Dr Imad Chami : General Pediatrician, Pediatric Neonatology, Sahel General Hospital- Haret Hreik-Lebanon
The right balance of energy and nutrition for young children is important to support rapid growth, brain development and immune system maturation. 1 The behavioral and physiological changes as well as the increasing levels of physical activity of toddlers require sufficient energy, macronutrients and micronutrients intake.
Macronutrients (Fat- Protein- Carbohydrate):
Fat intake requirements represent 30-40% of total energy intake. Polyunsaturated fatty acids (alpha-linolenic and linoleic acids) are the preferred sources of fat. Omega-3, and omega 6 fats (DHA, EPA and ALA) play a critical role in a toddler’s cognitive, brain, eye development, and absorption of fat-soluble vitamins²·³
Protein intake requirements 5-20% of total energy intake. Protein contributes to normal development of muscles and bones of toddlers1. Daily 1.1 g of protein for every one kg of body weight ensure optimum growth ⁴
Carbohydrates function primarily as an immediate energy source for the toddler’s daily activities. Daily 130gr are sufficient to cover glucose needs⁵
Micronutrients: vitamins (A, D, E, K, C, B vitamins) and minerals as (calcium, copper, fluoride, iodine, iron, selenium and zinc) are essential and vital. Fiber including prebiotics are also important for toddler’s health since 70% of immunity lies in the gut. Vitamin D (600 IU) and calcium (700 mg) are required on a daily level. Iron deficiency in young children have potential neurodevelopmental implications. Children between ages one to three should consume 7mg per day ⁶·⁷
Prebiotics including fructo-oligosaccharides (FOSs) and galacto-oligosaccharides (GOSs) enhance proliferation of Bifidobacterium and lactobacillus species in the gut. Breastmilk has the optimal combination of GOS FOS.
In case you can’t breastfeed, your doctor will prescribe for you an adapted fortified formula which will include (Gos and Fos). A ratio of 9:1 Gos/Fos have a significant role in building infant’s immunity and allergy prevention⁸⁸·⁹
Toddlers must eat foods from four key groups:
1. starchy foods (bread and cereals)
2. fruits and vegetables
3. meat, fish, eggs and beans.
4. milk formula and dairy products.
Toddlers need less milk as compared to their requirement in the first year of life – about 500 ml per day. Milk and other drinks should be given in beakers or cups¹⁰
Follow up formulas contain more calcium, iron, nucleotides found naturally in breast milk, and prebiotics to support the immune system. It also contains the essential fatty acids DHA and ARA, similarly to breast milk supporting brain and eye development.
So toddler formula is a great way to fill the nutrition gap for older infants who are beginning to eat baby foods and other solids but still require essential fats, iron, prebiotics and many other nutrients ending up with a complete and healthy transitional nutrition option.⁹
Aptamil is not the author of this article, as it has been written by Dr Imad Chami who is the owner of the content
1. Prado EL, Dewey KG. Nutrition and brain development in early life. Nutr Rev. 2014;72(4):267–284
2. Carlson SE, Colombo J. Docosahexaenoic Acid and Arachidonic Acid Nutrition in Early Development. Adv Pediatr 2016; 63:453.
Lauritzen L, Brambilla P, Mazzocchi A, et al. DHA Effects in Brain Development and Function. Nutrients 2016; 8.Michaelsen KF, Greer FR. Protein needs early in life and long-term health. Am J Clin Nutr. 2014;99(3):718S–722S.
3. Institute of Medicine of the National Academies. Dietary Reference Intakes (DRIs): For Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids, The National Academies Press, Washington, DC 2005
4. Wagner CL, Greer FR; American Academy of Pediatrics Section on Breastfeeding; American Academy of Pediatrics Committee on Nutrition. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents [published correction appears in Pediatrics. 2009;123(1):197]. Pediatrics. 2008;122(5):1142–1152.
5. McDonagh MS, Blazina I, Dana T, Cantor A, Bougatsos C. Screening and routine supplementation for iron deficiency anemia: a systematic review. Pediatrics. 2015;135(4):723–733 2014;99(3):718S–722S.
6. Van Hoffen E, Ruiter B, Faber J, M’Rabet L, Knol EF, Stahl B, Arslanoglu S, Moro G, Boehm G, Garssen J. A specific mixture of short-chain galacto-oligosaccharides and long-chain fructo-oligosaccharides induces a beneficial immunoglobulin profile in infants at high risk for allergy. Allergy. 2009 Mar;64(3):484-7.
7. Hatakka K, Savilahti E, Ponka A, et al Effect of long term consumption of probiotic milk on infections in children attending day care centres: double blind, randomised trial. BMJ. 2001;322(729
8. U.S. Department of Health and Human Services and U.S. Department of Agriculture. Dietary guidelines for Americans 2015–2020. Eighth edition.
9. Young Child Formula: A Position Paper by the ESPGHAN Committee on Nutrition
Hojsak, Iva∗; Bronsky, Jiri†; Campoy, Cristina‡; Domellöf, Magnus§; Embleton, Nicholas||; Fidler Mis, Nataša¶; Hulst, Jessie#; Indrio, Flavia∗∗; Lapillonne, Alexandre††; Mølgaard, Christian‡‡; Vora, Rakesh§§; Fewtrell, Mary||||; ESPGHAN Committee on Nutritio. Journal of Pediatric Gastroenterology and Nutrition: January 2018 – Volume 66 – Issue 1 – p 177-185
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