A presentation I made for a graduate-level Maternal & Childhood Nutrition course. This PowerPoint focuses on the important role good nutrition can play in this age group, as well as nutrition programs for this age group.
Growth in these stages is slower than in infancy, but young children need adequate calories and nutrients to meet their nutritional need.
Parents need to be reassured that a decrease in appetite is part of normal growth and development for children in this age group.Growth in these stages is slower than in infancy, but young children need adequate calories and nutrients to meet their nutritional need.
It is important to monitor a child’s growth over time and to identify any deviations in growth. Patterns are more telling than any 1 single measurement.
BMI increases in infancy, decreases during pre-k years, hitting its low in ages 4-6, then increases into adulthood. In pediatrics, the goal is to strive for a BMI-for-age in the normal range and not a specific BMI range as is the goal in adults.
At this age, children are especially vulnerable to accidental injuries and ingestion of harmful substances. In fact, the leading cause of death among young children is unintentional injuries. Child-safe environments important!
With an increase in motor development coupled with an increasing quest for independence, toddlers try to do more and more things, pushing their capabilities to the limit. Thus the toddler can become easily frustrated and negative. The child seeks more independence and at the same time needs the parents and caretakers for security ad reassurance.
Better to serve too little, and give 2nds rather than serve too much at the beginning.
Increasing autonomy, language skillsExperiencing broader social circumstancesExpanding ability to control behavior
Children can go to the farmer’s market or grocery store with you, help shop for food, pick out food, decide what whole grain side dish to have, decide what goes in the salad, help prepare (clean, peel, cut up fruits and vegetables)
Having your preschooler help you in the kitchen is a good way to get your child to try new foods. Kids feel good about doing something “grown-up.” Give them small jobs to do. Praise their efforts. Children are much less likely to reject foods that they helped make.As preschoolers grow, they are able to help out with different tasks in the kitchen.
If you force your child to clean their plate, they could be overeating. Also, if you use foods as rewards, they could be overeating as well.
External factors – caregivers rewarding children for finishing portions served to them, encouraging children to eat because “its time to eat” or “clean your plate, there are starving children in China”
DRI = daily reference intakesBy age 3, DRI equations based on child’s gender, age, height, weight, and physical activity level.
1-3 years of age – 7 mg/day3-8 years of age – 10 mg/day
CDC recommends children 1-5 years of age drink no more than 24 oz of cow’s milk, goat’s milk, or soy milk each day because of the low iron content of these milks. (Larger intakes may displace high-iron foods)
Upper front teeth are most severely affected by decay, which is where fluids pool when toddlers fall asleep while drinking from a bottle.Toddlers with baby-bottle tooth decay are at increased risk for caries in the permanent teeth.Foods containing carbohydrates that stick to the surface of the teeth, such as caramel, are strong caries promoters. Rinsing the mouth with water, or brushing teeth can reduce caries formation. Children allowed to graze throughout the day have longer exposure to carbohydrates on their teeth, which encourages tooth decay.
Gradually increase fiber in diet rather than all at once, to lessen gastrointestinal issues.
Toddlers are likely to develop diarrhea. Diarrhea results from excess water being pulled into the intestine.Chronic nonspecific diarrhea really presents more social and aesthetic problems than medical ones.
Lead-based paint chips taste sweet, tempting children to consume them.
I found data from 2005-2007 from the USDA that indicated Mississippi has the most food insecurity, at 17.4% of the population. North Dakota has the lowest food insecurity, at 6.5%.
Salmonella on the petri dish on the left, raw hamburger in the middle, and a photo of E. coli 0157:H7 on the right.
NHANES 1999-2000, 20.6% of 2-5 year olds in the US were overweight.Lean children ≤ 5 years of age have a 13-fold risk of adult obesity if both parents are obese.http://spectrum.diabetesjournals.org/content/18/4/213.full
Can be a sign for doctors to check for other health problems, such as Type 2 Diabetes Mellitus. Almost 75% of kids with T2DM develop AN, according to the American Diabetes Association.http://kidshealth.org/teen/your_body/skin_stuff/acanthosis.html#Decreased insulin sensitivity (insulin resistance) has been shown to precede the development of type 2 diabetes and CVD.
Eating a diet of a variety of foods is the preferred way to get needed nutrients because foods contain many other substances, such as phytochemicals and fiber, in addition to nutrients that benefit health.
Children most likely to receive a supplement are those at low risk of developing nutrient deficiencies. And children who would most likely benefit from a supplement are less likely to receive them.Avoid too high amounts of vitamin A and D! Tolerable upper intake levels should be used as a guide.
Based on 1600 calorie pattern
Young children can grow and develop normally on vegetarian or vegan diets, as long as their dietary patterns are intelligently planned. Children have small stomachs and in order to be able to eat all the food they need to eat to reach their caloric needs, they will have to eat several times throughout the day, and will have to include some energy-dense foods (cheese, avocados, peanut butter).
Food VouchersWIC participants receive food vouchers that can be used at local grocery stores, Wal-Mart, and even certain gas stations. A new offer from WIC is that participants can now receive a special $20 voucher to spend at local farmer’s markets on fresh fruits and vegetables!The quantities of foods depend on the type of participant. For example, breastfeeding mothers require more food than mother’s who are not breastfeeding. The types of foods that participants can receive with their vouchers include:4 cans of beans, 1 package of dried beans, OR a jar of peanut butter16 oz of sliced, cheddar, or blocked cheeseEggsBreadMilk (whole, 2%, 1%, or skim)Cereal (only certain brands)100% juices$10 or $6 voucher for fresh fruits and vegetablesInfant baby foods and formula
Early Head Start in 1995, for low-income families with children under age 3 and to pregnant women.Head Start is for children 3- the age at which they begin school (5 years).
If you visit the website, you’ll see there are lots of different songs (in English and Spanish), posters, a Choosy coloring sheet you can print out and kids can color, videos, T-shirts for around $8-$13.50, wristbands, DVDs, and games/activities.
These interventional programs have addressed public health issues within our state, reaching many rural West Virginians
“nobody is identified as poor”
Includes questions to ask your kids & family during mealtime (tell me something that made you laugh today), snack ideas & recipes, meal patterns for 1000, 1200, 1400, and 1600 calories, how to get your picky eater to try new foods, kitchen activities, etc.
Resources are also available in Spanish and Chinese.
Ellyn Satter pioneered the concepts of feeding relationship and eating competence.Parents are responsible for the what, when and where of feeding; Children are responsible for the how much and whether of eating.
This book explains the mealtime environment.
You can find tons of age-appropriate kitchen/nutrition activities for toddlers and preschoolers on Pinterest. I searched for “toddlers in the kitchen” and found a bunch of activities, crafts, and recipes. You can also follow specific boards– ChooseMyPlate.gov has a pinterest account (at Myplaterecipes) and they have a “Kid-friendly meals” board where you can find recipes that kids will like, that include whole grains and fruits and vegetables.
Outline• Introduction • Normal growth and development • Physiological and cognitive development• Nutrition Recommendations • Energy and nutrient needs • Common nutrition problems • Prevention of nutrition-related disorders • Dietary and physical activity recommendations• Key Nutrition Programs• Key Nutrition Resources• Conclusion 2
Importance of Nutrition• The eating habits established now impact food habits and health later in life.• Toddlers and Preschoolers need adequate intake in order to achieve full growth and developmental potential• Undernutrition impairs children’s cognitive development as well as their ability to explore their environments• Long-term effects of undernutrition (FTT, cognitive impairment) may be prevented or reduced with adequate nutrition and environmental support. 3
Normal Growth & Development• Infants triple birth weight in first 12 months, but growth slows after that• Toddlers gain 0.5 lbs and 0.4” per month• Preschoolers gain 4.4 lbs and 2.75” per year• Decrease in growth rate accompanied by decrease in appetite and food intake 4
2000 CDC Growth Charts• Gender-specific• Charts available for 0-36 months, and 2-20 years • If recumbent length measured, use 0-36 months • If standing height measured, use 2-20 years• Health care professional can plot and monitor: • Weight for age • Length/stature for age • BMI for age (2-20 yrs. only) • Head circumference for age (0-36 mos. only) • Weight for length • Weight for stature 5
2000 CDC Growth Charts• BMI provides guidelines for assessing underweight and overweight• Predictive of body fat for children over 2 years of age• BMI 85-95th percentile: risk of being overweight• BMI >95th percentile: overweight• BMI <5th percentile: underweight 6
Physiological Development -Toddlers • Most children begin to walk independently by 1st birthday • Gross motor skills, such as sitting on a small chair, climbing on furniture, walking up and down stairs, jumping in place, develop rapidly at this age • Increasingly mobile and independent, can explore environment • By 36 months, can ride tricycle 7
Cognitive Development-Toddlers• Develop new relationships, imitate others, learn about family’s cultural customs• Fears emerge during this period• Vocabulary is 100+ words at 2 years of age• By 36 months, child can use 3-word sentences• Increased determination to express their own will (temper tantrums). Can easily become frustrated and negative. 8
Development of Feeding Skillsin Toddlers• Toddlers can handle chopped or soft table foods• At 18-24 months, toddlers are able to use the tongue to clean the lips and have well-developed rotary chew movements. Now the toddler can handle meats, raw fruits and vegetables, and multiple textures of food. • Strong need for independence and self-feeding • Increasing fine motor and visual motor coordination skills allow toddlers to use cups and spoons more effectively, though may prefer to eat with their hands 9
Tips for Parents• Keep distractions (ie: TV) to a minimum during mealtimes• Allow their toddlers to practice self-feeding skills and to experience new foods and textures (no matter how messy!)• Risk of choking high at this age • Toddlers should always be seated during meals and snacks (high chair or booster seat with the family) • Foods that may cause choking: hard candy, popcorn, nuts, whole grapes, and hot dogs should not be served to children less than 2 years of age. 10
Feeding Behaviors of Toddlers• Many toddlers demonstrate strong food preferences and dislikes• “Food jags” – prolonged periods of refusing a particular food or foods they previously liked• To circumvent food jags: • Serve new foods along with familiar foods • Serve new foods when child is hungry • Other family members should eat the new foods in front of toddler• Mealtime an opportunity for parents to model healthy eating behaviors, toddlers to practice language and social skills, develop positive self-image 11 • Not the time for battles or “force feedings”
Food Intake in Toddlers• Rule of thumb: serving size is 1 tablespoon of food per year of age. • So a serving for a 2-yr old child would be about 2 tablespoons.• Because toddlers can’t eat a large amount of food at one time, snacks are vital in meeting the child’s nutritional needs.• Toddlers should not be allowed to “graze” throughout the day on sweetened beverages and foods such as cookies and chips. • These foods can lower their appetite for basic foods at meals• Establish regular but flexible meal and snack times to allow enough time in between for child to get hungry 12
Developments in Preschool-Age Children • Gross and fine motor capabilities expand • At age 4, child can hop, jump on one foot, climb, ride a tricycle or bicycle with training wheels, and can throw a ball overhand. • Magical thinking & egocentrism (not able to accept another’s point of view) • Play moves toward more organized group play, such as tag or “house” • Temper tantrums peak between the ages of 2-4 years • Between ages 2-5, vocabularies increase from 50-100 words to more than 2000 13 words, and complete sentences.
Development of Feeding Skillsin Preschool-Age Children• Use a fork, spoon, and cup well• Cutting and spreading with a knife may need some refinement• Eating not as messy as in toddlerhood• Unintentional spills• Modify foods to minimize risk of choking- cut grapes in half lengthwise and cut hot dogs in quarters lengthwise and cutting into small bites. 14
Feeding Behaviors ofPreschool-Age Children• Children want to be helpful and to please their parents and caretakers• Good time to teach children about food, food selection, and preparation • Get them involved! 15
Age-Appropriate Kitchen Activities• At 2 years• Wipe tables• Hand items to adult to put away (such as after grocery shopping)• Place things in trash• Tear lettuce or greens• Help “read” a cookbook by turning the pages• Make “faces” out of pieces of fruits and vegetables• Rinse vegetables or fruits • At 4 years:• Snap green beans • Peel eggs and some fruits, such as• At 3 years: oranges and bananas• Add ingredients • Set the table• Talk about cooking • Crack eggs• Scoop or mash potatoes • Help measure dry ingredients• Squeeze citrus fruits • Help make sandwiches and tossed• Stir pancake batter salads• Knead and shape dough • At 5 years:• Name and count foods • Measure liquids 16• Help assemble a pizza • Cut soft fruits with a dull knife • Use an egg beater
Innate Ability to ControlEnergy Intake• Ability to self-regulate food intake• If allowed to decide when to eat and when to stop eating without outside interference, children will eat as much as they need.• Can adjust their caloric intake to meet energy needs• Avoid using food as rewards or forcing child to “clean their plate” 17
3 yr old vs. 5 yr old study• Children served either small, medium, or large portion of macaroni and cheese, along with standard amounts of other foods.• Analysis of amount of food eaten showed that portion size did not affect the younger children’s intakes – their intakes remained the same despite the amount of food served to them.• 5-year-old children’s intakes increased significantly with larger portion sizes• By 5 years of age, children are influenced by external factors rather than internal cues (hunger & satiety signals) 18Rolls BJ, Engell D, Birch LL. Serving portion size influences 5-year-old but not 3-year-old children’s food intake. J Amer Diet Assoc. 2000; 100:232-34.
Appetite and Food Intake ofPreschoolers – Picky Eaters• Familiar foods may be comforting to the child• Child may be trying to exert control over this aspect of her/his life• Suggestions include: • Serve child-sized portions • Serve food in attractive way • Limit snacking and drinks between meals as to not “kill” appetite at mealtime• May take 8-10 exposures to new food before it is accepted• Children raised in an environment where all members of the family eat a variety of foods are more likely to eat a variety of foods. 19
Food Preferences• Their own food habits and food preferences are established at this time • Influenced by parents, caretakers, peers, siblings, TV • Spending more time away from home (day care, preschool)• At this age, children generally do not like: • strongly flavored vegetables • Spicy, sour, or bitter food • Food touching or mixed together (casseroles, salads)• Children naturally prefer sweet and slightly salty tastes• Foods served on a limited basis but used as a rewards become highly desirable.• Coercing or forcing children to eat foods can have a long-term negative impact on their preference for these foods. 20
NutritionRecommendationsEnergy and nutrient needs, common nutrition problems,prevention of nutrition-related disorders, dietary andphysical activity recommendations 21
Energy Needs • Children ages 13-35 months • (89 x kg BW – 100) + 20 (Kcal for energy deposition) • IE: 24-month old girl who weighs 12 kg would have an estimated energy requirement (EER) of (89x12 -100) + 20 = 988 kcalsAge/ Weight Height Sedentary Low Active Very ActiveGender (kg) (m) PAL Active PAL PAL (kcal/d) PAL (kcal/day) (kcal/d) (kcal/d)3 – Boy 14.3 0.95 1162 1324 1485 16834 – Boy 16.2 1.02 1215 1390 1566 17835 – Boy 18.4 1.09 1275 1466 1658 18943 – Girl 13.9 0.94 1080 1243 1395 1649 224 – Girl 15.8 1.01 1133 1310 1475 17505 – Girl 17.9 1.08 1189 1379 1557 1854
Protein Needs• Ingestion of high-quality protein (such as milk and other animal products) lowers the amount of total protein needed in the diet to provide the essential amino acids Age RDA (based on average weight for age) g/kg/d 1-3 years 1.1 g/kg/day or 13 g/day 3-8 years 0.95 g/kg/day or 19 g/day• RDA- Recommended dietary allowances -average daily dietary intake levels sufficient to meet the nutrient requirements of nearly all (97%-98%) healthy individuals in a population group. 23
Vitamins and Minerals• Most children from birth to 5 years are meeting targeted levels of consumption of most nutrients (analysis from NHANES I, II, III)• …with the exception of iron, calcium, and zinc Age Iron (mg/d) Zinc (mg/d) Calcium (mg/d) (RDA) (RDA) (AI) 1-3 years 7 3 500 4-8 years 10 5 800 24
IRON• Good sources of iron Food Amount Iron (mg) Baked beans ½ cup 3.0 Pork 3 oz 2.7 Chicken 3 oz 1.0 Breakfast cereals, 1 cup 8.0 (4-18) iron fortified Prune juice 1 cup 9.0 Raisins ¼ cup 1.3 Lima beans ½ cup 2.2 Peas ½ cup 1.5 25
ZINC• Good sources of zinc Food Amount Zinc (mg) Beef 3 oz 4.6 Turkey ham 3 oz 2.5 Pork 3 oz 2.4 Chicken 3 oz 2.0 Dried beans, ½ cup 1.0 cooked Split peas, cooked ½ cup 0.9 Breakfast cereal, 1 cup 1.5-4.0 fortified Oatmeal, cooked 1 cup 1.2 26 Peanut butter 2T 0.9 Cheddar cheese 1 oz 1.1
CALCIUM• Adequate calcium intake in childhood affects peak bone mass• 21% of children 2-8 years consume less than their DRI for calcium• Milk & milk products • Lowfat yogurt, milk, cheese, pudding, ice cream, frozen yogurt cottage cheese• Vegetables • Spinach, kale, broccoli• Legumes • Tofu, beans• Foods fortified with calcium • OJ, frozen waffles, soymilk, breakfast cereals 27
Iron-Deficiency Anemia• NWS-21.1 • Reduce iron deficiency among children aged 1-2 years; 15.9% in 2005-2008 to 14.3%• NWS-21.2 • Reduce iron deficiency among children aged 3-4 years; 5.3% in 2005-2008 to 4.3%• For children 2-5 years, hemoglobin value <11.1 g/dL or hematocrit <33.0% is diagnostic of iron-deficiency anemia.• Rapid growth rate coupled with frequently inadequate intake of dietary iron, places toddlers (especially 9-18 month olds) at the highest risk for iron deficiency• Iron deficiency anemia in young children appears to cause long-term delays in cognitive development and behavioral 29 disturbances.
Preventing Iron Deficiency• Children at high risk for iron deficiency should be tested between ages of 9-12 months, 6 months later, then annually from ages 2-5 • Children at risk: • Low income children • Recently arrived refugee children • Low-iron diet • Consume >24 oz of milk/day • Limited access to food due to poverty/neglect • Special healthcare needs (chronic illness, IEM)• Treatment: • Supplementation with iron drops, 3 mg/kg/day 30 • Counsel parents or caretakers about diet
Dental Caries• 1 in 5 children ages 2-4 years have decay in the primary or permanent teeth• Primary cause = habitual use of a bottle with milk or fruit juice at bedtime or throughout the day • “baby-bottle tooth decay”• Incidence is highest among Hispanic, American Indian, and Alaska Native children, and among children whose parents have less than a high school education 31
Fluoride• If water supply is not adequately fluoridated, then a supplement is recommended.• American Dental Association, American Academy of Pediatrics, and American Academy of Pediatric Dentistry: • Children 6 months – 3 years need 0.25 mg/day if water supply has <0.3 ppm of fluoride • Children 3-6 years need 0.5 mg/day if water supply has <0.3 ppm, or 0.25 mg/day if 0.3-0.6 ppm of fluoride in water supply• Fluorosis – excessive fluoride supplementation, consumption of fluoride toothpaste, and high fluoride levels in water supply, leads to permanent staining of enamel of teeth 32
Constipation• Hard & dry stools associated with painful bowel movements• Diets adequate in total or dietary fiber guard against constipation Adequate Intake of Total Fiber for Children 1-3 years of age 19g/day of total fiber 3-8 years of age 25g/day of total fiber• Whole grain breads and cereals, legumes, fruits and vegetables• Avoid too much fiber, however, as it can easily cause diarrhea in young children 33
Diarrhea• Acute Diarrhea • Goes along with an infection or from contamination of food or drinking water • Fever, vomiting • Dangerous because child will likely feel ill and nauseated and will refuse fluids & foods and sleep more (cause dehydration)• Chronic Nonspecific Diarrhea • Child is not sick • Eats well, normal pattern of growth and development • Excessively frequent or watery bowel pattern • Can last a day or several months or as long as 3 years • Can be caused by distortion in their diet, a cold, change in water 34 or schedule, antibiotics
Managing Acute Diarrhea• Maintain an adequate fluid intake to correct the fluid loss • Tiny sips of fluid (water, fruit juices, soda pop, ginger ale, jello, clear broth) • Crushed ice or popsicles • Limit fruit and juice intake • Hold down on sugar • Avoid artificial sweeteners • Make sure the diet has enough fat in it • Include yogurt 35
Lead Poisoning• 2.2% of children ages 1-5 have high blood lead levels, exceeding 10 mcg/dL• High blood lead levels affect brain and kidney function• Low-level exposure to lead associated with behavioral problems, decreased IQ, decreased growth• Lead-based paint chips, lead-soldered water pipes, canned goods from other countries, dirt, lead weights, ceramic glazes, pewter• Screening in children living in houses built before 1950, living in poverty, having a sibling with high blood lead levels, Medicaid, WIC• Adequate dietary calcium intake appears to protect against 36 high blood lead levels by decreasing absorption of lead.
Food Security• NWS-12 • Eliminate very low food security among children; 1.3% of households with children had very low food security among children in 2008 to 0.2%• Children who are hungry and have multiple experiences with food insufficiency are more likely to exhibit behavioral, emotional, and academic problems as compared to other children who do not experience hunger 37 repeatedly.
Food Safety• Young children especially vulnerable to food poisoning because they can become ill from smaller doses of organisms• Campylobacter, Salmonella, E. coli 0157:H7, Listeria monocytogenes • Campylobacter: Raw poultry, undercooked poultry, raw milk, nonchlorinated water, handling infected animal or human feces • Salmonella: raw/undercooked eggs, raw cookie dough • E. coli 0157:H7: contaminated undercooked hamburger meat, unpasteurized apple cider/juice, unpasteurized milk 38
FightBAC • Contamination of food can occur at any point along the way from production to consumption • Food safety education program, FightBAC, developed by the Partnership for Food Safety Education 39
Overweight/Obesity• NWS-10-1 • Reduce the proportion of children aged 2-5 years who are considered obese; 10.7% in 2005-2008 to 9.6%• Children with BMI > 85th percentile with complications (htn, gallbladder disease) or >95th percentile should be evaluated and possibly treated for obesity.• Since 1980, obesity prevalence among children and adolescents has almost tripled.• Hispanic male children more overweight than white male children.• Hispanic and black female children more likely to be overweight than white female children. 41
Overweight/Obesity• Maintaining weight while gaining height can be the best treatment for obese children between the ages of 2 and 7.• If child already exhibits secondary complications, such as htn, high cholesterol, or triglyceride levels, gradual weight loss may be indicated.• Sufficient nutrients must be provided for children to reach full height potential and to remain healthy.• Family education & involvement• Increasing physical activity, offering nutrient-dense snacks, focusing on behavior change not weight changes. 42
Cardiovascular Disease• Children with familial hyperlipidemia and obese children can have high levels of LDL cholesterol.• Fatty streaks, which can be precursors to the buildup of fat deposits in blood vessels, have been found in the arteries of young children.• AHA & AAP recommend children 2-3 to have 30-35% of total energy from fat• Children 4+, 25-35% of total energy from fat• Children with familial hyperlipidemia need periodic screening, saturated fat <7%, <200 mg cholesterol/day 43
Insulin Resistance• Acanthosis Nigricans • indicative of positive insulin resistance • Dark, velvety rash on back of neck • People who are overweight or obese are more likely to develop AN, and it often lessens or goes away with weight loss• CARDIAC Project in WV • AN screening began in 2006-2007 for kindergarteners • Total of 189 (1.6%) had confirmed AN from ‘06-’07 to ’11-’12 44
Vitamin and MineralSupplements• Children who consume a variety of basic foods can meet all of their nutrient needs without vitamin or mineral supplements.• AAP recommends vitamin and mineral supplementation for children who are at high risk of developing or have one or more nutrient deficiencies: • From deprived families/abuse/neglect • Anorexia/poor appetite/poor eating habits • “fad diet” or only consumes a few types of foods • Vegetarians without dairy products 45
Vitamin and MineralSupplements• NHANES III : Approximately 50% of 3-year-olds in the US are given a vitamin and mineral supplement by their parents.• Mothers who give supplements to their children: • Non-Hispanic white, older, more years of education, married, have life insurance, greater household income, took prenatal vitamins during pregnancy, receive care from a private health care provider 46
Dietary Recommendations• MyPyramid:• 4 year old male, 60+ minutes of physical activity • 5 oz grains • 2 cups vegetables • 1 ½ cup fruits • 3 cups milk • 5 oz meat/beans • 5 tsps oil/day • Limit extras – solid fats and sugars to 130 calories per day. 47
Key Dietary Recommendations• Variety, variety, variety!• ½ of grains should be whole• Children 2-8 years should drink 2 cups per day of fat-free or low-fat milk or equivalent milk products• Most fats should come from unsaturated sources – fish, nuts, vegetable oils• Beans, lean meats, poultry added as appropriate• Foods high in fat and sugar should be limited in diet• AHA recommends introducing and regularly serving fish to children • EPA and FDA advise fish and shellfish lower in mercury 48
Fats• Appropriate amount of fat in diet needed to meet needs for calories, essential fatty acids, and fat-soluble vitamins.• Foods high in fat should be used sparingly, especially those high in saturated and trans fat• Good sources of essential fatty acid linoleic acid: peanut, canola, corn, safflower, other vegetable oils• Good sources of essential fatty acid alpha-linolenic acid: flaxseed, soy, canola oil• Vitamin E: corn, soybean, safflower oils 49
Fluids• Healthy toddlers and preschoolers will consume enough fluid through beverages, foods, and sips and glasses of water.• Fluid requirements increase with fever, vomiting, diarrhea, and when children are in hot, dry, or humid conditions.• Approximately 50% of 2-5 year olds consume soft drinks• Children who consume >9 oz of soft drinks per day consume more calories and less milk and fruit juice than those with lower consumptions of regular soft drinks. 50
Where do kids eat?• According to the USDA report Food and Nutrient Intakes by Children, about 25% of children ages 4-8 years consumed fast food• 52% of 3-5 year olds eat away from home daily • Fast food restaurants, day care centers, friends’ houses• NWS-1 • Increase the number of states with nutrition standards for food and beverages provided to preschool aged children in childcare; 51 24 states in 2006 to 34 states
Vegetarian Diets• Young children need energy-dense foods to reduce the total amount of food required• Guidelines: • Allow the child to eat several times a day (ie: 3 meals, 2 snacks) • Avoid serving the child bran and an excessive amount of bulky foods, such as bran muffins and raw fruits and vegetables • Include in the diet some sources of energy-dense foods such as cheese and avocado • Include enough fat (at least 30% of total calories) and a source of omega-3 fatty acids, such as canola or soybean oils • Include sources of vitamin B12, D, and calcium, or supplement if required 52
Food Allergies• Estimated to be present in 2-8% of children• Usually identified in toddlers and preschoolers because allergy testing in infancy is not useful due to the incomplete development of the immune system• Anaphylaxis: sudden onset of a reaction with mild to severe symptoms, including a decrease in ability to breathe, which may be severe enough to cause a coma • Milk, eggs, wheat, peanuts, walnuts, soy, fish• Strict and complete avoidance of the food that causes the allergy is required 53
Physical Activity• 60+ minutes on most, preferably all, days of the week • Taking a nature walk • Riding a tricycle or bicycle • Walking, skipping, running • Free play outdoors • Running, swimming, tumbling, throwing, catching under adult supervision for preschoolers 54
Screen Time• PA-8.2.1 • Increase the proportion of children ages 2-5 who view TV, videos, or played video games for no more than 2 hours a day; 75.6% in 2005-2008 to 83.2%• No TV viewing for children less than 2 years of age• Screen time limited to less than 2 hours a day for all other ages. 55
Public Food andNutrition ProgramsWIC, Headstart, MyPlate, Choosy , Eatright.org, CARDIAC,NSLP, other USDA nutrition programs 56
• USDA – Special Supplemental Nutrition Program for Women, Infants, and Children• Participation in WIC services improves the growth, iron status, and the quality of dietary intake of nutritionally at-risk infants and children up to age 5 years.• For every $1 invested in the program, $3 in health care costs are saved• To qualify: children must live in a low-income household (185% or less federal poverty level) and be at “nutrition risk”• Nutrition risk: iron-deficiency anemia, under-weight, overweight, chronic illness, or consumes inadequate diet 57
• WIC provides the following services for eligible participants: • Free vouchers for specific, nutritious foods • Nutrition education in the form of one-on-one counseling with a dietitian, group classes, or grocery store tours • Low-cost or free immunizations for children • Breastfeeding services in the form of one-on-one counseling with a lactation consultant. Breastfeeding pumps are also available for lactating mothers in a limited supply • Screening and referrals to other health, welfare and social services• Vouchers for food items such as milk, juice, eggs, cheese, peanut butter, beans, eggs, bread, and fortified cereals are given to eligible families. 58• $20 voucher to spend at farmer’s market
• US Department of Health and Human Services, initiated in 1965• Comprehensive child development programs • Education, early childhood development, medical, dental, mental health services, nutrition services, parent education• Serving children 0-5 years of age, pregnant women, and families• Nearly 1 million US children participate• Goal: increase the readiness for school of children from low- income families (75% of Head Start families have incomes <$12,000 annually) 59
• Head Start projects provide meals and snacks as well as nutrition assessment and education for children and their parents• Head Start has been shown to improve children’s health: • Lower incidence of anemia • Receive more immunizations • Have better nutrition and improved overall health• 9 locations in Morgantown, West Virginia• http://eclkc.ohs.acf.hhs.gov/hslc/hs 60
• “Choosy Kids, LLC is a company devoted to promoting healthy, active lifestyles. It was founded on the belief that healthy preferences for food choices and physical activity can be developed early in life. Choosy Kids honors the role that Parents, Early Educators, and Health Providers play in helping children develop healthy preferences.” • Role model is “Choosy” • Music that appeals to kids and adults • Practical suggestions • Appropriate activities that promote active learning 61
Who is Choosy? • As an ambassador for healthy children, Choosy wants to help prevent childhood obesity. • Choosy is a role model who encourages healthy decision-making from all of us. • Choosy assists parents, teachers, and health professionals by supplying consistent health messages. • Choosy recognizes that preferences for food and physical activity are "learned" from others early in life. • Choosy helps grown ups to intentionally facilitate movement and nutrition experiences of young children so that healthy preferences are reinforced early and often. • Choosy helps to promote healthy messages and behaviors in homes, child care centers, agencies, and schools with lively songs, activities, and helpful materials. 62 • Choosys name is tied to his behavior, and his message is simple: Be Choosy Be Healthy
• “I have twins in the Choosy Kids Club. Between the two of them there are very few days that go by when one of them doesn’t mention doing something “The Choosy Way.” Whenever we have a chance to ride an elevator the boys look around for stairs and tell me the stairs are more “choosy.””• “My daughter loves the character Choosy so much that she has made many attempts at trying to perfect drawing him. She has memorized the Choosy song, and when making her lunch for school or choosing an after school snack she will often ask if it is a “Choosy food.”” 63
• 13 site coordinators, 640 preceptors, and hundreds of health science students identify children and their families at risk of CVD• Goal: to help provide, through collaboration with others, interventions that will facilitate knowledge, positive attitudes, and desired behaviors in children related to health risk factors• Blood pressure, weight, height, and blood lipid testing.• Testing has been done in Kindergarten, 2nd grade, 5th grade, 8th grade, and 9th grade.• More than 17,199 Kindergarteners have been screened from 2003-2012. 64
• In 2011-2012, 868 of 2435 eligible Kindergarten students were screened in 8 participating counties (35.6%)• 601 students underweight/normal• 149 students overweight• 118 students obese• 0.7% (6 students) had confirmed Acanthosis Nigricans 13.60% <85th Percentile 17.20% 85th-94th Percentile 69.20% >95th Percentile 65
National School LunchProgram• Operates in more than 99,800 public and nonprofit private school and residential child care institutions.• In 2007, it provided nutritionally balanced, low-cost or free lunches to more than 30.6 million school children each day• Locations receive reimbursement dollars, and offer free/reduced-price lunches to eligible children and meet specific nutrition guidelines. • At or below 130% poverty level, free lunch • 130%-185% poverty level, reduced-price lunch 66
NSLP Patterns (per lunch minimums)Food Group 1-2 years of age 3-4 years of ageLean meat, poultry, or 1 oz 1 ½ ozfishCheese 1 oz 1 ½ ozLarge egg(s) ½ ¾Cooked dry beans or ¼ cup 3/8 cuppeasPeanut Butter 2 Tablespoons 3 TablespoonsYogurt ½ cup ¾ cupPeanuts, soynuts, tree ½ oz ¾ oznuts, or seedsVegetable/Fruit, 2 ½ cup ½ cupservings, both to totalBread or Bread 5 servings/week 8 servings/week 67Alternative1 serving of fluid milk ¾ cup ¾ cup
Other USDA Food AssistancePrograms• School Breakfast Program • Established in 1966, made permanent in 1975• After School Snack Program • Established in 1998• Special Milk Program for Children• Summer Food Service Program for Children • Created in 1968 68
Charleston Gazette• http://wvgazette.com/News/theshapewerein/201204070047• “Success from scratch: Seven counties feed kids fresh food daily”• Last summer, seven of West Virginias poorest counties - Lincoln, Mingo, McDowell, Clay, Gilmer, Fayette and Mason - agreed to try cooking lunch and breakfast with fresh ingredients all year, five days a week. They would offer meals free to all students who want to eat.• Superintendent Jorea Marple wants to spread healthy cooking statewide. Their challenge: Prove it can be done. Avoid fattening, processed, prepackaged food. Find things kids like, and stay within budget. 69
• http://www.choosemyplate.gov/preschoolers.html• Provides health and nutrition information for parents, caregivers, and professionals• Topics include: • Daily food plan for preschoolers • Growth during preschool years • Developing healthy eating habits • Picky eating • Physical activity • Food safety • Meal & snack patterns and ideas • Phrases that help & hinder handout 72
• Academy of Nutrition and Dietetics• Under “Public” tab, click on “Children’s Health” • Sections on childhood obesity, nutrition for infants and toddlers, eat right at school, and get moving. • Dozens of articles written for the public• Relevant articles for toddlers/preschoolers include: • Size-wise nutrition for preschool-age children • Reducing the risk from food allergies • Raising healthy eaters from preschool to high school • Introducing solid foods to toddlers • Feeding vegetarian and vegan infants and toddlers • Coping with picky eating phases • Food safety tips, promoting positive body image in kids, breakfast 73 ideas, family dinner ideas
• Website by the Academy of Nutrition and Dietetics• Articles, tips, recipes, and videos• Toddler article examples: • “Picnic with your Toddler! The Perfect Mix of Food and Fun!” • By Karen Ansel, MS RD • “How to Avoid Choking” • By Roberta Duyff, MS RD FADA• Preschooler article examples: • “Healthy Eats at the Amusement Park” • “Talk to Your Child About Weight” • “When Should My Kids Snack?” • By Jo Ellen Shield, MED RD LD & Mary Mullen, MS RD 75
Books Division of Responsibility in Feeding the Toddler• Parents are responsible for what is presented to eat and the manner which it is presented (when and where)• The parent is not responsible for: • How much a child eats • Whether he eats • How his body turns out 76
Books• To promote good attitudes about food and good nutrition, it is important for your meals to be significant and pleasant.• Significant: • Meal on table • Someone in household planned, purchased, prepared food • Family showed up to eat meal, pay attention to it, spend some time over it• Pleasant: • Don’t argue, fight, or scold• Consider timing, seating arrangements, eating 77 mechanics, don’t enforce food consumption
Books• Tips for basic rules for raising a healthy eater; troubleshooting for picky eaters; meals, snacks, and beverages; activity; nutrition and health issues• Tip 47 – Plan a taste test challenge • Make child “official food tasting judge” • Use a blindfold, and a sip of water between each sample to cleanse palate • Prepare 2 different vegetables in different ways • Not everything will taste good, but the goal is to follow the “one bite rule” by tasting at least one bite. 78• Appendix in the back includes 22 recipes
Books• Chapter 10 & 11: Toddler and Preschooler Nutrition • Normal growth & development • Physiological and cognitive development • Energy and nutrient needs • Common nutrition problems • Prevention of nutrition-related disorders • Dietary and physical activity recommendations • Nutrition intervention for risk reduction • Public food and nutrition programs • Chronic conditions • Feeding problems 79 • Food allergies and intolerances
Books• Community Nutrition in Action• Gives descriptions of childhood nutrition programs • National School Lunch Program • School Breakfast Program • After School Snack Program • Special Milk Program for Children • Summer Food Service Program for Children • Food Distribution Program • Head Start • Eat Smart. Play Hard. • Farm to School Programs 80 • Fruits & Veggies – More Matters
Websites• USDA’s “Eat Smart. Play Hard.” • http://www.fns.usda.gov/eatsmartplayhardhealthylifestyle/• National Farm to School Programs • http://www.farmtoschool.org/• Fruits& Veggies – More Matters • http://www.fruitsandveggiesmatter.gov/• CDC Growth Charts • http://www.cdc.gov/growthcharts/• National Institute of Child Health and Development • http://www.nichd.nih.gov/• Action for Healthy Kids • http://www.actionforhealthykids.org/• West Virginia WIC • http://ons.wvdhhr.org/• Ellyn Satter, Associates 81 • http://www.ellynsatter.com/
Websites• Healthy People 2020 • http://www.healthypeople.gov/2020/topicsobjectives2020/• CDC Data & Statistics • http://www.cdc.gov/obesity/data/childhood.html• USDA’s Food & Nutrition Services Programs • http://www.fns.usda.gov/child-nutrition-programs• USDA’s Choose My Plate • http://www.choosemyplate.gov/preschoolers.html• Choosy Program • http://www.choosykids.com/CK2/• Academy of Nutrition & Dietetics – Children’s Health • http://www.eatright.org/Public/landing.aspx?TaxID=6442451994• Academy of Nutrition & Dietetics - Kids Eat Right • http://www.eatright.org/kids/• The CARDIAC Project 82 • http://www.cardiacwv.org/
Websites• Charleston Gazette’s “The Shape We’re In” – Resources for Parents • http://wvgazette.com/News/theshapewerein/201202110047• Children’s Nutrition Research Center at Baylor College of Medicine • http://www.kidsnutrition.org/• Dairy Council of California • http://www.healthyeating.org/• American Academy of Pediatrics • http://www.aap.org• Childhood Obesity Prevention Partnership • http://www.kidnetic.com/• International Life Sciences Institute’s Take10! Program • http://www.take10.net/• Let’s Move! Campaign 83 • http://www.letsmove.gov/
Conclusion• The eating habits established in toddler & preschool years impact food habits and health later in life. • Variety of food • Helping with preparation, choosing, cooking of meals • Making mealtime pleasant • Good nutrition (iron, calcium, zinc) • Staying physically active• Common nutrition problems/disorders include: • Dental caries • Iron-deficiency anemia • Constipation/diarrhea • Lead poisoning • Overweight/obesity • Insulin resistance 86 • Cardiovascular disease