Nurturing Nutrition: Toddler and Preschooler Growth and Development

1. Chapter 10Toddler and Preschooler Nutrition Nutrition Through the Life Cycle Judith E. Brown

2. Definitions of the Life Cycle Stage • Toddlers—1-3 years • Characterized by rapid increase in gross & fine motor skills • Preschool-age children—3-5 years • Characterized by increasing autonomy, broader social circumstances, increasing language skills, & expanding self-control

3. Importance of Nutrition Status • During toddler and preschool years, adequate nutrition is required to achieve full growth & development • Undernutrition impairs cognition & ability to explore environment

4. Tracking Toddler and Preschooler Health • Economic & nutrition status of U.S. children • 18% live in poverty (2006) • 14% have no health insurance • 33% lived in single-parent families (make them more likely to live in poverty)

5. Healthy People 2010 • Healthy People 2010 – objectives for the nation for improvements in health status by the year 2010 • Healthy People 2020 is under development (www.hhs.gov) • Table 10.1 lists the objectives for toddlers and preschoolers with results to date

6. Normal Growth and Development • From birth to 1 year, average infant triples his birthweight • Toddlers gain 8 oz and grow 0.4 in per month • Preschoolers gain 4.4 lb and grow 2.75 in per year

7. Monitoring Children’s Growth • Use calibrated scales & height board • Toddlers under age 2 years • Weighed without clothes or diaper • Determine recumbent length • Children over age 2 years • Weighed with light clothing • Measure stature with no shoes

8. The length of toddlers < 24 months are measured in the recumbent position Recumbent Length

9. The 2000 CDC Growth Charts • Charts are: • Gender specific - one set for girls & one for boys • Age specific - a set for ages birth to 36 months and 2-20 years • Monitor for: • Weight-for-age • Length- or stature-for-age • Weight-for-length or -stature • BMI-for-age

10. The 2000 CDC Growth Charts

11. WHO Growth Standards • WHO (World Health Organization) published growth standards for children from birth to 5 years. • International growth standards regardless of ethnicity or socioeconomic status. • See the “Resources” section at the end of the chapter or www.who.int/childgrowth

12. Common Problems with Measuring & Plotting Growth Data • Error in measuring may result in errors in health status assessment • Use of calibrated equipment and plotting accuracy are vital

13. Appropriate Measuring Equipment for Young Children

14. Physiological and Cognitive Development: Toddlers • A time of expanding physical and developmental skills • Walking begins as a “toddle,” improving in balance & agility • Progress by month • 15—crawl upstairs • 18—run stiffly • 24—walk up stairs one foot at a time • 30—alternate feet going up stairs • 36—ride a a tricycle

15. Cognitive Developmentof Toddlers • Toddlers “orbit” around parents • Transitions from self-centered to more interactive • Vocabulary expands: • 10-15 words at 18 months • 100 at 2 years • 3-word sentences by 3 years • Temper tantrums common (the terrible two’s)

16. Development of Feeding Skills of Toddlers • Gross & fine motor development improved • 9-10 months—weaning bottle begins • 12 to 14 months—completely weaned • 12 months—refined pincer • 18-24 months—able to use tongue to clean lips & has developed rotary chewing • Adult supervision vital to prevent choking

17. Feeding Behaviors of Toddlers • Rituals in feeding are common • May have strong preferences & dislikes • Food jags common • Serve new foods with familiar foods & when child is hungry • Toddlers imitate parents & older siblings

18. Appetite and Food Intake of Toddlers • Slowing growth results in decreased appetite • Toddler-sized portions average 1 tablespoon per year of age • Nutrient-dense snacks needed but avoid grazing on sugary foods that limit appetite for basic foods at meals

20. Cognitive Development of Preschool-Age Children • Egocentric—cannot accept another’s point of view • Learning to set limits for himself • Cooperative & organized group play • Vocabulary expands to >2000 words • Begins using complete sentences

21. Development of Feeding Skills of Preschool-Age Children • Can use a fork, spoon, & cup • Spills occur less frequently • Foods should be cut into bite-size pieces • Adult supervision still required

22. Feeding Behaviors of Preschool-Age Children • Appetite related to growth • Appetite increases prior to the “spurts” of growth • Include child in meal selection & preparation

23. Meal-preparation Activities of Young Children

24. Innate Ability to Control Energy Intake & Preschool-Age Children • Children adjust caloric intake to meet caloric needs • Avoid encouraging child to “clean your plate” • Healthful eating habits must be learned

25. Appetite and Food Intake of Preschool-Age Children • May prefer familiar foods • Serve child-sized portions • Make foods attractive • Strong-flavored or spicy foods may not be accepted • Control amount eaten between meals to ensure appetite for basic foods

26. Temperament differences • Temperament—the behavioral style of the children. Three main temperaments: • 40% “easy” temperaments • 10% “difficult” temperaments • 15% “slow-to-warm-up” • Remaining styles are “intermediate low” to “intermediate high”

27. Temperament differences • “Easy”—adapts to regular schedules & accepts new foods • “Difficult”—slow to adapt and may be negative to new foods • “Slow-to-warm-up”—slow adaptability, negative to new foods but can learn to accept new foods • “Intermediate low” to “intermediate high” – a mixture of behaviors

28. Food Preference Development, Appetite, and Satiety • Prefer sweet & slightly salty, reject sour & bitter foods • Eat familiar foods • May need 8–10 exposures to new foods before acceptance • Food intake related to parent’s preferences

29. Appetite and Satiety • Consumption of foods high in sugar and/or 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

30. Feeding Relationship • Parent or caretaker responsibilities: • “What” children are offered to eat • The environment in which food is served including “when” & “where” foods are offered • Child’s responsibilities: • “How much” they eat • “Whether” they eat a particular meal or snack

31. Feeding Relationship

32. Energy Needs • Dietary Reference Intakes (DRIs) have been developed • The reports present a comprehensive set of reference values for nutrient intakes of healthy individuals • Table 10.4 gives the Estimated Energy Requirements for reference boys and girls

33. Nutrient Needs: Protein

34. Vitamins & Minerals • Most toddlers and preschool-age children have adequate vitamin & mineral consumption except for iron, calcium and zinc

35. Common Nutrition Problems • Iron-deficiency anemia • Dental caries • Constipation • Lead poisoning • Food security • Food safety

36. Seen in 7% of toddlers May cause delays in cognitive development and behavioral disturbances Diagnosed by hematocrit and/or hemoglobin concentration Iron-deficiency Anemia

37. Iron-deficiency Anemia • Preventing Iron Deficiency: • Nutrition-Limit milk consumption to 24 oz/d since milk is a poor source of iron • Infants at risk should be tested at 9 to 12 months, 6 months later, and annually from ages 2 to 5 • Intervention for Iron Deficiency • Iron supplements • Counseling with parents • Repeat screening

38. Dental Caries • Prevalence: • 1 in 5 children ages 2 to 4 • Causes: • Bedtime bottle with juice or milk • Streptococcus mutans • Sticky carbohydrate foods • Prevention: • Fluoride—supplemental amounts vary by age & fluoride content of water supply

39. Constipation • Definition: Hard, dry stools associated with painful bowel movements • Causes: “Stool holding” and diet • Prevention: Adequate fiber

40. Lead Poisoning • Seen in ~2.2% of children ages 1-5 • Low levels of lead exposure linked to lower IQ & behavioral problems • High blood lead levels may decrease growth • Reduce lead poisoning by eliminating sources of lead

41. Food Security • Defined as access at all times to sufficient supply of safe, nutritious foods • Insecurity more common in minority populations • A concern for growing children since food insecurity may hinder growth & development

42. Food Safety • Young children vulnerable to food poisoning • Food safety practices by FightBAC: • Clean: wash hands & surfaces often • Separate: don’t cross-contaminate • Cook: cook to proper temperature • Chill: refrigerate promptly

43. Prevention of Nutrition-Related Disorders • Overweight and obesity • Prevention and treatment of overweight and obesity • Nutrition and prevention of cardiovascular disease • Vitamin and mineral supplements • Herbal supplements

44. Overweight and Obesity • Of children ages 2-5: • 10.4% are overweight (BMI/age ≥95%) • 20.6% are at risk for becoming overweight (BMI/age ≥ 85%-95%) • BMI is lowest from ages 4-6 years • Adiposity rebound—normal increase in BMI that occurs after BMI declines • Best treatment is allowing child to “grow into his or her height”

45. Prevention of Overweight & Obesity • Limit sugar-sweet beverages • Encourage fruits & vegetables • Limit TV • Daily breakfast • Limit fast foods • Limit portions • Calcium rich diets • Diets high in fiber • Follow the DRI for carbs, pro & fat • Promote physical activity • Limit energy-dense foods

46. Nutrition and Prevention of Cardiovascular Disease • Limit dietary saturated fats, trans fat & cholesterol • Acceptable total fat intake ranges: • 2 to 3 years—30 to 35% of calories • 4 to 18 years—25 to 35% of calories • For children at high risk of CVD limit saturated fat to < 7% of calories & cholesterol to < 200 mg

47. Vitamin and Mineral Supplements • A varied diet provides all vitamins & minerals needed • AAP recommends supplements for certain groups of children: • From deprived families • With anorexia, poor appetites or poor diets, or a dietary program for wt mgmt • Who consume only a few types of foods • Vegetarians without dairy products

48. Herbal Supplements • Parents who take herbs are likely to give them to their children • Advise parents of potential risks of herbal therapies & the need to closely monitor the child if given supplements

49. Dietary and Physical Activity Recommendations • Dietary guidelines • Offer a variety of foods, limiting foods high in fat & sugar • 60 minutes of vigorous physical activity each day • MyPyramid developed by the USDA for young children

50. MyPyramid