NUTR 2050 Chapter Notes - Chapter 10: Dietary Reference Intake, Growth Chart, Birth Weight
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Chapter 10: Toddler and Preschooler Nutrition
Growth during the toddler and preschooler age is slower than infancy but it is steady.
This slowing of growth velocity is reflected in a decrease of appetite; however they need
adequate calories for their nutrient needs. The habits that they take during this stage may
impact their food choices and health outcomes later on. The development of new skills
and increasing independence marks these stages.
Definitions of the Lifecycle Stage
Toddlers are generally defined as children between the ages of 1-3. This stage of
development is characterized by a rapid increase in gross/fine motor skills with increases
in independence, exploring the environment and language skills.
Preschool ages are those between 3-5. Characteristics include increasing autonomy,
experiencing broader social circumstances, further language skills and expanding their
ability to control behavior.
Importance of Nutrition
Adequate intake of energy and nutrients is necessary for these children to achieve their
full growth and development potential. Under nutrition during these years impacts their
cognitive development as well as their ability to explore environments.
Tracking Toddler and Preschooler Health
The percentage of children living in poverty is 20% an 18% increase from 2000 to 2009.
When evaluating young children’s nutrient status and offering education to parents, it is
important to consider their home environments. Disparities in child health indicators
include those of nutrition status in this age group among races/ethnicities
Normal Growth and Development
An infants birth weight triples in the first 12 months of life but the growth velocity slows
thereafter until the adolescent growth spurt. On average, toddlers gain 8onz per month
and 0.4in of height per month while preschoolers gain 4.4 pounds and 2.75 inches per
year including a reduced food intake and appetite in which parents should not be
concerned as this is normal.
Toddlers less than 2 years of age should be weighed without clothing or a diaper. The
recumbent length of toddlers should be measured on a length board and a moveable foot
board. Proper measurement requires two adults – one at the child’s head to make sure the
crown is placed firmly against the board and the other making sure that the legs are fully
extended and placing the child’s feet on the board.
Preschool children should be weighed and measured without shoes and in lightweight
clothing. Calibrated scales should be used and height board should be used for measuring
The 2000 CDC Growth Charts
Charts are gender specific and are available for birth to 36 months and for 2-20 years.
With these charts, the health care professional can plot and monitor weight for age,
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length/stature for age, head circumference for age, weight for length weight for stature
and BMI for age. There is overlap between the two sets of growth charts for those
between 24-46 months. If the child’s recumbent length is measured, than the birth to 36
months growth chart is the appropriate one to use. If the child over two years of age is
measured standing the 2-20 year growth chart is the correct choice. It is the pattern of
growth that is important to assess rather than any one single measurement, A weight
measurement without a length or stature measurement doesn’t indicate how appropriate
the weight is for the child’s length or stature. BMI is predictive of body fat for children
over 2 years. For children 2 years of age or older, a BMI in the 85th percentile or greater
but less than the 95th percentile indicates overweight, and a BMI in the 9th or greater
indicates obesity. For children less than 2 years of age a weight for length greater than the
95th percentile is considered overweight. A weight for length for age percentile less than
the 5th percentile indicates underweight. BMI fluctuates through out childhood. BMI
increases in infancy, decreases during preschool years, hitting the lowest point at ages 4-6
and increasing into adulthood. The slope of the curve is not as steep as it is during the
first year of life.
WHO Growth Standards
For those who are birth to age 5. It is based on how children should grow under optimal
environmental conditions regardless of their socioeconomic and ethnicity. The CDC
growth charts are recommended for children of 2 years and older in the USA. Because
the same charts can be used continuously from age 2-19 years and methods used to create
them are similar to that of the WHO charts. Make sure to choose the right chart.
Physiological/Cognitive Development – Toddlers
Most children begin to walk independently around their first birthday, it is more like a
toddle with a wide based gait. After practicing for several months they will be able to
stop, turn and stop without falling over. Gross motor skills, such as sitting on a small
chair and climbing furniture develop rapidly at this stage. At about 15 months, children
can crawl up stairs, by 18 moths, they can run stiffly, most can walk up and down stairs
one at a time and by 24 months they can jump in place. By 30 months children have
advanced to going up stairs by alternating their feet and by 36 months they are ready for
tricycles. Children become more mobile and independent with improvements in gross
motor skills. However, toddlers have no sense of dangerous situations. At this age,
children are especially vulnerable to accidental injuries and ingestion and harmful
Toddlers now have the power to control the distance between themselves and their
parents. They are “orbits”. From a socialization standpoint, the child moves from being
primarily self-centered to being more interactive. The toddler now possesses the ability to
explore the environment and develop new relationships. Fears of certain situations such
as (separation, darkness, wind, lightning) as they are learning to deal with their new
environments. Social development also involves imitating others, the child learns about
their family’s cultures customs including those to food and meals. Dramatic development
of language skills occurs from age 18-24 months. Once a child realizes that words can
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stand for this and their vocabulary goes from 100+ more words. The toddler soon begins
combining words to make simple sentences. By 36 months they use three word sentences.
They are determined to express their own free will. They are known to have the same
type of behavior seen in those of adolescents.
Many babies begin to wean from the breast/bottle at about 9-10 months when their solid
food intake increases and they learn to drink from a cup. Parents need to pay attention to
readiness cues. Weaning will be easier for those babies who adapt well to change. It is a
sign of a toddlers growing independence and is usually complete by 12-14 months of age.
Between 12 and 18 months, toddlers are able to move the tongue from side to side and
learn to chew foods with rotary rather than just up and down. They can handled chopped
or soft table food. At about 12 months, children have a refined pincer grasp that enables
them to pick up small objects (peas and carrots) and put them into their mouths. They
will be able to use a spoon around this age but not very well but by 18-24 months they
can clean their lips and have rotary movements; here they can handle meats, raw
fruit/veggies and multiple food textures. They have a strong urge for self-feeding and
become easily distracted. Increasing fine motor and visual motor coordination skills
allows them to use spoons and cups more efficiently. They want to eat with their hands
and they are messy and keeping distractions at a minimum. Learning to self feed helps
them with everyday life but make sure there is still adult supervision.
Feeding Behaviors and Intake
Most is linked to food jags. Many toddlers demonstrate strong food preferences and
dislikes. The intensity of the refusal or negative attitude toward a particular food will be
influenced by their temperament. New foods are better accepted if they are served when
the child is hungry and if she seems the other members of the family eating these foods
and their natural curiosity will get the best of them. Mealtime is an opportunity for them
to acquire language and social skills and developing a positive self image. They need
toddler sized portions – one table spoon per year. It is better to give a small portion and
let them ask for more if they are still hungry. They must be allowed to have snacks but
healthy ones and to be able to control the amount of food eaten and not get pressured by
Preschool Age Children – Cognitive
Magical thinking and egocentrism characterize this period although the child is not able
to accept another’s point of view. During the preschool years, children gradually move
from primarily relying on external behavioral limits from those o parents and caregivers
to limit their behavior internally. It is a prerequisite to functioning in a school classroom.
Control is central issue for preschool children. They will test their parents limits and
resort in temper tantrums to get their way. They generally peak by the age of 2-4 years.
The child’s challenge is to separate and the parents challenge is too appropriately set
limits and at the same time to let them go an to find the right balance. Between the ages
of 2 and 5, children’s vocabularies increase from 50-100 to more than 2000 words and to
two to three word full sentences.
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