Great Expectations: The Toddler Years

One of life’s great pleasures is having a meal with your family. If you’re a first-time parent whose idea of dinner is standing in the kitchen eating takeout, toddlerhood offers an opportunity for you to discover or rediscover the fun of preparing simple, fresh food. You can revisit all of those foods that you used to eat when you were younger, and create new family favorites while you learn your child’s tastes.

However, the simple pleasures of feeding your child also come with concerns and controversies. First, you might start with some basic questions about food and health: How can you tell if a child is eating enough? How do you get a picky eater to try new foods? And just how is it possible to shop, prepare, and eat while there’s a toddler who demands all of your attention?

Then there are always other nutrition issues that crop up: Could fatty-acid supplements really help boost your child’s brain power? How will you know if your toddler has a food allergy? Are vegetarian diets healthier for kids? Should you worry about sippy cups made of the wrong kinds of plastic, or fish contaminated by PCBs?

This chapter will help you find answers to old and new questions and how to make sure your toddler is well nourished. For in-depth information about child nutrition and a bevy of wholesome, easy recipes for making your own baby food, be sure to consult the companion volume Great Expectations: Best Food for Your Baby & Toddler by Jeannette L. Bessinger with Tracee Yablon-Brenner.

We’ll start with food safety, the basic tools you need to feed young toddlers, followed by what to feed an older toddler, and finally, how to manage important lifestyle issues, including practical tips for how to shop, prepare, and eat meals with a toddler.

It’s hard to believe that while food is so plentiful, inadequate nutrition could be such a huge problem. But that’s the case, sometimes because of severe poverty.

Obesity is a huge problem for U.S. children, too. One in seven children is obese in this country, and in 2008, the U.S. Centers for Disease Control and Prevention reported that about 14.6 percent of 2- to 4-year-old children were obese.

More often than not, our children’s nutritional deficiencies are the result of time-stressed parents not taking the time to shop wisely or prepare healthy meals when it’s faster and easier to rely on fast foods and prepackaged snacks despite their lack of nutritional value.

Convenience foods are an easy habit for a toddler—or anyone—to get into. Why sit down to eat when a drive-through can deliver a meal that any toddler would be happy to gobble down in the backseat? And why buy fresh fruit that will probably go bad when fruit leather lasts forever?

The biggest problem is that for a food to be mass-produced, it needs to be loaded with more fat, salt, and sugar than any home cook would have the nerve to add. And yet these are just the foods that our national tastebuds have become accustomed to.

Fresh food simply prepared provides good nutrition (and flavor) for people of all ages.

There are some healthy eating habits that you can teach your child early on by modeling the right behaviors. Bring home only quality foods, share family meals together, and avoid foods that deliver empty calories. Ingraining these early food habits could have a lifelong impact on your child’s health.

Granted, shopping for and preparing fresh foods takes more time, energy, and effort than pulling up to a drive-through window or punching buttons on a vending machine, but if you make good nutrition a priority, you’ll soon develop time-saving steps and routines that make the process easy and enjoyable. In addition, you’ll redevelop a taste for good foods and will have a natural aversion to many of the low-nutrient, high-fat, high-sodium, super-sweet foods so many of us eat.

The good news is: Your toddler is only beginning her lifetime of gustatory adventures. You get to introduce her to new taste experiences and the joy of eating, one small serving at a time.

There’s also the fulfillment of having a hand in creating new family rituals around meal sharing that she will fondly remember later. It’s not just about the food, but the experience of sitting down, talking, and sharing a meal together.

For your baby’s first year, breastmilk or formula made up most of her calories. After her first birthday, your toddler is able to eat virtually anything an adult can, as long as the food doesn’t pose a choking hazard. She also should switch to drinking cow’s milk and water for hydration, so this is a convenient time to replace the baby bottle with a sippy cup if you haven’t already.

Because switching from formula to milk is an important rite of passage for young children, you should be aware that regular cow’s milk has a very different nutritional profile than infant formula. For instance, cow’s milk is low in iron and can negatively affect the body’s absorption of iron. In addition, consuming more than 3 cups of cow’s milk a day can irritate the intestinal tract in some children, causing small amounts of bleeding, which leads to gradual blood loss through the stool and possibly anemia.

Milk should be limited to roughly 16 ounces per day for this age and split up into frequent, small servings.

The American Heart Association offers general guidelines for estimated daily calories and recommended food group servings for babies and toddlers.¹

	1 year	2-3 years
Kilocalories^a	900	1,000
Fat, % of total kcal	30-40	30-35
Milk/dairy, cups^b	2^c	2
Lean meat/beans, ounces	1 ½	2
Fruits, cups^d	1	1
Vegetables, cups^d	¾	1
Grains, ounces^e	2	3

^a Calorie estimates are based on a sedentary lifestyle. Increased physical activity will require additional calories: 0 to 200 kcal more a day if moderately physically active; 200 to 400 kcal more a day if very physically active.

^b Milk listed is fat-free (except for children under the age of 2 years). If 1%, 2%, or whole-fat milk is substituted, this will utilize, for each cup, 19, 39, or 63 kcal of discretionary calories and add 2.6, 5.1, or 9.0 g of total fat, of which 1.3, 2.6, or 4.6 g are saturated fat.

^c For 1-year-old children, calculations are based on 2% fat milk. If 2 cups of whole milk are substituted, 48 kcal of discretionary calories will be utilized. The American Academy of Pediatrics recommends that low-fat/ reduced-fat milk not be started before 2 years of age.

^d Serving sizes are ¼ cup for 1 year of age, 1/3 cup for 2 to 3 years of age, and ½ cup for 4 years of age and older. A variety of vegetables should be selected from each subgroup over the week.

^e Half of all grains should be whole grains.

Toddlers have small stomachs, and most need to eat about once every 2 ½ to 3 hours. A typical eating schedule for child is 3 meals a day plus two or three snacks a day. Snacks often account for up to 20 percent of their daily energy and nutritional requirements, so it’s important to put together snacks that are both nutritious and appealing.

Meals should be offered at about the same time every day, with snacks offered 2 to 3 hours prior to mealtime. Snacks should be used to satisfy hunger, but never used to reward behavior, calm a child, or dry tears.

Generally toddlers’ growth rate is much slower than that of 1-year-olds. As a general rule of thumb, you can figure a serving to be about 1 tablespoon of any food type per each year of your child’s age. So a 3-year-old’s serving would be 3 tablespoons of food. However, this is just a general guideline. Your child’s appetite is your more reliable guide.

Protein is found in every part of the body, from the hair to the toenails. Protein helps the body repair old cells and build new ones, so it’s an essential element for health. Protein can be found in abundance in meat, eggs, nuts, tofu, dairy products, legumes.

Sometimes parents worry that their toddlers aren’t getting enough protein because they refuse to eat meat, but a child doesn’t need to eat meat to get enough. A toddler will get a full day’s supply of protein just by drinking 2 cups of milk per day.

The only children who are at risk of not getting enough protein are those who are on vegan diets, which contain no animal products at all.

Keep in mind that your child doesn’t have molars yet, so pieces of meat larger than pea size will pose a choking hazard. Try small amounts of thinly sliced eggs or cheese, or deli meats such as meatloaf, liverwurst, sausage, or hamburger.

Do not give your 12- to 18-month-old pieces of meat or fish that haven’t been thoroughly cooked and finely chopped. Avoid nuts, other than nut butters or spreads. Toddlers aren’t able to chew them properly.

Important for building good vision and a healthy immune system, vitamin A is fat-soluble and commonly found in liver, fish, fish liver oils (cod liver oil), eggs, dairy products, leafy, dark green vegetables, and deep orange fruits and vegetables. The recommended daily allowance for vitamin A is 1,000 IU or 300 mcg, or about the amount found in a tablespoon of cooked carrots, a tablespoon of mashed sweet potatoes, or one to two tablespoons of chopped steamed spinach or kale.

Probably best known for supporting a healthy immune system, vitamin C (or ascorbic acid) helps in healing wounds, tissue growth, and bone production. It is a powerful antioxidant and is needed for enzyme reactions and cell protection. It also helps the body cope with physical and emotional stress. Good sources of vitamin C include broccoli, Brussels sprouts, cantaloupe, oranges, sweet red peppers, and tomatoes.

Vitamin D helps build bones by contributing to calcium absorption and bone health. It also aids in disease prevention, the building of teeth and hair, and contributes to cell growth and activity and organ regulation. It is the only vitamin that can be manufactured in the body. Good food sources include mushrooms, Atlantic mackerel, salmon, herring, sardines, cod liver oil, and eggs.

Probably due to a lack of sun exposure, about 12 percent of toddlers in the United States don’t get enough vitamin D. The Food and Nutrition Board (FNB) at the Institute of Medicine of The National Academies recommends that children between ages 1 and 3 get 200 IUs a day; however, the American Academy of Pediatrics feels that the recommended daily intake should be between 400 and 1,000 IUs, and that children who do not drink at least a quart of fortified milk per day should be given supplements.²

How much sun a child will need to manufacture adequate vitamin D on her own depends on the latitude where you live, the season, and how lightly the weather permits you to dress her. If dressed but not wearing a hat, a light-skinned child will need about 2 total hours of sun exposure per week; in a bathing suit, a half-hour of sun will do.³ Babies and young children with a medium skin tone will need an estimated average of 168 minutes (or 2 hours and 48 minutes) per week of sun exposure while dressed without a hat, and dark-skinned toddlers may need 3 to 12 hours of sun exposure weekly to produce adequate vitamin D supplementation.⁴ If you are concerned about the link between sun exposure and skin cancer, consider vitamin D supplements instead.

Thiamin helps with carbohydrate metabolization, energy production, and healthy skin. It also supports the nervous system. Good food sources of thiamine include whole and fortified grains and cereals, pork, nuts, seeds, and salmon.

Riboflavin is important for energy production and support of the nervous and immune systems, and necessary for tissue repair and healthy eyes. Soy products, meats, and vegetables, including peas, asparagus, beet greens, spinach, and okra, are good food sources of this vitamin.

Important for energy production, metabolism of fats, and maintenance of healthy skin, niacin also supports the nervous and digestive systems. Good food sources include liver, chicken, milk, eggs, avocados, sweet potatoes, nuts, seeds, and mushrooms.

This vitamin helps with metabolizing proteins, building red blood cells, and maintaining blood sugar and healthy skin. Good sources of B6 include fortified cereals, chickpeas, beef, turkey, brown rice, buckwheat flour, and halibut.

Also known as folic acid, folate is a water-soluble B vitamin best known for its importance during pregnancy in helping prevent anemia in the mother and neural tube defects in the fetus. Folic acid works closely with vitamin B12 in the synthesis of protein as well as the production of DNA and is a key player in development of red blood cells. Good food sources of folate/folic acid include beef liver, legumes, dark leafy greens, and citrus fruits.

Calcium is essential for building and maintaining bones, as 99 percent of it is stored in the bones and teeth. The American Academy of Pediatrics has stated that the average dietary intake of calcium by children is well below the recommended levels, which means that they will not develop optimal bone mass, and which can put them at risk for fractures. Toddlers need about 500 mg per day, or about two servings of vitamin D–fortified milk.

There are other great sources for calcium besides milk, including other dairy products, such as hard and soft cheeses, yogurt, and sour cream. Other nondairy sources include salmon, sardines, leafy greens, broccoli, peas, Brussels sprouts, and almond or sesame butters. There are also calcium-fortified orange juices and other calcium-fortified foods.

The amount of calcium in many prepared foods can vary depending upon the brand. For example, one type of cheese could supply only 5 percent of a child’s daily allowance of calcium (about 50 mg) while another might offer 30 percent (or 300 mg). Reading food labels can help ensure that your toddler is getting enough calcium.

As your toddler grows, the amount of hemoglobin in her blood increases. That’s what gives blood its red color. Iron is an important compound in the formation of hemoglobin, but if your child isn’t getting enough iron (called iron-deficiency anemia), then less oxygen is reaching her cells and tissues, affecting their function.

The symptoms of anemia from the lack of enough iron may come on gradually, but sometimes there are no visible symptoms. An anemic toddler may appear tired with dark circles under her eyes, she may seem sluggish, have a rapid heartbeat, seem more irritable than normal, or have a poor appetite, brittle nails, or a sore or swollen tongue.

The only way to know for sure if your toddler is anemic is through a simple blood test to measure hemoglobin, the substance that gives blood its red color and delivers oxygen to blood cells. Never attempt to treat your child’s suspected anemia yourself with iron supplements without first consulting your doctor, since too much iron can be poisonous and could even deadly.

Red meat, including ground beef, provides one of the most easily absorbed types of iron, but there are other sources for iron, too. Try dark-meat poultry (thighs and drumsticks), egg yolks, leafy green vegetables including spinach and kale, brown rice, dried fruits, nut butters, blackstrap molasses (which can be stirred into milk), and iron-fortified breakfast cereals.

The foundation of a healthy diet is a combination of carbohydrates, fats, and proteins. According to current information, carbohydrates should make up the bulk of the diet, about 45 to 65 percent of daily calories. Fats should amount to 30 to 40 percent of daily calories, and proteins should account for 5 to 20 percent of daily calories. Let’s take a look at each of these foundation items, called “macronutrients.”

Carbohydrates are one of the major energy sources for the human body. The body breaks carbohydrates down to turn them into usable energy. The process produces tiny molecules of sugar (blood sugar or blood glucose) that are absorbed into the bloodstream to supply energy for running the body’s cells. The body will either use its manufactured sugar right away, or it will store it in the liver and muscles for later use.

When it comes to your toddler’s health, not all carbohydrates are created equal. Some carbohydrates support good health, others don’t.

Simple carbohydrates are sugars that the body uses as fuel. In food terms, it is any starchy, white food. Think of cornstarch, white sugar, or white flour—sticky and gluey. Examples of simple carbohydrate products include white bread and bagels, white rice, white potatoes, most baked goods, candies, candy bars, and most energy bars. These carbohydrates will give you or your toddler a quick energy lift, but they’ll also abruptly leave your system, causing an energy “crash” and creating hunger pangs for more carbohydrates.

Complex carbohydrates, the “preferred” carbohydrates, are absorbed slowly by the body during digestion because they contain protein and/or fiber. Complex carbohydrates help your body retain fluids and provide long-lasting energy. They can be found in fruits, vegetables, beans, and whole grains, such as whole-wheat bread and pastas, brown rice, steel-cut oats, beans, and nut and seed butters.

Sugar is used for making cakes, cookies, candies, soft drinks, juice drinks, and sweetened cereals. But it is also found in other places, too: in breads, canned and packaged soups, ketchup, crackers, peanut butter, tomato sauces, frozen pizzas, cured meats, and salad dressings. These sugars go by many names, such as dextrose, maltose, fructose, lactose, sucrose, corn syrup and high-fructose corn syrup, honey, fruit juice concentrate, sorbitol, brown sugar, and molasses. Some of the new, natural sugars you might find on labels include agave syrup, stevia, and brown rice syrup.

The sugar that we know—the white, granulated kind—is made up of both fructose and glucose. Fructose is the critical element in high-fructose corn syrup (HFCS). At least one TV commercial says that HFCS is “okay in moderation,” but the problem is that HFCS now appears in a staggering array of packaged foods: breakfast cereals, pizzas, fruit and sports drinks, ketchup, fruit yogurts, and crackers and breads. That’s just the beginning of the list, and even very young children are ingesting far too much HFCS in relation to healthy carbohydrates supplied by fruits and vegetables.

Read the fine print on ingredient labels. Foods will often show sweeteners in their various forms among the top ingredients in many commercial products. Ingredients are listed in order of their importance in the food, so the foods with higher amounts of sugar will list sugar or a sugar derivative at the beginning of the ingredient list. People who ingest higher-than-recommended amounts of sugar run the risk of developing weight problems, diabetes, high blood pressure, heart disease, and more. Mounting research points to too much sugar (in its many forms) as a culprit in these health problems. Controlling your toddler’s (and family’s) sugar intake is a great step to improving everyone’s nutritional status.

Most young children consume too much juice. One study found that children who drank 12 ounces or more of juice daily were more likely to be shorter in stature and obese.⁵

The American Academy of Pediatrics and the American Academy of Pedodontics both recommend real fruits over fruit juices (see chart below), and milk or water as beverages. Juice, if offered at all to young children, should be limited to ½ cup per day and served in a cup, not a bottle. It should never be taken to bed or carried around during the day in a container, since that allows children’s teeth to be bathed in juice sugars, making them more vulnerable to decay. Also, buy beverages that contain 100 percent fruit juice. Beverages labeled as juice drinks can contain 10 percent fruit juice or less.

Whole fruits are better for your toddler than their juices. Since juices typically require multiple fruits to make a single cup of juice liquid, they concentrate juice sugars and they’re missing the pulp, fiber, and trace minerals of fruits. And, too much juice could cause bloating, gas, and diarrhea.

Here’s a comparison of the carbohydrate counts of raw fruits versus their juices:

FRUIT	AMOUNT	GRAMS OF CARBOHYDRATES
Whole apple Apple juice	1 medium 1 cup	21 28.97
Whole grapes Grape juice	1 cup 1 cup	15.78 37.85
Whole orange Orange juice	1 medium 1 cup	15.39 25.05
Whole pear Pear nectar	1 medium 1 cup	25.66 39.40

Fat has gotten a bad reputation that isn’t fully deserved. It used to be thought that fats were all “bad,” but now we know that some are needed by the body, and others are “bad” and can make the body sick.

Good fats are found in your child’s brain and body. About 95 percent of your toddler’s brain growth occurs between birth and 18 months of age, and her brain is 60 percent fat by weight. Between 30 percent and 40 percent of her calories need to be supplied by fat. But what kinds?

There are four basic kinds of fats, from healthiest to least healthy: monounsaturated, polyunsaturated, saturated, and trans fats.

Monounsaturated fats are considered the healthiest source for fats. Typically, they are liquid at room temperature and turn cloudy when refrigerated. The best sources for these fats are in plant-based oils, such as cold-expelled, extra virgin olive oil. Olive oil and other fats in the monounsaturated fat category have been found to lower rates of heart disease and colon cancer in later life as well as to reduce the risk of diabetes and osteoporosis in adults. In addition, extra-virgin olive oil is higher in vitamin E than other oils. Canola is another monounsaturated oil. Additional sources for these healthy fats are avocados and nuts, which can be made palatable for toddlers by grinding almonds, hazelnuts, sesame seeds, or pecans into nut butters and serving a thin layer on breads, fruits, or vegetable pieces. (Whole nuts can be a choking hazard.)

Polyunsaturated fats stay liquid at both room temperatures as well as at cold temperatures. Their primary sources are sunflower, corn, soybean, and flaxseed oils, and they can also be found in foods such as walnuts, flaxseed, and fish. This fat family includes the omega-3 group of fatty acids, which the body can’t produce on its own and which are thought to be powerful inflammation fighters. Good food sources of polyunsaturated fats include fish, whole wheat, peanut butter, bananas, and sunflower seeds.

Saturated fats remain solid at room temperature and melt only at high temperatures. Saturated fats are found in animal products such as red meat, poultry, and fish, tropical vegetable oils such as coconut oil and palm oil, and food products made with those oils. Most toddlers get their fats from the saturated fats found in dairy products, such as whole fat milk, yogurt, and cheeses.

Trans fats are considered the least healthy of all fats. They are created by heating liquid vegetable oils in the presence of hydrogen gas, a process called hydrogenation, which makes them less likely to spoil—very good for food manufacturers but very bad for human bodies. The primary sources of partially hydrogenated vegetable oils are shortening, some brands of margarine, and processed foods that have been manufactured with shortening or margarine. (Packages will list partially hydrogenated oils as part of their ingredients on their labels.) Foods that typically contain these unhealthy fats include crackers, candies, cookies, snack foods, fried foods, baked goods, and other processed foods. Trans fats are thought to raise low-density lipoproteins (LDL or “bad” cholesterol), which increases the risk of coronary heart disease, as well as lower high-density lipoproteins (HDL, or “good” cholesterol).

Remember that for toddlers’ safety, nuts and seeds should be shaved, ground, or turned into butters or pastes and served as a thin spread (never by the spoonful). Ideally, nuts and seeds should also be unsalted. To help demystify “healthy” fat sources, refer to this quicklist.

TYPE	SPECIFIC ITEMS
Oils	Canola oil, flaxseed oil (unheated), grapeseed oil, olive oil, peanut oil, sesame oil, soybean oil, walnut oil
Nuts	Almonds, brazil nuts, cashews, hazelnuts, macadamias, pecans, peanuts, pine nuts, pistachios, walnuts (all unsalted)
Seeds	Ground flaxseed; pumpkin seeds; sesame seeds, oil, and tahini (sesame paste); sunflower seeds
Other	Avocados, olives (black or green, pitted)

Of special note: The membranes surrounding nerves and brain cells contain omega-3 and omega-6 fatty acids. The human body cannot manufacture either of these substances, so they have to be obtained from foods. While most people get lots of omega-6 fatty acids, children who are picky eaters may be deficient in the omega-3s.

Food sources for omega-3 fatty acids include oily fish (such as salmon and anchovies), ground walnuts, flaxseed, pumpkin seeds, canola oil, and soy products. Other sources for omega-3s include special eggs produced by feeding hens omega-3 fatty acids, meat from grass-fed cattle, and special mayonnaise that has fatty acids added.

Protein is found in every part of the body, from your toddler’s hair to her toenails. It helps the body repair old cells and build new ones, so it’s essential for health. Proteins are broken down into amino acids. The body can’t make all of the amino acids it needs, so some must be supplied by foods.

There are two kinds of protein that the body uses: complete and incomplete. Complete proteins are found in meats, poultry and fish, soybeans (read more about soy), and quinoa. Incomplete proteins don’t contain all of the amino acids the body requires but are found in vegetables, beans, nuts, grains, and fruits.

Sometimes parents worry that their toddlers aren’t getting enough protein because they refuse to eat meat, but most U.S. children get adequate protein from their diets. For example, it’s fairly easy for your child to get enough protein if she drinks 2 cups of milk a day, has ¼ cup of ground beef or turkey, half an egg, or ¼ cup of cheese.

The only children who are at risk of not getting enough protein are those who do not eat meat, eggs, milk, or other combined proteins to make them more complete. To make a complete protein, combine incomplete proteins, such as rice with peas, corn with lentils or beans, or milk with wheat cereal.

Remember that for toddlers’ safety, foods should be cut into ¼-inch pieces, or in strips or shreds. All foods should be cooked, steamed, roasted, or pureed. Eggs should be fully cooked. To help demystify the best protein sources, refer to this quicklist.

FOOD TYPE	SPECIFIC ITEMS
Beans	Kidney, lima, navy, pinto, and soybean products (including vegetarian patties, tofu, and tempeh)
Meat	Beef, buffalo, chicken, lamb, pork, turkey, veal
Fish	Pollock, salmon, sardines, snapper, tilapia, trout
Dairy products	Cheese (cheddar, cottage, goat, Monterey Jack, mozzarella, provolone, ricotta, Swiss), milk, sour cream, yogurt (plain)
Eggs	Boiled, scrambled
Nut butters	Almond, sesame, peanut (unsweetened, unsalted)

Fish and other seafood can play an important role in a good diet, since they are high in protein and low in unhealthy fats, making them a great alternative to red meat. The safest fish to eat are those with virtually undetectable amounts of mercury or methylmercury, including: American shad, anchovies, Altantic croaker, Atlantic haddock, butterfish, catfish, clams, cod, crab, crawfish, flounder, hake, herring, mullet, North Atlantic mackerel, ocean perch, Pacific mackerel chub, pollock, salmon (including canned), scallops, shrimp, sole, spiny lobster, squid, tilapia, trout (freshwater), whitefish, and whiting.

Some fish contain heavy metals or other toxins. Many of these toxins are thought to accumulate over time, and they may alter children’s brain development. PCBs, for instance, have been linked to learning and memory problems in children, and heart problems and possibly cancer in adults.

Avoid these types of fish: king mackerel, shark, swordfish, and tilefish. Also beware of tuna. Fresh and frozen tuna come from bigger fish with much higher levels of mercury, so avoid serving tuna to your child, whether cooked or raw as sushi.

If you have a source for licensed, locally caught fish or like to catch your family’s meals, you can follow local and state fish advisories by going to www.epa.gov/waterscience/fish/states.htm. For a reputable nongovernment source, try Seafood Watch, with a free online seafood search, downloadable pocket guides, and smart-phone application from the Monterey Bay Aquarium. Visit www.montereybayaquarium.org.

Of course, be aware of your child’s likelihood for developing food allergies, including for fish and shellfish. See the warning called “Food Reactions” at the beginning of this chapter.

Soy comes from soybeans (edamame beans), and it is widely used in the United States (soy sauce, miso, tofu, and so on). Soy milk began to be used a century ago in the U.S. for controlling diarrhea in babies. By the 1980s it began to be a popular substitution for cow’s-milk-based formulas when babies had allergic reactions to them. Tofu, tempeh, and miso are considered excellent sources of protein, dietary fiber, vitamin B6, and iron. Soy products are often used by vegetarians and vegans as good substitutes for meat.

On the negative side: Soy can cause allergic reactions in toddlers, such as intestinal inflammation, skin rashes, and, possibly, asthma-like symptoms including respiratory problems, wheezing, and runny nose. With severe allergic reactions, soy can result in serious problems with nutrient absorption (malabsorption syndrome) and severe intestinal inflammation including ulcers along the GI tract and bleeding. The cure for all of these reactions is simply removing soy from the diet.

Isoflavones in soy products have been found to mimic human hormones, such as estrogen. Soy is also thought to interfere with healthy thyroid-pancreatic functioning and the absorption of vitamins A, D, E, and K. The hormonelike properties in soy could potentially affect children’s reproductive health later on. The Center for the Evaluation of Risks to Human Reproductive Health (CERHRH) has stated that the risk of soy effects cannot be dismissed, and some European health agencies are suggesting that young children should not be exposed to soy-based foods.

Soy is available in many forms, and it is used in a variety of food products, including milks, hot dogs, vegetable-based hamburgers, cereals, and flours used in doughnuts and similar products. Experts suggest that parents monitor the quantity of soy foods their children consume. Although small amounts of soy appear to be safe, you may want to limit your toddler’s intake of soy milks and other soy-based products until research is clearer regarding its safety and long-term effects.

Most vitamins are nutrients your toddler must get from food because her body doesn’t produce them on its own. The best vitamins come from foods and not from chewable vitamins or tablets.

Vitamin B12 is an important contributor to nerve and red blood cell health and to energy levels. This vitamin is found only in animal foods, and good sources of B12 include clams, beef, turkey, chicken, crab, salmon, fortified cereal, trout, and herring.

Along with other vitamins, E helps boost immune function and assists in preventing disease. It helps protect the body against heavy-metal toxicity and carcinogens. Vitamin E also fights the free radicals that are destructive to cells. Good sources of this vitamin include vegetable oils, wheat germ, nuts, green leafy vegetables, and whole grains.

This is another important component of the blood. It is needed for blood clotting and healthy healing. Vitamin K is made from intestinal bacteria. Good food sources include Brussels sprouts, broccoli, scallions, and leafy greens such as kale, collards, spinach, turnip greens, beet greens, and mustard greens.

If your toddler is eating mostly healthy foods, then it’s very likely she’s getting all the nutrition she needs without the need for extra vitamins. But if she’s a picky eater, or eats a lot of sugary processed foods and drinks a lot of juices, then you may want to consider giving her a daily dose of vitamins.

Most parents assume that the U.S. Food and Drug Administration (FDA) regulates how vitamins are manufactured and sold in the United States. However, that’s not the case. Manufacturers themselves are responsible for ensuring that a dietary supplement is safe before it goes on the market, which means unsafe vitamins could be sold. Manufacturers do not need to register their products with FDA nor get FDA approval before producing or selling them, but product labels have to be truthful and not misleading.

Vitamins are made up of several different components—enzymes, co-enzymes, and cofactors—that must work together to have their intended effects on your toddler’s body. The majority of commercial vitamin supplements found in supermarkets and pharmacies contain synthetic vitamins derived primarily from coal tar derivatives. Although they may mimic vitamins from natural food sources, in some cases they may not perform as well as those that occur naturally.

It’s important to look at the fine print on the label to ensure that the vitamins you’re giving your toddler are made from real foods, which will be listed there. Many synthetic vitamin C supplements, for example, contain only ascorbic acid or a compound called ascorbate, which contains less acid. In reality, ascorbic acid represents only a portion of vitamin C complex. So, in this case, look for rose hips and other food sources used for making the vitamin.

In 2007, Consumer Labs, an independent, consumer laboratory that tests the purity and consistency of commercial vitamins and the accuracy of their ingredient labels, found widespread quality variations, with more than half (52 percent) of the brands tested either including lead (a contaminant), breaking apart improperly, or containing significantly more or less of the ingredients claimed on the labels.⁶

One brand of children’s vitamins was found to contain 216 percent more than its labeled vitamin A, delivering potentially toxic levels to children younger than 8 years of age.

In addition, some children develop allergic reactions to their vitamins. Symptoms are wide ranging, from more irritability and fatigue than usual to coldlike symptoms that don’t go away, such as a clear nasal discharge, sneezing, sniffling, wheezing, and even asthma, or skin reactions such as otherwise unexplainable itching and skin rashes, and sometimes sleeping problems.

For safety’s sake: Keep all drugs, including vitamins, in childproof cabinets your toddler cannot reach. Avoid taking vitamins and other medications in front of your child, because she may be tempted to copy you. Don’t keep medications in your purse or night table where she could get into them, and never call vitamins “candy” or encourage repeat dosages of children’s vitamins, even if they’re packaged like candy. Bottom line: Whenever you’re in doubt about the quality of your child’s multivitamin, consult your health-care provider for recommended brands and amounts.

Between 12 months and 18 months, your toddler will begin to chew with a rotary movement of her jaws. Her hand and mouth coordination are starting to improve, and she’s interested in trying to hold and manage a spoon. She can sit alone easily and is interested in socializing with others, so she may like the idea of joining family meals, even if only for a short time.

By the time she reaches 3, she’ll be a lot neater and more civilized and able to sit down on her booster seat at the table with the family, fork and spoon in hand to share what everyone else is eating. But until that happy day, you’re going to need a durable (and washable) high chair, a supply of bibs and sippy cups, and lots of patience. Even though your 1-year-old may appear ready and able to learn how to feed herself, it will involve lots of messy practice and clean-ups.

Opinions have changed for what makes good food for children at this age. In the past, it was thought that a toddler’s delicate stomach couldn’t manage adult foods. Now, the sky’s the limit, and it’s thought that toddlers enjoy trying out a variety flavors and textures, just as children and adults to. Any food that’s non-alcoholic and not too salty will do, as long as it’s soft enough or in small enough pieces that it won’t cause choking.

Simple flavors work best. For a child’s tablespoon-sized servings, any vegetable that is boiled, steamed, or microwaved until tender, then cooled and mashed or finely chopped will work. Plus, with such ease of preparation, nothing’s lost if she decides to turn her nose up at it.

There is some basic gear that no parent of a toddler should be without. Here’s what you need:

• High chair. Your child should always be seated and strapped down when eating to avoid messes, choking, and falls. A chair with removable, washable coverlets, an easy-to-install tray, and lockable wheels is a godsend.

• Spoons. Once your child gets to the “I’ll feed myself” toddler stage, her fingers may be the best utensils, followed by a short, thick-handled spoon and rounded fork set. There shouldn’t be any sharp points or edges, and all should be dishwasher safe.

• Bowls and dishes. The steeper the sides of the bowl, the easier it will be for your child to scoop up food. Even though you can buy fancy warming dishes or ones with suctioned bases, the most important features are that they are unbreakable, and dishwasher safe, and contain no nooks and crannies to harbor dried food and germs. Steep-sided rice bowls, salad bowls, and ramekins will have a life beyond Baby.

• Quick chopper. There was a time when moms had to prechew their children’s food if they were concerned about choking hazards. Now baby fare comes prechopped and blended to make it more digestible and appealing. Until your child sprouts her first set of premolars for grinding tough stuff (generally around 24 months), you’ll need to chop up her food into roughly ¼-inch pieces. A simple 1- or 2-cup mini-chopper will do the job.

• Microwave. Many parents swear by microwaves as timesavers, but they do heat food unevenly, leaving pockets of scalding heat that could burn your child’s mouth. If you decide to microwave food for your toddler, heat only small portions for 15 to 30 seconds, then stir the food with a clean finger to make sure it’s evenly warmed. Scrambled eggs or instant oatmeal will need more time to cool down than they took to cook in the first place.

• Bibs. The best versions come with a trough at the bottom to contain spills and keep your child’s clothes clean and dry. Most of those tidbits can make an appetizing “second course.” Disposable bibs come in handy for travel and eating out. In a pinch, a snack bag clip, hair claw, or clothespin can be recruited to fasten a dish towel or a cloth napkin around your toddler’s neck.

• “Splat” mat. If you worry about your toddler’s meals ending up on your floors, a thick shower curtain cut to extend one foot beyond your child’s high chair, or a square of thick, vinyl sheeting can be used for a good moisture-proof catchall. Just don’t trip on it!

• High-chair toys. Toys with strong suction cups that fasten onto the high-chair tray are a handy distraction while you’re preparing food and put an end to the “drop it over the side and watch Mom pick it up” game. Shower-curtain rings, spoons, paper-towel tubes, or balls of foil can be makeshift distracters.

• Dining room digs. Restless toddlers may not be able to sit through a family meal. Consider adding some interesting toys in a bin in your dining area so she can play on the floor nearby and everyone can finish the meal in peace.

Once a toddler’s “I’m my own person” phase hits, food strikes are common. Refusals could also apply to anything green, mushy, or any other particular food quality your toddler has decided, at least for now, are offensive to her sensibilities. No cajoling, threats, or silliness can change her mind.

A super-busy toddler may only be interested in grabbing food on the go, or she may be ravenous for a day or two followed by several days of less appetite. She may squirm and complain to be let down almost from the minute she’s strapped into her high chair, or decide she’s only interested in playing with her food or throwing it overboard instead of eating it. (Lucky dog!)

Toddlers’ small bellies are designed for frequent grazing in small quantities. Typically, they need to refuel every few hours to keep running at peak efficiency.

The easiest way to work through a finicky-tot situation is to take a relaxed attitude. No healthy child will allow herself to starve. As long as she isn’t losing weight and is otherwise healthy, there’s nothing to fear.

• Natural feeding patterns. Toddlers naturally tend to stock up on food during their active, daytime hours, and their appetites diminish in the evening.

• Drinks. If your child is tanking up on milk or juice, the chances are really good that her appetite for food will be affected.

• Snacks. Loading up on snacks within 2 hours of a meal could affect her hunger.

• The “I wanna do it!” phase. She may refuse to eat from a spoon because she wants to feed herself with her fingers, which for her is a lot easier and more pleasurable than using a utensil.

• Texture preferences. Some toddlers prefer mushy textures to crunchy ones. Sore gums from an erupting tooth may also be causing chewing discomfort.

• Hunger cycles. Appetites may be small on some days and big on others. An oncoming illness such as a cold can affect appetite, too, and an ear infection could make swallowing painful.

• More serious causes. If your child is losing weight, seems pale or listless, gags frequently, or has chronic diarrhea or constipation, then there could be a more serious physical problem going on that needs your health-care provider’s attention.

As you will soon realize, mealtime may not the best time to try to mold your toddler into the genteel and polite child of your dreams. You want your tot to clean her plate, to eat her vegetables before dessert, and to start using a child-sized fork or spoon instead of her grubby hands.

You decide to get tough and to lay down “the rules,” but that inevitably escalates into your issuing ultimatums, pleading, and arguing when she doesn’t get with your program. Instead of getting polite compliance and “yes, ma’am,” you get mealtime drama, lots of fiddling, and back-arching accompanied by an adamant “no!”

It’s very tempting (and easy) to slip into using food and treats to get your toddler to do what you want her to, and or to threaten to withhold food and treats for the same reason, as in: “No ice cream for you today because you had a temper tantrum in the store.”

One study of 20- to 24-montholds found that 12 percent of parents resorted to bribery to get their toddlers to eat. The tactic is just another way of putting pressure on your child to consume food, when what’s more important is that she learns to heed her own “I’m hungry,” and “I’m satisfied” signals.

From a toddler’s point of view, a grown-up’s denial or reward of food seems very arbitrary, since she doesn’t fully grasp what you consider “good” or “bad” behavior and what that has to do with being given something to eat or being denied a promised treat.

So, she may not make the connection between acting out in the store and having food withheld. Plus, using food for bribes could spur bad eating habits later on.

Research shows that if there are only healthy food choices in toddlers’ homes and that’s what they’re offered to eat all of the time, they are more likely to choose those food options even when they’re away from home. On the other hand, if there’s lots of grazing on salty snacks, sugary between-meal treats, or heavy desserts then those preferences will stick with toddlers, too, wherever they are.

It’s really not that hard to make over your family’s food choices when you compare how similar a toddler’s diet is to an adult’s diet.

An abundance of food options can be used for mini meals and quick bites for active older toddlers any time of day. Many of these are not intended for younger toddlers, who could choke on them:

• Cold, unsweetened applesauce mixed with plain, full-fat yogurt and sprinkled with cinnamon

• Baked or stir-fried zucchini strips marinated in Italian dressing and sprinkled with seasoned bread crumbs and Parmesan cheese

• Bite-sized pieces of baked sweet potatoes

• Small, bite-sized pieces of cantaloupe or strawberries

• Frozen bite-size blueberries

• Whole-wheat bread with a thin layer of natural, creamy peanut or almond butter and topped with banana slices

• Mashed pinto or black beans seasoned with ground cumin

• Mashed, cooked sweet potatoes or winter squash formed into small bite-sized balls and rolled in cereal crumbs

• Scrambled or boiled egg in bite-sized pieces

• Chopped, seeded watermelon, peaches, and other soft fruit

• Cottage cheese with crushed fruit

• French toast made from egg and milk and grilled in canola oil or butter

• Mini-sized whole wheat or buckwheat pancakes spread with all-fruit jam

• Cheese slices melted on half of a whole-grain English muffin

• Mini whole-wheat waffle sandwich with peanut butter and mashed banana filling

• Instant oatmeal made with a choice of diced, dried raisins, cranberries cherries, or fresh blueberries

• Thin strips of bell peppers served with a pureed cottage cheese and dill dip

• Steamed broccoli, cauliflower, or carrot pieces coated in melted butter or healthy margarine and sprinkled with Parmesan or other shredded cheeses

• Peeled cucumber strips served with ranch dressing

• Cold yogurt “parfait” in with layers of plain yogurt, cereal, and berries or mandarin orange segments

• Banana strips dipped in plain yogurt and rolled in crushed cereal and frozen on a cookie sheet

• Half a whole-grain pita pocket stuffed with ricotta cheese and thin slices of peeled apple

• Ready-to-eat cereal mixed with dried fruit in a sandwich bag for travel

• Half a whole-grain waffle, spread with plain yogurt and thinly sliced peaches

• Toasted pita triangles for dipping in hummus or pureed bean dip

• Whole-grain bread fingers spread with olive oil and toasted for dipping in mild salsa

• Mini whole-grain toaster waffle cut into fingers for dipping in unsweetened cinnamon applesauce

• Whole grain bread slices cut into shapes with cookie cutters and spread with peanut butter, whipped cream cheese spread, or pimento cheese

• Lettuce leaves topped with thin turkey or ham strips and shredded cheese, rolled up like a tortilla

• Mini toasted pizza made from half of a whole-wheat English muffin spread with tomato paste and topped with mozzarella cheese heated in the toaster oven and cut into 1-inch squares

• Mustard spread on a slice of deli turkey and wrapped around a breadstick

• A grilled, thin-sliced turkey or ham with Swiss cheese sandwich using whole-grain bread and cut into quarters

• Quesadilla strips made from a warmed whole-wheat tortilla, and heated fat-free refried beans, and topped with chopped tomatoes and shredded cheese

• Small pieces of pizza made from whole-grain pita bread topped with steamed veggies (in ¼-inch dice) and shredded cheddar or mozzarella cheese

• Sweet-potato or rutabaga “fries” roasted in canola oil and sprinkled with salt-substitute seasoning or dill weed

• Whole wheat crackers spread with avocado guacamole and mild salsa

• Shredded raw carrots and chopped raisins moistened with low-fat or olive oil–based mayonnaise and spread on whole-wheat bread

• Waffilla: Whole wheat tortilla sandwich spread with shredded cheese and low-fat refried beans, toasted in waffle iron, and cut into small triangles

• Homemade vegetable soup made with organic vegetable or chicken broth

• Creamed soups using steamed vegetables pureed in milk, served in a cup.

If you’re ready to do a family food makeover, one of the best ways to get started is to plan ahead what your toddler and your family are going to have at the beginning of each week. Think ahead about healthy breakfasts, lunches, and dinners, and the nutritious snacks you’ll need at your fingertips. Creating a formal grocery list and sticking to it will feel like a positive step in the right direction and will keep you from falling for less-than-healthy foods on impulse.

Arrange your list according to where you plan to begin and end in the store. Select your market carefully. These days you’re not limited to big-box superstores or chain groceries. Now you can shop at whole foods and health food stores, farmers markets, and other alternatives for fresh meats and produce. And there’s no need to stop there: Some families are growing their own produce, including urban dwellers, so don’t feel limited by your options.

But if you’re walking through the typical food store, your top priorities should be nutritious, healthful, body-building foods found along the perimeter of the store, such as fresh meats, poultry, and fish, colorful fresh vegetables and fruits, and dairy. Whole-grain breads and cereals and brown rice also play a part in supplying needed vitamins, minerals, and fiber while also providing sustained energy.

Let’s be clear: a healthy diet doesn’t mean an austere one. It doesn’t mean a low-fat or fat-free one, either. Toddlers’ brains and bodies need fat to thrive. Full-fat milk and dairy foods can contribute much-needed vitamins such as potassium and vitamin D to help to maintain strong bones and teeth.

However, according to the American Academy of Pediatrics (AAP), not all toddlers need to drink whole milk. Children often get their fat intake from non-milk sources, and those who are at risk for overweight or obesity, or those whose families have a history of high cholesterol or heart disease, can use reduced-fat and even skim milk starting at 24 months of age. Recent studies have shown that toddlers who drink reduced-fat and nonfat milks develop normally.

Here are some tips for encouraging your toddler to eat:

• Plan ahead. When possible, plan your toddler’s meals in advance.

• Diversify. Offer between two and five food choices per mealtime (one per snack).

• Scale down. Serve just a few room-temperature tablespoons at a time.

• Start with fingers. Young toddlers like pinching up their food from their high-chair tray.

• Bowl tricks. For a spoon feeder, serve a couple of different foods next to each other in a small, unbreakable bowl.

• Be colorful. Strive for a variety of colorful foods. First comes room-temperature finger foods, such as berries, liverwurst, soft pieces of peas, or Cheerios with a sippy cup of water on the side. Follow with messier foods that have more complex flavors.

• Recycle. Offer rejected food again. It may take three or four times before she’s willing to try it, or she may never like some foods.

• Share the fun. Join your child at mealtimes, and make it a relaxing and enjoyable time to be together. Sit with her and be very excited about what you’re eating.

• Don’t be a neatnik. Let dinnertime be messy. There’s always a bath and tooth brushing before bed.

Vegetarian toddlers can easily meet their protein needs by eating a varied diet, as long as they consume enough calories to maintain their weight. In the past, the common opinion was that foods had to be carefully combined to make sure that toddlers got “complete” proteins with every meal. But that opinion has changed, and it is now thought that a mixture of proteins throughout the day is sufficient.⁷

Many common foods can quickly add up to provide sufficient protein for your toddler. Good food sources include: beans, lentils, nut and seed butters, chickpeas, green peas, whole-grain breads, leafy greens, potatoes, and corn.

Monitor the following nutrients if your toddler is vegetarian or vegan: vitamin B12, riboflavin, vitamin D, calcium, iron, and zinc.

Since B12 is found only in animal foods, lacto-ovo vegetarians (those who eat milk and eggs) can get their daily allowances through dairy products and eggs. Vegan children can try soy products within limits (see soy discussion), veggie burgers, nutritional yeast, and some breakfast cereals. Some toddlers may need a vitamin B12 supplement.

Also known as vitamin B2, riboflavin helps convert macronutrients (carbohydrates, fats, and proteins) to energy and helps support tissue repair. Soy products (see discussion), green peas, asparagus, beet greens, spinach, and okra are good food sources of this vitamin. Vegan toddlers can also try almond butter, yeast extract spread (such as Vegemite), and fortified breakfast cereals.

Most of the best vitamin D sources are found in animal foods, but with moderate amounts of sunlight (about 20 minutes per day on the hands and face), most light-skinned children can manufacture sufficient amounts of vitamin D internally. However, if ultraviolet rays are blocked by air pollution, your child is dark-skinned, or you follow a vegan diet, supplementation may be necessary. Vegetarian toddlers can get their vitamin D through cow’s milk, soy milk, and some fortified breakfast cereals.

Calcium, as discussed earlier, is found in the body, mostly in bones and teeth. Vegetarian toddlers typically get ample calcium in their diet from dairy products. Vegan toddlers can try beans, blackstrap molasses, Chinese cabbage, collard greens, ground nuts (be aware of nut allergens), kale, and turnip greens.

Getting sufficient iron is important for all toddlers, especially if they don’t eat meat. Vegetarian and vegan toddlers can get adequate iron from dried fruits, baked potatoes, mushrooms, cashews, dried beans, spinach, chard, tofu and tempeh (again, see the soy discussion), bulgur, and iron-fortified foods such as cereals, instant oatmeal, and veggie “meats.”

Using iron cookware can also increase iron intake, and combining vitamin C–rich foods (citrus fruit or juices, tomatoes, or broccoli) with iron sources can help your toddler’s body absorb iron better.

Zinc supports normal growth and development in toddlers, and supports immune system function and the healing of wounds. Because there are rich plant-based sources of zinc, most toddlers of all dietary persuasions typically get about the same amounts of zinc through diet.

However, vegetarian and vegan toddlers tend to eat more amounts of foods that are high in phytic acid (whole grains and legumes), which blocks the absorption of zinc. Eating miso soup or miso paste with zinc-rich foods will help enhance zinc absorption. Other things you can do to reduce the phytic acid in grains and legumes is by soaking them for at least 3 hours or overnight, then discarding the soak water, and by eating yeasted grains, such as whole-grain breads.

Most choking fatalities among toddlers are caused by nonfood items. These might include small parts from toys, pen and marker caps, marbles, coins, magnets, watch batteries, and deflated latex balloons. Although it’s fairly rare for tots to suffer a fatal choking accident from food, it’s important to always play it safe. But where does a parent begin? Right here.

There are some foods that might seem to be no-brainer no-nos for toddlers, such as hard candies. But a few old-favorites foods, such as cheese chunks, are also potential dangers. Avoid serving foods that break into chunks (Vienna sausages and toddler meat sticks); thick, sticky foods (peanut butter); or foods that could plug a child’s windpipe (carrot coins or hot dog slices). Taking these precautions and preparing toddler-friendly portions takes the scare out of these foods.

• Nuts, seeds, and popcorn. Whole and chopped nuts, pumpkin and sunflower seeds, and popcorn can cause choking in children under 3. Nuts should be crushed, flaked, or pureed into butters. Never feed spoonfuls of nut butters, such as peanut butter, to your child. Use smooth rather than chunky versions and spread them in a thin layer on crackers, bread, or thin slices of fruits or vegetables.

• Hot dogs. Their rounded shape and flexibility form a perfect airway plug and they are very difficult to dislodge once they get stuck there. They, and finger-shaped sausages and “toddler” meat sticks, are equally as dangerous. Either serve in small pieces (¼-inch dice) or avoid altogether.

• Hard vegetables, crunchy fruits, and chunky cheeses. Raw carrots, whole grapes, raw or cooked corn, cherry tomatoes, raw green beans, and cheese chunks also pose a risk unless they’re diced or shredded.

• Chewing gum and hard or sticky candies. Toddlers shouldn’t be given gum to chew. They’ll swallow it, and they could choke on it. Round or hard candies such as gumdrops, butterscotch candies, caramels, marshmallows, and jelly beans should be avoided, too, since they can form a perfect seal in a tot’s small windpipe and cut off her air supply.

Children who have swallowing problems often are extremely picky eaters. They frequently may gag on food or throw up during or after eating and will reject foods that are difficult for them to chew and get down. The problem could be poor tongue, jaw, or throat muscle tone and coordination, or the problem could also be a chronically inflamed throat from gastroesophageal reflux (GER) disease, in which food travels up the esophagus and digestive acids cause burning sensations in the throat.

If you suspect either of these problems, your toddler’s doctor is the best person to advise you on how to help your child. Some university medical schools have pediatric gastroenterologists (children’s gastrointestinal specialists), and many communities have physical, occupational, and speech therapists who have training in helping children with these issues.

Until you find a solution, you may want to offer nutritious pureed foods or fruit or fruit-and-veggie smoothies served in cups with wide straws, along with child versions of vitamins and minerals in liquid or appealing, chewable forms that would normally be supplied by a well-rounded diet.

• Cut small strips. Cut round, slick foods, such as hot dogs, toddler meat sticks, celery, and cucumbers, into short, matchstick-sized strips, and shred carrots.

• Chop up chunks. To reduce the threat of choking, cut cooked potatoes, carrots, beets, string-free celery, meats, or fish—anything in large chunks—into small, bite-sized (¼-inch) pieces.

• Debone. Carefully remove all bones from fish, chicken, and meat before serving.

• Remove pits and seeds. Remove seeds and pits from plums, peaches, grapes, olives, and other seeded foods.

• Give food a fork test. Cook foods until they’re easily pierced with a fork.

Choking occurs when something blocks your child’s airway. If she can speak or cough loudly, her airway is only partly blocked—do not try to open the airway. Instead, phone 911.

Signs of choking in the child with a completely blocked airway:

• The child suddenly begins to cough, gag, or have high-pitched, noisy breathing.

• The child holds her neck with one or both hands.

• She has bluish lips or skin.

ACTIONS TO RELIEVE CHOKING IN A CHILD

When a child 12 months or older is choking and can’t breathe or speak, you must give abdominal thrusts (the Heimlich maneuver). The Heimlich maneuver pushes air from the child’s lungs, like a cough.

1. Kneel or stand firmly behind him and wrap your arms around her so that your hands are in front.

2. Make a fist with one hand.

3. Put the thumb side of your fist slightly above the navel (belly button) and well below the breastbone.

4. Grasp the fist with your other hand and give quick upward thrusts into her abdomen.

5. Give thrusts until the object is forced out and she can breathe, cough, or talk or until she stops responding.

If the child becomes unresponsive, shout for help or call 911, lower the child to the ground, and start CPR. If someone else is present, send that person to call 911 while you start CPR.

For information about giving CPR, visit www.americanheart.org, before an emergency happens.

Q: I’m worried about my 1-year-old. He seems ravenous all the time! He refuses baby food and cries and complains until we feed him “table food” like the rest of the family. He has a bigger appetite than my 4-year-old daughter! Should I stop him from overeating? How much can one toddler eat? I don’t want him to be overweight.

A: Your child is equipped with an elegant, built-in program that tells him when he’s full and when to stop eating, so it’s important to allow him to regulate how much he eats (or doesn’t). Toddlers’ appetites vary a lot, and some children aren’t interested in eating, while others have huge appetites, especially when they’re going through a growth spurt and mastering how to crawl and walk. What’s important is to supply your child with healthy food choices, such as palatable meats, fruits, vegetables, and whole-grain cereals, pastas, and breads, instead of allowing him to load up on snack foods that are nutrition deficient, greasy, salty, or loaded with sugar, high-fructose corn syrup, and other sweeteners, or chemicals and preservatives.

Q: Our 14-month-old daughter has suddenly become a very picky eater. She’s getting downright finicky, and she’s not much into meat. One day she may love pasta and cheese, and the next day she may refuse it, mash it into her high chair tray, or drop it on the floor. Any advice?

A: Most kids do become picky at about that age. And they also continue to grow and thrive, even when they have eating strikes. It’s hard to know in advance what will work for them from one day to the next. The best idea is to look at nutrition from a weekly or monthly perspective, rather than a daily one. There’s no need to get into a battle of wills. Just give her healthy choices, and remove her from the chair if she starts dawdling and dropping food overboard, a sure sign she’s finished and getting bored. Teach her to say “all done” and to hand over her bowl as a substitute for giving everything to the dog.

Q: Our son was normal weight at birth, but his growth curve slowed way down from 3 months onward. He was breastfed the first year and started solids at 4 months. Now, at 28 months, he weighs only 21 pounds, 6 ounces. He doesn’t eat much and often skips meals, but otherwise, he’s active and seems healthy. Medical tests don’t show anything wrong with him. What can we do to make sure he’s well nourished?

A: First, check on your size and the size of your child’s other parent. If either of you is petite, he’s likely reverting to his genetic code. If your son chokes or gags frequently and seems to only want to eat pureed foods, he may have a swallowing problem that needs to be looked at by a specialist. That said, it’s typical that kids his age to turn into picky eaters, only wanting cheese, French fries, or other quirky food choices. Try serving him small meals every few hours, measured in tablespoonfuls and centered around his favorite foods, with new things introduced alongside them. If there are no issues with dairy, try sprinkling some of his foods with grated parmesan cheese, or serving veggies with a tasty cup of dip of herb-flavored yogurt or diluted nut butter. Also keep an eye on beverages, as they can affect appetite. A chewable vitamin pill can help to ensure he’s getting all the vitamins and minerals he needs until his appetite picks up.

Q: Our daughter is 3 and she has been having diarrhea every few days. Her doctor told me to give her clear liquids, applesauce, and banana. Isn’t there something else she can eat besides that?

A: Diarrhea in toddlers has lots of causes. It can be aggravated by lots of things, including teething, allergies to milk products, fatty foods, too much juice, viruses, taking antibiotics, and so on. Follow your doctor’s advice about what to feed your toddler, but inform the doctor if your daughter’s problem doesn’t improve, or she appears to be unwell and to be losing weight. Ask about her drinking Pedialyte or other beverages designed to replace lost electrolytes and minerals. The BRAT diet, which stands for bananas, rice, apples, and toast or tea, is often recommended for diarrhea. Applesauce has pectin that helps to solidify stools. Bananas have the same effect. You might also consider serving her warmed chicken or beef broth. After her diarrhea eases up, your toddler’s intestinal tract may be aided by yogurts with probiotics that help to replace the intestines’ friendly bacteria that have been lost.

Vegetables	Carrots, bell peppers, green beans, okra, pumpkin, squash, sweet potatoes, zucchini
Fruits	Apples and unsweetened applesauce, bananas, blueberries, grapes (seedless halves), mandarin oranges, mango, pineapple, raspberries, tomatoes
Whole grains	Amaranth, millet, oats, quinoa, and other wholegrains

SAMPLE TODDLER MENU	SAMPLE ADULT MENU
Breakfast Scrambled eggs Cheerios Cup of milk	Breakfast Scrambled eggs Toast Cup of milk
Snack Banana Cup of water	Snack Banana Water
Lunch Berries Cup of hummus and thin slices of pita Cup of milk	Lunch Berries Hummus pita sandwich Drink
Snack Pretzel sticks	Snack Pretzel sticks
Dinner Lumps of liverwurst Minced broccoli Cooled, mashed baked potato Cup of water	Dinner Steak Broccoli Mashed potato Water, wine, coffee, or tea