Hilliard Pediatrics, Inc. - Dr. Tim Teller, MD

Children between the ages of 12 months to 3 years offer some nutritional challenges to their parents, from what they eat and how they eat to how much they eat. This guide will help you make smart choices about these issues.

Good nutrition requires a variety of foods from the four food groups: milk and milk products, meat and protein foods, vegetables and fruits, and the bread and grain group. This chart offers the number of servings per day and the serving size for toddlers. Remember that although charts such as this one are helpful, if your child is eating different amounts but has been growing and developing well and is in good health, they are likely doing what is right for them. Also, it is important to know that growth is naturally slower after the 1st birthday than before, so your child may not want or need as much to eat as before. Note: 1 cup = 8 ounces; 1 ounce (oz.) = 2 tablespoons (tbsp.) = 6 teaspoons (tsp.).  

Please note that our latest recommendations are that it is fine to do all milk, soy, peanut, tree nut, fish, shellfish, wheat, and egg products after the first birthday for otherwise healthy children with no history of food allergies. 

• Children between the age of 12 months and 24 months of age should be on whole milk ("vitamin D" in the stores). This is to ensure that they get the fat required for good growth and brain development. After the 2nd birthday, children can be on 1/2 to 2% milk. At your child’s check-ups, ask about which milk is appropriate for your child. Make sure that your toddler drinks more milk than juice. Children who drink more juice are not getting the best nutrition, are less likely to grow as well, and are more likely to have what is called "toddler's diarrhea", which is loose, frequent stools from excessive juice. Note from the chart above that most toddlers need 16 ounces of milk each day. Taking in more than 36 ounces of milk each day is not recommended.  

 It is important to have toddlers off the bottle by 15 months. Encourage your toddler to drink from a sippy cup. Many children will prefer to transition through using a “spill-able” sippy cup before moving on to the “spill-proof” kind. Children can use “open-top” cups once they are keeping the spilling to a minimum. Introducing children to spoons and forks for them to use is fine, but expect your toddler to want to eat most things with their fingers. Offering foods in bite-sized pieces helps. Many toddlers prefer that food items stay separated on their plates, so plastic child-sized plates with separate compartments are useful.

Other notes:

1. Be patient! Toddlers and their eating habits can be frustrating. Healthy children will eat when they are hungry. Offer small portions. Do not force a child to finish all the food on their plate.
2. Set a good example. Because youngsters are great imitators, if you show your child that you like and enjoy the same foods, they are more likely to try something new.
3. Respect your child's likes and dislikes. You may have to offer a new food 10-20 times (or more!) before your child tries it.
4. Let your child sit at the table in a booster seat or high chair. Discourage your child from playing with or throwing the food by getting them down from the table once they are "mostly" playing with their food.
5. Make meals interesting. Toddlers like different colors and textures of foods. However, toddlers tend to like easily identified pieces of a single food (casseroles may confuse a toddler).
6. Few toddlers need vitamin supplements. For those toddlers who do not eat well-balanced nutrition, a daily dose of a liquid or chewable vitamin supplement may be helpful. Any of the commonly available brands are fine to use. Follow the instructions on the vitamins package.
7. Don't overwhelm a toddler with a large serving size. Serve a little less than you think your toddler will eat, and allow them to ask for more.
8. Offer 3 meals and 2- 3 snacks per day with meal time coinciding with your own. If you have questions, ask the doctor or nurse or consult the references listed below.
9. Many organic foods and drinks are now available. Are they better for us than non-organic foods? No one knows for sure. So although it is fine to use organic products, we do not actively encourage children to consume only organic foods.

The 3 situations below are very common amongst toddlers. They are frustrating but normal.

1. Picky eaters refuse to try new foods or complain about what is served.
   • Offer small portions at the start of a meal when a child is still hungry.
   • Serve new foods several times. Repetition helps children like new foods. It takes many children months and years to improve.
   • Serve new foods to the whole family. Be a good role model as a parent by eating a good healthy variety.
   • Include foods children like at every meal, such as bread, fruit, and milk.
   • Avoid forcing, rewarding, or bribing. This encourages unhealthy eating habits now and later in life.
   • Don't be afraid to let a child wait until the next meal or snack time to eat.
2. Food jags are when children eat only a very small number of foods, meal after meal after meal.
   • Avoid pressuring a child to eat other foods. Pressuring may increase how long this lasts.
   • Food jags usually don't last long enough to cause any harm. Relax and don't forbid a child to eat a certain healthy food again and again.
   • Offer small portions of other foods at every meal.
   • Make sure that you offer and that the child eats at least a small amount from each food group.
3. Drops in appetite occur when children seem to lose interest in eating anything at all.
   • Although children need a regular supply of calories and nutrients, their appetites often fluctuate. Don't be concerned as long as the over-all diet is well-balanced, the child is healthy, and growth and development continue to be normal.
   • Adults are best judge of what foods should be offered and the child should be considered the best judge on how much they eat.
   • No vitamin, supplement, or safe and effective medicine has ever been shown to help a toddler eat more healthy foods. 

The following foods are hard for children to chew without a full set of teeth. They could cause the child to choke. Only offer these foods when the child can chew and swallow well. It is important to watch your toddler closely while they are eating, especially with these food items.

• Hot dogs with meat sticks
• Peanuts and other nuts
• Seeds
• Grapes
• Peanut butter
• Hard chunks of uncooked vegetables
• Apple slices and chunks
• Sausage
• Round candies
• Popcorn

Healthy snacks are important to give young children the energy to grow, play, and learn. Remember that snack time is an opportunity to balance the diet. For example, children who neglect milk at meals can be given cheese or yogurt at snack time. Do not bribe toddlers with sweets. This creates problems later in life by setting us up to reward ourselves with food, which is bad for the waistline and does not encourage well-balanced nutrition. Some healthy snacks include: 

• Cheese and yogurt
• Steamed or raw vegetables
• Saltine or graham crackers
• Whole milk or fruit juice
• Fresh fruit or frozen juice pops
• Unsweetened cereals
• Bagel or bread
• Pretzels

One word of caution about “fruit snacks”: most fruit snacks are not a good substitute for eating fruit, are full of sugar, and are not good for the teeth since the sugars tend to cling to the teeth after eating the fruit snack. These sugars can lead to tooth decay. Although they are ok occasionally as a special treat, please do not allow your child to eat these regularly. 

Books:

Nutrition: What Every Parent Needs To Know by Dietz, PhD and Stern, PhD - American Academy of Pediatrics, 2011.

Food Fights: Winning The Nutritional Challenges of Parenthood by Jana, MD and Shu, MD – American Academy of Pediatrics, 2012. 

Websites:

The new food pyramid and information about nutrition can be found at www.choosemyplate.gov.

Many of the toddler food makers have nutritional information of their websites. These include:

• www.gerber.com
• www.beechnut.com
• www.heinzbaby.com
• www.naturesgoodness.com

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