Toddler and Early

Childhood Nutrition

(Ages 1-5 years)KIM-ASHLEIGH MOSTERT

Learning Objectives

When asked by the presenter, participants will be able to identify

three community programs available to toddlers and

preschoolers

Given a scenario, participants will be able

to recognize three appropriate eating behaviors for toddlers.

Given a scenario, participants will be able

to determine one nutrition intervention to increase the number of

foods a young child will eat.

Toddler and Preschooler Characteristics

Toddler: Ages 1-3 years

Characterizations:

rapid development of gross and

fine motor skills

Increased ability to explore their

environment and language

Increasing independence

Preschooler: Ages 3-5 years

Characterizations:

Increasing autonomy

Experiencing broader social

circumstances

Increasing language skills

Expanding ability to control behavior

1 1

DRIs

Nutrition is key

during these years

to ensure full

growth and

development

potential

2

1

Growth Charts

Heights and weights are plotted

in gender-specific charts

Used to portray a pattern rather

than specific measurements

Identifies any deviations in growth

3

1, 3

Development of Skills - Toddlers

Decreased growth and appetite

Weaning

Internal hunger/fullness cues

Development ability to chew foods of different

textures

Learn to move tongue laterally and chew with rotary movements

12-18 months: can handle soft or chopped foods

18-24 months: can handle meat, raw

fruits/vegetables and multiple texture foods

1

1

Development of Skills - Toddlers

Intense need for independence

Self-feeding begins

Preferences and dislikes develop

Toddler sized

Portions

Snacks

1

1

Development of Skills - Preschoolers

Can now use forks, spoons and cups well

Spills and mess still occurs but not

intentionally

Good age to begin teaching about food,

food selection and preparation

Allow children to be involved

Reinforce good eating habits

Parents as role models

Image courtesy of Donnie Ray Jones at flickr.com

1

1, 4, 5

Development of Skills - Preschoolers

Children have an innate ability to self-regulate

caloric intake

No inborn mechanism to consume a well-balanced

diet

Food preferences, appetite and satiety develop

“picky” eaters

Preference for sweet and slightly salty taste, reject

sour or bitter taste

Image courtesy of Julian King at flickr.com

1

1, 4, 5

Temperament

Temperament: How the child tends to behave

“easy” ~40%

Adapts well, tires new foods

“difficult” ~10%

Irregular preferences, resistant

“slow to warm-up” ~15%

Slow to adapt

1

Food-Related Parenting Styles

Permissive: child eats what he wants

Authoritarian: control child’s intake via commands,

instructions, coercion

Authoritative: uses questions and reasoning in

attempt to shape and guide a child’s behavior 5

5

5

Common Nutrition Problems

Dental caries

Sleeping with a bottle

Constipation

Vitamin D Deficiency

Calcium deficiency

Iron deficiency9,10

6

1

7,8

Common Nutrition Problems

Food security

Children have a high nutrient need

Very vulnerable

Food safety

Foodborne illnesses

USDA guidelines for children

Obesity

1

1

Image courtesy of Merelize at Stockvault.net

Early Childhood Obesity

Early intervention is important

Overweight toddlers overweight adults

Prevention policies:

Growth monitoring

Physical activity

Healthy eating

Marketing and screen time

Sleep Image courtesy of Jack Moreh at Stockvault.net

11

12

“Adult” Diseases on the Rise

Type II Diabetes

Hypertension/Prehypertension

Underdiagnosed in toddlers/preschoolers

Cardiac problems

13,14

13,14

Nutrition Related Programs

Head Start

Early Head start

Child and Adult Care Food Program (CACFP)

Women, Infants, Children (WIC)

First 5 California

15,16

17

18,19

20

Head Start Programs

Administered by the Administration for Children and Families (ACF)

Within the Department of Health and Human Services (HHS)

Edibility usually based on income at or below the poverty line

Support children’s growth and development through:

Early learning

Health

nutrition

Family well-being

Child and Adult Care Food Program (CACFP)

Funded via grants to States

Located at various locations

Child care centers

Day care homes

Afterschool programs

Eligibility/pricing

<130% poverty line – free meals

130%-185% - reduced price meals

>185% - full price

Women, Infants, Children (WIC)

Supplemental program

Provides food, health care, nutrition education

Eligibility based on income

Must be pregnant, breastfeeding, or just had a

baby

Infants and children up to age 5

First 5 California

All children ages 0-5years are eligible

Various programs and resources throughout the community

Health

Oral health

Nutrition and Physical Activity

Quality early care and education

School readiness

Effective parenting

Case Study

Ava is a 2-year old living with her parents in low-income housing. During the week

Ava’s parents work full-time so Ava stays at a child care center where she usually

eats mac and cheese or PB&J for lunch. On the weekends, her parents enjoy

spending time with Ava but much of the time is spent running errands and catching

up on tasks around the house. Partly to appease Ava, her parents allow her to have

as much of her favorite snacks, apple juice from a sippy cup, crackers, and cookies, as she wants between meals. When the family sits down to have a meal together,

Ava usually doesn’t eat much and plays with her food. She complains of not liking

the food and wants something different. Ava becomes very fussy and wants to leave

the table. In an attempt to keep Ava at the table with them, her parents turn on the

TV and if that doesn’t quiet Ava, her mother offers to make another meal of Ava’s choice

adapted from Case Study 10.1 Nutrition through the Lifecycle p.2731

Questions?

References

1. Brown J, Isaacs J, Krinke UB, et al. Nutrition through the Lifecycle. 4th ed. Belmont, CA: Cengage Learning; 2011.

2. DRI Tables and Application Reports | Food and Nutrition Information Center. https://fnic.nal.usda.gov/dietary-guidance/dietary-reference-intakes/dri-tables-and-application-reports. Published 2011. Accessed September 20, 2016.

3. Growth Charts - Clinical Growth Charts. http://www.cdc.gov/growthcharts/clinical_charts.htm. Accessed September 20, 2016.

4. Nicklas T a, Baranowski T, Baranowski JC, Cullen K, Rittenberry L, Olvera N. Family and child-care provider influences on preschool children’s fruit, juice, and vegetable consumption. Nutr Rev. 2001;59(7):224-235. doi:10.1111/j.1753-4887.2001.tb07014.x

5. Patrick H, Nicklas TA. A Review of Family and Social Determinants of Children’s Eating Patterns and Diet Quality. J Am Coll Nutr. 2005;24(2):83-92. doi:10.1080/07315724.2005.10719448.

6. Voskuijl WP. Paediatric constipation and functional non-retentive faecal soiling. 2005. http://dare.uva.nl/record/1/239374. Accessed September 18, 2016.

7. Gartner L, Greer F. Prevention of Rickets and Vitamin D Deficiency: New Guidelines for Vitamin D Intake. Pediatrics. 2003;111:908-910.

8. Gordon CM, Feldman HA, Sinclair L, et al. Prevalence of Vitamin D Deficiency Among Healthy Infants and Toddlers. Arch PediatrAdolesc Med. 2008;162(6):505. doi:10.1001/archpedi.162.6.505.

9. Baker RD, Greer FR. Diagnosis and Prevention of Iron Deficiency and Iron-Deficiency Anemia in Infants and Young Children (0–3 Years of Age). Pediatrics. 2010;126(5).

10. Lozoff B, Jimenez E, Hagen J, Mollen E, Wolf A. Poorer Behavioral and Developmental Outcome More than 10 Years After Treatment for Iron Deficiency in Infancy. Pediatrics. 2006;105.

References

11. Paul IM, Bartok CJ, Downs DS, Stifter CA, Ventura AK, Birch LL. Opportunities for the primary prevention of obesity during infancy. AdvPediatr. 2009;56(1):107-133. doi:10.1016/j.yapd.2009.08.012.

12. Early Childhood Obesity Prevention Policies: Goals, Recommendations, and Potential Actions. Washington, DC; 2011.

13. Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents.; 2005. https://www.nhlbi.nih.gov/files/docs/resources/heart/hbp_ped.pdf. Accessed September 20, 2016.

14. Hansen ML, Gunn PW, Kaelber DC, et al. Underdiagnosis of Hypertension in Children and Adolescents. JAMA. 2007;298(8):874. doi:10.1001/jama.298.8.874.

15. Early Childhood Health and Wellness: Nutrition. https://eclkc.ohs.acf.hhs.gov/hslc/tta-system/health/nutrition. Published 2016. Accessed September 24, 2016.

16. Head Start Program Facts Fiscal Year 2015. https://eclkc.ohs.acf.hhs.gov/hslc/data/factsheets/docs/head-start-fact-sheet-fy-2015.pdf. Published 2016. Accessed September 24, 2016.

17. Child and Adult Care Food Program (CACFP). http://www.fns.usda.gov/cacfp/why-cacfp-important.

18. Women, Infants and Children Program. http://www.cdph.ca.gov/programs/wicworks/Pages/default.aspx/. Published 2016. Accessed September 24, 2016.

19. About WIC | Food and Nutrition Service. http://www.fns.usda.gov/wic/about-wic.

20. First 5 California. http://www.ccfc.ca.gov/.