Growth and Nutrition in Early Childhood

Learning Outcomes

  • Summarize overall physical growth and nutrition during early childhood
  • Examine nutritional concerns during early childhood

Growth in early childhood

Children between the ages of 2 and 6 years tend to grow about 3 inches in height each year and gain about 4 to 5 pounds in weight each year. The average 6-year-old weighs about 46 pounds and is about 46 inches in height. The 3-year-old is very similar to a toddler with a large head, large stomach, short arms, and short legs. During early childhood, children start to lose some of their baby fat, making them less like a baby, and more like a child as they progress through this stage. By around age 3, children will have all 20 of their primary teeth, and by around age 4, may have 20/20 vision. Many children take a daytime nap until around age 4 or 5, then sleep between 11 and 13 hours at night.

By the time the child reaches age 6, the torso has lengthened and body proportions have become more like those of adults. It should be noted that these growth patterns are seen where children receive adequate nutrition. Studies from many countries support the assertion that children tend to grow more slowly in low SES areas, and thus they are smaller.[1][2][3]

This growth rate is slower than that of infancy and is accompanied by a reduced appetite between the ages of 2 and 6. This change can sometimes be surprising to parents and lead to the development of poor eating habits.

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Nutritional concerns

toddler girl sits behind her grapes and hotdog with a grumpy face.

Figure 1. While young children can be picky eaters, it is important to expose them to a variety of healthy foods and avoid too many high-fat or low-nutritional foods, such as corndogs.

According to the Centers for Disease Control and Prevention (CDC), 1 in 5 American children between the ages of 2 and 5 are overweight or obese. The American Academy of Pediatrics (AAP) recommends a number of steps to take to help reduce the chances of obesity in young children. Removing high-calorie low-nutrition foods from the diet, offering whole fruits and vegetables instead of just juices, and getting kids active are just some of the recommendations that they make. Muckelbauer and colleagues (2009) found that increasing water consumption in school-aged children by just 220ml (just under 8 oz) per day decreased the risk of obesity by 31%. Finally, the AAP suggests that parents can begin offering milk with a lower fat percentage (2%, 1%, or skim milk) to 2-year-olds. The switch to lower fat milk may help avoid some of the obesity issues discussed above. Parents should avoid giving the child too much milk as calcium interferes with the absorption of iron in the diet as well.

Caregivers (whether parents or non-parents) need to keep in mind that they are setting up taste preferences at this age. Young children who grow accustomed to high-fat, very sweet, and salty flavors may have trouble eating foods that have more subtle flavors such as fruits and vegetables. Lack of a healthy diet may lead to obesity during this and future stages. Offering a diet of diverse food options, limiting foods with high calories but low nutritional value, and limiting high-calorie drink options can all contribute greatly to a child’s health during this stage of life.

Caregivers who have established a feeding routine with their child can find the normal reduction in appetite a bit frustrating and become concerned that the child is going to starve. However, by providing adequate, sound nutrition, and limiting sugary snacks and drinks, the caregiver can be assured that 1) the child will not starve, and 2) the child will receive adequate nutrition. Preschoolers can experience iron deficiencies if not given well-balanced nutrition.

Tips for Establishing Healthy Eating Patterns

Consider the following advice about establishing eating patterns for years to come (Rice, F.P., 1997). Notice that keeping mealtime pleasant, providing sound nutrition and not engaging in power struggles over food are the main goals.

1. Don’t try to force your child to eat or fight over food. Of course, it is impossible to force someone to eat. But the real advice here is to avoid turning food into some kind of ammunition during a fight. Do not teach your child to eat to or refuse to eat in order to gain favor or express anger toward someone else.

2. Recognize that appetite varies. Children may eat well at one meal and have no appetite at another. Rather than seeing this as a problem, it may help to realize that appetites do vary. Continue to provide good nutrition, but do not worry excessively if the child does not eat.

3. Keep it pleasant. This tip is designed to help caregivers create a positive atmosphere during mealtime. Mealtimes should not be the time for arguments or expressing tensions. You do not want the child to have painful memories of mealtimes together or have nervous stomachs and problems eating and digesting food due to stress.

4. No short order chefs. While it is fine to prepare foods that children enjoy, preparing a different meal for each child or family member sets up an unrealistic expectation from others. Children probably do best when they are hungry and a meal is ready. Limiting snacks rather than allowing children to “graze” continuously can help create an appetite for whatever is being served.

5. Limit choices. If you give your preschool-aged child choices, make sure that you give them one or two specific choices rather than asking “What would you like for lunch?” If given an open choice, children may change their minds or choose whatever their sibling does not choose!

6. Serve balanced meals. This tip encourages caregivers to serve balanced meals. A box of macaroni and cheese is not a balanced meal. Meals prepared at home tend to have better nutritional value than fast food or frozen dinners. Prepared foods tend to be higher in fat and sugar content as these ingredients enhance taste and profit margin because fresh food is often more costly and less profitable. However, preparing fresh food at home is not costly. It does, however, require more activity. Preparing meals and including the children in kitchen chores can provide a fun and memorable experience.

7. Don’t bribe. Bribing a child to eat vegetables by promising dessert is not a good idea. For one reason, the child will likely find a way to get the dessert without eating the vegetables (by whining or fidgeting, perhaps, until the caregiver gives in), and for another reason, because it teaches the child that some foods are better than others. Children tend to naturally enjoy a variety of foods until they are taught that some are considered less desirable than others. A child, for example, may learn the broccoli they have enjoyed is seen as yucky by others unless it’s smothered in cheese sauce!

 To what extent do these tips address cultural practices? How might these tips vary by culture?

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  1. Van Rossem, R., & Pannecoucke, I. (2019). Poverty and a child's height development during early childhood: A double disadvantage? A study of the 2006-2009 birth cohorts in Flanders. PloS one, 14(1), e0209170. doi:10.1371/journal.pone.0209170
  2. Neumann, Janice (September 2015). Small height differences among kids may reflect economic disparities. Reuters, Health News. Retried from https://www.reuters.com/article/us-health-children-height-poverty/small-height-differences-among-kids-may-reflect-economic-disparities-idUSKCN0RR11720150927.
  3. Kerr GR, Lee ES, Lorimor RJ, Mueller WH, Lam MM (1982) Height distributions of U.S. children: associations with race, poverty status and parental size. Growth 46: 135–149.