14.6.1: Nutrition

Learning Objectives

1. Describe the importance of and caregiver influences on establishing healthy eating habits in early childhood.
2. Identify age-appropriate nutritional needs and caloric requirements for young children.
3. Recognize common challenges in early childhood eating, and describe strategies to support positive mealtime behaviors.
4. Explain the impact of food insecurity on child development.
5. Define childhood obesity.
6. Identify the factors, including behavioral and environmental influences, that contribute to childhood obesity.
7. Discuss the short- and long-term health consequences of childhood obesity.
8. Identify strategies for preventing and managing childhood obesity.

Early childhood is a critical window for developing lifelong eating habits. Research indicates that dietary patterns formed during this period often persist into adolescence and adulthood (Birch & Anzman-Frasca, 2011). Establishing good nutrition habits early on helps reduce the risk of obesity, promotes overall health and adequate growth, and encourages a positive relationship with food and healthy eating behaviors.

Healthy Eating and Habits

Healthy eating in early childhood involves consuming a well-balanced diet that provides essential nutrients for growth and development. According to the Dietary Guidelines for Americans (2020-2025), a nutritious diet for young children includes fruits, vegetables (particularly dark green vegetables), whole grains, protein sources, dairy products, and healthy fats, such as those found in fish, nuts, or avocados.

Parents and caregivers play a crucial role in shaping children's eating habits by modeling healthy food choices, maintaining structured mealtimes, and introducing a variety of foods. Children between the ages of 2 and 3 need 1,000 to 1,400 calories, while children between the ages of 4 and 8 need 1,200 to 2,000 calories (Mayo Clinic, 2016a).² However, young children also have smaller stomachs and higher energy needs relative to their size, meaning they require frequent and nutrient-dense meals and snacks throughout the day.

Recommendations to Promote

Figure \(\PageIndex{1}\): Offering opportunities to try different and/or new foods with a variety of flavors and textures helps children learn balanced eating habits. Image by USDA is licensed CC0.

Parents and caregivers need to keep in mind that they are setting up taste preferences at this age and set up a supportive food environment. Young children who become accustomed to high-fat, very sweet, and salty flavors may struggle to eat foods with more subtle flavors, such as fruits and vegetables. By offering a variety of foods, children are exposed to diverse flavors and textures, which contributes to more balanced eating habits. Structured mealtimes, or windows, can help reduce grazing and reliance on processed foods.

Picky Eaters and Appetite Changes

Picky eating is a common behavior among young children, often peaking between ages 2 and 5 (Brown et al., 2016). This phase is developmentally normal and can stem from various reasons. Some children have a natural tendency to be more cautious about new foods, often referred to as neophobia. Others develop increased sensory sensitivities to certain textures or flavors, and/or have an increased desire for independence in control over their food choices.

The slower rate of growth in early childhood is also accompanied by a reduced appetite between the ages of 2 and 6. This change can sometimes be surprising to parents and lead to the development of poor eating habits. Parents and caregivers may find the reduction in appetite frustrating and become concerned that the child is going to starve.

So, how can parents and caregivers manage picky eating and these changes in appetite?

• By eating as a family, adults can model positive food behaviors, such as trying new foods or balancing their plates to include foods from all the food groups.
• Children often benefit from repeated exposure to foods. A child may have to try a new food 10-15 times before developing a taste for it (More, 2015).
• Coercing and pressuring children will likely increase their refusal and create negative associations, so creating a pressure-free environment is key.
• It is also not a good idea to restrict a food they like and use it as a reward for eating a food they dislike. This strategy is also likely to backfire, increasing the child's desire for the restricted food and having little or no impact on their attitude towards the disliked food (Parker-Pope, 2008).
• Finally, allowing children to be involved in the food preparation process tends to increase their interest in trying new foods.

By providing adequate, sound nutrition and limiting sugary snacks and drinks, the caregiver can be assured that 1) the child will not starve and 2) the child will receive adequate nutrition. Preschoolers can experience iron deficiencies if they are not given well-balanced nutrition or if they consume too much milk, as calcium can interfere with the absorption of iron in the diet.

Food Insecurity

Food insecurity is the lack of consistent access to adequate food and affects millions of young children in the United States. According to the U.S. Department of Agriculture (USDA, 2022), one in eight children lives in a household that is food insecure. Food insecurity can have numerous impacts on young children, leading to poor growth and developmental delays, increasing the risk of chronic illnesses such as anemia and obesity, as well as behavioral and emotional challenges, including anxiety about food availability (Gundersen & Zaliak, 2015).

Figure \(\PageIndex{2}\): 13.5 percent (18.0 million) of U.S. households were food insecure at some time during 2023. The 2023 prevalence of food insecurity was statistically significantly higher than the 12.8 percent (17.0 million) in 2022. Image by USDA is in the public domain.

Programs such as the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and the Child and Adult Care Food Program (CACFP) provide support to families experiencing food insecurity, helping ensure children receive adequate nutrition.

Childhood Obesity

Childhood obesity is a complex health issue. It occurs when a child is significantly above the normal or healthy weight for their age and height. Childhood obesity is a serious problem in the United States, putting children at risk for poor health. According to the Centers for Disease Control and Prevention (CDC, 2024), approximately 14.7% of children aged 2- to 5-year-olds were classified as obese.

Where people live can affect their ability to make healthy choices. Obesity disproportionally affects children from low-income families.

Causes of Obesity

The causes of excess weight gain in young children are similar to those in adults, including factors such as a person’s behavior and genetics. Behaviors that influence excess weight gain include (Simmonds et. al, 2016):

• eating high-calorie, low-nutrient foods
• not getting enough physical exercise
• sedentary activities (such as watching television or other screen devices)
• medication use
• sleep routines

Figure \(\PageIndex{3}\): A child watching TV instead of playing. Image by Melissa Gutierrez is licensed under CC-BY-2.0.

Consequences of Obesity

The consequences of childhood obesity are both immediate and long-term. It can affect physical, social, and emotional well-being.

• More Immediate Health Risks
  • High blood pressure and high cholesterol are risk factors for cardiovascular disease (CVD).
  • Increased risk of impaired glucose tolerance, insulin resistance, and type 2 diabetes.
  • Breathing problems, such as asthma and sleep apnea.
  • Joint problems and musculoskeletal discomfort.
  • Fatty liver disease, gallstones, and gastroesophageal reflux (i.e., heartburn).
• Childhood obesity is also related to
  • Psychological problems such as anxiety and depression.
  • Low self-esteem and lower self-reported quality of life.
  • Social problems such as bullying and stigma.
• Future Health Risks
  • Children who are obese are more likely to become adults with obesity. Adult obesity is associated with increased risk of a number of serious health conditions, including heart disease, type 2 diabetes, and cancer.
  • If children have obesity, their obesity and disease risk factors in adulthood are likely to be more severe.

Obesity Prevention and Management

Preventing and managing obesity in early childhood necessitates a comprehensive approach that involves families, schools, and communities. It starts with encouraging healthy eating habits based on many of the strategies shared earlier in this section in addition to promoting mindful eating (eating slowly and recognizing hunger/fullness cues to avoid overeating). Other strategies include increasing physical activity and encouraging outdoor play. Young children should engage in at least three hours of physical activity per day (WHO, 2019).

References, Contributors and Attributions

2. Children’s Development by Ana R. Leon is licensed under CC BY 4.0

Lifespan Development: A Psychological Perspective by Martha Lally and Suzanne Valentine-French is licensed under CC BY-NC-SA 3.0

3. Children’s Development by Ana R. Leon is licensed under CC BY 4.0

Birch, L. L., & Anzman-Frasca, S. (2011). Learning to eat in an obesogenic environment: A developmental systems perspective on childhood obesity. Child Development Perspectives, 5(1), 50–58. https://doi.org/10.1111/j.1750-8606.2010.00152.x

Brown, C. L., Perrin, E. M., Peterson, K. E., & Skinner, A. C. (2016). Parental feeding practices and child weight outcomes: A systematic review. Journal of Pediatric Psychology, 41(1), 18–32. https://doi.org/10.1093/jpepsy/jsv071

Centers for Disease Control and Prevention. (2023). Childhood obesity facts. https://www.cdc.gov/obesity/data/childhood.html

Gundersen, C., & Ziliak, J. P. (2015). Food insecurity and health outcomes. Health Affairs, 34(11), 1830–1839. https://doi.org/10.1377/hlthaff.2015.0645

More, J. (2015). Nutrition and health in the early years. In L. Stewart & J. Thompson (Eds.). Early years nutrition and healthy weight (pp. 14-29). Wiley-Blackwell.

Parker-Pope. T. (2008). Six food mistakes parents make. The New York Times. Retreived from: https://www.nytimes.com/2008/09/15/h...al2/15eat.html

U.S. Department of Agriculture. (2022). Household food security in the United States in 2021. Economic Research Service. https://www.ers.usda.gov/publication.../?pubid=104655

U.S. Department of Agriculture & U.S. Department of Health and Human Services. (2020). Dietary guidelines for Americans, 2020–2025. https://www.dietaryguidelines.gov

Simmonds, M., Llewellyn, A., Owen, C. G., & Woolacott, N. (2016). Predicting adult obesity from childhood obesity: A systematic review and meta‐analysis. Obesity Reviews, 17(2), 95–107. https://doi.org/10.1111/obr.12334

World Health Organization. (2019). Guidelines on physical activity, sedentary behavior, and sleep for children under 5 years of age. https://www.who.int/publications/i/item/9789241550536