Nutrition for Breastfeeding Toddlers

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It seems that all the the information I see regarding toddler nutrition assumes that your toddler is no longer breastfeeding and is eating mainly solids. As a result, many moms of breastfeeding toddlers (particularly those who are eating few solids) have lots of questions about how to adapt this information to their particular child.

• Introduction
• Cow’s milk?
• How much should my toddler be eating?
• Average toddler growth
• Feeding suggestions for toddlers
• Additional information

Introduction

Your child can continue breastfeeding just as often during the second year, but offer solid foods a few times a day. After 12 months, you can begin offering the solids BEFORE baby nurses, if you wish, instead of after. Your milk is still an important part of baby’s diet and will offer him many benefits (nutritionally, immunilogically and emotionally). There is not any particular “recommended number of times per day” that a toddler should be nursing. Some are only nursing once or twice a day, while others continue to enjoy lots of time at their mother’s breast. As baby slowly moves into eating more solids, your milk will fill any nutritional gaps nicely. Once you do start to breastfeed less often, remember that you must make a greater effort to ensure that your child eats several meals of nutritious food each day.

Cow’s milk?

Many nursing moms are told that they must introduce cow’s milk at a year. Your nursing toddler is already getting the best milk he can get – mother’s milk! Breastmilk has a higher fat content than whole cow’s milk (needed for baby’s brain growth), and all the nutrients of human milk are significantly more bioavailable than those of cow’s milk because it is species specific (not to mention all the components of mother’s milk that are not present in cow’s milk).

There is no need to add cow’s milk to your toddler’s diet (or the equivalent nutrients from other milks or foods) as long as your baby is nursing at least 3-4 times per day. Cow’s milk is really just a convenient source of calcium, protein, fats, vitamin D, etc. – it’s not required. There are many people in many parts of the world who do not drink milk and still manage to get all the calcium, protein, fats, vitamin D, etc. that they need.

• Good non-dairy sources of protein include meats, fish, peas & beans (chick peas, lentils, baked beans, etc.), tofu and other soy products, boiled eggs, peanut and other nut butters (if your child is not allergic).
• Good non-dairy sources of fats include soy and safflower oils, flax seed and flax seed oil, walnuts, fish and fish oils, avocado. Adding fats to cooking and baking can work well, for example, stir fry in safflower oil or make mini-muffins with soy or rice milk, oil or butter, and eggs.
• Calcium may be derived from many nondairy sources.
• Vitamin D can be supplied by sunlight exposure and food sources.
• If your child is not nursing regularly and is not allergic to cow’s milk products, but simply doesn’t like cow’s milk, you can incorporate milk into your child’s diet in other ways. Many children like cheese, whole-fat yogurt or ice cream. You can also put milk into various food products: pancakes, waffles, muffins, French toast, scrambled eggs, mashed potatoes, and baked goods.
• Some moms wish to offer cow’s milk to their toddler, but baby doesn’t like it. Over the age of 12 months, milk becomes a more minor part of a child’s diet. It is sometimes helpful to mix increasing amounts of cow’s milk with your expressed milk to help baby get used to the taste. Many dietitians see nothing wrong with adding some flavor (such as strawberry or chocolate) to cow’s milk.

Pediatricians now recommend that any cow’s milk be whole milk from a cup after the first year and until the child is at least 2 years of age. This ensures that your child receives enough fat, which is essential to proper brain development. After the age of two, if growth is good, you can switch to low-fat or nonfat milk. Note: If your child is nursing, then remember that mom’s milk is “whole” milk – the more breastmilk your child gets, the less need to worry about your child getting additional fat from whole milk or other sources.

It’s best to limit the amount of cow’s milk that your child receives to 2-3 cups (16-24 ounces) per day, since too much cow’s milk in a child’s diet can put him at risk for iron-deficiency anemia (because cow’s milk can interfere with the absorption of iron) and may decrease the child’s desire for other foods.

How much should my toddler be eating?

Between ages one and five, a child’s growth is in a decelerated stage; that is, they have slowed down in growth. Since growth slows down, their need for calories subsequently decreases, which in turn leads to a smaller quantity of food ingested per day. Added to the decelerated growth is a burgeoning independence which limits the variety of foods your child is willing to eat (“finicky eater”). Rest assured that toddlers do not need as much food as you might expect because of this slowing down of the growth rate. Three small meals and two snacks a day (and some will eat a good bit less) will probably be enough to fuel even the most active toddler. Please realize, too, that finicky eaters are the rule rather than the exception.

Some toddlers are eating very few solids, or even no solids, at 12 months. This is not unusual and really depends on your child – there is quite a big variation. We like to see breastmilk making up the majority (around 75%) of baby’s diet at 12 months. Some babies will be taking more solids by 12 months, but others will still be exclusively or almost-exclusively breastfed at this point. It is normal for baby to keep breastmilk as the primary part of his diet up until 18 months or even longer. An example of a nice gradual increase in solids would be 25% solids at 12 months, 50% solids at 18 months, and 80% solids at 24 months.

Some children take a little longer to begin taking solids well. Some of them have food sensitivities and this may be their body’s way of protecting them until their digestive system can handle more. Others are late teethers or have a lot of difficulty with teething pain. At this point there is NOTHING that your milk lacks that your child needs, with the possible exception of enough iron. As long as his iron levels are within acceptable levels and when he does eat you are offering him foods naturally rich in iron, then you have plenty of time before you need to worry about the amount of solids he’s getting.

All you need to do is to continue to offer foods. Don’t worry if he’s not interested or takes very small amounts. Your only true responsibility is what you offer, when you offer it and how you offer it, not whether or not he eats it. That has to be up to him. Trying to force, coax, or cajole your child into eating is never recommended. Continue to nurse on demand, day and night, and trust your child to increase the solids when he’s ready. As baby slowly moves into eating more solids, your milk will fill any nutritional gaps nicely.

Average toddler growth

see Average Toddler Growth

Feeding suggestions for toddlers

Finger foods are always great for toddlers, and your toddler will also begin to learn how to feed himself with a spoon and fork. Many babies prefer to eat foods which they can pick up and feed themselves, rather than foods that must be spooned to them. A lot of babies would rather have food right off the table than the blander-tasting baby foods.

After the age of twelve months, continue to be on the lookout for any allergic reactions to new foods and keep in mind that the choking hazard is still very real. Supervise your toddler’s meals in case of choking, and continue to avoid foods such as popcorn, hard candies, hot dogs, jelly beans, chunks of carrots, grapes, raisins, and nuts. Cut or finely chop such foods, or simply wait until your baby gets older.

Toddlers should be offered a variety of foods. They can eat the same things as the rest of the family. Foods rich in protein, calcium, and iron, along with fruits and vegetables, breads, etc. should be made available on a routine basis. Serve the most healthful foods possible, but don’t expect your toddler to eat a big meal at each sitting. Most children, when offered nutritious meals and snacks and allowed to eat what they wish, will meet their nutritional requirements over several days or even a week. Don’t let your child fill up on empty-calorie snacks, but don’t force him to eat when he doesn’t want to.

Many toddlers eat better when they have food available throughout the day, rather than just at a few set times (see grazing). Simply offer your toddler nutrient-dense snacks throughout the day (cut-up vegetables, bite-sized pieces of fruit, hard-boiled-egg slices, yogurt, whole wheat breads and cereals, cheeses) and let him eat what he wants. Some parents have had good luck with Dr. William Sears’ suggestion of a “nibble tray,” where you fill a tray (like an ice cube tray, muffin tin, etc.) with several types of healthy foods and leave it out for your toddler to nibble on throughout the day.

Check out the current USDA daily food guide for preschoolers (ages 2-6).

Additional information

Feeding the Picky Eater by William Sears, MD

Is your child getting enough to eat? How to tell by William Sears, MD

 

Calorie Boosters for Kids by Kelly Vieira, MS, RD

Daily Food Guide for Preschoolers from the US Department of Agriculture

Dietary Reference Intakes (DRI) and Recommended Dietary Allowances (RDA) from the USDA Food & Nutrition Center

Latham MC. Human nutrition in the developing world, (FAO Food and Nutrition Series No. 29). Rome: Food and Agriculture Organization of the United Nations, 1997.

Dairy

Calcium and nursing toddlers by William Sears, MD