This site is intended for health professionals only

Article: Portion sizes for children aged 1-4

Offering toddlers appropriate portion sizes of food can reduce anxiety at meal times and is also a key factor in reducing the risk of obesity. This article, exclusive to Nursing in Practice, gives an advice overview for nurses and health visitors to share

Portion size information for 1-4 year olds has been identified as an area where guidance is lacking and people are under-informed. Research carried out by the Infant & Toddler Forum (ITF) showed that 77% of parents have never received clear advice about toddler portion sizes (1) and only 16% of parents answered a question on toddler portion sizes correctly.(2) 

The number of calories toddlers need on average each day varies depending on their size and how active they are. When parents have no clear, accessible guidance on what sized portion to offer their child, they serve toddlers whatever food and portion sizes they consider suitable. One predictor of how much young children eat is how much is put on their plates.(5,6) Toddlers who are given and eat large portion sizes, particularly of energy-dense foods, are at risk of becoming overweight or obese. Parents/carers who insist their toddlers eat more food when they have clearly indicated they have had enough will be exacerbating their toddler's risk of becoming overweight. 

Chief executive of Public Health England, Duncan Selbie, recently advised that parents should consider giving children smaller plates at meal times to reduce the amount of food they eat. 

One in five children aged between four and five and one in three children aged between 10 and 11 are now overweight or obese.(3) These children are at increased risk of orthopaedic problems, bullying from their peer group and long-term conditions such as type 2 diabetes as they are more likely to remain overweight throughout childhood and during their adult life.(4)

'Reassurance'

The award-winning Portion Sizes for Children aged 1-4 Factsheet from the Infant & Toddler Forum can be used as best practice guidance by nurses working in primary and community care to address parental anxiety and lack of knowledge around over- and under-feeding. 

This practical, visual guide can help nurses to reassure parents and carers who worry their children aren't eating enough and dissuade them from coercing toddlers to eat larger portions than they need to. 

The Factsheet provides appropriate portion size ranges rather than specific amounts. These ranges address the fluctuating appetites of toddlers as they will eat more at some meals than others and more on some days than others.

Young children should be allowed to eat to their appetite because the vast majority of under-fives will eat just what they need for their activity, growth and development. 

Parents can be reassured that when young children eat a variety of foods in amounts within the range of portion sizes presented in this Factsheet, they are eating adequately. Signals that toddlers have had enough are: 

 - Shutting their mouths. 

 - Turning their heads away.

 - Pushing the spoon or plate aside.

 - Refusing to swallow and holding food in their mouths.

 - Spitting food out.

 - Screaming or crying.

 - Gagging or vomiting.

The Factsheet can also help nurses to feel confident in advising families on limiting high calorie foods. It's a good idea to recommend that toddlers less than two years of age are not offered sweet drinks, confectionery, chocolate or savoury snacks such as crisps. For those over two years of age these foods should be limited to once per week.

The food that parents and carers offer infants and toddlers influences taste preferences and eating habits, with implications for later health. Therefore, it is never too early for nurses to start promoting nutritious, balanced diets and encouraging them throughout childhood.

Nurses can also recommend that parents download the Tot It Up app which provides a personal analysis of a toddler's daily - or more importantly, weekly - food intake compared against current recommendations. Often parents find their toddler is eating better than they thought and this helps to remove the stress from mealtimes. When parents feel more relaxed and confident in feeding their toddler a problem of fussy eating may resolve.

Portion Sizes for Children aged 1-4 is free to download from the Infant & Toddler Forum website.

 

References 

1. Who's feeding your toddler?' One Poll on behalf of the Infant & Toddler Forum, 2010

2. Online poll by the ITF in 2010 asked “How many table spoons of baked beans in tomato sauce is about the right amount to offer to a toddler?” Responses as of 12 October 2011. Out of 62 respondents, 10 gave the correct answer.

3. Health and Social Care Information Centre National Child Measurement Programme - England, 2012-13 school year [Internet]. 2013 [cited 2014 Aug 5]. 

4. Public Health England. Health risks of childhood obesity [Internet]. 2014. 

5. Savage, J.S. et al. Serving smaller age-appropriate entree portions to children aged 3-5 y increases fruit and vegetable intake and reduces energy density and energy intake at lunch. Am J Clin Nutr. 2012 Feb;95(2):335-41.

6. Fisher, J.O. et al. Effects of portion size and energy density on young children's intake at a meal. Am J Clin Nutr. 2007 Jul;86(1):174-9.