Nutritionists and mums Amanda Ursell and Johanna Hignett answer questions about toddler nutrition and Growing Up Milk.
Amanda Ursell, TV nutritionist, author and mum, provides toddler nutrition advice.
What’s unique about a toddler’s growth?
Believe it or not, between the ages of one and three, toddlers grow faster than at any other time since they’ve been born. On average, they gain an astonishing 40 per cent in height and weight over these three short years.
What’s more, toddlers have very active brains and bodies. They need lots of energy and the right amount of nutrients to fuel their daily exploring, discovering and tearing around. Unfortunately, it appears from studies by the Department of Health that many toddlers are not getting all the right nutrients in the right quantities so their needs are not being met.
What are the ‘right’ nutrients to fuel toddler growth?
Getting the right balance of overall energy, carbohydrates, protein, fats and sugars as well as vitamins and minerals is crucial. Of particular importance are iron, calcium, vitamins A, C and D and Omega 3.
The UK Department of Health recommend that all children aged between one and five years be given supplements containing vitamins A, C and D. You may also think about using Growing Up Milk because 300ml of it daily will go a long way to helping meet those vitamin requirements as well as providing iron, calcium and Omega 3 and 6.
How big is the problem of toddler nutrition?
A recent poll* showed that up to 81% of parents offer their toddlers pre-packaged foods designed for adults which can be high in salt and sugar. These are inappropriate for toddlers who really should be eating a lot less salt and sugar than adults. What they need is extra energy in comparison to their size, and key nutrients that support their growth and development.
What can I do to help my toddler?
Start early and lay down a solid foundation with good eating habits during the toddler years. Establish regular mealtimes and stick to them. A good pattern is breakfast-snack-lunch-snack-dinner with an extra snack before bedtime if you think it’s necessary.
Choose water and milk as your toddler’s main drinks but be careful about giving them too much milk because it can leave your toddler too full to eat.
Sit and enjoy eating with your toddler and other children at every opportunity, and encourage people caring for them to do the same. This can help them to feel safe, secure and more adventurous about trying new foods, textures and tastes.
Is fussy eating normal?
Refusing food is normal during the early years, with most toddlers going through a phase of fussy eating at some time or another. Previously-loved foods might be suddenly rejected and new foods may be refused point blank.
A common type of fussy eating occurs in the second year of life and is called ‘neophobia’ which means ‘fear of the new’. It helps for parents to think of this fear as a survival technique which stops their newly-mobile toddler from independently seeking out things to eat that might harm them. Neophobia is a completely normal phase of development which may see your toddler suddenly stick rigidly to a narrow range of foods he feels completely safe with. If your toddler is growing well then phases of fussy eating like this are not usually a long-term problem.
What can cause fussy eating?
Typically, fussy eating is simply a normal phase of toddler development. Occasionally, there may be a medical reason for your toddler suddenly not wanting to eat. For instance, being constipated, anaemic or perhaps having difficulty swallowing can put them off their meals. Sometimes, just being over-tired or very hungry can cause fussy eating as well.
Perhaps not surprisingly, toddler eating habits can also be affected by ‘life changes’. By this I mean things like moving house, starting nursery, the arrival of a new brother or sister, changes to their usual routine or carer, like the introduction of a new child-minder. Any one of these can be enough to trigger fussy eating.
Sometimes it may be the case that your toddler is not hungry because he is ‘filling up’ on too much fluid. Milk, juices and drinks like smoothies between meals can reduce hunger and lead to food refusal at mealtimes.
What’s your advice for mums of fussy eaters?
Firstly, I know that this can be worrying for mums because I’ve been through it myself. The key is to be patient and hold your nerve – most toddlers do grow out of this phase. So try hard to stay calm and ride out the storm, with a business-as-usual attitude to meal-times, and you should both come out of the other end unscathed. I will say though, it may need a bit of acting on your part, pretending that you aren’t bothered when you actually feel anxious and stressed inside!
Secondly, keep offering breakfast, lunch and dinner at regular times with two nutritious snacks in-between. This stable routine will mean that you can relax in the knowledge that if your toddler has not eaten much at one meal, he will be offered a nutritious snack within a few hours. Remember, if your toddler is hungry, he almost certainly will eat.
We have a meal/snack pattern but each time is so stressful!
Try sitting with your toddler and eating the same food as him because this helps him to feel secure that the food on his plate is safe and normal. A parent or carer with a relaxed, happy attitude to meal-times can often help things enormously. Try not to bribe him and avoid saying things like “if you eat this, you can have that for pudding”. If your toddler is still refusing food after 20 minutes of trying, call it a day and bring the meal to an end.
Remember that it can take ten or more times of offering a food to a toddler before it is finally accepted so keep trying.
Are supplements important when my toddler’s not eating well?
Toddlers often regulate their dietary intakes over several days and so may naturally just eat more one day than another. Bear this in mind before you worry that your toddler isn’t eating well and remember that the UK Departments of Health recommend that children aged between one and five years be given supplements containing vitamins A, C and D even if they are enjoying a healthy, balanced diet.
You can also think about offering around 300ml of Growing Up Milk every day to deliver some of their vitamin requirement and other important nutrients such as iron**, calcium and Omega 3 and 6 which are needed to support a toddler’s rapid growth and development.
Do toddlers need extra iron?
Newborns arrive with enough iron in their bodies to last for around six months. After these initial stores run out, they need to get iron from the food they eat.
How can I get iron into my toddler’s diet?
Foods such as lean red meat, green vegetables like broccoli and pulses like peas and beans are great for iron. Fortified foods like bread and some breakfast cereals also give us this crucial mineral.
Vitamin C boosts all of our bodies’ – toddlers included – ability to absorb iron from the food we eat. It is therefore well worth trying to combine iron-rich foods with vitamin C in, for example, a piece of red pepper when having baked beans.
Another good way of upping iron is Growing Up Milk so consider introducing 300ml a day to increase daily iron intake as well as providing other important nutrients like calcium, vitamins A, C and D, and Omega 3 and 6.
What is Vitamin D?
Vitamin D is an essential vitamin and is needed for normal growth and development of bone in children. Ensuring your toddler gets enough vitamin D*** is very important.
Can you tell me how to increase my toddler’s vitamin D intake?
Remember to expose your toddler to appropriate amounts of time in the sun. This is the primary way for them to get vitamin D and works by the action of ultraviolet rays on their skin. Just fifteen minutes of sun on the hands, face and arms two to three times a week (without high factor sunscreen), from April through to September, is believed to be enough to keep vitamin D levels up while keeping the risk of sun damage low.
A good source of food that gives us vitamin D is oily fish. A weekly serving of fish such as salmon or sardines can help. All margarines contain a little added vitamin D as do some breakfast cereals, and including eggs regularly in your toddler’s meal plan will boost intake.
This is why the UK Departments of Health recommend that children aged between one and five years be given supplements containing vitamins A, C and D even if they are enjoying a healthy, balanced diet.
You might also consider 300ml of Growing Up Milk daily. It is specially fortified and contains vitamin D along with other important nutrients such as vitamins A and C, the minerals iron and calcium and Omega 3 and 6.
References
* Little People’s Plates. Toddler Feeding Time. Poll of 1,000 mothers with children aged between 9 months and 3 years, 2009. Available from: www.littlepeoplesplates.co.uk/toddlerfeeding-time.html
** The Reference Nutrient Intake of iron for a toddler 1-3 years is 6.9µg per day (DH, 1991)
*** The Reference Nutrient Intake of vitamin D for toddlers is 7µg per day
Johanna Hignett
Johanna, nutritionist and mum of two, has appeared on Radio 4 Today Programme, BBC News, Channel 4 News and BBC Breakfast. Here Johanna provides toddler nutrition advice.
What do you think of toddler diets in the UK?
Nutrition is so critical at this young age; toddlerhood is a period when children are growing and developing rapidly and they need plenty of energy and other nutrients to support this. They are also learning to walk and talk and beginning to assert their own independence, which can often spill over into food and mealtimes and manifest as fussy eating. Having said that, many toddlers are well-nourished and grow well; of concern are those who are not encouraged to develop good eating habits. They may be fussy eaters and not encouraged to try new foods so often or who follow very restricted diets for health or cultural reasons. The more you limit variety in the diet the more you limit the variety of nutrients in the diet. So children who have a restricted range of foods in the diet, who eat only tiny portions of a limited range of foods or who are heavily reliant on cows’ milk as a drink often struggle to meet their energy or nutrient requirements.
Do enough mums know about the need for fortification, as advised by the DoH?
The Department of Health recommends that all children aged between one and five years be given supplements containing vitamins A, C and D. Remember, babies aged six months plus need these vitamins as well however, babies drinking more than 500ml of formula milk per day won’t need additional vitamin supplements. These vitamins are important for development and are often low in toddler’s diets.
Vitamin D is a particularly important vitamin as it is essential for the absorption of calcium in the body, thus playing a role in the formation of strong bones and teeth in toddlers. The awareness of the need for vitamin drops is low. In fact, when my children were that age, vitamin drops were the last thing on my mind! I don’t recall being reminded about them by the health professionals I came into contact with.
Do enough mums know what a healthy balanced diet should look like for toddlers or is it all a bit confusing?
I think it’s confusing! Toddlers are not simply little adults, they have unique requirements and the healthy eating advice for adults (to choose foods low in fat and high in fibre) is simply not appropriate for toddlers. Toddlers need energy and nutrient dense food. They have small tummies so the smaller portions they do eat need to provide all the energy and nutrients they need. So skimmed milk, low fat yogurts, high fibre mueslis and low calorie drinks are all fine for mum but not for a toddler!
I think mums and dads often struggle with giving enough variety in a toddler’s diet. It’s all too easy to give the foods a toddler likes rather than persevere with new foods that they may reject a few times before becoming accustomed to them. Choosing the right portions for a child is a challenge too and information on typical toddler portion sizes is available but I suspect many parents are not aware of it.
Why should we be bothered about toddler’s diets and fortification? Does it really matter that much?
Research by the Department of Health investigating the quality of toddlers diets has shown that they are often low in iron, zinc and vitamins including A, C and D.
What would you say to someone who says ‘But we didn’t need all those extra vitamins and stuff in my day and we grew up fine’?
I hear that frequently, but as our knowledge develops we learn more and more about the nutritional needs of toddlers and how important this subject is. Times change and dietary habits change. For instance, the breastfeeding rates today are significantly higher than they were in the 70s or 80s, yet our toddlers are eating more fast food and snacks than years ago. Many toddlers are well-nourished but it’s the pockets where we see these deficiencies that are concerning. None of us want to see our children grow up suffering because a poor diet during the early years has affected growth and development. The Department of Health’s recommendation for use of vitamin drops is based on scientific evidence showing that these nutrients are commonly lacking in toddlers’ diets.
What are your five top tips for ensuring a toddler gets as good a diet as possible?
- Encourage them to eat a wide variety of foods. The wider the variety of foods the wider the variety of nutrients in the diet. Fussy eaters who eat only a handful of different foods are likely to struggle to get all the nutrients they need.
- Eat family meals together. Eating is a social occasion and encouraging your toddler to eat with the family helps them learn to enjoy food as you do. Equally your toddler will learn to enjoy the type of foods you and your family eat, making your food preparation easier!
- Try new foods regularly. It can often take a few attempts before a toddler learns to accept and then enjoy new foods so persevere and you will hopefully be rewarded by the fact that your toddler will eat a wide variety of different foods.
- Try to keep calm. Encouraging kids to eat and try new foods is a gentle process, aided by a little peace and calm, without too much pressure.
- A treat every now and then is fine. And brings a smile to their faces! As long as they are eating a good variety of healthy foods a treat at the end of a meal occasionally is fine.
Why are Vitamins A, C, and D important for toddlers?
These vitamins play an important role in the growth and development of young children and are essential for everyone. The British Nutrition Foundation has excellent information on the role of these nutrients in the diet www.nutrition.org.uk.
Why is Omega 3 and 6 important for toddlers?
Omega 3 and 6 are different types of unsaturated fatty acids. Omega 3s are found in oily fish, rapeseed oil and some nuts whilst omega 6s are found in seed oils such as corn or sunflower oil.
Two essential fatty acids, alpha-linoloeic (omega 3) and linoleic acid (omega 6) are important for health, including growth and development, as the body cannot make them. Other types of omega 3 and 6′s are long chain polyunsaturates (LCPs) and are important for the development of key organs including the brain and the eye. Research is ongoing in this area looking at the key roles for these important nutrients in toddlers.
Why is calcium important for toddlers?
Calcium is needed for the normal growth and development of bone in children. Getting adequate calcium during toddler years is essential to help build a strong skeleton that forms the foundation of the bone structure right through to adulthood. A lack of calcium can cause problems such as osteoporosis or fragile bones much later in life.
Calcium is found in dairy products such as milk, cheese, yogurts and fromage frais. It is also found in fish such as sardines, whitebait and canned salmon where the bones are soft enough to eat. Finally some green leafy vegetables, nuts and pulses also contain calcium though this is not as well absorbed as dairy calcium. Toddlers should be having three portions of dairy a day (such as milk, cheese, yogurt) to ensure they have an adequate intake. Don’t forget that vitamin D is important for the absorption of calcium in the body.
What are some easy ways to ensure toddlers get the nutrients they need?
The most obvious way is to eat a good variety of food, but for many that is easier said than done! In many cases fortified foods can be useful additions to the diet. Those are foods such as breakfast cereals that have added vitamins and iron, yogurts and fromage frais with added vitamins and fortified milks such as Growing Up Milk. These should never be the substitute for a good diet but if you are concerned about your toddler’s overall intake of nutrients foods like these can help.
Should mums switch their children onto cows’ milk at 12 months?
At the age of twelve months cows’ milk is OK as the main milk drink. Cows’ milk is not recommended before twelve months of age as it has a very low iron content. However, if a mum is concerned about their child’s nutrient intake, perhaps they are a fussy eater or have a very small appetite so the nutrients they are getting from food are limited then a Growing Up Milk may be useful because they are fortified with a variety of vitamins and minerals including vitamin D and iron, and can be a useful drink to give toddlers to ensure they are getting enough key vitamins and minerals.
What do you think of Growing Up Milk?
I think it’s a valuable and convenient source of key nutrients, which can be particularly useful for fussy or picky eaters who may not be getting all the key nutrients they need. A simple switch from ordinary cows’ milk to Growing Up Milk can make a big difference to the overall nutrient intake in some toddlers.
Would you suggest mums consider Growing Up Milk? Why?
Growing Up Milk can be really useful for some toddlers. It’s not recommended for everyone in the same way that babies who are under 12 months of age and not breast fed should be given a specially prepared infant or follow-on formula rather than unmodified cows’ milk. The toddler years can be tricky from a nutrition sense for those who don’t like a variety of foods or don’t eat much at mealtimes. It’s these children who may have marginal nutrient intakes and may suffer low intakes of really important nutrients such as calcium, iron or vitamin D. Fortified foods can be useful and Growing Up Milk is a good one to include as it is easy to swap their beaker of cows’ milk for Growing Up Milk without having to make too significant a change (especially if the toddler is particularly fussy!).
Can you identify with the struggles mums have feeding toddlers, be it fussy eaters, busy lifestyles etc? What are your own experiences with your children, in your professional capacity? What would your advice be?
I remember many a struggle with my two! It makes me smile now, but at the time it was soul destroying when a toddler who had previously enjoyed my lovely cooked vegetables rejected them outright! And amusing watching one of them eat Spaghetti Bolognese, only to process a mouthful and spit out the meat! But a little perseverance, patience and some degree of lightheartedness got us to where we are now – two kids who eat and enjoy most (not all!) foods and who are adventurous enough to try most of the things I cook!
Juggling work and family is always a challenge, trying to ensure that there is a well balanced meal for the family in the evening and healthy snacks around. I’m always on the look out for easy recipes and try to involve the children in the preparation (to some extent anyway!) to help ensure that they are interested in food and cooking.
As for advice, I would recommend persevering to encourage children to eat well, after all good eating habits in these early years will last right into adulthood. Take some small steps at first getting them to try new foods and gradually build up the range of foods they eat. Involve them in the shopping and cooking (as far as is possible!), I have found they are more likely to eat food they have helped choose or cook.
Finally, try not to make a big issue of food. If they wont eat something one day, try again another day. Try to eat with them so they see you setting a good example!