Toddler Observation Questions

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Toddler and Preschooler Nutrition

Chapter 10

Key Nutrition Concepts

  • continue to grow and develop
  • Physically
  • Cognitively
  • Emotionally
  • New 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 skills
  • Rapid increases in gross motor skills

Preschool age

  • 3-5 years of age (36 months-5th BD/Begin Kindergarten)
  • increasing autonomy
  • broader social circumstances
  • increasing language skills
  • expanding 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 slows
  • Gain 5.5 to 7.5 inches total
  • gain 9-11 pounds total
  • Higher energy expended

Preschoolers

  • 3 – 4 inches total
  • 5 – 6 pounds per year

Developmental connections to nutrition: toddlers

  • Initial neophobia
  • Exerting independence
  • imitation

Developmental connections: preschoolers

  • Egocentrism
  • Cooperation socially
  • Control –
  • language
  • Start to limit behavior internally

Importance of nutrition status

  • adequate energy & nutrients
  • Undernutrition
  • FTT & cognitive impairment

Disparity of nutrition status among racial and ethnic groups

  • 8% of low income children under age of 5 are growth retarded
  • 15% of African-American low income children

  • 8% of white children have iron deficiency anemia
  • 17% of Mexican American children
  • 10% of African American children

Normal Growth and Development

  • The 2000 CDC Growth Charts
  • body 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%tile
  • Normal: BMI for age 5-85%tile
  • At risk of overweight: BMI for age 85-95%tile
  • Overweight: 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 needs
  • Protein
  • Vitamins and minerals

Toddlers

  • Macronutrients:

Estimated energy requirement (EER) is kcal/day = (89 x weight(kg)-100)+20

  • DRI 992-1046 kcal
  • 30%-40% of total kcal from fat
  • 1.1 grams of protein per kg body weight
  • 130 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 water
  • Supplements ???
  • 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 diet
  • A vegan diet may lack essential vitamins and minerals

Preschoolers

  • Macronutrients:
  • Energy – 1642-2279 depending on gender and age
  • Total fat intake should gradually drop to a level closer to adult fat intake
  • 25%-35% of total energy from fat
  • 0.95 grams protein per kg body weight
  • 130 grams carbohydrate per day
  • 14 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 toddlers
  • RDAs for iron and zinc also increase

Preschoolers

  • Fluid:
  • 1.7 liters per day
  • Supplements:
  • ?????
  • May be recommended when particular food groups are not eaten regularly
  • Supplements should be appropriate for the child’s age

Vitamin and mineral supplements

  • Not strictly necessary
  • May be beneficial when entire food groups are not consumed with regularity
  • Should be age specific
  • Monitor UL
  • At 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 differences
  • 40% easy, 10% difficult, 15% slow-to-warm-up
  • Food 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

Exposure

Target Children’s Literature

Learning across the curriculum

Pregnancy Books

Family Meals

Proper Influence

Most common nutrition problems

  • Iron-deficiency anemia
  • Dental caries
  • fluoride
  • Constipation
  • Lead poisoning
  • Food Security
  • Food 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/day
  • Milk 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 source
  • chelation

Dietary and Physical Activity Recommendations

  • Dietary guidelines
  • Food 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 programs
  • WIC
  • Head Start and Early Head Start
  • Food Stamps

Other Concerns

  • Food allergies and intolerance
  • Dietary supplements and herbal remedies
  • Sources of nutrition services