Elizabeth M. Ward, MS, RD
Renee A Alli, MD
Your child is walking, climbing, running, and "talking" nonstop now. Such developmental milestones mean his nutritional needs have changed, too.
Welcome to toddler territory. Armed with some basic know-how, you'll discover how best to nourish your child up to age 3.
It's ironic: Because of a slowdown in growth, toddlers, who are far more active than infants, have lower calorie needs, pound for pound. That doesn't diminish the importance of good nutrition, but it does present some challenges.
Toddlers need between 1,000 and 1,400 calories a day, depending on their age, size, and physical activity level (most are considered active). The amount of food a toddler requires from each of the food groups is based on daily calorie needs.
In addition to choices from each of the food groups, toddlers need the equivalent of 3 to 4 teaspoons of healthy oils, such as canola oil and tub margarine.
3, at least half from whole-grain sources
5, at least half from whole-grain sources
1 slice of whole-grain bread; 1 mini bagel; 1/2 cup cooked pasta, rice, or cereal; 1 cup ready-to-eat cereal
1 small apple; 1 cup sliced or cubed fruit; 1 large banana
1 cup cooked mashed or finely chopped vegetables including legumes (chickpeas, black beans, etc.)
1 cooked egg; 1 ounce cooked meat, poultry, or seafood; 1 tablespoon nut butter; 1/4 cup cooked legumes
1 cup milk or yogurt; 2 ounces processed American cheese; 1 1/2 ounces natural cheese, such as cheddar (low-fat for ages 2 and older)
Every day, toddlers hone their motor skills, including at the table. Mastering the pincer grasp, which allows children to pick up small bits of food (and other objects) between their thumbs and the forefingers, is one of the first steps to self-feeding, says pediatrician Tanya Remer Altman, MD, author of Mommy Calls.
Children start to develop the pincer grasp around 9 months, the same time they're ready for a lidded sippy or straw cup filled with infant formula or breast milk.
Many toddlers can self-feed an entire meal at around a year old, while other toddlers may need help until 18 months or so, Altman tells WebMD.
"After age 2, most toddlers can use a regular cup without a lid without spilling, but if they enjoy a straw cup or a sippy cup, there's no harm in that," Altman says.
Once a child discovers he can get food into his own mouth, he may not want you to help so much anymore.
Toddler self-feeding gives a whole new meaning to the term mess hall, but it's worth it to let him try to get food into his mouth, says Elisa Zied, MS, RD, author of Feed Your Family Right! and a spokeswoman for the American Dietetic Association.
"Self-feeding is an important developmental skill that parents should nurture," Zied says.
Allow children to self-feed as much as they can and want to, advises Altman, but if they aren't getting enough food, you can help, too.
Dairy foods, particularly milk, are rich in bone-building calcium and vitamin D. There's no rush to serve a child milk, however.
"Wait until his first birthday to offer cow's milk," says Zied.
The reason? Unlike fortified infant formula, cow's milk is low in iron and may lead to iron deficiency that compromises a child's thinking capacity, energy levels, and growth. Breast milk is low in iron, but the iron is well-absorbed by the child's body.
Most toddlers begin by eating full-fat dairy foods for the calories, fat, and cholesterol necessary to fuel their growth and development. In some cases, your pediatrician or registered dietitian may recommend 2% reduced-fat milk, so ask what is right for your child.
By the age of 2, most toddlers can start transitioning to lower-fat dairy foods, such as 2% reduced-fat milk or 1% low-fat milk, Zied says.
Milk is particularly beneficial because it provides vitamin D. Children of all ages need 400 international units (IU) of vitamin D daily, according to the American Academy of Pediatrics (AAP).
Toddlers require 16 ounces of milk or another calcium-containing product every day. It is possible to have too much of a good thing, however.
Like any beverage, filling up on milk leaves less room for foods, including iron-rich choices such as lean beef, chicken, and pork.
Strictly speaking, children do not need juice. The AAP recommends limiting fruit juice intake to 6 ounces a day or less until 6 years of age.
"It's better to get your child accustomed to the taste of water than juice at a young age," Altman says.
It's not that fruit juice is bad. It's an important source of several vitamins and minerals that fuel growth, including vitamin C. Fortified juices offer additional nutrients, such as calcium and vitamin D, too.
The problem is, drinking [fruit] juice, even when it's diluted, may give kids a taste for sweets, Altman says. Drinking fruit juice at a young age could encourage the consumption of the "liquid calories" that some experts have fingered as a contributor to childhood obesity. And excessive fruit juice intake may cause cavities.
Altman suggests sticking with whole fruit for toddlers. "I don't know very many toddlers who don't like fruit," she says.
A multivitamin/multimineral supplement (multi) designed for toddlers won't hurt and may even help a child's diet, Zied tells WebMD. Opt for a liquid formulation until the age of 2 and then discuss a chewable with your pediatrician.
"Toddlers are erratic eaters, and some may go days or even weeks coming up short for one or more nutrients," she says.
Dietary supplements provide some insurance against a toddler's unpredictable eating, but they are just that -- supplements, not substitutes for a balanced diet. Multis fall short for many nutrients toddlers need every day, including calcium.
Multis with vitamin D may be in order if your toddler doesn't get the recommended 400 IU of vitamin D daily.
The body makes vitamin D; its production is initiated in the skin by strong sunlight. Living in a northern climate increases the risk of vitamin D deficiency in children and adults, making the case for supplemental vitamin D compelling.
Few foods other than milk are good sources of vitamin D. Some good ones include:
Zied and Altman agree: Children should become accustomed at a young age to the natural flavors of food rather than to a salty taste.
But it may come as a surprise that the salt shaker is a minor source of sodium in the American diet.
Processed foods, including toddler favorites such as hot dogs, macaroni and cheese, and chicken nuggets, provide 75% of the sodium we eat.
Too much dietary sodium has been linked to high blood pressure in adults. Research suggests a lower sodium intake during childhood may lessen the risk of high blood pressure with age.
While it's a good idea to avoid the salt shaker, it's even better to cook from scratch as much as possible. "Limit processed products and season food with herbs and spices to cut down on the salt in your family's diet," Zied advises.
It’s not possible to totally escape sugar. Natural sugars are present in some of the most nutritious foods, including fruit, veggies, and milk.
But a bigger concern is the overall quality of the food. Whole foods have many nutrients to offer. Processed, sugary foods -- such as candy, cake, and cookies -- are often packed with fat and lack other nutrients. Added sugar is found in healthier choices also, such as breakfast cereals, yogurt, and snack bars.
Zied says older children get upwards of 25% of their calories from sugar, far too much to ensure nutritional adequacy.
"Generally speaking, sugary foods are OK in small doses," Zied says.
She suggests avoiding soft drinks and limiting fruit juice intake as well as serving no more (and preferably less) than 25 to 38 grams of added sugar a day, the equivalent of two to three Oreo cookies.
SOURCES:Wagner, C. Pediatrics, 2008; vol 122: p 1142.Committee on Nutrition, American Academy of Pediatrics: "The Use and Misuse of Fruit Juice in Pediatrics."U.S. Department of Agriculture: "Dietary Guidelines for Americans 2005."Feng, J. Hypertension, 2006; vol 48: p 861.MyPyramid.gov web site.Tanya Remer Altman, MD, author, Mommy Calls.Elisa Zied, MS, RD, author, Feed Your Family Right; spokeswoman, The American Dietetic Association.Ward, E. The Complete Idiot's Guide to Feeding Your Baby and Toddler, Alpha, 2005.
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