Infant and Toddler Nutrition by Richard Kahn, M.S., Registered Dietitian

By August 3, 2010Blog

Infant and toddler nutrition is a complicated subject and complexity leads to communication breakdowns. One common miscommunication occurs between parents and pediatricians. The pediatrician gives your child clean bill of health. Great! Yet, your child never eats vegetables and prefers white bread to whole grain or just eats 4 or 5 foods. That cherished goal of a perfect diet is dashed not only by the child but, in addition, the physician is not that concerned. You may be mystified, frustrated or even angry, but the physician sees that the child is eating enough based on the growth chart, even though your child may be technically underweight. That physician judges that the child's height and weight are adequate, the skin, hair and lips look fine, the child is energetic. In clinical short hand, the doctor looks at appearance, height and iron. If your child is consistently getting taller, despite difficulties, enough protein, carbohydrates and fats are entering your child. An iron sufficient child is getting enough iron, a marker nutrient, and the proteins and vitamins that go into hemoglobin production and hence enough of everything.

The focus on carbohydrates, fats and proteins is macronutrient nutrition, the most level of nutrition because macronutrients represent basic needs and calories. From the point of view of macronutrient nutrition, the vitamins, minerals and other important micronutrients, such as antioxidants, fiber and essential fatty acids, take care of themselves because they are in common foods. Macronutrients are measured in grams. When parents focus on nutrition, they tend to worry about macronutrients, eating enough, and micronutrients, eating well. Micronutrients are measured in milli- and micrograms. A milligram is one thousandth the size of a green Monopoly house. Other nutrients such as Vitamins A and D are measured in International Units, a measure of potency but still a small amount.

Parents naturally want to provide a complete diet. The combination of facts and feelings is almost too powerful to resist, not to mention, the power that comes from being older and bigger. The parent s desire, however, may be different from the child's once the food is on the plate.

Different desires create the second communication breakdown. The previously fine mealtimes disappear when the parent s desire to nurture meets the child's desire for independence. While parents worry about micro and macro nutrients, your toddler is looking for you to acknowledge a different need that could be called developmental or life cycle nutrition. In developmental nutrition, food satisfies hunger and the desire to develop mastery. The differing goals between parent and child are behind most feeding problems. The natural parenting desire to provide macro and micronutrients gets separated from the child's desire to self feed. The breakdown is not unlike your nutrition disconnect with your pediatrician. Different ideas of nutrition can collide. Just ask Dean Ornish and Dr. Atkins.

The infant s desire to feed his or herself kicks in at around 6 months. That desire to develop can manifest in refusing baby food or by pushing the spoon away. Your exploring child has figured out that you are not eating pureed carrots but something else, something far more interesting and you are feeding yourself. Your baby who cannot walk or crawl is beginning to separate and the drive for independence often occurs first at mealtime. Standard developmental milestone guides say that children can use a cup at around 6 months, finger feed around 7 or 8 months and use a spoon sometime after that. That s great if your child follows along. Educated parents look to that kind of guide as a ruler, but your child is the best guide. Guides do not take into account that some children quickly copy older children or favorite adults sooner than anticipated, especially if your relationship is great. Even when a developmental delay clouds the picture, children who refuse to be fed by others are exhibiting standard behaviors known to people who help parents who are just struggling too much at mealtimes. If your child is giving you a hard time, your child probably thinks you are giving him or her a hard time.

When mealtimes collapse into struggles, arents may feel alone, rejected or forced to engage in dramatic actions when their child does not eat. Such feelings of parents are universal, as are the problems. The World Health Organization (WHO) has taken up the task of helping parents feed their children because feeding struggles are worldwide. Visit the WHO website http://www.who.int/childgrowth/training/en/ to find the latest recommended practices. For WHO, after 6 months the best guide on feeding your child is your child. Just pay attention to the trinity of feeding practices: the cup, finger foods and the spoon. Your child will let you know how they want to eat, fingers, spoons or even let y ou feed them if there is no fights and lots of smiles. If your cultural preference is for eating by hand feeding or chopsticks, your child has already figured that out, too. Once you begin to experience refusals and too many games at the table it is time to help your child develop new skills. Then you will have smiles. If mealtimes are not pleasant for you, they are certainly not engaging for your child. If you cannot make mealtimes more productive, speak to a professional who knows about feeding behavior and nutrition.

“>Richard Kahn, PhD, RD, is a NYC pediatric nutritionist in private practice specializing in the needs of young children. Reach him at richard@brooklynletters.com or RichardKahnNutrition.com.

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