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).

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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.