What to Expect the Toddler Years (175 page)

Too much dietary fat is usually the major culprit in the accumulation of too much body fat. So while a young toddler shouldn’t have his or her fat or cholesterol intake restricted (children under the age of two should continue drinking whole milk and eating eggs; see page 348), it makes sense to limit
excessive
amounts of dietary fat. A diet that’s heavy on greasy foods (such as French fries and chips) can tip the scales at any age. Once a child passes the second birthday, heart-smart eating habits are essential, both to long-term health, and normal growth and weight gain. Switch to low-fat or nonfat milk, low-fat cheese, yogurt, and other dairy products; keep meat portions small and lean; and limit whole eggs or egg yolks to three a week (serve egg whites, as long as they are cooked, as often as you like). But because too little fat in childhood can also be a problem, even after the second year, don’t reduce your toddler’s fat intake to below 30% of his or her total calories without the doctor’s supervision.

And if you aren’t already, start setting the right dietary example for your toddler.

How much does your toddler drink?
Many toddlers, especially those who still get most of their fluids from a bottle, guzzle a lot of unneeded calories. Most often the fluid at fault is apple juice (which, incidentally, provides little nutrition for the calories). Weaning to a cup, if you haven’t already, and diluting juices, particularly apple and apple-based juices, with water will help to cut calories safely.

When does your toddler eat?
Snacks have a legitimate place in the diets of active young children, most of whom can’t go the four or five hours between meals without refueling. But too many such pit stops can be a pitfall when trying to control weight. Provide your toddler with a nutritious, moderate-calorie snack between breakfast and lunch, another between lunch and dinner, and one more before bedtime. But that should be it.

How does your toddler eat?
Toddlers who are still being spoon-fed often consume more than they want or need. So give your toddler plenty of opportunity to self-feed—and when he or she loses interest in the meal, end it. And forget trying to enlist your child in the “clean plate club”—studies show that adult members of that society usually weigh more than nonmembers. Fast eaters are often fast gainers. If your toddler shovels food in nonstop, try to slow down the pace at mealtimes with conversation or other distractions.

Why does your toddler eat?
There’s only one good reason for eating: Hunger. Children who learn this vital lesson at an early age rarely have eating (or weight) problems of any kind later in life. It’s when eating becomes a source of comfort, a release from tension, an escape from boredom, or a substitute for attention that the trouble begins. Avoid the cookie to make the boo-boo better, the candy to buy quiet in the supermarket aisles, and the chips to fill time while you balance your checkbook. If you don’t give food for the wrong reasons, your child won’t eat for the wrong reasons.

How much exercise does your toddler get?
For toddlers who exercise little but their appetite, weight is sure to become a problem, even if it isn’t one now. Structured classes aren’t necessary, but plenty of opportunities to run, climb, jump, and walk are. And don’t forget to practice what you preach. A family that exercises together stays slim for a lifetime, together.

How much TV does your toddler watch?
While exercise is a proven way to avoid obesity, television viewing has been proven to encourage it. The TV viewing habits your child develops in the toddler years are likely to stick for the rest of his or her life. So limit TV viewing now (see page 159).

Remember, no matter how much you may worry about overweight, you should not put your toddler on a diet. Young children need calories to grow and thrive. The goal is not to get the overweight toddler to lose weight, just to slow down the rate of gain while
maintaining
healthy growth.

Thinness, like chubbiness, is often in the eye of the beholder. And, as with chubbiness, when that beholder is a parent, the perspective is often a little skewed. So rather than believing your eyes, check with the doctor to see if your toddler is really abnormally thin from a clinical perspective. If the doctor is satisfied with your toddler’s growth and general health, put your concerns aside, and begin to accept and appreciate your toddler’s shape as is.

If your toddler is indeed under-weight, it will be important for you to work together with the doctor to figure out why. To determine just what your toddler is eating and whether either the quantity or quality of food being consumed (or both) is at the root of the problem, you may be asked to keep a very detailed food and drink diary for a week or two, a diary that lists not just what your toddler eats, but when and in what circumstances. (Keeping track of a toddler’s intake won’t be easy, of course, considering how much of each meal generally ends up on face, clothing, high chair, floor, and elsewhere, and never makes it to the mouth.) Many factors, some of which are likely to be uncovered when a diary is evaluated, can contribute to a toddler being underweight. Happily, most can be easily remedied:

Excessive fluid intake.
Many young children fill up on fluids (milk, juice, soft drinks, and/or water), leaving no room for solids. So judiciously limit liquids (see page 521).

Easy distractability.
The child who is distracted during mealtime by toys, siblings, or television, may leave the table before eating enough. So decrease distraction (see page 518).

Lack of assertiveness.
Some toddlers never complain when they’re hungry; since they never ask for food, their parents may forget to feed them often enough. For these children, it’s especially important to provide regular meals and snacks at approximately the same time each day.

Uncomfortable seating.
The child who isn’t comfortable at the table is a child who isn’t going to stay at the table long enough to eat a full meal. See page 149 for tips on mealtime seating for toddlers.

Unpleasant eating conditions.
Mealtime stress can affect the appetites of children as well as adults. So serve up an atmosphere conducive to eating (see page 517).

Hurried mealtimes.
Many young children are poky eaters. Given the opportunity, they eat a hearty meal. When rushed, they may leave the table before they’re done, and go away hungry (see page 519).

Poor food choices.
Sometimes a child is offered foods that don’t adequately fuel growth and weight gain: foods that are too low in fat (see page 348); low in calories (artificially-sweetened “diet” foods, for example); low in nutrition (junk foods, overly processed and refined foods). In planning meals for your under-weight toddler, focus on foods that are calorie and nutrient dense, and that will help meet The Toddler Diet Daily Dozen requirements (see page 504).

Self-feeding problems.
Some young toddlers are not yet ready for exclusive self-feeding; when the feeding is left to them, they may not eat enough. Others are eager to self-feed and, when denied the chance, won’t eat much at all. So turn the tables (see page 519).

Continued breastfeeding.
Breast milk itself is not nutritionally adequate for children past the first year, and a toddler who is still nursing may not be getting an adequate intake of other fluids and of solid foods. So limit this liquid, too (see page 521).

Ill-timed snacks.
Snacking just before meals is sure to dull a child’s appetite. So hold the line on snacks (see page 512).

Ill-timed meals.
Toddlers who wait too long for a meal often lose their appetites altogether. So feed when hunger strikes (see page 517).

Untimed meals.
Many toddlers need regularity to thrive. So try to serve your toddler’s meals and snacks at roughly the same time each day.

Inadequate eating at day care.
Sometimes, day-care workers are not able to see to it that each of their charges finishes a whole meal. An inattentive (or nutritionally unaware) baby-sitter or nanny may also fail to feed your child adequately—or may be serving the wrong foods. If you suspect your toddler is not eating well enough in another’s care, take steps to remedy the situation. Include the caregiver in any attempt to change your toddler’s diet.

Increased activity.
The toddler years are a time of greatly increased activity (and, in the case of some toddlers, of what seems like perpetual motion). Sometimes, parents fail to recognize that all this activity needs to be fueled by ample amounts of high-energy foods. Be sure the very active child gets enough calories to compensate for those that are being burned. Also try to introduce a few quiet activities during the day (reading, puzzles, block-building, and so on) to reduce the overall burning of calories a bit.

Illness.
A wide range of physical ailments can contribute to underweight, including frequent ear or other infections, asthma or allergies, digestive problems, a metabolic disorder, an iron or zinc deficiency. Certain medications, including some antibiotics, can also dampen a child’s appetite. Discuss these possibilities with the doctor.

Stress.
Stress of all kinds—parental pressure to eat, family problems (such as illness or job loss), family changes (divorce, separation, a new baby, a move), a new or unhappy child-care or school situation, an overly busy schedule—can interfere with a toddler’s appetite. When stress affects your child’s appetite, try to eliminate or modify that cause, and use stress reduction techniques to relax your toddler (see page 173). If this doesn’t help, talk to your toddler’s doctor about professional help.

Growth during the childhood years can be baffling. There’s just no predicting future size from newborn size. Some babies are small at birth and start out slowly, but pick up the pace between four months and two years and eventually turn out to be taller than average. Those destined by genetic blueprint to be small may start off with a bang; large at birth, they may grow rapidly during the first few months, but growth slows down as they move toward their genetic norm. When the growing is over, most kids turn out to be about the same size as their parents. If one parent is tall and the other short, the children tend to range somewhere in between.

A downward shift in the growth curve in the first eighteen to twenty-four months of life is generally not cause for concern if a toddler is healthy, active, eats well, and if height and weight tail off together. Concern arises, however, when the growth curve—for both height and weight—does not inch upward in the third year, when growth should start proceeding at a steady, consistent rate.

When both weight and height are below the fifth percentile, or when there’s been a drop of two percentiles in weight, when a toddler fails to gain weight for three months or more or suddenly loses weight, and especially when any of these signs is combined with fatigue, listlessness, or behavior changes, there is reason to suspect a syndrome known as failure to thrive (FTT). Some causes the doctor will look for:

Intrauterine growth retardation.
The child who was born small for gestational age may still not have caught up to peers, though he or she probably will eventually; those children who weighed under four pounds at a full-term birth may always be smaller than average.

A constitutional growth delay.
Some children are programmed to grow slowly; their bone development lags one to four years behind that of their peers. This kind of delay may run in the family or may just affect a single child; either way, it’s nothing to worry about. Though these children may have a difficult time and may need extra emotional support in the early teen years, they eventually reach average height, or taller.

Illness and disease.
Sometimes illness is behind a child’s failure to thrive. It may be diabetes, another endocrine disorder (such as a hormone deficiency), or a disorder affecting the digestive tract, the kidneys, the heart, the lungs, or the bones. The symptoms of early lead poisoning and zinc or iron deficiency may look like those of FTT, so the doctor may check for these.