A presentation I made for a graduate-level Maternal & Childhood Nutrition course. This PowerPoint focuses on the important role good nutrition can play in this age group, as well as nutrition programs for this age group.

1. Toddler and
Preschooler Nutrition
By Emily Todhunter, HNF 512, Spring 2013
1

2. Outline
• Introduction
• Normal growth and development
• Physiological and cognitive development
• Nutrition Recommendations
• Energy and nutrient needs
• Common nutrition problems
• Prevention of nutrition-related disorders
• Dietary and physical activity recommendations
• Key Nutrition Programs
• Key Nutrition Resources
• Conclusion
2

3. Importance of Nutrition
• The eating habits established now impact food habits and
health later in life.
• Toddlers and Preschoolers need adequate intake in order to
achieve full growth and developmental potential
• Undernutrition impairs children’s cognitive development as
well as their ability to explore their environments
• Long-term effects of undernutrition (FTT, cognitive
impairment) may be prevented or reduced with adequate
nutrition and environmental support.
3

4. Normal Growth & Development
• Infants triple birth weight in first 12
months, but growth slows after that
• Toddlers gain 0.5 lbs and 0.4” per
month
• Preschoolers gain 4.4 lbs and 2.75” per
year
• Decrease in growth rate accompanied
by decrease in appetite and food intake
4

5. 2000 CDC Growth Charts
• Gender-specific
• Charts available for 0-36 months,
and 2-20 years
• If recumbent length measured,
use 0-36 months
• If standing height measured, use
2-20 years
• Health care professional can plot
and monitor:
• Weight for age
• Length/stature for age
• BMI for age (2-20 yrs. only)
• Head circumference for age (0-36
mos. only)
• Weight for length
• Weight for stature 5

6. 2000 CDC Growth Charts
• BMI provides guidelines for
assessing underweight and
overweight
• Predictive of body fat for
children over 2 years of age
• BMI 85-95th percentile: risk of
being overweight
• BMI >95th percentile:
overweight
• BMI <5th percentile:
underweight
6

7. Physiological Development -
Toddlers
• Most children begin to walk
independently by 1st birthday
• Gross motor skills, such as sitting
on a small chair, climbing on
furniture, walking up and down
stairs, jumping in place, develop
rapidly at this age
• Increasingly mobile and
independent, can explore
environment
• By 36 months, can ride tricycle
7

8. Cognitive Development-
Toddlers
• Develop new relationships, imitate others, learn about family’s
cultural customs
• Fears emerge during this period
• Vocabulary is 100+ words at 2 years of age
• By 36 months, child can use 3-word sentences
• Increased determination to express
their own will (temper tantrums).
Can easily become frustrated and
negative.
8

9. Development of Feeding Skills
in Toddlers
• Toddlers can handle chopped or soft table foods
• At 18-24 months, toddlers are able to use the tongue to clean
the lips and have well-developed rotary chew movements.
Now the toddler can handle meats, raw fruits and vegetables,
and multiple textures of food.
• Strong need for independence and
self-feeding
• Increasing fine motor and visual
motor coordination skills allow
toddlers to use cups and spoons
more effectively, though may prefer
to eat with their hands
9

10. Tips for Parents
• Keep distractions (ie: TV) to a minimum during
mealtimes
• Allow their toddlers to practice self-feeding
skills and to experience new foods and textures
(no matter how messy!)
• Risk of choking high at this age
• Toddlers should always be seated during meals
and snacks (high chair or booster seat with the
family)
• Foods that may cause choking: hard candy,
popcorn, nuts, whole grapes, and hot dogs should
not be served to children less than 2 years of age.
10

11. Feeding Behaviors of Toddlers
• Many toddlers demonstrate strong food preferences and
dislikes
• “Food jags” – prolonged periods of refusing a particular food
or foods they previously liked
• To circumvent food jags:
• Serve new foods along with familiar foods
• Serve new foods when child is hungry
• Other family members should eat the new foods in front of
toddler
• Mealtime an opportunity for parents to model healthy eating
behaviors, toddlers to practice language and social skills,
develop positive self-image 11
• Not the time for battles or “force feedings”

12. Food Intake in Toddlers
• Rule of thumb: serving size is 1 tablespoon of food per year of
age.
• So a serving for a 2-yr old child would be about 2 tablespoons.
• Because toddlers can’t eat a large amount of food at one time,
snacks are vital in meeting the child’s nutritional needs.
• Toddlers should not be allowed to “graze” throughout the day
on sweetened beverages and foods such as cookies and chips.
• These foods can lower their appetite for basic foods at meals
• Establish regular but flexible meal and snack times to allow
enough time in between for child to get hungry
12

13. Developments in Preschool-
Age Children
• Gross and fine motor capabilities expand
• At age 4, child can hop, jump on one foot,
climb, ride a tricycle or bicycle with training
wheels, and can throw a ball overhand.
• Magical thinking & egocentrism (not able to
accept another’s point of view)
• Play moves toward more organized group
play, such as tag or “house”
• Temper tantrums peak between the ages of
2-4 years
• Between ages 2-5, vocabularies increase
from 50-100 words to more than 2000 13
words, and complete sentences.

14. Development of Feeding Skills
in Preschool-Age Children
• Use a fork, spoon, and cup well
• Cutting and spreading with a knife may need some refinement
• Eating not as messy as in toddlerhood
• Unintentional spills
• Modify foods to minimize risk of choking- cut grapes in half
lengthwise and cut hot dogs in quarters lengthwise and
cutting into small bites.
14

15. Feeding Behaviors of
Preschool-Age Children
• Children want to be helpful and to please their parents and
caretakers
• Good time to teach children about food, food selection, and
preparation
• Get them involved!
15

16. Age-Appropriate Kitchen Activities
• At 2 years
• Wipe tables
• Hand items to adult to put away (such
as after grocery shopping)
• Place things in trash
• Tear lettuce or greens
• Help “read” a cookbook by turning the
pages
• Make “faces” out of pieces of fruits and
vegetables
• Rinse vegetables or fruits • At 4 years:
• Snap green beans • Peel eggs and some fruits, such as
• At 3 years: oranges and bananas
• Add ingredients • Set the table
• Talk about cooking • Crack eggs
• Scoop or mash potatoes • Help measure dry ingredients
• Squeeze citrus fruits • Help make sandwiches and tossed
• Stir pancake batter salads
• Knead and shape dough • At 5 years:
• Name and count foods • Measure liquids 16
• Help assemble a pizza • Cut soft fruits with a dull knife
• Use an egg beater

17. Innate Ability to Control
Energy Intake
• Ability to self-regulate food intake
• If allowed to decide when to eat and when to stop eating
without outside interference, children will eat as much as they
need.
• Can adjust their caloric intake to meet energy needs
• Avoid using food as rewards or forcing child to “clean their
plate”
17

18. 3 yr old vs. 5 yr old study
• Children served either small, medium, or large portion of
macaroni and cheese, along with standard amounts of other
foods.
• Analysis of amount of food eaten showed that portion size did
not affect the younger children’s intakes – their intakes
remained the same despite the amount of food served to
them.
• 5-year-old children’s intakes increased significantly with larger
portion sizes
• By 5 years of age, children are influenced by external factors
rather than internal cues (hunger & satiety signals)
18
Rolls BJ, Engell D, Birch LL. Serving portion size influences 5-year-old but not 3-
year-old children’s food intake. J Amer Diet Assoc. 2000; 100:232-34.

19. Appetite and Food Intake of
Preschoolers – Picky Eaters
• Familiar foods may be comforting to the child
• Child may be trying to exert control over this aspect of her/his
life
• Suggestions include:
• Serve child-sized portions
• Serve food in attractive way
• Limit snacking and drinks between meals as to not “kill” appetite
at mealtime
• May take 8-10 exposures to new food before it is accepted
• Children raised in an environment where all members of the
family eat a variety of foods are more likely to eat a variety of
foods. 19

20. Food Preferences
• Their own food habits and food preferences are established at
this time
• Influenced by parents, caretakers, peers, siblings, TV
• Spending more time away from home (day care, preschool)
• At this age, children generally do not like:
• strongly flavored vegetables
• Spicy, sour, or bitter food
• Food touching or mixed together (casseroles, salads)
• Children naturally prefer sweet and slightly salty tastes
• Foods served on a limited basis but used as a rewards become
highly desirable.
• Coercing or forcing children to eat foods can have a long-term
negative impact on their preference for these foods. 20

21. Nutrition
Recommendations
Energy and nutrient needs, common nutrition problems,
prevention of nutrition-related disorders, dietary and
physical activity recommendations
21

22. Energy Needs
• Children ages 13-35 months
• (89 x kg BW – 100) + 20 (Kcal for energy deposition)
• IE: 24-month old girl who weighs 12 kg would have an estimated
energy requirement (EER) of (89x12 -100) + 20 = 988 kcals
Age/ Weight Height Sedentary Low Active Very Active
Gender (kg) (m) PAL Active PAL PAL
(kcal/d) PAL (kcal/day) (kcal/d)
(kcal/d)
3 – Boy 14.3 0.95 1162 1324 1485 1683
4 – Boy 16.2 1.02 1215 1390 1566 1783
5 – Boy 18.4 1.09 1275 1466 1658 1894
3 – Girl 13.9 0.94 1080 1243 1395 1649
22
4 – Girl 15.8 1.01 1133 1310 1475 1750
5 – Girl 17.9 1.08 1189 1379 1557 1854

23. Protein Needs
• Ingestion of high-quality protein (such as milk and other
animal products) lowers the amount of total protein needed in
the diet to provide the essential amino acids
Age RDA (based on average
weight for age) g/kg/d
1-3 years 1.1 g/kg/day or 13 g/day
3-8 years 0.95 g/kg/day or 19 g/day
• RDA- Recommended dietary allowances -average daily dietary
intake levels sufficient to meet the nutrient requirements of
nearly all (97%-98%) healthy individuals in a population group.
23

24. Vitamins and Minerals
• Most children from birth to 5 years are meeting targeted
levels of consumption of most nutrients (analysis from
NHANES I, II, III)
• …with the exception of iron, calcium, and zinc
Age Iron (mg/d) Zinc (mg/d) Calcium (mg/d)
(RDA) (RDA) (AI)
1-3 years 7 3 500
4-8 years 10 5 800
24

25. IRON
• Good sources of iron
Food Amount Iron (mg)
Baked beans ½ cup 3.0
Pork 3 oz 2.7
Chicken 3 oz 1.0
Breakfast cereals, 1 cup 8.0 (4-18)
iron fortified
Prune juice 1 cup 9.0
Raisins ¼ cup 1.3
Lima beans ½ cup 2.2
Peas ½ cup 1.5
25

26. ZINC
• Good sources of zinc
Food Amount Zinc (mg)
Beef 3 oz 4.6
Turkey ham 3 oz 2.5
Pork 3 oz 2.4
Chicken 3 oz 2.0
Dried beans, ½ cup 1.0
cooked
Split peas, cooked ½ cup 0.9
Breakfast cereal, 1 cup 1.5-4.0
fortified
Oatmeal, cooked 1 cup 1.2 26
Peanut butter 2T 0.9
Cheddar cheese 1 oz 1.1

27. CALCIUM
• Adequate calcium intake in childhood affects peak bone mass
• 21% of children 2-8 years consume less than their DRI for
calcium
• Milk & milk products
• Lowfat yogurt, milk, cheese, pudding, ice cream, frozen yogurt
cottage cheese
• Vegetables
• Spinach, kale, broccoli
• Legumes
• Tofu, beans
• Foods fortified with calcium
• OJ, frozen waffles, soymilk, breakfast cereals 27

28. Common Nutrition
Problems in
Toddlers &
Preschoolers
Iron-deficiency anemia, dental caries, constipation, diarrhea,
lead poisoning, food security, food safety
28

29. Iron-Deficiency Anemia
• NWS-21.1
• Reduce iron deficiency among children aged 1-2 years; 15.9% in
2005-2008 to 14.3%
• NWS-21.2
• Reduce iron deficiency among children aged 3-4 years; 5.3% in
2005-2008 to 4.3%
• For children 2-5 years, hemoglobin value <11.1 g/dL or
hematocrit <33.0% is diagnostic of iron-deficiency anemia.
• Rapid growth rate coupled with frequently inadequate intake
of dietary iron, places toddlers (especially 9-18 month olds) at
the highest risk for iron deficiency
• Iron deficiency anemia in young children appears to cause
long-term delays in cognitive development and behavioral
29
disturbances.

30. Preventing Iron Deficiency
• Children at high risk for iron deficiency should be tested
between ages of 9-12 months, 6 months later, then annually
from ages 2-5
• Children at risk:
• Low income children
• Recently arrived refugee children
• Low-iron diet
• Consume >24 oz of milk/day
• Limited access to food due to poverty/neglect
• Special healthcare needs (chronic illness, IEM)
• Treatment:
• Supplementation with iron drops, 3 mg/kg/day
30
• Counsel parents or caretakers about diet

31. Dental Caries
• 1 in 5 children ages 2-4 years have decay in the primary or
permanent teeth
• Primary cause = habitual use of a bottle with milk or fruit juice
at bedtime or throughout the day
• “baby-bottle tooth decay”
• Incidence is highest among Hispanic, American Indian, and
Alaska Native children, and among children whose parents
have less than a high school education
31

32. Fluoride
• If water supply is not adequately fluoridated, then a
supplement is recommended.
• American Dental Association, American Academy of Pediatrics,
and American Academy of Pediatric Dentistry:
• Children 6 months – 3 years need 0.25 mg/day if water supply has
<0.3 ppm of fluoride
• Children 3-6 years need 0.5 mg/day if water supply has <0.3 ppm,
or 0.25 mg/day if 0.3-0.6 ppm of fluoride in water supply
• Fluorosis – excessive fluoride supplementation, consumption
of fluoride toothpaste, and high fluoride levels in water
supply, leads to permanent staining of enamel of teeth
32

33. Constipation
• Hard & dry stools associated with painful bowel movements
• Diets adequate in total or dietary fiber guard against
constipation
Adequate Intake of Total Fiber for Children
1-3 years of age 19g/day of total fiber
3-8 years of age 25g/day of total fiber
• Whole grain breads and cereals, legumes, fruits and
vegetables
• Avoid too much fiber, however, as it can easily cause diarrhea
in young children
33

34. Diarrhea
• Acute Diarrhea
• Goes along with an infection or from contamination of food or
drinking water
• Fever, vomiting
• Dangerous because child will likely feel ill and nauseated and will
refuse fluids & foods and sleep more (cause dehydration)
• Chronic Nonspecific Diarrhea
• Child is not sick
• Eats well, normal pattern of growth and development
• Excessively frequent or watery bowel pattern
• Can last a day or several months or as long as 3 years
• Can be caused by distortion in their diet, a cold, change in water 34
or schedule, antibiotics

35. Managing Acute Diarrhea
• Maintain an adequate fluid intake to correct the fluid loss
• Tiny sips of fluid (water, fruit juices, soda pop, ginger ale, jello,
clear broth)
• Crushed ice or popsicles
• Limit fruit and juice intake
• Hold down on sugar
• Avoid artificial sweeteners
• Make sure the diet has enough fat in it
• Include yogurt
35

36. Lead Poisoning
• 2.2% of children ages 1-5 have high blood lead levels,
exceeding 10 mcg/dL
• High blood lead levels affect brain and kidney function
• Low-level exposure to lead associated with behavioral
problems, decreased IQ, decreased growth
• Lead-based paint chips, lead-soldered water pipes, canned
goods from other countries, dirt, lead weights, ceramic glazes,
pewter
• Screening in children living in houses built before 1950, living
in poverty, having a sibling with high blood lead levels,
Medicaid, WIC
• Adequate dietary calcium intake appears to protect against 36
high blood lead levels by decreasing absorption of lead.

37. Food Security
• NWS-12
• Eliminate very low food
security among children;
1.3% of households with
children had very low
food security among
children in 2008 to 0.2%
• Children who are hungry
and have multiple
experiences with food
insufficiency are more
likely to exhibit behavioral,
emotional, and academic
problems as compared to
other children who do not
experience hunger 37
repeatedly.

38. Food Safety
• Young children especially vulnerable to food poisoning
because they can become ill from smaller doses of organisms
• Campylobacter, Salmonella, E. coli 0157:H7, Listeria
monocytogenes
• Campylobacter: Raw poultry, undercooked poultry, raw milk,
nonchlorinated water, handling infected animal or human feces
• Salmonella: raw/undercooked eggs, raw cookie dough
• E. coli 0157:H7: contaminated undercooked hamburger meat,
unpasteurized apple cider/juice, unpasteurized milk
38

39. FightBAC
• Contamination of food
can occur at any point
along the way from
production to
consumption
• Food safety education
program, FightBAC,
developed by the
Partnership for Food
Safety Education
39

40. Prevention of
Nutrition-Related
Disorders
Overweight/Obesity, Cardiovascular Disease, Vitamin and
Mineral Supplements
40

41. Overweight/Obesity
• NWS-10-1
• Reduce the proportion of children aged 2-5 years who are
considered obese; 10.7% in 2005-2008 to 9.6%
• Children with BMI > 85th percentile with complications (htn,
gallbladder disease) or >95th percentile should be evaluated
and possibly treated for obesity.
• Since 1980, obesity prevalence among children and
adolescents has almost tripled.
• Hispanic male children more overweight than white male
children.
• Hispanic and black female children more likely to be
overweight than white female children. 41

42. Overweight/Obesity
• Maintaining weight while gaining height can be the best
treatment for obese children between the ages of 2 and 7.
• If child already exhibits secondary complications, such as htn,
high cholesterol, or triglyceride levels, gradual weight loss may
be indicated.
• Sufficient nutrients must be provided for children to reach full
height potential and to remain healthy.
• Family education & involvement
• Increasing physical activity, offering
nutrient-dense snacks, focusing on
behavior change not weight changes.
42

43. Cardiovascular Disease
• Children with familial hyperlipidemia and obese children can
have high levels of LDL cholesterol.
• Fatty streaks, which can be precursors to the buildup of fat
deposits in blood vessels, have been found in the arteries of
young children.
• AHA & AAP recommend children 2-3 to have 30-35% of total
energy from fat
• Children 4+, 25-35% of total energy from fat
• Children with familial hyperlipidemia need periodic screening,
saturated fat <7%, <200 mg cholesterol/day
43

44. Insulin Resistance
• Acanthosis Nigricans
• indicative of positive insulin resistance
• Dark, velvety rash on back of neck
• People who are overweight or obese are more likely to develop
AN, and it often lessens or goes away with weight loss
• CARDIAC Project in WV
• AN screening began in 2006-2007 for kindergarteners
• Total of 189 (1.6%) had confirmed AN from ‘06-’07 to ’11-’12
44

45. Vitamin and Mineral
Supplements
• Children who consume a variety of basic foods can meet all of
their nutrient needs without vitamin or mineral supplements.
• AAP recommends vitamin and mineral supplementation for
children who are at high risk of developing or have one or
more nutrient deficiencies:
• From deprived families/abuse/neglect
• Anorexia/poor appetite/poor eating habits
• “fad diet” or only consumes a few types of foods
• Vegetarians without dairy products
45

46. Vitamin and Mineral
Supplements
• NHANES III : Approximately 50% of 3-year-olds in the US are given a
vitamin and mineral supplement by their parents.
• Mothers who give supplements to their children:
• Non-Hispanic white, older, more years of education, married, have
life insurance, greater household income, took prenatal vitamins
during pregnancy, receive care from a private health care provider
46

47. Dietary Recommendations
• MyPyramid:
• 4 year old male, 60+ minutes of physical activity
• 5 oz grains
• 2 cups vegetables
• 1 ½ cup fruits
• 3 cups milk
• 5 oz meat/beans
• 5 tsps oil/day
• Limit extras – solid
fats and sugars to 130
calories per day.
47

48. Key Dietary Recommendations
• Variety, variety, variety!
• ½ of grains should be whole
• Children 2-8 years should drink 2 cups per day of fat-free or
low-fat milk or equivalent milk products
• Most fats should come from unsaturated sources – fish, nuts,
vegetable oils
• Beans, lean meats, poultry added as appropriate
• Foods high in fat and sugar should be limited in diet
• AHA recommends introducing and regularly serving fish to
children
• EPA and FDA advise fish and shellfish lower in mercury
48

49. Fats
• Appropriate amount of fat in diet needed to meet needs for
calories, essential fatty acids, and fat-soluble vitamins.
• Foods high in fat should be used sparingly, especially those
high in saturated and trans fat
• Good sources of essential fatty acid linoleic acid: peanut,
canola, corn, safflower, other vegetable oils
• Good sources of essential fatty acid alpha-linolenic acid:
flaxseed, soy, canola oil
• Vitamin E: corn, soybean, safflower oils
49

50. Fluids
• Healthy toddlers and preschoolers will consume enough fluid
through beverages, foods, and sips and glasses of water.
• Fluid requirements increase with fever, vomiting, diarrhea,
and when children are in hot, dry, or humid conditions.
• Approximately 50% of 2-5 year olds consume soft drinks
• Children who consume >9 oz of soft drinks per day consume
more calories and less milk and fruit juice than those with
lower consumptions of regular soft drinks.
50

51. Where do kids eat?
• According to the USDA report Food and Nutrient Intakes by
Children, about 25% of children ages 4-8 years consumed fast
food
• 52% of 3-5 year olds eat away from home daily
• Fast food restaurants, day care centers, friends’ houses
• NWS-1
• Increase the number of states with nutrition standards for food
and beverages provided to preschool aged children in childcare; 51
24 states in 2006 to 34 states

52. Vegetarian Diets
• Young children need energy-dense foods to reduce the total
amount of food required
• Guidelines:
• Allow the child to eat several times a day (ie: 3 meals, 2 snacks)
• Avoid serving the child bran and an excessive amount of bulky
foods, such as bran muffins and raw fruits and vegetables
• Include in the diet some sources of energy-dense foods such as
cheese and avocado
• Include enough fat (at least 30% of total calories) and a source of
omega-3 fatty acids, such as canola or soybean oils
• Include sources of vitamin B12, D, and calcium, or supplement if
required
52

53. Food Allergies
• Estimated to be present in 2-8% of children
• Usually identified in toddlers and preschoolers because allergy
testing in infancy is not useful due to the incomplete
development of the immune system
• Anaphylaxis: sudden onset of a reaction with mild to severe
symptoms, including a decrease in ability to breathe, which
may be severe enough to cause a coma
• Milk, eggs, wheat, peanuts, walnuts, soy, fish
• Strict and complete avoidance of the food that causes the
allergy is required
53

54. Physical Activity
• 60+ minutes on most, preferably all, days of the week
• Taking a nature walk
• Riding a tricycle or bicycle
• Walking, skipping, running
• Free play outdoors
• Running, swimming, tumbling, throwing, catching under adult
supervision for preschoolers
54

55. Screen Time
• PA-8.2.1
• Increase the proportion of children ages 2-5 who view TV, videos,
or played video games for no more than 2 hours a day; 75.6% in
2005-2008 to 83.2%
• No TV viewing for children less than 2 years of age
• Screen time limited to less than 2 hours a day for all other
ages.
55

56. Public Food and
Nutrition Programs
WIC, Headstart, MyPlate, Choosy , Eatright.org, CARDIAC,
NSLP, other USDA nutrition programs
56

57. • USDA – Special Supplemental Nutrition Program for Women,
Infants, and Children
• Participation in WIC services improves the growth, iron status,
and the quality of dietary intake of nutritionally at-risk infants
and children up to age 5 years.
• For every $1 invested in the program, $3 in health care costs
are saved
• To qualify: children must live in a low-income household
(185% or less federal poverty level) and be at “nutrition risk”
• Nutrition risk: iron-deficiency anemia, under-weight,
overweight, chronic illness, or consumes inadequate diet
57

58. • WIC provides the following services for eligible participants:
• Free vouchers for specific, nutritious foods
• Nutrition education in the form of one-on-one counseling with a
dietitian, group classes, or grocery store tours
• Low-cost or free immunizations for children
• Breastfeeding services in the form of one-on-one counseling with
a lactation consultant. Breastfeeding pumps are also available for
lactating mothers in a limited supply
• Screening and referrals to other health, welfare and social
services
• Vouchers for food items such as milk, juice, eggs, cheese,
peanut butter, beans, eggs, bread, and fortified cereals are
given to eligible families. 58
• $20 voucher to spend at farmer’s market

59. • US Department of Health and Human Services, initiated in
1965
• Comprehensive child development programs
• Education, early childhood development, medical, dental, mental
health services, nutrition services, parent education
• Serving children 0-5 years of age, pregnant women, and
families
• Nearly 1 million US children participate
• Goal: increase the readiness for school of children from low-
income families (75% of Head Start families have incomes
<$12,000 annually)
59

60. • Head Start projects provide meals and snacks as well as
nutrition assessment and education for children and their
parents
• Head Start has been shown to improve children’s health:
• Lower incidence of anemia
• Receive more immunizations
• Have better nutrition and improved overall health
• 9 locations in Morgantown, West Virginia
• http://eclkc.ohs.acf.hhs.gov/hslc/hs
60

61. • “Choosy Kids, LLC is a company devoted to promoting healthy,
active lifestyles. It was founded on the belief that healthy
preferences for food choices and physical activity can be
developed early in life. Choosy Kids honors the role that
Parents, Early Educators, and Health Providers play in helping
children develop healthy preferences.”
• Role model is “Choosy”
• Music that appeals to kids and adults
• Practical suggestions
• Appropriate activities that promote active learning
61

62. Who is Choosy?
• As an ambassador for healthy children, Choosy wants
to help prevent childhood obesity.
• Choosy is a role model who encourages healthy
decision-making from all of us.
• Choosy assists parents, teachers, and health
professionals by supplying consistent health messages.
• Choosy recognizes that preferences for food and
physical activity are "learned" from others early in life.
• Choosy helps grown ups to intentionally facilitate
movement and nutrition experiences of young children
so that healthy preferences are reinforced early and
often.
• Choosy helps to promote healthy messages and
behaviors in homes, child care centers, agencies, and
schools with lively songs, activities, and helpful
materials. 62
• Choosy's name is tied to his behavior, and his message
is simple: Be Choosy Be Healthy

63. • “I have twins in the Choosy Kids Club. Between the two of
them there are very few days that go by when one of them
doesn’t mention doing something “The Choosy Way.”
Whenever we have a chance to ride an elevator the boys look
around for stairs and tell me the stairs are more “choosy.””
• “My daughter loves the character Choosy so much that she
has made many attempts at trying to perfect drawing him. She
has memorized the Choosy song, and when making her lunch
for school or choosing an after school snack she will often ask
if it is a “Choosy food.”” 63

64. • 13 site coordinators, 640 preceptors, and hundreds of health
science students identify children and their families at risk of
CVD
• Goal: to help provide, through collaboration with others,
interventions that will facilitate knowledge, positive attitudes,
and desired behaviors in children related to health risk factors
• Blood pressure, weight, height, and blood lipid testing.
• Testing has been done in Kindergarten, 2nd grade, 5th grade, 8th
grade, and 9th grade.
• More than 17,199 Kindergarteners have been screened from
2003-2012.
64

65. • In 2011-2012, 868 of 2435 eligible Kindergarten students were
screened in 8 participating counties (35.6%)
• 601 students underweight/normal
• 149 students overweight
• 118 students obese
• 0.7% (6 students) had confirmed Acanthosis Nigricans
13.60%
<85th Percentile
17.20%
85th-94th Percentile
69.20% >95th Percentile
65

66. National School Lunch
Program
• Operates in more than 99,800 public and nonprofit private
school and residential child care institutions.
• In 2007, it provided nutritionally balanced, low-cost or free
lunches to more than 30.6 million school children each day
• Locations receive reimbursement dollars, and offer
free/reduced-price lunches to eligible children and meet
specific nutrition guidelines.
• At or below 130% poverty level, free lunch
• 130%-185% poverty level, reduced-price lunch
66

67. NSLP Patterns (per lunch minimums)
Food Group 1-2 years of age 3-4 years of age
Lean meat, poultry, or 1 oz 1 ½ oz
fish
Cheese 1 oz 1 ½ oz
Large egg(s) ½ ¾
Cooked dry beans or ¼ cup 3/8 cup
peas
Peanut Butter 2 Tablespoons 3 Tablespoons
Yogurt ½ cup ¾ cup
Peanuts, soynuts, tree ½ oz ¾ oz
nuts, or seeds
Vegetable/Fruit, 2 ½ cup ½ cup
servings, both to total
Bread or Bread 5 servings/week 8 servings/week 67
Alternative
1 serving of fluid milk ¾ cup ¾ cup

68. Other USDA Food Assistance
Programs
• School Breakfast Program
• Established in 1966, made permanent in 1975
• After School Snack Program
• Established in 1998
• Special Milk Program for Children
• Summer Food Service Program for Children
• Created in 1968
68

69. Charleston Gazette
• http://wvgazette.com/News/theshapewerein/201204070047
• “Success from scratch: Seven counties feed kids fresh food
daily”
• Last summer, seven of West Virginia's poorest counties -
Lincoln, Mingo, McDowell, Clay, Gilmer, Fayette and Mason -
agreed to try cooking lunch and breakfast with fresh
ingredients all year, five days a week. They would offer meals
free to all students who want to eat.
• Superintendent Jorea Marple wants to spread healthy cooking
statewide. Their challenge: Prove it can be done. Avoid
fattening, processed, prepackaged food. Find things kids like,
and stay within budget. 69

70. ‹#›

71. Key Resources
Eat Right, Kids Eat Right, Books, Websites, Twitter, Pinterest
71

72. • http://www.choosemyplate.gov/preschoolers.html
• Provides health and nutrition information for
parents, caregivers, and professionals
• Topics include:
• Daily food plan for preschoolers
• Growth during preschool years
• Developing healthy eating habits
• Picky eating
• Physical activity
• Food safety
• Meal & snack patterns and ideas
• Phrases that help & hinder handout 72

73. • Academy of Nutrition and Dietetics
• Under “Public” tab, click on “Children’s Health”
• Sections on childhood obesity, nutrition for infants and toddlers,
eat right at school, and get moving.
• Dozens of articles written for the public
• Relevant articles for toddlers/preschoolers include:
• Size-wise nutrition for preschool-age children
• Reducing the risk from food allergies
• Raising healthy eaters from preschool to high school
• Introducing solid foods to toddlers
• Feeding vegetarian and vegan infants and toddlers
• Coping with picky eating phases
• Food safety tips, promoting positive body image in kids, breakfast 73
ideas, family dinner ideas

74. 74

75. • Website by the Academy of Nutrition and Dietetics
• Articles, tips, recipes, and videos
• Toddler article examples:
• “Picnic with your Toddler! The Perfect Mix of Food and Fun!”
• By Karen Ansel, MS RD
• “How to Avoid Choking”
• By Roberta Duyff, MS RD FADA
• Preschooler article examples:
• “Healthy Eats at the Amusement Park”
• “Talk to Your Child About Weight”
• “When Should My Kids Snack?”
• By Jo Ellen Shield, MED RD LD & Mary Mullen, MS RD 75

76. Books
Division of Responsibility in
Feeding the Toddler
• Parents are responsible for
what is presented to eat and
the manner which it is
presented (when and where)
• The parent is not responsible
for:
• How much a child eats
• Whether he eats
• How his body turns out
76

77. Books
• To promote good attitudes about food and
good nutrition, it is important for your meals
to be significant and pleasant.
• Significant:
• Meal on table
• Someone in household
planned, purchased, prepared food
• Family showed up to eat meal, pay attention to
it, spend some time over it
• Pleasant:
• Don’t argue, fight, or scold
• Consider timing, seating arrangements, eating 77
mechanics, don’t enforce food consumption

78. Books
• Tips for basic rules for raising a healthy eater;
troubleshooting for picky eaters; meals,
snacks, and beverages; activity; nutrition and
health issues
• Tip 47 – Plan a taste test challenge
• Make child “official food tasting judge”
• Use a blindfold, and a sip of water between
each sample to cleanse palate
• Prepare 2 different vegetables in different ways
• Not everything will taste good, but the goal is
to follow the “one bite rule” by tasting at least
one bite.
78
• Appendix in the back includes 22 recipes

79. Books
• Chapter 10 & 11: Toddler and
Preschooler Nutrition
• Normal growth & development
• Physiological and cognitive development
• Energy and nutrient needs
• Common nutrition problems
• Prevention of nutrition-related disorders
• Dietary and physical activity
recommendations
• Nutrition intervention for risk reduction
• Public food and nutrition programs
• Chronic conditions
• Feeding problems 79
• Food allergies and intolerances

80. Books
• Community Nutrition in Action
• Gives descriptions of childhood nutrition
programs
• National School Lunch Program
• School Breakfast Program
• After School Snack Program
• Special Milk Program for Children
• Summer Food Service Program for Children
• Food Distribution Program
• Head Start
• Eat Smart. Play Hard.
• Farm to School Programs 80
• Fruits & Veggies – More Matters

81. Websites
• USDA’s “Eat Smart. Play Hard.”
• http://www.fns.usda.gov/eatsmartplayhardhealthylifestyle/
• National Farm to School Programs
• http://www.farmtoschool.org/
• Fruits& Veggies – More Matters
• http://www.fruitsandveggiesmatter.gov/
• CDC Growth Charts
• http://www.cdc.gov/growthcharts/
• National Institute of Child Health and Development
• http://www.nichd.nih.gov/
• Action for Healthy Kids
• http://www.actionforhealthykids.org/
• West Virginia WIC
• http://ons.wvdhhr.org/
• Ellyn Satter, Associates 81
• http://www.ellynsatter.com/

82. Websites
• Healthy People 2020
• http://www.healthypeople.gov/2020/topicsobjectives2020/
• CDC Data & Statistics
• http://www.cdc.gov/obesity/data/childhood.html
• USDA’s Food & Nutrition Services Programs
• http://www.fns.usda.gov/child-nutrition-programs
• USDA’s Choose My Plate
• http://www.choosemyplate.gov/preschoolers.html
• Choosy Program
• http://www.choosykids.com/CK2/
• Academy of Nutrition & Dietetics – Children’s Health
• http://www.eatright.org/Public/landing.aspx?TaxID=6442451994
• Academy of Nutrition & Dietetics - Kids Eat Right
• http://www.eatright.org/kids/
• The CARDIAC Project 82
• http://www.cardiacwv.org/

83. Websites
• Charleston Gazette’s “The Shape We’re In” – Resources for Parents
• http://wvgazette.com/News/theshapewerein/201202110047
• Children’s Nutrition Research Center at Baylor College of Medicine
• http://www.kidsnutrition.org/
• Dairy Council of California
• http://www.healthyeating.org/
• American Academy of Pediatrics
• http://www.aap.org
• Childhood Obesity Prevention Partnership
• http://www.kidnetic.com/
• International Life Sciences Institute’s Take10! Program
• http://www.take10.net/
• Let’s Move! Campaign
83
• http://www.letsmove.gov/

84. @SchoolLunch
@letsmove
@healthyschools
@schoolfoodFOCUS
@joannadolgoffMD
@JollyTomato
@Fruits_Veggies
@Veggiecation
@KidsCookMonday
84
@lunchboxproject

85. http://pinterest.com/myplaterecipes/
85

86. Conclusion
• The eating habits established in toddler & preschool years impact
food habits and health later in life.
• Variety of food
• Helping with preparation, choosing, cooking of meals
• Making mealtime pleasant
• Good nutrition (iron, calcium, zinc)
• Staying physically active
• Common nutrition problems/disorders include:
• Dental caries
• Iron-deficiency anemia
• Constipation/diarrhea
• Lead poisoning
• Overweight/obesity
• Insulin resistance 86
• Cardiovascular disease

87. The End
Questions?
87