Toddler and Preschooler Development

Life-Cycle Stage Definitions

• Toddlers are defined as children aged one to three years.
• Toddlers experience a rapid increase in gross and fine motor skills.
• Preschool-age children are defined as those aged three to five years.
• Preschoolers develop increasing autonomy and broader social circumstances.
• Preschoolers experience increasing language skills and expanding behavior control.

Normal Growth and Development

• Infants triple their birthweight within the first twelve months.
• Toddlers gain an average of eight ounces per month and grow 0.4 inches per month.
• Preschoolers gain an average of 4.4 pounds a year and grow 2.75 inches a year.
• BMI (Body Mass Index) is used to assess appropriate weight for height after 2 years of age.
• WHO (World Health Organization) growth charts are intended for use with children up to 2 years old.
• CDC (Centers for Disease Control and Prevention) growth charts are for children ages 2-19 years.

Physiological and Cognitive Development in Toddlers

• Toddlers experience physical and developmental skill expansion.
• 15-month-olds can crawl upstairs.
• 18-month-olds can run stiffly.
• 24-month-olds can walk up stairs one foot at a time and jump in place.
• 30-month-olds alternate feet when going up stairs.
• 36-month-olds can ride a tricycle.
• Toddlers often "orbit" around parents.
• Toddlers transition from being self-centered to more interactive.
• Toddlers' vocabulary expands significantly.
• Temper tantrums, also called the "terrible twos," are common in toddlers.
• Bottle weaning typically occurs between nine to ten months.
• The process of being completely weaned occurs around 12 to 14 months.
• A refined pincer grasp develops by 12 months.
• Toddlers aged 18-24 months 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 for toddlers.
• Toddlers may have strong food preferences and dislikes.
• Food jags are common among toddlers.
• New foods should be served with familiar ones.
• Toddlers imitate the eating behavior of others.
• Slowing growth results in decreased appetite in toddlers.
• Toddler-sized portions average one tablespoon per year of age.
• Regular but flexible meal and snack times should be established.

Physiological and Cognitive Development in Preschoolers

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

Innate Ability to Control Energy Intake

• Children adjust caloric intake to meet caloric needs.
• Children should not be told to "clean their plate."
• Healthful eating habits must be learned.
• Preschoolers may prefer familiar foods for comfort or control.
• Young children often dislike their foods touching or being mixed together.

Temperament Differences

• Temperament differences reflect the behavioral style of a child.
• Main temperamental clusters include "easy," "difficult," and "slow-to-warm-up" temperaments.
• Remaining styles range from "intermediate low" to "intermediate high."

Food Preference Development, Appetite, and Satiety

• Children's food preferences determine the foods they consume.
• Children naturally prefer sweet and slightly salty flavors.
• Preferences exist for energy-dense foods.
• Media, like fast-food ads, influences food choices.
• The ability to adjust caloric intake is based on caloric need.

Factors Affecting Dietary Intake

• Decreased nutrition needs occur between 2–5 years, decreasing appetite.
• Diets tend to lack variety between 2-5 years.
• High activity levels and low stomach capacity mean nutrient density is important.
• A food jag is a condition where an individual consumes the same food, prepared the same way, consistently.
• A food aversion is a strong dislike resulting in refusal to try or eat certain foods.
• Food neophobia is the reluctance to eat or avoid new foods.
• Addressing eating issues is done by offering new/disliked nutritious foods with accepted nutritious foods.
• Young children can self-regulate food intake.
• Between 3 and 5 years, children become less responsive to internal cues, leading to eating without hunger.
• Personality can impact food intake.
• Kids in the U.S. are exposed to advertisements for high-fat, high-sugar foods.
• More time spent watching TV increases the effect of media influence.
• Food advertising drives consumer behavior through various modes.
• Advertising creates expectations.
• Purchases are accompanied by positive feelings.
• The entertaining dimension of advertising generates a pleasant mood.
• Children often lack the ability to recognize the persuasive nature of advertising.

Parental Influence

• Parental feeding practices are linked to children's eating and weight status.
• Food choices are influenced by beliefs, values, norms, knowledge, cost, quality, and availability.
• Modeling eating habits leads children to adopt those of parents or caregivers.
• Food restrictions, pressuring, and serving sizes all influence food consumption.
• Restricting "unhealthy" foods and pressuring "healthy" foods impacts food preferences.
• Large portions of food result in increased intake.
• Maternal influences include parents who demonstrate intuitive eating, creating a positive feeding environment.
• There is a division of responsibility of who determines the food and the amount to eat: -The parent determines what food is offered, when, and where. -The child determines how much to eat.
• Obesogenic environments that promote weight gain and hinder weight loss cause barriers to choosing healthful behaviors.
• Common barriers include: -Lack of time -Lack of neighborhood safety -Limited knowledge of portion size, cooking methods, and ways to prepare healthy foods -The perceived cost of healthy options -Family members who are picky eaters

Nutrition Recommendations and Requirements

• Carbohydrates are the primary energy source for the body.
• Fiber in carbohydrates has many health benefits.
• Children in the U.S. tend to have lower fiber intake than recommended.
• Recommended Dietary Allowance (RDA) for fiber is: -19 g per day for children ages 2 and 3 years -25 g per day for children ages 4 and 5 years
• 45% to 65% of total daily calories should come from carbohydrates.
• Protein is important for growth in toddler/preschool years.
• The recommended Dietary Allowance (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 is used for muscle maintenance, growth, and hormone production.
• Fat builds nerve tissue and hormones.
• Fat is essential for brain development.
• Fat helps absorb fat-soluble vitamins, insulates and protects, and contributes to the feeling of satiety.
• Many children eat more fat than recommended, which can lead to weight gain, heart disease, high blood pressure, and diabetes.

Recommended Fat Intake

• 30% to 35% of calories for children ages 1 to 3 years
• 25% to 35% of total calories for children ages 4+.
• Calcium helps build strong 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 in the American diet.
• 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.
• Kids 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 and non-heme iron describe different forms, types impacts of iron.

Common Nutrition Problems

• 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 yrs: a hemoglobin level less than 11.0 g/dL or a Hematocrit less than 32.9% indicate iron-deficiency anemia
• Age 2-5 yrs: a hemoglobin level less than 11.1 g/dL or a Hematocrit less than 33% indicate iron-deficiency anemia
• Exclusively breastfed infants should supplement with 1 mg/kg/day of iron starting no later than 4 months and continuing until iron-containing foods are introduced.
• Formula contains iron to meet daily needs.
• Infants at risk should be tested at nine to 12 months, six months later, and annually from ages two to five.
• Toddlers should consume iron-rich foods.
• Supplementation with 3 to 6 mg/kg of body weight is a treatment.
• Avoid dairy 1 hour before and 1 hour after iron supplementation.
• Vitamin C aids in iron absorption.
• Dental caries affect approximately one in three children ages three to five.
• Causes of dental carries include bedtime bottles with juice or milk, Streptococcus mutans, and sticky carbohydrate foods.
• Prevention of dental caries includes fluoride, and supplemental amounts vary by age and fluoride content of the water supply.
• Constipation is defined as hard and dry stools associated with painful bowel movements.
• Constipation results from "stool holding" and diet; Can be caused by low fiber diets, medications, and GI issues.
• Prevention of constipation includes adequate fiber and fluid.
• 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.
• Reduce lead poisoning by eliminating sources of lead.
• Factors for elevated blood lead levels are the same risk factors for iron-deficiency anemia.
• Young age, poor nutrition, and low socioeconomic status are risk factors.
• Food security is defined as access at all times to sufficient supply of safe, nutritious foods.
• Food insecurity may hinder growth and development for growing children.
• Young children are especially vulnerable to foodborne illnesses.
• Fight-BAC 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 should: -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) -Ensure an adequate intake of calcium, zinc, iron, and vitamins B12 and D
• Physical activity recommendations help maintain energy balance while strengthening muscles.
• Physical activity examples: Games in the yard or park, Family walks after dinner, Freestyle dance, Hide and seek, Ring around the Rosie, and Simon says