Toddlers, calcium and vitamin D
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Melissa Little

Pediatric and Antenatal Dietician. She is a spokesperson for the British Dietetics Association on TV and in print. Member of the parliamentary group for a Fit and Healthy Childhood at Westminster for the UK Government.
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Toddler / Toddler Nutrition

Why won’t my toddler eat properly?

There is so much going on in the toddler years when it comes to food. They are learning to self-feed, use a knife and fork, and experiment with new flavours and textures.
In Short
You need to offer toddlers a range of food which includes, good fats, dairy, carbohydrates, protein, fruit and vegetables.

Low-fat or high fibre foods are inappropriate.

Eating whole grain or brown versions of carbs are not recommended until toddlers are two or above as it is harder for them to absorb calories from wholemeal foods.

Eating too much sugar leads to crashes, which can in turn lead to moodiness, anger and tantrums.

Offer them regular, balanced and nutritious meals and snacks.

There is so much going on in the toddler years when it comes to food. Your toddler is:

  • Moving to three meals a day.
  • Learning about new tastes and textures.
  • Starting to eat with the family.
  • Understanding the sensations of hunger and fullness and appetite.
  • Learning to self feed.

There’s so much going on that it’s no wonder that they can become a bit tricky about eating!

Why are toddler’s such picky eaters?

There are several reasons that toddlers are picky eaters:

  • Our ‘caveman appetite’.
  • Being a ‘supertaster’.
  • A possible food allergy.
Our ‘caveman’ appetite

On the whole, toddlers prefer sweet tasting and high-calorie foods. This reflects a human instinct born on the savannah in the Palaeolithic era when obesity was unheard of, and the preference for high-calorie food was beneficial and a good strategy for our hunter-gatherer ancestors. This means that a toddler given their choice might happily eat ice cream and biscuits day in and day out.

So when it comes to your toddler’s diet, you will need to offer her a balanced diet of food, flavours and textures to educate her palate.

This means a range of:

  • Good fats (e.g., avocado, coconut oil, omega three fatty oils found in seeds and oily fish).
  • Dairy (e.g., eggs, full-fat milk, cheese, natural yoghurt).
  • Carbohydrates (e.g., potatoes, rice, pasta, bread).
  • Protein (e.g., red meat, white meat, fish, lentils and pulses).
  • Fruit and vegetables (e.g., aim for five fruits and vegetable portions each day – fruit juice isn’t recommended as you get the fructose with no fibre).

Remember that toddlers and their brains are growing very fast, and they need lots of energy. This requires lots of good fats in the diet.

This means a low-fat diet isn’t appropriate for toddlers, but you should avoid trans fats and hydrogenated fats. There is a now an emerging understanding that saturated fats e.g., coconut oil (they are saturated with hydrogen atoms, but the word is very offputting) have perhaps been overly demonised and can be very good to eat. Other good fats include essential fatty acids such as omega three, and omega nine are vital for brain development and vision such as oily fish and avocados.

Adult diets are not appropriate for toddlers

In general, many low fat ‘diet’ foods and high fibre foods are inappropriate for toddlers. Diet foods are often full of sugar (to replace the flavour of the fat with sweetness). Perhaps surprisingly, eating whole grain or brown versions of carbs is not recommended until toddlers are two or above as it is harder for them to absorb calories from wholemeal foods.

Sugar

Too many calories from refined sugar (such as from sweets, biscuits, sugary breakfast cereals and fizzy drinks) have arguably led to the obesity crisis we face in the developed world today. Eating sweet processed foods and treats leads to sugar crashes where toddlers’ blood sugar will crash after a sweet meal which can lead to feelings of moodiness, anger and increased tantrums.

However, zero sugar attitudes can go hand in hand with zero fun if it means that a toddlers never gets to bake and eat muffins, and learn the idea that some foods become ‘bad.’ A militant zero sugar approach can lead to an overly anxious, obsessive and puritanical attitude to food which parents can unwittingly pass on to their child. That said, toddlers do not nutritionally need sugar added to their diet so, with many things in parenting, it’s a matter of balance.

Hunger and fullness – how to develop your toddler’s appetite

A toddler that has been allowed to develop her appetite and satiety instincts will quickly feel full with high-calorie food and not eat it to excess in my experience.

Parents seem to vacillate between worrying that their toddler prefers bad food and worrying that they don’t eat enough. Don’t worry that your toddler will starve; like cats, toddlers are very good at regulating their appetite as long as they are offered regular, balanced and nutritious meals and snacks.

Your toddler’s appetite and satiety skills need to be supported from birth, whether breastfeeding or formula feeding. Even newborn babies display feeding cues of hunger (rooting for the breasts, licking lips and eventually crying). Babies also have feeding cues for fullness (closing their mouth, turning their head away, fussing and spitting out milk or food).

It is really important for toddlers to learn to self-regulate their appetites. This means while it is important to offer them a big range of foods, don’t force them to eat things or finish everything on their plate. It forces them to ignore their fullness messages from their brains, and they will lose the important ability to eat mindfully (eat when hungry and stop when full). Indeed, the Department of Health states that there are no set portion sizes for toddlers and that children shouldn’t be forced to finish their meals. This is because they are concerned that it may pave the way for childhood obesity.

Note
Top Tip: give toddlers a small size plate so as not to overwhelm them.
Neophobia

When toddlers turn their nose up at a new food (neophobia), it may partly be due to our evolutionary past. Being cautious of new food probably protected them from eating poisonous berries in our evolutionary past. However, this behaviour is very contrary as it seems to fail toddlers at crucial moments, such as when they come across new poisonous berries or brightly coloured dishwasher tablets – so you always need to supervise them.

Try offering a new food to your toddler at least seven times. Even if toddlers don’t eat it or choose it initially, they will get used to seeing it and will be more likely to try it the 8th time they are offered the food.

‘My children seem to have no overlap in their favourite foods which makes things a bit tricky. I have a fruit lover, a carb fanatic and a meat eater. I make balanced meals and snacks, but they don’t eat them in a balanced way, but overall they do ok.’
Real mum story. Cathleen, mum to Cormack 7, John 5 and Maddy 2 years.
Modelling happy and healthy attitudes to food

Toddlers rely in part on ‘social referencing’ of their parents to understand everything, including food. Facial expressions are key in all this. In our evolutionary past if a mother was disgusted as she tasted a new berry and spat it out it was helpful that a child watched and learned. The facial expression of disgust is universal across all cultures and so powerful that toddlers don’t need language to understand – it predates language. So, bear in mind what you and your face communicate about food. Try to be open and adventurous in your eating behaviour to allow your toddler to model your happy and positive eating behaviour.

Food should be a joy and an adventure, and we should be keen to try a wide range of food and enjoy a healthy diet. Try to avoid passing on your personal hang-ups and prejudice about food, even if it’s talking endlessly about ‘healthy food’ or calorie counting. If you are faddy, try to encourage your toddler to try new foods with you. If you are happy to eat a pint of prawns with the shell on, big shiny mushrooms or a bowl of mussels she may well too!

Your toddler’s growth

If you are concerned about your toddler’s diet or growth, speak to your doctor and get your toddler weighed and measured. This is particularly important if you have noticed that she is having any digestion problems such as bloating, diarrhoea, constipation, pale poo covered in mucus or if she complains of tummy ache after meals. A recent study found that doctors were able to predict coeliac disease (an autoimmune disease that affects 1 in 100 people ) in 80% of toddlers and young children simply by looking for low growth rates amongst children. Symptoms of coeliac disease can include tummy ache and pale, floating stools. Some children with coeliac disease may have no symptoms like tummy ache, but their growth may have dropped off, or they may suffer with frequent low blood sugar: feeling tired, grumpy and emotional. Coeliacs who are not yet diagnosed and eating a gluten free diet often crave high sugar food as their gut linings are so damaged that they are not absorbing nutrients. Once diagnosed with coeliac disease (which can be done with a blood test without a need for an endoscopy), your toddler would have to eat a gluten-free diet.

Common toddler eating dilemmas
What should I do if my toddler refuses to eat her lunch?

It’s important not to communicate, in your words and your behaviour, that you are anxious or obsessed with your toddler’s eating behaviour. Sometimes toddlers pick up on this vibe, and the pressure to eat makes them stubborn. It is also important to look at what your toddler is eating or drinking in the morning. If she been drinking a huge beaker of juice and a plate of biscuits in the morning, she may just not feel hungry by lunchtime. She may need a little snack and water mid-morning, rather than grazing constantly.

Toddlers are also very easily distracted, and they want to keep playing. Keep lunchtime short with minimal distraction and if possible try to eat lunch with your toddler so she gets used to this as part of her routine. Try not to worry, as long as she is growing and doesn’t seem to be in pain after eating; she should be okay. If you are ever worried speak to your doctor about your concerns.

My toddler only eats the same foods day in, day out!

It can be stressful in your toddler will only eat yoghurt and rejects everything else. As in the question above, you have to try not to communicate your anxiety about this and offer your toddler other food along with her preferred food. Praise her if she will lick or try new food (in an extreme case) and when she enjoys the praise and realises that other food is okay it will help her to break down this ‘food phobia’ that may have developed. Try to be very matter of fact and calm about meals. Don’t be overly attentive to your toddler as she eats and try to get your family to eat with her. If she’s able to see you all getting on with your meals she won’t feel under such scrutiny and may want to be part of the gang eating the good stuff.

Should my toddler still have milk?

The World Health Organisation states that there are no global recommendations for milk or dairy consumption. Instead, countries have developed national dietary guidelines based on local factors and recommendations vary widely. However, most countries recommend at least one serving of milk daily, with some countries recommending up to three servings per day.

The Department of Health in the UK recommends that toddlers should drink full-fat whole milk until two years of age. After her second birthday, you can introduce semi-skimmed milk to your toddler if that is more convenient. Skimmed milk isn’t suitable for children under five.

Should toddlers have vitamin supplements or not?

It’s hard to provide all the nutrients that your toddler needs from her diet and so some vitamin supplements are a good idea. Speak to your health visitor about a vitamin drop or supplement designed for toddlers. Many children in the northern hemisphere are Vitamin D deficient due the latitude they live at (in the UK, for example, it is not possible to manufacture enough Vitamin D in the skin between the months of October and May) so a Vitamin D drop is really important to prevent acute and chronic health problems. Toddlers with dark skin will manufacture less Vitamin D in their skin at high latitudes so if your toddler has dark skin or is very covered up speak to your doctor about appropriate Vitamin D supplementation. In the USA some food is supplemented with Vitamin D and your doctor will bear this in mind.

See our article on toddler’s calcium and vitamin D requirements.

References and further reading

Saari et al (2015) ‘Systematic Growth Monitoring for the Early Detection of Celiac Disease in Children.’ JAMA Pediatr. 2015;169(3):e1525. doi:10.1001/jamapediatrics.2015.25.

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DISCLAIMER
This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Essential Parent has used all reasonable care in compiling the information from leading experts and institutions but makes no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details click here.