To advise family’s on appropriate dietary intake one must first consider the developmental age of a child and understand the “normal” fluctuations in dietary habits. Often, underweight children have not achieved developmental milestones for eating the full range of foods beyond a developmental age of two or older. For example, some children have developmental conditions that might affect their ability to eat (e.g., mental retardation, pervasive developmental disorders & autism, genetic conditions, structural abnormalities). Children with these impairments may be unable or unwilling to advance to a chronologically age appropriate diet (e.g., delayed dependence on formula, soft or pureed foods). Detailed description of developmentally appropriate menus.
Background Education for Providers
In the first two years of life, children are learning to eat. Families need to know how to identify their child’s developmental stage, what the child’s physical skills are, what the child’s eating skills are, how to accurately identify a child’s hunger and fullness cues, and what the range of appropriate foods and textures are. Some children who are underweight do not have the skills to eat a full range of menu choices. Specifically, children beyond the age of two should be able to drink all consistencies of fluids, and eat all textures of foods including: smooth/puree/mashed foods, soft cooked foods, dissolvable solids, chewable solids, and mixed textured foods.
For children with developmental disabilities, food offerings should be consistent with their child’s developmental age. Families may also benefit from additional assessment of their child’s developmental level. Therefore, consideration of a referral for a developmental evaluation should be discussed with the family.
To encourage a child to consume a balanced diet, it often is recommended that caregivers offer small portions of various nutritious foods and permit the child to determine what and how much of these items he or she chooses to eat. It is important to work closely with families to assess their knowledge of appropriate portion size, as parents may deliberately overfeed or underfeed children secondary to incorrect beliefs about children’s nutritional needs. Other parents may offer an overly narrow range of foods to support a balanced diet. It is important to consider the broadest range of foods that is appropriately matched to a child’s ability level, as this is a primary goal to meet a “balanced diet”.
Instructions for Provider
Children beyond two years of age should be able to drink all consistencies of fluids, and eat all textures of foods. Fluids range in consistency from thin liquids (e.g., water) to thick liquids (e.g., milkshake consistency). Smooth/puree/mashed foods consist of gelatin, pudding, yogurt, and meat spreads. Soft cooked foods include cooked vegetables, and canned fruits. Dissolvable solids include breads, crackers, dry cereal, chips, and popcorn. Chewable solids (foods that do not dissolve in saliva) include raw vegetables and meats. Mixed textured foods are foods which consist of more than one texture. Examples include casseroles and soups. To evaluate completeness of accepted textures, families should complete a verbal recall of foods commonly consumed by the child. Alternatively a formal food record may be completed and reviewed at a later session.
Providers are advised that exclusion of any one or more of the above categories in a typically developing child above the age of two warrants further evaluation with a developmental specialist and/or a speech and language pathologist.