Toddlers: Essential Nutrition

By Kara Rienzo, R.D.N.

Early childhood is an important time to establish healthy eating habits that can last a lifetime. While infants grow rapidly within the first year of life, growth begins to slow after their first birthday. Typically food intake of toddlers can be lower and weight gain slows down. However, an adequate vegetarian or vegan diet is still necessary for normal growth and development during this time [1]. 

Energy Needs

A well-planned vegetarian or vegan diet can easily meet a toddler’s nutritional needs [1]. Healthy, plant-based diets are typically high in fiber, which is found in vegetables, fruits, legumes, and whole grain products. Fiber can cause a child to feel full before they have consumed enough nutrients. An easy way to fix this is to reduce fiber content of a child’s diet by incorporating refined grain products, fruit juice, and peeled fruits and vegetables. Including foods that are high in energy, such as avocado, nut and seed butters, bean spreads, dried fruits, vegetable oils, and full fat soy products can provide additional concentrated calories to help children meet their nutrient needs.

Weaning Off Breast Milk or Formula

Some toddlers may still be breastfeeding and this should be taken into account when looking at their total daily diet. For children who are no longer nursing, soy milk should be provided. Soy milk contains more calories, protein, and other nutrients necessary for healthy growth and should be given over other plant-based milks. While most toddlers take the transition away from breast milk or formula well, it may be necessary to slowly introduce soy milk if the child is having a tough time. Start by mixing 75 percent formula or breast milk with 25 percent soy milk. Do this for 3 to 4 days, and then change to 50 percent formula or breast milk and 50 percent soy milk for 3 to 4 days. Then, transition to 25 percent formula or breast milk combined with 75 percent soy milk for 3 to 4 days and then finally to 100 percent soy milk. The whole process should take 1.5 to 2 weeks. Also, remember that while formula or breast milk was food for them while they were an infant, soy milk is just a beverage for them at this stage, and they should not be having more than 16 to 20 ounces daily.

Many parents may wonder about the use of “toddler formulas.” While not harmful, these formulas are simply a marketing tactic by the formula companies to keep parents dishing out money for an expensive product after the healthy infant is weaned from formula at 1-year-old. At this stage, the toddler should be getting their nutrients from foods, not drinking a liquid meal replacement to fill their small stomachs, which can then deter them from eating healthy solid foods to establish a well-balanced diet. Another issue with toddler formulas is that they are sweet in taste and can be preferred by the toddler over full fat soy milk and other nutritious foods. Healthy eating habits are established in childhood, and teaching a healthy toddler to drink their nutrients in the form of a sweetened beverage is not ideal. However, some toddlers could benefit from liquid nutrients if there are feeding problems, such as an oral motor delay or chewing and swallowing issues, but this should be discussed with the toddler’s healthcare provider.

Protein

Toddlers can easily meet their protein requirements by eating a variety of plant-based foods, which can provide all of the essential amino acids. It was previously believed that “protein complimenting” or intentionally combining of specific foods was necessary, but as long as children are eating an adequate amount of calories from different sources, it’s likely their protein intake will be sufficient as well. Good sources of protein include legumes, grains, tofu, plant-based meats, and nut butters.

Omega-3 Fatty Acids (DHA)

Essential fatty acids are vital for children for optimal neurological function, brain development, and psychomotor development [2]. The human body does not make omega-3 fatty acids on its own; therefore, it is important to include foods containing DHA or take a supplement. Lacto-ovo vegetarians consume little DHA, and vegan diets contain virtually no DHA. This can be taken in a microalgae-based supplement, and it is recommended that toddlers take 100mg per day; there are several vegan DHA supplements on the market. Mothers who are continuing to breastfeed their toddlers should continue to take 300mg of DHA daily. Foods containing DHA, from algal oil, include Silk DHA Omega-3 soy milk and fortified olive and canola oils. 

Calcium

Adequate calcium intake is necessary for proper bone growth and healthy teeth. It also plays a role in healthy nerve and muscle function. Calcium recommendations for children ages 1 to 3 is 700mg daily [3]. Good sources of calcium for toddlers include fortified soy milk, fortified fruit juices, soy yogurt, green leafy vegetables, tofu, and almond butter. Calcium absorption from these foods has been shown to be adequate in meeting calcium needs [4].

Vitamin D

Vitamin D works with calcium for bone growth and development. Exposing the skin to sunlight normally produces vitamin D, which can then be used by the body, but many factors come into play, including the use of sunscreen, skin pigmentation, and location in which a child is living [5]. Children who are dark-skinned, live in regions with little sun, or who have no dietary source of vitamin D are recommended to take supplements [5]. The American Academy of Pediatrics recommends children should have a Vitamin D intake of at least 400 IU a day [5]. Dietary sources of vitamin D include fortified soy milk and fortified ready to eat cereals. Vitamin D3, or cholecalciferol, is derived from animals and can be found in fortified foods or supplements. Vitamin D2, or ergocalciferol, is derived from plants and is the ideal source of vitamin D for vegetarians or vegans.

Iron

One of the most common nutritional problems in childhood is iron deficiency anemia. However, it is no more likely to occur in vegetarian or vegan children than it is in non-vegetarian children [6]. The best way to ensure the child is consuming enough iron is to include foods such as whole or enriched whole grains, dried fruits, fortified cereals, beans and legumes, and green leafy vegetables. Including a source of vitamin C (citrus fruits, bell peppers) with iron rich foods can help increase iron absorption by the body.

Vitamin B₁₂

Parents should ensure that their child’s diet contains an adequate amount of vitamin B₁₂, as it is necessary for healthy blood and nerve function. Vegan toddlers should consume foods fortified with vitamin B₁₂, since it is only found naturally in foods that come from animals. However there are plenty of foods that are fortified with vitamin B₁₂ including fortified soy milk, some meat alternatives, vitamin B₁₂ fortified nutritional yeast, and some ready-to-eat cereals. Toddlers who do no eat these fortified foods should be taking a supplement of 0.9 micrograms a day [7]. Most children’s multivitamins contain this amount, but check the label to be sure.

Zinc

Zinc is necessary for growth and sexual maturation. Plant foods are typically low in zinc bioavailability, meaning the degree to which the nutrients from food can be absorbed and utilized by the body. Highlighting foods that are good sources of both zinc and protein, such as legumes and nut products, can help to increase absorption by the body [8]. Other good sources of zinc include whole grains, wheat germ, and fortified cereals.

* 1 serving of nuts/seeds and 1 full-fat soy product should be offered per day (Adapted from [9]).

Breastfeeding

Breastfeeding is recommended and is healthy for toddlers [10]. Both mom and child should continue as long as they both enjoy it. One cup of breast milk counts as 1 serving towards the 3 recommended servings a day of milk.

Choking Risks

Toddlers are more likely to choke because they have immature chewing and swallowing skills and have fewer teeth. To reduce the risk of choking, toddlers should always sit up when eating and be told to take small bites and completely chew foods before swallowing. To avoid choking, toddlers should not be given foods that are round and about the size of a nickel or these foods should be cut to a size no larger than half of an inch. Foods like soft fruits and cooked vegetables should always be cut into small pieces, and seeds, pits, and tough skins should be removed. Vegetarian hot dogs should be cut both lengthwise and then crosswise before serving. Cooked beans should be mashed.

Foods that can cause choking and should NOT be given to a toddler include [11]:

• Ice cubes
• Vegan marshmallows
• Raisins and other dried fruit
• Popcorn and pretzels
• Raw vegetables, such as celery and carrots
• Nuts, peanuts, and seeds unless finely ground
• Nut butters by the spoonful

Tips for Healthy Eating

Parents are responsible for repeatedly offering a variety of healthy foods at mealtime. Children’s preferences change frequently, and it is not uncommon for a child to be offered a food upwards of 15 times before accepting it. They should be encouraged to try at least one bite of new foods, but should never be forced to eat certain foods or finish everything on their plate. Toddlers have an innate ability to regulate food intake, meaning they decide when they are hungry or full, and it is important for a parent to recognize this. Forcing a child to eat when they are no longer hungry or using food as a reward can lead to unhealthy eating habits throughout their lifetime. Remember that toddlers have a lower food intake and slower weight gain. A good indicator of growth is that the child remains at a normal percentile on the World Health Organization’s growth chart between the ages of 1 and 2.

Other healthy tips include being a good food role model. Children look up to their parents and are more likely to eat foods if they see their parents eating them as well. Most importantly, keep food fun! Cutting food into shapes, adding color with fruits and vegetables, or even using creative names for foods, like “little trees” for broccoli, can help a child enjoy mealtime.

Physical Activity

Toddlers should be actively playing every day and should not be sitting still for one hour or more unless they are sleeping [12]. Active play includes running, dancing, hopping, jumping, playing with riding toys, throwing a ball, and playing with push or pull toys, such as wagons or strollers. Physical inactivity can lead to undesirable weight gain. Be creative in finding fun ways the family can be active together!

Tooth Decay

Toddlers should stop drinking from a bottle by 12 to 14 months. Extended bottle use can lead to tooth decay. The sooner a child is weaned from the bottle, the easier it will be for all parties involved. At first let the toddler drink from a small sippy cup with a top. Later the child can practice drinking from a cup with no lid. Remember, spills are normal as a child is learning, so don’t be discouraged! It is not recommended to let the child sip on juice, soy milk, or other sweetened beverages between meals on a regular basis. Water is a much better option if the toddler is thirsty between meals or before bed. [13]

Offering your toddler a variety of foods, including whole grains, fruits, vegetables, fortified plant-based milks, beans, and legumes, will set them up for a healthy life. For more support, please consider joining the Generation Veggie Community where you can chat with other expectant and new parents, and check out the “Everyday Nutrition for Vegan Kids” advice column.

Resources

1. Messina VK, Burke KI. Position of the American Dietetic Association: Vegetarian diets. J Am Diet Assoc 1997;97:1317-1321.
2. Byrd-Bredbenner, C., Moe, G., Beshgetoor, D., Berning, J. Wardlaw’s Perspectives in Nutrition, 8^th ed. New York: McGraw-Hill, 2009
3. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, D.C.: National Academies Press, 1997.
4. Weaver CM, Plawecki KL. Dietary calcium: Adequacy of a vegetarian diet. Am J Clin Nutr 1994;59(suppl):1238S-41S.
5. Wagner CL, Greer FR; American Academy of Pediatrics Section on Breastfeeding; American Academy of Pediatrics Committee on Nutrition. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics. 2008;122:1142-1152.
6. Craig WJ, Mangels AR. Position of the American Dietetic Association: Vegetarian diets. J Am Diet Assoc. 2009;109:1266-1282.
7. Food and Nutrition Board, Institute of Medicine. Dietary reference intakes for thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B₁₂, pantothenic acid, biotin, and choline. Washington, DC: National Academy Press; 1998.
8. Sandström B. (1992) Dose dependence of zinc and manganese absorption in man. Proc. Nutr. Soc. 51:211-218.
9. Mangels R, Messina V, Messina M. The Dietitian’s Guide to Vege-tarian Diets, 3rd ed. Sudbury, MA: Jones and Bartlett Learning, 2011
10. American Academy of Pediatrics. Policy statement: Breastfeeding and the use of human milk. Pediatrics. 2012 March;129[3]:e827-e841.
11. United States Department of Agriculture (2015). Food safety: Choking hazards. Retrieved from http://www.choosemyplate.gov/preschoolers/food-safety/choking-hazards.html
12. United States Department of Agriculture (2015). Health and nutrition information for preschoolers: Physical activity. Retrieved from http://www.choosemyplate.gov/preschoolers/physical-activity.html
13. American Academy of Pediatrics (2015). Preventing tooth decay in children. Retrieved from http://www.healthychildren.org/English/healthy-living/oral-health/Pages/Preventing-Tooth-Decay-in-Children.aspx