{"id":267,"date":"2021-11-02T21:05:27","date_gmt":"2021-11-02T21:05:27","guid":{"rendered":"https:\/\/pressbooks.ccconline.org\/accece\/chapter\/chapter-fourteen-providing-good-nutrition\/"},"modified":"2023-10-20T20:25:02","modified_gmt":"2023-10-20T20:25:02","slug":"chapter-fourteen-providing-good-nutrition","status":"publish","type":"chapter","link":"https:\/\/pressbooks.ccconline.org\/accece\/chapter\/chapter-fourteen-providing-good-nutrition\/","title":{"raw":"Chapter Fourteen: Providing Good Nutrition","rendered":"Chapter Fourteen: Providing Good Nutrition"},"content":{"raw":"<div class=\"textbox textbox--learning-objectives\"><header class=\"textbox__header\">\n<p class=\"textbox__title\">Chapter 14 Learning Objectives<\/p>\n\n<\/header>\n<div class=\"textbox__content\">\n\nBy the end of this chapter, you should be able to:\n<ul>\n \t<li>Describe the changes in nutritional needs as children mature (get older).<\/li>\n \t<li>Advocate for the support of breastfeeding mothers.<\/li>\n \t<li>Relate bottle-feeding practices.<\/li>\n \t<li>Discuss the transition to solid foods and self-feeding.<\/li>\n \t<li>Summarize feeding challenges for toddlers.<\/li>\n \t<li>Explain effective ways to respond to picky eating.<\/li>\n \t<li>Outline the importance of inclusive nutrition policies and practices.<\/li>\n \t<li>Identify how to support children with unique nutritional and feeding needs.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<h2>Introduction<\/h2>\nTo provide all children the appropriate nutrition, it is important to understand how nutritional needs and feeding practices change as children mature. Children with special needs may have different nutritional and feedings needs. Working with families and medical providers, programs can ensure that they meet each and every child\u2019s needs. Early care and education programs can also support and empower families to provide the best nutrition to their children.\n<h2>Feeding Infants<\/h2>\nRequirements for macronutrients and micronutrients on a per-kilogram basis are higher during infancy than at any other stage in the human life cycle. See the average calorie needs for infants in Table 14.1. An infants\u2019 resting metabolic rate is two times that of an adult. These needs are affected by the rapid cell division that occurs during growth, which requires energy and protein, along with the nutrients that are involved in DNA synthesis.<a href=\"#_ftn1\">[1]<\/a>\n\n&nbsp;\n<div style=\"text-align: left\" align=\"center\">\n<div class=\"textbox textbox--examples\"><header class=\"textbox__header\">\n<p class=\"textbox__title\"><strong>Table 14.1 \u2013 Average Calorie Needs for Infants<\/strong> <a href=\"#_ftn2\"><strong>[2]<\/strong><\/a><\/p>\n\n<\/header>\n<div class=\"textbox__content\">\n<table class=\"grid landscape\">\n<thead>\n<tr>\n<td><strong>Sex\/Age<\/strong><\/td>\n<td><strong>Calories<\/strong><\/td>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td>Boys (0-6 months)<\/td>\n<td>472-645 calories<\/td>\n<\/tr>\n<tr>\n<td>Girls (0-6 months)<\/td>\n<td>438-593 calories<\/td>\n<\/tr>\n<tr>\n<td>Boys (6-12 months)<\/td>\n<td>645-844 calories<\/td>\n<\/tr>\n<tr>\n<td>Girls (6-12 months)<\/td>\n<td>593-768 calories<\/td>\n<\/tr>\n<tr>\n<td>Boys (1-2 years)<\/td>\n<td>844-1,050 calories<\/td>\n<\/tr>\n<tr>\n<td>Girls (1-2 years)<\/td>\n<td>768-997 calories<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n<span style=\"text-align: initial;font-size: 1em\">During this period, children are entirely dependent on their parents and other caregivers to meet these needs. For almost all infants six months or younger, breast milk is the best source to fulfill nutritional requirements. An infant may require feedings eight to twelve times a day or more in the beginning. After six months, infants can gradually begin to consume solid foods to help meet nutrient needs.<\/span>\n\n<\/div>\nHow often an infant wants to eat will also change over time due to growth spurts, which typically occur at about two weeks and six weeks of age, and again at about three months and six months of age.<a href=\"#_ftn3\">[3]<\/a>\n<h4>Breastfeeding<\/h4>\nThe dietary recommendations for infants are based on the nutritional content of human breast milk. Carbohydrates make up about 45 to 65 percent of the caloric content in breast milk. Protein makes up about 5 to 20 percent of the caloric content of breast milk. About 30 to 40 percent of the caloric content in breast milk is made up of fat. A diet in high unsaturated fat is necessary to encourage the development of neural pathways in the brain and other parts of the body.\n\nAlmost all of the nutrients that infants require can be met if they consume an adequate amount of breast milk. There are a few exceptions, though. Human milk is low in vitamin D, which is needed for calcium absorption and building bone, among other things. Breast milk is also low in vitamin K, which is required for blood clotting, and deficits could lead to bleeding or hemorrhagic disease. Infants are born with limited vitamin K, so supplementation may be needed initially and some states require a vitamin K injection after birth. Also, breast milk is not high in iron, but the iron in breast milk is well absorbed by infants. After four to six months, however, an infant needs an additional source of iron other than breast milk. Therefore, breastfed children often need to take a vitamin D supplement in the form of drops. <a href=\"#_ftn4\">[4]<\/a>\n<div class=\"textbox textbox--key-takeaways\"><header class=\"textbox__header\">\n<p class=\"textbox__title\"><strong>Supporting Breastfeeding in Early Care and Education<\/strong><\/p>\n\n<\/header>\n<div class=\"textbox__content\">\n\nEarly care and education programs play an important role in supporting breastfeeding All staff members\u2014despite their comfort or experience with breastfeeding\u2014play an\u00a0important role in breastfeeding promotion. They have an opportunity to share the facts about breastfeeding with families, and to help them decide what's best for them and their babies.<a href=\"#_ftn5\">[5]<\/a>\n\nYou can support breastfeeding mothers when you:\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Talk about why breastfeeding is so good for their infant.\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Tell them you want to care for breastfed infants and support breastfeeding mothers.\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Share other places in the community they can go to for help with breastfeeding.\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Share and discuss resources about breastfeeding.\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Try to time feedings to the mother\u2019s schedule (being sure to respond to the infant\u2019s needs and cues).\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Offer a place to nurse that is comfortable, quiet, and private.\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Communicate about their infant\u2019s day.<a href=\"#_ftn6\">[6]<\/a>\n\n<\/div>\n<\/div>\n[caption id=\"attachment_266\" align=\"aligncenter\" width=\"300\"]<img class=\"size-medium wp-image-258\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2021\/11\/14.1-300x200.jpg\" alt=\"Rocking chair in a quiet spot with supplies nearby\" width=\"300\" height=\"200\"> Figure 14.1 \u2013 This child care center provides mothers a space to breastfeed. [7][\/caption]\n<h3>Feeding with Breastmilk in Early Care and Education Programs<\/h3>\nMothers may choose to have their breastfed infants fed in one of several ways when the infant is in child care including:\n<ol>\n \t<li>mother uses her breaks to come to the child care site at feeding times to nurse her infant;<\/li>\n \t<li>child care provider gives the infant the breastmilk that the mother has expressed on a previous day.<\/li>\n<\/ol>\nFollow the feeding method that the mother chooses. Feeding advice such as the use of infant formula should come from the infant's doctor or clinic.\n\nExpressed breastmilk needs to be stored and handled safely to keep it from spoiling. Remind mothers to label, date, and chill or refrigerate their breastmilk right after they express it. Ask mothers to bring the milk in hard plastic bottles.\n\nAsk mothers to bring in enough breastmilk to feed the infant each day. Be sure that each bottle or other container of breastmilk is labeled with the infant's name and the date the milk was expressed. Bottles should have just the amount both you and the mother think the infant will take at each feeding. This amount will be about 2 to 4 ounces of breastmilk for the younger infant. As the infant gets older, the mother can put more breastmilk in each bottle. Keep breastmilk in the refrigerator or freezer until ready to use. Breastmilk that is not frozen, should be disposed of if not eaten within 72 hours.\n\nThaw frozen breastmilk by running the container under cool water. Do not set breastmilk out to thaw at room temperature. Do not thaw breastmilk by heating on the stove or in a microwave.<a href=\"#_ftn8\">[8]<\/a> See below for instructions on how to bottle feed an infant.\n\nAlthough breast milk is ideal for almost all infants, not all mothers will be able to breastfeed and some mothers should not breastfeed (including women with HIV, who are being treated for cancer, or who are taking drugs that are not safe while breastfeeding).\n<h4>Formula Feeding<\/h4>\nInfant formula provides a balance of nutrients. However, not all formulas are the same and there are important considerations that parents and caregivers must weigh. Standard formulas use cow\u2019s milk as a base. They have 20 calories per fluid ounce, similar to breast milk, with vitamins and minerals added. Soy-based formulas are usually given to infants who develop diarrhea, constipation, vomiting, colic, or abdominal pain, or to infants with a cow\u2019s milk protein allergy. Hypoallergenic protein hydrolysate formulas are usually given to infants who are allergic to cow\u2019s milk and soy protein. This type of formula uses hydrolyzed protein, meaning that the protein is broken down into amino acids and small peptides, which makes it easier to digest.\n\nInfant formula comes in three basic types:\n<ol>\n \t<li>Powder that requires mixing with water. This is the least expensive type of formula.<\/li>\n \t<li>Concentrates, which are liquids that must be diluted with water. This type is slightly more expensive.<\/li>\n \t<li>Ready-to-use liquids that can be poured directly into bottles. This is the most expensive type of formula. However, it requires the least amount of preparation. Ready-to-use formulas are also convenient for traveling.<\/li>\n<\/ol>\nMost infants need about 2.5 ounces of formula per pound of body weight each day. Therefore, the average infant should consume about 24 fluid ounces of breastmilk or formula per day. When preparing formula, caregivers should carefully follow the safety guidelines, since an infant has an immature immune system. All equipment used in formula preparation should be sterilized. Prepared, unused formula should be refrigerated to prevent bacterial growth. Caregivers should make sure not to use contaminated water to mix formula in order to prevent foodborne illnesses. Follow the instructions for powdered and concentrated formula carefully\u2014formula that is overly diluted would not provide adequate calories and protein, while overly concentrated formula provides too much protein and too little water which can impair kidney function.<a href=\"#_ftn9\">[9]<\/a>\n<h6>Feeding with Formula in Early Child Care and Education Programs<\/h6>\nEarly care and education programs provide commercially prepared formulas to infants, under the direction of the family. Bottles of formula should come prepared in bottles labeled with the infant\u2019s name and the date. Unused mixed formula should not be stored for more than 24 hours.\n<h6>Bottle Feeding (Both Expressed Breastmilk and Formula)<\/h6>\nAlways wash your hands before handling bottles or feeding the infant. Use only clean bottles, nipples, and cups. For infants that do not crawl, bottles and nipples should be sterilized. If you need to reuse them, sterilize by boiling in water for 5 minutes or by washing in a dishwasher.\n\nWarm breastmilk and formula by placing the bottle in a pan of warm water or by holding it under warm running water for a few minutes. Do not warm breastmilk or formula on the stove or in a microwave. Microwave heating causes hot spots in the milk that can burn the infant's mouth and throat. These hot spots may stay even if you shake the bottle. And heating also destroys most of the natural substances in breastmilk.\n\nDouble-check the labels on bottles before feeding to ensure the infant is getting the correct breastmilk or formula. Always hold the infant when bottle feeding. Try different positions for infants who do not want to take their bottles. Some infants are happier if you feed them in the usual cradle position. Others prefer a different position. Do not prop up a bottle to feed an infant or put an infant in a crib with a bottle. Bottle propping could cause the infant to choke, tooth decay, and ear infections.\n\n[caption id=\"attachment_266\" align=\"aligncenter\" width=\"300\"]<img class=\"size-medium wp-image-259\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/14.2-300x200.jpg\" alt=\"Infant drinking from a bottle in caregiver's arms\" width=\"300\" height=\"200\"> Figure 14.2 \u2013 Not only is holding an infant during bottle feeding safest, but it is also an important time for caregiver and infant to connect and build their relationship. [10][\/caption]Burp by placing the infant high over your shoulder or over your knee. You can also lean the infant forward in a sitting position supported by your hands. Pat or rub the infant's back. This puts gentle pressure on the abdomen to push extra air from the stomach.<a href=\"#_ftn11\">[11]<\/a>\n\nUneaten breastmilk or formula should be discarded after a feeding as bacteria from the infant\u2019s mouth may have made it into the bottle.\n<h4>When to Feed<\/h4>\nIn the early months, infants will need to be fed \u201con demand\u201d\u2014this means that they are able to feed whenever they are hungry or show hunger cues. Hunger cues are unique to each infant. An infant might:\n<ul>\n \t<li>Have a specific hunger cry<\/li>\n \t<li>Root or look around for food<\/li>\n \t<li>Suck on their hand or fingers<\/li>\n \t<li>Become irritable or restless<\/li>\n \t<li>Repeat a unique behavior to demonstrate hunger<\/li>\n<\/ul>\nWhen adults respond to an infant\u2019s hunger cues, the infant can also tell how much food they want and when they are full. This feeding practice supports healthy eating habits, growth, and development later in life.<a href=\"#_ftn12\">[12]<\/a>\n<div class=\"textbox textbox--exercises\"><header class=\"textbox__header\">\n<p class=\"textbox__title\"><strong>Pause to Reflect<\/strong><\/p>\n\n<\/header>\n<div class=\"textbox__content\">\n<table style=\"border-collapse: collapse;width: 100%\" border=\"0\">\n<tbody>\n<tr>\n<td style=\"width: 16.9%\"><img class=\"alignleft size-thumbnail wp-image-89\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/P2R-150x150.png\" alt=\"\" width=\"150\" height=\"150\"><\/td>\n<td style=\"width: 83.1%\">Some families put infants on a schedule that dictates when they eat (and even sleep)? Is this compatible with feeding on demand as described above? How might you discuss this with a family?<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n<h4>Introducing Solid Foods<\/h4>\nInfants should be breastfed or formula-fed exclusively for the first six months of life according to the WHO. (The American Academy of Pediatrics recommends breast milk or bottle formula exclusively for at least the first four months, but ideally for six months.) Infants should not consume solid foods before six months because solids do not contain the right nutrient mix that infants need. Also, eating solids may mean drinking less breast milk or bottle formula. If that occurs, an infant may not consume the right quantities of various nutrients. If parents try to feed an infant who is too young or is not ready, their tongue will push the food out, which is called an extrusion reflex. After six months, the suck-swallow reflexes are not as strong, and infants can hold up their heads and move them around, both of which make eating solid foods more feasible.<a href=\"#_ftn13\">[13]<\/a>\n<div class=\"textbox textbox--key-takeaways\"><header class=\"textbox__header\">\n<p class=\"textbox__title\"><strong>Knowing When an Infant is Ready for Solid Foods<\/strong><\/p>\n\n<\/header>\n<div class=\"textbox__content\">\n\nHere are several ways you can tell that an infant is ready to eat solid foods:\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 The infant\u2019s birth weight has doubled.\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 The infant can control their head and neck movements.\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 The infant can sit up with some support.\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 The infant can show you they are full by turning their head away or by not opening their mouth.\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 The infant begins showing interest in food when others are eating.\n\n<\/div>\n<\/div>\nSolid baby foods can be bought commercially or prepared from regular food using a food processor, blender, food mill, or grinder.<a href=\"#_ftn14\">[14]<\/a> Baby food can be served at room temperature. If it is warmed, it must be stirred to distribute evenly.<a href=\"#_ftn15\">[15]<\/a>\n\nPortion the amount of food you intend to serve the baby (any uneaten food will need to be thrown away after a feeding and use small amounts on an infant-sized spoon. When beginning solid foods, timing is important. To keep mealtimes positive, choose a time when the infant is happy and when you have the patience and time to focus. Offer 1 to 2 teaspoons after a breastmilk or formula feeding. This can increase over time to 2 to 3 tablespoons.\n\nIt is normal for infants to refuse new foods. Sometimes it can take 10 to 12 times of offering a food before an infant will accept it. Infants know when they have had enough and may turn their head away. Don\u2019t force them to keep eating.<a href=\"#_ftn16\">[16]<\/a>\n\nAs families and caregivers introduce solids, they should feed the child only one new food at a time, to help identify allergic responses or food intolerances. An iron supplement is also recommended at this time.<a href=\"#_ftn17\">[17]<\/a>\n<div class=\"textbox textbox--key-takeaways\"><header class=\"textbox__header\">\n<p class=\"textbox__title\"><strong>Foods to Avoid for Infants<\/strong><\/p>\n\n<\/header>\n<div class=\"textbox__content\">\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Never give honey to infants. It may contain bacteria that can cause botulism, a rare, but serious illness.\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Do not give infants cow's milk until they are 1 year old. Before age 1, they have a difficult time digesting cow's milk.\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Avoid foods with added salt or sugar.\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Do not give infants egg white until after they are 1 (egg yolks 3-4 per week are okay)<a href=\"#_ftn18\">[18]<\/a>\n\n<\/div>\n<\/div>\n<h4>Learning to Self-Feed<\/h4>\nWith the introduction of solid foods, young children begin to learn how to handle food and how to feed themselves. At six to seven months, infants can use their whole hand to pick up items (this is known as the palmer grasp). They can lift larger items, but picking up smaller pieces of food is difficult. At eight months, a child might be able to use a pincer grasp, which uses fingers to pick up objects.<a href=\"#_ftn19\">[19]<\/a>\n\nServe food that is soft and mashed. Cut food into small pieces (cubes no larger than 1\/4 inch) or thin slices that your baby can easily chew and swallow. Avoid high-risk choking foods such as small, slippery foods; dry foods that are hard to chew or sticky; and tough foods. <a href=\"#_ftn20\">[20]<\/a>\n<div class=\"textbox textbox--key-takeaways\"><header class=\"textbox__header\">\n<p class=\"textbox__title\"><strong>Finger Foods<\/strong><\/p>\n\n<\/header>\n<div class=\"textbox__content\">\n\nHere are some good food choices for self-feeding children:\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Soft cooked vegetables\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Washed and peeled fruits\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Graham crackers\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Melba toast\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Noodles\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Soft cooked vegetables\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Washed and peeled fruits\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Graham crackers\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Melba toast\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Noodles\n\nHere are foods to <span style=\"text-decoration: underline\"><strong><em>AVOID<\/em><\/strong><\/span> as they are a <strong>choking<\/strong> hazard:\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Apple chunks or slices\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Grapes\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Berries\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Raisins\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Dry flake cereals\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Hot dogs\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Sausages\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Peanut butter\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Popcorn\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nuts\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Seeds\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Round candies\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Raw vegetables<a href=\"#_ftn21\">[21]<\/a>\n\n<\/div>\n<\/div>\nTo minimize choking, ensure that infants are seated while eating.\u00a0If using a high chair, make sure to use the safety straps.<a href=\"#_ftn22\">[22]<\/a>\n\n[caption id=\"attachment_266\" align=\"aligncenter\" width=\"300\"]<img class=\"size-medium wp-image-260\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/14.3-300x245.png\" alt=\"Infant feeding herself\" width=\"300\" height=\"245\"> Figure 14.3 \u2013This older infant has been served food on an unbreakable plate with a small utensil. [23][\/caption]After the age of one, children slowly begin to use utensils to handle their food. Unbreakable dishes and cups are essential, since very young children may play with them or throw them when they become bored with their food. <a href=\"#_ftn24\">[24]<\/a>\n<h2>Supporting Infant Nutrition<\/h2>\nNutrition during the first year of life is really important. While babies who are breastfed for at least 6 months are more likely to have a healthy weight as they grow up, mothers often report that breastfeeding is harder than they thought. And mothers may be more likely to stop breastfeeding if they feel unsupported and have nowhere to turn for help. And families that choose not to or cannot breastfeed have questions and need support to feed their infants in a healthy and safe way, too. Babies should be ready to start eating simple solids around 6 months. Babies who start eating solid foods too early are more likely to have weight problems as children and adults.<a href=\"#_ftn25\">[25]<\/a>\n\nEarly care and education programs can support infant nutrition with the following practices:\n<ul>\n \t<li>All food brought from home should be labeled with the child\u2019s name and date.<\/li>\n \t<li>Part of the care plan that families share with their program and that is updated regularly, should be instructions for feeding. Families should determine how and what their infant is fed (as long as it\u2019s in compliance with licensing).<\/li>\n \t<li>Support parents with materials on providing optimal nutrition for their infant (such as the tips just listed).<\/li>\n \t<li>Be supportive of mothers who are breastfeeding. For mothers who can come to nurse, provide a space conducive to that. Ensure the breastmilk that is brought to the program is properly labeled, stored, and prepared.<\/li>\n \t<li>For infants that are formula fed, ensure that formula is prepared according to the label (or doctor\u2019s instructions).<\/li>\n \t<li>Hold all infants during bottle feedings. Not only does this keep them safe, but it is also valuable one-on-one time (caregiving routines are the heart of infant\/toddler curriculum).<\/li>\n \t<li>Follow the cues of the infant you are feeding (when they are hungry and full).<\/li>\n \t<li>When feeding pureed baby food, use a small spoon and make sure you transfer food from a jar into a dish and throw away any uneaten food.<\/li>\n \t<li>Have appropriate seating available for infants that are beginning to self-feed (high chairs, booster seats, or enclosed small chairs at a low table)<\/li>\n \t<li>Provide unbreakable dishes to serve food to self-feeding infants.<\/li>\n<\/ul>\n&nbsp;\n<div class=\"textbox textbox--key-takeaways\"><header class=\"textbox__header\">\n<p class=\"textbox__title\"><strong>Engaging Families in Supporting Their Infant\u2019s Nutrition<\/strong><\/p>\n\n<\/header>\n<div class=\"textbox__content\">\n\nHere are tips you can share with families\n<ul>\n \t<li>If breastfeeding is harder than you thought it would be you are not alone!<\/li>\n \t<li>Lots of people say that breastfeeding just comes \u201cnaturally\u201d but for many moms, it doesn\u2019t.<\/li>\n \t<li>Going back to work and wanting to get back into a normal family routine can make it hard to stick with breastfeeding. Using a breast pump can help ensure your baby still gets the best nutrition.<\/li>\n \t<li>If you need support or help at any time while you are breastfeeding call 1-800-994-9662 (the National Breastfeeding Hotline) for free breastfeeding support.<\/li>\n \t<li>Don\u2019t use pillows or other objects to hold a bottle for your baby. This makes it hard for her to spit out the bottle when she\u2019s done - it can cause her to keep eating after she\u2019s full.<\/li>\n \t<li>Make sure you take the bottle away if your baby falls asleep. If you let the baby keep the bottle in her mouth when he\u2019s sleeping, formula can stay in her mouth and can damage his teeth or cause her to choke.<\/li>\n \t<li>Stick with ONLY breast milk or formula for feeding your baby until she is 6 months old. Unless your doctor tells you something different, adding cereal to a baby\u2019s bottle adds extra calories to her diet that she doesn\u2019t need. <a href=\"#_ftn26\">[26]<\/a><\/li>\n \t<li>Infants are usually ready to eat solid foods at about 6 months of age.<\/li>\n \t<li>If you introduce one new food at a time, you will be able to identify any foods that cause\u00a0allergies\u00a0in your baby.<a href=\"#_ftn27\">[27]<\/a><\/li>\n \t<li>Start solid feedings with iron-fortified baby cereal mixed with breast milk or formula. Mix it with enough milk so that the texture is very thin. Start by offering the cereal 2 times a day, in just a few spoonfuls.<\/li>\n \t<li>You can make the mixture thicker as your baby learns to control it in their mouth.<\/li>\n \t<li>You can also introduce iron-rich pureed meats, fruits, and vegetables. Try green peas, carrots, sweet potatoes, squash, applesauce, pears, bananas, and peaches.<\/li>\n \t<li>Some dietitians recommend introducing a few vegetables before fruits. The sweetness of fruit may make some vegetables less appealing.<\/li>\n \t<li>The amount your child eats will vary between 2 tablespoons (30 grams) and 2 cups (480 grams) of fruits and vegetables per day. How much your child eats depends on their size and how well they eat fruits and vegetables.<a href=\"#_ftn28\">[28]<\/a><\/li>\n<\/ul>\n<\/div>\n<\/div>\n<h2>Feeding Toddlers<\/h2>\nMajor physiological changes continue into the toddler years. Unlike in infancy, the limbs grow much faster than the trunk, which gives the body a more proportionate appearance.\u00a0Their physical growth and motor development slow compared to the progress they made as infants. The toddler years pose interesting challenges for parents or other caregivers, as children learn how to eat on their own and begin to develop personal preferences. However, with the proper diet and guidance, toddlers can continue to grow and develop at a healthy rate.\n\n[caption id=\"attachment_266\" align=\"aligncenter\" width=\"300\"]<img class=\"size-full wp-image-261\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/14.4.png\" alt=\"Teacher tossing a ball to a toddler\" width=\"300\" height=\"219\"> Figure 14.4 \u2013 Caloric intake will depend on a toddler\u2019s activity level. [29][\/caption]The energy requirements for ages two to three are about 1,000 to 1,400 calories a day. In general, a toddler needs to consume about 40 calories for every inch of height. For example, a young child who measures 32 inches should take in an average of 1,300 calories a day. However, the recommended caloric intake varies with each child\u2019s level of activity. Toddlers require small, frequent, nutritious snacks and meals to satisfy energy requirements. The amount of food a toddler needs from each food group depends on daily calorie needs.\n\nForty-five to 65% of their daily caloric intake should come from carbohydrates. Protein should make up 5 to 20% of their daily calories. And fat should make up 30 to 40% of their daily intake. Essential fatty acids are vital for the development of the eyes, along with nerve and other types of tissue. However, toddlers should not consume foods with high amounts of trans fats and saturated fats.\n\nAs a child grows bigger, the demands for micronutrients increase. These needs for vitamins and minerals can be met with a balanced diet, with a few exceptions. According to the American Academy of Pediatrics, toddlers and children of all ages need 600 international units of vitamin D per day. Vitamin D-fortified milk and cereals can help to meet this need. However, toddlers who do not get enough of this micronutrient should receive a supplement. Pediatricians may also prescribe a fluoride supplement for toddlers who live in areas with fluoride-poor water. Iron deficiency is also a major concern for children between the ages of two and three.<a href=\"#_ftn30\">[30]<\/a>\n<h4>Self-Feeding<\/h4>\nAs children grow older, they enjoy taking care of themselves, which includes self-feeding. During this phase, it is important to offer children foods that they can handle on their own and that helps them avoid choking and other hazards. Examples include fresh fruits that have been sliced into pieces, orange or grapefruit sections, peas or potatoes that have been mashed for safety, a cup of yogurt, and whole-grain bread or bagels cut into pieces. Even with careful preparation and training, the learning process can be messy. As a result, parents and other caregivers can help children learn how to feed themselves by providing the following:\n<ul>\n \t<li>small utensils that fit a young child\u2019s hand<\/li>\n \t<li>small cups that will not tip over easily<\/li>\n \t<li>plates with edges to prevent food from falling off<\/li>\n \t<li>small servings on a plate<\/li>\n \t<li>highchairs, booster seats, or small enclosed chairs to reach a low table<a href=\"#_ftn31\">[31]<\/a><\/li>\n<\/ul>\n[caption id=\"attachment_266\" align=\"aligncenter\" width=\"300\"]<img class=\"size-medium wp-image-262\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/14.5-300x206.png\" alt=\"Young boy feeding himself with a small fork and sippy cup\" width=\"300\" height=\"206\"> Figure 14.5 \u2013 Set toddlers up for success in self-feeding. [32][\/caption]\n<h4>Feeding Challenges in the Toddler Years<\/h4>\nDuring the toddler years, parents may face a number of problems related to food and nutrition. Possible obstacles include difficulty helping a young child overcome a fear of new foods, or fights over messy habits at the dinner table. Even in the face of problems and confrontations, parents and other caregivers must make sure their preschooler has nutritious choices at every meal. For example, even if a child stubbornly resists eating vegetables, parents should continue to provide them. Before long, the child may change their mind, and develop a taste for foods once abhorred. It is important to remember this is the time to establish or reinforce healthy habits.\n\nNutritionist Ellyn Satter states that feeding is a responsibility that is split between parent and child. According to Satter, parents are responsible for what their infants eat, while infants are responsible for how much they eat. In the toddler years and beyond, parents are responsible for what children eat, when they eat, and where they eat, while children are responsible for how much food they eat and whether they eat. Satter states that the role of a parent or a caregiver in feeding includes the following:\n<ul>\n \t<li>selecting and preparing food<\/li>\n \t<li>providing regular meals and snacks<\/li>\n \t<li>making mealtimes pleasant<\/li>\n \t<li>showing children what they must learn about mealtime behavior<\/li>\n \t<li>avoiding letting children eat in between meal- or snack-times<\/li>\n<\/ul>\nYou are likely to notice a sharp drop in their child\u2019s appetite. Children at this stage are often picky about what they want to eat. They may turn their heads away after eating just a few bites. Or, they may resist coming to the table at mealtimes. They also can be unpredictable about what they want to consume for specific meals or at particular times of the day. Although it may seem as if toddlers should increase their food intake to match their level of activity, there is a good reason for picky eating. A child\u2019s growth rate slows after infancy, and toddlers ages two and three do not require as much food.<a href=\"#_ftn33\">[33]<\/a>\n\nEstablishing healthy meal routines is an important step in healthy toddler development. Ideally, mealtimes should take place at regular times, at a table with limited distraction, and children should be encouraged to feed themselves with adult support as needed. <a href=\"#_ftn34\">[34]<\/a> Best practices in early care and education include creating positive meal and snack times that are served family-style with adult modeling eating balanced nutrition.\n<div class=\"textbox textbox--key-takeaways\"><header class=\"textbox__header\">\n<p class=\"textbox__title\"><strong>Engaging Families in Supporting Their Toddler\u2019s Nutrition<\/strong><\/p>\n\n<\/header>\n<div class=\"textbox__content\">\n\nHere are tips you can share with families:\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Serving sizes for toddlers are much smaller than serving sizes for adults.\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 A typical serving size for a toddler drink is 4-6 ounces. Water and milk are the best choices for toddlers\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Your toddler (and you too!) needs food from all five of the food groups\u2014grains, protein, vegetables, fruit, and dairy. Try offering a variety of foods from these groups at meals and snacks.\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Your toddler may eat more some days and less on others. Don\u2019t worry, this is normal! Keep offering regularly scheduled meals and snacks.\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Allow your toddler to tell you when she is full. This teaches them to listen to their body for signs of hunger or fullness.\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Try using child-size plates, bowls, and utensils for \u201cright-size\u201d portions for your toddler. Using child-size utensils also makes it easier for your toddler to eat.\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Encourage toddlers to drink from cups and avoid the use of bottles or sippy cups.\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Limit distractions during meal and snack times to allow your toddler to enjoy the food. Turn off the TV and sit at a table.\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Toddlers get hungry between meals. Snack time is a great chance to feed your toddler healthy foods (like fruits and veggies).\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Remember to have a start and end time for snack time. Toddlers should not be snacking (or grazing) all day.<a href=\"#_ftn35\">[35]<\/a>\n\n<\/div>\n<\/div>\n<h2>Feeding Preschoolers<\/h2>\nChildren\u2019s attitudes and opinions about food deepen. They not only begin taking their cues about food preferences from family members, but also from peers and the larger culture. This time in a child\u2019s life provides an opportunity for families and other caregivers to reinforce good eating habits and to introduce new foods into the diet while remaining mindful of a child\u2019s preferences. Adults should also serve as role models for their children, who will often mimic their behavior and eating habits.<a href=\"#_ftn36\">[36]<\/a>\n\n[caption id=\"attachment_266\" align=\"aligncenter\" width=\"300\"]<img class=\"size-medium wp-image-263\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/14.6-300x224.jpg\" alt=\"Caregiver sitting and eating with six children\" width=\"300\" height=\"224\"> Figure 14.6 \u2013 Eating with children allows you to model healthy eating. [37][\/caption]MyPlate also provides a guide daily for calories based on sex and activity-level for preschool-aged children (although children\u2019s needs may differ from the average and appetites can vary from day to day).\n\n&nbsp;\n<div style=\"text-align: left\" align=\"center\">\n<div class=\"textbox textbox--examples\"><header class=\"textbox__header\">\n<p class=\"textbox__title\"><strong>Table 14.1 \u2013 Average Calorie Needs for Preschoolers <\/strong><a href=\"#_ftn38\"><strong>[38]<\/strong><\/a><\/p>\n\n<\/header>\n<div class=\"textbox__content\">\n<div align=\"center\">[h5p id=\"27\"]<\/div>\n<\/div>\n<\/div>\n<span style=\"text-align: initial;font-size: 1em\">In early childhood, children should still get 45-65% of their daily calories from carbohydrates. Carbohydrates high in fiber should make up the bulk of intake. Their intake of protein increases to 10\u201330% of their daily calories to support muscle growth and development. High levels of essential fatty acids are needed to support growth (although not as high as in infancy and the toddler years). As a result, the daily recommendation for fat is 25\u201335% of their daily calories. And they should get 17\u201325 grams of fiber per day.<\/span>\n\n<\/div>\nTheir micronutrient needs should be met with foods first. Families and caregivers should select a variety of foods from each food group to ensure that nutritional requirements are met. Because children grow rapidly, they require foods that are high in iron, such as lean meats, legumes, fish, poultry, and iron-enriched cereals. Adequate fluoride is crucial to support strong teeth. One of the most important micronutrient requirements during childhood is adequate calcium and vitamin D intake. Both are needed to build dense bones and a strong skeleton. Children who do not consume adequate vitamin D should be given a supplement of 10 micrograms (400 international units) per day.<a href=\"#_ftn39\">[39]<\/a>\n<h3>Feeding Challenges in the Preschool Years<\/h3>\nPicky eating is typical for many preschoolers.\u00a0It\u2019s simply another step in the process of growing up and becoming independent. As long as a preschooler is healthy, growing normally, and has plenty of energy, they are most likely getting the nutrients they need.\n<h4>Typical Picky Eating Behaviors<\/h4>\nMany children will show one or more of the following behaviors during the preschool years. In most cases, these will go away with time.\n<ul>\n \t<li>Refusal of a food based on a certain color or texture. For example, they could refuse foods that are red or green, contain seeds, or are squishy.<\/li>\n \t<li>Only eating a certain type of food. A preschooler may choose 1 or 2 foods they like and refuse to eat anything else.<\/li>\n \t<li>\u201cWasting\u201d of time at the table and seeming interested in doing anything but eating.<\/li>\n \t<li>Unwillingness to try new foods. It is normal for a preschooler to prefer familiar foods and be afraid to try new things.<a href=\"#_ftn40\">[40]<\/a><\/li>\n<\/ul>\n<div class=\"textbox textbox--key-takeaways\"><header class=\"textbox__header\">\n<p class=\"textbox__title\"><strong>Helping Families Cope with Picky Eating<\/strong><\/p>\n\n<\/header>\n<div class=\"textbox__content\">\n\nPicky eating is temporary. If adults don\u2019t make it a big deal, it will usually end before school age. The following tips are tips to help deal with picky eating behavior positively.\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Let your kids be \u201cproduce pickers.\u201d\u00a0Let them pick out fruits and veggies at the store.\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Have your child help you prepare meals.\u00a0Children learn about food and get excited about tasting food when they help make meals. Let them add ingredients, scrub veggies, or help stir.\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Offer choices.\u00a0Rather than ask, \u201cDo you want broccoli for dinner?\u201d ask \u201cWhich would you like for dinner, broccoli or cauliflower?\u201d\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Enjoy each other while eating family meals together.\u00a0Talk about fun and happy things. If meals are times for family arguments, your child may learn unhealthy attitudes toward food.\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Offer the same foods for the whole family.<strong>\u00a0<\/strong>\u00a0Serve the same meal to adults and kids. Let them see you enjoy healthy foods. Talk about the colors, shapes, and textures on the plate.<a href=\"#_ftn41\">[41]<\/a>\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Make food fun\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Cut food into fun and easy shapes with cookie cutters.\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Encourage your child to invent and help prepare new snacks.\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Name a food your child helps create.<a href=\"#_ftn42\">[42]<\/a>\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Focus on the meal and each other. Your child learns by watching you. Children are likely to copy your table manners, your likes and dislikes, and your willingness to try new foods.\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Offer a variety of healthy foods. Let your child choose how much to eat. Children are more likely to enjoy a food when eating it is their own choice.\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Let your children serve themselves. Teach your children to take small amounts at first. Let them know they can get more if they are still hungry.<a href=\"#_ftn43\">[43]<\/a>\n\n<\/div>\n<\/div>\n<h4>Trying New Foods<\/h4>\nIt is normal for children to reject foods they have never tried before. Here are some tips to get preschoolers to try new foods:\n<ul>\n \t<li>Small portions, big benefits<strong>.\u00a0<\/strong>Let children try small portions of new foods that you enjoy. Give them a small taste at first and be patient with them.<\/li>\n \t<li>Offer only one new food at a time and ideally with a favored food. Offering many new foods all at once could be too much for children.<\/li>\n \t<li>Be a good role model.<strong>\u00a0<\/strong>Try new foods yourself. Describe their taste, texture, and smell to the children.<\/li>\n \t<li>Offer new foods first when children are most hungry.<\/li>\n \t<li>Offer new foods many times. It may take up to a dozen tries for a child to accept a new food.<a href=\"#_ftn44\">[44]<\/a><\/li>\n<\/ul>\n<div class=\"textbox textbox--exercises\"><header class=\"textbox__header\">\n<p class=\"textbox__title\"><strong>Pause to Reflect<\/strong><\/p>\n\n<\/header>\n<div class=\"textbox__content\">\n<table style=\"border-collapse: collapse;width: 100%\" border=\"0\">\n<tbody>\n<tr>\n<td style=\"width: 16%\"><img class=\"alignleft size-thumbnail wp-image-89\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/P2R-150x150.png\" alt=\"\" width=\"150\" height=\"150\"><\/td>\n<td style=\"width: 84%\">Think back to your childhood. Were you a picky eater or more adventurous? Why do you think that it was? How did your caregivers respond to your eating preferences? Do you have similar preferences now or have you expanded your tastes\/preferences?<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n<h2>Feeding School-Aged Children<\/h2>\nWhile calorie needs go up as children get older, until around age 9 (or the beginning of puberty), nutritional needs for school-aged children are very similar to preschoolers. Once puberty begins, there is a period of rapid growth as girls grow 2-8 inches and boys grow 4-12 inches.\n<div class=\"textbox textbox--examples\"><header class=\"textbox__header\">\n<p class=\"textbox__title\"><strong>Table 14.2 \u2013 Average Calorie Needs for School-Aged Children <\/strong><a href=\"#_ftn45\"><strong>[45]<\/strong><\/a><\/p>\n\n<\/header>\n<div class=\"textbox__content\">\n<div align=\"center\">[h5p id=\"28\"]<\/div>\n<\/div>\n<\/div>\nSchool-aged children should still get 45-65% of their daily calories from carbohydrates. Carbohydrates high in fiber should make up the bulk of that. Their intake of protein remains at 10\u201330% of their daily calories to support muscle growth and development. And the daily recommendation for fat also remains at 25\u201335% of their daily calories.\n\nA few micronutrients take on added importance, especially at the beginning of puberty. These include vitamins, D, K, and B12, calcium, and iron. Whenever possible these additional micronutrient needs should be met with dietary choices and not supplements (with the exception of iron).<a href=\"#_ftn46\">[46]<\/a>\n<h4>School Meals<\/h4>\nSchool-aged children can often eat both breakfast and lunch at school, which can save families time and provide children with nutritious food.\n<h6>Breakfast<\/h6>\nResearch has shown that children that eat breakfast do better in school and have higher intakes of fiber, B vitamins, calcium, and other nutrients.<a href=\"#_ftn47\">[47]<\/a> Refer to Figure 14.7 to see what a school breakfast includes.\n<h6>Lunch<\/h6>\nLunch is important because it meets 1\/3 of the nutritional needs of most children for the day. And kids with healthier eating patterns have better academic performance. And farm to school programs (in 42% of schools) increase children\u2019s access to locally produced foods.<a href=\"#_ftn48\">[48]<\/a> Refer to Figure 14.8 to see a breakdown of school lunches provide.\n\n[caption id=\"attachment_266\" align=\"aligncenter\" width=\"769\"]<img class=\"size-full wp-image-264\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/14.7.png\" alt=\"Typical school breakfast; fruit, milk, English muffin with egg and ham, hash browns\" width=\"769\" height=\"610\"> Figure 14.7 - School breakfast [49][\/caption][caption id=\"attachment_266\" align=\"aligncenter\" width=\"746\"]<img class=\"size-full wp-image-265\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/14.8.png\" alt=\"Typical school lunch; vegetable soup, sandwich with meat, cheese, tomato and lettuce, cut up fruit and milk\" width=\"746\" height=\"599\"> Figure 14.8 \u2013 School lunch [50][\/caption]\n<h6>Meals and Snacks in School-Aged Care Programs<\/h6>\nOn school days, children that are in care before school may need to be fed breakfast (if they did not eat at home or will not be eating at school). After school, they will need substantial, healthy snacks. On full days of care, they will need breakfast, lunch, and a snack.\n\nFollow the menu planning advice in Chapter 15. And involve the children in menu planning and food preparation whenever possible and see which of the suggestions in the following feature for families might also be incorporated into the classroom.\n\n<em>Figure 14.9 \u2013 These 9-year-olds learned the knife skills to help prepare this snack of fruit.<\/em><a href=\"#_ftn51\">[51]<\/a>\n<div class=\"textbox textbox--key-takeaways\"><header class=\"textbox__header\">Activities Families Can Do with Children<\/header>\n<div class=\"textbox__content\">\n<table>\n<tbody>\n<tr>\n<td>Choosemyplate.gov offers some fun ideas for families to teach their children about healthy eating and engage the whole family in making healthy choices. Some of these include:\n<ul>\n \t<li>Food critic game where children select a new food to try and rate it on visual appeal, smell, taste, and texture<a href=\"#_ftn52\">[52]<\/a><\/li>\n \t<li>Grocery store bingo where children identify foods they see in the grocery store to try to get a 5 in a row bingo<a href=\"#_ftn53\">[53]<\/a><\/li>\n \t<li>Make food visually appealing by turning it into art<\/li>\n \t<li>Kid\u2019s Restaurant: Kids get to plan out the meal, design the menu, and prepare the dish<\/li>\n \t<li>Growing a garden (or starting small with an herb box in a window)<\/li>\n \t<li>Going to a local farmer\u2019s market or farm stand to find local food options to buy, take home, and turn into a delicious meal.<\/li>\n<\/ul>\n<strong>Making Mealtimes Fun<\/strong>\n<ul>\n \t<li>Here are some tips for families for making mealtimes more relaxed and enjoyable:<\/li>\n \t<li>Remove distractions, such as phones, tablets, and turn off the television.<\/li>\n \t<li>Have conversations. Use starters like:<\/li>\n \t<li>Give each family member the spotlight to share their highlight, lowlight, and \u201cfunnylight\u201d<\/li>\n \t<li>If our family lived in a zoo, what animals would we be and why?<\/li>\n \t<li>If you could have one superpower, what would it be and why?<\/li>\n \t<li>If you were stranded on a desert island and could only have one food to eat, what would it be and why?<\/li>\n \t<li>Pass on traditions, both the foods and the stories behind them<\/li>\n \t<li>Let the children make the choices (from a healthy selection of foods)<\/li>\n \t<li>Let everyone help prepare and clean up after meals<\/li>\n \t<li>Consider a change of scenery, like a picnic<\/li>\n \t<li>Reserve a special plate to rotate between family members, for example on birthdays, when someone gets a good grade, or any other occasion you\u2019d like to recognize.<a href=\"#_ftn54\">[54]<\/a><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n&nbsp;\n\n<\/div>\n<\/div>\n<h2>Feeding Children with Special Needs<\/h2>\nSome disabilities and other exceptional needs may affect children\u2019s nutrition. For example,\n<ul>\n \t<li>children with cerebral palsy or cystic fibrosis may have different caloric needs<\/li>\n \t<li>children with celiac disease or irritable bowel syndrome may have dietary restrictions<\/li>\n \t<li>children with cleft lip or palate may have physical difficulties with eating<\/li>\n \t<li>children on the autism spectrum may have strong food preferences or aversions<\/li>\n<\/ul>\n[caption id=\"attachment_266\" align=\"aligncenter\" width=\"300\"]<img class=\"size-medium wp-image-266\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/14.10-300x258.jpg\" alt=\"Infant with a cleft lip (opening in the top lip) that makes it difficult to suck on a bottle\" width=\"300\" height=\"258\"> Figure 14.10 \u2013 This child with a cleft lip may find sucking from a bottle challenging. [55][\/caption]Because each child\u2019s specific needs will vary, early care and education programs should work closely with families, and medical providers as needed, to ensure that they understand and can meet the nutritional and feeding needs of the individual child (not a generalization or assumption about the child might need based on a diagnosis or label).\n\nNutrition policies and practices should be created to be inclusive of children with special needs. Some general considerations early care and education programs and schools should make to ensure that all children\u2019s nutritional needs are met and that all children experience positive meal and snack times include:\n<ul>\n \t<li>Ensure that the spaces in which children eat and access to drinking water are fully accessible to all children, including those with mobility impairments (and if needed, assistive devices should be provided).<\/li>\n \t<li>Staff should be trained to provide for children who may have additional or differing nutritional or feeding needs so they can work effectively and comfortably with all children.<\/li>\n \t<li>Follow any dietary restrictions.<a href=\"#_ftn56\">[56]<\/a><\/li>\n<\/ul>\n<h2>Summary<\/h2>\nEarly care and education programs can provide for all children\u2019s nutrition when they understand\n<ul>\n \t<li>the general changes children have in nutritional needs as they mature,<\/li>\n \t<li>common challenges across the different stages of development, and<\/li>\n \t<li>strategies that foster positive meal and snack times at each age stage, and<\/li>\n \t<li>the fact that children may have diverse and unique nutritional needs<\/li>\n<\/ul>\nPrograms also play an important role in children\u2019s nutrition by empowering families by providing support, information, and resources as they make decisions about how to feed their children.\n<div class=\"textbox textbox--exercises\"><header class=\"textbox__header\">\n<p class=\"textbox__title\">Chapter 14 Review<\/p>\n\n<\/header>\n<div class=\"textbox__content\">\n<p style=\"text-align: center\">[h5p id=\"29\"]<\/p>\n\n<\/div>\n<\/div>\n<div class=\"textbox shaded\">\n\n<strong>Resources for Further Exploration<\/strong>\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/sites\/default\/files\/pdf\/growing-healthy-flipchart.pdf\">Head Starts\u2019 <em>Growing Healthy<\/em> guide<\/a>: https:\/\/eclkc.ohs.acf.hhs.gov\/sites\/default\/files\/pdf\/growing-healthy-flipchart.pdf\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <a href=\"https:\/\/www.ellynsatterinstitute.org\/how-to-feed\/child-feeding-ages-and-stages\/\">Ellyn Satter Institute<\/a>: https:\/\/www.ellynsatterinstitute.org\/how-to-feed\/child-feeding-ages-and-stages\/\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/sites\/default\/files\/pdf\/breastfeeding-why-not-give-it-a-try-eng.pdf\">USDA\u2019s <em>Breastfeeding: Why Not Give It a Try?<\/em><\/a>: https:\/\/eclkc.ohs.acf.hhs.gov\/sites\/default\/files\/pdf\/breastfeeding-why-not-give-it-a-try-eng.pdf\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <a href=\"https:\/\/www.nal.usda.gov\/sites\/default\/files\/fnic_uploads\/toddler.pdf\">Toddler Nutrition and Health Resource List:<\/a> https:\/\/www.nal.usda.gov\/sites\/default\/files\/fnic_uploads\/\/toddler.pdf\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Resources on MyPlate.gov:\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <a href=\"https:\/\/choosemyplate-prod.azureedge.net\/sites\/default\/files\/audiences\/HealthyEatingForPreschoolers-MiniPoster.pdf\">Daily Food Plan<\/a>: https:\/\/choosemyplate-prod.azureedge.net\/sites\/default\/files\/audiences\/HealthyEatingForPreschoolers-MiniPoster.pdf\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <a href=\"https:\/\/www.choosemyplate.gov\/browse-by-audience\/view-all-audiences\/children\/health-and-nutrition-information\">Preschoolers<\/a>: https:\/\/www.choosemyplate.gov\/browse-by-audience\/view-all-audiences\/children\/health-and-nutrition-information\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <a href=\"https:\/\/www.choosemyplate.gov\/browse-by-audience\/view-all-audiences\/children\/kids\">Kids<\/a>: <a href=\"https:\/\/www.choosemyplate.gov\/browse-by-audience\/view-all-audiences\/children\/kids\">https:\/\/www.choosemyplate.gov\/browse-by-audience\/view-all-audiences\/children\/kids<\/a>\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <a href=\"https:\/\/cchp.ucsf.edu\/content\/healthy-beverages-early-care-education\">Healthy Beverages in Early Care and Education<\/a>: https:\/\/cchp.ucsf.edu\/content\/healthy-beverages-early-care-education\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <a href=\"https:\/\/www.cdc.gov\/breastfeeding\/resources\/toolkits.html\"><em>The CDC Guide to Strategies to Support Breastfeeding Mothers and Babies<\/em><\/a>: https:\/\/www.cdc.gov\/breastfeeding\/resources\/toolkits.html\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <a href=\"https:\/\/kidshealth.org\/en\/parents\/nutrition-center\/?WT.ac=p-nav-nutrition-center\">KidsHealth From Nemours Nutrition &amp; Fitness Center<\/a>: https:\/\/kidshealth.org\/en\/parents\/nutrition-center\/?WT.ac=p-nav-nutrition-center\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <a href=\"https:\/\/www.fns.usda.gov\/accommodating-children-special-dietary-needs-school-nutrition-programs\">USDA\u2019s <em>Accommodating Children with Special Dietary Needs in the School Nutrition Programs<\/em><\/a>: https:\/\/www.fns.usda.gov\/accommodating-children-special-dietary-needs-school-nutrition-programs\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <a href=\"https:\/\/www.nal.usda.gov\/fnic\/curricula-and-lesson-plans\">USDA\u2019s <em>Nutrition Curricula<\/em><\/a>: https:\/\/www.nal.usda.gov\/fnic\/curricula-and-lesson-plans\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <a href=\"https:\/\/www.urmc.rochester.edu\/childrens-hospital\/nutrition\/diets.aspx\">Golisano Children's Hospital\u2019s <em>Special Diets for Nutritional Special Needs<\/em><\/a>: <a href=\"https:\/\/www.urmc.rochester.edu\/childrens-hospital\/nutrition\/diets.aspx\">https:\/\/www.urmc.rochester.edu\/childrens-hospital\/nutrition\/diets.aspx<\/a>\n\n<\/div>\n&nbsp;\n\n&nbsp;\n<div class=\"textbox textbox--exercises\"><header class=\"textbox__header\">\n<p class=\"textbox__title\">Chapter 14 Workbook<\/p>\n\n<\/header>\n<div class=\"textbox__content\">\n\n[h5p id=\"30\"]\n\n<\/div>\n<\/div>\n&nbsp;\n<h5>References:<\/h5>\n<div>\n<div>\n\n<a href=\"#_ftnref1\">[1]<\/a> <a href=\"http:\/\/pressbooks.oer.hawaii.edu\/humannutrition\/chapter\/infancy\/\">Human Nutrition<\/a> by <a href=\"https:\/\/cms.ctahr.hawaii.edu\/hnfas\/Undergraduate\/Food-Sciences-Human-Nutrition\/Culinology\">University of Hawai\u2018i at M\u0101noa Food Science and Human Nutrition Program<\/a> is licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a>\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref2\">[2]<\/a> <a href=\"http:\/\/pressbooks.oer.hawaii.edu\/humannutrition\/chapter\/infancy\/\">Human Nutrition<\/a> by <a href=\"https:\/\/cms.ctahr.hawaii.edu\/hnfas\/Undergraduate\/Food-Sciences-Human-Nutrition\/Culinology\">University of Hawai\u2018i at M\u0101noa Food Science and Human Nutrition Program<\/a> is licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a>\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref3\">[3]<\/a> <a href=\"http:\/\/pressbooks.oer.hawaii.edu\/humannutrition\/chapter\/infancy\/\">Human Nutrition<\/a> by <a href=\"https:\/\/cms.ctahr.hawaii.edu\/hnfas\/Undergraduate\/Food-Sciences-Human-Nutrition\/Culinology\">University of Hawai\u2018i at M\u0101noa Food Science and Human Nutrition Program<\/a> is licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a>\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref4\">[4]<\/a> <a href=\"http:\/\/pressbooks.oer.hawaii.edu\/humannutrition\/chapter\/infancy\/\">Human Nutrition<\/a> by <a href=\"https:\/\/cms.ctahr.hawaii.edu\/hnfas\/Undergraduate\/Food-Sciences-Human-Nutrition\/Culinology\">University of Hawai\u2018i at M\u0101noa Food Science and Human Nutrition Program<\/a> is licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a>\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref5\">[5]<\/a> <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/nutrition\/article\/important-role-staff-breastfeeding-education-support\">The Important Role of Staff in Breastfeeding Education and Support<\/a> by <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/\">Head Start Early Childhood Learning &amp; Knowledge Center<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref6\">[6]<\/a> <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/sites\/default\/files\/pdf\/breastfed-babies-childcare.pdf\">Breastfed Babies Welcome Here!<\/a> by the <a href=\"https:\/\/www.fns.usda.gov\/\">USDA Food and Nutrition Service<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref7\">[7]<\/a> <a href=\"https:\/\/www.nellis.af.mil\/News\/Art\/igphoto\/2000182917\/\">Nellis Child Development Center II<\/a> by Staff Sgt. Taylor Worley (USAF) is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref8\">[8]<\/a> <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/sites\/default\/files\/pdf\/breastfed-babies-childcare.pdf\">Breastfed Babies Welcome Here!<\/a> by the <a href=\"https:\/\/www.fns.usda.gov\/\">USDA Food and Nutrition Service<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref9\">[9]<\/a> <a href=\"http:\/\/pressbooks.oer.hawaii.edu\/humannutrition\/chapter\/infancy\/\">Human Nutrition<\/a> by <a href=\"https:\/\/cms.ctahr.hawaii.edu\/hnfas\/Undergraduate\/Food-Sciences-Human-Nutrition\/Culinology\">University of Hawai\u2018i at M\u0101noa Food Science and Human Nutrition Program<\/a> is licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a>\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref10\">[10]<\/a> <a href=\"https:\/\/pixabay.com\/id\/photos\/bayi-muda-orang-orang-mewah-472923\/\">Image<\/a> by <a href=\"https:\/\/pixabay.com\/id\/users\/ben_kerckx-69781\/\">Ben Kerckx<\/a> on <a href=\"https:\/\/pixabay.com\/id\/service\/license\/\">Pixabay<\/a>\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref11\">[11]<\/a> <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/sites\/default\/files\/pdf\/breastfed-babies-childcare.pdf\">Breastfed Babies Welcome Here!<\/a> by the <a href=\"https:\/\/www.fns.usda.gov\/\">USDA Food and Nutrition Service<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref12\">[12]<\/a> <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/sites\/default\/files\/pdf\/no-search\/healthy-feeding-start.pdf\">Healthy Feeding from the Start: A Resource for Expectant Families<\/a> by the <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/about-us\/article\/national-center-early-childhood-health-wellness-ncechw\">National Center on Early Childhood Health and Wellness<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref13\">[13]<\/a> <a href=\"http:\/\/pressbooks.oer.hawaii.edu\/humannutrition\/chapter\/infancy\/\">Human Nutrition<\/a> by <a href=\"https:\/\/cms.ctahr.hawaii.edu\/hnfas\/Undergraduate\/Food-Sciences-Human-Nutrition\/Culinology\">University of Hawai\u2018i at M\u0101noa Food Science and Human Nutrition Program<\/a> is licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a>\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref14\">[14]<\/a> <a href=\"http:\/\/pressbooks.oer.hawaii.edu\/humannutrition\/chapter\/infancy\/\">Human Nutrition<\/a> by <a href=\"https:\/\/cms.ctahr.hawaii.edu\/hnfas\/Undergraduate\/Food-Sciences-Human-Nutrition\/Culinology\">University of Hawai\u2018i at M\u0101noa Food Science and Human Nutrition Program<\/a> is licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a>\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref15\">[15]<\/a> <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/safety-practices\/article\/tips-keeping-infants-toddlers-safe-developmental-guide-home-visitors-mobile-infants\">Tips for Keeping Infants and Toddlers Safe: A Developmental Guide for Home Visitors \u2013 Mobile Infants<\/a> by <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/ncecdtl\">Early Head Start National Resource Center<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref16\">[16]<\/a> <a href=\"http:\/\/conditions.health.qld.gov.au\/HealthCondition\/condition\/8\/78\/412\/introducing-solids-feeding-from-around-6-mont\">Introducing Complementary Foods: Feeding from Around 6 Months<\/a> by <a href=\"https:\/\/www.qld.gov.au\/\">Queensland Government <\/a>is licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a>\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref17\">[17]<\/a> <a href=\"http:\/\/pressbooks.oer.hawaii.edu\/humannutrition\/chapter\/infancy\/\">Human Nutrition<\/a> by <a href=\"https:\/\/cms.ctahr.hawaii.edu\/hnfas\/Undergraduate\/Food-Sciences-Human-Nutrition\/Culinology\">University of Hawai\u2018i at M\u0101noa Food Science and Human Nutrition Program<\/a> is licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a>\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref18\">[18]<\/a> <a href=\"https:\/\/medlineplus.gov\/ency\/patientinstructions\/000713.htm\">Feeding Patterns and Diet - Children 6 Months to 2 Years<\/a> by <a href=\"https:\/\/medlineplus.gov\/\">MedlinePlus<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref19\">[19]<\/a> <a href=\"http:\/\/pressbooks.oer.hawaii.edu\/humannutrition\/chapter\/infancy\/\">Human Nutrition<\/a> by <a href=\"https:\/\/cms.ctahr.hawaii.edu\/hnfas\/Undergraduate\/Food-Sciences-Human-Nutrition\/Culinology\">University of Hawai\u2018i at M\u0101noa Food Science and Human Nutrition Program<\/a> is licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a>\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref20\">[20]<\/a> <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/safety-practices\/article\/tips-keeping-infants-toddlers-safe-developmental-guide-home-visitors-mobile-infants\">Tips for Keeping Infants and Toddlers Safe: A Developmental Guide for Home Visitors \u2013 Mobile Infants<\/a> by <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/ncecdtl\">Early Head Start National Resource Center<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref21\">[21]<\/a> <a href=\"https:\/\/medlineplus.gov\/ency\/patientinstructions\/000713.htm\">Feeding Patterns and Diet - Children 6 Months to 2 Years<\/a> by <a href=\"https:\/\/medlineplus.gov\/\">MedlinePlus<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref22\">[22]<\/a> <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/safety-practices\/article\/tips-keeping-infants-toddlers-safe-developmental-guide-home-visitors-mobile-infants\">Tips for Keeping Infants and Toddlers Safe: A Developmental Guide for Home Visitors \u2013 Mobile Infants<\/a> by <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/ncecdtl\">Early Head Start National Resource Center<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref23\">[23]<\/a> <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/sites\/default\/files\/pdf\/growing-healthy-flipchart.pdf\">Image<\/a> by the <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/about-us\/article\/national-center-early-childhood-health-wellness-ncechw\">National Center on Early Childhood Health and Wellness<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref24\">[24]<\/a> <a href=\"http:\/\/pressbooks.oer.hawaii.edu\/humannutrition\/chapter\/infancy\/\">Human Nutrition<\/a> by <a href=\"https:\/\/cms.ctahr.hawaii.edu\/hnfas\/Undergraduate\/Food-Sciences-Human-Nutrition\/Culinology\">University of Hawai\u2018i at M\u0101noa Food Science and Human Nutrition Program<\/a> is licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a>\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref25\">[25]<\/a> <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/sites\/default\/files\/pdf\/growing-healthy-flipchart.pdf\">Growing Healthy<\/a> by the <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/about-us\/article\/national-center-early-childhood-health-wellness-ncechw\">National Center on Early Childhood Health and Wellness<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref26\">[26]<\/a> <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/sites\/default\/files\/pdf\/growing-healthy-flipchart.pdf\">Growing Healthy<\/a> by the <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/about-us\/article\/national-center-early-childhood-health-wellness-ncechw\">National Center on Early Childhood Health and Wellness<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref27\">[27]<\/a> <a href=\"https:\/\/medlineplus.gov\/infantandnewbornnutrition.html\">Infant and Newborn Nutrition<\/a> by <a href=\"https:\/\/medlineplus.gov\/\">MedlinePlus<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref28\">[28]<\/a> <a href=\"https:\/\/medlineplus.gov\/ency\/patientinstructions\/000713.htm\">Feeding Patterns and Diet - Children 6 Months to 2 Years<\/a> by <a href=\"https:\/\/medlineplus.gov\/\">MedlinePlus<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref29\">[29]<\/a> <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/sites\/default\/files\/pdf\/growing-healthy-flipchart.pdf\">Growing Healthy<\/a> by the <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/about-us\/article\/national-center-early-childhood-health-wellness-ncechw\">National Center on Early Childhood Health and Wellness<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref30\">[30]<\/a> <a href=\"http:\/\/pressbooks.oer.hawaii.edu\/humannutrition\/chapter\/toddler-years\/\">Human Nutrition<\/a> by <a href=\"https:\/\/cms.ctahr.hawaii.edu\/hnfas\/Undergraduate\/Food-Sciences-Human-Nutrition\/Culinology\">University of Hawai\u2018i at M\u0101noa Food Science and Human Nutrition Program<\/a> is licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a>\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref31\">[31]<\/a> <a href=\"http:\/\/pressbooks.oer.hawaii.edu\/humannutrition\/chapter\/toddler-years\/\">Human Nutrition<\/a> by <a href=\"https:\/\/cms.ctahr.hawaii.edu\/hnfas\/Undergraduate\/Food-Sciences-Human-Nutrition\/Culinology\">University of Hawai\u2018i at M\u0101noa Food Science and Human Nutrition Program<\/a> is licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a>\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref32\">[32]<\/a> <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/sites\/default\/files\/pdf\/growing-healthy-flipchart.pdf\">Image<\/a> by the <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/about-us\/article\/national-center-early-childhood-health-wellness-ncechw\">National Center on Early Childhood Health and Wellness<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref33\">[33]<\/a> <a href=\"http:\/\/pressbooks.oer.hawaii.edu\/humannutrition\/chapter\/toddler-years\/\">Human Nutrition<\/a> by <a href=\"https:\/\/cms.ctahr.hawaii.edu\/hnfas\/Undergraduate\/Food-Sciences-Human-Nutrition\/Culinology\">University of Hawai\u2018i at M\u0101noa Food Science and Human Nutrition Program<\/a> is licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a>\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref34\">[34]<\/a> <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/sites\/default\/files\/pdf\/nch-feeding-toddler.pdf\">Feeding Your Toddler<\/a> by <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/\">Head Start Early Childhood Learning &amp; Knowledge Center<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref35\">[35]<\/a> <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/sites\/default\/files\/pdf\/nch-feeding-toddler.pdf\">Feeding Your Toddler<\/a> by <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/\">Head Start Early Childhood Learning &amp; Knowledge Center<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref36\">[36]<\/a> <a href=\"http:\/\/pressbooks.oer.hawaii.edu\/humannutrition\/chapter\/introduction-15\/\">Human Nutrition<\/a> by <a href=\"https:\/\/cms.ctahr.hawaii.edu\/hnfas\/Undergraduate\/Food-Sciences-Human-Nutrition\/Culinology\">University of Hawai\u2018i at M\u0101noa Food Science and Human Nutrition Program<\/a> is licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a>\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref37\">[37]<\/a> <a href=\"https:\/\/www.usda.gov\/media\/blog\/2016\/07\/22\/serving-spoons-and-healthy-habits-encouraging-positive-mealtimes-and\">Serving Spoons and Healthy Habits<\/a> by Mallory Feeney is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref38\">[38]<\/a> <a href=\"https:\/\/www.choosemyplate.gov\/browse-by-audience\/view-all-audiences\/children\/health-and-nutrition-information\/how-much-does-my-preschooler-need\">How Much Does My Preschooler Need?<\/a> by the <a href=\"https:\/\/www.fns.usda.gov\/cnpp\">USDA Center for Nutrition Policy and Promotion<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref39\">[39]<\/a> <a href=\"http:\/\/pressbooks.oer.hawaii.edu\/humannutrition\/chapter\/childhood\/\">Human Nutrition<\/a> by <a href=\"https:\/\/cms.ctahr.hawaii.edu\/hnfas\/Undergraduate\/Food-Sciences-Human-Nutrition\/Culinology\">University of Hawai\u2018i at M\u0101noa Food Science and Human Nutrition Program<\/a> is licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a>\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref40\">[40]<\/a> <a href=\"https:\/\/www.choosemyplate.gov\/browse-by-audience\/view-all-audiences\/children\/health-and-nutrition-information\/preschoolers-picky-eating\">Tips for Picky Eaters<\/a> by the <a href=\"https:\/\/www.fns.usda.gov\/cnpp\">USDA Center for Nutrition Policy and Promotion<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref41\">[41]<\/a> <a href=\"https:\/\/www.choosemyplate.gov\/browse-by-audience\/view-all-audiences\/children\/health-and-nutrition-information\/preschoolers-picky-eating\">Tips for Picky Eaters<\/a> by the <a href=\"https:\/\/www.fns.usda.gov\/cnpp\">USDA Center for Nutrition Policy and Promotion<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref42\">[42]<\/a> <a href=\"https:\/\/choosemyplate-prod.azureedge.net\/sites\/default\/files\/printablematerials\/HealthyTipsforPickyEaters_031418_508.pdf\">Healthy Tips for Picky Eaters<\/a> by the <a href=\"https:\/\/www.fns.usda.gov\/cnpp\">USDA Center for Nutrition Policy and Promotion<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref43\">[43]<\/a> <a href=\"https:\/\/choosemyplate-prod.azureedge.net\/sites\/default\/files\/audiences\/HealthyEatingForPreschoolers-MiniPoster.pdf\">Healthy Eating for Preschoolers<\/a> by the <a href=\"https:\/\/www.fns.usda.gov\/cnpp\">USDA Center for Nutrition Policy and Promotion<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref44\">[44]<\/a> <a href=\"https:\/\/www.choosemyplate.gov\/browse-by-audience\/view-all-audiences\/children\/health-and-nutrition-information\/preschoolers-picky-eating\">Tips for Picky Eaters<\/a> by the <a href=\"https:\/\/www.fns.usda.gov\/cnpp\">USDA Center for Nutrition Policy and Promotion<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref45\">[45]<\/a> Dietary Guidelines for Americans 2015\u20132020 Appendix 2. Estimated Calorie Needs per Day, by Age, Sex, and Physical Activity Level by the <a href=\"https:\/\/health.gov\/\">Office of Disease Prevention and Health Promotion<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref46\">[46]<\/a> <a href=\"http:\/\/pressbooks.oer.hawaii.edu\/humannutrition\/chapter\/adolescence\/\">Human Nutrition<\/a> by <a href=\"https:\/\/cms.ctahr.hawaii.edu\/hnfas\/Undergraduate\/Food-Sciences-Human-Nutrition\/Culinology\">University of Hawai\u2018i at M\u0101noa Food Science and Human Nutrition Program<\/a> is licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a>\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref47\">[47]<\/a> MyPlate Guide to School Breakfast for Families by the <a href=\"https:\/\/www.fns.usda.gov\/cnpp\">USDA Center for Nutrition Policy and Promotion<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref48\">[48]<\/a> MyPlate Guide to School Breakfast for Families by the <a href=\"https:\/\/www.fns.usda.gov\/cnpp\">USDA Center for Nutrition Policy and Promotion<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref49\">[49]<\/a> Image by the <a href=\"https:\/\/www.fns.usda.gov\/cnpp\">USDA Center for Nutrition Policy and Promotion<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref50\">[50]<\/a> <a href=\"https:\/\/fns-prod.azureedge.net\/sites\/default\/files\/tn\/SL_Infographic_81216a.pdf\">Image<\/a> by the <a href=\"https:\/\/www.fns.usda.gov\/cnpp\">USDA Center for Nutrition Policy and Promotion<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref51\">[51]<\/a> <a href=\"https:\/\/www.schriever.af.mil\/News\/Photos\/igphoto\/2002158312\/\">Schriever Children Learn New Skills at Cooking Camp<\/a> by 2nd Lt. Idal\u00ed Beltr\u00e9 Acevedo (USAF) is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref52\">[52]<\/a> <a href=\"https:\/\/choosemyplate-prod.azureedge.net\/sites\/default\/files\/printablematerials\/Food_Critic_508.pdf\">Kids Food Critic Activity<\/a> by the <a href=\"https:\/\/www.fns.usda.gov\/cnpp\">USDA Center for Nutrition Policy and Promotion<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref53\">[53]<\/a> <a href=\"https:\/\/choosemyplate-prod.azureedge.net\/sites\/default\/files\/printablematerials\/Bingo_508.pdf\">MyPlate Grocery Store Bingo<\/a> by the <a href=\"https:\/\/www.fns.usda.gov\/cnpp\">USDA Center for Nutrition Policy and Promotion<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref54\">[54]<\/a> <a href=\"https:\/\/www.choosemyplate.gov\/browse-by-audience\/view-all-audiences\/families\">MyPlate, MyWins for Families<\/a> by the <a href=\"https:\/\/www.fns.usda.gov\/cnpp\">USDA Center for Nutrition Policy and Promotion<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref55\">[55]<\/a> <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Cleft_Nurser_Mead_Johnson.jpg\">Cleft Nurser Mead Johnson<\/a> by <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Cleft_Nurser_Mead_Johnson.jpg\">King97tut<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref56\">[56]<\/a> <a href=\"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2016.00045\/full\">Are School Feeding Programs Prepared to Be Inclusive of Children with Disabilities?<\/a> by <a href=\"https:\/\/loop.frontiersin.org\/people\/263458\/overview\">Sergio Meresman<\/a> and <a href=\"https:\/\/loop.frontiersin.org\/people\/164169\/overview\">Lesley Drake<\/a> is licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a>\n\n<\/div>\n<\/div>","rendered":"<div class=\"textbox textbox--learning-objectives\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\">Chapter 14 Learning Objectives<\/p>\n<\/header>\n<div class=\"textbox__content\">\n<p>By the end of this chapter, you should be able to:<\/p>\n<ul>\n<li>Describe the changes in nutritional needs as children mature (get older).<\/li>\n<li>Advocate for the support of breastfeeding mothers.<\/li>\n<li>Relate bottle-feeding practices.<\/li>\n<li>Discuss the transition to solid foods and self-feeding.<\/li>\n<li>Summarize feeding challenges for toddlers.<\/li>\n<li>Explain effective ways to respond to picky eating.<\/li>\n<li>Outline the importance of inclusive nutrition policies and practices.<\/li>\n<li>Identify how to support children with unique nutritional and feeding needs.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<h2>Introduction<\/h2>\n<p>To provide all children the appropriate nutrition, it is important to understand how nutritional needs and feeding practices change as children mature. Children with special needs may have different nutritional and feedings needs. Working with families and medical providers, programs can ensure that they meet each and every child\u2019s needs. Early care and education programs can also support and empower families to provide the best nutrition to their children.<\/p>\n<h2>Feeding Infants<\/h2>\n<p>Requirements for macronutrients and micronutrients on a per-kilogram basis are higher during infancy than at any other stage in the human life cycle. See the average calorie needs for infants in Table 14.1. An infants\u2019 resting metabolic rate is two times that of an adult. These needs are affected by the rapid cell division that occurs during growth, which requires energy and protein, along with the nutrients that are involved in DNA synthesis.<a href=\"#_ftn1\">[1]<\/a><\/p>\n<p>&nbsp;<\/p>\n<div style=\"text-align: left; margin: auto;\">\n<div class=\"textbox textbox--examples\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\"><strong>Table 14.1 \u2013 Average Calorie Needs for Infants<\/strong> <a href=\"#_ftn2\"><strong>[2]<\/strong><\/a><\/p>\n<\/header>\n<div class=\"textbox__content\">\n<table class=\"grid landscape\">\n<thead>\n<tr>\n<td><strong>Sex\/Age<\/strong><\/td>\n<td><strong>Calories<\/strong><\/td>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td>Boys (0-6 months)<\/td>\n<td>472-645 calories<\/td>\n<\/tr>\n<tr>\n<td>Girls (0-6 months)<\/td>\n<td>438-593 calories<\/td>\n<\/tr>\n<tr>\n<td>Boys (6-12 months)<\/td>\n<td>645-844 calories<\/td>\n<\/tr>\n<tr>\n<td>Girls (6-12 months)<\/td>\n<td>593-768 calories<\/td>\n<\/tr>\n<tr>\n<td>Boys (1-2 years)<\/td>\n<td>844-1,050 calories<\/td>\n<\/tr>\n<tr>\n<td>Girls (1-2 years)<\/td>\n<td>768-997 calories<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n<p><span style=\"text-align: initial;font-size: 1em\">During this period, children are entirely dependent on their parents and other caregivers to meet these needs. For almost all infants six months or younger, breast milk is the best source to fulfill nutritional requirements. An infant may require feedings eight to twelve times a day or more in the beginning. After six months, infants can gradually begin to consume solid foods to help meet nutrient needs.<\/span><\/p>\n<\/div>\n<p>How often an infant wants to eat will also change over time due to growth spurts, which typically occur at about two weeks and six weeks of age, and again at about three months and six months of age.<a href=\"#_ftn3\">[3]<\/a><\/p>\n<h4>Breastfeeding<\/h4>\n<p>The dietary recommendations for infants are based on the nutritional content of human breast milk. Carbohydrates make up about 45 to 65 percent of the caloric content in breast milk. Protein makes up about 5 to 20 percent of the caloric content of breast milk. About 30 to 40 percent of the caloric content in breast milk is made up of fat. A diet in high unsaturated fat is necessary to encourage the development of neural pathways in the brain and other parts of the body.<\/p>\n<p>Almost all of the nutrients that infants require can be met if they consume an adequate amount of breast milk. There are a few exceptions, though. Human milk is low in vitamin D, which is needed for calcium absorption and building bone, among other things. Breast milk is also low in vitamin K, which is required for blood clotting, and deficits could lead to bleeding or hemorrhagic disease. Infants are born with limited vitamin K, so supplementation may be needed initially and some states require a vitamin K injection after birth. Also, breast milk is not high in iron, but the iron in breast milk is well absorbed by infants. After four to six months, however, an infant needs an additional source of iron other than breast milk. Therefore, breastfed children often need to take a vitamin D supplement in the form of drops. <a href=\"#_ftn4\">[4]<\/a><\/p>\n<div class=\"textbox textbox--key-takeaways\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\"><strong>Supporting Breastfeeding in Early Care and Education<\/strong><\/p>\n<\/header>\n<div class=\"textbox__content\">\n<p>Early care and education programs play an important role in supporting breastfeeding All staff members\u2014despite their comfort or experience with breastfeeding\u2014play an\u00a0important role in breastfeeding promotion. They have an opportunity to share the facts about breastfeeding with families, and to help them decide what&#8217;s best for them and their babies.<a href=\"#_ftn5\">[5]<\/a><\/p>\n<p>You can support breastfeeding mothers when you:<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Talk about why breastfeeding is so good for their infant.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Tell them you want to care for breastfed infants and support breastfeeding mothers.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Share other places in the community they can go to for help with breastfeeding.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Share and discuss resources about breastfeeding.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Try to time feedings to the mother\u2019s schedule (being sure to respond to the infant\u2019s needs and cues).<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Offer a place to nurse that is comfortable, quiet, and private.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Communicate about their infant\u2019s day.<a href=\"#_ftn6\">[6]<\/a><\/p>\n<\/div>\n<\/div>\n<figure id=\"attachment_266\" aria-describedby=\"caption-attachment-266\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-258\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2021\/11\/14.1-300x200.jpg\" alt=\"Rocking chair in a quiet spot with supplies nearby\" width=\"300\" height=\"200\" srcset=\"https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2021\/11\/14.1-300x200.jpg 300w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2021\/11\/14.1-65x43.jpg 65w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2021\/11\/14.1-225x150.jpg 225w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2021\/11\/14.1-350x234.jpg 350w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2021\/11\/14.1.jpg 664w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-266\" class=\"wp-caption-text\">Figure 14.1 \u2013 This child care center provides mothers a space to breastfeed. [7]<\/figcaption><\/figure>\n<h3>Feeding with Breastmilk in Early Care and Education Programs<\/h3>\n<p>Mothers may choose to have their breastfed infants fed in one of several ways when the infant is in child care including:<\/p>\n<ol>\n<li>mother uses her breaks to come to the child care site at feeding times to nurse her infant;<\/li>\n<li>child care provider gives the infant the breastmilk that the mother has expressed on a previous day.<\/li>\n<\/ol>\n<p>Follow the feeding method that the mother chooses. Feeding advice such as the use of infant formula should come from the infant&#8217;s doctor or clinic.<\/p>\n<p>Expressed breastmilk needs to be stored and handled safely to keep it from spoiling. Remind mothers to label, date, and chill or refrigerate their breastmilk right after they express it. Ask mothers to bring the milk in hard plastic bottles.<\/p>\n<p>Ask mothers to bring in enough breastmilk to feed the infant each day. Be sure that each bottle or other container of breastmilk is labeled with the infant&#8217;s name and the date the milk was expressed. Bottles should have just the amount both you and the mother think the infant will take at each feeding. This amount will be about 2 to 4 ounces of breastmilk for the younger infant. As the infant gets older, the mother can put more breastmilk in each bottle. Keep breastmilk in the refrigerator or freezer until ready to use. Breastmilk that is not frozen, should be disposed of if not eaten within 72 hours.<\/p>\n<p>Thaw frozen breastmilk by running the container under cool water. Do not set breastmilk out to thaw at room temperature. Do not thaw breastmilk by heating on the stove or in a microwave.<a href=\"#_ftn8\">[8]<\/a> See below for instructions on how to bottle feed an infant.<\/p>\n<p>Although breast milk is ideal for almost all infants, not all mothers will be able to breastfeed and some mothers should not breastfeed (including women with HIV, who are being treated for cancer, or who are taking drugs that are not safe while breastfeeding).<\/p>\n<h4>Formula Feeding<\/h4>\n<p>Infant formula provides a balance of nutrients. However, not all formulas are the same and there are important considerations that parents and caregivers must weigh. Standard formulas use cow\u2019s milk as a base. They have 20 calories per fluid ounce, similar to breast milk, with vitamins and minerals added. Soy-based formulas are usually given to infants who develop diarrhea, constipation, vomiting, colic, or abdominal pain, or to infants with a cow\u2019s milk protein allergy. Hypoallergenic protein hydrolysate formulas are usually given to infants who are allergic to cow\u2019s milk and soy protein. This type of formula uses hydrolyzed protein, meaning that the protein is broken down into amino acids and small peptides, which makes it easier to digest.<\/p>\n<p>Infant formula comes in three basic types:<\/p>\n<ol>\n<li>Powder that requires mixing with water. This is the least expensive type of formula.<\/li>\n<li>Concentrates, which are liquids that must be diluted with water. This type is slightly more expensive.<\/li>\n<li>Ready-to-use liquids that can be poured directly into bottles. This is the most expensive type of formula. However, it requires the least amount of preparation. Ready-to-use formulas are also convenient for traveling.<\/li>\n<\/ol>\n<p>Most infants need about 2.5 ounces of formula per pound of body weight each day. Therefore, the average infant should consume about 24 fluid ounces of breastmilk or formula per day. When preparing formula, caregivers should carefully follow the safety guidelines, since an infant has an immature immune system. All equipment used in formula preparation should be sterilized. Prepared, unused formula should be refrigerated to prevent bacterial growth. Caregivers should make sure not to use contaminated water to mix formula in order to prevent foodborne illnesses. Follow the instructions for powdered and concentrated formula carefully\u2014formula that is overly diluted would not provide adequate calories and protein, while overly concentrated formula provides too much protein and too little water which can impair kidney function.<a href=\"#_ftn9\">[9]<\/a><\/p>\n<h6>Feeding with Formula in Early Child Care and Education Programs<\/h6>\n<p>Early care and education programs provide commercially prepared formulas to infants, under the direction of the family. Bottles of formula should come prepared in bottles labeled with the infant\u2019s name and the date. Unused mixed formula should not be stored for more than 24 hours.<\/p>\n<h6>Bottle Feeding (Both Expressed Breastmilk and Formula)<\/h6>\n<p>Always wash your hands before handling bottles or feeding the infant. Use only clean bottles, nipples, and cups. For infants that do not crawl, bottles and nipples should be sterilized. If you need to reuse them, sterilize by boiling in water for 5 minutes or by washing in a dishwasher.<\/p>\n<p>Warm breastmilk and formula by placing the bottle in a pan of warm water or by holding it under warm running water for a few minutes. Do not warm breastmilk or formula on the stove or in a microwave. Microwave heating causes hot spots in the milk that can burn the infant&#8217;s mouth and throat. These hot spots may stay even if you shake the bottle. And heating also destroys most of the natural substances in breastmilk.<\/p>\n<p>Double-check the labels on bottles before feeding to ensure the infant is getting the correct breastmilk or formula. Always hold the infant when bottle feeding. Try different positions for infants who do not want to take their bottles. Some infants are happier if you feed them in the usual cradle position. Others prefer a different position. Do not prop up a bottle to feed an infant or put an infant in a crib with a bottle. Bottle propping could cause the infant to choke, tooth decay, and ear infections.<\/p>\n<figure id=\"attachment_266\" aria-describedby=\"caption-attachment-266\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-259\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/14.2-300x200.jpg\" alt=\"Infant drinking from a bottle in caregiver's arms\" width=\"300\" height=\"200\" srcset=\"https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/14.2-300x200.jpg 300w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/14.2-768x513.jpg 768w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/14.2-65x43.jpg 65w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/14.2-225x150.jpg 225w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/14.2-350x234.jpg 350w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/14.2.jpg 910w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-266\" class=\"wp-caption-text\">Figure 14.2 \u2013 Not only is holding an infant during bottle feeding safest, but it is also an important time for caregiver and infant to connect and build their relationship. [10]<\/figcaption><\/figure>\n<p>Burp by placing the infant high over your shoulder or over your knee. You can also lean the infant forward in a sitting position supported by your hands. Pat or rub the infant&#8217;s back. This puts gentle pressure on the abdomen to push extra air from the stomach.<a href=\"#_ftn11\">[11]<\/a><\/p>\n<p>Uneaten breastmilk or formula should be discarded after a feeding as bacteria from the infant\u2019s mouth may have made it into the bottle.<\/p>\n<h4>When to Feed<\/h4>\n<p>In the early months, infants will need to be fed \u201con demand\u201d\u2014this means that they are able to feed whenever they are hungry or show hunger cues. Hunger cues are unique to each infant. An infant might:<\/p>\n<ul>\n<li>Have a specific hunger cry<\/li>\n<li>Root or look around for food<\/li>\n<li>Suck on their hand or fingers<\/li>\n<li>Become irritable or restless<\/li>\n<li>Repeat a unique behavior to demonstrate hunger<\/li>\n<\/ul>\n<p>When adults respond to an infant\u2019s hunger cues, the infant can also tell how much food they want and when they are full. This feeding practice supports healthy eating habits, growth, and development later in life.<a href=\"#_ftn12\">[12]<\/a><\/p>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\"><strong>Pause to Reflect<\/strong><\/p>\n<\/header>\n<div class=\"textbox__content\">\n<table style=\"border-collapse: collapse;width: 100%\">\n<tbody>\n<tr>\n<td style=\"width: 16.9%\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-thumbnail wp-image-89\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/P2R-150x150.png\" alt=\"\" width=\"150\" height=\"150\" \/><\/td>\n<td style=\"width: 83.1%\">Some families put infants on a schedule that dictates when they eat (and even sleep)? Is this compatible with feeding on demand as described above? How might you discuss this with a family?<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n<h4>Introducing Solid Foods<\/h4>\n<p>Infants should be breastfed or formula-fed exclusively for the first six months of life according to the WHO. (The American Academy of Pediatrics recommends breast milk or bottle formula exclusively for at least the first four months, but ideally for six months.) Infants should not consume solid foods before six months because solids do not contain the right nutrient mix that infants need. Also, eating solids may mean drinking less breast milk or bottle formula. If that occurs, an infant may not consume the right quantities of various nutrients. If parents try to feed an infant who is too young or is not ready, their tongue will push the food out, which is called an extrusion reflex. After six months, the suck-swallow reflexes are not as strong, and infants can hold up their heads and move them around, both of which make eating solid foods more feasible.<a href=\"#_ftn13\">[13]<\/a><\/p>\n<div class=\"textbox textbox--key-takeaways\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\"><strong>Knowing When an Infant is Ready for Solid Foods<\/strong><\/p>\n<\/header>\n<div class=\"textbox__content\">\n<p>Here are several ways you can tell that an infant is ready to eat solid foods:<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 The infant\u2019s birth weight has doubled.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 The infant can control their head and neck movements.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 The infant can sit up with some support.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 The infant can show you they are full by turning their head away or by not opening their mouth.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 The infant begins showing interest in food when others are eating.<\/p>\n<\/div>\n<\/div>\n<p>Solid baby foods can be bought commercially or prepared from regular food using a food processor, blender, food mill, or grinder.<a href=\"#_ftn14\">[14]<\/a> Baby food can be served at room temperature. If it is warmed, it must be stirred to distribute evenly.<a href=\"#_ftn15\">[15]<\/a><\/p>\n<p>Portion the amount of food you intend to serve the baby (any uneaten food will need to be thrown away after a feeding and use small amounts on an infant-sized spoon. When beginning solid foods, timing is important. To keep mealtimes positive, choose a time when the infant is happy and when you have the patience and time to focus. Offer 1 to 2 teaspoons after a breastmilk or formula feeding. This can increase over time to 2 to 3 tablespoons.<\/p>\n<p>It is normal for infants to refuse new foods. Sometimes it can take 10 to 12 times of offering a food before an infant will accept it. Infants know when they have had enough and may turn their head away. Don\u2019t force them to keep eating.<a href=\"#_ftn16\">[16]<\/a><\/p>\n<p>As families and caregivers introduce solids, they should feed the child only one new food at a time, to help identify allergic responses or food intolerances. An iron supplement is also recommended at this time.<a href=\"#_ftn17\">[17]<\/a><\/p>\n<div class=\"textbox textbox--key-takeaways\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\"><strong>Foods to Avoid for Infants<\/strong><\/p>\n<\/header>\n<div class=\"textbox__content\">\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Never give honey to infants. It may contain bacteria that can cause botulism, a rare, but serious illness.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Do not give infants cow&#8217;s milk until they are 1 year old. Before age 1, they have a difficult time digesting cow&#8217;s milk.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Avoid foods with added salt or sugar.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Do not give infants egg white until after they are 1 (egg yolks 3-4 per week are okay)<a href=\"#_ftn18\">[18]<\/a><\/p>\n<\/div>\n<\/div>\n<h4>Learning to Self-Feed<\/h4>\n<p>With the introduction of solid foods, young children begin to learn how to handle food and how to feed themselves. At six to seven months, infants can use their whole hand to pick up items (this is known as the palmer grasp). They can lift larger items, but picking up smaller pieces of food is difficult. At eight months, a child might be able to use a pincer grasp, which uses fingers to pick up objects.<a href=\"#_ftn19\">[19]<\/a><\/p>\n<p>Serve food that is soft and mashed. Cut food into small pieces (cubes no larger than 1\/4 inch) or thin slices that your baby can easily chew and swallow. Avoid high-risk choking foods such as small, slippery foods; dry foods that are hard to chew or sticky; and tough foods. <a href=\"#_ftn20\">[20]<\/a><\/p>\n<div class=\"textbox textbox--key-takeaways\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\"><strong>Finger Foods<\/strong><\/p>\n<\/header>\n<div class=\"textbox__content\">\n<p>Here are some good food choices for self-feeding children:<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Soft cooked vegetables<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Washed and peeled fruits<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Graham crackers<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Melba toast<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Noodles<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Soft cooked vegetables<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Washed and peeled fruits<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Graham crackers<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Melba toast<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Noodles<\/p>\n<p>Here are foods to <span style=\"text-decoration: underline\"><strong><em>AVOID<\/em><\/strong><\/span> as they are a <strong>choking<\/strong> hazard:<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Apple chunks or slices<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Grapes<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Berries<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Raisins<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Dry flake cereals<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Hot dogs<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Sausages<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Peanut butter<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Popcorn<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nuts<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Seeds<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Round candies<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Raw vegetables<a href=\"#_ftn21\">[21]<\/a><\/p>\n<\/div>\n<\/div>\n<p>To minimize choking, ensure that infants are seated while eating.\u00a0If using a high chair, make sure to use the safety straps.<a href=\"#_ftn22\">[22]<\/a><\/p>\n<figure id=\"attachment_266\" aria-describedby=\"caption-attachment-266\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-260\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/14.3-300x245.png\" alt=\"Infant feeding herself\" width=\"300\" height=\"245\" srcset=\"https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/14.3-300x245.png 300w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/14.3-65x53.png 65w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/14.3-225x184.png 225w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/14.3-350x286.png 350w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/14.3.png 408w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-266\" class=\"wp-caption-text\">Figure 14.3 \u2013This older infant has been served food on an unbreakable plate with a small utensil. [23]<\/figcaption><\/figure>\n<p>After the age of one, children slowly begin to use utensils to handle their food. Unbreakable dishes and cups are essential, since very young children may play with them or throw them when they become bored with their food. <a href=\"#_ftn24\">[24]<\/a><\/p>\n<h2>Supporting Infant Nutrition<\/h2>\n<p>Nutrition during the first year of life is really important. While babies who are breastfed for at least 6 months are more likely to have a healthy weight as they grow up, mothers often report that breastfeeding is harder than they thought. And mothers may be more likely to stop breastfeeding if they feel unsupported and have nowhere to turn for help. And families that choose not to or cannot breastfeed have questions and need support to feed their infants in a healthy and safe way, too. Babies should be ready to start eating simple solids around 6 months. Babies who start eating solid foods too early are more likely to have weight problems as children and adults.<a href=\"#_ftn25\">[25]<\/a><\/p>\n<p>Early care and education programs can support infant nutrition with the following practices:<\/p>\n<ul>\n<li>All food brought from home should be labeled with the child\u2019s name and date.<\/li>\n<li>Part of the care plan that families share with their program and that is updated regularly, should be instructions for feeding. Families should determine how and what their infant is fed (as long as it\u2019s in compliance with licensing).<\/li>\n<li>Support parents with materials on providing optimal nutrition for their infant (such as the tips just listed).<\/li>\n<li>Be supportive of mothers who are breastfeeding. For mothers who can come to nurse, provide a space conducive to that. Ensure the breastmilk that is brought to the program is properly labeled, stored, and prepared.<\/li>\n<li>For infants that are formula fed, ensure that formula is prepared according to the label (or doctor\u2019s instructions).<\/li>\n<li>Hold all infants during bottle feedings. Not only does this keep them safe, but it is also valuable one-on-one time (caregiving routines are the heart of infant\/toddler curriculum).<\/li>\n<li>Follow the cues of the infant you are feeding (when they are hungry and full).<\/li>\n<li>When feeding pureed baby food, use a small spoon and make sure you transfer food from a jar into a dish and throw away any uneaten food.<\/li>\n<li>Have appropriate seating available for infants that are beginning to self-feed (high chairs, booster seats, or enclosed small chairs at a low table)<\/li>\n<li>Provide unbreakable dishes to serve food to self-feeding infants.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<div class=\"textbox textbox--key-takeaways\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\"><strong>Engaging Families in Supporting Their Infant\u2019s Nutrition<\/strong><\/p>\n<\/header>\n<div class=\"textbox__content\">\n<p>Here are tips you can share with families<\/p>\n<ul>\n<li>If breastfeeding is harder than you thought it would be you are not alone!<\/li>\n<li>Lots of people say that breastfeeding just comes \u201cnaturally\u201d but for many moms, it doesn\u2019t.<\/li>\n<li>Going back to work and wanting to get back into a normal family routine can make it hard to stick with breastfeeding. Using a breast pump can help ensure your baby still gets the best nutrition.<\/li>\n<li>If you need support or help at any time while you are breastfeeding call 1-800-994-9662 (the National Breastfeeding Hotline) for free breastfeeding support.<\/li>\n<li>Don\u2019t use pillows or other objects to hold a bottle for your baby. This makes it hard for her to spit out the bottle when she\u2019s done &#8211; it can cause her to keep eating after she\u2019s full.<\/li>\n<li>Make sure you take the bottle away if your baby falls asleep. If you let the baby keep the bottle in her mouth when he\u2019s sleeping, formula can stay in her mouth and can damage his teeth or cause her to choke.<\/li>\n<li>Stick with ONLY breast milk or formula for feeding your baby until she is 6 months old. Unless your doctor tells you something different, adding cereal to a baby\u2019s bottle adds extra calories to her diet that she doesn\u2019t need. <a href=\"#_ftn26\">[26]<\/a><\/li>\n<li>Infants are usually ready to eat solid foods at about 6 months of age.<\/li>\n<li>If you introduce one new food at a time, you will be able to identify any foods that cause\u00a0allergies\u00a0in your baby.<a href=\"#_ftn27\">[27]<\/a><\/li>\n<li>Start solid feedings with iron-fortified baby cereal mixed with breast milk or formula. Mix it with enough milk so that the texture is very thin. Start by offering the cereal 2 times a day, in just a few spoonfuls.<\/li>\n<li>You can make the mixture thicker as your baby learns to control it in their mouth.<\/li>\n<li>You can also introduce iron-rich pureed meats, fruits, and vegetables. Try green peas, carrots, sweet potatoes, squash, applesauce, pears, bananas, and peaches.<\/li>\n<li>Some dietitians recommend introducing a few vegetables before fruits. The sweetness of fruit may make some vegetables less appealing.<\/li>\n<li>The amount your child eats will vary between 2 tablespoons (30 grams) and 2 cups (480 grams) of fruits and vegetables per day. How much your child eats depends on their size and how well they eat fruits and vegetables.<a href=\"#_ftn28\">[28]<\/a><\/li>\n<\/ul>\n<\/div>\n<\/div>\n<h2>Feeding Toddlers<\/h2>\n<p>Major physiological changes continue into the toddler years. Unlike in infancy, the limbs grow much faster than the trunk, which gives the body a more proportionate appearance.\u00a0Their physical growth and motor development slow compared to the progress they made as infants. The toddler years pose interesting challenges for parents or other caregivers, as children learn how to eat on their own and begin to develop personal preferences. However, with the proper diet and guidance, toddlers can continue to grow and develop at a healthy rate.<\/p>\n<figure id=\"attachment_266\" aria-describedby=\"caption-attachment-266\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-261\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/14.4.png\" alt=\"Teacher tossing a ball to a toddler\" width=\"300\" height=\"219\" srcset=\"https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/14.4.png 300w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/14.4-65x47.png 65w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/14.4-225x164.png 225w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-266\" class=\"wp-caption-text\">Figure 14.4 \u2013 Caloric intake will depend on a toddler\u2019s activity level. [29]<\/figcaption><\/figure>\n<p>The energy requirements for ages two to three are about 1,000 to 1,400 calories a day. In general, a toddler needs to consume about 40 calories for every inch of height. For example, a young child who measures 32 inches should take in an average of 1,300 calories a day. However, the recommended caloric intake varies with each child\u2019s level of activity. Toddlers require small, frequent, nutritious snacks and meals to satisfy energy requirements. The amount of food a toddler needs from each food group depends on daily calorie needs.<\/p>\n<p>Forty-five to 65% of their daily caloric intake should come from carbohydrates. Protein should make up 5 to 20% of their daily calories. And fat should make up 30 to 40% of their daily intake. Essential fatty acids are vital for the development of the eyes, along with nerve and other types of tissue. However, toddlers should not consume foods with high amounts of trans fats and saturated fats.<\/p>\n<p>As a child grows bigger, the demands for micronutrients increase. These needs for vitamins and minerals can be met with a balanced diet, with a few exceptions. According to the American Academy of Pediatrics, toddlers and children of all ages need 600 international units of vitamin D per day. Vitamin D-fortified milk and cereals can help to meet this need. However, toddlers who do not get enough of this micronutrient should receive a supplement. Pediatricians may also prescribe a fluoride supplement for toddlers who live in areas with fluoride-poor water. Iron deficiency is also a major concern for children between the ages of two and three.<a href=\"#_ftn30\">[30]<\/a><\/p>\n<h4>Self-Feeding<\/h4>\n<p>As children grow older, they enjoy taking care of themselves, which includes self-feeding. During this phase, it is important to offer children foods that they can handle on their own and that helps them avoid choking and other hazards. Examples include fresh fruits that have been sliced into pieces, orange or grapefruit sections, peas or potatoes that have been mashed for safety, a cup of yogurt, and whole-grain bread or bagels cut into pieces. Even with careful preparation and training, the learning process can be messy. As a result, parents and other caregivers can help children learn how to feed themselves by providing the following:<\/p>\n<ul>\n<li>small utensils that fit a young child\u2019s hand<\/li>\n<li>small cups that will not tip over easily<\/li>\n<li>plates with edges to prevent food from falling off<\/li>\n<li>small servings on a plate<\/li>\n<li>highchairs, booster seats, or small enclosed chairs to reach a low table<a href=\"#_ftn31\">[31]<\/a><\/li>\n<\/ul>\n<figure id=\"attachment_266\" aria-describedby=\"caption-attachment-266\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-262\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/14.5-300x206.png\" alt=\"Young boy feeding himself with a small fork and sippy cup\" width=\"300\" height=\"206\" srcset=\"https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/14.5-300x206.png 300w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/14.5-65x45.png 65w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/14.5-225x155.png 225w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/14.5-350x240.png 350w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/14.5.png 514w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-266\" class=\"wp-caption-text\">Figure 14.5 \u2013 Set toddlers up for success in self-feeding. [32]<\/figcaption><\/figure>\n<h4>Feeding Challenges in the Toddler Years<\/h4>\n<p>During the toddler years, parents may face a number of problems related to food and nutrition. Possible obstacles include difficulty helping a young child overcome a fear of new foods, or fights over messy habits at the dinner table. Even in the face of problems and confrontations, parents and other caregivers must make sure their preschooler has nutritious choices at every meal. For example, even if a child stubbornly resists eating vegetables, parents should continue to provide them. Before long, the child may change their mind, and develop a taste for foods once abhorred. It is important to remember this is the time to establish or reinforce healthy habits.<\/p>\n<p>Nutritionist Ellyn Satter states that feeding is a responsibility that is split between parent and child. According to Satter, parents are responsible for what their infants eat, while infants are responsible for how much they eat. In the toddler years and beyond, parents are responsible for what children eat, when they eat, and where they eat, while children are responsible for how much food they eat and whether they eat. Satter states that the role of a parent or a caregiver in feeding includes the following:<\/p>\n<ul>\n<li>selecting and preparing food<\/li>\n<li>providing regular meals and snacks<\/li>\n<li>making mealtimes pleasant<\/li>\n<li>showing children what they must learn about mealtime behavior<\/li>\n<li>avoiding letting children eat in between meal- or snack-times<\/li>\n<\/ul>\n<p>You are likely to notice a sharp drop in their child\u2019s appetite. Children at this stage are often picky about what they want to eat. They may turn their heads away after eating just a few bites. Or, they may resist coming to the table at mealtimes. They also can be unpredictable about what they want to consume for specific meals or at particular times of the day. Although it may seem as if toddlers should increase their food intake to match their level of activity, there is a good reason for picky eating. A child\u2019s growth rate slows after infancy, and toddlers ages two and three do not require as much food.<a href=\"#_ftn33\">[33]<\/a><\/p>\n<p>Establishing healthy meal routines is an important step in healthy toddler development. Ideally, mealtimes should take place at regular times, at a table with limited distraction, and children should be encouraged to feed themselves with adult support as needed. <a href=\"#_ftn34\">[34]<\/a> Best practices in early care and education include creating positive meal and snack times that are served family-style with adult modeling eating balanced nutrition.<\/p>\n<div class=\"textbox textbox--key-takeaways\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\"><strong>Engaging Families in Supporting Their Toddler\u2019s Nutrition<\/strong><\/p>\n<\/header>\n<div class=\"textbox__content\">\n<p>Here are tips you can share with families:<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Serving sizes for toddlers are much smaller than serving sizes for adults.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 A typical serving size for a toddler drink is 4-6 ounces. Water and milk are the best choices for toddlers<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Your toddler (and you too!) needs food from all five of the food groups\u2014grains, protein, vegetables, fruit, and dairy. Try offering a variety of foods from these groups at meals and snacks.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Your toddler may eat more some days and less on others. Don\u2019t worry, this is normal! Keep offering regularly scheduled meals and snacks.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Allow your toddler to tell you when she is full. This teaches them to listen to their body for signs of hunger or fullness.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Try using child-size plates, bowls, and utensils for \u201cright-size\u201d portions for your toddler. Using child-size utensils also makes it easier for your toddler to eat.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Encourage toddlers to drink from cups and avoid the use of bottles or sippy cups.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Limit distractions during meal and snack times to allow your toddler to enjoy the food. Turn off the TV and sit at a table.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Toddlers get hungry between meals. Snack time is a great chance to feed your toddler healthy foods (like fruits and veggies).<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Remember to have a start and end time for snack time. Toddlers should not be snacking (or grazing) all day.<a href=\"#_ftn35\">[35]<\/a><\/p>\n<\/div>\n<\/div>\n<h2>Feeding Preschoolers<\/h2>\n<p>Children\u2019s attitudes and opinions about food deepen. They not only begin taking their cues about food preferences from family members, but also from peers and the larger culture. This time in a child\u2019s life provides an opportunity for families and other caregivers to reinforce good eating habits and to introduce new foods into the diet while remaining mindful of a child\u2019s preferences. Adults should also serve as role models for their children, who will often mimic their behavior and eating habits.<a href=\"#_ftn36\">[36]<\/a><\/p>\n<figure id=\"attachment_266\" aria-describedby=\"caption-attachment-266\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-263\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/14.6-300x224.jpg\" alt=\"Caregiver sitting and eating with six children\" width=\"300\" height=\"224\" srcset=\"https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/14.6-300x224.jpg 300w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/14.6-65x49.jpg 65w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/14.6-225x168.jpg 225w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/14.6-350x262.jpg 350w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/14.6.jpg 499w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-266\" class=\"wp-caption-text\">Figure 14.6 \u2013 Eating with children allows you to model healthy eating. [37]<\/figcaption><\/figure>\n<p>MyPlate also provides a guide daily for calories based on sex and activity-level for preschool-aged children (although children\u2019s needs may differ from the average and appetites can vary from day to day).<\/p>\n<p>&nbsp;<\/p>\n<div style=\"text-align: left; margin: auto;\">\n<div class=\"textbox textbox--examples\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\"><strong>Table 14.1 \u2013 Average Calorie Needs for Preschoolers <\/strong><a href=\"#_ftn38\"><strong>[38]<\/strong><\/a><\/p>\n<\/header>\n<div class=\"textbox__content\">\n<div style=\"margin: auto;\">\n<div id=\"h5p-27\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-27\" class=\"h5p-iframe\" data-content-id=\"27\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Average Calorie Needs for Preschoolers\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<p><span style=\"text-align: initial;font-size: 1em\">In early childhood, children should still get 45-65% of their daily calories from carbohydrates. Carbohydrates high in fiber should make up the bulk of intake. Their intake of protein increases to 10\u201330% of their daily calories to support muscle growth and development. High levels of essential fatty acids are needed to support growth (although not as high as in infancy and the toddler years). As a result, the daily recommendation for fat is 25\u201335% of their daily calories. And they should get 17\u201325 grams of fiber per day.<\/span><\/p>\n<\/div>\n<p>Their micronutrient needs should be met with foods first. Families and caregivers should select a variety of foods from each food group to ensure that nutritional requirements are met. Because children grow rapidly, they require foods that are high in iron, such as lean meats, legumes, fish, poultry, and iron-enriched cereals. Adequate fluoride is crucial to support strong teeth. One of the most important micronutrient requirements during childhood is adequate calcium and vitamin D intake. Both are needed to build dense bones and a strong skeleton. Children who do not consume adequate vitamin D should be given a supplement of 10 micrograms (400 international units) per day.<a href=\"#_ftn39\">[39]<\/a><\/p>\n<h3>Feeding Challenges in the Preschool Years<\/h3>\n<p>Picky eating is typical for many preschoolers.\u00a0It\u2019s simply another step in the process of growing up and becoming independent. As long as a preschooler is healthy, growing normally, and has plenty of energy, they are most likely getting the nutrients they need.<\/p>\n<h4>Typical Picky Eating Behaviors<\/h4>\n<p>Many children will show one or more of the following behaviors during the preschool years. In most cases, these will go away with time.<\/p>\n<ul>\n<li>Refusal of a food based on a certain color or texture. For example, they could refuse foods that are red or green, contain seeds, or are squishy.<\/li>\n<li>Only eating a certain type of food. A preschooler may choose 1 or 2 foods they like and refuse to eat anything else.<\/li>\n<li>\u201cWasting\u201d of time at the table and seeming interested in doing anything but eating.<\/li>\n<li>Unwillingness to try new foods. It is normal for a preschooler to prefer familiar foods and be afraid to try new things.<a href=\"#_ftn40\">[40]<\/a><\/li>\n<\/ul>\n<div class=\"textbox textbox--key-takeaways\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\"><strong>Helping Families Cope with Picky Eating<\/strong><\/p>\n<\/header>\n<div class=\"textbox__content\">\n<p>Picky eating is temporary. If adults don\u2019t make it a big deal, it will usually end before school age. The following tips are tips to help deal with picky eating behavior positively.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Let your kids be \u201cproduce pickers.\u201d\u00a0Let them pick out fruits and veggies at the store.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Have your child help you prepare meals.\u00a0Children learn about food and get excited about tasting food when they help make meals. Let them add ingredients, scrub veggies, or help stir.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Offer choices.\u00a0Rather than ask, \u201cDo you want broccoli for dinner?\u201d ask \u201cWhich would you like for dinner, broccoli or cauliflower?\u201d<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Enjoy each other while eating family meals together.\u00a0Talk about fun and happy things. If meals are times for family arguments, your child may learn unhealthy attitudes toward food.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Offer the same foods for the whole family.<strong>\u00a0<\/strong>\u00a0Serve the same meal to adults and kids. Let them see you enjoy healthy foods. Talk about the colors, shapes, and textures on the plate.<a href=\"#_ftn41\">[41]<\/a><\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Make food fun<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Cut food into fun and easy shapes with cookie cutters.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Encourage your child to invent and help prepare new snacks.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Name a food your child helps create.<a href=\"#_ftn42\">[42]<\/a><\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Focus on the meal and each other. Your child learns by watching you. Children are likely to copy your table manners, your likes and dislikes, and your willingness to try new foods.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Offer a variety of healthy foods. Let your child choose how much to eat. Children are more likely to enjoy a food when eating it is their own choice.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Let your children serve themselves. Teach your children to take small amounts at first. Let them know they can get more if they are still hungry.<a href=\"#_ftn43\">[43]<\/a><\/p>\n<\/div>\n<\/div>\n<h4>Trying New Foods<\/h4>\n<p>It is normal for children to reject foods they have never tried before. Here are some tips to get preschoolers to try new foods:<\/p>\n<ul>\n<li>Small portions, big benefits<strong>.\u00a0<\/strong>Let children try small portions of new foods that you enjoy. Give them a small taste at first and be patient with them.<\/li>\n<li>Offer only one new food at a time and ideally with a favored food. Offering many new foods all at once could be too much for children.<\/li>\n<li>Be a good role model.<strong>\u00a0<\/strong>Try new foods yourself. Describe their taste, texture, and smell to the children.<\/li>\n<li>Offer new foods first when children are most hungry.<\/li>\n<li>Offer new foods many times. It may take up to a dozen tries for a child to accept a new food.<a href=\"#_ftn44\">[44]<\/a><\/li>\n<\/ul>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\"><strong>Pause to Reflect<\/strong><\/p>\n<\/header>\n<div class=\"textbox__content\">\n<table style=\"border-collapse: collapse;width: 100%\">\n<tbody>\n<tr>\n<td style=\"width: 16%\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-thumbnail wp-image-89\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/P2R-150x150.png\" alt=\"\" width=\"150\" height=\"150\" \/><\/td>\n<td style=\"width: 84%\">Think back to your childhood. Were you a picky eater or more adventurous? Why do you think that it was? How did your caregivers respond to your eating preferences? Do you have similar preferences now or have you expanded your tastes\/preferences?<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n<h2>Feeding School-Aged Children<\/h2>\n<p>While calorie needs go up as children get older, until around age 9 (or the beginning of puberty), nutritional needs for school-aged children are very similar to preschoolers. Once puberty begins, there is a period of rapid growth as girls grow 2-8 inches and boys grow 4-12 inches.<\/p>\n<div class=\"textbox textbox--examples\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\"><strong>Table 14.2 \u2013 Average Calorie Needs for School-Aged Children <\/strong><a href=\"#_ftn45\"><strong>[45]<\/strong><\/a><\/p>\n<\/header>\n<div class=\"textbox__content\">\n<div style=\"margin: auto;\">\n<div id=\"h5p-28\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-28\" class=\"h5p-iframe\" data-content-id=\"28\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Average Calorie Needs for School-Aged Children\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<p>School-aged children should still get 45-65% of their daily calories from carbohydrates. Carbohydrates high in fiber should make up the bulk of that. Their intake of protein remains at 10\u201330% of their daily calories to support muscle growth and development. And the daily recommendation for fat also remains at 25\u201335% of their daily calories.<\/p>\n<p>A few micronutrients take on added importance, especially at the beginning of puberty. These include vitamins, D, K, and B12, calcium, and iron. Whenever possible these additional micronutrient needs should be met with dietary choices and not supplements (with the exception of iron).<a href=\"#_ftn46\">[46]<\/a><\/p>\n<h4>School Meals<\/h4>\n<p>School-aged children can often eat both breakfast and lunch at school, which can save families time and provide children with nutritious food.<\/p>\n<h6>Breakfast<\/h6>\n<p>Research has shown that children that eat breakfast do better in school and have higher intakes of fiber, B vitamins, calcium, and other nutrients.<a href=\"#_ftn47\">[47]<\/a> Refer to Figure 14.7 to see what a school breakfast includes.<\/p>\n<h6>Lunch<\/h6>\n<p>Lunch is important because it meets 1\/3 of the nutritional needs of most children for the day. And kids with healthier eating patterns have better academic performance. And farm to school programs (in 42% of schools) increase children\u2019s access to locally produced foods.<a href=\"#_ftn48\">[48]<\/a> Refer to Figure 14.8 to see a breakdown of school lunches provide.<\/p>\n<figure id=\"attachment_266\" aria-describedby=\"caption-attachment-266\" style=\"width: 769px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-264\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/14.7.png\" alt=\"Typical school breakfast; fruit, milk, English muffin with egg and ham, hash browns\" width=\"769\" height=\"610\" srcset=\"https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/14.7.png 769w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/14.7-300x238.png 300w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/14.7-65x52.png 65w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/14.7-225x178.png 225w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/14.7-350x278.png 350w\" sizes=\"auto, (max-width: 769px) 100vw, 769px\" \/><figcaption id=\"caption-attachment-266\" class=\"wp-caption-text\">Figure 14.7 &#8211; School breakfast [49]<\/figcaption><\/figure>\n<figure id=\"attachment_266\" aria-describedby=\"caption-attachment-266\" style=\"width: 746px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-265\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/14.8.png\" alt=\"Typical school lunch; vegetable soup, sandwich with meat, cheese, tomato and lettuce, cut up fruit and milk\" width=\"746\" height=\"599\" srcset=\"https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/14.8.png 746w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/14.8-300x241.png 300w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/14.8-65x52.png 65w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/14.8-225x181.png 225w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/14.8-350x281.png 350w\" sizes=\"auto, (max-width: 746px) 100vw, 746px\" \/><figcaption id=\"caption-attachment-266\" class=\"wp-caption-text\">Figure 14.8 \u2013 School lunch [50]<\/figcaption><\/figure>\n<h6>Meals and Snacks in School-Aged Care Programs<\/h6>\n<p>On school days, children that are in care before school may need to be fed breakfast (if they did not eat at home or will not be eating at school). After school, they will need substantial, healthy snacks. On full days of care, they will need breakfast, lunch, and a snack.<\/p>\n<p>Follow the menu planning advice in Chapter 15. And involve the children in menu planning and food preparation whenever possible and see which of the suggestions in the following feature for families might also be incorporated into the classroom.<\/p>\n<p><em>Figure 14.9 \u2013 These 9-year-olds learned the knife skills to help prepare this snack of fruit.<\/em><a href=\"#_ftn51\">[51]<\/a><\/p>\n<div class=\"textbox textbox--key-takeaways\">\n<header class=\"textbox__header\">Activities Families Can Do with Children<\/header>\n<div class=\"textbox__content\">\n<table>\n<tbody>\n<tr>\n<td>Choosemyplate.gov offers some fun ideas for families to teach their children about healthy eating and engage the whole family in making healthy choices. Some of these include:<\/p>\n<ul>\n<li>Food critic game where children select a new food to try and rate it on visual appeal, smell, taste, and texture<a href=\"#_ftn52\">[52]<\/a><\/li>\n<li>Grocery store bingo where children identify foods they see in the grocery store to try to get a 5 in a row bingo<a href=\"#_ftn53\">[53]<\/a><\/li>\n<li>Make food visually appealing by turning it into art<\/li>\n<li>Kid\u2019s Restaurant: Kids get to plan out the meal, design the menu, and prepare the dish<\/li>\n<li>Growing a garden (or starting small with an herb box in a window)<\/li>\n<li>Going to a local farmer\u2019s market or farm stand to find local food options to buy, take home, and turn into a delicious meal.<\/li>\n<\/ul>\n<p><strong>Making Mealtimes Fun<\/strong><\/p>\n<ul>\n<li>Here are some tips for families for making mealtimes more relaxed and enjoyable:<\/li>\n<li>Remove distractions, such as phones, tablets, and turn off the television.<\/li>\n<li>Have conversations. Use starters like:<\/li>\n<li>Give each family member the spotlight to share their highlight, lowlight, and \u201cfunnylight\u201d<\/li>\n<li>If our family lived in a zoo, what animals would we be and why?<\/li>\n<li>If you could have one superpower, what would it be and why?<\/li>\n<li>If you were stranded on a desert island and could only have one food to eat, what would it be and why?<\/li>\n<li>Pass on traditions, both the foods and the stories behind them<\/li>\n<li>Let the children make the choices (from a healthy selection of foods)<\/li>\n<li>Let everyone help prepare and clean up after meals<\/li>\n<li>Consider a change of scenery, like a picnic<\/li>\n<li>Reserve a special plate to rotate between family members, for example on birthdays, when someone gets a good grade, or any other occasion you\u2019d like to recognize.<a href=\"#_ftn54\">[54]<\/a><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<\/div>\n<\/div>\n<h2>Feeding Children with Special Needs<\/h2>\n<p>Some disabilities and other exceptional needs may affect children\u2019s nutrition. For example,<\/p>\n<ul>\n<li>children with cerebral palsy or cystic fibrosis may have different caloric needs<\/li>\n<li>children with celiac disease or irritable bowel syndrome may have dietary restrictions<\/li>\n<li>children with cleft lip or palate may have physical difficulties with eating<\/li>\n<li>children on the autism spectrum may have strong food preferences or aversions<\/li>\n<\/ul>\n<figure id=\"attachment_266\" aria-describedby=\"caption-attachment-266\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-266\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/14.10-300x258.jpg\" alt=\"Infant with a cleft lip (opening in the top lip) that makes it difficult to suck on a bottle\" width=\"300\" height=\"258\" srcset=\"https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/14.10-300x258.jpg 300w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/14.10-65x56.jpg 65w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/14.10-225x193.jpg 225w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/14.10-350x301.jpg 350w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/14.10.jpg 698w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-266\" class=\"wp-caption-text\">Figure 14.10 \u2013 This child with a cleft lip may find sucking from a bottle challenging. [55]<\/figcaption><\/figure>\n<p>Because each child\u2019s specific needs will vary, early care and education programs should work closely with families, and medical providers as needed, to ensure that they understand and can meet the nutritional and feeding needs of the individual child (not a generalization or assumption about the child might need based on a diagnosis or label).<\/p>\n<p>Nutrition policies and practices should be created to be inclusive of children with special needs. Some general considerations early care and education programs and schools should make to ensure that all children\u2019s nutritional needs are met and that all children experience positive meal and snack times include:<\/p>\n<ul>\n<li>Ensure that the spaces in which children eat and access to drinking water are fully accessible to all children, including those with mobility impairments (and if needed, assistive devices should be provided).<\/li>\n<li>Staff should be trained to provide for children who may have additional or differing nutritional or feeding needs so they can work effectively and comfortably with all children.<\/li>\n<li>Follow any dietary restrictions.<a href=\"#_ftn56\">[56]<\/a><\/li>\n<\/ul>\n<h2>Summary<\/h2>\n<p>Early care and education programs can provide for all children\u2019s nutrition when they understand<\/p>\n<ul>\n<li>the general changes children have in nutritional needs as they mature,<\/li>\n<li>common challenges across the different stages of development, and<\/li>\n<li>strategies that foster positive meal and snack times at each age stage, and<\/li>\n<li>the fact that children may have diverse and unique nutritional needs<\/li>\n<\/ul>\n<p>Programs also play an important role in children\u2019s nutrition by empowering families by providing support, information, and resources as they make decisions about how to feed their children.<\/p>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\">Chapter 14 Review<\/p>\n<\/header>\n<div class=\"textbox__content\">\n<p style=\"text-align: center\">\n<div id=\"h5p-29\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-29\" class=\"h5p-iframe\" data-content-id=\"29\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Chapter 14 Review\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"textbox shaded\">\n<p><strong>Resources for Further Exploration<\/strong><\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/sites\/default\/files\/pdf\/growing-healthy-flipchart.pdf\">Head Starts\u2019 <em>Growing Healthy<\/em> guide<\/a>: https:\/\/eclkc.ohs.acf.hhs.gov\/sites\/default\/files\/pdf\/growing-healthy-flipchart.pdf<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <a href=\"https:\/\/www.ellynsatterinstitute.org\/how-to-feed\/child-feeding-ages-and-stages\/\">Ellyn Satter Institute<\/a>: https:\/\/www.ellynsatterinstitute.org\/how-to-feed\/child-feeding-ages-and-stages\/<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/sites\/default\/files\/pdf\/breastfeeding-why-not-give-it-a-try-eng.pdf\">USDA\u2019s <em>Breastfeeding: Why Not Give It a Try?<\/em><\/a>: https:\/\/eclkc.ohs.acf.hhs.gov\/sites\/default\/files\/pdf\/breastfeeding-why-not-give-it-a-try-eng.pdf<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <a href=\"https:\/\/www.nal.usda.gov\/sites\/default\/files\/fnic_uploads\/toddler.pdf\">Toddler Nutrition and Health Resource List:<\/a> https:\/\/www.nal.usda.gov\/sites\/default\/files\/fnic_uploads\/\/toddler.pdf<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Resources on MyPlate.gov:<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <a href=\"https:\/\/choosemyplate-prod.azureedge.net\/sites\/default\/files\/audiences\/HealthyEatingForPreschoolers-MiniPoster.pdf\">Daily Food Plan<\/a>: https:\/\/choosemyplate-prod.azureedge.net\/sites\/default\/files\/audiences\/HealthyEatingForPreschoolers-MiniPoster.pdf<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <a href=\"https:\/\/www.choosemyplate.gov\/browse-by-audience\/view-all-audiences\/children\/health-and-nutrition-information\">Preschoolers<\/a>: https:\/\/www.choosemyplate.gov\/browse-by-audience\/view-all-audiences\/children\/health-and-nutrition-information<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <a href=\"https:\/\/www.choosemyplate.gov\/browse-by-audience\/view-all-audiences\/children\/kids\">Kids<\/a>: <a href=\"https:\/\/www.choosemyplate.gov\/browse-by-audience\/view-all-audiences\/children\/kids\">https:\/\/www.choosemyplate.gov\/browse-by-audience\/view-all-audiences\/children\/kids<\/a><\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <a href=\"https:\/\/cchp.ucsf.edu\/content\/healthy-beverages-early-care-education\">Healthy Beverages in Early Care and Education<\/a>: https:\/\/cchp.ucsf.edu\/content\/healthy-beverages-early-care-education<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <a href=\"https:\/\/www.cdc.gov\/breastfeeding\/resources\/toolkits.html\"><em>The CDC Guide to Strategies to Support Breastfeeding Mothers and Babies<\/em><\/a>: https:\/\/www.cdc.gov\/breastfeeding\/resources\/toolkits.html<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <a href=\"https:\/\/kidshealth.org\/en\/parents\/nutrition-center\/?WT.ac=p-nav-nutrition-center\">KidsHealth From Nemours Nutrition &amp; Fitness Center<\/a>: https:\/\/kidshealth.org\/en\/parents\/nutrition-center\/?WT.ac=p-nav-nutrition-center<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <a href=\"https:\/\/www.fns.usda.gov\/accommodating-children-special-dietary-needs-school-nutrition-programs\">USDA\u2019s <em>Accommodating Children with Special Dietary Needs in the School Nutrition Programs<\/em><\/a>: https:\/\/www.fns.usda.gov\/accommodating-children-special-dietary-needs-school-nutrition-programs<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <a href=\"https:\/\/www.nal.usda.gov\/fnic\/curricula-and-lesson-plans\">USDA\u2019s <em>Nutrition Curricula<\/em><\/a>: https:\/\/www.nal.usda.gov\/fnic\/curricula-and-lesson-plans<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <a href=\"https:\/\/www.urmc.rochester.edu\/childrens-hospital\/nutrition\/diets.aspx\">Golisano Children&#8217;s Hospital\u2019s <em>Special Diets for Nutritional Special Needs<\/em><\/a>: <a href=\"https:\/\/www.urmc.rochester.edu\/childrens-hospital\/nutrition\/diets.aspx\">https:\/\/www.urmc.rochester.edu\/childrens-hospital\/nutrition\/diets.aspx<\/a><\/p>\n<\/div>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\">Chapter 14 Workbook<\/p>\n<\/header>\n<div class=\"textbox__content\">\n<div id=\"h5p-30\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-30\" class=\"h5p-iframe\" data-content-id=\"30\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Chapter 14 Workbook\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<\/div>\n<p>&nbsp;<\/p>\n<h5>References:<\/h5>\n<div>\n<div>\n<p><a href=\"#_ftnref1\">[1]<\/a> <a href=\"http:\/\/pressbooks.oer.hawaii.edu\/humannutrition\/chapter\/infancy\/\">Human Nutrition<\/a> by <a href=\"https:\/\/cms.ctahr.hawaii.edu\/hnfas\/Undergraduate\/Food-Sciences-Human-Nutrition\/Culinology\">University of Hawai\u2018i at M\u0101noa Food Science and Human Nutrition Program<\/a> is licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a><\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref2\">[2]<\/a> <a href=\"http:\/\/pressbooks.oer.hawaii.edu\/humannutrition\/chapter\/infancy\/\">Human Nutrition<\/a> by <a href=\"https:\/\/cms.ctahr.hawaii.edu\/hnfas\/Undergraduate\/Food-Sciences-Human-Nutrition\/Culinology\">University of Hawai\u2018i at M\u0101noa Food Science and Human Nutrition Program<\/a> is licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a><\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref3\">[3]<\/a> <a href=\"http:\/\/pressbooks.oer.hawaii.edu\/humannutrition\/chapter\/infancy\/\">Human Nutrition<\/a> by <a href=\"https:\/\/cms.ctahr.hawaii.edu\/hnfas\/Undergraduate\/Food-Sciences-Human-Nutrition\/Culinology\">University of Hawai\u2018i at M\u0101noa Food Science and Human Nutrition Program<\/a> is licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a><\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref4\">[4]<\/a> <a href=\"http:\/\/pressbooks.oer.hawaii.edu\/humannutrition\/chapter\/infancy\/\">Human Nutrition<\/a> by <a href=\"https:\/\/cms.ctahr.hawaii.edu\/hnfas\/Undergraduate\/Food-Sciences-Human-Nutrition\/Culinology\">University of Hawai\u2018i at M\u0101noa Food Science and Human Nutrition Program<\/a> is licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a><\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref5\">[5]<\/a> <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/nutrition\/article\/important-role-staff-breastfeeding-education-support\">The Important Role of Staff in Breastfeeding Education and Support<\/a> by <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/\">Head Start Early Childhood Learning &amp; Knowledge Center<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref6\">[6]<\/a> <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/sites\/default\/files\/pdf\/breastfed-babies-childcare.pdf\">Breastfed Babies Welcome Here!<\/a> by the <a href=\"https:\/\/www.fns.usda.gov\/\">USDA Food and Nutrition Service<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref7\">[7]<\/a> <a href=\"https:\/\/www.nellis.af.mil\/News\/Art\/igphoto\/2000182917\/\">Nellis Child Development Center II<\/a> by Staff Sgt. Taylor Worley (USAF) is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref8\">[8]<\/a> <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/sites\/default\/files\/pdf\/breastfed-babies-childcare.pdf\">Breastfed Babies Welcome Here!<\/a> by the <a href=\"https:\/\/www.fns.usda.gov\/\">USDA Food and Nutrition Service<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref9\">[9]<\/a> <a href=\"http:\/\/pressbooks.oer.hawaii.edu\/humannutrition\/chapter\/infancy\/\">Human Nutrition<\/a> by <a href=\"https:\/\/cms.ctahr.hawaii.edu\/hnfas\/Undergraduate\/Food-Sciences-Human-Nutrition\/Culinology\">University of Hawai\u2018i at M\u0101noa Food Science and Human Nutrition Program<\/a> is licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a><\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref10\">[10]<\/a> <a href=\"https:\/\/pixabay.com\/id\/photos\/bayi-muda-orang-orang-mewah-472923\/\">Image<\/a> by <a href=\"https:\/\/pixabay.com\/id\/users\/ben_kerckx-69781\/\">Ben Kerckx<\/a> on <a href=\"https:\/\/pixabay.com\/id\/service\/license\/\">Pixabay<\/a><\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref11\">[11]<\/a> <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/sites\/default\/files\/pdf\/breastfed-babies-childcare.pdf\">Breastfed Babies Welcome Here!<\/a> by the <a href=\"https:\/\/www.fns.usda.gov\/\">USDA Food and Nutrition Service<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref12\">[12]<\/a> <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/sites\/default\/files\/pdf\/no-search\/healthy-feeding-start.pdf\">Healthy Feeding from the Start: A Resource for Expectant Families<\/a> by the <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/about-us\/article\/national-center-early-childhood-health-wellness-ncechw\">National Center on Early Childhood Health and Wellness<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref13\">[13]<\/a> <a href=\"http:\/\/pressbooks.oer.hawaii.edu\/humannutrition\/chapter\/infancy\/\">Human Nutrition<\/a> by <a href=\"https:\/\/cms.ctahr.hawaii.edu\/hnfas\/Undergraduate\/Food-Sciences-Human-Nutrition\/Culinology\">University of Hawai\u2018i at M\u0101noa Food Science and Human Nutrition Program<\/a> is licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a><\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref14\">[14]<\/a> <a href=\"http:\/\/pressbooks.oer.hawaii.edu\/humannutrition\/chapter\/infancy\/\">Human Nutrition<\/a> by <a href=\"https:\/\/cms.ctahr.hawaii.edu\/hnfas\/Undergraduate\/Food-Sciences-Human-Nutrition\/Culinology\">University of Hawai\u2018i at M\u0101noa Food Science and Human Nutrition Program<\/a> is licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a><\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref15\">[15]<\/a> <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/safety-practices\/article\/tips-keeping-infants-toddlers-safe-developmental-guide-home-visitors-mobile-infants\">Tips for Keeping Infants and Toddlers Safe: A Developmental Guide for Home Visitors \u2013 Mobile Infants<\/a> by <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/ncecdtl\">Early Head Start National Resource Center<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref16\">[16]<\/a> <a href=\"http:\/\/conditions.health.qld.gov.au\/HealthCondition\/condition\/8\/78\/412\/introducing-solids-feeding-from-around-6-mont\">Introducing Complementary Foods: Feeding from Around 6 Months<\/a> by <a href=\"https:\/\/www.qld.gov.au\/\">Queensland Government <\/a>is licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a><\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref17\">[17]<\/a> <a href=\"http:\/\/pressbooks.oer.hawaii.edu\/humannutrition\/chapter\/infancy\/\">Human Nutrition<\/a> by <a href=\"https:\/\/cms.ctahr.hawaii.edu\/hnfas\/Undergraduate\/Food-Sciences-Human-Nutrition\/Culinology\">University of Hawai\u2018i at M\u0101noa Food Science and Human Nutrition Program<\/a> is licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a><\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref18\">[18]<\/a> <a href=\"https:\/\/medlineplus.gov\/ency\/patientinstructions\/000713.htm\">Feeding Patterns and Diet &#8211; Children 6 Months to 2 Years<\/a> by <a href=\"https:\/\/medlineplus.gov\/\">MedlinePlus<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref19\">[19]<\/a> <a href=\"http:\/\/pressbooks.oer.hawaii.edu\/humannutrition\/chapter\/infancy\/\">Human Nutrition<\/a> by <a href=\"https:\/\/cms.ctahr.hawaii.edu\/hnfas\/Undergraduate\/Food-Sciences-Human-Nutrition\/Culinology\">University of Hawai\u2018i at M\u0101noa Food Science and Human Nutrition Program<\/a> is licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a><\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref20\">[20]<\/a> <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/safety-practices\/article\/tips-keeping-infants-toddlers-safe-developmental-guide-home-visitors-mobile-infants\">Tips for Keeping Infants and Toddlers Safe: A Developmental Guide for Home Visitors \u2013 Mobile Infants<\/a> by <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/ncecdtl\">Early Head Start National Resource Center<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref21\">[21]<\/a> <a href=\"https:\/\/medlineplus.gov\/ency\/patientinstructions\/000713.htm\">Feeding Patterns and Diet &#8211; Children 6 Months to 2 Years<\/a> by <a href=\"https:\/\/medlineplus.gov\/\">MedlinePlus<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref22\">[22]<\/a> <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/safety-practices\/article\/tips-keeping-infants-toddlers-safe-developmental-guide-home-visitors-mobile-infants\">Tips for Keeping Infants and Toddlers Safe: A Developmental Guide for Home Visitors \u2013 Mobile Infants<\/a> by <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/ncecdtl\">Early Head Start National Resource Center<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref23\">[23]<\/a> <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/sites\/default\/files\/pdf\/growing-healthy-flipchart.pdf\">Image<\/a> by the <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/about-us\/article\/national-center-early-childhood-health-wellness-ncechw\">National Center on Early Childhood Health and Wellness<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref24\">[24]<\/a> <a href=\"http:\/\/pressbooks.oer.hawaii.edu\/humannutrition\/chapter\/infancy\/\">Human Nutrition<\/a> by <a href=\"https:\/\/cms.ctahr.hawaii.edu\/hnfas\/Undergraduate\/Food-Sciences-Human-Nutrition\/Culinology\">University of Hawai\u2018i at M\u0101noa Food Science and Human Nutrition Program<\/a> is licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a><\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref25\">[25]<\/a> <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/sites\/default\/files\/pdf\/growing-healthy-flipchart.pdf\">Growing Healthy<\/a> by the <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/about-us\/article\/national-center-early-childhood-health-wellness-ncechw\">National Center on Early Childhood Health and Wellness<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref26\">[26]<\/a> <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/sites\/default\/files\/pdf\/growing-healthy-flipchart.pdf\">Growing Healthy<\/a> by the <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/about-us\/article\/national-center-early-childhood-health-wellness-ncechw\">National Center on Early Childhood Health and Wellness<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref27\">[27]<\/a> <a href=\"https:\/\/medlineplus.gov\/infantandnewbornnutrition.html\">Infant and Newborn Nutrition<\/a> by <a href=\"https:\/\/medlineplus.gov\/\">MedlinePlus<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref28\">[28]<\/a> <a href=\"https:\/\/medlineplus.gov\/ency\/patientinstructions\/000713.htm\">Feeding Patterns and Diet &#8211; Children 6 Months to 2 Years<\/a> by <a href=\"https:\/\/medlineplus.gov\/\">MedlinePlus<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref29\">[29]<\/a> <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/sites\/default\/files\/pdf\/growing-healthy-flipchart.pdf\">Growing Healthy<\/a> by the <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/about-us\/article\/national-center-early-childhood-health-wellness-ncechw\">National Center on Early Childhood Health and Wellness<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref30\">[30]<\/a> <a href=\"http:\/\/pressbooks.oer.hawaii.edu\/humannutrition\/chapter\/toddler-years\/\">Human Nutrition<\/a> by <a href=\"https:\/\/cms.ctahr.hawaii.edu\/hnfas\/Undergraduate\/Food-Sciences-Human-Nutrition\/Culinology\">University of Hawai\u2018i at M\u0101noa Food Science and Human Nutrition Program<\/a> is licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a><\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref31\">[31]<\/a> <a href=\"http:\/\/pressbooks.oer.hawaii.edu\/humannutrition\/chapter\/toddler-years\/\">Human Nutrition<\/a> by <a href=\"https:\/\/cms.ctahr.hawaii.edu\/hnfas\/Undergraduate\/Food-Sciences-Human-Nutrition\/Culinology\">University of Hawai\u2018i at M\u0101noa Food Science and Human Nutrition Program<\/a> is licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a><\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref32\">[32]<\/a> <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/sites\/default\/files\/pdf\/growing-healthy-flipchart.pdf\">Image<\/a> by the <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/about-us\/article\/national-center-early-childhood-health-wellness-ncechw\">National Center on Early Childhood Health and Wellness<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref33\">[33]<\/a> <a href=\"http:\/\/pressbooks.oer.hawaii.edu\/humannutrition\/chapter\/toddler-years\/\">Human Nutrition<\/a> by <a href=\"https:\/\/cms.ctahr.hawaii.edu\/hnfas\/Undergraduate\/Food-Sciences-Human-Nutrition\/Culinology\">University of Hawai\u2018i at M\u0101noa Food Science and Human Nutrition Program<\/a> is licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a><\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref34\">[34]<\/a> <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/sites\/default\/files\/pdf\/nch-feeding-toddler.pdf\">Feeding Your Toddler<\/a> by <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/\">Head Start Early Childhood Learning &amp; Knowledge Center<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref35\">[35]<\/a> <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/sites\/default\/files\/pdf\/nch-feeding-toddler.pdf\">Feeding Your Toddler<\/a> by <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/\">Head Start Early Childhood Learning &amp; Knowledge Center<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref36\">[36]<\/a> <a href=\"http:\/\/pressbooks.oer.hawaii.edu\/humannutrition\/chapter\/introduction-15\/\">Human Nutrition<\/a> by <a href=\"https:\/\/cms.ctahr.hawaii.edu\/hnfas\/Undergraduate\/Food-Sciences-Human-Nutrition\/Culinology\">University of Hawai\u2018i at M\u0101noa Food Science and Human Nutrition Program<\/a> is licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a><\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref37\">[37]<\/a> <a href=\"https:\/\/www.usda.gov\/media\/blog\/2016\/07\/22\/serving-spoons-and-healthy-habits-encouraging-positive-mealtimes-and\">Serving Spoons and Healthy Habits<\/a> by Mallory Feeney is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref38\">[38]<\/a> <a href=\"https:\/\/www.choosemyplate.gov\/browse-by-audience\/view-all-audiences\/children\/health-and-nutrition-information\/how-much-does-my-preschooler-need\">How Much Does My Preschooler Need?<\/a> by the <a href=\"https:\/\/www.fns.usda.gov\/cnpp\">USDA Center for Nutrition Policy and Promotion<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref39\">[39]<\/a> <a href=\"http:\/\/pressbooks.oer.hawaii.edu\/humannutrition\/chapter\/childhood\/\">Human Nutrition<\/a> by <a href=\"https:\/\/cms.ctahr.hawaii.edu\/hnfas\/Undergraduate\/Food-Sciences-Human-Nutrition\/Culinology\">University of Hawai\u2018i at M\u0101noa Food Science and Human Nutrition Program<\/a> is licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a><\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref40\">[40]<\/a> <a href=\"https:\/\/www.choosemyplate.gov\/browse-by-audience\/view-all-audiences\/children\/health-and-nutrition-information\/preschoolers-picky-eating\">Tips for Picky Eaters<\/a> by the <a href=\"https:\/\/www.fns.usda.gov\/cnpp\">USDA Center for Nutrition Policy and Promotion<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref41\">[41]<\/a> <a href=\"https:\/\/www.choosemyplate.gov\/browse-by-audience\/view-all-audiences\/children\/health-and-nutrition-information\/preschoolers-picky-eating\">Tips for Picky Eaters<\/a> by the <a href=\"https:\/\/www.fns.usda.gov\/cnpp\">USDA Center for Nutrition Policy and Promotion<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref42\">[42]<\/a> <a href=\"https:\/\/choosemyplate-prod.azureedge.net\/sites\/default\/files\/printablematerials\/HealthyTipsforPickyEaters_031418_508.pdf\">Healthy Tips for Picky Eaters<\/a> by the <a href=\"https:\/\/www.fns.usda.gov\/cnpp\">USDA Center for Nutrition Policy and Promotion<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref43\">[43]<\/a> <a href=\"https:\/\/choosemyplate-prod.azureedge.net\/sites\/default\/files\/audiences\/HealthyEatingForPreschoolers-MiniPoster.pdf\">Healthy Eating for Preschoolers<\/a> by the <a href=\"https:\/\/www.fns.usda.gov\/cnpp\">USDA Center for Nutrition Policy and Promotion<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref44\">[44]<\/a> <a href=\"https:\/\/www.choosemyplate.gov\/browse-by-audience\/view-all-audiences\/children\/health-and-nutrition-information\/preschoolers-picky-eating\">Tips for Picky Eaters<\/a> by the <a href=\"https:\/\/www.fns.usda.gov\/cnpp\">USDA Center for Nutrition Policy and Promotion<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref45\">[45]<\/a> Dietary Guidelines for Americans 2015\u20132020 Appendix 2. Estimated Calorie Needs per Day, by Age, Sex, and Physical Activity Level by the <a href=\"https:\/\/health.gov\/\">Office of Disease Prevention and Health Promotion<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref46\">[46]<\/a> <a href=\"http:\/\/pressbooks.oer.hawaii.edu\/humannutrition\/chapter\/adolescence\/\">Human Nutrition<\/a> by <a href=\"https:\/\/cms.ctahr.hawaii.edu\/hnfas\/Undergraduate\/Food-Sciences-Human-Nutrition\/Culinology\">University of Hawai\u2018i at M\u0101noa Food Science and Human Nutrition Program<\/a> is licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a><\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref47\">[47]<\/a> MyPlate Guide to School Breakfast for Families by the <a href=\"https:\/\/www.fns.usda.gov\/cnpp\">USDA Center for Nutrition Policy and Promotion<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref48\">[48]<\/a> MyPlate Guide to School Breakfast for Families by the <a href=\"https:\/\/www.fns.usda.gov\/cnpp\">USDA Center for Nutrition Policy and Promotion<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref49\">[49]<\/a> Image by the <a href=\"https:\/\/www.fns.usda.gov\/cnpp\">USDA Center for Nutrition Policy and Promotion<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref50\">[50]<\/a> <a href=\"https:\/\/fns-prod.azureedge.net\/sites\/default\/files\/tn\/SL_Infographic_81216a.pdf\">Image<\/a> by the <a href=\"https:\/\/www.fns.usda.gov\/cnpp\">USDA Center for Nutrition Policy and Promotion<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref51\">[51]<\/a> <a href=\"https:\/\/www.schriever.af.mil\/News\/Photos\/igphoto\/2002158312\/\">Schriever Children Learn New Skills at Cooking Camp<\/a> by 2nd Lt. Idal\u00ed Beltr\u00e9 Acevedo (USAF) is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref52\">[52]<\/a> <a href=\"https:\/\/choosemyplate-prod.azureedge.net\/sites\/default\/files\/printablematerials\/Food_Critic_508.pdf\">Kids Food Critic Activity<\/a> by the <a href=\"https:\/\/www.fns.usda.gov\/cnpp\">USDA Center for Nutrition Policy and Promotion<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref53\">[53]<\/a> <a href=\"https:\/\/choosemyplate-prod.azureedge.net\/sites\/default\/files\/printablematerials\/Bingo_508.pdf\">MyPlate Grocery Store Bingo<\/a> by the <a href=\"https:\/\/www.fns.usda.gov\/cnpp\">USDA Center for Nutrition Policy and Promotion<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref54\">[54]<\/a> <a href=\"https:\/\/www.choosemyplate.gov\/browse-by-audience\/view-all-audiences\/families\">MyPlate, MyWins for Families<\/a> by the <a href=\"https:\/\/www.fns.usda.gov\/cnpp\">USDA Center for Nutrition Policy and Promotion<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref55\">[55]<\/a> <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Cleft_Nurser_Mead_Johnson.jpg\">Cleft Nurser Mead Johnson<\/a> by <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Cleft_Nurser_Mead_Johnson.jpg\">King97tut<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref56\">[56]<\/a> <a href=\"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2016.00045\/full\">Are School Feeding Programs Prepared to Be Inclusive of Children with Disabilities?<\/a> by <a href=\"https:\/\/loop.frontiersin.org\/people\/263458\/overview\">Sergio Meresman<\/a> and <a href=\"https:\/\/loop.frontiersin.org\/people\/164169\/overview\">Lesley Drake<\/a> is licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY 4.0<\/a><\/p>\n<\/div>\n<\/div>\n","protected":false},"author":32,"menu_order":3,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[47],"contributor":[],"license":[],"class_list":["post-267","chapter","type-chapter","status-publish","hentry","chapter-type-standard"],"part":227,"_links":{"self":[{"href":"https:\/\/pressbooks.ccconline.org\/accece\/wp-json\/pressbooks\/v2\/chapters\/267","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.ccconline.org\/accece\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.ccconline.org\/accece\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.ccconline.org\/accece\/wp-json\/wp\/v2\/users\/32"}],"version-history":[{"count":2,"href":"https:\/\/pressbooks.ccconline.org\/accece\/wp-json\/pressbooks\/v2\/chapters\/267\/revisions"}],"predecessor-version":[{"id":361,"href":"https:\/\/pressbooks.ccconline.org\/accece\/wp-json\/pressbooks\/v2\/chapters\/267\/revisions\/361"}],"part":[{"href":"https:\/\/pressbooks.ccconline.org\/accece\/wp-json\/pressbooks\/v2\/parts\/227"}],"metadata":[{"href":"https:\/\/pressbooks.ccconline.org\/accece\/wp-json\/pressbooks\/v2\/chapters\/267\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.ccconline.org\/accece\/wp-json\/wp\/v2\/media?parent=267"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.ccconline.org\/accece\/wp-json\/pressbooks\/v2\/chapter-type?post=267"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.ccconline.org\/accece\/wp-json\/wp\/v2\/contributor?post=267"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.ccconline.org\/accece\/wp-json\/wp\/v2\/license?post=267"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}