AN EVIDENCE-BASED GUIDE TO TODDLER NUTRITION FOR HEALTHCARE PROFESSIONALS
Healthcare Professionals have a role to play in helping parents of toddlers (1-3 years) understand how important the right fluids are for health
- The right intake is essential. An adequate daily intake of fluid for a toddler is 1.3 litres.
- Water is best. Water is essential for health, and the most tooth-kind drink a toddler can have.
- Monitor milk intake. Many toddlers drink more milk than they need, which can affect overall nutrition because they can be less hungry for main meals.
THE IMPORTANCE OF FLUID
Water is essential for life: from thermoregulation to cognitive function, water plays a role1. Toddlers can lose water through urine and faeces as well as through respiration and perspiration2. Toddlers and children lose more water through their skin than adults, because they have a greater surface-to-mass ratio. This means they are more likely to become dehydrated during hot weather or from physical activity3.
HOW MUCH FLUID DOES A TODDLER NEED?
In 2004, the Institute of Medicine4 set an adequate intake of fluid for toddlers of 1.3 litres of fluid per day. As this includes water from food as well as drinks, and can also vary based on their weight, a general guide is about six to eight drinks per day, of 150-200mls/5-7oz each. However, on hot days toddlers may require more drinks3. Nappy weight or frequency of potty use are good indicators. Toddlers still in nappies should have several fairly heavy nappies during the day as well as first thing in the morning. If all the nappies are light, then they may need more to drink. Checking urine colour is another way for parents to check if their toddler is getting enough fluid. Urine should be light yellow to clear. Dark urine may indicate the need for more fluid.
QUICK TIP FOR PARENTS
To help monitor fluid intake, check nappy weight or keep an eye on how often your toddler uses the potty during the day.
INTRODUCING BEAKERS TO TODDLERS
As drinks other than breastmilk are introduced, it’s best to use an open beaker. Use of an open beaker is a safe and easily learned skill in infancy. Encouraging the use of an open beaker can help to avoid prolonged bottle feeding5,6. An open beaker can lead to spillage and mess, so some parents opt for a lidded beaker with no-spill valves. These still encourage a sucking action instead of helping toddlers to drink in a mature way7. An open beaker is the better approach. It also reduces the possibility of toddlers sipping milk or other fluids constantly through the day with potentially harmful effects on dental health8.
WHY TIMING IS KEY
Toddlers have relatively small stomachs, so it is easy for them to fill up on drinks. For this reason, advise parents that it’s best not to offer their toddler a drink for 30-60 minutes before their next meal. This makes it easier for them to be able to eat, as they are more likely to feel hungry9. It is best not to offer toddlers a drink until they are at least half through their meal, or even at the end of the meal. This way they can focus on eating and take a drink later, when they need one. Advise parents to offer drinks after and in between meals to help their toddler stay hydrated.
QUICK TIP FOR PARENTS
Watch out for fruit juice drinks:they often have sugar and water added.
WHAT DRINKS ARE SUITABLE?
Water is the best drink for toddlers.
Water helps to hydrate toddlers without adding any extra calories or unwanted sugar. Because it is also safe for teeth, it is especially good to use in between meals.
Toddlers still need lots of calcium and milk and other dairy foods like yoghurt and cheese are great sources. It is best to have milk with a meal and drink water in between.
Milk is a tooth-friendly drink, as it is not acidic. However, many toddlers drink more milk than they need. Toddlers need about two beakers of milk per day (150-200mls/5-7oz per beaker). More than this and they can fill up on milk, and be less hungry for main meals9. Although milk is a nutritious food, toddlers do need to learn to eat their normal meals if they are going to have a balanced diet as they grow up. If they prefer not to drink milk, they can swap a beaker of milk for some yoghurt or cheese to make up calcium.
Over the age of one, toddlers can continue to use breast milk or use cows’ milk as their main milk drink. Cows’ milk is not suitable as a main milk drink before this. Parents should give full fat cows’ milk, not low fat. Low fat milk is suitable from age two. Milk fortified with vitamin D can be useful in ensuring that toddlers continue to meet requirements for vitamin D. Toddlers can also have growing up milks, which have iron, vitamin D and other nutrients added.
- FRUIT JUICE & FRUIT JUICE DRINKS
Fruit juices for toddlers should be diluted with water, taken only once a day, and are best kept to mealtimes, with water as the main drink in between meals8.
Although fruit is important for toddlers as a source of vitamin C and fibre, fruit juice drinks can add more sugar to a toddler’s diet, so advise parents to limit them. Pure fruit juice is made with 100% fruit juice, but fruit juice drinks are different and often have sugar and water added. A recent study suggests that pure fruit juice may not be linked with dental caries10, but parents may not be aware of the difference between pure fruit juice and fruit juice drinks. Fruit juice and fruit juice drinks are more acidic than milk or water and may have an impact on tooth enamel erosion8. Additionally, fruit juice intake may displace intake of breastmilk, and may contribute to inadequate intakes of nutrients from solid foods11.
- FRUIT SQUASH
Squashes are fine to use now and again, but should be diluted with plenty of water.
A fruit squash adds flavour to water, but is not as tooth-kind as plain water. They are fine to use now and again, but should be diluted with plenty of water (one part squash to eight parts water). Advise parents to use these in moderation as they are more acidic than water and many do contain sugar (even the no-added-sugar varieties). It is better for toddlers to get into the habit of drinking plain water without added flavourings.
- TEA AND COFFEE
Caffeinated drinks are best avoided.
There is insufficient evidence available to determine a safe intake of caffeine for children12. Due to its effects on sleep in toddlers, drinks such as tea, coffee and energy drinks are best avoided in young children12.
- SOFT DRINKS
These are best avoided.
Soft drinks often contain a lot of sugar and calories and have few or no beneficial nutrients. They are also quite acidic and not good for a toddler’s teeth.
Many people believe that smoothies contribute to more than one portion of fruit and vegetables a day, but that’s not the case.
Smoothies count as only a single daily portion of fruit and veg, no matter how many you have! Smoothies shouldn’t be had between meals, because they are high in naturally-occurring sugar which can damage teeth. Using a straw reduces how much sugar comes in contact with the teeth.
Suitable articles for parents on this topic are available at www.toddlebox.ie/nutritionShow References