By the end of this section, you should be able to:
Describe the changes in nutritional needs as children mature (get older).
Summarize feeding challenges for toddlers.
Explain effective ways to respond to picky eating..
Identify how to support children with unique nutritional and feeding needs.
Feeding Toddlers
Major physiological changes continue into the toddler years. Unlike in infancy, the limbs grow much faster than the trunk, which gives the body a more proportionate appearance. Their physical growth and motor development slow compared to the progress they made as infants. The toddler years pose interesting challenges for parents or other caregivers, as children learn how to eat on their own and begin to develop personal preferences. However, with the proper diet and guidance, toddlers can continue to grow and develop at a healthy rate.
Figure 11.4.1 – Caloric intake will depend on a toddler’s activity level.658
The energy requirements for ages two to three are about 1,000 to 1,400 calories a day. In general, a toddler needs to consume about 40 calories for every inch of height. However, the recommended caloric intake varies with each child’s level of activity. Toddlers require small, frequent, nutritious snacks and meals to satisfy energy requirements. The amount of food a toddler needs from each food group depends on daily calorie needs.
As a child grows bigger, the demands for micronutrients increase. These needs for vitamins and minerals can be met with a balanced diet, with a few exceptions. According to the American Academy of Pediatrics, toddlers and children of all ages need 600 international units of vitamin D per day. Vitamin D-fortified milk and cereals can help to meet this need. Therefore, it's recommended that toddlers between ages 1-2 should drink whole milk. However, toddlers who do not get enough of this micronutrient should receive a supplement. Pediatricians may also prescribe a fluoride supplement for toddlers who live in areas with fluoride-poor water. Iron deficiency is also a major concern for children between the ages of two and three.659
Self-Feeding
As children grow older, they enjoy taking care of themselves, which includes self-feeding. During this phase, it is important to offer children foods that they can handle on their own and help them avoid choking and other hazards. Examples include fresh fruits that have been sliced into pieces, orange or grapefruit sections, peas or potatoes that have been mashed for safety, a cup of yogurt, and whole-grain bread or bagels cut into pieces. Even with careful preparation and training, the learning process can be messy. As a result, parents and other caregivers can help children learn how to feed themselves by providing the following:
small utensils that fit a young child’s hand
small cups that will not tip over easily
plates with edges to prevent food from falling off
small servings on a plate
highchairs, booster seats, or small enclosed chairs to reach a low table660
Figure 11.4.2 – Set toddlers up for success in self-feeding.661
Feeding Challenges in the Toddler Years
During the toddler years, parents may face some problems related to food and nutrition. Possible obstacles include difficulty helping a young child overcome a fear of new foods, or fights over messy habits at the dinner table. Even in the face of problems and confrontations, parents and other caregivers must make sure their preschooler has nutritious choices at every meal. For example, even if a child stubbornly resists eating vegetables, parents should continue to provide them. Before long, the child may change their mind, and develop a taste for foods once abhorred. It is important to remember this is the time to establish or reinforce healthy habits.
Nutritionist Ellyn Satter states that feeding is a responsibility that is split between parent and child. According to Satter, parents are responsible for what their infants eat, while infants are responsible for how much they eat. In the toddler years and beyond, parents are responsible for what children eat, when they eat, and where they eat, while children are responsible for how much food they eat and whether they eat. Satter states that the role of a parent or a caregiver in feeding includes the following:
selecting and preparing food
providing regular meals and snacks
making mealtimes pleasant
showing children what they must learn about mealtime behavior
avoiding letting children eat in between meal- or snack-times
You are likely to notice a sharp drop in a child’s appetite. Children at this stage are often picky about what they want to eat. They may turn their heads away after eating just a few bites. Or, they may resist coming to the table at mealtimes. They also can be unpredictable about what they want to consume for specific meals or at particular times of the day. Although it may seem as if toddlers should increase their food intake to match their level of activity, there is a good reason for picky eating. A child’s growth rate slows after infancy, and toddlers ages two and three do not require as much food.662
Establishing healthy meal routines is an important step in healthy toddler development. Ideally, mealtimes should take place at regular times, at a table with limited distraction, and children should be encouraged to feed themselves with adult support as needed.663 Best practices in early care and education include creating positive meal and snack times that are served family-style with adult modeling eating balanced nutrition.
Engaging Families in Supporting Their Toddler’s Nutrition
Here are tips you can share with families:
Serving sizes for toddlers are much smaller than serving sizes for adults.
A typical serving size for a toddler drink is 4-6 ounces. Water and milk are the best choices for toddlers
Your toddler (and you too!) needs food from all five of the food groups—grains, protein, vegetables, fruit, and dairy. Try offering a variety of foods from these groups at meals and snacks.
Your toddler may eat more on some days and less on others. Don’t worry, this is normal! Keep offering regularly scheduled meals and snacks.
Allow your toddler to tell you when she is full. This teaches them to listen to their body for signs of hunger or fullness.
Try using child-size plates, bowls, and utensils for “right-size” portions for your toddler. Using child-size utensils also makes it easier for your toddler to eat.
Encourage toddlers to drink from cups and avoid the use of bottles or sippy cups.
Limit distractions during meal and snack times to allow your toddler to enjoy the food. Turn off the TV and sit at a table.
Toddlers get hungry between meals. Snack time is a great chance to feed your toddler healthy foods (like fruits and veggies).
Remember to have a start and end time for snack time. Toddlers should not be snacking (or grazing) all day.664
Feeding Preschoolers
Children’s attitudes and opinions about food deepen as they get older. They not only begin taking their cues about food preferences from family members, but also from peers and the larger culture. This time in a child’s life provides an opportunity for families and other caregivers to reinforce good eating habits and to introduce new foods into the diet while remaining mindful of a child’s preferences. Adults should also serve as role models for their children, who will often mimic their behavior and eating habits.665
Figure 11.4.3 – Eating with children allows you to model healthy eating.666
Their micronutrient needs should be met with foods first. Families and caregivers should select a variety of foods from each food group to ensure that nutritional requirements are met. Because children grow rapidly, they require foods that are high in iron, such as lean meats, legumes, fish, poultry, and iron-enriched cereals. Adequate fluoride is crucial to support strong teeth. One of the most important micronutrient requirements during childhood is adequate calcium and vitamin D intake. Both are needed to build dense bones and a strong skeleton. Children who do not consume adequate vitamin D should be given daily supplements.668
Feeding Challenges in the Preschool Years
Picky eating is typical for many preschoolers. It’s simply another step in the process of growing up and becoming independent. As long as a preschooler is healthy, growing normally, and has plenty of energy, they are most likely getting the nutrients they need.
Typical Picky Eating Behaviors
Many children will show one or more of the following behaviors during the preschool years. In most cases, these will go away with time.
Refusal of a food based on a certain color or texture. For example, they could refuse foods that are red or green, contain seeds, or are squishy.
Only eating a certain type of food. A preschooler may choose 1 or 2 foods they like and refuse to eat anything else.
“Wasting” time at the table and seeming interested in doing anything but eating.
Unwillingness to try new foods. It is normal for a preschooler to prefer familiar foods and be afraid to try new things.669
Helping Families Cope with Picky Eating
Picky eating is temporary. If adults don’t make it a big deal, it will usually end before school age. The following tips are tips to help deal with picky eating behavior positively.
Let your kids be “produce pickers.” Let them pick out fruits and veggies at the store.
Have your child help you prepare meals. Children learn about food and get excited about tasting food when they help make meals. Let them add ingredients, scrub veggies, or help stir.
Offer choices. Rather than ask, “Do you want broccoli for dinner?” ask “Which would you like for dinner, broccoli or cauliflower?”
Enjoy each other while eating family meals together. Talk about fun and happy things. If meals are times for family arguments, your child may learn unhealthy attitudes toward food.
Offer the same foods for the whole family. Serve the same meal to adults and kids. Let them see you enjoy healthy foods. Talk about the colors, shapes, and textures on the plate.670
Make food fun
Cut food into fun and easy shapes with cookie cutters.
Encourage your child to invent and help prepare new snacks.
Name a food your child helps create.671
Focus on the meal and each other. Your child learns by watching you. Children are likely to copy your table manners, your likes and dislikes, and your willingness to try new foods.
Offer a variety of healthy foods. Let your child choose how much to eat. Children are more likely to enjoy a food when eating it is their own choice.
Let your children serve themselves. Teach your children to take small amounts at first. Let them know they can get more if they are still hungry.672
Trying New Foods
It is normal for children to reject foods they have never tried before. Here are some tips to get preschoolers to try new foods:
Small portions, big benefits. Let children try small portions of new foods that you enjoy. Give them a small taste at first and be patient with them.
Offer only one new food at a time and ideally with a favored food. Offering many new foods all at once could be too much for children.
Be a good role model.Try new foods yourself. Describe their taste, texture, and smell to the children.
Offer new foods first when children are most hungry.
Offer new foods many times. It may take up to a dozen tries for a child to accept a new food.673
Pause to Reflect
Think back to your childhood. Were you a picky eater or more adventurous? Why do you think that it was? How did your caregivers respond to your eating preferences? Do you have similar preferences now or have you expanded your tastes/preferences?
Feeding School-Aged Children
While calorie needs go up as children get older, until around age 9 (or the beginning of puberty), nutritional needs for school-aged children are very similar to preschoolers. Once puberty begins, there is a period of rapid growth as girls grow 2-8 inches and boys grow 4-12 inches
A few micronutrients take on added importance, especially at the beginning of puberty. These include vitamins, D, K, and B12, calcium, and iron. Whenever possible these additional micronutrient needs should be met with dietary choices and not supplements (with the exception of iron).675
School Meals
School-aged children can often eat both breakfast and lunch at school, which can save families time and provide children with nutritious food. Research has shown that children who eat breakfast do better in school and have higher intakes of fiber, B vitamins, calcium, and other nutrients.676 Refer to Figure 14.7 to see what a school breakfast includes. Lunch is important because it meets 1/3 of the nutritional needs of most children for the day. And kids with healthier eating patterns have better academic performance.
Meals and Snacks in School-Aged Care Programs
On school days, children who are in care before school may need to be fed breakfast (if they did not eat at home or will not be eating at school). After school, they will need substantial, healthy snacks. On full days of care, they will need breakfast, lunch, and a snack.
Figure 11.4.4 – These 9-year-olds learned the knife skills to help prepare this snack of fruit.680
Activities Families Can Do with Children
Choosemyplate.gov offers some fun ideas for families to teach their children about healthy eating and engage the whole family in making healthy choices. Some of these include:
Food critic game where children select a new food to try and rate it on visual appeal, smell, taste, and texture681
Grocery store bingo where children identify foods they see in the grocery store to try to get a 5 in a row bingo682
Make food visually appealing by turning it into art
Kid’s Restaurant: Kids get to plan out the meal, design the menu, and prepare the dish
Growing a garden (or starting small with an herb box in a window)
Going to a local farmer’s market or farm stand to find local food options to buy, take home, and turn into a delicious meal.
Making Mealtimes Fun
Here are some tips for families to make mealtimes more relaxed and enjoyable:
Remove distractions, such as phones, tablets, and turn off the television.
Have conversations. Use starters like:
Give each family member the spotlight to share their highlight, lowlight, and “funnylight”
If our family lived in a zoo, what animals would we be and why?
If you could have one superpower, what would it be and why?
If you were stranded on a desert island and could only have one food to eat, what would it be and why?
Pass on traditions, both the foods and the stories behind them
Let the children make the choices (from a healthy selection of foods)
Let everyone help prepare and clean up after meals
Consider a change of scenery, like a picnic
Reserve a special plate to rotate between family members, for example on birthdays, when someone gets a good grade, or any other occasion you’d like to recognize.683
Feeding Children with Special Needs
Some disabilities and other exceptional needs may affect children’s nutrition. For example:
children with cerebral palsy or cystic fibrosis may have different caloric needs;
children with celiac disease or irritable bowel syndrome may have dietary restrictions;
children with cleft lip or palate may have physical difficulties with eating;
children on the autism spectrum may have strong food preferences or aversions.
Because each child’s specific needs will vary, early care and education programs should work closely with families, and medical providers as needed, to ensure that they understand and can meet the nutritional and feeding needs of the individual child (not a generalization or assumption about the child might need based on a diagnosis or label).
Nutrition policies and practices should be created to be inclusive of children with special needs. Some general considerations early care and education programs and schools should make to ensure that all children’s nutritional needs are met and that all children experience positive meal and snack times include:
Ensure that the spaces in which children eat and access to drinking water are fully accessible to all children, including those with mobility impairments (and if needed, assistive devices should be provided).
Staff should be trained to provide for children who may have additional or differing nutritional or feeding needs so they can work effectively and comfortably with all children.
Follow any dietary restrictions.685
Figure 14.10 – This child with a cleft lip may find sucking from a bottle challenging.684
Summary
Early care and education programs can provide for all children’s nutrition when they understand
the general changes children have in nutritional needs as they mature,
common challenges across the different stages of development, and
strategies that foster positive meal and snack times at each age stage, and
the fact that children may have diverse and unique nutritional needs.
Programs also play an important role in children’s nutrition by empowering families by providing support, information, and resources as they make decisions about how to feed their children.
