Lecture 12 - Toddler + Preschooler and School aged children

What age range defines a Toddler vs. a preschooler

Toddler = 1+2 years old

Preschooler = 3+4 years old

Toddler + preschooler age is an Important time to establish ____________ and ___________

Healthy food preferences + eating habits

• ~1 yrs of age = should be eating what the family eats

******Development: What is the progression of MOTOR SKILL DEVELOPMENT?

• at what age should they be doing what?

  • from 12 months to 36 months

• WALKING = 12 months

• CRAWLING up stairs = 15 months

• RUNNING = 18 months

• WALKIN up stairs = 24 months

• Pedaling on a TRICYCLE = 26 months

Expanded ability for physical activity by 5 years of age (eg. kicking + throwing a ball)

******Compare the Motor development FEEDING SKILLS between a TODDLER + PRESCHOOLER

• What method of feeding and aspects related to feeding are they capable of?

Toddler:

• Self feeding + using a cup

• Preference for hand feeding

• Chewing ability enhanced

Preschooler

• spoon + fork use

• able to participate in meal preparation

*****Development: what are the characteristics of Cognitive + social development in TODDLERS?

• Newly discovered INDEPENDENCE+ More INTERACTIVE with broadening social interactions

• Observe + IMITATE

• learn FAMILY CUSTOMS

• FEARS can develop

• EXPRESSION OF WILLS: manifesting as negativism + temper tantrums (frustration due to lack of ability to vocalize feeling)

*******Development; Cognitive + social: Language skills of TODDLERS

• Language skills expand from 10 words at months to over 100 at ___months

Language explosion during toddler years

10 words at 18 months

over 100 at 24 months

*****Development: what are the characteristics of Cognitive + social development in PRSCHOOLERS?

• EGOCENTRISM + magical thinking (eg. tooth fairy + easter bunny etc.)

• Increasing social INTERACTION+ COOPERATIVE PLAY (toddlers = play side by side = no interacting; Preschooler = play together)

• external behavior limits (affect)🡪 internal limits

• TESTING OF LIMITS (control)

******In PRESCHOOLERS when talking about TESTING LIMITS during cognitive + social development, What are the results when:

• Too much parental control

• Too Little parental control

TOO MUCH = Lowered self confidence + initiative

TOO little = Anxiety

Define egocentrism

Can only think about themselves and not bale to understand what others are thinking

****What is the General Diet quality of Toddlers + preschoolers?

Require improvement

• average diet quality decreases from 2-3 to 4-8

*****What is E needed for? What is the factor that most greater influences Energy need of a toddler or preschooler?

E = needed for maintenance, growth + activity

• ACTIVITY = the most variable for the child (depends on stage of development, age, etc.)

****What is the formula for EER of a toddler?

EER = (89 x wt in kg -100) + 20

****What is different about the EER calculation for 3-8 year olds?

SEPERATE Formulas for BOYS + GIRLS

• take into account wt, height, age + physical activity level

• Toddler = only take into account wt

******What is the physical activity recommendations for children 0-4 (toddler + preschool) according to the 24hr movement guideline?

• how long should they sit + screen time?

• How long should they sleep

• How long should they move + intensity of movement

High level of physical activity + low sedentary behaviors + Sufficient sleep

• General consensus = Children not active enough for optimum growth

Sit:

• Not restrained for more than 1 hour

• Less than 2 yrs = NO SCREEN TIME

• 2-4 yrs = <1 hr screen time

Quality sleep:

• 0-3months= 14-17

• 1-2 yrs = 11-14

• 3-4 yrs = 10-13

Move:

• <1 yr = interactive play several times

• 1-2 yrs = 180min any intensity

• 3-4 = 180 min + 60 min ENERGETIC play

(remember 1-2 = toddler, 3-4 = preschool)

*****Do preschoolers Toddlers eat enough fiber?

NO (just like everyone else)

Canadian community health survey 2004

• 9.9 g → 1-3 yrs

• 13.4 g —> 4-9 yrs

*****What is the FIBRE DRI for toddlers (1-3) + preschoolers (4-8)?

1-3= 19 g

4-8 = 25 g

****What are the Other Macronutrient requirements for 1-3 yrs + 4-8 yrs

• Carb levels stay the same

• Fiber, Linolenic acid + linoleic acid, and water INCREASE as age increases

• PROTEIN per kg = DECREASES as age increases

*****What is the AMDR (acceptable macronutrient distribution range) % E of each macro for 1-3 yrs vs. 4-18 yrs?

• 1-3 yrs = still emphasizing FAT intake (high)

• 4-18 = closer to adult AMDR

****What are the 2 macronutrients of concern for toddlers + preschoolers?

1. FIBER

2. FAT

*****Compare Fat intake in 1-3 yrs vs. 4-8 yrs

• 1-3 yrs: _____% of fat intake = below + _____% = above

• 4-8 yrs: _____% of fat intake = below + _____% = above

Younger age = not getting enough fat

• 1-3 yrs: 47% of fat intake = below + <3% = above

• 4-8 yrs: 5.5 % of fat intake = below + 6.8% = above

****What are 5 MICRONUTRIENTS of concern for toddlers + preschoolers

• WHICH IS THE MOST COMMON nutrient deficiency?

• Which has the highest proportion of inadequate intake?

• Which has highest EXCESS intake

1. iron = MOST COMMON deficiency

2. Ca

3. Vit D = Most inadequate intake

4. Sodium = Most EXCEESS intake

5. Potassium

Iron: ___% of 1-8 year olds had intake below EAR

Ca: ___% of 4-8 year olds had intake EAR

Vit D:____% of 1-3 year olds + ___% of 4-8 year olds had intake below EAR

Sodium: ____% of 1-3 year olds + ___% of 4-8 year olds had intake ABOVE UL

Potassium: Intake vs. AI in 1-8 yr olds

Iron = <5% but is the most common nutrient deficiency despite having less inadequate intake (this can be due to other factors other than intake eg. malaria, absorption, dietary choices etc)

Calcium = 23%

Vit D = 86% (1-3) + 93% (4-8) + MOST INADEQUATE

Sodium = 77% (1-3) + 93% (4-8) MOST EXCESS

Potassium = median intake = BELOW AI (1-8 yrs)

What does Low K and High Na indicate about a food?

LOW nutrient density = PROCESSED FOODS

*****What are the 3 stages of Iron Deficiency?

1. Depletion of stores

2. Reduced transport of iron (think 380 low RBC)

3. Iron deficiency ANEMIA

*****What type of diet is typical of Children that are LOW IN IRON or IRON DEFIENCIENT

1. Infants not provided iron-fortified foods @ 6 months of age

2. Young children with HIGH cow’s milk consumption (Ca+ = mineral competition for abs of Fe)

****What are some concern in regards to the impact of IRON DEFICIENCY in children?

Prevalence of deficiency = not clear → large population studies show 1-3% of children 3-11 yrs = iron deficient

concerns impact on COGNITIVE development + LEARNING

*****Iron deficiency in children is MORE prevalent in what population in Canada?

• FIRST NATIONS + INUIT

• Disadvantaged Urban: 25-50% of children have Iron deficient anemia

*****There should be no fat restrictions for those under the age of_____

2 years

***is a vegetarian or Vegan diet healthy for children?

YES

• but it is difficult to get adequate E + Fat for children < than 2 yrs without animal products?

****What are some nutrients of concern for a VEGAN or VEGETARIAN diet for children?

Protein, Vit D + B12, Zinc, Iron, Calcium + Omega 3 (same as for adults)

****What are 2 types of foods recommended for vegan or vegetarian children?

1. Soy based follow-up formulas (a type of special formula for after 1 yr olds after breast feeding)

2. Fortified cereals

What are the GOALS of Toddler + Preschooler feeding?

• adequate but not excessive E, Nutr + intake

• Support normal development (growth, motor, cognitive + Social)

• Establish healthy eating patterns + behaviors

• Support self regulation of E intake

****Division of responsibility in feeding: What do PARENTS + CHILDREN DECIDE respectively

• hint: think the 4W’s + H

Parents = What, When + Where

Child = Whether they eat or not + How much

How to Feed a toddler + preschooler (not too sure what the take away of this slide was)

• Role modeling - types of foods, eating patterns, attitudes, activity/screen time/sleep

• Foods available + accessible

• Food preparation

*****How to feed a toddler + preschooler: What are the suggestions in regards to:

• Eating schedule + role modelling

• Exposure to new foods

Consistent Eating schedule = VERY IMPORTANT)

• planned meals + snacks (With some flexibility)

Remove distractions (eg. electronics) when eating

• sit at table with family when possible

Exposure to a variety of food + textures = combat neophobia

• offer new foods WITH preferred foods

• DO NOT make something specially for them if they won’t eat what you eat (give options within your control)

How many meals + snacks should toddlers + preschoolers eat? What should be the only thing consumed between meals or snacks?

3 meals + 2-3 snacks (2-3 hrs apart)

WATER should be the only thing between meals + snacks

How many Exposures to a new food does it take for a toddler or preschooler to accept it?

15+

• see, smell, touch + taste = required before acceptance

***What is the encouraged method of feeding for toddlers + preschoolers? WHY?

encourage self-feeding regardless of messiness

• IMPORTNAT for MOTOR skill development + SELF-CONFIDENCE

****What are 4 common Feeding Concerns for toddlers + preschoolers. Give explanation for why some of these occur.

• SHOULD THE PARENT BE CONCERNED?

DON’T be CONCERNED generally DOES NOT result in undernutrition

1. Lack of interest in food + smaller appetite (compared to infancy)

2. Unpredictable amounts eaten

cause of above: eating will reflect their needs (growth rate decreases with age + occurs in spurts)

1. Reluctance to try new foods (neophobia)

2. Picky eating + food jags (only eat 1 thing for 1 week then hate it the next)

****What foods to offer a toddler + preschooler?

• formula + breast feeding?

After 12 months formula = no longer needed but breastfeeding can continue (with Vit D supplements to 2 years)

Healthy foods

• Variety

• Unprocessed or minimally processed should be emphasized

• Processed in moderation

• Ultra processed = NOT needed

****In terms of BEVERAGE what should and should not be offered?

Beverages other than water should be limited

• adequate milk but not excessive

• NO sweetened beverages

*****What percent of MILK + what type should be offered until 2 years of age + why?

3.25% (full fat) → no fat restrictions under 2 years of age

• other soy or plant based mils are NOT recommended for toddlers (not enough fat?)

• soy formula until 2 years if no breast or other animal milk

*****What is the common cause of dental carries in young children?

Use of bottle or sippy cup when sleeping or throughout the day (recommend only H2O between meals and in cups + no sticky foods between meals)

• constant exposure to carbs

• Sticky foods also increase potential for dental carries

Simple CHO = used by bacteria in mouth → produced acid + erodes enamel

******What is the recommendation when it comes to how much to offer a toddler + preschooler? WHY?

Small amounts of food offered (0.25 or 0.5 servings of each food) → can always get more if not full

Progress to child self-serving from what is offered

Toddler/preschooler decides IF eat + HOW MUCH eaten

WHY = Promotion of AUTONOMY + REGULATION OF APPETITE

****Summarize the article by Birch L.L 2016 Learning to Eat: Behavioral and Psychological Aspects

• What is the genetic predisposition of children

• Traditional feeding risks + why?

Predisposition= bias to prefer sweet and salty tastes, and to reject new foods and flavors (neophobia)

• need to introduce new foods + variety

Traditional feeding: is generally the default method of feeding (evolved to protect children from food scarcity, can be maladaptive in current environments) = increases risk of obesity

Responsive feeding + introduction to new food + variety = promote self-regulatory skills in feeding, beneficial as children are learning to eat in our obesogenic environment.

******What are INTERNAL REGULATION OF E INTAKE?

• what is the control center

• What are the 3 internal cues

Hypothalamus = control center for hunger + satiety

• INTERNAL CUES: signals from nervous system, hormones + blood nutrient levels

***what internal cues trigger Hunger vs. Satiety?

Hunger = Low blood glucose, Ghrelin release, Other hormones

Satiety = stretch, CKK, Leptin + Other hormones

What are some examples EXTERNAL cues that influence the regulation E intake

• Define external cues

Definition: Anything that can influence consumption other than feelings of hunger + satiety

• Rewards

• Peers

• Portion size

• Praise

• social influence (social get togethers involves food)

• “clean your plate”

• How others around you are eating

• Advertisements

• Sight, smell + taste

• Food as a reward

From the results of food records from toddler + preschool age children reveals _______ (variable/consistent) E intake in individual meals BUT _______ (variable/consistent) daily intake

VARIABLE E from individual meals

CONSISTENT daily intake regardless of the variability of individual meals

*****Info dump on the results of the Fat substitution study

• How does the Food intake in toddlers + preschoolers respond to Low vs. High fat foods

Foods tasted the same but diff Fat% = different kcals

Results = Overall E intake in children from both groups = the same

• COMPENSATED by adjusting amount eaten based on Kcal

  • Low E due to Low fat = Increased intake of Carb + protein sources to balance out E intake

*****how do Toddlers + preschoolers respond to Internal vs. External cues (is there an Influence?)

• in relation to example of study given in class. High vs. Low Kcal yogurt + Internal vs. External cues effect on the amount of snacks eaten after eating yogurt

Result = EXTERNAL CUES DOES influence amount of food eaten

• Internal cues only (no external cues) results = children who consumed lower kcal yogurt before offered snacks = ate MORE snacks than children who consumed higher Kcal Yogurt

  • children were able to think about how full they feel and consume adequate amounts of kcal based on how they feel

• External cues results = children who consumed higher kcal yogurt at an excess of kcal as the external cues prompted them to eat more snacks

******How does parental behavior (praise/rewards) affect Toddler + preschooler food acceptance ?

• Does encouraging to eat more affect how much is consumed

Encouragement or rewards does not increase the likelihood to eat a food/ improve food acceptance

• it may even DECREASE

******How does Portion size affect amount of food consumed

• at what age does portion size become an influence?

• What is the take home message?

3.5 years = ate similar amounts of food regardless of portion size (respond to INTERNAL cues)

5 yrs = Increased consumption with Increased portion size

• BE AWARE of how much you are giving your child

******How does Modeling affect toddler + preschooler food consumption?

• WHO has to be the role model?

Modelling has a influence on food consumption → will change in the direction of the model

PEERS influence (no effect if parents were role models)

• Children who didn’t like vegetable before modeling = increase intake of said vegetable

• Children who liked vegetable before modeling = decreased intake of said vegetable

****Summary in terms of internal + external cues for toddlers + preschoolers

• What are they responsive to

• what can effect amount eaten?

Toddlers are responsive to internal cues: E intake variability, Eat more if lower E density

But are starting to become more sensitive to External cues: Praise, rewards, potion size, peers

****What has the biggest influence on toddler + preschooler eating + feeding?

FAMILY

****What ages are defined as School age children:

• What ages are considered Middle childhood vs. Preadolescence

Middle childhood = 5-9

Preadolescence = 9-11 GIRLS + 10-12 BOYS

school age is still an important time to establish ______ and _______

establishing healthy food preferences + eating habits

*********What is INCREASING IN INFLUENCE for school aged children?

Increasing influence outside family

*****What are the characteristics of Motor skill development in school aged children?

• Improved motor coordination

• ability to perform more complex pattern movements

• increasing muscular strength

*****Does physical activity start to contribute more or less to energy expenditure in school aged children?

= contributing MORE

• E expenditure starts to become highly variable

*****what are school aged children supposed to be able to do in regards to feeding + food skills?

• Masted used of utensils

• Should be involved in food preparation + chores related to meals

• Ready to learn about simple (not complex or “good” vs. “bad” food)nutrition facts + relate to foods they are eating (Eg. this food helps make you strong)

*****What are the characteristics of Social + cognitive development in school aged children?

• Decreased egocentrism

• More rational cause/effect reasoning (but thinking = concrete not flexible)

• Development of sense of self + self efficacy

• Increase importance of peer relationships

• independence

******How do eating behaviors change in school age children vs. toddler + preschool

• eating more meals + snacks away from home

  • culture of setting (eg. school, sports, extracurriculars) + food availability

• increased independence on food choices away from home

• Increased influence of marketing

*******In school aged children what has the Strongest influence on food choices?

FAMILY = still the strongest

*******In school aged children what 3 influence on food choices are increasing ?

• Peers

• Environment outside of home

• Media

****What is the Diet quality for school aged children how does it compare to toddlers + preschoolers?

Majority = require improvement

• poor quality = increased + good quality = decreased

*****In School aged children what has the biggest influence on EER?

• EER formula?

E = required for maintenance, growth + activity

PHYSICAL ACTIVITY LEVEL + BIGGEST INFLUENCE

EER

• separate formula for Boy + girl

• Different formula for 3-8 vs. 9-18

********According to the 24hr movement guideline for 5-17 year olds

• how long to sit + screen time

• How long to Sleep

• Step

• Sweat

Sit

• Limit sitting for extended periods

• no more than 2 hours of RECREATIONAL screen time

Uninterrupted Sleep

• 5-13 yrs = 9-11

• CONSISTENT bed + wake times

Step = Light activity

• several hours, structured + unstructured

Sweat = moderate to vigorous

• at least ONE HOUR

• Vigorous activities, muscle and bone strengthening at least 3 days/week

How is the FIBER intake for school aged children 4-13?

Median intake = BELOW AI

*****What is the DRI for FIBER

• Age 4-8

• MALE 9-13

• FEMALE 9-13

4-8 = 25g

MALE 9-13 = 31

FEMALE 9-13 = 36

• fiber intake = calculated as 14g/1000kcal

*****Other than fiber what is the DRI for other MACROS in school aged children?

• Carb, Linolenic acid + protein = stay CONSISTENT

• Water increases for as you get older

• Linoleic acid increases for MALE only

*****What is the AMDR (adequate macro, distribution range) as % of E intake for school aged children 4-18

• focus on % of fat

• how does it change from toddler/preschool?

FAT decreases as you age

****FAT intake in 9-13 year old school age children:

• Girls: ____% of fat intake was BELOW + ___% ABOVE

• Boys: ____% intake ABOVE

Boys take in more fat

Generally there is less inadequate intake compared to toddlers/preschoolers

• Girls: 6.5% of fat intake was BELOW + 11% ABOVE

• Boys: 12% intake ABOVE

*******What are 8 MICRONUTRIENT of CONCERN for 9-13 year olds (intake less than EAR or over UL)

• male vs female

1. IRON

2. CA

3. Vit D MOST

4. Vit A

5. Magnesium + Zinc: generally for girls only?

6. Potassium under AI

7. Sodium = ABOVE UL

Females = MORE DEFICIENT than males

What is the goal when it comes to feeding SCHOOL AGE CHILDREN?

SAME as toddlers + preschoolers

• adequate but not excessive E + NUTR intake

• Support normal development (growth, motor, cognitive + social)

• Encourage healthy eating patterns + behaviors (family = STRONGEST influence)

• Support self-regulation of E intake

*******Division of responsibility in feeding for school age children

• What do Parents vs. children decide

Parents = What, When + Where

Children = how much + whether

How to feed school aged children (5 points - don’t really get the take away of this slide)

• role modeling

• Foods available + accessible

• Food preparation

• consistent schedule

• Meals at table without distractions

  • selecting foods + serving size from what is offered

*****What are some Practices of Parental control that can HAVE NEGATIVE IMPACT

• pressure to eat

• restriction for weight

• Threats or bribes

• Intrusive control vs. permissive feeding

• Other practices if done with pressure, consequences or overriding internal cues

  • prompt to eat, rules + limits, redirection + negotiation

*****Body image

• when does it start

• What can affect/cause?

Negative image + disordered eating can start in early childhood

Trigger/cause:

• rebound adiposity can trigger negative opinions of body image

• Parents own attitude towards own body wt

• Sever restrictions of unhealthy foods + or focus on wt can increase risk of disordered eating in children

******Summary Toddler/preschool + School age

• growth rate

• impacts on feeding + preferences

• diet quality of Canadians

• Growth rate DECREACES compared to infancy

• Development impacts feeding skills + eating behaviors

• Food preferences + behaviors develop early

• Division of responsibility with feeding (4 W’s + How; parents vs. child) important in regulation of E intake

• Small percentage of Canadian Children have good diet quality, intake of some nutrients = above or below rec.

*****Summary of Development of responsibilities in feeding (W’s + how, parent vs. child)

• Infant

• Toddler/preschool

• School age

• Adolescent

Infant

• Child = Whether they eat, Where, When + how much

• parent = What

Toddler → adolescence

• child = How much and if they eat (Whether)

• Parent = What + When + Where