Parents and caregivers know that feeding toddlers can be a daunting job. In fact, somewhere between 20% and 50% of children in the United States are described by their parents as being “picky” eaters (Wright et al. 2007). Many toddlers are reluctant to try certain foods or tend to avoid any new food that is put in front of them; there’s even a name for this condition: neophobia (Dovey et al. 2007).
Attitudes like this can be frustrating for parents and may even lead to growth and nutrient deficiencies in young children. But, with a little bit of knowledge and the following strategies, parents can avoid those dreaded mealtime traumas while still ensuring that their toddlers are building healthy bodies and positive attitudes for life.
During the first 5 years of life, children’s palates evolve quickly as they are exposed to a new and varied world of food tastes and textures. Good nutrition is imperative during this stage of development, which is marked by rapid physical growth and change. The eating behaviors that toddlers develop become the foundation for their future attitudes about food (Savage, Fisher & Birch 2007). According to the U.S. Department of Agriculture (USDA), kids between the ages of 2 and 5 years have relatively high energy requirements because the average toddler grows 21/2 inches taller and gains 4–5 pounds each year (www.mypyramid.gov/preschoolers/growth/index.html). Growth is one of the best indicators of good health and nutrition in toddlers. Other factors that affect their growth rates include family history/genetics; gender; sleep patterns; and health status. Cultural and familial beliefs, attitudes and practices surrounding food and eating are also linked to children’s eating behaviors and weight status (Savage, Fisher & Birch 2007).
A child’s taste preferences begin to be established as early as conception; evidence shows that solid food preferences actually develop prior to birth (Savage, Fisher & Birch 2007). Researchers have detected the odors and presence of spices, such as garlic, cumin and curry, in the amniotic fluid of pregnant women, meaning an infant’s first experiences with flavors are the result of swallowing amniotic fluid (Savage, Fisher & Birch 2007). This prenatal exposure can provide a “flavor bridge” that familiarizes infants with tastes and sets food preferences in utero (Savage, Fisher & Birch 2007).
From infancy, children have innate, unlearned preferences for the basic tastes: sweet, salty, sour, bitter and umami, a Japanese term for “savory.” Not surprisingly, shortly after birth kids quickly prefer sweet tastes over sour and bitter (Birch 1979). Interestingly, toddlers typically prefer flavors associated with energy-rich foods, such as bananas, apples, potatoes and peas (Gibson & Wardle 2003).
Even those toddlers who eat only a limited variety of foods are likely to be getting enough calories for normal growth and development. Although parents tend to worry about toddlers’ eating habits, studies have found that the majority of kids this age do eat well and enthusiastically (Wright et al. 2007). However, their appetites can be spoiled if they are allowed to drink large amounts of beverages (especially milk), according to researchers who found that milk drinking at meal time is inversely related to appetite (Wright et al. 2007). If toddlers appear to have a small appetite (as perceived by the parents), they are probably “drinking” their calories instead of getting them through solid foods, but this caloric substitution will likely have no effect on their weight gain (Wright et al. 2007). One important caveat about kids’ beverages: liquid calories can add up fast, so it is best to limit the amount of sugar-laden juice in your toddler’s diet!
The general consensus these days is that many toddlers do not eat the daily recommended number of fruit and vegetable portions and consequently lack sufficient micronutrients and fiber (Dovey et al. 2007). But that’s because their parents are replacing those fruits and vegetables with high-calorie, fat-laden processed foods. “A child will never become a broccoli eater if you give up serving broccoli, nor will they become a broccoli eater if you force them to eat it before they are ready,” warns Melinda Johnson, MS, RD, a national spokesperson for the American Dietetic Association (ADA) in Chandler, Arizona.
Providing healthy food choices to toddlers is the job of their parents, say the experts. “The adult is in charge of the menu, and the child is in charge of putting the food served into his mouth (or not),” explains Johnson.
To assist the parents of toddlers, the USDA recently launched a website geared toward 2- to 5-year-olds, called MyPyramid for Preschoolers. The new pyramid was created by a team of experts to give “a helping hand to families so they can help their kids to eat a more nutritious diet.” This new MyPyramid model, which is based on the 2005 federal Dietary Guidelines for Americans and current scientific research, offers an interactive component that lets parents create a customized eating plan based on a toddler’s age, gender and activity level. The website (www.mypyramid.gov/preschoolers/growth/index.html) also provides growth charts and explanations of growth rates; tips on snacking; strategies to handle picky eaters; recommendations for physical activity levels; food safety precautions; and sample daily menus.
Parents should reduce some of the saturated fat from their toddler’s diet after age 2 by switching from whole milk to low-fat (1%) or skim (fat-free) milk. Because the calcium and vitamin D content is the same for all types of milk, the only difference between varieties is their levels of saturated fat and calories.
Fat is a vital nutrient for cognitive development and growth in toddlers. The Institute of Medicine (IOM) recommends that 30%–40% of a toddler’s daily calories come from fat; after age 4, the range
decreases to 25%–35% (IOM 2009). Growing children should get 5%–10% of their fat calories from essential fatty acids, such as omega-3s and omega-6s (IOM 2009). To incorporate these “healthier” fats into your toddler’s diet, serve wild salmon or chunk light tuna twice a week; 1 tablespoon of flaxseed a day; and at least 1 tablespoon of extra virgin olive oil or canola oil per day.
As far as the other two macronutrients—carbohydrates and protein—the IOM recommends that more than half (45%–65%) of a toddler’s daily calories come from carbs and that protein comprise 5%–20% of calories for kids ages 1–3 years or 10%–30% for those aged 4–18 years (IOM 2009). For a more detailed look at daily macronutrient needs, see the sidebar “Sample Daily Food Plan for Toddlers.”
Micronutrients that are important for the proper development of toddlers include iron, calcium, vitamin D and sodium.
Because it facilitates oxygen transport in the red blood cells, iron is of extreme importance. Without enough iron in
the blood, toddlers can look pale, act cranky and not have enough energy. Iron-deficiency anemia is one of the most common nutritional problems in children (Satter 2000). The iron requirement for children 1–12 years of age is 7–10 milligrams per day (mg/day) (Satter 2000). Iron-rich foods include meat, fish, chicken, whole grains, beans and tofu. To increase iron absorption, serve these items with vitamin C-rich foods, such as tomatoes, spinach, broccoli, oranges and strawberries.
Calcium is an essential mineral for bone building and general bone health throughout life. Aim for 500 mg/day for children ages 1–3 years and 800 mg/day for those aged 4–8 years (Satter 2000). One cup of milk contains 300 mg of calcium, so you can ensure your toddler achieves the recommended amount by adding milk to fruit smoothies, puddings and hot cereals or simply by adding cheese to sandwiches, salads, macaroni and pizza. If your child does not drink milk products or is lactose intolerant, serve leafy green vegetables, canned fish (with bones), tofu (made with calcium lactate) or calcium-fortified orange juice daily.
Another crucial micronutrient, vitamin D aids in the absorption of calcium and phosphorus and the formation of strong bones and teeth. The American Academy of Pediatrics recently doubled its vitamin D recommendations from 200 International Units (IU) to 400 IU per day (Wagner 2008). This means your toddler needs to drink at least 4 cups of vitamin D-fortified milk a day. Other foods that contain vitamin D include salmon, egg yolks and some yogurts. And don’t rule out the value of getting enough sunshine—toddlers need at least 10 minutes of sun exposure each day.
One micronutrient to limit or avoid in your toddler’s diet is sodium. Reduce the amount of salt you normally add to recipes, and try to buy foods with no salt added or with reduced sodium content. The recommended intake for sodium is less than 1,500 mg/day for children 1–3 years old and less than 1,900 mg/day for those 4–8 years old (USDA 2009). Remember that 1 teaspoon of salt contains 2,300 mg of sodium, so use that shaker sparingly.
When introducing new foods to your toddler, try, try and then try again. “There are many ways to reduce pickiness in kids, but of importance is to keep on trying new foods and get those picky eaters in the kitchen to experiment,” says Sarah Krieger, MPH, RD, LD, a national spokesperson for the ADA in St. Petersburg, Florida.
According to IDEA contributing editor Jennie McCary, MS, RD, LD, the best way to expose toddlers to new foods is to build acceptance slowly. “Serve the new food with a food that you know your child likes. Another effective strategy is to introduce the new food before you bring any other food to the table, when your toddler is most hungry,” says McCary, who serves as the wellness director for the Albuquerque Public School District.
It is also imperative to create and maintain a calm mealtime environment for toddlers when introducing them to new foods. “Avoid mealtime power struggles, and ‘trust’ your child’s appetite,” advises McCary. “Appetite wanes as growth slows, so toddlers may take a few bites and then stop eating. Parents need to trust their kids when they say they are full, and not push too much.”
According to Ellyn Satter, MS, RD, author of Child of Mine: Feeding with Love and Good Sense (Bull Publishing 2000), appropriate feeding is based on trust—trust in your child’s ability to eat and in his or her ability to grow in the way nature intended.
McCary also recommends establishing and maintaining a set daily schedule for meals and snacks. “Toddlers have small stomachs, and healthy snacks are an important part of their meal plan,” she advises. n
A food allergy is an abnormal response to a food, triggered by the body’s immune system. In young children, the most common food allergens are eggs, milk, wheat, soy, peanuts and tree nuts. Symptoms of food allergies include red skin or rash; upset stomach; diarrhea; vomiting; runny/itchy nose; and difficulty breathing or a tightening in the chest. In some cases, food allergens can cause a severe reaction called anaphylaxis, which can lead to death. Call 9-1-1 immediately if a toddler’s reaction is very severe.
Parents should always be aware of choking hazards that can occur during meals or anytime a toddler is eating. Foods that typically cause kids to choke include popcorn; hot dogs; grapes; small pieces of raw vegetables and fruit; raisins; hard candies, such as jellybeans; nuts; and peas.
Based on the new MyPyramid for Preschoolers, here is what Grant, my 3-year-old son (who is active about 30–60 minutes a day) would need to eat to meet his daily macro- and micronutrient requirements:
1,400 calories per day
no more than 170 calories of “extras” (solid fat and added sugars)
4 teaspoons of healthy oils (e.g., olive oil, canola oil, avocado, olives)
5 ounces of grains (e.g., 100% whole-grain breads or pastas, crackers or oatmeal)
11/2 cups of vegetables (of varied colors, such as orange, red, yellow and green)
11/2 cups of fruit (choose whole fruits instead of juice; use fresh, frozen, canned (in own juice) or dried produce
2 cups milk (e.g., milk, cheese or yogurt)
4 ounces of meat/beans (e.g., meat, poultry, fish, dried beans, peas, eggs, nuts and/or seeds)
Source: USDA. 2009. MyPyramid for Preschoolers.www.mypyramid.gov/preschoolers/growth/index.html.
Birch. L.L. 1979. Preschool children’s food preferences and consumption patterns. Journal of Nutrition Education, 11 , 189–92.
Carruth, B.R., et al. 1998. The phenomenon of “picky eater”: A behavioral marker in eating patterns of toddlers. Journal of the American College of Nutrition, 17 , 180–86.
Dovey, T.M., et al. 2008. Food neophobia and “picky/fussy” eating in children: A review. Appetite, 50, 181–93.
Gibson, E.L., & Wardle, J. 2003. Energy density predicts preferences for fruit and vegetables in 4-year-old children. Appetite, 41, 97–98.
Institutes of Medicine (IOM). 2009. Dietary reference intakes (DRIs), acceptable macronutrient distribution ranges. Accessed at www.iom.edu.object.file/master/
21/372/0.pdf; retrieved Mar. 2009.
Satter, E. 2000. Child of Mine: Feeding with Love and Good Sense. (3rd ed.). Boulder, Colorado: Bull Publishing.
Savage, J.S., Fisher, J.O., & Birch, L.L. 2007. Parental influence on eating behavior: Conception to adolescence. Journal of Law, Medicine & Ethics, 35 , 22–34.
Schaal, B., Marlier, L., & Soussignan, R. 2000. Human foetuses learn odours from their pregnant mother’s diet. Chemical Senses, 25, 729–37.
U.S. Department of Agriculture (USDA). 2008. MyPyramid for Preschoolers. www.mypyramid.gov/preschoolers/
growth/index.html; retrieved Mar. 2009.
Wagner, C.L., Greer, F.R., & the Section on Breastfeeding and Committee on Nutrition 2008. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics, 122 , 1142–52.
Wright, C.M., et al. 2007. How do toddler eating problems relate to their eating behavior, food preferences and growth? Pediatrics, 120, 1069–75.
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