Several topics in this column have addressed nutrition issues specifically in terms of toddlers. Why, you might ask, should there be such focus on this age group? Because the toddler years provide an opportune time to establish healthy eating patterns that will continue into adulthood. As Ryan and Dwyer (2003) reported, however, parents do not always offer toddlers the most nutritious foods. How then, can nurses help parents establish healthy eating behaviors when they are dealing with children during a typically difficult period of development, that is, from 12 to 24 months of age?

Toddlers present unique challenges to parents in terms of eating (Cathey & Gaylord, 2004). They are very active and have a difficult time sitting still during meals or snacks. Nurses can encourage parents to place bite-sized portions of foods, such as thinly sliced apples, small cubes of cheese, and bananas, on a tray that is readily accessible to the toddler. Toddlers can snack as they move about the home. Parents should be advised when using this strategy that foods only last about 2 hours before they should be discarded (http://www.askdrsears.com/html/3/T030800.asp).

Toddlers exert their independence in various ways, one of which is choosing what to eat. Nurses can reinforce that parents decide what and when food is served, while the toddler decides how much and whether to eat. Encourage parents to think of a nutritionally balanced week rather than a nutritionally balanced day, because toddlers often restrict their intake to one food at a time (http://www.askdrsears.com/html/3/T030800.asp).

Toddlers like to have control over their environment, and they are happiest when dealing with the familiar. Consequently, parents should be aware that they may need to present a new food up to 15 times before the toddler will sample it. A good idea is to introduce the new food, then try again in a few days. Parents can also model the behavior by eating the new food. Toddlers tend to emulate peer behaviors, so parents may wish to invite a toddler whom they know likes a particular food to be present when introducing that food to their toddler.

Parents often worry that their toddler is not getting enough food to eat. However, Fox, Devaney, Reidy, Razafindrakoto, and Ziegler (2006), using data from the Feeding Infants and Toddler Study, reported that both infants and toddlers have the ability to self-regulate their energy intake. In other words, infants and toddlers who eat more frequently during the day consume smaller than average portions, whereas children who eat less frequently consume larger than average portions. Consequently, based on these findings, parents and caregivers can be assured that their toddlers have an innate ability to regulate what they eat. However, environmental factors (such as select parental behaviors discussed in prior columns) may interfere with a toddler's innate self-regulatory ability.

So what kind of information would be more beneficial for parents and caregivers? Let parents know that energy requirements decrease in the second year of life. Most references indicate that a toddler should consume between 1,000 and 1,400 calories a day, depending on their size. Multiplying a toddler's height by 40 calories yields a rough estimate of caloric needs for a specific toddler. Most authorities state that toddlers should have at least three meals and two snacks a day. Snacks and meals should occur at established times, because toddlers like routine. Moreover, meals should be a family affair.

Eating is a social and cultural event for which the foundation is laid during childhood. Parents have a wonderful opportunity to expose their children to new and different healthy foods while they are toddlers. However, they can only do this when they understand toddler behavior. Nurses are in an excellent position to be able to help them gain this understanding. Here are some Web sites that might be helpful as you advise parents and caregivers:

* http://www.keepkidshealthy.com/cgi-bin/extlink.pl?l=

* http://www.kidshealth.org/parent/growth/feeding/feed12yr.html

* http://www.keepkidshealthy.com/toddler/feeding_your_toddler.html

* http://www.healthservices.gov.bc.ca/cpa/publications/feeding_toddler.pdf

References