San Jose State University
Chapter 10 & AND Position Paper??Toddler and Preschooler NutritionKey ConceptsGrow and develop physically, cognitively, and emotionally, adding many new skills rapidlyLearning to enjoy new foods and develop feeding skillsIncreasing independence and exploration.Key ConceptsChildren have an innate ability to self-regulate food intake.Caregiver provides what and when they eatChild determines how muchCaregiver influences development of appropriate eatingphysical activitylead by exampleLife Cycle StageToddlers— 1-3 yearsrapid increase in gross & fine motor skillsPreschool-age children—3-5 yearsincreasing autonomyplay with othersincreasing language skillsexpanding self-controlImportance of NutritionAdequate nutrition for full growth and developmentUndernutrition impairs growth, cognitive development & ability to explore environmentOf US Children49% of kids under 6 w/ single female head of household live in poverty (2016)44% of kids under 6 live in poor or near poor families: Hispanic, Black & American IndianNormal Growth and DevelopmentToddlers: gain 8 oz/mo & grows 0.4 in/moPreschoolers: gain 4.4 lb/yr & grow 2.75 in/yr Growth velocity slowsAccurate assessments are essentialErrors in measure = errors in health assessment Length vs. StatureRecumbent length < 24 monthsStature > 24 mosGrowth Charts?WHO 0-2 yo?CDC 2-20 yoToddlers?Feeding SkillsGross & fine motor development improved 9 to 10 months—weaned from bottle12 months—refined pincer12-18 months – rotary chewing 18-24 months—able to use tongue to clean lips Prevent chokingToddlers?Feeding BehaviorsFood ritualsMay have strong preferences & dislikesFood jags commonServe new foods with familiar foods Serve when child is hungryLots of imitationToddlers?Appetite and Food Intake Slowing growth -> ?Toddler-sized portions1 tablespoon per year of age per type of foodNutrient-dense snacks needed Limit grazingPreschool?Feeding Skills Can use a fork, spoon, & cupCut food into bite-size piecesAdult supervision still requiredAppetite varies: related to growthIncreases prior to growth “spurts”“Clean you plate”?Include child in meal choices & preparationAge appropriate meal-prep activitiesPreschool?Feeding BehaviorsThey learn healthy eatingMay prefer familiar foodsAppropriate portion sizesMake foods attractive & funMaking food an issue….don’tMay need 8–10 exposures to new foods before acceptanceAdult responsibilities:“What”, “when” & “where” Child’s responsibilities:“How much?”“Whether?”Restricting palatable foods increases preference for the foodsPrefer sweet & saltyBy 5 yo kids may be less responsive to satiety cues than earlier.Energy Needs13-36 mos:EER = (89 x wt [kg] – 100) + 20> 36 mos:EER based on activity level, sex, age ht & wtProtein NeedsVitamins & MineralsMost toddlers and preschool-age children have adequate vitamin & mineral consumption except for iron, zinc and calcium Nutrition-related ProblemsIron-deficiency anemiaDental cariesConstipationFood securityFood safetyWeight Iron-deficiency AnemiaEtiology: rapid growth and poor consumptionMore prevalent in low income & non-White kidsPreventing iron deficiency:Limit milk consumption to 24 oz/d milk is a poor source of ironIron-rich foodsNutrition Intervention: Counseling parentsBeef, fish, dark meat poultry + vit C, fortified foodsPrescription iron supplements3 mg/kg/d dropsReassess in 4 weeksEarly Childhood Caries (ECC)Prevalence: 1 in 3 children ages 3 to 5 from 1999-2004More prevalent in non-White kidsCauses:Bedtime bottle with juice or milkSticky carbohydrate foodsPrevention:Brush after eating or rinse w/ waterFluoridated water & toothpaste – depending on agePossible fluoride supplementsConstipationDefinition: Painful BM, hard, dry stoolsEtiology: “Stool holding” and/or dietPrevention: Adequate fiber, MD Tx Food Security & Food SafetySecurity = access at all times to sufficient, safe, nutritious foodsInsecurity may hinder growth & developmentMore likely: behavioral, emotional and academic problemsSafety: especially vulnerable to foodborne illnessesFood safety practices by FightBAC:Clean: wash hands & surfaces oftenSeparate: don’t cross-contaminateCook: cook to proper temperatureChill: refrigerate promptly?Overweight & Obesity?For kids > 2 yoOvwt = BMI-for-age 85th-94th Obesity = BMI-for-age > 95thScreen for: Wt &Parental obesity, family medical history, wt related problems (OSA, asthma)Behaviors: dietary & PABMI-reboundPrevention:Offer nutrient dense foodsFocus on behavior not weightSuch as…Focus on BehaviorsLimit sugar-sweet beveragesEncourage fruits & vegetablesLimit screen timeDaily breakfastLimit restaurantsLimit portionsCalcium rich foodsHigh fiber foodsFollow the DRI for CHO, prot & fatPromote mod/vigorous physical activity 60 min/dLimit energy-dense foods4-stage approach to O & OStage 1: Identify early. Focus on prevention and behaviorsStage 2: Structured eating plan and 60 min PA dailyStage 3: Weekly visits with multi-disciplinary teamStage 4: Surgery but not for this ageDietary RecommendationsTips for offering a variety of foods:Physical ActivityEngage in active play several times each dayIndoor and outdoor activitiesNo screen time if < 2 yo< 2 hours/d for all other agesNo screens in bedrooms ................
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