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Normal Nutrition, Growth and Development
One to Three Years Old
Growth and Development:
- Rate of growth slows considerably during the second year of life, and generally remains steady, but slow through preschool and pre-adolescent years. Annual increases in weight and height are fairly small, about 2-3 kg and 6-8 cm respectively, during the years from age 2 through age nine or ten.
- Body proportions change, there is little head growth, trunk growth slows and the limbs lengthen considerably as "baby" shape yields to childlike form
- Growth measurement should be monitored at regular intervals; height and weight should be assessed for being in proportion with one another. Weight increasing at a much faster rate than height or vice versa can indicate inappropriate energy intake
- Age one - two years
Feeding "on demand" yields to a more structured feeding pattern as stomach capacity now is sufficient for child to sleep through the night and consume enough food by eating three meals and 2-4 snacks per day. At one year of age, regular whole milk cow's milk is introduced. From age 1-2 years, whole milk should be consumed as a higher fat intake is needed. Milk volume should not exceed about 2-3 cups per day. High milk intake can contribute to iron deficiency in this age group.
Breastfeeding may continue during toddler years but it should not be the primary source of nutrition. A variety of table foods including fruits, vegetables, grains, milk and protein foods are needed
- Age 2 and beyond
A higher fat intake is no longer needed. Now is the time to replace whole milk with low fat or nonfat dairy products. Children of this age should also follow general dietary guidelines for health and limit saturated fat, added sugars, etc.
- Bottle feedings are no longer needed.
- Fruit juice should be limited to 2-4 oz per day
- Appropriate sized plates, utensils and cups with "sip spouts" will facilitate self-feeding skills
- Children should be offered limited, not open-ended choices (e.g. do you want carrots or broccoli with lunch?"- Not "what do you want for lunch?")
- Introduce new foods with a familiar "favorite to increase food acceptance
- Parents should role model healthy eating behaviors and eat with children
- Children should be allowed to decide how much to eat. Encouraging a child to eat "one more bite" may encourage over eating and a loss of ability to self-regulate food intake. It is the parents' role to decide what will be eaten and provide structure for meal and snack times. The child should be allowed to decide how much and even whether to eat. Children should not be forced to "try" foods if they are reluctant. When offered a good variety of healthy foods, they usually will select an adequate diet.
- Snack foods should include the same healthy food choices offered at meals, not be a time for low nutrient "treats"
- Food should never be used as a reward or punishment
- Choking is a concern as children in this age are just learning to manipulate and swallow a variety of foods. Popcorn, nuts, hard candy, gum, whole grapes, and raw carrots should be avoided. Hot dogs should be sliced lengthwise into small pieces. Meats pose a choking risk and may need to be ground, cut very fine and/or moistened
- Children of this age are at the highest risk for iron deficiency. Make sure dairy intake isn't excessive and that meat, fish, poultry or vegetarian sources of iron are included. Make sure the diet is rich in vitamin C packed fruits and vegetables to enhance iron absorption
- Not hungry at meal times
If children are eating healthy foods at snack times, low food intake at meals isn't always a problem. If child is consistently not eating at meal times, meal/snack schedules should be evaluated. Children aren't always hungry at the same times adults are.
- Messy eaters
Toddlers are trying to master self-feeding skills and they will be messy eaters. As long as they aren't "playing" without eating their food, a certain amount of food exploration, eating with hands and making a mess is healthy and to be expected.
- Food Jags
Children of this age are beginning to possess a self-awareness and may want to explore their abilities to make choices by refusing certain foods, even ones that have been favorites, or wanting to eat the same foods breakfast, lunch and dinner. Including favorite foods while continuing to offer a variety of other choices will usually result in a healthy overall diet.
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