Nutrition in infants and toddlers

Infants will grow more in their first year of life than at any other time. Although breast milk and/or formula will provide all the nutrition they need to grow, infants will eventually begin eating other types of foods. The age at which a child is ready for “solid” food varies. The American Academy of Pediatrics (AAP) recommends starting to introduce supplemental foods between the ages of 4 months and 6 months. The first foods to be introduced are semi-solid and often include ground rice or oat cereal mixed with a little breast milk or formula. Sometime around 7 months, an infant might begin eating strained or mashed foods.

The speed in which food should be introduced varies greatly; some children take to new textures and tastes readily whereas others (especially premature infants) may not be as receptive. The AAP recommends not forcing or rushing an unwilling infant to try new foods. Foods should be introduced one at a time to help detect allergies and intolerances (which are most likely to occur within the first year of life), and avoid overwhelming an infant with new textures. New foods may need to be introduced many times (e.g., 10 or more times) before they are accepted.

Between the ages of 6 months and 8 months, caregivers may want to introduce fruits, other types of cereals (such as Cheerios) and vegetables. Between the ages of 9 months and 12 months, soft foods such as pasta, yogurt, cheese and beans may be introduced. After one year, whole cow’s milk can be given. After age 2, low-fat milk is recommended.

According to the AAP, the recommended minimum daily intake for a child between 12 months and 18 months should resemble the following:

• 16 to 24 ounces of whole milk
  
  
• 4 to 8 tablespoons of fruits and vegetables
  
  
• 4 servings of bread and cereals (1 serving equals ¼ slice of bread or 2 tablespoons of rice)
  
  
• 2 servings (½ ounce) of meat, poultry, fish, eggs

After the first year, it is normal to see a sharp drop in a child’s appetite as their rapid rate of growth slows. The calorie intake of a toddler will vary widely, depending on the child’s activity level and body type. In general, each inch requires roughly 40 calories every day for children between ages 1 and 3 years, according to the AAP. This means a 32-inch child would need to eat 1,300 calories a day.

Although this means that different toddlers have different caloric needs, the AAP recommends that a child aged 1 to 3 years consume a diet that is similar to the following:

• 6 servings of grains (1 serving equals ¼ to ½ slice of bread, 4 tablespoons of cooked rice, cereal or pasta, ¼ cup of dry cereal, or 1 to 2 crackers)
  
  
• 2 to 3 servings of vegetables (1 serving equals 1 tablespoon of cooked vegetables for each year of the child’s age)
  
  
• 2 to 3 servings of fruits (1 serving equals ¼ cup of cooked or canned fruit, ½ piece of fresh fruit, or 2 to 4 ounces of juice)
  
  
• 2 to 3 servings of dairy (1 serving equals ½ cup of milk, 1/3 cup of yogurt, or 1-inch cube of cheese)
  
  
• 2 servings of protein (1 serving equals 1 ounce of meat, ½ egg, 2 tablespoons of soaked and cooked beans, peas or legumes, or 1 tablespoon of smooth peanut butter spread thin on bread, toast or a cracker)

Fruit juice is a good source of many vitamins and minerals. However, it is also an ample source of sugar and calories. All of the same vitamins and minerals as well as additional nutrients can be obtained from eating whole fruits. The Food and Drug Administration (FDA) requires that products labeled as “fruit juice” contain 100 percent juice. Products with less than 100 percent juice may be referred to as fruit drinks, beverages or cocktails. It is generally recommended that children and adolescents consume no more than half of their suggested fruit intake in the form of fruit juice (and not fruit drinks).

Although mealtimes can become a frustrating test of wills, it is normal for a child’s appetite to decrease. The AAP suggests avoiding cajoling, begging, bribing or threatening to get a child to eat more. If a child continually refuses to eat, the AAP recommends offering only the foods that have been put on the table rather than cooking an entirely new meal to a child’s liking. If the child refuses to eat all foods, calmly end the meal. Although parents often worry a child is not eating enough, healthy children will not starve as long as nutritious food is available.

Children benefit from predictable routines. It is best to have each meal and snack at the same time every day. For young children, small, frequent feedings (three meals and two to three snacks) are best. Portions should remain small