Colleen Shaw M.D.

Moms4Moms October 16, 2013

Our Childs Growing Nutrition

Outline: Nutrition 101 Ages and Stages Whats normal? Picky Eaters Patience Possible solutions Common Nutrition Concerns

Nutrition 101

Food Group Pyramid

Bite-Size Milestones: Signs of Solid Food Readiness

Its not coincidental that many of the physical skills necessary to embark on solid food feeding are reached at right about the same time that babies can rise to the occasion. And just when breast milk or formula consumption often isnt enough to tide them over, their digestive systems become ready to take on the challenge of solid foods. When your baby learns to master the following mealtime milestones, she is likely to be ready, willing, and able to start out on her feeding adventure.

Hold Her Head Up High. Although some babies are able to lift their heads in a show of strength from the day they are born, its usually not until 3 or 4 months of age that the ability to hold ones head up consistently higher and for longer periods sets in. Sitting Pretty. Babies typically start sittingalbeit initially with a fair bit of proppingat about 6 months of age. Fortunately, several modernday high chairs and feeding chairs come with convenient recline features that offer additional support for those not quite ready to sit fully upright on their own. Big Enough to Take It. As a rough rule of thumb, babies are big enough to tackle solid foods right around the time when they double their birth weight and reach a minimum of about 13 pounds. Open Wide. As babies become more aware of the world around them, they also tend to become more interested in foodoften watching food intently and opening their mouths in eager anticipation when they see some headed their way.

Sample Daily Menu: 8-12 Month Old

1 cup = 8 ounces [240 ml] 4 ounces = 120 ml 6 ounces = 180 ml Breakfast 1412 cup cereal or mashed egg 1412 cup fruit, diced (if your child is self- feeding) 46 oz. formula/breastmilk Snack 46 oz. breastmilk/formula or water 14 cup diced cheese or cooked vegetables Lunch 1412 cup yogurt or cottage cheese or meat 1412 cup yellow or orange vegetables 46 oz. formula/breastmilk Snack 1 teething biscuit or cracker 14 cup yogurt or diced (if child is self-feeding) fruit Water Dinner 14 cup diced poultry, meat, or tofu 1412 cup green vegetables 14 cup noodles, pasta, rice, or potato 14 cup fruit 46 oz. formula/breastmilk Before Bedtime 68 oz. formula/breastmilk or water (If formula or breastmilk, follow with water or brush teeth afterward.)

A toddlers energy requirements are not very large. Heres a general guide for feeding your toddler. Each day, a child between ages 1 and 3 years needs about 40 calories for every inch of height. This means, for example, that a toddler who measures 32 inches should be taking in an average of about 1,300 calories a day, but the amount varies with each childs build and activity level. The childs serving size should be approximately one-quarter of an adults. For example, heres an average toddler-sized meal.

One ounce of meat, or 2 to 3 tablespoons of beans One to 2 tablespoons of vegetable One to 2 tablespoons of fruit One-quarter slice of bread Your toddler will get enough calories along with all the protein, vitamins, and minerals he needs from an average daily intake similar to the following:
Average Daily Intake for a Toddler

Food Group Grains

Servings Per Number of Day 6 servings Calories Per Day 250 calories

One Serving Equals Bread, to slice Cereal, rice, pasta, cooked, 4 tablespoons Cereal, dry, cup Crackers, 1 to 2

Vegetables Fruits

2 to 3 servings 2 to 3 servings

75 calories 75 calories

Vegetables, cooked 1 tablespoon for each year of age Fruit, cooked or canned, cup Fruit, fresh, piece Juice, to cup (2-4 oz)

Dairy

2 to 3 servings

300-450 calories

Milk, cup Cheese, oz (1-inch cube) Yogurt, 1/3 cup

Protein group: meat, fish, poultry, tofu

2 servings

200 calories

1 oz (equal to two 1-inch cubes of solid meat or 2 tablespoons of ground meat) Egg, any size, yolk and white

Legumes: dried beans, 2 servings peas, lentils Peanut butter (smooth only)

200 calories 95 calories

Soaked and cooked, 2 tablespoons (1/8 cup) 1 tablespoon spread thin on bread, toast, or cracker

Last Updated 9/30/2013 Source: Nutrition: What Every Parent Needs to Know (Copyright American Academy of Pediatrics 2011)

American Academy of Pediatrics

Sample Daily Menu: 2-Year-Old

This menu shows a typical day of healthy eating for a 2-year-old who weighs about 27 pounds. Breakfast Cereal (12 cup, iron-fortified) or 1 egg Citrus or tomato juice (1/2 cup) or cantaloupe or strawberries (13 cup) Toast (1/2 slice) Margarine or butter (12 teaspoon) Jelly (1 teaspoon) Two-percent milk (34 cup) Snack Crackers (4) Cream cheese (1 oz) (1 oz = 2 tablespoons) Juice (12 cup) Lunch Sandwich (12 ):Whole wheat bread (1 slice),meat (1 oz or 1 slice) Margarine or butter (1 teaspoon) or salad dressing (2 teaspoons) 2 tablespoons dark-yellow or dark-green vegetables Low-fat oatmeal cookie (1 small) Two-percent milk (12 cup) Snack Apple (12, sliced), grapes (13 cup, sliced), or orange (12) Two-percent milk (12 cup) Dinner Meat (2 oz) (2 oz is about the size of your childs palm.) Vegetable (2 tablespoons) Pasta, rice, or potato (13 cup) Margarine or butter (1 teaspoon) or salad dressing (2 teaspoons) Two-percent milk (12 cup)

With all the energy your toddler uses, his stomach cant hold enough to keep him from getting hungry between meals. Many children need a morning and afternoon snack, which should be timed so they wont interfere with lunch or dinner. Snacks should include a satisfying balance of healthful foods.
Healthy Snacks for Toddlers
Fresh Fruits

Apples, bananas, peaches, nectarines, pears (sliced) Cherries, grapes, plums (sliced or smushed and pitted) Orange or grapefruit sections (cut into pieces) Strawberries Apples, apricots, peaches, pears (cut up) Dates, prunes (pitted, cut up) Raisins Carrots, green beans (well cooked, diced) Steamed cauliflower, broccoli Yams (cooked and diced) Peas (mashed for safety; a child can inhale whole peas) Potatoes (cooked and diced) Cheese (grated or diced) Cottage cheese Yogurt, fresh or frozen
Milk

Dried Fruits

Vegetables

Dairy Products

Breads and Cereals

Whole wheat bread Bagel cut into small pieces Crackers (saltine, graham, whole grain) Dry cereal Pretzels Rice cakes
Fish (canned tuna, salmon, sardines; whitefish)

Meat/Protein Group

Peanut butter (smooth, spread thin on bread or cracker)

Snacks to Avoid

Raw vegetables are mostly too difficult for toddlers to manage, and somecarrots, whole cherry tomatoes, whole green beans, celeryare a serious choking hazard for toddlers. But theres no reason that a toddler shouldnt enjoy well-cooked vegetables cut into manageable pieces. Big chunks of any food and glob-like spoonfuls of peanut butter are hazardous and should not be given to children younger than 4 years; the same advice is just as important for any types of nuts, peanuts, or popcorn because children arent able to grind food and reduce it to a consistency safe for swallowing. Chunks of peanut butter can stick to their palate and end up choking them.

Sample Daily Menu: 4-Year-Old

This menu is planned for a four-year-old child who weighs approximately 36 pounds (16.5 kg). 1 teaspoon = 13 tablespoon (5 ml) 1 tablespoon = 12 ounce (15 ml) 1 ounce = 30 ml 1 cup = 8 ounces (240 ml)

Breakfast
12 cup nonfat or low-fat milk 12 cup cereal 46 oz. or 12 cup cantaloupe or strawberries or banana

Snack
12 cup nonfat or low-fat milk 12 cup fruit such as melon, banana, or berries 12 cup yogurt

Lunch
12 cup nonfat or low-fat milk 1 sandwich2 slices whole wheat bread with 12 oz. of meat and cheese, veggie and dressing (if needed) or peanut butter and jelly 14 cup dark-yellow or dark-green vegetable

Snack
1 teaspoon peanut butter with 1 slice whole wheat bread or 5 crackers or string cheese or cut-up fruit

Dinner
12 cup nonfat or low-fat milk 2 ounces meat, fish, or chicken 12 cup pasta, rice, or potato 14 cup vegetable
If your family would like to include margarine, butter, or salad dressing as a side option to any meal, choose low - fat or healthier versions, if possible, and only give 1 or 2 teaspoons to your child.

Last Updated 7/31/2013 Source Caring for Your Baby and Young Child: Birth to Age 5 (Copyright 2009 American Academy of Pediatrics)

General Guidelines of Nutrition 101

A variety of nutrient-dense foods from the basic food groups should be offered each day. Foods and beverages should contain or be prepared with little added salt, sugar, or caloric sweeteners FAT 1-2 years: Fat and cholesterol intake are not restricted 2-3 years: Fat should comprise 30-35% of total energy intake 4-18 years: Fat should comprise about 25% of total energy intake MEAT/PROTEIN Daily intake of protein rich sources: meat, poultry, fish, eggs, peanut butter, and beans FRUITS and VEGETABLES A colorful variety of fruits and veggies should be offered each day, with every meal and/or snack Whole fruit is always preferred to fruit juice but 1 serving can be provided in the form of 100% fruit or vegetable juice Consumption of 100% fruit or vegetable juice should be limited to 4-6 ounces in children aged 1-6 years and no more than 8-12 ounces in children older than 7 years. GRAINS At least of total grains consumed should be whole grains. Whole grain should be first ingredient on label COWS MILK 1-2 years: 2 cups of whole milk daily (or alternative dairy source) 2-8 years: 2-3 cups of fat-free or low fat milk daily (or alternative dairy source) >9 years: 3 cups fat-free or low fat milk daily (or alternative dairy source) BEVERAGES Plain, unflavored water is the preferred beverage for children

Ages and Stages: Whats Normal

9-24 months Developing motor skills allows for self-feeding Playing with food Throwing food and utensils Spitting food out Open to exploring new foods and textures at first turning to increasing pickiness by age 2 2-3 years Decreased need for steady, predictable calories as growth rate slows, toddler gets busy, and behavior becomes more erratic PICKY, PICKY, and more PICKY is the norm For weeks, they may eat 1 or 2 preferred foodsand nothing else May eat big breakfast or lunch and show no interest in eating anything else the rest of the day Increased independence in feeding self, able to fully use utensils and cup Not wanting to come to the table 4-5 years Able to sit with family and contribute to meal time May talk back about not wanting to eat certain foods Highly influenced by peers food choices, media, and presentation of food Explores boundaries of table manners

PICKY EATERS

Picky eaters: 1. Can be very disruptive to family and household routines. 2. One of the most common complaints at well child visits. Our job is to offer a variety of healthy meal options and snacks throughout the day Our kids job is to decide how much and if/when they eat. 1. Try to involve child in dinner making process a. Give as many choices as possible 2. Dont be a short order cook 3. A child wont starve overnight if they dont eat 4. Healthy boundaries 5. Never make a child clean his/her plate 6. Sit down as a family to eat 7. Practice healthy eating habits yourself 8. Dont say negative things about food, body image, or weight in front of children 9. Get creative and be patient

Food jags: Eats only one food, meal after meal

Make sure your child is hungry when mealtime comes. Offer only healthy snacks, and do not offer snacks too close to mealtime.

Food strikes: Refuses to eat whats served, which can lead to short-order cook syndrome

Let your child eat what he wants if the jag food is healthy. Offer other foods at each meal before the jag food. Be patient. After a few days, your child likely will try other foods. Food jags rarely last long enough to cause any harm. Make sure your child is hungry when mealtime comes. Offer only healthy snacks, and do not offer snacks too close to mealtime.

Have whole-grain bread and rolls as well as fruit available at each meal, so there are usually choices that your child likes. You shouldnt prepare separate meals for each child, unless you want to be a short-order cook.

The TV habit: Wants to watch TV at mealtime

Dont be afraid to let your child go hungry if she wont eat what is served. Turn off the TV during meals. Watching TV during meals is a distraction that prevents family interaction and interferes with a childs eating. Mealtime is often the only time during the day that families can be together.

The complainer: Whines or complains about the food served

If your child whines and complains about the food offered, encourage her to eat what she can. If she continues to whine and complain, have her go to her room or sit quietly away from the table until the meal is finished. She can return and finish her meal only if she promises not to complain.

If your child is hungry and wants to come back to finish eating, let her know that its good to have her rejoin the family.

Avoid letting her take food away from the table to eat, return for dessert, or snack until the next planned meal or snack time.

The great American white food diet: Eats

Encourage your child to eat what he can. Do not force your child to eat other foods. Giving more attention to finicky eating habits only reinforces a childs demands to limit foods. Offer a variety of foods from all the food groups. Be patient. Eventually your child will move on to other foods. Model eating and enjoyment of new foods yourself by introducing new foods at each meal.

only white bread, potatoes, macaroni, and milk

Fear of new foods: Refuses to try new foods

Encourage your child to allow a small portion of the new food to sit on her plate instead of forcing her to try new foods. Be patient. It may take many tries before a child is ready to taste a new food and a lot of tastes before liking new food.

Common Nutrition Problems:

Children and adolescents lack calcium, potassium, fiber, magnesium, and vitamin D & E. Sources of these nutrients:
Fiber- whole grains, fruits and vegetables Vitamin E nuts, seeds, wheat germ oil and vegetable oils Calcium- low fat and fat free dairy products, rhubarb, spinach, collard greens, and sardines Magnesium- whole grains, nuts, pumpkin seeds, and white, black, navy beans Potassium- legumes, potatoes, dried apricots, beet greens, prune juice and dairy products Vitamin D- sunshine, fortified dairy and juice, cod liver oil, salmon, tuna and mackerel

Not enough Iron in the diet Too much milk Picky about eating meat Constipation Not enough water Not enough fresh fruits and vegetables Food allergy Limits nutrient intake, particularly of dairy (Calcium and Vit D) Gastrointestinal distress due to allergies

References

Healthychildren.org UpToDate Food Fights: Winning the Nutritional Challenges of Parenthood Armed with Insights, Humor, and a Bottle of Ketchup, by Laura a Jana, M.D., FAAP, and Jennifer Shu, M.D., FAAP. American Academy of Pediatrics