Toddler Nutrition

Question 1

Life cycle stage

Answer 1

toddlers 1-3
Characterised by rapid increase in gross and fine motor skills and language skills

Pre school 3-5
Characterised by increasing autonomy, broader social circumstances, increasing language skills and expanding self control

Question 2

Importance of nutrition status

Answer 2

During toddler and preschool years, adequate nutrition is required to achieve full growth and development
Undernutrition impairs cognition and availing to explore environment and thus development
17% of children live in poverty, 19% single parent families

Question 3

Normal growth and development

Answer 3

From birth to 1 year, average infant triples his birth weight
Toddlers gain 200g and grow 1cm per month (approx 12cm from 1-2yo)
Preschoolers gain approx 2kg and grow 7 cm per year
Decrease in growth rate is accompanied by a reduced appetite and food intake

Question 4

Monitoring children’s growth

Answer 4

Use calibrated scales and height board
Toddlers under 2- weighed without clothes or diaper, determine recumbent length

Over age 2- weighed with light clothing, measure stature with no shoes
Recumbent length- <24 months are measured in the recumbent position

Growth charts used to compare development and growth to other healthy children of same age and gender
0-24: head circ, wt, ht
2-18: wt, ht, BMI

Question 5

Growth charts

Answer 5

Percentiles drawn- lines represent 5th, 10th, 25th, 75yh, 90th and 97th percentiles for weight, height and head circumference
Most babies weight and length fall somewhere between the 5th and 97th, if baby in 5th, 95% of babies are taller and heavier than she is. Appropriate percentiles may be different for Asians or babies with downs

<5th- healthy weight/ underweight. Low body fat, low level of health risk
5th-85th- healthy weight. Appropriate fat. Lowest health risk.
85th-95th- risk of overweight or is overweight. Raised body fat and health risk.
>85th- overweight/ obese. High body fat, high level of health risk.

Question 6

Common problems with measuring and plotting growth data

Answer 6

Error in measuring may result in errors in health status assessment.
Use of calibrated equipment and plotting accuracy are vital
Not choosing appropriate chart.

Question 7

Cognitive development of toddlers

Answer 7

Orbit around parents 
Transition from self centred to more interactive 
Vocabulary expands- 
10-15 words at 18months 
100 at 2 years 
3 word sentences by 3 years 

Temper tantrums common- learning about selves and ability to control environment

Question 8

Development of feeding skills and behaviours of preschool age children

Answer 8

Can use a fork, spoon and cup well
Spills occur less frequently
Foods should be cut into bite size pieces
Adult supervision still required
Appetite related to growth
Appetite increases prior to the spurts of growth
Include child in meal selection and preparation eg shopping, peeling, cleaning or cutting

Question 9

Energy intake in preschool age children

Answer 9

Adjust energy intake to meet energy needs
I ate ability to self regulate food intake
Avoid encouraging child to clean your plate and using food as a reward
Parents need to provide a selection of healthy and nutritious foods and let child decide how much to eat
Healthful eating habits must be learned

Question 10

Appetite

Answer 10

Prefer familiar food, strong flavours may not be accepted
Serve child sized portions and make food attractive.
Control amount eaten between meals to ensure appetite for basic foods

Consumption of foods high in sugar and fat before meals decreases intake of basic foods
Offering large portions increases food intake and may promote obesity
Restriction of palatable foods increases preference for the foods

Question 11

Food preference development

Answer 11

Intitially tend to reject new foods
May need 8-10 exposures before accepting
Food intake related to parents preference
Prefer sweet and salt, reject sour and bitter
Preference for energy dense foods- pleasant feeling of satiety, associated with special occasions, used as a reward, media/advertising

Question 12

Feeding relationship

Answer 12

Parent or caretaker responsible for:
What children are offered
Environment it is served (when and where)
Respond to child’s hunger and satiety cues

Child responsible for:
How much they eat
Whether they eat a particular meal or snack

Question 13

Fussy eating

Answer 13

Limited intake of food groups 
Food fads 
Rejection of foods 
Reluctance to try new foods
Extreme likes and dislikes 
Concern- significant changes in growth pattern, one major food group rejected for a long period of time, fussy eaters at higher risk of iron, zinc B13 and fibre deficiencies 

Management
Repeated exposure 
Limited choices 
Positive language and role modelling 
Routines
Fluids
Screen time
Don't bribe
Meal prep involvement 
Limit duration of meal times

Question 14

Energy needs

Answer 14

Estimated requirements-
Toddlers up to 2 years considers age, gender, weight, length and growth factor
Above 2 years- recommended to calculate BMR and to apply appropriate OAL
Cereal and dairy are a significant source of energy

Protein:
1-3: RDI 1.08g/kg
4-8: RDI 0.91g/kg

Fat:
Support growth, provide EFAs and fat soluble vitamins
<2 years- full fat dairy and 40% e from fat
2-5 years- low fat fairy and 30% e from fat

Question 15

Vitamins and minerals

Answer 15

Nutrients of particular importance 
- b group vitamins 
- iron 
- calcium
- vit D 
Most toddlers and preschool age children have adequate vitamin and mineral consumption except iron, calcium and zinc

Question 16

Common nutrition problems - iron deficiency

Answer 16

Iron deficiency anaemia

• 19% toddlers with depleted iron stores
• 4% iron deficiency anaemia

May cause delays in cognitive development and behavioural disturbances
Prevention:
- limit milk consumption to 500-700ml/d since milk is poor source if iron and may displace better options
- infants at risk should be tested 9-12 motnsh, 6 months later and annually aged 2-5
- educate caregivers on appropriate food choices

Intervention

• iron supplements
• counselling with parents in adequate diets and repeat screening 4 weeks later

Diet:

• meat and meat alternatives
• prepare far rich foods in diff ways
• but C sources at mealtimes

Question 17

Common nutrition problems - dental caries

Answer 17

Prevalence 
- 1-3 children aged 4-6 in Aus 
Causes 
- bedtime bottle with juice or milk 
- streptococcus mutans
- sticky carbohydrate foods 
- sugar containing beverages 

Prevention

• Fluoride supplemental amounts vary by age and fluoride content of water supply
• brush teeth twice per day
• reduce grazing during the day

Question 18

Common nutrition problems - constipation and diarrhoea

Answer 18

Constipation
Hard, dry stools associated with painful bowel movements
Causes: stool holding and diet
Prevention: consume adequate fibre and water
Excessive milk may be linked to consummation- usually because milk displaces fibre containing foods

Diarrhoea
Large amounts of fruit juice may reduce the guts ability to absorb water
Issue tends to resolve around three or four years of age and may be related to hit immaturity in absorbing water

Question 19

Food security

Answer 19

Poor access to foods at all times, insecurity common in minority populations, low income families and single parent families
Concern for child growth and development

Question 20

Food safety

Answer 20

Young children vulnerable to food poisoning

Food safety practices:

• clean hands and surfaces
• separate foods
• cook to proper room temp
• refrigerate foods promptly