12.3: Nutrition in the Toddler Years

Learning Objectives

• Summarize nutritional requirements and dietary recommendations for toddlers.
• Examine feeding problems that parents and caregivers may face with toddlers.

By the age of two, children have advanced from infancy and are on their way to becoming school-aged children. Their physical growth and motor development slows compared to the progress they made as infants. However, toddlers experience enormous intellectual, emotional, and social changes. Of course, food and nutrition continue to play an important role in a toddler’s development. During this stage, the diet shifts from breastfeeding or formula feeding to solid foods and healthy beverages. The toddler years pose interesting challenges for parents and caregivers, as children learn how to eat on their own and begin to develop personal preferences.

Nutritional Requirements

A toddler’s serving sizes should be approximately one-quarter that of an adult’s. One way to estimate serving sizes for young children is one tablespoon for each year of life. For example, a two-year-old child would be served 2 tablespoons of fruits or vegetables at a meal, while a four-year-old would be given 4 tablespoons, or 1/4 cup. Here is an example of a toddler-sized meal:

• 1 ounce of meat or chicken, or 2 to 3 tablespoons of beans
• One-quarter slice of whole-grain bread
• 1 to 2 tablespoons of cooked vegetable
• 1 to 2 tablespoons of fruit

Energy

The energy requirements for per kilogram of weight for toddlers is lower than it is for infants, but the total energy requirements are higher because toddlers are larger and more active than infants. The recommended caloric intake varies with each toddler’s level of activity. Because toddlers have small stomachs they require small, frequent, nutritious snacks and meals to satisfy energy requirements.

Macronutrients

The Acceptable Macronutrient Distribution Ranges (AMDRs) for toddlers are listed in Table \(\PageIndex{1}\). Carbohydrate recommendations include eating complex carbohydrates for energy needs. While 100% juice can be a source of nutrients, the American Academy of Pediatrics recommends limiting consumption of fruit juice to 4 ounces (1/4 cup) per day or less.² The AMDR for fat for toddlers is 30-40% of total calories including essential fatty acids that are vital for the development of the toddler's nervous system.

Table \(\PageIndex{1}\): Acceptable Macronutrient Distribution Ranges (AMDRs) for Toddlers¹

Macronutrient	AMDR
Carbohydrate	45-65% of total calories
Protein	5-20% of total calories
Fat	30-40% of total calories

Micronutrients

As a child grows bigger, the demands for micronutrients increase. These needs for vitamins and minerals can be met with a balanced diet, with a few exceptions. Nutrients of concern include:

• Vitamin D. Toddlers need 15 micrograms of vitamin D per day. Vitamin D-fortified milk and cereals can help to meet this need. However, toddlers who do not get enough of this micronutrient should receive a supplement. According to the American Academy of Pediatrics, toddlers who are consuming less than 32 ounces per day of vitamin D-fortified milk, should receive a vitamin D supplement of 10 micrograms a day.³
• Calcium. Calcium is needed for toddlers to build optimal bone mass. Toddlers need 700 mg of calcium per day. Dairy products and calcium-fortified beverages are good sources of calcium. At one year old, whole-fat cow’s milk may be given; at two year’s old, milk can be reduced-fat.
• Iron. Iron-deficiency anemia is the most common nutrient deficiency in young children. Iron-deficiency anemia causes a number of problems including weakness, pale skin, shortness of breath, and irritability. It can also result in intellectual, behavioral, or motor problems. In infants and toddlers, iron-deficiency anemia can occur as young children are weaned from iron-rich foods, such as breast milk and iron-fortified formula. There are steps that parents and caregivers can take to prevent iron-deficiency anemia, such as adding more iron-rich foods to a child’s diet, including lean meats, fish, poultry, eggs, legumes, and iron-enriched whole-grain breads and cereals.

Feeding Problems in the Toddler Years

During the toddler years, parents and caregivers may face a number of problems related to food and nutrition. Possible obstacles include difficulty helping a young child overcome a fear of new foods, or fights over messy habits at the dinner table. Even in the face of problems and confrontations, parents and caregivers must make sure their toddler has nutritious choices at every meal. Toddlers' stomachs are small; providing 3 meals and 2-3 snacks per day is recommended. The gold standard in feeding children is called the Division of Responsibility designed by Ellyn Satter, a registered dietitian. According to the Division of Responsibility, feeding is a responsibility that is split between parent/caregiver and child:

• Parents and caregivers are responsible for what toddlers eat, when they eat, and where they eat.
• Toddlers are responsible for how much food they eat and whether they eat.

Parents’ and caregivers' responsibilities in feeding include:

• selecting and preparing food
• providing regular meals and snacks
• making eating times pleasant
• showing children, by example, how to behave at family mealtime
• being considerate of children's lack of food experience without catering to likes and dislikes
• not letting children have food or beverages (except for water) between meals and snack times
• letting children grow up to get bodies that are right for them⁴

High-Risk Choking Foods

Certain foods (that tend to be small and round) are difficult for toddlers to manage and pose a high risk of choking, including:

• Hot dogs
• Nuts and seeds
• Chunks of meat or cheese
• Whole grapes
• Hard, gooey, or sticky candy
• Popcorn
• Chunks of peanut butter
• Raw vegetables
• Raisins
• Chewing gum
• Marshmallows

Picky Eaters

Parents and caregivers of toddlers are likely to notice a sharp drop in their child’s appetite. This is normal since toddlers' growth rate is slower than it was when they were an infant. Children at this stage are often picky about what they want to eat and they are beginning to develop food preferences. Toddlers may reject new foods, but it's helpful to know that food preferences take time to develop. It can take as many as 10 or more times tasting a food before a toddler’s taste buds accept it.

Food Jags

For weeks, toddlers may go on a food jag and eat one or two preferred foods—and nothing else. It is important to understand that preferences will be inconsistent as a toddler develops eating habits. This is one way that young children can assert their individuality and independence. However, parents and caregivers should be concerned if the same food jag persists for several months, instead of several weeks. Options for addressing this problem include rotating acceptable foods while continuing to offer diverse foods, remaining low-key to avoid exacerbating the problem, and discussing the issue with a pediatrician. Also, children should not be forced to eat foods that they do not want. It is important to remember that food jags do not have a long-term effect on a toddler’s health, and are usually temporary situations that will resolve themselves.

Key Takeaways

• Toddlers' physical growth and motor development slows compared to the progress they made as infants.
• Recommendations for fat intake are lower than recommendations for infants, but higher than recommendations for adults.
• Nutrients of concern for toddlers include vitamin D, calcium, and iron.
• The Division of Responsibility is considered the gold standard for feeding children. Parents and caregivers are responsible for what toddlers eat, when they eat, and where they eat; toddlers are responsible for how much food they eat and whether they eat.
• Some food- and nutrition-related problems that can occur during the toddler years include choking, picky eating, and food jags.

References

1. Summary Report of the Dietary Reference Intakes. nationalacademies.org. www.nationalacademies.org/our-work/summary-report-of-the-dietary-reference-intakes. Accessed July 11, 2020.
2. Where we stand: fruit juice. healthychildren.org. https://www.healthychildren.org/English/healthy-living/nutrition/Pages/Where-We-Stand-Fruit-Juice.aspx. Accessed July 11, 2020.
3. Vitamin D: on the double. healthychildren.org. https://www.healthychildren.org/English/healthy-living/nutrition/Pages/Vitamin-D-On-the-Double.aspx. Accessed July 11, 2020.
4. Raise a healthy child who is a joy to feed. ellynsatterinstitute.org. https://www.ellynsatterinstitute.org/how-to-feed/the-division-of-responsibility-in-feeding/. Accessed July 11, 2020.