Toddler and Preschool Development

Definitions of the Life-Cycle Stage

• Toddler years occur between the ages of one to three.
• Rapid increase in gross and fine motor skills develops during the toddler life-cycle stage.
• Preschool-age children are aged between three to five years.
• Preschool-age children experience increasing autonomy, broader social circumstances, increasing language skills, and expanding behavior control.

Normal Growth and Development

• Infants triple their birth weight between birth and twelve months.
• Toddlers gain eight ounces per month on average and grow 0.4 inches.
• Preschoolers gain 4.4 pounds a year on average and grow 2.75 inches.
• BMI is used to assess appropriate weight for height after two years of age,
• WHO growth charts are intended to be used on all children up to the age of 2 years.
• CDC growth charts are intended to be used for children ages 2–19 years.

Physiological and Cognitive Development of Toddlers

• At 15 months, a toddler crawls upstairs.
• At 18 months, a toddler runs stiffly.
• At 24 months, a toddler walks up stairs one foot at a time and jumps in place.
• At 30 months, a toddler alternates feet going up stairs.
• At 36 months, a toddler rides a tricycle
• Toddlers often "orbit" around parents
• Toddlers experience transitions between being self-centered to more interactive
• Vocabulary expands in toddlerhood.
• Temper tantrums are common in toddlerhood

Feeding Skills and Behaviors

• Between nine to ten months, bottle weaning should have begun.
• By 12 to 14 months, toddlers should be completely weaned.
• By 12 months, toddlers develop a refined pincer grasp.
• Between 18-24 months, toddlers can use their tongue to clean lips and have well-developed rotary chewing.
• Adult supervision is vital to prevent choking.
• Rituals in feeding are common in toddlers.
• Toddlers may have strong food preferences and dislikes.
• Food jags are common.
• New foods should be served with familiar foods.
• Toddlers imitate how other people eat.
• Slower growth results in decreased appetite.
• Average toddler-sized portions are one tablespoon per year of age.
• Regular but flexible meal and snack times should be established.

Cognitive Development of Preschool-Age Children

• Preschool-age children experience magical thinking and egocentrism.
• Preschool-age children learn to set limits for themselves
• Preschool-age children begin cooperative and organized play.
• Vocabulary expands to over 2000 words in the preschool years.
• Preschool age children begin using complete sentences
• Preschool-age children can use a fork, spoon, and cup.
• Eating becomes less messy in the preschool-age.
• Spills occur less frequently in the preschool-age.
• Foods should be cut into bite-size pieces for preschool-age children.
• Adult supervision is imperative for preschool-age children.
• Appetite is related to growth; increases prior to the "spurts"
• Children should be involved in meal selection and preparation

Food Preference Development, Appetite, and Satiety

• Children adjust caloric intake to meet caloric needs.
• Telling a child to "clean your plate" should be avoided.
• Healthful eating habits must be learned
• Preschoolers may prefer familiar foods
• Young children often do not like their foods to touch or to be mixed together
• Behavioral style, or temperament, impacts eating habits and preferences
• Children's food preferences determine what foods they consume
• Children naturally prefer sweet and slightly salty foods.
• Children prefer energy dense foods.
• Children are influenced by media.
• Children are able to adjust caloric intake based on caloric need.

Factors That Affect Dietary Intake

• Nutrition needs decrease between the ages of 2-5 years
• Appetite decreases between the ages of 2-5 years
• Diets of children in this age group tend to lack variety
• Nutrient density is important due to high activity levels and low stomach capacity.
• Food jag: a condition in which an individual consumes the same food, prepared the same way, on a consistent basis
• Food aversion: a strong feeling of dislike that results in refusal to try or to eat certain foods
• Food neophobia: the reluctance to eat or the avoidance of new foods
• Best way to address eating issues is to continue to offer the child new or disliked nutritious foods along with a variety of other accepted nutritious foods
• Young children can self-regulate food intake
• Between the ages of 3 and 5 years, children become less responsive to internal cues and more responsive to external cues, which may result in eating in the absence of hunger/overeating
• Personality can impact food intake
• Kids in the U.S. are exposed to advertisements for high-fat, high-sugar foods
• Food advertising may drive children's consumer behavior through four different modes
• Advertising creates expectations
• The purchase is accompanied by positive feelings
• The entertaining dimension of advertising generates a pleasant mood
• Children do not always possess the ability to recognize the persuasive nature of advertising
• Parental feeding practices linked to eating and weight status of children
• Food choices influenced by beliefs, values, norms, knowledge, cost, quality, and availability of various foods
• Children are likely to adopt the eating habits of their parents or caregivers
• Restricting "unhealthy" foods and pressure “healthy” foods
• Being served large portions of food results in increased intake
• Parents who demonstrate intuitive eating may create a more positive feeding environment
• Division of responsibility in feeding young children with an emphasis on decreasing parental pressure on the child to eat
• Parents determine what food is offered, when, and where
• Children determine how much to eat
• Environments that promote gaining weight and that are not conducive to weight loss
• Common barriers to choosing healthful behaviors include: lack of time, lack of neighborhood safety, limited knowledge of portion size, cooking methods, and ways to prepare healthy foods, perceived cost of healthy options, and family members who are picky eaters

Dietary Intake Recommendations

• Carbohydrates are the body's primary energy source.
• Fiber is a key component of carbohydrates that has many health benefits.
• Children's fiber intake tends to be lower than recommended.
• The RDA for fiber: children ages 2 and 3 years = 19 g per day; children ages 4 and 5 years = 25 g per day
• 45% to 65% of total daily calories should come from carbohydrates
• Protein is important for growth in toddler and preschool years.
• The RDA for protein: toddlers = 1.1 g/kg of body weight; preschool age = 0.95 g/kg of body weight
• Protein from animal sources is of high quality
• Adequate calorie intake is important to ensure protein can be used for muscle maintenance, growth and hormone production
• Fat builds nerve tissue and hormones.
• Fat helps the body absorb fat-soluble vitamins.
• Fat insulates and protects the body.
• Fat contributes to the feeling of satiety.
• Many children eat more fat than is recommended which can lead to weight gain, heart disease, high blood pressure, and diabetes.
• Fat intake recommendations: children ages 1 to 3 years should consume 30% to 35% of calories from fat; children ages 4+ should consume 25% to 35% of total calories

Micronutrient Recommendations and Deficiencies

• Calcium helps build bones.
• Vitamin D aids in calcium absorption and mineralization of bone.
• Rickets results from inadequate calcium/vitamin D.
• Fortified foods provide most of the vitamin D; dairy products provide the majority of calcium.
• Supplements may be warranted in certain circumstances.
• Iron is a component of hemoglobin and myoglobin.
• Toddlers need 7 mg of iron each day.
• Children ages 4 and 5 years old need 10 mg of iron each day.
• Serum ferritin level is a good indicator of iron status.
• Iron status and type of iron impact absorption
• Heme vs. non-heme iron
• Iron-deficiency anemia is a prevalent problem among young children.
• Iron-deficiency anemia may cause delays in cognitive development and behavioral disturbances.
• Iron-deficiency anemia is diagnosed by hematocrit and/or hemoglobin concentration.
• Age 1-2 years: hemoglobin less than 11.0g/dL and hematocrit less than 32.9% indicate iron deficiency.
• Age 2-5 years: hemoglobin less than 11.1g/dL and hematocrit less than 33% indicate iron deficiency.
• Exclusively breastfed infants should be supplemented with 1 mg/kg/day of iron starting no later than 4 months and continuing until iron containing foods are introduced.
• Formula contains iron.
• Infants at risk for iron deficiency should be tested at nine to 12 months, six months later, and annually from ages two to five.
• Toddlers should consume iron-rich foods
• Iron-deficiency anemia treatment requires supplementation with 3 to 6 mg/kg of body weight for at least 3 months.
• Dairy should be avoided 1 hour before and 1 hour after taking iron.
• Vitamin C aids in iron absorption.

Other Considerations

• Dental caries affect one in three children aged three to five.
• Dental caries are caused by bedtime bottle with juice or milk, Streptococcus mutans, and sticky carbohydrate foods
• Dental caries can be prevented with fluoride with supplemental amounts varying by age and fluoride content of water supply
• Constipation: hard and dry stools associated with painful bowel movements
• Constipation can be caused by "stool holding" and diet; Can be caused by low fiber diets, medications, and Gl issues
• Elevated blood lead levels are seen in 1.6 percent of children ages one to five
• Low-level lead exposure is linked to lower IQ and impaired motor, behavioral, and physical abilities
• High blood lead levels may decrease growth
• Lead poisoning can be reduced by eliminating sources of lead
• Factors for elevated blood lead levels are also the same risk factors for iron-deficiency anemia: young age, poor nutrition, and low socioeconomic status
• Food security: defined as access at all times to sufficient supply of safe, nutritious foods
• Food insecurity may hinder growth and development
• Young children are especially vulnerable to foodborne illnesses
• Key food safety practices: Clean; wash hands and surfaces often, Separate; don't cross-contaminate, Cook; cook to proper temperatures, and Chill; refrigerate promptly
• Vegetarian diet guidelines: Provide three meals and two to three snacks per day, Avoid excessive bulky foods (e.g., bran), Include energy dense foods (e.g., cheese), Provide an omega-3 fatty acid source (e.g., tofu), and Ensure an adequate intake of calcium, zinc, iron, and vitamins B12 and D
• Physical activity helps to maintain energy balance while strengthening muscles
• Examples of physical activity for this age group: games in the yard or park, family walks after dinner, freestyle dance, hide and seek, ring around the Rosie, and Simon says