Toddler 1 - 3 years

Aim

To provide a balanced diet with a variety of foods for children 1-3 years of age who are managing a range of textures, finger food and family foods.

Characteristics

Diet contains adequate and varied nutrition for optimal growth and development in children aged 1-3 years from developmentally appropriate foods. A wide range of foods from all food groups is included. Meets the Nutrition standards for paediatric inpatients in NSW hospitals.

Food texture is generally soft to slightly firm, including foods that can be easily chewed, but require minimal biting, although a wide range of textures is available to allow progression in texture management. Foods may need to be cut up. Snacks contribute significantly to nutrient intake because of the wide variation in the amount of food eaten at different meal times.

Indications

Suitable for children from 1-3 years of age, when developmentally appropriate and at parent/carer discretion. Suitable for infants who are nutritionally well and nutritionally at-risk.

May be combined with other therapeutic diet orders for children who have special or high nutritional needs. This diet may be combined with thickened fluids/texture modifications.

Nutritional adequacy

Nutritionally adequate.

Note ½ serve sizes to ensure sufficient food variety and manageable serve size.

Refer to the Paediatric Nutrition Standards for Minimum Menu Choice for serve size requirements for varying ages.

Precautions

Solids provide a much larger contribution to nutrient intake than breast milk or cows’ milk so are offered first.

Breast milk and/or cows’ milk are still important in nutrient intake but are required less frequently. Amounts will depend on individual age, growth and stage of solids development. Stage of progression with solids will determine appropriate textures for each individual. Food should not be tough, stringy and should be without fat, gristle or bone.

Food that can break into small hard pieces are not allowed as they may present a choking hazard.

Appropriate seating giving support to the head and neck should be available at younger range of age group. Age appropriate cutlery should be used. Young children still need supervision when feeding in case of choking.

For children with altered nutrition needs, additional therapeutic diet orders will affect textures and foods allowed.

Specific menu planning guidelines

	Allowed	Not allowed
Hot main dishes	½ serve size Soft dishes that can be mashed with a fork (e.g. tuna/salmon mornay, soft macaroni cheese, flaked fish, cottage pie) Soft dishes cut up (e.g. lasagne, smooth quiche with crumbly base, fish cakes, crepes) Roasts, diced or minced, with or without gravy Crumbed or fried fish (e.g. fish cakes, fish fingers) Well-cooked legumes (e.g. baked beans)	Meat with gristle Dishes with hard pastry (e.g. spinach pie, regular quiche, pizza) Casseroles with large pieces (e.g. curried prawns) Dishes with crisp topping Strong spices and flavours
Sauces, gravies	All others including mild herbs and spices	Strongly spiced and flavoured (e.g. chilli, cayenne)
Starchy vegetables/pasta /rice	All ½ serve size	-
Vegetables	½ serve size All cooked vegetables to be mashed or cut up and served in small pieces or finger sized strips Cut up or grated raw vegetables	All others (e.g. corn cob) Hard raw vegetables
Soups	None	All
Sandwiches	All	-
Salads, dressings	All others	Raw onion, radish
Breads, cereals	All	Unprocessed bran
Spreads	All	-
Hot breakfast choices	All	-
Fruit	All Dried fruit in cooking	Dried fruit as a snack/item
Yoghurt	All (full cream preferred)	-
Desserts	All	Any with hard pastry
Milk and cheese	All milks (full cream milk preferable as main beverage) Breast milk All cheese	-
Beverages	All others	Soft drink, tea, coffee
Biscuits	Plain biscuits or crackers, biscuits containing dried fruit	Cream biscuits, choc coated biscuits Biscuits with nuts, or hard pieces that don’t dissolve
Miscellaneous	Starch based, locust bean (carob bean) gum and guar gum thickeners for thickening EBM or formula or fluid	Xanthan gum based thickeners for thickening EBM or formula or other fluids Salt, pepper sachet Nuts Popcorn Hard lollies Alcohol

References

1. Agency for Clinical Innovation. Nutrition standards for paediatric inpatients in NSW hospitals. Sydney 2011.
2. Agency for Clinical Innovation. Nutrition standards for adult inpatients in NSW hospitals. Sydney 2011.
3. American Dietetic Association. Paediatric Nutrition Care Manual. Chicago: ADA.
4. Dietitians Association of Australia. 2009. Nutrition Manual 8th ed. Canberra: DAA.
5. Shaw V and Lawson M. Clinical Paediatric Dietetics. 3rd Edition. 2007. Blackwell Publishing.
6. Sydney Children’s Hospital Network factsheet.
7. Food Standards Code FSANZ.