Los Angeles, CA 90012
USA
Mr. Nathaniel Willis
Division of Nutritional Sciences
University of Illinois at
Urbana-Champaign
317 Louise Freer Hall
906 South Goodwin Avenue
Urbana, IL 61821
USA
Challenges in Nutrition in Toddlers and Young Children
Published online: November 6, 2020
Black MM, Singhal A, Hillman CH (eds): Building Future Health and Well-Being of Thriving Toddlers and Young Children. Nestlé Nutr Inst Workshop Ser. Basel, Karger, 2020, vol 95, pp 1–11 (DOI: 10.1159/000511518)
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Toddler Development and Autonomy: Baby-Led Weaning, Neophobia, and Responsive Parenting
Maureen M. Black
Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA, RTI International, Research Triangle Park, NC, USA
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Abstract
Toddlerhood, the period from 12 to 36 months, represents striking changes in children’s development. Along with mastery of skills such as walking, talking, self-feeding, sleeping through the night, and bowel and bladder control, toddlers strive for autonomy as they learn to regulate their emotions. Toddlers’ increasing autonomy impacts feeding behavior and may increase or restrict their food exposures. Baby-led weaning, allowing infants to participate in the family meal by selecting food and feeding themselves, exposes children to the family diet. Food neophobia, a normal developmental phase whereby children reject novel foods, may limit children’s exposure to high-quality foods. Food preferences formed during toddler and preschool years often persist into adulthood, making toddlerhood an ideal time to help children build healthy habits. Toddlerhood can be both joyful and challenging as children acquire new skills and assert their autonomy. Effective parenting practices include providing age-appropriate structure and opportunities for toddlers, reading toddler’s signals, and responding promptly, appropriately, and with nurturance. Responsive parenting ensures that toddlers receive the guidance and nurturant care needed to develop healthy feeding behavior and emotional well-being.
© 2020 S. Karger AG, Basel
Introduction
Toddlerhood (age 12–36 months), the transition between infancy and the preschool years, is a period of multiple developmental changes. During toddlerhood, children consolidate many of the skills that begin to emerge during infancy. Walking with a wide-based gait becomes steady walking, running, and jumping. Single words become multiword sentences. Being fed by a caregiver becomes self-feeding along with food preferences. These advances represent toddlers’ increasing neurocognitive, motor, and language skills along with their desire for autonomy and their emerging ability to regulate their behavior and emotions. This chapter begins with a review of the development changes that occur during toddlerhood and then addresses toddler eating behavior, focusing on how toddlers’ advancing developmental skills impact their eating behavior, dietary preferences, and mealtime habits.
Toddler Development
The home is a central environment for toddlers [1], with caregivers helping toddlers develop daily habits and routines. Patterns developed in toddlerhood related to diet, sleep, and physical activity set the stage for lifestyle patterns throughout childhood and adolescence [2]. Toddlers’ increasing autonomy impacts their feeding behavior and may increase or restrict their food exposures. Dietary patterns established during toddlerhood often persist into adulthood, making toddlerhood an ideal time to increase children’s dietary diversity [1]. Toddlers benefit from parenting that is responsive, while ensuring that their introduction to the family meal includes exposure not only to nutrient-rich food but also to healthy mealtime behaviors.
Growth, Motor Skills, and Physical Activity
During toddlerhood, the rate of weight and height gain slows down from the rate of growth during infancy, body fat declines, muscle tone increases, and body proportions change as toddlers take on the physical appearance of children rather than infants. Excess weight gain during toddlerhood can increase the risk of overweight and obesity throughout childhood and adolescence [3, 4], which renders toddlerhood an ideal time to establish healthy dietary and physical activity habits. In 2014, 14.5% of US children aged 2–4 years who were participating in the Special Nutrition Supplemental Program for Women, Infants, and Children were obese (age-and sex-specific body mass index ≥ 95th percentile) [5], underscoring the increasing rates of excess weight gain in toddlers that have been observed globally.
Gross motor skills progress rapidly as toddlers become adept at walking and running without falling. Balance improves, and they are eager to jump and climb. Gradually toddlers build coordination, although skills such as riding a tricycle and catching a ball are often not accomplished before age 3 years.
Gross motor skills and physical activity are related and stimulate reciprocally. A recent review found that among children under 5 years of age, moderate-to-vigorous physical activity was consistently associated with motor development, fitness, and bone and skeletal health [6]. The World Health Organization has recently released guidelines for physical activity among children under 5 years of age [7], emphasizing the importance of toddlers developing appropriate physical activity habits.
By 12 months of age, oral motor skills, including tongue laterality, have progressed to enable toddlers to handle increasingly complex food by chewing, moving food to the back of the oral cavity, and swallowing. Fine motor skills also advance as toddlers practice picking up and manipulating small items, such as blocks and toys. They learn to stack blocks and to color with crayons. Applied to self-feeding, toddlers progress from using their hands to using utensils, and from drinking from a cup with a protective spout to an open cup. Although the advancing skills are often accompanied by spills and messes, they add to toddlers’ sense of mastery and autonomy.
Learning
Toddlers learn through 3 primary processes: observation/imitation, exploration, and play. Imitation begins within the first 72 h after birth as newborns imitate mouth openings and tongue protrusions [8]. Young children continue to learn by observing and modeling [9]. Exploration occurs through toddlers’ developing sensory and motor skills, illustrated by their interest in touching, smelling, and putting things into their mouth – both food and nonfood items. Through play, toddlers practice their emerging skills, initially by touching items