Chapter 10 Toddler and Preschooler Nutrition Through the

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

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

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

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)

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 (www. hhs. gov) • Table 10. 1 lists the objectives for toddlers and preschoolers with results to date

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

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

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

The 2000 CDC Growth Charts • Charts are: – 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

The 2000 CDC Growth Charts

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 www. who. int/childgrowth

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

Appropriate Measuring Equipment for Young Children

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

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)

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

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

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

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

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

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

Meal-preparation Activities of Young Children

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

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

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”

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

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

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

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

Feeding Relationship

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

Nutrient Needs: Protein

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

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

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

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

Dental Caries • Prevalence: – 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

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

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

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

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

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

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 height”

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

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

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

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

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 • My. Pyramid developed by the USDA for young children

My. Pyramid

My. Pyramid

My. Pyramid

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

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 2150 -2400 mg (rec 2300 mg) – Table 10. 10 shows the mean % of calories

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 B 12, 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

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!

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