Toddler Food Guidelines

Eating meals with your toddler allows you to lead by example.

• Toddlers eat because they are hungry and it is fun. Eliminate either of these and an unnecessary battle between toddler and parents may ensue.
• Children less than 2 years of age have no restrictions on fat/cholesterol intake. Those over 2 years of age should participate in the heart healthy diet that their parents (hopefully) follow. As such, parents should lead by example.
• Poor nutrition is brought upon by excessive sugar ingestion, foods high in fat/cholesterol, empty calories (for example, high fructose corn syrup), trans fats, and excessive salt intake.
• Food protein allergy may be severe, moderate, or mild in manifestation. Food allergies may be evaluated by either blood tests or scratch tests of the skin.

Newborn babies are expected to double their birth weight by 4-6 months of age and triple their birth weight by their first birthday. As an example, a 7-pound newborn will weigh about 21 pounds by 12 months of age. If this pace were to continue, a 2-year-old child would weigh approximately 60 pounds! It is obvious that the infant/toddler's rate of growth progressively slows. The need for fewer calories is coupled with a progressively more mobile and active individual who "burns up" more calories than the sedentary infant who spends large blocks of their day asleep. Toddlers have advanced from passively ingesting pure liquid nutrition (breast milk or formula) to self-feeding of table foods. This independence may be a double-edged sword from a parent's point of view -- self-feeding vs. "playing" with food. Toddlers enjoy exploration, whether it is at the park or investigating various tastes and textures of foods and enjoying gravity (dropping food to the floor). It is not unreasonable, therefore, that being "trapped" in the high chair with the expectation to happily eat all food types may lead to frustration for everyone!

A healthy diet contains four basic elements: carbohydrates, protein, fat, and minerals (for example, iron and calcium) and vitamins. The USDA has recently revised the food pyramid to reflect the most current consensus regarding infant, child, and adult nutrition. Carbohydrate sources include grains, vegetables, and fruits. Protein sources include meats (beef, pork, poultry, and fish), tofu and lentils, eggs, and milk/dairy products. While fats are important for general health (especially for brain and nervous system development for children <2 years of age), an emphasis on monounsaturated fats is recommended. Similarly, excessive intake of saturated fats and trans fats should be avoided.

Parents must accept a fundamental point. Their job is to provide a healthy diet and lead by example. Their child's job is to eat when hungry. If a toddler is not hungry or believes he can "hold out" and get treats, he will refuse to eat. The good news is that almost no child will let himself go hungry, much less "starve." Toddlers are in a continuous battle for independence, whether it is mastering language and motor skills or determining what will enter their mouth. Being very observant, they quickly realize that eating is the only facet of their daily activities over which they have 100% control -- and they will not surrender that control to anyone! Pediatric registered dieticians suggest evaluating your child's nutritional intake on a weekly (not daily) basis. Several long-term studies have demonstrated that, when offered a quality diet, toddlers will consume appropriate portions of the foods necessary for good health. A major advertising campaign for the toddler food dollar exists -- take out/fast food intake has been rising steadily over the recent years. Marketing has been a success. A 2-year-old child can identify 20 logos, many of which are food related: golden arches, fried chicken buckets, and others constantly shower children with enticements of fun foods and games and are often co-marketed with the latest movie. At the end of the day, if a parent is concerned their child isn't getting enough vitamins and minerals, taking a daily multivitamin is a reasonable option. Such a supplement does not, however, provide the necessary carbohydrates, protein, or fats necessary for a healthy child.

Parents must realize that toddlers love to control their environment and enjoy predictability. They will often binge on one particular food at the expense of all others. Then suddenly they will become bored with food "A," refuse that food, and randomly switch to food "B." Trying to predict when this change will occur and what food "B" will be is a waste of parental time. Another reality is that toddlers don't know or appreciate the time and effort parents will muster to provide a meal. Food to toddlers is a given. It was always there and it always will be. Parents have a great emotional investment in meal preparation; however, don't take it personally when your toddler rejects a meal outright. Try to view yourself as a waitress in a restaurant. If your child is hungry, the food will be consumed; if not, you can nibble on it yourself! Many parents observe that breakfast is often consumed with gusto, lunch is accepted, and dinner deteriorates into a battleground (and possibly a war zone with food flying everywhere). The following general suggestions may lessen the stress of meals:

1. Have a reasonable expectation of food amounts necessary for good health. A general guideline for children less than 5 years of age is one tablespoon/year of age. There are not a lot of green beans in a tablespoon.
2. Avoid foods which need molars for consumption -- it's just too much effort for many children. Instead of steak consider ground round (for example, meat loaf, tacos).
3. Don't be afraid of spices - children get bored of bland food just like you do. However, do not add extra salt.
4. Consider bright colored and play foods - red/yellow bell pepper; let them put olives on their fingers (you probably did it too).
5. Let children participate in food preparation (stirring or washing fruit).
6. Let children serve out their portion size. Even if it's minuscule, they can always get more.
7. Let them dip vegetables (such as melted cheese for hand dipping cooked broccoli = "broccoli trees").
8. Eat you meal with your child. Remember you want to lead by example.
9. Don't pick up the mess (either on the child or on the floor) until the meal is done. The mess will recur and you'll just get frustrated.
10. Make sure that the child's chair has a foot rest. Try sitting still in a chair where your feet don't touch the ground!

Current guidelines regarding seafood consumption are conservative by nature. Concern exists regarding mercury and organic chemical ingestion. One source suggests the following monthly limits based upon seafood type.

• 2 servings/month halibut, sole, mahi mahi
• 3 servings/month monkfish, albacore, canned light tuna, skate
• 4 servings/month wild Alaskan salmon, black sea bass
• >4 servings/month cod, crab, lobster, canned (farm-raised) salmon, scallops, shrimp, squid, tilapia

The following are USDA guidelines for juice, milk, and salt.

1. Juice: 4-6 oz/day. Fresh fruit is superior to juice and is recommended instead.
2. Milk: 16-24 oz/day. Children less than 2 years of age should drink whole milk; after 2 years of age, they may drink either low fat or nonfat milk. Dairy products can also be a good source of calcium, phosphorus, and Vitamin D.
3. Salt: Less than 1,500 mg/day from ages 1-3 and less than 1,900 mg/day for ages 4 through 8. Children's food should not have extra salt added exclusive of what the recipe calls for. Hidden sources of salt are common, including white toast (520 mg/slice), macaroni and cheese (1,650 mg/serving), small fries (2,000 mg/serving), and pepperoni pizza (4,100/slice)!

There are two primary triggers for mealtime temper tantrums. Often the child is tired and emotionally and physically exhausted. This situation most commonly surfaces at dinnertime. Unrealistic parental expectations regarding volume and type of food may also stimulate a war zone atmosphere. Dealing with temper tantrums often implies a "time out" session. The one minute/year of age guideline is reasonable. Removing the child from the eating area defuses the situation and will often do the trick. If the child adamantly refuses to eat, remove him from the area and take heart in the fact that he will be more inclined to eat having missed the current meal. Avoid offering multiple chances to entice him to eat. Such activity often leads to the toddler continuing to "raise the ante" at the next similar situation.

Children less than 2 years of age should not have restrictions placed on their intake based upon fat or cholesterol. These both promote brain maturation by providing building blocks for the "insulation" which surrounds nerve cells and thus optimizes their function. However, avoiding "empty calories" such as high sugar foods, foods with high fructose corn syrup, trans fats, and excessive salt is a good idea. Children older than 2 years of age may drink low-fat or nonfat milk, but also need to be wary of excessive juice intake (>4-6 oz/day), "fast foods" which may be laden with high fat and salt content, and soda (both regular and diet).

Pica is a "medical disorder characterized by persistent and compulsive cravings to eat non-food items." For infants and early toddlers, this fascination is generally considered age appropriate and exploratory in general. With increasing age, persistence of pica is considered a pathological behavior. Anecdotal information has linked dirt and excessive ice ingestion as indicative of iron, calcium, zinc, or vitamin deficiency. No studies have consistently confirmed these observations. There are, however, known risk factors for several non-food items:

1. Lead toxicity: paint chips from older homes with lead-based paint
2. Infection: dirt may harbor soil-borne parasites
3. GI obstruction: eating hair may promote formation of a hairball (bezoar)
4. Teeth: dental abrasion and fracture

General breastfeeding guidelines from the American Academy of Pediatrics include:

• 0-6 months of age: breast milk alone with an added source of vitamin D (unless >17oz/day formula)
• 6-9 months of age: sequential addition of cereals, vegetables, meats, and fruit
• 9-12 months of age: introduction of finger foods - there is no clear evidence that avoiding common allergens in the diet is helpful; avoid choking-hazard foods (for example, raisins, and popcorn), however.
• >12 months of age: continued transition to table foods. Children will commonly prefer finger feeding in lieu of utensils until past 18 months of age. May wean from breast to whole milk -- maximum 15-24oz/day. Introduce sipper cup if not done already.
• > 2 years of age: table foods using utensils. Can reduce to nonfat or low-fat milk.

Food allergies generally represent an immunologic response to a protein found in the suspect food. Symptoms may range from severe (anaphylaxis, asthma, swelling of the vocal cords, abdominal pain, and vomiting) to moderate (hives, tingling of the lips/mouth, eczema) to mild (nasal congestion, sneezing, mild skin rash). Children are most likely to be sensitive to egg whites, milk, and peanuts. Older children and adults are most likely to be sensitive to fish and shellfish, peanuts and tree nuts (for example,. walnuts), and egg whites. Evaluation for food protein allergy may be done either via a blood test (commonly identified as a RAST test) or by an allergist performing "scratch" testing. Children with abdominal pain and/or diarrhea or vomiting after eating wheat, barley, or rye foods may have gluten sensitivity and should be evaluated by their doctor for celiac disease.

Nutrition specialists recommend the following to promote proper nutrition.

1. Lead by example. If you follow a healthy diet, it is more likely your child will also.
2. Avoid "fast foods." These foods are much more likely to have high fat and added salt.
3. Don't battle over eating. If your toddler isn't hungry, don't panic. He will eat when he is. If he doesn't eat a meal, don't fill him up with milk.
4. Avoid bargaining. "If you eat this, you'll get a cookie."
5. Allow treats, but avoid allowing them to become a mainstay of the diet. They should be "a treat."

Betty Crocker editors. Betty Crocker's Kids Cook! Hoboken: Wiley, 2007.

Davis, Tina. Look and Cook: A Cookbook for Children. New York: Stewart, Tabori and Chang, 2004.