Promoting optimum health Promoting optimum health during toddler hoodduring toddler hood

1. Nutrition1. Nutrition

During the period from 12 to 18 During the period from 12 to 18 months ,the growth rate slows.months ,the growth rate slows.

The protein and caloric are still relatively The protein and caloric are still relatively high to meet the demands for muscle high to meet the demands for muscle tissue growth and high activity level .tissue growth and high activity level .

The need for minerals such as iron, The need for minerals such as iron, calcium, and phosphorus is still high calcium, and phosphorus is still high

NutritionNutrition

Physiologic anorexiaPhysiologic anorexia: is a phenomenon that : is a phenomenon that most toddler at approximately 18 months of age most toddler at approximately 18 months of age manifest decreased nutritional need with a manifest decreased nutritional need with a decreased appetite.decreased appetite.Toddlers are increasingly aware of the Toddlers are increasingly aware of the nonnutritive function of food: the pleasure of nonnutritive function of food: the pleasure of eating, the social aspect of mealtime, and the eating, the social aspect of mealtime, and the control of refusing food. control of refusing food. If a family member refuses to eat some timing, If a family member refuses to eat some timing, toddlers are likely to imitate that response.toddlers are likely to imitate that response.By 12 months of age most children are eating By 12 months of age most children are eating the same food prepared for rest of family.the same food prepared for rest of family.

Nutritional counselingNutritional counseling

Eating habits established in the first 2 or 3 years Eating habits established in the first 2 or 3 years of life .of life .If food is used as a reward or sign of approval , If food is used as a reward or sign of approval , a child may overeat for nonnutritive reasons.a child may overeat for nonnutritive reasons.Mealtimes should been joyable rather than times Mealtimes should been joyable rather than times for discipline or family argument.for discipline or family argument.The social aspect of mealtime may be distracting The social aspect of mealtime may be distracting for young children.for young children.Calling the toddlers from play 15 minutes before Calling the toddlers from play 15 minutes before mealtime allows them ample opportunity to get mealtime allows them ample opportunity to get ready for eating while setting down their active ready for eating while setting down their active minds and bodies.minds and bodies.

Nutritional counselingNutritional counseling

The method of serving food also takes on more The method of serving food also takes on more importance during this period.importance during this period.The ritualism of this age also dictates certain principles The ritualism of this age also dictates certain principles in feeding practices, like the same dish, cup. Or spoon in feeding practices, like the same dish, cup. Or spoon every time of eat.every time of eat.If one food touches another, they often refuse to eat it.If one food touches another, they often refuse to eat it.Mixed foods are rarely favorites.Mixed foods are rarely favorites.Best to use is plastic dishes and cups, for both economy Best to use is plastic dishes and cups, for both economy and safety.and safety. large round foods should be avoided (hot dogs, grasps, large round foods should be avoided (hot dogs, grasps, peas, carrots). peas, carrots). Active play while eating should be discouraged to Active play while eating should be discouraged to prevent choking.prevent choking.

Dietary guidelineDietary guideline

Iron deficiency anemia is a significant health Iron deficiency anemia is a significant health concern during the second year of life. whole concern during the second year of life. whole cow's milk is low in iron and interferes with iron cow's milk is low in iron and interferes with iron absorptionabsorption Iron deficiency anemia has been associated Iron deficiency anemia has been associated with impaired mental status and psychomotor with impaired mental status and psychomotor development during the first 2 years of life.development during the first 2 years of life.Iron fortified cereals and iron-rich foods are Iron fortified cereals and iron-rich foods are recommended for all children beyond 6 months recommended for all children beyond 6 months of age.of age.Iron rich diet as meats fish, green leafy Iron rich diet as meats fish, green leafy vegetables, dried fruit, beans.vegetables, dried fruit, beans.

Dietary guidelineDietary guideline

Calcium and vitamin D are essential for healthy Calcium and vitamin D are essential for healthy bone development .bone development .Adequate intake of calcium for the child 1to 3 Adequate intake of calcium for the child 1to 3 years of age is 500 mg.years of age is 500 mg.Sources for calcium : whole milk, cheese, Sources for calcium : whole milk, cheese, yogurt, beans, and vegetables.yogurt, beans, and vegetables.Adequate vitamin D intake is essential to prevent Adequate vitamin D intake is essential to prevent rickets, a recommended dose is 200 IU daily.rickets, a recommended dose is 200 IU daily.Sources of vit D: fish, fish oils, egg yolks,Sources of vit D: fish, fish oils, egg yolks,Vit C enhances iron absorption (fruit juice)Vit C enhances iron absorption (fruit juice)

2. Sleep and activity2. Sleep and activity

Total sleep decreases only slightly during the second Total sleep decreases only slightly during the second year and averages about 12 hours a day.year and averages about 12 hours a day.Most children take one nap a day.Most children take one nap a day.Children reach an adult pattern of sleep by 3 years of Children reach an adult pattern of sleep by 3 years of age.age.Sleep problems are common:Sleep problems are common:

- Going to bed.Going to bed.- Falling sleep.Falling sleep.- Response to fear: can be provoked by a child's daily Response to fear: can be provoked by a child's daily

stressors such as pressure to toilet train, moves, sibling stressors such as pressure to toilet train, moves, sibling birth, experiencing a loss, or separation from parents.birth, experiencing a loss, or separation from parents.

- Awareness of separation.Awareness of separation.

Sleep problemsSleep problems

Management of sleep problems:Management of sleep problems:- Establishing a regular bedtime and Establishing a regular bedtime and

routine.routine.- Providing transitional objects ,such as a Providing transitional objects ,such as a

favorite stuffed animal or blanket.favorite stuffed animal or blanket.- Limit prolonged bedtime rituals by defining Limit prolonged bedtime rituals by defining

a length of time and set of activities (one a length of time and set of activities (one more story).more story).

3. Dental health3. Dental health

Regular dental examinationsRegular dental examinations :the American :the American Academy of pediatrics(2003) now recommends that Academy of pediatrics(2003) now recommends that every child have an oral health examination by 6 months every child have an oral health examination by 6 months of age if the child is in high-risk category for caries.of age if the child is in high-risk category for caries.

Removal of plaqueRemoval of plaque: soft bacterial deposits that : soft bacterial deposits that adhere to the teeth and cause dental caries (decay or adhere to the teeth and cause dental caries (decay or cavities) and gum disease.cavities) and gum disease.

- Poor oral hygiene and poor dietary habits are associated Poor oral hygiene and poor dietary habits are associated with the development of caries in children.with the development of caries in children.

- The most effective methods for plaque removal are The most effective methods for plaque removal are brushing and flossing. several brushing techniques exist.brushing and flossing. several brushing techniques exist.

Dental healthDental health

For effective cleaning a small toothbrush with soft For effective cleaning a small toothbrush with soft rounded multitufted nylon bristles that are short and rounded multitufted nylon bristles that are short and uniform in length is recommended.uniform in length is recommended.Introduce toothpaste around 2 years of age .Introduce toothpaste around 2 years of age .When using toothpaste, children should select the flavor When using toothpaste, children should select the flavor they like to encourage the brushing habit..they like to encourage the brushing habit..After the teeth have been cleaned, flossing with dental After the teeth have been cleaned, flossing with dental floss is done to remove plaque and debris from between floss is done to remove plaque and debris from between the teeth and below the gum margin.the teeth and below the gum margin.Ideally the teeth should be cleaned after each meal and Ideally the teeth should be cleaned after each meal and especially before bedtimeespecially before bedtime

Dental healthDental health

Fluoride supplementationFluoride supplementation should be considered should be considered for any child over the age of 6 months whose drinking for any child over the age of 6 months whose drinking water is deficient in fluoride.water is deficient in fluoride.

Low-Cariogenic DietLow-Cariogenic Diet: : - Diet is critical to developing good teeth because the Diet is critical to developing good teeth because the

carious process depends primarily on fermentable carious process depends primarily on fermentable sugars, especially sucrose.sugars, especially sucrose.

- Table sugar, honey. Dried fruit are highly cariogenic.Table sugar, honey. Dried fruit are highly cariogenic.- Suggestions can be helpful to eliminate the problem:Suggestions can be helpful to eliminate the problem:1.The frequency with which sugar is consumed is more 1.The frequency with which sugar is consumed is more

important than the total amount eaten. important than the total amount eaten.

Dental healthDental health

2. the form of sugar is important. the more cariogenic 2. the form of sugar is important. the more cariogenic foods are those that are sticky or hard, because they foods are those that are sticky or hard, because they remain in the mouth longerremain in the mouth longer

Nursing cariesNursing caries :nursing bottle caries: bottle-: mouth :nursing bottle caries: bottle-: mouth caries: which occurs when the child is caries: which occurs when the child is

- routinely given a bottle of milk or juice at nap or bedtime, routinely given a bottle of milk or juice at nap or bedtime, - use a bottle as a pacifier while awake. use a bottle as a pacifier while awake. - Frequent nocturnal breast – feeding for prolonged Frequent nocturnal breast – feeding for prolonged

periods.periods.- The practice of coating pacifiers in honey can also to The practice of coating pacifiers in honey can also to

contribute to caries or botulism poisoningcontribute to caries or botulism poisoning

Dental healthDental health

PreventionPrevention involves: eliminating the bedtime involves: eliminating the bedtime bottle completely, bottle completely,

- Feeding the last bottle before bedtime,Feeding the last bottle before bedtime,- Not using the bottle as a pacifiers.Not using the bottle as a pacifiers.- Never coating a pacifiers in sweet substances.Never coating a pacifiers in sweet substances.- Juice should always be offered in a cup .Juice should always be offered in a cup .- Toddler should be encouraged to drink from a Toddler should be encouraged to drink from a

cup at the first birthday and weaned from a cup at the first birthday and weaned from a bottle by 14 months of age.bottle by 14 months of age.

4. Injury prevention4. Injury prevention

Motor vehicle injuries.Motor vehicle injuries.Drawing.Drawing.Burns.Burns.Poisoning.Poisoning.Falls.Falls.Aspiration and suffocation.Aspiration and suffocation.Bodily damage.Bodily damage.Terrorism/violence.Terrorism/violence.

See table 12- 3 p 406See table 12- 3 p 406

Anticipatory guidance-care of Anticipatory guidance-care of familiesfamilies

See family home care p 414See family home care p 414