Nutrition for 1 to 2 year olds

Eating habits

From the age of one, your child should be eating and enjoying healthy meals and meal times with the rest of the family. Offer ‘family meals’ as often as possible. Most children do not need special foods. If you need to, just modify the texture of the food you are eating, e.g. cut up meats and serve small pasta pieces that are easy for your child to pick up. Parents often become concerned that their child is not eating enough and frustrated when everything they prepare is refused. Remember that children do not grow as quickly in their second year as they do in their first. This means their appetite will not be as big.

A toddler is also more capable of expressing likes and dislikes. You are responsible for what your child is offered to eat, when the food is offered and for making meal times pleasant. Your child is responsible for how much, or even whether, they eat. But remember, toddlers’ little stomachs need small amounts 5-6 times a day.

Planning meals from 12 months

How much food is eaten at this age varies from child to child and from day to day and is influenced by growth and activity levels. These serving sizes and amounts can be used as a guide to feeding your 1-2 year-old each day. Some serving sizes are different from those commonly used for adults.

Breads, cereals, rice, pasta, noodles

3 to 5 servings daily (one serving = 1 slice of bread, or 1/2 cup cereal, or 1/2 cup cooked

rice, pasta, noodles).

.

Vegetables and legumes

3 to 5 servings daily (one serving = 1/4 cup).

Encourage your baby to taste and try a wide variety of both raw and cooked vegetables. This is important in helping your baby develop healthy eating habits. Fresh vegetables are best but frozen and canned are also good alternatives. Avoid hard vegetables such as raw carrot sticks, which could cause choking.

Fruit

1-2 servings daily (one serving = one piece – e.g. Small apple, banana, pear, stone fruit, etc. ).

Fresh fruit is best, but frozen, canned and dried are also good alternatives.

Milk, yogurt, cheese

3 servings daily (one serving = 1 cup of milk, 6 oz yogurt

or 1 oz cheese or cheese slice).

Meat, fish, poultry, eggs, nuts, legumes

2 servings daily (one serving = 1/2 cup meat, 1/2 cup kidney beans or other legume, 4 to 6 oz fish,1 egg, or 1 tablespoon peanut butter).

Red meat is an excellent source of iron. Try to include it often in lean cuts.

Nuts are not recommended for young children as they may cause choking. Use only smooth nut pastes.

Some points to remember

·         Choose foods low in salt.

·         Eat only moderate amounts of sugar and foods containing added sugar.

·         Care for your child’s food: Prepare and store it correctly.

·         Your child should also have plenty of opportunity to be active.

What to drink

·         Choose water as a drink. Fruit juice, cordials and soft drinks are not necessary.

·         Continue to breastfeed on demand for as long as you and your child would like. Breast milk still provides benefits into the second year of life.

How to help your child eat a nutritious, healthy diet

·         Plan regular meal and snack times – toddlers need structure, routines and limits.

·          Make meals and snacks look appealing e.g. include a range of colors and shapes. Food should also be easy to chew and handle.

·          Encourage your child to eat with you and your family. Children learn by imitating the people around them.

·         Do not force your child to eat. Respect that they may have certain likes and dislikes and give them some choice in selecting food, e.g. let them choose between two types of fruit or sandwich fillings.

·         Be consistent with how you handle food refusal.

·         Avoid substituting uneaten meals for other foods. ‘Treating’ your child with unhealthy food because you are worried they are not eating only makes them less likely to eat healthier foods.

·         Only buy and offer healthy foods.

·         Do not use food as a bribe for behavior.

·         Set aside 20-30 minutes for meal times and 10-12 minutes for snacks.

Your child’s healthy height and weight should be a guide to their diet. If you are concerned about your child’s diet, talk to your child health nurse or your doctor.

unsafe foods and food-born disease

As a new mother I am constantly worried about potentially unsafe foods and food-born illinesses. After talking to my child’s pediatrician and reviewing the Center for Disease Control (CDC) guidelines here are a few recommendations to help keep you and your little one(s) safe and healthy.

Recommendations:

To prevent botulism, do not use honey in the feeding of infants under 1 year of age.

 To prevent salmonella poisoning, cook all eggs well and do not use products containing raw eggs also be aware of any recalls in the media that are intended to alert consumers to

 Hard, small and round, smooth and sticky solid foods are not recommended because they may cause choking and aspiration.

Ensure that infants and toddlers are always supervised during feeding.

 Avoid feeding an infant using a "propped" bottle.

 Infant botulism. Honey is a risk factor for infant botulism and, to date, is the only food directly implicated in infant botulism. The USDA and the AAP recommends that honey should not be fed to children less than 12 months of age.

Unlike that for honey, the evidence for corn syrup as a risk factor for infant botulism is tenuous. A 2-year case control study indicated that ingestion of corn syrup may be a risk factor for infant botulism (Spika et al., 1989). However, an epidemiological study in California did not find a correlation between corn syrup consumption and infant botulism (Arnon et al., 1994).

Corn syrup has never been directly implicated in a case of infant botulism(Olsen and Swardlow, 2000). Corn syrup solids or corn syrup are used in infant formulas. The heat processing that liquid infant formulas undergo would destroy any C. botulinum spores; moreover, no infant formula has ever been implicated in infant botulism. The conflicting evidence implicating corn syrup in infant botulism is not strong enough to classify corn syrup as a risk factor and, as such, it is not recommend against feeding corn syrup to infants.

Salmonellosis. Salmonella bacteria can occasionally be transmitted from infected hens directly into the eggs before the shells are formed. Also, cracks in egg shells can allow transfer of salmonella from the shell surface to the egg contents. Eggs contaminated with salmonella bacteria may cause salmonellosis. Avoid raw eggs and foods containing raw eggs to prevent salmonellosis.

Choking and aspiration. The risk of choking can be lowered when caregivers are aware of their toddlers' chewing and swallowing abilities, supervise infants while eating, avoid offering foods with the potential to cause choking, and know how to handle choking if it occurs.

Supervision. The use of a "propped bottle" to feed an unattended infant is not recommended because of the danger of choking or aspirating as the flow of milk into the mouth may be too rapid. Supervision includes the infant sitting upright while eating, and not lying down, walking, running or being distracted from the task of safe eating. Eating in the car is considered unsafe since if choking should occur, it is difficult to pull over to the side of the road safely. In addition, there is the increased risk of choking if the car stops suddenly.

Unsafe foods. Hard, small and round, smooth and sticky solid foods can block a young child's airway. The following foods are not safe for infants and children under 4 years of age: popcorn, hard candies, gum, cough drops, hot dogs, raisins, peanuts or other nuts, sunflower seeds, fish with bones, and snacks using toothpicks or skewers. The following foods are safer for infants and young children when they are prepared as described: grated raw carrots or hard fruit pieces, fruits with pits removed, chopped grapes, and peanut butter spread thinly on crackers or bread. Peanut butter served alone, or on a spoon, is potentially unsafe because it can stick in the palate or posterior pharynx leading to asphyxia.

Transitioning to Textured and Solid Foods

My daughter just turned nine months and she is busy and moving all the time. While she is still growing very well, at her 9 month wellness checkup I was informed that she had dropped from the 50^th percentile for weight to the 25^th percentile for weight while maintaining her height at the 50^th percentile. While I am not too concerned yet since children do grow in spurts I do feel that we need to start increasing her total calorie intake by adding more healthy snacks to her daily routine. I spoke about my concerns with my child’s pediatrician who then encouraged me to increase the texture and variety of my daughter’s diet. We have already pretty firmly established a variety of fruits and vegetables in our child’s diet and aim for 5 servings each day and to have a variety of colors and textures. However, when it comes to snacks I thought this might also be a good time to start introducing our little one to dairy products such as yogurt (not cow’s milk though until at least one year) and independent eating but starting solid foods such as cheerios and whole grain puffs.  The transition to other solid foods, such as more textured purées, finger foods and table foods eaten by the rest of the family, usually takes place around this time around 8 to 10 months because infants are ready to chew and need more texture in their foods. Some infants go from semi-liquid cereals and puréed baby foods to finger foods and table foods in just a few months. Safe finger foods include bread crusts, dry toast, pieces of soft cooked vegetables and fruits, soft ripe fruit such as banana, cooked meat and poultry, and cheese cubes. At this time, most infants are developmentally ready to feed themselves and should be encouraged to do so. Today was the first day that my daughter was able to get a broken whole grain puff into her mouth without assistance and was so proud of herself. Other feeding behaviors at this time include taking food from a spoon, chewing, self-feeding with fingers or a spoon, and independent drinking from a cup or bottle. By 1 year of age it is recommended that  the child’s diet includes of a variety of foods from the different food groups represented by USDA food pyramid.

Making your own baby foods

This past weekend I had every intention of making my own baby food and learning to store it properly, actually I have had this intention for the past 5 weekends. My daughter has been eating pureed fruits and vegetables since she turned 6 months old. She is now 9 months and just moving on to pureed meats as well as more textured, chunky foods. I am not sure why I feel so guilty about the fact that I purchase commercially prepared baby food but regardless, I do. Maybe it’s the fact that I was not able to breast feed her as long as I would have liked to. Possibly it has something to do with the numerous people who constantly ask me if I make my own baby food, or the multitude of internet sites that preach the joys and benefits of preparing your infant’s pureed foods. Whatever the case may be, I have made the decision to purchase commercially prepared foods. The good news is that even though grocery stores are full of over processed, nutrient-depleted food products, the baby food isle is not one of them. However, I do agree that if you want to make your own baby food, I fully support your decision and in fact secretly envy you. From all my work to get prepared (even if I didn’t quite follow through), I thought I would share some information that I found on how to make, store, and have fun making your own baby foods.

How do I make homemade baby foods?

·         Do not add any salt, sugar, butter, margarine, gravy or seasoning.

·         Blend or grind foods to the texture that is appropriate for your baby’s development.

·         Puree foods – offer pureed foods to an infant just learning to eat solids. Puree soft fruits, vegetables or meats.

·         Mashed foods – offer soft, mashed foods with tiny lumps when your baby can chew from side-to-side (not just up and down). Try: cooked noodles; applesauce; mashed, cooked whole peas; and mashed potatoes.

·         Ground, finely chopped foods – offer ground, finely chopped foods to your baby when he is ready. When your child picks up foods in her fingers or palms, puts food in her mouth and chews, she is ready for finger foods. Try: ground meat; soft cooked vegetables; soft ripe fruit pieces; crackers; dry cereal; canned fruit.

·         Follow food safety guidelines very carefully as babies are just developing immune systems to fight off bacteria and germs. To keep baby's food safe, do NOT give:

§  uncooked luncheon meat,

§  uncooked hot dogs, or

§  uncooked tofu

Preparing Baby Food

Equipment Needed
A blender or food processor works best for making early foods smooth. As your baby moves on to more textured foods, a fork or food grinder is often all that is needed. Inexpensive baby food grinders are available in the baby departments of discount stores and on the Internet. Make sure all equipment and work surfaces are clean before you start.
Fruits
For soft ripe fruits such as bananas, peaches, pears and avocados, simply remove any seeds and peels; then purée, grind or mash.
For other fresh or frozen fruits:

• Wash, peel and cut into small pieces.
• Add 1 cup fruit to 1/4 cup boiling water in pan or microwave-safe container.
• Cover, reduce heat and cook slowly until tender.
• Next, purée, mash or grind the cooled fruit, adding water, juice, breast milk or formula for desired consistency.

Peeled and chopped canned fruits packed in fruit juice can be prepared without additional cooking.
Vegetables
Wash, peel and slice fresh vegetables or frozen vegetables without added seasonings. Boil or microwave vegetables in covered container with 1/2 to 1 inch of water until they are tender.
Purée, grind or mash with some of the cooking water.
Meats/Protein
Remove skin, bone, fat and gristle. Cut in 1/2-inch cubes and place in cooking pan. Add water just to cover and heat until boiling. Reduce heat and cook slowly until very tender. (High heat makes meat tough.)
Purée or grind, adding cooking liquid, breast milk, formula or water for desired consistency.
For cooked egg, cooked fish or cooked dry beans, purée, grind or mash finely with a fork. Add liquid for desired consistency if needed.

Storing Baby Food

Refrigeration
Store in tightly-covered containers and place in coldest part of the refrigerator for no more than 2 days. Meats, eggs, fish and chicken should be used within 1 day.
Freezing
Food Cube Method - Place puréed/mashed food into ice cube trays or paper cupcake liners.
"Plop" Method - "Plop" spoonfuls of puréed/mashed food onto a cookie sheet.
Cover food with plastic wrap or foil and freeze.
Once frozen, put food portions in labeled and dated freezer bags. Store in the freezer for up to 1 month.
Before Mealtime, take out the food you want to serve. Thaw it in the refrigerator or in a microwave on defrost setting.
Reheating
Completely reheat refrigerated or frozen baby food to at least 165° before feeding. Allow food to cool to lukewarm. Stir the food and test its temperature to make sure it is not too hot before serving to baby. Throw out any uneaten leftover food in the baby's dish or the serving dish.

Sample Baby Food Recipes

Carrots and Apples

• 1 cup carrots, peeled and sliced
• 1 medium apple, peeled, cored and cut in quarters
• 1/4 cup water

1 Combine carrots, apple and water in a baking dish or microwave-safe container.
2 Cover and bake for 45 minutes at 350°F or microwave for 8 minutes on high, until tender.
3 Purée or mash with a fork, adding cooking liquid for desired consistency.

Sweet Potato Chicken

• 1 small sweet potato
• 1/4 cup cooked chicken cut into bite-size pieces
• 1/2 cup cooked brown rice
• 1/2 cup breast milk, water or prepared formula

1 Wash and bake sweet potato in oven 50 minutes at 425° or microwave for 5 minutes on high heat until soft throughout.
2 Peel and combine with chicken, rice and liquid (breast milk, water or prepared formula).
3 Blend, mash or grind until as smooth as desired.
Babies like trying new combinations:

• Beef, peas, and potatoes
• Chicken, broccoli, and rice
• Beef, squash, and macaroni
• Apples and sweet potato
• Banana and avocado
• Beef and barley
• Sweet potato and papaya
• Carrots and potato
• Butternut squash and corn
• Chicken and rice

And Finally All babies are different and will not like/tolerate the same foods or food textures. Do Not Despair. You should be willing to experiment with baby solid food for your baby. Offer your baby different foods, use different ways of preparing those baby foods and be willing to have a huge store of patience.

Pureed Foods

Starting at about six months your pediatrician may encourage you to increase the variety of your infant’s diet by adding pureed fruits and vegetables and later on pureed meats. Whether or not you decide to make your own baby food or purchase commercially prepared baby food here is some information concerning what benefits to your infants diet adding fruits, vegetables, and meats will have.

What nutrients do infant vegetables and fruits provide?
Infant vegetables and fruits are rich in many nutrients. Here are just a few:
Vitamin A keep eyes and skin healthy and helps protect against infections
Vitamin C helps heal cuts and wounds and keeps teeth and gums healthy
Potassium helps maintain fluid and electrolyte balance in the body
Folate helps produce DNA and form healthy new cells

What nutrients does infant meat provide?
Iron helps carry oxygen in the blood to every part of your body; this helps you to have energy. Iron also helps protect you from infections.
Zinc helps form protein in the body and assists in wound healing. It plays a role in general growth and maintenance of all body tissues.

My baby is ready for solids. How do I start and use the infant foods?
Here are some guidelines for starting infant foods:
Start new foods one at a time. Wait 5 or more days to see how your baby accepts them. If a new food causes stomachache, diarrhea or skin rash, wait a month and try it again.
Always feed the infant foods from a spoon.
Your baby may take only a few spoonfuls of a vegetable or fruit the first time.
Always feed infant foods from a dish. Don't feed your baby right out of the jar. Saliva will make the food spoil faster. Throw out food left in the dish after a meal.
Use refrigerated infant food within 2 days.
Remember, your baby's tastes are different than yours. His food doesn't need salt, sugar, butter, margarine or seasoning.

Probiotics

Good nutrition is essential for the growth and development of infants, however, other substances in food which do not supply the body with nutrients such as calories, protein, fat, and so forth, may also be beneficial. As I make the decision concerning what type of formula or single grain cereal to feed my daughter, one thing I have noticed on the market shelves is the addition of probiotics. Even as you move away from the infant and toddler section of a store you will be hard pressed not to see the addition of prebiotics or probiotics to many of your normal grocery items, including dairy products, juice, and cereal.

What are prebiotics and probiotics? Prebiotics are nondigestible nutrients that are used as an energy source by certain beneficial bacteria that naturally live in your intestines. Prebiotics are sometimes known as fermentable fiber. Probiotics, in contrast, are the beneficial, or friendly, bacteria themselves. By acting as a food source, prebiotics give the probiotic bacteria a chance to exert their influence.

One widely used definition, developed by the World Health Organization and the Food and Agriculture Organization of the United Nations, is that probiotics are "live microorganisms, which, when administered in adequate amounts, confer a health benefit on the host." (Microorganisms are tiny living organisms—such as bacteria, viruses, and yeasts—that can be seen only under a microscope.).  These benefits vary depending on the type of beneficial culture or probiotic that’s used, and range from aiding digestion to supporting a healthy immune system.

Most probiotics are bacteria similar to those naturally found in people's guts, especially in those of breastfed infants (who have natural protection against many diseases). Most often, the bacteria come from two groups, Lactobacillus or Bifidobacterium. Within each group, there are different species (for example, Lactobacillus acidophilus and Bifidobacterium bifidus), and within each species, different strains (or varieties). A few common probiotics, such as Saccharomyces boulardii, are yeasts, which are different from bacteria.

Several studies have supported the practice of supplementing preterm and term infants with prebiotics and probiotics. Boehm et al., (2010) suggested the these factors may play a role as modulators of the postnatal development of the immune system. Likewise in a 2008 study by Moreno, research indicated that probiotics may play an important role in the prevention of infections and allergies in infants.

The role of iron and starting fortified cereals

Iron is an essential mineral throughout life, although especially during a baby’s first year. Iron deficiency is the most common deficiency at any age. The American Academy of Pediatrics (AAP) just issued that the new iron guidelines will be available in November (Journal of Pediatrics). However, it has been reported that 4 to 15 percent of children under the age of 3 years are iron-deficient.

Getting enough iron is important for your growing baby, it is a necessary for proper physical growth and mental development. Iron’s main function is to increase the number of red blood cells that supply your baby’s body with s oxygen. All infants are born with iron reserves that last them with enough iron until they are about four months old.  Most bottle-fed babies received enough iron from iron-fortified formulas. Breast-fed babies, however, need another source of iron starting between 4-6 months to avoid depleting their iron stores.

This is why starting around 4 to 6 months your pediatrician may recommend that you introduce single grain fortified cereals (such as brown rice or oatmeal). Not only are these fortified cereals a good source of iron, they are also a great way to start introducing solids to your baby’s diet. Before you start solids you will want to make sure that your little one is ready. Signs of readiness include a body weight that is at least twice their birth weight, able to sit with support, good control of head and neck muscles, suckling motion or movement of the tongue when lips are touched, interest in your food, and if they still seem hungry after 10 to 12 feedings.

After my doctor informed me that I should start adding cereals to my daughter’s diet (rice first, followed by oatmeal), I went to the store to get the necessary supplies. I bought bowl bowls, age-appropriate spoons, and of course cereal. There isn’t a huge selection of infant cereals out there but you will have the chance to choose between regular iron-fortified, organic, probiotic and prebiotic-added cereals, and ones that are fortified with DHA essential fatty acids. I will admit that I made my choice mostly due to advertising.

Your baby’s first solids will have the consistency of thin milk. Mix on tablespoon with 4 to 5 tablespoons of fluid, breast milk, formula, or water. As your baby becomes accustom to eating from a spoon (always use a spoon, not a bottle with the tip cut off) and to they new textures you can change the consistency of the cereal to your child’s preference. After you have introduced pureed fruits and vegetables you can mix the cereal with fruit.

The one thing that I learned from my experience with introducing cereal was to have patience. For the first two weeks my daughter would not take more than 4 or 5 bites and for the first month we both ended up wearing more of the cereal than she actually swallowed. Eventually we got a routine down, although once she was introduced to vegetables she no longer cared for the taste of cereals, that, however, is another story.