WASHINGTON — Recognize parenting strategies that hinder or support the development of healthy eating patterns, and you can help prevent obesity in toddlers, Jennifer Orlet Fisher, Ph.D., and Susan L. Johnson, Ph.D., said in a presentation at the annual meeting of the American Academy of Pediatrics.
Approximately 11% of American infants aged 0–23 months are above the 95th percentile for weight, said Dr. Fisher of Baylor College of Medicine in Houston.
Few studies of activity levels in toddlers exist, she said. The best data come from a recent study of 100 Scottish children. These data revealed that toddlers spend a majority of their time in sedentary activity followed by light activity, and surprisingly very little time is spent in moderate to vigorous activity. However, moderate to vigorous activity did not predict total energy expenditure, which suggests that light activity is the primary contributor to total energy expenditure. There was little daily variation or weekday/weekend variation.
Television watching contributes to increased sedentary time for toddlers. A national longitudinal study showed that nearly half of toddlers are watching more than 2 hours daily, and children who watched more than 2 hours as toddlers were almost three times more likely to watch more than 2 hours at age 6 years, Dr. Fisher said.
The other side of the equation is what foods toddlers eat, and where and how they eat. Toddlerhood is a time of transition to a modified adult diet, Dr. Fisher explained. “In a relatively short time you see a huge increase in the energy from table food.”
“On average, a 2-year-old's intake is 1,249 calories, which is 32% higher than the estimated daily requirement,” said Dr. Fisher.
Data from the Feeding Infants & Toddlers Study (FITS), a 2003 survey of eating patterns in more than 3,000 children aged 4–24 months conducted by Gerber, indicated that toddlers average seven eating occasions per day. Also, nearly 25% of 19- to 24-year-olds did not eat vegetables daily, and French fries were the most commonly consumed vegetable by children aged 15–24 months.
Some research has examined whether young children can adequately regulate their own energy intake. Dr. Fisher and colleagues conducted an observational study in which young children expressed preferences for the flavored beverage that had the highest energy, suggesting that energy content influenced preferences for flavor.
Data from another study of preschool children showed that children adjusted their energy intake by consuming less high-density drink when left to choose for themselves. Children are much better than adults in regulating energy intake, Dr. Fisher said.
“Opportunities to positively influence food preference begin at the earliest point in development,” she noted. She cited a study in which pregnant women consumed carrot juice during the last trimester and during early breast-feeding. Infants exposed to carrots showed better acceptance of carrot-flavored cereals on first introduction to those foods.
The influence of the environment on eating is a huge area of study; the increase in pediatric overweight can't be explained by genetics alone.
Parents have a very influential role on toddlers' eating habits, and food exposure is related to intake. If something is available and accessible in the home, children are more likely to eat it, but parents have to make the nutritious food available.
Often, well-meaning parents will reduce the variety of foods offered to children; they conclude after 3 or so presentations and rejections that the child doesn't like a particular food. In fact, evidence shows that it takes 5–10 exposures for a child to accept a novel food, Dr. Fisher said, and the number of foods liked in toddlerhood predicts the number liked at age 6–8 years.
Parents, take note: a study in 2000 showed that when adults enthusiastically modeled food, children were more likely to eat it. In addition, parents can be mindful of their feeding strategies for toddlers, including pressuring them to eat, or restricting specific foods. Some parents are controlling, while others provide minimal structure or supervision.
“We actually know very little about best practices for feeding children,” Dr. Fisher said, “but what we do know is that authoritarian feeding practices usually backfire.” Pressure to eat can create a dislike for certain foods and disrupt children's ability to regulate energy intake, and food restriction can encourage children to eat when they aren't hungry.
Doctors are strapped for time, but there are some points they can make in the office that might help parents prevent or control overweight and obesity in toddlers, said Dr. Johnson, director of the Children's Eating Laboratory at the University of Colorado, Denver.