Nutritional Requirements of Children
The 1-year-old child has several teeth, and the various digestive and metabolic systems are functioning at or near adult capacity. Thus, the earlier restrictions with respect to source of nutrients no longer apply. Indeed, by 1 year of age, most children tolerate table foods, either as presented to other family members or with minimal alterations.
Although coordination remains poor until 3 to 4 years of age, most children begin at least attempting to feed themselves during the early part of their 2nd year of life. Until coordination improves, however, these attempts usually result in as much food on the table or floor as in the child’s stomach.
Most children are walking or beginning to walk by 1 year of age. Hence, with improved coordination over the next few years, activity increases dramatically. This greater activity, in turn, increases energy needs. Concurrently, the rate of growth decreases; for example, while the birth weight triples over the 1st year of life, it does not quadruple until about 3 years of age. Thus, although the energy requirement incident to activity increases dramatically after the 1st year of life, the requirement for nutrients stored during growth decreases. These changing nutrient needs are reflected in the RDAs for various nutrients for children from 1 to 3, 4 to 6, and 7 to 10 years of age.
As demonstrated by Davis almost 75 years ago and more recently by Birch et al., most young children given access to a varied diet including items from each of the major food groups consume adequate amounts of all nutrients. However, most children, particularly those under 5 to 6 years of age, are very finicky eaters. Moreover, many tend to use eating (or not eating) to exert control over parents and/or caretakers. Thus, the intake of most children at a single meal, or even over an entire day, is not necessarily well balanced. Rather, a balanced intake is achieved over a period of several days.
The erratic eating pattern of most young children is usually of considerable concern to parents, particularly those who have not witnessed this behavior before. Unfortunately, their efforts to control the child’s intake usually make matters worse. They should be reassured and instructed to present the child with well-balanced meals and snacks throughout the day, to remove the food after a reasonable period of time, and to avoid coaxing and cajoling, particularly offering preferred foods or treats as rewards.
The importance of providing items from most or all of the major food groups cannot be overemphasized. Obviously, if the child does not have access to items from all food groups on a regular basis, self-selection of a balanced diet, either in the same day or over several days, is impossible. It also is important to limit intake between regular meals and snacks. Otherwise, the child is unlikely to be hungry when the regularly scheduled meal or snack is offered. Alternatively, if the appetite is not dampened, intake between regular meals and snacks will increase total energy intake disproportionately and contribute to development of obesity. A major distinction between meals and snacks also should be avoided so that the child has access to an adequate amount and variety of food when he or she is hungry or willing to eat rather than only at conventional meal times.
As the child matures and begins to socialize more, it becomes increasingly difficult to control the content of snacks or meals. Many modern children, in fact, eat away from home as much or more as they eat at home—a practice that many think contributes to development of obesity. Perhaps the best that can be done, short of changing modern lifestyles, is to counsel parents concerning the potential problem and advise them to devise ways of assessing their children’s intakes away from home. Regular monitoring of weight and height should alert the clinician to existence of a potential problem.