Nutrition for Toddler and Preschoolers

Authoritative:

caregiver sets appropriate limits, but allows the child to have some autonomy in food choices and amount of food eaten

CDC growth charts

children 2 to 20 years sold

permissive

indulgent; few limits are set on food choices and timing of meals or snacks; the child eventually gets whatever he desires.

Who growth charts

infants and toddlers up to 2 years of age

Avoidant Restrictive Food Intake Disorder

involve limitations in the amount or types of food consumed, but unlike anorexia, AFRID does not involve body image

Explain why it is counterproductive to severely restrict access to palatable foods (i.e., high-fat, high-sugar choices).

-Children have a natural preference for sweet and slightly salty flavors -Restricting access to palatable foods makes those foods seem more desirable -Promotes bingeing or secretive eating -Associates eating with guilt

State basic principles for treatment of overweight and obesity among toddlers and preschoolers

-Children have the advantage of being able to grow into their weight *Maintain weight as height naturally increases *Weight loss, if needed, should not exceed 1 pound per month -Ensure nutrient adequacy (protein, vitamins, minerals, essential fatty acids) Every sound weight management program should include three key elements: -Calorie control -Increased physical activity -Modification of problem behaviors (consistent monitoring is crucial)

physiological and cognitive development in toddler 1 to 3 years old

-Development of motor skills Able to self-feed Able to handle utensils, drink from cup -Increasing mobility Caregivers should require that the child sit at the table to eat to prevent choking and mindless eating -Increasing independence Able and determined to self-feed Start to make food choices within limits set by caregivers May contribute to food jags (eating only one food or just a few favorite foods for a period of time), food refusals (Don't freak out about food jags or food refusals! These things are totally normal for this stage of development! Only get worried if the child is not growing as expected.) -Exploration of environment May be distracted at mealtimes, less interested in eating Caregivers should try to limit distractions (e.g., television) at mealtimes -Keep inappropriate foods, drinks, supplements out of reach -Developing language skills Family mealtimes are an excellent opportunity to foster development of language and social skills Imitates others Caregivers must be good role models; children do not always do what we say, they do what we do! -Need for rituals May contribute to food jags Offering a new food with a favorite food may foster acceptance of the new food

Identify underweight, overweight, and obesity in children 0 to 2

-For children under age 2, we don't calculate BMI yet. We use the weight-for-length growth chart, which is a similar concept. Weight Status Category Percentile Range Underweight <5th Normal or healthy weight 5th up to 95th Overweight ≥95th

Generalize weight and stature gains of toddlers and preschoolers.

-For comparison, during infancy (0 to 12 months), growth velocity is quite rapid. On average, a term infant weighs ~7 pounds and will double his birth weight by 6 months of age and triple his birth weight by 12 months of age. On average, an infant will increase in length by 10 inches (25 cm) during the first year of life. To support this rapid growth during the first year, the infant's appetite is voracious! Caregivers get used to seeing the infant's hearty appetite. -After the first year of life, growth velocity normally slows down. Weight gains during the toddler and preschool years are usually around 4 to 5 pounds per year. Stature gains gradually slow from about 4 inches per year to about 3 inches per year by age 5. Because growth velocity has slowed down, appetite will naturally decrease. Caregivers are often surprised that the toddler and preschool doesn't have such a hearty appetite, but it is NORMAL during this stage for appetite to decrease because the demands for growth have decreased.

Describe how to collect accurate weight measurements.

-For infants, it is most accurate to measure weight with no diaper on, using a calibrated infant scale -For toddlers and preschoolers, measure weight in minimal clothing, without shoes

Recognize that growth velocity predicts appetite among toddlers and preschoolers.

-Growth patterns are not linear; growth occurs in spurts -Appetite tends to increase just before a growth spurt -Decreased appetite during toddler/preschooler years is normal!

physiological and cognitive development in toddler 3 to 5 years old

-Increasing autonomy Self-feeding Allow children to choose foods (within limits set by caregivers) Children may enjoy participating in food selection and preparation Good opportunity to develop dexterity May improve acceptance of foods -Broadening social circumstances Peers and media influence eating behaviors -Developing language skills Expression of hunger, satiety, food preferences Family mealtimes still offer ideal space for language and social development -Expanding ability to control behavior Children at this age are always testing the limits of authority; they may act out, but don't let mealtime become a battleground! Respect the child's ability to self-regulate food intake

Differentiate between iron deficiency and iron deficiency anemia

-Iron deficiency: depletion of iron stores Low transferrin saturation (Links to an external site.)Links to an external site. Low serum ferritin (Links to an external site.)Links to an external site. -Iron-deficiency anemia: unhealthy red blood cells due to depletion of iron stores Low hemoglobin (Links to an external site.)Links to an external site. Low hematocrit (Links to an external site.)Links to an external site.

Outline strategies to prevent iron deficiency among young children.

-Limit consumption of cow's milk to 24 fl oz/d -Milk is poor source of iron Large volume of milk may fill the child's stomach and displace iron-rich food sources -Iron-fortified breakfast cereal -Lean meat, fish, poultry -Combine non-heme sources of iron with a source of vitamin C to enhance absorption -Screening (blood tests) ~12 months of age (especially for children in low-income families or children with special health care needs)

Describe nutrition interventions for iron-deficiency anemia among young children.

-Once iron-deficiency anemia has developed, dietary changes are inadequate to restore iron status; supplementation is necessary -3 mg/kg/d for several weeks

Recognize that children are born with the ability to self-regulate calorie intake.

-Respect the child's hunger and satiety cues -Do not force or bribe a child to eat -Regular growth will indicate nutritional adequacy -Ellyn Satter's division of responsibility. Caregivers are responsible for the what, when, and where of eating; children are responsible for whether and how much As children get older, external influences play a greater role in appetite regulation

AHA guidelines for blood lipid screening for children.

-Screen at-risk children starting after age 2, but not later than age 10 "At risk" Family history of dyslipidemia or premature cardiovascular disease Unknown family history Overweight or obese Hypertension Diabetes

List strategies for prevention of early childhood caries.

-Wean from bottle to cup by 18 months of age -Limit continuous access to carbohydrate-rich fluids Sippy cups Bedtime bottle -Rinse mouth with water or brush teeth after meals and snacks -Use fluoridated water and/or toothpaste (supervise use of toothpaste to prevent excessive ingestion of fluoride) -Discuss the need for fluoride supplementation with pediatrician or dentist if water supply is not fluoridated

stature

-after two years of age -standing height -no SHOES -using a calibrated stadiometer

Recumbent length

-up to 2 years of age -infant/toddler is measured lying down, using a calibrated length headboard -Infant (or young toddler) should be supine (i.e., lying down) with shoulders and legs flat against the table and arms at the sides -Head should be firmly touching the headboard -Line of vision should be perpendicular to the table -Soles of feet should be vertical; the footboard should be pressed firmly against the soles of the feet

Recall protein needs of young children

1 to 3 years: 1.1 g/kg/d (or 13 g/d) 4 to 8 years: 0.95 g/kg/d (or 19 g/d)

approximate fluid needs of young children

1 to 3 years: 1.3 L/d (~5.5 cups/d) 4 to 8 years: 1.7 L/d (~7 cups/d)

AMDR for fat for young children

1 to 3 years: 30% to 40% of total kcal 4 to 18 years: 25% to 35% of total kcal

RDA for iron for young children

1 to 3 years: 7 mg/d 4 to 8 years: 10 mg/d

RDA for calcium for young children

1 to 3 years: 700 mg/d 4 to 8 years: 1000 mg/d

Suggest good food sources of calcium for young children.

2 to 3 servings of low-fat or fat-free dairy products per day Canned fish with soft bones Dark green, leafy vegetables Tofu made with calcium Fortified breakfast cereals Fortified orange juice

carbohydrate requirements of young children are the same as for adults

AMDR: 45% to 65% of total kcal RDA: 130 g/d

the RDA for vitamin D for children

All children, age 1 and older: 15 mcg/d

List possible causes for failure to thrive.

Digestive problems Breathing problems Neurological conditions Conditions that increase kcal or nutrient needs Abuse, neglect, or lack of caregiver knowledge

Energy needs may be less than expected

Down syndrome Spina bifida Nonambulatory children with diplegia Prader-Willi syndrome

heart-healthy sources of fat for young children

Choose low-fat or fat-free dairy products after age 2 Choose plant oils instead of animal fats most of the time Include 2 servings of fish per week Sources of essential fatty acids Linoleic acid (omega-6) Nuts, peanut oil Canola oil Corn oil Safflower oil Alpha-linolenic acid (omega-3) Flaxseeds, flaxseed oil Soy Canola oil

Energy needs may be more than expected

Cystic fibrosis: malabsorption of energy-yielding nutrients Renal disease: loss of energy-yielding nutrients during peritoneal dialysis Ambulatory children with diplegia: increased energy expenditure during physical activity Pediatric AIDS Bronchopulmonary dysplasia: extra work of breathing

failure to thrive

Declining >2 major growth percentiles Weight-for-age, stature-for-age, or BMI-for-age <5th percentile

Explain why snacks are an important part of the young child's dietary pattern.

High energy and nutrient needs/kg, yet small stomach capacity View snacks as small, nutrient-dense meal

iron deficiency is the most common nutrient deficiency worldwide.

Highest risk: 9 to 18 months of age Rapid growth rate during infancy Inadequate dietary intake

Normal picky eating

Normal -Decreased appetite due to decreased growth velocity -Need for rituals -Developing independence, control -Neophobia (i.e., fear of new things) is normal at this age; familiar things are comfortable -Young children have more sensitive taste buds

Not normal picky eating

Not normal -Decreased appetite due to indiscriminate snacking -Illness: medical interventions (e.g., tube feeding, respirator) during infancy and childhood may disrupt normal development of feeding skills and lead to feeding problems -Eating disorders

Name two (rare) genetic disorders that result in obesity or overgrowth in toddlers and preschoolers

Prader-Willi syndrome (Links to an external site.)Links to an external site. Wiedemann-Beckwith syndrome (Links to an external site.)Links to an external site.

Suggest good sources of vitamin D for young children.

Sun exposure (~10 to 15 minutes per day of sun exposure on face and arms) Fortified dairy products Fatty fish AAP recommends 400 IU supplemental vitamin D until food intake supplies this much

food intolerance

adverse reaction to food that does not involve an immune response; usually due to lack of enzyme

food allergy

adverse reaction to food that involves an immune response to a food component (usually a protein); may involve one or more of the following symptoms (symptoms marked with * indicate anaphylaxis, a life-threatening emergency)

amount and type of physical activity for toddlers and preschoolers.

at least 3 hours per day for children between the ages of 3 and 5.

eight common food allergens

milk soy wheat shellfish peanuts fish tree nuts eggs

authoritarian

parent centered; the parent or caregiver dictates most aspects of feeding without much regard for the child's personal preferences or appetite

Neglectful:

parent is uninvolved in the feeding process and may not have appropriate food choices available

Identify underweight, overweight, and obesity in children 2 to 20

use BMI-for-age growth chart Weight Status Category Percentile Range Underweight <5th Normal or healthy weight 5th up to 85th Overweight 85th up to 95th Obese ≥95th

Recall appropriate servings sizes for toddlers.

~1 tablespoon of each food per year of age. For example, a three-year-old may eat 1 ounce of chicken, 3 tablespoons of applesauce, 3 tablespoons of peas, and 3 tablespoons of rice at dinner. Remember that a child's stomach is about the size of his fist; the total volume of food a child can eat at one meal or snack is quite small