Chapter 7 Feeding Toddlers, Preschoolers, and School-Age Children

After reading this chapter, you should be able to:

1. 7.1 Define the nutritional needs of toddlers and discuss how to manage eating issues
typical of this age group.
2. 7.2 Describe characteristics of preschool children’s diets and factors that enhance how
preschoolers learn about food and nutrition.
3. 7.3 Explain how to create a healthy nutritional environment for school-age children that
supports the dietary guidelines and enhances the goals of the school lunch program.

PART 1: Understanding and Managing the Nutritional Needs of Toddlers

Feeding toddlers (children from 12 to 36 months of age) is different from feeding infants.
Infants’ easy acceptance of food often changes when they become toddlers. Appetites that were
once consistent in infants become sporadic and selective in toddlerhood. In addition, toddlers
establish their autonomy by asserting themselves at mealtimes. Toddlers, like Michaela, are often
ready and willing to battle about what they will and will not eat. The wise caregiver remains
neutral, does not overreact, and continues to offer nutritious foods in a supportive manner.
caregivers should:

• Allow toddlers to explore foods as they become increasingly independent in their food
choices.
• Promote pleasure and success while eating.
• Avoid succumbing to unreasonable demands.

1-1 Division of Responsibility in Feeding

Teachers are responsible for what children eat, when they eat, and where they eat. Children are
responsible for whether they eat and how much they eat (Satter, 2008). Children’s
responsibility relies on their innate ability to select and eat the amount of food needed to
maintain growth and a healthful weight.
When teachers take over the child’s responsibility, negative repercussions may result. Children
may overeat or display defiance and not eat enough. Allowing children to regulate their own
food intake preserves the feeding relationship and helps children become competent eaters.
Competent eaters know when they are hungry and when they are full.
1-2 Understanding the Nutritional Needs of Toddlers

As the amount of solid food eaten increases and begins to provide more of the nutrient needs
of the toddler, the role of milk in the diet decreases. However, breastfeeding still has an
important role, so teachers should support the mother who chooses to continue to breast-feed
after 1 year, called extended breastfeeding.

1-3 Balancing Toddler Diets (MyPlate)

Fruits and vegetables in an assortment of rich colors are more likely to add nutrients such as
vitamins A and C, potassium, and fiber to the diet. Meats, poultry, and fish are rich sources of
iron and zinc, and dairy products are good sources of vitamin D and calcium.

1-4 Understanding Portion Sizes for Toddlers

Children’s appetites should dictate portion size. One rule of thumb to use when deciding how
much to serve at meals is that children need about 1 tablespoon of food from each food group
per year of age.

Teachers are often surprised at the small portions recommended for children. Usually these
amounts are sufficient for most children; however, the CACFP recommendations describe
minimum portions, and some children may require or desire more food. It is important to serve
enough food so that children feel satisfied.
1-5 Modifying Food Textures and Consistency

The textures and consistencies of food need to be adjusted for toddlers, especially when they
begin to master table foods. Meats, poultry, and other foods need to be chopped into pieces no
larger than ¼ inch in diameter for children 1–2 years of age and ½ inch in diameter for those 3–
5 years of age.
Reinforcing and offering children different textures (e.g., smooth, lumpy, and mushy) can help
children develop preferences for various textures in addition to different flavors.
1-6 Timing of Meals
Toddlers have small stomachs. However, they are ready to shift from on-demand feeding to
scheduled meals. Offering three meals plus snacks every 2–3 hours provides toddlers ample
opportunity to refuel. This routine is supportive of toddlers’ variable appetites. In fact, meals
and snacks should be at least 2 hours but no more than 3 hours apart.
1-7 Understanding Impacts of Development
Children’s developmental skills influence their ability to navigate biting, chewing, and
swallowing certain foods.

• Decrease in Growth Rate

A toddler’s rate of growth is slower than it is during the infant period. Because of this, the
child’s food intake decreases. This natural decrease in eating is sometimes seen as having a
poor appetite or being picky.

• The Need for “Sameness”

Toddlers are busy maturing, developing, changing, and learning many new skills. Sometimes
routine foods provide comfort and security during times of rapid change and development.
Toddlers may be less likely to try new foods.
1-7 Changing Taste Perceptions
Taste buds are located on the roof of the mouth, the cheeks, and the tongue. Research suggests
there are variations in the ability to taste bitter. Some children may taste bitter more strongly;
and in general, children have a greater number of taste buds compared with adults. Therefore,
their food preferences are not within their control.
Spinach, broccoli, Brussel sprouts, cabbage, and grapefruit have flavors that may be too strong
for some toddlers.
1-8 Understanding Challenges in Feeding Toddlers

Toddlers experience significant developmental transitions as they strive to establish their

independence. They are increasingly mobile and may occasionally show their autonomy
through challenging behavior. “No” may become a well-used word in their vocabulary.
Teachers are better able to help promote positive eating habits if they recognize and anticipate
potential feeding challenges and are prepared to address them.
1-9 Selective Eaters
Selective eaters are children who accept a limited variety of foods, eat small portions, and may
not be interested in eating. This eating pattern is sometimes called picky or finicky. Selective
eating, however, is relatively common in the toddler age group and is considered normal.
Some selective eaters limit food choices to such an extent that teachers may become
concerned about the nutritional adequacy of the child’s diet. The best way to determine
whether the problem is a significant issue is to assess the child’s growth patterns using a
growth chart. If children are growing at a normal rate, then they are getting sufficient calories
to grow and develop in spite of their selective eating habits.
1-10 Food Neophobia
Food neophobia refers to fear of new foods. Toddlers are often suspicious of new foods. This
fear may be an adaptive behavior that has historically protected young children from eating
poisonous substances. Children may inherit their fear of new foods from their relatives;
children may inherit their fear of new foods from their relatives.
Despite children’s food neophobia, if they are introduced to a variety of new foods early on and
are given ample exposure to foods, it can help overcome their hesitations. The same holds true
for learning to accept new foods. Young children must be exposed to new foods as many as 15
times before they accept them. Toddlers also benefit from having role.
Another strategy is to offer new foods along with foods toddlers already like. This takes the
pressure off the toddler because there is something available that he or she likes to eat.
1-11 Food Jags
A food jag occurs when toddlers select a very limited number of favorite foods to eat and reject
all others, including foods they liked in the past. Sometimes a well-loved favorite will suddenly
no longer have appeal and another food will take its place. Teachers and families who recognize
a food jag should try to focus on what the children are still eating rather than focusing on what
they are no longer eating.

1-12 Weaning from the Bottle

Children should wean from the bottle to reduce the risk of dental cavities and to avoid a lag in
the development of appropriate feeding skills. The American Academy of Pediatrics
recommends weaning children from a bottle by 12–15 months of age (Kleinman, 2009).
Teachers can help support weaning by collaborating with families and making sure a consistent
message is sent to toddlers both in the home and child care setting.
1-13 Switching to Whole Milk
Infants require breast milk or formula during their first year of life. Once they reach their first
birthday, they are ready to make the transition from formula to whole milk. Fat-free, 1%, and
2% milk may be too low in fat content to support an adequate rate of weight gain and growth
and should be offered only if recommended by a physician. The fat and cholesterol in whole
milk may support neurological development and aids in vitamin A and D absorption. However,
low-fat milk is encouraged after 2 years of age.
1-14 Exploring Cultural Differences in Feeding Toddlers
Teachers need to use culturally sensitive approaches when discussing family food practices.
Teachers also should support healthful traditional food practices and find ways to incorporate
diverse foods in the children’s menu at school. This can be accomplished by planning menus to
include foods that reflect cultural preferences or special cultural occasions and by planning
social events such as potlucks where families can share special cultural dishes to promote
awareness.

PART 2: Engaging Preschoolers to Learn About Food and Nutrition

Children’s body fat naturally decreases as they leave the toddler years and enter the preschool
years. This means preschool children’s appetites, like those of toddlers, can be sporadic.
Preschool children may eat well one day but less the next day. As their experience with foods
expands, they also develop distinct preferences. To support preschoolers in their efforts to
develop positive eating habits, teachers need to understand the nutritional needs and
characteristics of the diets of this age group, understand how to create positive mealtime
experiences, and teach children healthful nutrition concepts.
2-1 Understanding the Nutritional Needs of Preschool Children
The goal is to balance their nutrient needs with their calorie requirements and energy
expenditure. This is best accomplished by providing a variety of foods rich in tastes, colors, and
textures while establishing habits that promote an active lifestyle.
Teachers can find dietary advice about feeding preschool-age children from several sources:
• These include the federal government’s MyPlate food guidance system
(https://www.myplate.gov/)
• The CACFP (https://www.fns.usda.gov/cacfp)
• Dietary Guidelines for Americans (https://www.dietaryguidelines.gov/)
• Department of Health and Human Services (https://www.hhs.gov/)
2-2 Recognizing Characteristics of Preschool Children’s Diets
2-2-1 Food Textures and Consistencies
Preschool children have completed the teething process and are ready to eat most solid foods.
But chewing and swallowing skills are still developing, so special attention must be given to
foods that could represent a choking hazard. Foods that are difficult to chew, such as meats, still
need to be cut into pieces that are ½ inch in diameter or smaller to avoid choking. Round cherry
tomatoes and grapes, because of their shape, present a choking risk. However, by chopping fresh
tomatoes or quartering grapes, this risk is avoided. Cutting raw vegetables such as carrots into
thin strips makes them easier for children to bite and chew safely. Supervision at mealtime is
crucial. To decrease the risk of choking, teachers may need to remind preschool children to stay
seated when they eat.
2-2-2 Scheduling Meals and Snacks
Preschool children become accustomed to eating meals and snacks at predictable times. As with
toddlers, providing three meals and three snacks at intervals of every 2–3 hours provides active
preschoolers with a consistent energy source throughout the day. Snacks should be planned to
provide important nutrients and should be low in added fat and sugars.
2-2-3 Avoiding Portion Distortion
Children consume more calories when large portions are offered, especially if they are already
overweight. Providing the opportunity for preschool children to serve themselves through
family-style meal service, with guidance from teachers, puts a focus on their internal hunger and
fullness cues that may help prevent excess calorie intake, thereby reducing the risk of obesity.
Using child-sized plates and bowls also prevents portion distortion.
2-2-4 Understanding the Teacher’s Role in Creating a Positive Mealtime Experience
Similar to supporting toddlers, teachers help create this positive environment for preschoolers by
creating a comfortable space and establishing routines that children can be a part of.

Space for children to eat should be adequate without being crowded. Chairs and tables should be
child-sized so children can sit comfortably and focus on eating. Silverware, cups, plates, and
serving utensils should be sized to match children’s motors skills (Academy of Nutrition and
Dietetics, 2018b).
2-2-5 Arranging the Mealtime Environment
The environment should be free of hazards such as food-warming units, electrical cords, and
large containers of hot foods. Tables should be properly sanitized before and after use. The food
served should be visually appealing and prepared in such a way as to promote children’s success
when eating. The setting can be decorated with a changing array of posters or food-related
displays that convey nutrition messages, while adding color and interest to the space.
2-2-6 Establishing Comfortable Routines
Children learn to predict their responsibilities and tasks, which provide them with a sense of
security and comfort about mealtime. For example, children can wash their hands, help set the
table, serve themselves family style, and help with cleanup.
2-2-7 Considering Cultural Traditions
Mealtimes are important for nourishing children, but they also convey social and cultural values.
Mealtime practices vary across different social groups in the way children participate, the timing
of meals, the items served, and the sequence of food presentation. Children obtain cultural
knowledge about food and eating by their active observation and participation in mealtime
routines and socialization.
2-2-8 Encouraging Conversation
Talking and visiting during mealtime helps children learn new vocabulary and how to listen and
tell stories (Fishel, 2010). Children acquire command of culturally relevant knowledge, and
conversation contributes to language and cognitive skills that support children’s ability to learn
to read and write (Snow & Beals, 2006). Teachers encourage visiting by actively listening to
children, restating and elaborating on what children have said, and asking probing questions
during mealtime conversations:
• “Oh, you went to the zoo with your family this weekend. What sorts of things did you see
and do at the zoo?”
• “Tell us about your new baby brother.”
• “Tell us about that game you were playing outside today.”
2-2-9 Supporting Children’s Internal Cues of Hunger and Fullness
Children are born with this innate ability. It’s like an internal thermostat that regulates their
intake. If caregivers trust and respect this ability, children who are typically developing will eat
just the right amount of food. As children enter their preschool years, however, they are more
easily influenced by environmental cues such as the presence of desirable food, the time of day,
and the portion size.
Table 7-2 provides examples of mealtime phrases that may either override or support children’s
self-regulation of energy intake.

2-2-10 Being a Good Role Model

An important aspect of modeling for preschool children involves helping children learn to make
decisions about food by providing opportunities for children to serve themselves and choose
what and how much they eat.
For example, a teacher with a food allergy may say, “My doctor helped me to learn that my body
cannot accept eating peanuts. This is only true for some people, not everyone.” Food restrictions
related to cultural or religious practices can be explained by stating, “In my culture, we choose
not to eat cheese.” When teachers do not like a food that is served, they might respond by saying
in a neutral way, “I don’t care for broccoli when it is cooked. I like it better raw.”
2-3 Teaching Preschoolers About Nutrition
2-3-1 School Gardens
Preschool children may not have a clear understanding of where food comes from. When asked,
they may say that food comes from the kitchen, restaurant, or grocery store. Concepts such as
what the origin of food is, how seeds grow into plants, where milk comes from, how food gets
from the farm to the table, or how grains of wheat become loaves of bread may be new.
Children are better able to develop a clear picture of the origin of food when they plant seeds,
watch them grow, tend to the plants, and then have the pleasure of eating what they produced.
School gardens have the potential to support children’s healthy eating behaviors and increase
physical activity.
2-3-2 Cooking with Children
• Washing foods: Place a sturdy chair in front of the sink, fill a large bowl or salad spinner
with water, and show children how to clean the lettuce leaves or other vegetables.
• Cutting soft foods: Seat children at a table with a cutting board and a plastic knife. Give
them a soft fruit or vegetable to cut, like a banana or mushroom.
• Making funny faces: Give them an assortment of fruits, such as peach, pear, mandarin
orange, or apple slices and raisins. Show them ways to arrange fruits on a plate to make a
face.
• Layering parfaits: Give children cut fruit, yogurt and granola or other breakfast cereals.
Show them how to layer these foods into parfaits in clear plastic cups.
• Dumping and stirring: Have them stir together dry ingredients into large bowls.
2-3-3 Activities that Support Nutrition Education
The following activities relate to pizza, a five-food-group food.
• Dramatic play props for an Italian restaurant: chef’s hat; aprons; pizza delivery boxes;
pizza pans; plastic pizza cutters; checkered tablecloth; plastic food models of pizza,
spaghetti, salad, milk.
• Math props: a cash register and play money.
• Literacy props: menu, paper to record “pizza orders,” telephone to receive take-out
orders.
• Creative materials to “make” pizza: colored paper to cut and paste to make paper pizzas
with a tan crust, green and red peppers, brown mushrooms, yellow pineapple and cheese,
and black olives.
• Science exploration center with ingredients to make pizza: whole-wheat flour, yeast, salt,
warm water, measuring cups and spoons, bowls, pizza sauce, and toppings.
PART 3: Creating a Healthy Nutritional Environment for School-Age Children That
Supports the Dietary Guidelines
Primary school-age children become captains of their own ships when it comes to eating. They
are now in a larger environment and experience less supervision at mealtimes. A school cafeteria
is rife with activity, and throwing away parts of a packed lunch or choosing not to select or eat
certain components of a school lunch menu are decisions that primary school-age children can
make. Here is where they practice all the nutrition-related decision-making skills they learned in
their home and early childhood programs.
3-1 Understanding the Nutritional Needs of School-Age Children
School-age children’s rate of growth is slow compared with infancy and preschool years. Their
nutrient requirements increase with their increasing size and are reflected by larger portions in
the CACFP food guidance system’s recommendations. Children are able to accommodate longer
time periods between meals.
The school-age years are a time when children’s food choices are increasingly influenced by peer
groups and media advertising. Maintaining a steady rate of growth can be hampered by societal
influences such as decreased opportunities for physical activity, increased time in front of TVs
and computers, increased exposure to foods of minimal nutritional value, and snack items that
can lead to excess weight gain.
3-2 Recognizing Characteristics of School-Age Children’s Diets
School-age children have usually worked out the kinks of eating and experience fewer food-
related feeding problems compared with toddlers and preschoolers. During this time, children
become more responsible for selecting their own foods. If they are not pressured, school-age
children can manage their internal hunger and satiety cues sufficiently to support growth and
maintain normal weight.
3-3 Timing of Meals
A pattern of three meals with three snacks per day is still advised for school-age children. In
most kindergarten and first-grade classroom settings, children consume snacks in the morning.
By the time children are in second and third grade, the morning snack is discontinued. Teachers
should be sensitive to the hunger cues among children in their classroom to determine whether to
plan snacks as part of the morning routine. The type of snack is important. If snacks take the
place of meals such as breakfast or dinner, they often are higher in added sugar and solid fat and
lower in vitamins and minerals.
3-4 The Importance of Breakfast
Some school-age children eat breakfast at home, whereas others participate in the School
Breakfast Program. Children who skip breakfast may be more at risk for obesity because by the
time they are able to eat, they are so hungry they may make poor choices and overeat. In
addition, prolonged fasts, which occur when the breakfast meal is skipped, may increase the
insulin response to food offered later in the day, promoting fat storage and weight gain.
3-5 School Breakfast Program
The SBP is an important core child nutrition program that becomes even more valuable during
difficult economic times when families may not be able to afford meals for their children. Some
children are not hungry when they first wake up or they prioritize sleep over time to eat
breakfast. The SBP gives them another opportunity to eat a nutritious meal a little later in the
morning (Food Research & Action Center, 2015). The SBP and NSLP are available free of
charge to children whose family income is 130% or less than the federal poverty level. A
reduced-price option is also available to families whose income is between 130–185% of the
established federal poverty level (FDA, 2018). This makes the SBP accessible to many children
and families.
3-5-1 Impact of Breakfast on Learning
Breakfast is a significant meal not only because it helps children maintain a balanced diet, but
also because it can impact learning. Studies show that children who eat breakfast experience
benefits such as:
• Increased math and reading scores (Food Research & Action Center, 2016).
• Improved speed and memory on cognitive tests (Centers for Disease Control and
Prevention [CDC], 2014; Rampersaud, 2009).
• Improved school behavior and attentiveness, which supports the overall educational
environment.
3-6 Providing School Lunch
3-6-1 National School Lunch Program
3-6-2 School Lunch: Before or After Recess?
The predominant practice in primary schools is to eat lunch and then participate in outdoor
recess. Yet research shows children who eat lunch after recess eat better, waste less food, and
behave better.
3-2 Understanding the Teacher’s Role in Creating a Quality Nutrition Environment
Increasing rates of childhood obesity and decreasing rates of activity have led to a greater
awareness of the need to provide more healthful meals, more physical activity, and foods that are
produced and purchased in more sustainable ways.
3-2-1 School Wellness Policy
In 2004, the Child Nutrition and WIC Reauthorization Act required schools to establish a school
wellness policy by January 2006. This law has shifted the focus of food service from providing
not only adequate nutrient intake, but also meals that promote healthful eating habits in an effort
to prevent chronic diseases such as obesity, diabetes, high blood pressure, heart disease, and
stroke.
In addition, school wellness policies must address the provision of food that occurs outside the
realm of traditional school food service. For example, food is commonly available at after-school
programs and school social and sporting events.
3-2-2 Sodas in Schools
Beverages elementary schools are allowed to sell include plain water, unflavored low-fat milk,
flavored or unflavored nonfat milk, and 100% fruit and vegetable juices. States and school
boards and districts are still allowed to enact stricter standards for competitive foods. However,
these rules do not apply outside of the school day.
Teachers can also promote healthy eating in the classroom by (CDC, 2011):
• Allowing students to visit the water fountain throughout the school day and to carry water
bottles in class.
• Not using food or beverages to reward student achievement or good behavior.
• Encouraging parents to provide healthy foods and beverages for birthday and classroom
parties.
• Organizing events that engage students, families, and the community, such as walk-a-
thons, bicycle rides, and basketball tournaments.
3-2-3 Children with Special Needs
Teachers cannot make medical recommendations, but they can encourage collaboration among
families, school nutrition personnel, registered dietitian nutritionists, and health care providers to
ensure children’s special nutritional needs have been addressed appropriately.
3-2-4 Children and Peanuts
Recent American Academy of Pediatrics (2019) research shows that early introduction of infant-
safe forms of peanuts to the diet can be helpful for preventing peanut allergies. The guidelines by
the National Institute of Allergy and Infectious Diseases divide children into three groups
(Togias et al., 2017):
• For children with severe eczema and/or egg allergy, testing for peanut allergy is
recommended.
• For children with mild to moderate eczema, try peanut products at around 6 months of
age.
• For children who do not have any eczema or food allergy, peanut products can be
introduced along with other foods based on their family’s preferences and cultural
practices. It is not as important to do it early, but it is fine if parents do it.
3-2-5 Children from Culturally Diverse Backgrounds
Efforts to promote wellness among all children must be addressed in culturally appropriate ways.
Strategies include:
• Communicating school wellness goals, policies, and educational materials in the home
languages of children attending the school.
• Incorporating healthful ethnic dishes in the school menu.
• Providing translation services at parent education seminars
• 3-2-6 The Cafeteria as a Learning Lab
3-2-6 The Cafeteria as a Learning Lab
Activities that use the cafeteria as a learning center include:
 • Offering taste tests of new foods and recipes.
• Displaying food sculptures.
• Conducting nutrition poster contests.
• Providing cafeteria kitchen tours.
• Preparing healthful recipes.
• Inviting important guest visitors to promote good nutrition and physical activity.
3-2-7 Teachers as Advocates
They promote healthful nutrition and wellness among school-age children by advocating for
nutritious menus and supporting the school breakfast and lunch programs. Teachers continue to
serve as role models for healthful eating and physical activity behaviors. Eating school lunches
with children and participating in physically active games and events during recess send
important messages to young children.
3-2-8 Helping Families Access Nutrition Services
Families may turn to teachers with their concerns. Teachers can direct families to appropriate
health care providers and support their recommendations.
The focus on the obesity epidemic has revealed another health care concern relating to weight:
eating disorders. Eating disorders represent an extreme dysfunction in eating habits that develop
gradually and can negatively impact the growth, development, and health of children (Kleinman,
2009; Mahan, Escott-Stump, & Raymond, 2012). Two commonly recognized types of eating
disorders include anorexia nervosa and bulimia nervosa. Anorexia nervosa is caused by a
distortion of body image and is characterized by the severe restriction of food intake resulting in
significant weight loss. Bulimia nervosa entails binge eating followed by purging activities such
as vomiting, using laxatives, or exercising excessively.
Teachers should support nutritious diets to promote good health and avoid focusing on weight or
appearance when discussing healthful eating with children. For example, it is appropriate to
comment on healthful food choices such as, “It’s great to see you drinking water instead of
soda”; on the other hand, it’s detrimental to state, “If you drink that soft drink, you’re going to
get fat.”
3-3 Teaching School-Age Children About Nutrition
• Teaching Basic Nutrition Concepts
• Using an Integrated Nutrition Curriculum
• Teaching about Sustainable Nutrition