Toddler & Preschool Nutrition Tips for Picky Eaters, Grazers, and Chow

HoundsAmy Belko, PhD, MD, FAAP

Olympia PediatricsMay 24, 2011

Disclosures

• Born in the 1950s with a stay- at-home mother who pressure cooked all vegetables until they were beyond recognition.

• B.S. in Food and Dairy Science from the University of Wisconsin (Cheese and Beer capital of the USA).

• M.S. and Ph.D in Human Nutrition from Cornell University.

• M.D. from University of Vermont (more cheese).

• Training in Pediatrics at Seattle Children’s/UW.• Pediatrician in Olympia since 1994 (Memorial

Clinic and now Olympia Pediatrics).• Mother of two daughters, one who ate

everything and one who ate like a hummingbird.

Outline

• Review of Growth Charts• Nutrition for Toddlers, Preschoolers, and School

Aged– Developmental milestones– How much/what to feed.– Tips– When to Worry, When to Cry, When to Laugh

• Recipes/Taste Testing• Trickery

Great Resources

More Great Resources

Great Stories for Kids

Punchline

• If left on their own, toddlers and preschoolers will eat a diet that allows them to grow and develop normally.

• It is the parents/caregivers’ job to provide the food. It is the child’s job to eat the food.

• Food battles are a child’s way of expressing independence. They are not intended to destroy the self-confidence, psyche, or emotional well being of the parent/caregiver.

Old Sayings Ring True

• Babies double their birth weight in the first 6 months and triple it in a year (for babies 6-8#).

• Growth slows in the second year of life with an average of 5-8 pounds gained.

• Children ages 2-8 have the slowest growth rate.

Review of Growth Charts

How to Use a Growth Chart

Official USDA Recommendations

jCalorie, protein and nutrient needs vary with age, size, and activity level of the child…rough estimate is 1000-1200 calories per day for ages 2-3 and 1200-1600 for 4-6yr.

New pyramid emphasizes importance of all nutrient groups with exercise. Great web resources for kids at mypyramid.gov

Toddler Fun

How Much to Feed a 2-3 year old (average guidelines)

• Milk, cheese, yogurt: 4, ½ cup servings.– (1.5 oz cheese = ½ cup)

• Veggies and fruit:– Vitamin C source (berries, citrus) ½ cup.– Vitamin A source (veggies, fruit) 3

Tablespoons.– Other veggie (potato): 3 Tablespoons.– Other fruit (apple, banana): 1/3 cup.

• Protein (lean meat, chicken, fish, legumes):– 3, 3 Tablespoon portions.

• Cereals (whole grain and non-added sugar):– 2, 1/3 cup portions.

• Bread: 1 slice or 1 small muffin or ½ bagel.

Tips for Toddlers

• Don’t worry appetites are SMALLER.• Don’t worry food choices avoidances are part of

independence.• Strict schedule…3 meals, 3 snacks.• Calories come early in day not at supper.• No comments positive or negative. Buy, prepare,

and present food. Do not “after feed”.• Water anytime. Juice and milk only at meals.• No soda.

Pre-School Fun

How Much to Feed ages 4-6 years

Milk, Cheese, Yogurt4 servings (1/2 cup milk or yogurt, 1.5 oz cheese)

Veggies and FruitVitamin C source (berries, citrus) : ½ cupVitamin A source (green or yellow fruit/veggie): ¼-1/3 cup.Other veggie (potato/legume):1/2 cup.Other fruit (apples, bananas) :1/2cup.

Protein: 3, 6 Tablespoon portions.Cereals (whole grained no added sugar): 2, 1/2 cup.Bread: 1 slice or small muffin or ½ small bagel.

Tips for Ages 4-6

• Expect dawdling (at meal times and anytime).• Meal-time atmosphere helps…TV off.• Encourage participation in food preparation.• Explain how food works in body.

– Carrots for eyes, dairy for bones/teeth, fruit for gums, skin, pasta for energy, protein for strength, etc.

• Limit screen time.– Decreased activity and eating while on the screen.– TV heavy on junk food advertising.

• Silly foods as a treat.– Green Eggs and Ham, Pancakes for supper, Pizza for

breakfast.• Ethnic food exposure.

School Lunches from Around the World

Tips for School Age• Breakfast and lunch become critical.• After school and evening activities put eating on the

run. Avoid fast food every night. Microwave meals such as Lean Cuisine etc. will do in a pinch.

• Provide fun lunches. Presentation matters.• Provide one food in the lunch which can be traded

but only one food.• Encourage participation in shopping and planning

menus and food preparation.• Dispute advertisements…laugh about how TV tries

to sell and doesn’t always tell the truth.• More nutrition info…which foods are healthy and

which aren’t.

Portion Size

Refusal

Hide, Disguise, EmphasizeUltimately Deceive

• Is it OK to resort to trickery in order to promote health?

• Don’t they need to learn to like healthy food on their own?

• Who is the boss here?• Grandma says “Make her eat it!”

Disguise

Hide

Emphasize

General Tipsfor Hiding

• Pureeing and blending work well: nutrient dense therefore have to consume less volume.

• Beware of the color wheel. If you mix red and green you get brown! Try to combine similar colors whenever possible.

• Start with small amounts and work up.• Be aware of texture…and after taste.

General Tipsfor Survival

• Do your best. Try to provide healthy food 90% of the time. I try to surprise them 10% of the time.

• Sometime, hopefully before graduation, they will be more adventurous. It will click. They won’t be eating macaroni and cheese at their wedding.

• Pick your battles.

http://youtu.be/EJ_l9tumpbc

A Christmas Story: Mommy's little piggy

Questions?