Nutritional needs for growth are unique to infants, children, and adolescents. Growth rates fall rapidly in early life. By 1 year of age, energy needs for growth have fallen to <3% of total energy requirements but relatively high proportions of protein and micronu-trients per unit of energy are still required for growth. These needs must be reflected in the quantity and quality of foods offered to young children.
High nutrient and energy needs per kilogram body weight make it difficult for young children to consume sufficient food with only two meals a day. Frequent feeding, perhaps three significant meals and two to three snacks interposed between these meals, should overcome the problems posed by the large volumes of food per kilogram body weight needed daily. As children grow, mature, and their growth rates slow, the volumes of food needed decline. Growing independence and, with this, the ability to obtain and consume frequent snacks increase with age. By the end of their first year children are consuming foods similar to the rest of the family. The consistency of their food will still be different since their inexperience of chewing and biting off appropriately sized pieces of food means that most food requires chopping or mashing lightly.
Table 1 lists some feeding skills that develop after infancy. Young children need encouragement to practice the skills that enable them to progress from breast- and bottle-feeding to soft malleable foods in early weaning and to foods that require chewing by 9 months to 1 year. After 1 year they should be taking fluids (other than breast milk) predominantly from cups rather than bottles. Continuing to offer drinks from feeding bottles after 12 months can discourage children from accepting foods that need to be chewed. Persistent bottle-feeders may have excessively high fluid intakes because these provide their main nutrition. If the fluid is milk or infant formula, obesity may result. If fruit juices or carbonated drinks are fed, fluids may
Table 1 Developmental skills associated with feeding acquired after first year of life
Age Relevant skills
12-15 months Sits well and can move around in chair when feeding Keen to feed self
Tries to feed with spoon but cannot manage rotation of wrist so food falls off spoon before reaching mouth Finger feeds well with thumb-first finger apposition
Interested in emptying cups and throwing food and food containers from chair Will search for them after throwing 18 months Manages to feed with rotation of wrist so food reaches mouth Hand preference beginning to show Drinks well without spilling Hands cup back to adult 21 months Will ask for drink or food
Follows family eating habits 2= years Very self willed and determined
May be stubborn and rebellious Active - may not stay sitting throughout meal 3 years Feeds with spoon and fork - rather messily
Will carry utensils and can help lay table 5 years Feeds with spoon and fork neatly
Has clear and persistent likes and dislikes for foods
Understands consequences of choice Greatly influenced by peer group preferences for foods substitute for other more energy-dense foods. Failure to thrive may then result.
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