Picky eating is a common concern for parents of toddlers. Many factors can contribute to “dinnertime battles,” such as resistance to unfamiliar foods, aversion to certain textures and desire to only consume favorite foods1.
Toddlerhood represents an important time in social development, especially in the toddler’s sense of self. Their picky eating may result from desiring to select and feed their own foods, or from modeling the eating habits of family members or their peers2.
Toddler nutrition during the first 1,000 days
Help ensure toddlers are getting the nutrition they may need
Picky eating habits could lead to missing out on key nutrients
The Feeding Infants and Toddlers Study (FITS) found that toddlers generally under-consume foods such as dairy products, lean red meats, leafy greens like spinach and kale, dark red and yellow vegetables, cantaloupe, salmon, and eggs, all of which provide essential nutrients3.
A recent analysis of data from the National Health and Nutrition Examination Survey (NHANES) found that many toddlers consumed less than the recommended amount for nutrients like vitamin D and DHA4.
Nutritional gaps in toddlers
Vitamin D
Vitamin D deficiency may be difficult to detect in routine clinical practice, as a child’s vitamin D status is not typically evaluated as part of routine care7.
One study has found significant predictors of vitamin D insufficiency include breastfeeding without supplementation among infants and lower milk intake among toddlers7.
Healthy infants and toddlers (N=365) in a cross-sectional sample in an urban primary care clinic.
‡ Defined as serum 25-hydroxyvitamin D (250HD) concentrations <20 ng/mL (50 nmol/L).
Iron
Adequate iron intake in the first 1,000 days is important for brain development and helps deliver adequate oxygen to organs and muscles. Severe and unmitigated iron deficiency during the first year of life can have irreversible impacts.
Iron deficiency in children in the U.S. may have a negative impact on brain development. Studies have found that by age 5, children who were iron deficient exhibited cognitive and socioemotional developmental impairments5,6.
‡ DHA intake calculated for 6-month-old infants exclusively fed a 20 kcal/fl oz formula that has DHA at 17 mg/100 kcal. Formula intake volume per day (~32 fl oz) is based on WHO average age daily energy requirements for 6-month-old boys and girls. DHA intake calculation for exclusively breastfed infants at 6 months of age assumes breast milk daily intake volume of 32 fl oz (based on WHO average daily energy requirements) and the DHA worldwide average breast milk level of 0.32% of total fatty acids (17 mg/100 kcal).
Bridging the nutrient gap
Studies have shown that proper nutritional supplementation along with psychosocial stimulation results in greater improvements in child development, rather than one of these approaches alone10.
Iron supplementation
Iron deficiency is the most common nutritional insufficiency in the world11. The AAP recommends the below iron supplementation12:| Age | Iron amount | Notes |
|---|---|---|
| 4-6 months (partially/fully breastfed) | 1 mg/kg/d | Supplementation until appropriate iron-containing complementary foods are introduced |
| 0-12 months (formula fed) | 10-12 mg/L | Supplementation until appropriate iron-containing complementary foods are introduced |
| 6-12 months | 11 mg/d; | Liquid iron supplements are appropriate if iron needs are not being met by the intake of formula and complementary foods |
| 1-3 years | 7 mg/d; | Liquid iron supplements are appropriate if iron needs are not being met by the intake of formula and complementary foods |
Vitamin D supplementation
To prevent vitamin D deficiency in healthy infants and toddlers, a vitamin D intake of at least 400 IU/day is recommended. The AAP recommends the below vitamin D supplementation13:
| Age | Notes |
|---|---|
| Breastfed/partially breastfed infants | Supplementation should begin in the first few days of life and be continued unless the infant is weaned to at least 1 L/day or 1 qt/day of vitamin D–fortified formula or whole milk |
| Nonbreastfed infants and weaned older children | Other dietary sources of vitamin D, such as fortified foods, may be included in the daily intake |
| Children with increased risk of vitamin D deficiency | At-risk children include those with chronic fat malabsorption and those chronically taking antiseizure medications; these children may require higher doses of vitamin D supplementation |
DHA supplementation
Global experts including EFSA and AFSSA recommend that toddlers have 70-100 mg/day of DHA; however, most U.S. children do not meet expert recommendations for DHA intake14. The FAO/WHO recommends the following dietary intake for DHA15:
| Age | Notes |
|---|---|
| 0-6 months | >0.2-0.36% total fatty acids |
| 6-24 months | 10-12 mg/kg body weight |
| 2-3 years | 70 mg/day |
Supplementing with nutritional drinks
Nutritional drinks made with real milk and fortified with key nutrients can complement the toddler diet to help close nutritional gaps. Studies have demonstrated that drinking toddler milks (also known as growing-up milks) can help toddlers meet daily nutrient recommendations16-18.
Provide parents with the nutritional strategies their toddler may need