Chill: refrigerate promptly
Overweight & Obesity
• Ovwt = BMI-for-age 85th-94th
• Obesity = BMI-for-age @ > 95th
• Screen for: Wt &
– Parental obesity, family medical history,
wt related problems (OSA, asthma)
– Behaviors: dietary & PA
• Prevention:
– Offer nutrient dense foods
– Focus on behavior not weight
– Such as…
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 mod/vigorous physical
activity 60 min/d
• Limit energy-dense foods
Cardiovascular Disease
• High risk:
– Familial hyperlipidemia
– Obesity of child
• AHA guidelines in childhood
– Screening: wt, blood lipids,
– Tx
• Healthy eating & wt
• Desirable lipid & BP
• Daily PA
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 2150-2400 mg (rec
2300 mg)
Dietary Supplements
• Not usually necessary
• Poorly regulated
• Only upon MD recommendation
MyPyramid for Kids
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
Other Concerns
• Cross-cultural considerations
– 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
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
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
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)
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
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