This Week’s Sproutings Saturday is featuring nutrition pointers and guidelines for Toddlers and Preschoolers. If you missed “Nutrition in a Nutshell for Your Sprout: Infancy,” be sure to check it out!
Quick Clicks:
General Pre-School/Toddler Nutrition Guidelines (2-5 Years) Includes calorie requirements for each age
Iron-Deficiency Anemia in Toddlers
Toddler Nutrition (1 Year Old)
- Growth rate slows after 1 year, so appetite will likely level off or decrease.
- Activity levels increase, toddler becomes more interested in activities than eating.
- Overall intake will vary day to day, some days being “good eater” days and other days where your toddler won’t eat as much. Don’t worry, their intake will even out over the course of the week.
- Favorites may be rejected all of a sudden, this is normal.
- Don’t get caught up with making sure your toddler has a certain amount of vegetables or fruits. A varied and balanced diet will happen, but it may be spread through the course of a few days to a week.
- When sitting down for meals, try not to push “eat all your corn!” Don’t pressure him to eat all of one certain food if he’s not interested. This may lead to stigmas with food and he may feel more nervous about eating the food that you are pressuring him to eat. (This is hard for me)
- Do not let your toddler fill up on low-nutrient dense “empty calorie” foods like cookies, candy, and chips. Your toddler needs energy that helps his body grow, and filling up on sugar will do more harm than good.
- Foods eaten at this age still affect preferences for the future, so make sure that nutritious healthy foods are readily available and offered often.
- 1 year old toddlers need about 1,000 calories per day.
- Remember, if still BFing, depending on how frequently you nurse, your toddler may receive 400-600 of those calories consumed via breastmilk.
- No more than 1 serving (4 oz) of 100% fruit juice per day. Dilute it with some water, to stretch out their 4 ounces!
- Limit added sugar and salt. When cooking, try not to add salt. Remember, salt is an acquired taste.
- Honey is now allowed at this point, but keep in mind that it shouldn’t be used in excess for them to fill up on empty calories from sugar! However, honey is a much better sweetener than refined sugar (which should be avoided if possible).
- Whole fat cow’s milk can be introduced slowly along with formula or breast milk, if breastfeeding will be weaned.
- For BF moms, you don’t have to move to cow’s milk right away. It’s not a requirement at this age.
- It is recommended to continue to provide breast milk up if desired and possible, but cow’s milk can be slowly introduced at this time.
- For more on how to introduce cow’s milk while breastfeeding, see KellyMom’s guide here. (KellyMom is a well-respected and recommended resource for all breastfeeding questions and was referred to me by my regional La Leche League International representative)
- If introducing cow’s milk:
- Do so slowly to prevent constipation.
- Introduce a little at a time, mixed with formula or breastmilk, and increase a little bit every few days.
- Milk consumption is about 16-20 ounces at this age, per day.
- Be careful not give your toddler more than 24 ounces of milk per day, as this can interfere with iron absorption and can lead to iron-deficiency anemia. (Click here to jump below for more about iron anemia.)
- Give liquids in a cup if you haven’t started!
- Do not limit cholesterol at this age! Cholesterol is still very important for healthy brain and tissue development.
- 50% of calories will be from fat at this age.
- Heavily spiced, salted, sugared foods can be harmful down the line. Some degree of seasoning is healthy and encouraged, but over-seasoning foods will block the natural flavor of healthy foods and the preference for salty and sugary foods will set the stage for less healthful eating habits in the future.
- Make sure you’re testing the temperature of foods before placing in front of your toddler. Those eager hands may excitedly grab at foods that are too hot.
- If you haven’t started already, feed liquids from a cup!
- Prevent choking! Cut foods into pieces that are small and that won’t block their airway. about 1/2 inch pieces are safe.
If your 1-year old (or older child) is choking, perform the Heimlich! This is safe for ages 1 year and up. Never perform the Heimlich maneuver on an infant. For review, read: Infant CPR and Choking.
American Academy of Pediatric’s HealthyChildren.org Feeding and Nutrition for Your One-Year Old: http://www.healthychildren.org/English/ages-stages/toddler/nutrition/Pages/Feeding-and-Nutrition-Your-One-Year-Old.aspx
Toddler Nutrition (2 Year Old)¹
- Designated FAMILY MEALTIMES are very important to establish early on.
- Eats 3 meals per day, +1-2 snacks
- Don’t focus on amounts, type (veggies) or make mealtimes a fight. Mealtimes should be viewed as a positive part of the day, so that healthy habits are developed. The more you fight with your toddler about eating a certain food, the more he will resist your efforts.
- What you eat is what he eats, your 2-year old can eat the same foods as you at mealtime
- Toddlers at 2 are impatient during meal times because they’re ready to run around and play, increasing risk of choking.
- Foods that have a higher risk for choking:
- hotdogs – slice lengthwise and then small cuts across, to avoid throat-sized pieces
- raw carrots & celery
- large spoonfuls of peanut butter – the thick treat can block the airway if swallowed in a large bite. Spread onto crackers or veggies like snap peas, broccoli, etc.
- trail mix type foods – whole peanuts and bigger dried fruit should be avoided, they are hard, can clump together, and can be hard to swallow or could easily become lodged in little throats
- raw cherries with pits. Cooked cherries are softer and can be swallowed easier.
- Hard candies and gum; not nutritious but toddlers can choke on these easily, as hard candies require patience and sucking, and gum does not physically break down like food in the mouth so it stays intact and gummy which is risky.
- whole grapes; slice in half
- marshmallows. The shape and density of the food is a choking hazard since the size is easily stuck in the throat.
- No more than 1 serving (4 oz) of 100% fruit juice per day (pasteurized)
- Artificial Sweeteners: Due to limited research in children, the AAP does not have an official position on artificial sweeteners in children’s diets6, but in the dietetic community, we want to be sure that growing children are consuming nutritious foods that are naturally sweetened. In my opinion, it’s best to keep these chemicals out of children’s diets. Since there’s no research indicating if they are safe or not, it’s better to heir on the side of safety and not give it.
- Understand that iron-deficiency anemia is common in young toddlers because of their rapid growth rate at this age. There is a higher risk of anemia if mom is anemic or if your child is a vegetarian or vegan.
It is important to address anemia because untreated, your toddler will show signs of fatigue, poor attention, lower thinking and processing abilities, low energy, and a diminished immune response.²
- Iron supplements might be prescribed if your toddler is anemic from not eating much meat or if they are drinking an excess of milk (because too much milk leads to poor absorption of iron). For usual supplement dosing, please see reference #2.
- Milk: 16 ounces (2 cups) of low fat milk per day, for healthy calcium and vitamin D intake, but NO MORE than 32 ounces (4 cups) per day. Exceeding even 24 ounces (3 cups) can lead to iron absorption problems and can lead to iron deficiency anemia.
If your toddler is test-confirmed anemic:2,3,4,5
- Try to increase your child’s intake of heme (animal sourced) iron found in red meat, poultry, and seafood. Heme iron is more readily absorbed (25-35%) in the body. Non-heme iron is from plant sources and is much less efficiently absorbed (“bioavailable”, only about 10%), which means that if your child is vegan or vegetarian, they will need to consume much more iron-rich foods to account for the difference in absorption. (for a great reference on Vegetarian Toddler Nutrition, click here)
Children need 7-11 mg of daily iron, so if only plant sources are consumed, dietary intake needs to be much higher to account for only 10% absorption.
- When consuming an iron-rich food, feed with a vitamin C source to enhance absorption!
- Cook in a cast-iron skillet, the iron from the skillet will transfer into the food (this was a tip given to me from my pediatric nurse practitioner)
- Limit milk consumption to 24 ounces (3 cups) or less in 1 day. As mentioned above, overconsumption of milk will block absorption of iron.
- Wait a couple of hours between drinking milk and feeding them their high-iron food + vitamin C to reduce milk’s interference with iron absorption
- Dietary iron supplements for 2-5 year olds are generally in a 20-30 mg dose2 (powder, liquid, crushable tablet), remember to take with vitamin C! Some iron supplements have vitamin C combined.
- Spinach (and many other foods) contains polyphenols which actually inhibit the absorption of iron, even though spinach itself has a high iron-content.
1) HealthyChildren.org Your Two-Year Old: http://www.healthychildren.org/English/ages-stages/toddler/nutrition/Pages/Feeding-and-Nutrition-Your-Two-Year-Old.aspx
2) Iron Supplementation in Pediatrics: http://depts.washington.edu/nutr/student_projects/dietetic/Supplements/2012/Iron%20in%20Pediatrics_2012.pdf
3) National Institutes of Health: Iron http://ods.od.nih.gov/factsheets/Iron-HealthProfessional/
4) UCLA S.N.A.C. http://www.dining.ucla.edu/housing_site/dining/SNAC_pdf/PumpingTheIron.pdf
5) CDC.gov Nutrition for Everyone – Iron and Iron Deficiency: http://www.cdc.gov/nutrition/everyone/basics/vitamins/iron.html
6) Healthychildren.org Sweeteners and Sugar Substitutes: http://www.healthychildren.org/English/healthy-living/nutrition/Pages/Sweeteners-and-Sugar-Substitutes.aspx
Toddler Nutrition (3 Year Old)
Wow. Your little baby is now considered a PRE-SCHOOLER! Time flies, those days of having a little toddler are gone, but she is still growing and definitely still requires healthy and nutritious meals and snacks. It’s harder to control the types of foods your 3-year old will consume since she spends much of her time around other children in pre-school, but your positive influence is still very important.
- I’m looking forward to this part – mealtimes are no longer the time for your toddler to show their defiance! The relationship between food and nourishment/appetite is understood.
- Specific preferences and/or inconsistencies for a favorite food from one day to the next may still exist.
- Still, no more than 1 serving (4 oz) of 100% fruit juice per day!
- The Clean Plate Rule (as in, don’t enforce it): Don’t insist on “finishing” the “whole thing” if he doesn’t seem interested in a certain food. Shift focus and give a different food to try.
- Let your toddler choose what and how much they want to eat, when given a variety of healthy options.
- Healthy Options: Not “overly sugary, fatty, or salty”
- Try not to get frustrated if she refuses her vegetables. If she has other healthy options on her plate, and continue to provide those vegetables at every meal, eventually she will give them a try.
- The AAP warns against TV advertising, linking 3 or more hours of television to obesity
- Incorporate 30-60 minutes of physical activity into your every day routine, even if it’s chasing the dog in the yard. Involve all members of the family (especially you, the parent!!!!) Get them used to being active so that it is second nature to maintain.
- Don’t be a couch potato! If you are sedentary, your toddler will be sedentary too. It’s important to model good and healthful behaviors towards not only food, but also activity!
HealthyChildren.org Your Three-Year Old: http://www.healthychildren.org/English/ages-stages/toddler/nutrition/Pages/Feeding-and-Nutrition-Your-Three-Year-Old.aspx
This last section is to help guide choices that can be made with some parental discretion.
General Pre-School/Toddler Nutrition Guidelines (2-5 years)1,2,3
- Approximately 1,000-1,600 calories/day depending on physical activity level. Click here to visit ChooseMyPlate.gov’s Meal and Snack Patterns and Ideas resources, according to each calorie group.
Daily Calorie Needs Based on Activity Level (Source: ChooseMyPlate.gov)
- Set a good example for healthful eating! Your toddler’s perception of healthy choices and positive eating behaviors are modeled after you.
- Don’t force the CLEAN PLATE! Give appropriate serving sizes (for more on serving sizes and meal planning for your pre-schooler, check ChooseMyPlate.gov) My parents enforced the “clean plate rule” at our house and I can tell you that my brother and I scarf down all our food super fast. I wasn’t allowed to leave the dinner table until I was finished. Don’t do this!
- Offer a variety of foods day-to-day to introduce new flavors or revisit foods they did not initially love, so that with frequent exposure, they may develop a taste.
- Encourage them to “serve themselves” with small bowls and plates, so they can learn healthy appropriate serving sizes
- Have plenty of healthy snacks* on hand to offer, since it is difficult for pre-schoolers to get all of their nutrients in 3 meals. Click here for ChooseMyPlate.gov’s Snack Ideas for Pre-schoolers.
- Yogurt or cottage cheese topped with fresh fruit or sliced cherry tomatoes
- Whole wheat toast or crackers with peanut butter and sliced bananas
- Graham crackers (choose those not made with high fructose corn syrup) to dip in yogurt
- Whole grain pita triangles with hummus or bean dip
- Thinly sliced vegetables (carrots, zucchini, bell peppers) with hummus dip
- Small-sliced apples with cheese or peanut butter
- Follow a meal and snack schedule to establish routine
- Make smart beverage choices – remember, beverages also count as calories, so make them healthy!
- No more than 1 serving (4 oz) of 100% fruit juice per day
- Limit sodium intake from salt. This preference is learned, so it’s good to start off on the right foot without adding salt to foods. (Remember, excess sodium intake leads to water retention which later in life negatively impacts blood pressure and makes the heart work harder, which can lead to heart failure)
- Look for “low sodium” or “no salt added” foods
- 1000 mg or less for children 1-3 years old
- 1200 mg or less for children 4-8 years old
1) USDA National Agricultural Library Toddler Nutrition: http://fnic.nal.usda.gov/lifecycle-nutrition/toddler-nutrition
2) ChooseMyPlate.gov Meal and Snack Patterns and Ideas, including each calorie requirement group: http://www.choosemyplate.gov/preschoolers/meal-and-snack-patterns-ideas.html
3) ChooseMyPlate.gov Snack Ideas for PreSchoolers: http://www.choosemyplate.gov/preschoolers/snack-ideas.html
*make sure that all raw vegetables and fruits are prepared to minimize risk of choking.
Extra Resources:
Dietary Guidelines for Americans (2010) from the USDA and DHHS http://www.cnpp.usda.gov/sites/default/files/dietary_guidelines_for_americans/PolicyDoc.pdf
Academy of Nutrition and Dietetics: Vegetarian Nutrition for Toddlers and Preschoolers http://vegetariannutrition.net/docs/Toddlers-Preschoolers-Vegetarian-Nutrition.pdf
ChooseMyPlate.gov Tips for Protein Foods Group: http://www.choosemyplate.gov/preschoolers/daily-food-plans/about-protein-foods.html
Guide for Picky Eaters from ChooseMyPlate.gov http://www.choosemyplate.gov/preschoolers/picky-eaters.html
More about Salt from ChooseMyPlate.gov http://www.choosemyplate.gov/preschoolers/daily-food-plans/about-salt.html
Empty Calories and Healthier Choices for Pre-Schoolers: http://www.choosemyplate.gov/preschoolers/daily-food-plans/about-empty-calories.html
Coming Soon – Child CPR and Relief of Choking (1 Year of Age-Puberty)!