Monday, February 10, 2014

Toddler/Preschooler Portion Sizes

Parent's frequently ask me how much their child needs to be eating. Parents get nervous that their child may not be getting the nutrition they need or enough calories to grow. As an OT, I follow some general guidelines, but am not an expert on nutrition.  I was thrilled when today's  guest blogger and soon-to-be-dietitian Amelia Sherry, of feedingisla.com, agreed to help us out with a thorough and practical explanation. Amelia explains why—and how to support your kids’ natural know-how for perfecting portion sizes. Believe it or not, most toddlers know more about how much they should eat than any pediatrician or nutritionist.  



4 Keys to Perfecting Portion Sizes!

Throughout my pregnancy, there was one thing I really wanted to ace as a mom: Breastfeeding. To be sure I got it right, I read every book recommended to me, quizzed every mom brave enough to answer my questions, and even enrolled in a three-hour class (including demonstrations!) on the topic. If you asked me about breastfeeding the day before my daughter Isla was born, I would have arrogantly rattled off a dissertation on the holding positions, timing, and feeding techniques recommended for success. If you asked me about it in the minutes following her birth, I would have timidly realized that I knew nothing. A hands-on, crash-course lesson was coming my way though- and it wasn't a nurse, lactation, consultant, or pediatrician who taught it. It was Isla.

Like most new parents, in the moments following birth I was nothing but thunderstruck by the sight of my infant daughter. When the nurse handed her to me to the last thing on my mind was getting her into the recommended feeding position, never mind remembering exactly what that was. Fortunately, as I sat there gawking this tiny little stranger turned her face towards me, attached her mouth to my nipple, and very casually began to suckle. I was amazed by her intelligence: Less than a half-hour old and Isla knew she needed to feed—to nourish herself—better than any scientist who’d been studying the subject for years, and most definitely better than me. Today, at two and half years old, I’d argue that in some respects she still does.


Eating Intelligence

Is Isla an eating genius? Yes—but in the same way that all healthy infants and toddlers are: She has an innate wisdom that allows her to rather unconsciously regulate her food intake based on her individual energy needs. That means that her hunger waxes and wanes in relation to how much activity she’s done, how much growth she’s experiencing, and how much she has (or hasn’t) recently had to eat or drink. Scientists who study children’s feeding patterns observe that this amazing ability is strongest in infancy and toddlerhood and then begins to diminish at about three to four years old—coinciding, of course, with an increasing awareness of the social cues surrounding them[1].
In other words, your toddler has a natural and fairly exacting ability to calculate the exact amount they should eat at any given meal or snack until outside influences (such as a subtle encouragement to clean a plate or an admonishment for overindulging) begin to sink in and suggest to them they don’t.
Since being in touch with true hunger is one of the most important skills a healthy eater can have—and, heck, one most adults need to learn this themselves—then supporting a child’s natural ability to connect with their appetite is just as important as knowing appropriate portion sizes. So when parents ask me how much they should feed their toddler at each meal, I don’t just rattle off a list of serving sizes. Instead, I give them these three pieces of advice…  

1. Start with the rule of thumb

Even though I don’t believe in sticking to a rigid measure-out-each-portion eating plan for kids, it’s still important to know what the recommended serving sizes for kids look like. They’re great starting points for putting together a well-balanced plate—the same plate you’re sure if they’re going to inhale or push away. Just remember, it’s best to think of the following numbers as a guideline not a rule; healthy children are the best determinants of how much they need to eat (or not eat) to feel healthfully satisfied.
Keeping that in mind, here’s the skinny on sizes: Experts[2] estimate that your toddler ‘should’ eat about 1000 to 1200 calories per day, which should be spread out in three meals and two snacks (or a food offering every two to three hours) and contain a total of; three ounces of grains (at least half of which should be whole grains); two cups of dairy; two ounces of meat/protein; one cup of fruit; and, one cup of vegetables.

A cheat sheet to help translate those amounts into real food examples…

One ounce of grains           = ½ cup oatmeal, rice, or pasta
(Serve three daily)            = 1 slice of bread
 = 5 whole grain crackers
 = 1 cup dry cereal
                                   
One cup of dairy                = 1 cup milk
(Serve two daily)               = 1 cup yogurt (or an 8 oz container)
 = 3 slices processed cheese
 = 2 slices of hard cheese
 = I cup of soymilk
                                   
One ounce of protein         = 1 egg
(Serve two daily)              = 1 tablespoon peanut or almond butter
 = ¼ cooked beans
 = 2 tablespoons of hummus           
 = Beef, pork, or poultry about the size of a pack of gum

One cup of fruit                 = ½ large apple or 1 cup applesauce
(Serve one daily)               = 1 large banana
                                        = 32 grapes
                                        = 8 large strawberries
                                        = ½ cup dried fruit                                                                                                  

One cup of vegetables        = 1 cup of cooked or raw vegetables
(Serve one daily)               = 2 cups of leafy greens      
                                               
Another way experts recommend calculating pint-sized portions is to simply dole out ¼ to ½ of an adult serving size (as defined by the 2010 USDA Dietary Guidelines) of each food offered. This definitely makes for easy math; the problem, however, is that most of us are pretty off the mark when it comes to estimating appropriate portion sizes for ourselves, which means we’re probably not going to be too accurate if we use them as a measuring stick for our kids. A third (even more down and dirty!) way to estimate appropriate food amounts: Serve ‘em a tablespoon per year. That means, for instance, a three year old gets three tablespoons of fruits, vegetables, protein, and grains, for example, at each meal.

Again, these are just guidelines which is why it’s okay that they’re a little bit loosey goosey. Feeding experts know that being strict about amounts can have negative consequences for most kids when it comes to being a healthy eater, so they don’t recommend strict counting of calories or measuring of portion sizes (expect in cases where there’s an illness or disability at play.)

2. Divvy up the work

Yes, your toddler’s good at determining appropriate portion sizes but they’re not yet good at deciding other important aspects of eating, such as choosing what’s on the menu. To help them stay in touch with their natural appetite, caregivers of toddlers should stay in charge of all other aspects of eating. This is based on an easy-to-follow feeding system called the Division of Responsibility (DOR). Devised by Ellyn Satter, the DOR goes like this: At any give meal or snack, toddlers should be in charge of determining HOW MUCH and WHETHER or not they will eat and caregivers should be in charge of WHAT to eat, WHERE to eat, and WHEN to eat. So it’s your responsibility to offer a balanced meal or snack of healthy options (the WHAT) at regular two to three hour intervals (the WHEN) in a calm and safe environment (the WHERE) and you can leave figuring out HOW MUCH to eat, including WHETHER they want to eat at all, up to your kid.
            One aspect of this can be tricky: Trusting your kids to do their job. Even though I’m well aware of the DOR and believe it its value completely, I admit to slipping up sometimes. I can get distraught by the fact that Isla has eaten barely anything for three meals in a row (and equally uncomfortable at other times when it seems like she’s eaten twice as much as anyone else at the table) and have caught myself telling her she can’t do this or that until she eats more (as well as insisting that’s she’s already had enough). Still, I work hard to quell the urge to intervene on amounts whenever possible; the consequences of convincing her that hunger cues can’t be trusted are too great not to.

3. Hand over the serving spoon

Research shows young children can regulate their food intake even better when they dole out their own portion right into their own dish[3]. After you fix your little one a balanced plate including all the food groups you’re offering at that meal, try putting a bowl of extras within their reach. One tip: Give them the option of serving themselves only the healthiest (and sometimes least-favored) options of each meal, such as vegetables or plant-based proteins. This is especially helpful for kids who are picky eaters since combining a sense of control with a little bit of hunger can be a powerful tool in helping them feel braver about trying foods they may not usually eat.

4. Bite your own tongue

Harmless as it may seem, saying things like “have just one more bite” or try this because “it’s good for you” can have surprisingly negative consequences. Kids who feel pressured to eat end up with lower body mass and have a lower intake of fruits and vegetables than kids who don’t get the same prompting from parents, according to studies. Tame your own urge to talk your kid into eating more (or less) by focusing on your very important role of providing healthy food option and balanced meals instead.

The bottom line: Despite feeling like a child eats ‘way too much’ or ‘hardly anything,’ if they haven’t shot over or dropped off their growth curve, then you can trust that they’re likely eating the perfect amount of food each day. (If in doubt, your pediatrician can help you understand the growth curve, which isn’t a measure of how large or small your child is but how consistently they are growing.) The key is consistently offering a balanced mix of healthy options from all the food groups—and then getting out of the way while they determine the amount they need to eat.

Amelia Sherry is a self-proclaimed 'overly indulgent foodie,' a graduate student of nutrition (en route to becoming a dietitian), and mom to a two year old girl, named Isla. She blogs about everything she’s learning while trying to fit all three things together at feedingisla.com. Follow her on facebook/FeedingIsla. 











[1] Rolls BJ, Engell D, Birch LL. Serving portion size influences 5-year-old but not 3-year-old children's food intakes. Journal of the American Dietetic Association. 2000;100:232-234.
[2] Academy of Nutrition and Dietetics and the American Academy of Pediatrics
[3] Fisher JO, Rolls BJ, Birch LL. Children's bite size and intake of an entree are greater with large portions than with age-appropriate or self-selected portions. Am J Clin Nutr. 2003;77:1164-1170.

5 comments:

  1. this post has helped me so much thank you!

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  2. I love this, it all makes a lot of sense, but I'm wondering what you do if you let them leave the table having not eaten very much only to hear that they want a snack 10 minutes later. How do you maintain designated meal and snack times, while respecting their ability to regulate their food intake? Thanks :)

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    1. Great question! You still need to establish some routines and boundaries or their feeding will be totally awry. Once they are 2.5 they are capable of understanding that if they don't finish this meal they will get nothing until the next. See the tab at the top that says basics to eating for more of this. Both of these principles can work together well.

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  3. Thank you so much for your post. I constantly struggle with adapting to my 18 month olds eating habits (or lack there of). This post helped a lot! And gave some great meal ideas when I start to lose sight on what she will actually eat!

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