Nutrition Assessment of Infants & Toddlers

A child's early years has long been recognized as a particularly critical time for developing good dietary habits. It also is an important time for taking in nutrients in the amounts required not only for optimal growth and development, but for influencing mental development as well.

A childcare program's nutrition services should promote infant and child wellness by providing nutritious foods and educating children about how to meet their own nutritional needs in a manner appropriate to the child's culture as well as developmental and feeding readiness. To do this effectively, however, you must first know the current nutritional status of each young child, and these factors can change rapidly over a period of weeks or months. So, how can you assess nutritional status and determine the best way to meet the needs of each child?

Nutritional assessment requires the expertise of qualified professionals, such as a Registered Dietitian (RD), Licensed Dietitian (LD), or physicians (MD or DO), as well as information from and collaboration with families and child caregivers. For example, it is very important that parents provide regular information about an infant or toddler's nutritional needs, eating habits, cultural and religious preferences about food, and overall health. This is especially important for children with health problems or disabilities.

Comprehensive nutritional assessments may include medical history, a physical examinations, laboratory data, height and weight information, dietary history, and mealtime observations. All of this information is evaluated and integrated to determine a child's current nutritional status. Then, if problems or potential risks are identified, the child's parents and caregivers can work with cooks and health and nutrition professionals to meet the child's dietary needs.

Medical History

A child's medical history includes information such as current immunization status, medications, previous diseases or injuries, and medical or surgical procedures. Laboratory data often includes nutritional data such as the child's cholesterol, blood sugar, hematocrit (Hct) and/or hemoglobin (Hgb) level. Hematocrit measures the percent of red blood cells in total blood volume. Hemoglobin is the oxygen-carrying pigment found in red blood cells. Its primary purpose is to combine with and transport oxygen from the lungs and deliver it to all the living cells in the body. Hct and Hgb levels indicate the amount of iron in the body and are measured by testing a blood sample gathered through a simple finger stick. Iron is essential in the formation of hemoglobin. Low Hct and Hgb levels are an indication of iron-deficiency anemia. The cause of this type of anemia is a diet that does not provide enough iron.

Children and pregnant women require more iron than others and are particularly prone to iron-deficient anemia. Iron deficiency anemia is associated with impaired cognitive development and an abnormal growth pattern. Symptoms include fatigue, headaches, sometimes a sore mouth or tongue and brittle nails. The U.S. Recommended Dietary Allowances (RDA) suggest an iron intake of 10 mg. for infants up to six months old; 15 mg. for infants between six months and three years; and 10 mg. of iron daily for four-six year olds. Treatment for iron deficiency anemia includes a well-balanced diet with an iron supplement. Iron is contained in a variety of foods, such as lean meats, eggs, fish, green leafy vegetables, nuts, and beans. However, parents and caregivers should never self-prescribe iron supplements for children. Too much iron can be toxic! Each year, there are more than 3,500 iron poisonings in children under the age of six years, and it is one of the most frequent causes of poisoning death in children.

Physical Examination

A child's physical appearance can indicate poor nutritional health. A well-nourished and healthy child should appear strong and energetic, with sparkling eyes and shiny hair. The skin should have a healthy "glow" and scratches or cuts should heal quickly. A dental exam also is important because good tooth formation and lack of cavities is a good indicator of nutritional wellness. Also, the gums should be pink and firm; extreme redness, bleeding, or swelling can indicate nutritional or other problems. In older children, damage to tooth enamel by stomach acid may be a first indicator of bulimia, an eating disorder in which the person vomits after eating.

Although the rate of growth varies with age and individual difference, a child's growth is generally predictable. To assess growth, the child's height and weight are measured and marked on a percentile graph, commonly known as a "height and weight chart." By comparing height and weight for the child's age, the dietitian or nutritionist can identify children who are below the average height for their age or over/underweight for their height. By comparing height and weight measurements over a period of time, one can assess the child's progress and growth pattern. This is important information that parents and caregivers should be aware of. When discussing this information with parents it is important to point out that growth patterns should not be used to compare one child to another but to monitor each child's individual growth.

Dietary History

Another tool in assessing a child is a dietary history. The diet history records the child's food intake and feeding schedule over a period of time, usually one-seven days. Food frequency questionnaires collect information on how often certain foods and food groups are consumed, and also are used to check for nutritional adequacy. Food preferences of children, along with family or cultural preferences or restrictions, are important pieces of information to include as well.

Childcare providers can work with parents and nutritionists/dietitians in providing nutritious foods that children will eat. By considering the nutritional status and needs of each child and planning carefully, childcare providers can help assure that each child receives proper nourishment each day through enjoyable meals and snacks.

Internet Resources

Child Care and Nutrition, Inc.; http://www.frontiernet.net/~manage/ccni

Children's Research Center, Baylor College of Medicine publishes a quarterly newsletter Nutrition & Your Child for parents, health professionals and childcare provides. Sign up for the free electronic/email version by emailing cnrc@bcm.tmc.edu or visit the site www.bcm.tmc.edu/cnrc

Growth charts can be obtained from the Centers for Disease Control and Prevention (CDC) by download from the website; www.cdc.gov/growthcharts

The U.S. Department of Agriculture's Child Care Nutrition Resource System offers a variety of information on its website including posters (to be downloaded) and more: www.nal.usda.gov/childcare

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