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Toddler and Preschooler Nutrition
Chapter 10
Key Nutrition Concepts
continue to grow and developPhysicallyCognitivelyEmotionallyNew skills rapidly with time
Key Nutrition Concepts
innate ability to self-regulate food intake
Parents & caretakers provide nutritious foods
children decide if & how much to eat
Key Nutrition Concepts
Parents & caretakers tremendous influence
Toddlers
1-3 years (12-36 months)Increase in fine motor skillsRapid increases in gross motor skills
Preschool age
3-5 years of age (36 months-5th BD/Begin Kindergarten) increasing autonomybroader social circumstances increasing language skillsexpanding self-control of behavior
Physical growth
Decrease in rate Body proportions change – head growth is
minimal ; trunk & limbs lengthen Fat proportions decrease Catch-up growth can occur c adequate TX
Toddlers
Rapid growth rate of infancy slowsGain 5.5 to 7.5 inches totalgain 9-11 pounds totalHigher energy expended
Preschoolers
3 – 4 inches total 5 – 6 pounds per year
Developmental connections to nutrition: toddlers
Initial neophobiaExerting independenceimitation
Developmental connections: preschoolers
EgocentrismCooperation sociallyControl – languageStart to limit behavior internally
Importance of nutrition status
adequate energy & nutrientsUndernutritionFTT & cognitive impairment
Disparity of nutrition status among racial and ethnic groups
8% of low income children under age of 5 are growth retarded15% of African-American low income
children
8% of white children have iron deficiency anemia
17% of Mexican American children10% of African American children
Normal Growth and Development
The 2000 CDC Growth Chartsbody mass index (BMI)
2000 CDC Growth charts
Birth to 36 months: weight/age; length for age; head circumference for age; weight for length
2-20 years: weight for age; stature for age; body mass index
BMI
Predictive of body fat for children over age of 2
Interpreting the BMI
Underweight: BMI/age <5%tileNormal: BMI for age 5-85%tileAt risk of overweight: BMI for age 85-
95%tileOverweight: BMI for age>95%tile
Recumbent length
Not my husband
Head Circumference
Not my baby
Physiological and Cognitive Development
Development of feeding skills
Feeding behaviors
Appetite and food intake
Growth
Energy and Nutrient Needs
Energy needsProteinVitamins and minerals
Toddlers
Macronutrients:Estimated energy requirement (EER) is
kcal/day = (89 x weight(kg)-100)+20
DRI 992-1046 kcal30%-40% of total kcal from fat1.1 grams of protein per kg body weight130 g carbohydrates per day 14 grams fiber per 1,000 kcal/day
Toddlers
Micronutrients: fruits and vegetables
Vitamins A, C, E, calcium, iron, zinc
Iron deficient anemia
Toddlers
Fluid needs:1.3 liters per day
Supplements: fluoride via fluoridated waterSupplements ???
If giving supplements, should not exceed 100% RDA for any nutrient
Toddlers
Allergies:watch for food allergies introduce one new food at a time
Vegetarian families: including eggs and dairy can be a healthful
dietA vegan diet may lack essential vitamins
and minerals
Preschoolers
Macronutrients: Energy – 1642-2279 depending on gender
and ageTotal fat intake should gradually drop to a
level closer to adult fat intake25%-35% of total energy from fat
0.95 grams protein per kg body weight130 grams carbohydrate per day14 grams fiber per 1,000 kcal
Preschoolers
Micronutrients:Vitamins and minerals
fruits and vegetables continue to be a concern Vitamins A, C, E, calcium, iron, zinc
AI of calcium increases for toddlersRDAs for iron and zinc also increase
Preschoolers
Fluid:1.7 liters per day
Supplements:?????May be recommended when particular food
groups are not eaten regularlySupplements should be appropriate for the
child’s age
Vitamin and mineral supplements
Not strictly necessaryMay be beneficial when entire food
groups are not consumed with regularityShould be age specificMonitor ULAt risk children: abused or neglected;
anorexia; fad diets; vegan diet
Feeding skills: toddlers
Weaning Ability to chew and
self feed “I do it” Prefer to eat with
hands Can use cups and
spoons
Food jags: strong food preferences and dislikes
Food refusals Natural to have
decreased interest in food
Feeding skills: Preschoolers
Skilled with fork, spoon, cup
Tolerates most textures of foods
Must be careful of choking hazards
Messy eating is not the norm
Growth variable….appetite and intake increase prior to growth spurt
Desire to help and please
May be picky – exerting control, comforted by familiar foods
How much food intake?
Toddlers – 1 T food per year of age
Caregivers tend to overestimate portion sizes
Important to establish regular (yet flexible) patterns
Avoid uncontrolled grazing
Serve child sized portions
Avoid mixing foods together
Again, regular but flexible patterns
Avoid uncontrolled grazing
Mealtime
Is a time for learning Not a time for battles
Other Factors
Temperament differences40% easy, 10% difficult, 15% slow-to-warm-
upFood preference development
Food Preference Development
a complex process Influences
Genetics Parents Media educators at school
*By age 3, the dislike for certain foods has already developed.*
Food Preferences
Malnourished children vs Well- Nourished Children
Biological Influence
Genetic pre-disposition of tastes
Food Neophobia Exposure After-meal results Self-Regulation Developmental
Landmarks Cognitive
Development
Parental & Familial Influence
Economics & Geography
Nutrition Knowledge Foods Consumed
During Pregnancy Food Modeling Short-Order Cooking Restriction
Implications for Practice
1. Exposure2. Target Children’s Literature3. Learning across the curriculum4. Pregnancy Books5. Family Meals6. Proper Influence
Most common nutrition problems
Iron-deficiency anemiaDental caries
fluorideConstipationLead poisoningFood SecurityFood Safety
Diagnostic levels
1-2 years of age: Hgb<11 g/dl; Hct <32.9%
2-5 years: Hgb <11.1 g/dl; Hct <33%
Prevention
7-10 mg iron/dayMilk intake – should meet calcium needs
but not replace iron rich foods.Max. 24 oz/day
Lead
Exposure old paint, pieces of metal, lead pipes leaching into
water ;soil; imported canned foods; household dust; 5-10x higher rate of absorption Other nutrient deficiencies exacerbate
vitamin c, iron, calcium, Vitamin D, zinc 3x more likely to have elevated lead levels
The signs and symptoms of lead poisoning in children are nonspecific and may include:
Irritability Loss of appetite Weight loss Sluggishness Abdominal pain Vomiting Constipation Pallor from anemia
Complications of lead contamination
Nervous system and kidney damage Learning disabilities Speech, language and behavior problems Poor muscle coordination Decreased muscle and bone growth Hearing damage
Treatment
Removal of sourcechelation
Dietary and Physical Activity Recommendations
Dietary guidelinesFood Guide Pyramid developed by the
USDA for young children
School-Aged Children
http://www.letsmove.gov/kids-state-dinner
Nutrition Intervention for Risk Reduction
Public food and nutrition programsWICHead Start and Early Head StartFood Stamps
Other Concerns
Food allergies and intoleranceDietary supplements and herbal
remediesSources of nutrition services