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Helping professionals tackle toddler nutrition

Dipti Aistrop
BSc(Hons) Nursing Studies RGN

Health Practitioner Member
Infant & Toddler Forum

Toddler nutrition is gaining recognition as a public health priority but consistent, practical advice for feeding this age group is scarce. In contrast there is a wealth of information on breastfeeding and weaning babies to guide healthcare professionals and mothers.

In recent years there has also been increasing publicity around healthy school lunches, with information and advice now available for school-aged children. Yet, in terms of sound advice for parents of younger children or healthcare professionals,
one could say that the toddler years are the “forgotten years”.

Why is this age group so important?
With research, there is now increasing evidence to show that the toddler years are a time when it is vital to encourage healthy foods and good eating habits. An unhealthy start in life can contribute to poor health in later life, particularly as the habits and food preferences learnt at this stage can help shape eating habits as adults. 

In meeting the demands of changing family lifestyles, it is likely that families increasingly resort to using pre-cooked meals several times a week, and that enjoying home cooked meals from fresh ingredients is less than a daily event for many children. An overweight child has a 40-70% chance of becoming an obese adult.2 In adulthood, obesity can of course lead to a range of serious conditions from diabetes to cardiovascular disease to some cancers.

There has never been a more important time to make a long-term impact for positive health outcomes for children, with iron deficiency anaemia and rickets still affecting many toddlers in the UK due to deficiencies in their diet; there are also rising numbers of obese toddlers as a result of nutritionally inadequate and excessive intake.

Tooth decay is prevalent in the UK with 30% of children having had decay by the time they are five years old.3 This imbalance in the diets and health of those not getting enough nutrients daily and those who are getting too much presents serious problems for the health of future generations. 

While there is evidence of the important link between early nutrition and later health, many practitioners report that they do not feel effectively equipped to carry out the tasks set by the Healthy Child Programme.1 A survey of healthcare professionals by the Infant & Toddler Forum found that nine out of 10 wanted more information about dietary advice for this age group, and a third of the respondents reported that they did not feel that their professional training had been adequate in supporting their role of giving parents effective, timely and appropriate nutritional advice for longer-term health outcomes for children.4

Practical advice for parents that can be easily incorporated into their daily routines is essential, as is the need to provide resources for healthcare professionals.

Offering appropriate information and advice about introducing weaning foods to babies should, further on, lead to discussions about “healthy eating” into toddlerhood, supporting parents to explore their own nutritional intake and enabling them to make healthy food choices to provide a balanced diet for their toddler, based on family foods whenever possible.

A vital piece of advice for parents is that a toddler's daily nutrient requirement is very different from that of an adult. Toddlers will generally need around three times the energy intake of an adult. Of course, all toddlers are different and some will be growing more rapidly and some may be more active than others. However, all toddlers need higher amounts
of nutrients per kilogram of their body weight
than adults.

Combining foods from the five food groups is key to providing a healthy diet for this age group.
These are:

  • Bread, rice, potatoes, pasta and other starchy foods.
  • Fruit and vegetables.
  • Milk, cheese and yogurt.
  • Meat, fish, eggs, nuts and pulses.
  • Food and drinks high in fat and sugar.

A toddler should be offered appropriate amounts of different foods from each of the food groups to gain the balance of nutrients, including high- and low-calorie foods. A sensible combination of savoury and sweet foods is important to develop new tastes and textures as well as providing variety in the diet.

Toddlers should benefit from a sound routine with snacks offered between meals. Every toddler is different, but three meals and two-to-three snacks per day is about right, and grazing on food should be avoided or discouraged.

One of the questions parents often ask is about portion sizes for toddlers. Although there are no “correct” portion sizes for toddlers, the Infant & Toddler Forum has recently produced some examples of portions for this age group. The examples give a “portion range” rather than one portion size, as a large active toddler will need more food than a smaller, less active child.  For further information, visit the Infant & Toddler website - Ten Steps for Healthy Toddlers (see Resources).

There is no doubt that combating obesity and promoting healthy choices in toddlers is a major task in which primary care practitioners play a vital role. However, without practical and evidence-based resources to work with, this job becomes challenging. More work needs to be done to ensure that healthcare professionals receive regular and current training and to equip them with adequate resources in order to meet the standards set by the Healthy Child Programme.1 

References
1. Department of Health. The Healthy Child Programme: Two Year Review. London: Department for Children, Schools and Family; 2009.
2. National Audit Office (NAO). Tackling Child Obesity - First Steps. London: The Stationery Office; 2006.
3. Lakhani A, Olearnik H, Eayres D (eds). Compendium of Clinical and Health Indicators. London: The Information Centre for health and social care/National Centre for Health Outcomes Development; 2007-8.
4. TNS Healthcare. Toddler HCP U&A Study. Available from: www.infantandtoddlerforum.org/page_Reports+Articles_id-20.html

Resources
Infant & Toddler Forum: Ten Steps for Healthy Toddlers
W: www.infantandtoddlerforum.org/page_Ten+Steps+for+Healthy+Toddlers_id-102...

Healthy Child Programme: Two Year Review
W: www.swdc.org.uk/silo/files/healthy-child-programme--the-two-year-review.pdf