Feeding routine changes: From babies to toddlers and beyond

You’ve just about grasped the routine with your baby –  balancing three meals, milk feeds and sleep routine, but before you know it,  you have toddler feeding advice coming at you from all angles. From 12+ months of age, there is a range of feeding routine changes and transitions to be made with toddlers. This is often coupled with huge developmental leaps and new behaviours to contend with. To support you through these transitions Paediatric Dietitian, Lucy Upton, talks through some key routine changes and how to support your little one (and yourselves) through these.

Feeding routines 

From 12+ months of age, you are likely to start incorporating snacks into your child’s routine. Up until now, your little one may have been having ongoing milk feeds between their main meals, however past 12 months of age you can introduce nourishing snacks between their meals. This is often alongside ongoing gradual reductions in their milk feeds (more information on this below).

A typical routine from around 12+ months of age would now start to look like three main meals and two snacks per day. Toddlers have high energy requirements but small stomachs, so having an opportunity to top up with that all-important fuel for learning and play is key. Aim to have 2-3 hours between each meal and snack time (counting from the start of the last meal or snack), and try to avoid allowing your toddler to graze or flit to and from the snack cupboard between meals. Having snacks or foods offered too frequently can disrupt appetite regulation for children, and the overall balance of foods or nutrients they consume across the day. For a guide on providing balanced meals and snacks for toddlers and younger children, keep reading!

Milk routines and changes

From 12 months of age, the NHS recommends transitioning your child from formula milk to whole (‘full fat’) cow’s milk. This doesn’t have to be a direct switch the day after their first birthday, but can be a much more gradual transition.  

• If your baby is formula fed, then you may wish to gradually transition them to cow’s milk by mixing whole milk with their formula 1oz at a time.  For example, if they have a 4oz feed, combine 3oz of their usual formula with 1oz of whole milk. Gradually increase the amount of whole milk and decrease the amount of formula across a few days or weeks. You may prefer to do a straight switch one feed at a time and/or offer cows’ milk from a cup rather than the bottle.   Reducing bottle use is also recommended from 12 months of age
• If your baby is breastfeeding and you plan to continue breastfeeding then there is no need to replace their breastfeeds with cow’s milk. If you wish you can still offer some whole cow’s milk to drink from a cup e.g. at snack time.  Advice on cow’s milk and dairy volumes can be found next

When transitioning over to cow’s milk, it can also be helpful for parents to be aware of how much milk children need after 12 months of age. Due to a drop in energy and nutrient requirements, it’s often much less than parents realise – so reducing overall milk consumption (if formula feeding particularly) whilst transitioning over to cow’s milk can be helpful too.

From around 12+ months of age, children do not need much more than 350-400ml of milk per day, which includes milk used in foods e.g. cereal. In fact, if your child is also having foods such as yoghurt and cheese in their diet they can safely consume less milk than this daily too.  As a general rule, we’d recommend that toddlers and young children have 2-3 portions of dairy per day.  As an example a  portion of dairy would be;

• 80-125g yoghurt or
• 15-20g cheese or
• 100-150mls milk

Excess consumption of cow’s milk in toddlers and young children can have an impact on their appetite for food (e.g. 500mls of whole milk could provide as much as 40-50% of a child’s requirement for energy for the day), but also increase the risk of Iron Deficiency Anaemia.

But what if my child can’t have cow’s milk, or we follow a plant-based diet?

If your child cannot include cow’s milk in their diet, for reasons such as allergy, intolerance or through personal choice, then from 12 months of age they may be able to transition onto a well-fortified milk alternative e.g. soya or oat-based. Plant-based milk alternatives don’t however hold equivalent nutritional value to cow’s milk, so parents should be guided to options that are similar in energy (e.g. >50-55kcal/100mls), and contain fortification with key nutrients such as calcium, iodine and B12. Avoiding sweetened options is also important for young children, to prevent dental caries. For some children on specialist formula milk, it may be recommended these are continued for up to 2 years, to support nutritional needs (under the advice of a Dietitian or Doctor). Milk alternatives to avoid in young children include those which are:

• Low in calories – such as nut-based milk alternatives
• Labelled as  ‘organic’, and thus contain no added vitamins or minerals
• Known to be unsafe for young children to consume e.g. rice-based milk alternatives

Feeding behaviours

Aside from dietary and feeding routine changes, it is very common to see changes to how your child eats and interactions with food or meal times during the toddler years.  These changes are predominantly driven by their development, but also factors such as growth changes and the interactions with others at mealtimes. Common changes to mealtimes or feeding can include;

Appearing to eat less or skipping meals entirely – this is entirely normal, but can often be a huge source of worry for parents. After a year of age, children’s rate of growth starts to slow down.  Less energy needed for growth means, well, less food needs to be eaten!  Children are also very good at regulating their own appetite, so you may find days or weeks when they are eating you out of house and home, and others where you can’t work out where their energy is coming from.  Trusting your child’s appetite, no matter how unpredictable, can be helpful to avoid adding pressure or stress to mealtimes. Check back on our blog about responsive feeding to remind yourself of children’s hunger and fullness cues.

Getting bored at the table, trying to leave or climb out of their chair – Again this is very typical for this age group whose priorities after often learning and playing – so sometimes mealtimes can seem like such a hassle. It can be beneficial to consider how long to expect young children to sit at the table – and their overall attention span on any task is a good marker! If your child lasts 10-20 minutes on a task, then it’s likely we shouldn’t expect them to spend 30 minutes at the table. Other things to check in with if your child seems to hate the table, is whether:

• There are others there to eat and engage with.  Eating can be more appealing for children if it’s a social occasion. It’s one of the reasons why a child may seem to eat much better at nursery or childcare
• If they are comfortable? Children may well be growing out of high chairs, not feeling supported or feeling trapped.  Check-in with how appropriate their seating is
• If they are still eating away from others in a highchair? It might be time to take the tray off and bring them up to the table

Messy or seemingly disruptive eating behaviours – young children continue to eat with their hands for a good period of time like to make a mess, try new combinations out (dipping food in their drink), take food off your plate, feed you, feed the cat…the list can go on! Again, all of these sorts of behaviours are very typical for young children and relate to their learning and development. It can be helpful to reframe mealtimes with children and remember they don’t need to conform to adult norms, rules or manners. Most of these behaviours also pass on their own, without the need for much intervention. Just remember to keep showing your child what to do at mealtimes, by sitting and eating with them rather than just telling them!

Food refusal (see more information on fussy eating) – The toddler years can be a time of turbulence for eating, and your baby who used to eat everything may start to turn their nose up at a few or many foods, even their old favourites. Much like a reduction in the amount your child is eating, food refusal or fussy eating can be a big worry for lots of parents. Fussy eating is a relatively common phenomenon with 25-30% of children experiencing a fussy stage between 18 months -10 years of age. Developmental changes like a drive for autonomy and food neophobia, combined with reducing growth rates can contribute to a child reducing their range of foods, rejecting new foods and at times seeming nonchalant about food in general. For some top tips on how to approach fussy eaters, see the section below.

Balanced meals from 12 months of age and beyond

Now you’re feeding a toddler, do you need to be offering or doing anything different to the mealtime habits and balance you established during weaning? The answer is yes and no!

Firstly it’s important to remember that the <5s have unique nutritional needs, and it isn’t appropriate to translate adult healthy eating advice or recommendations to this age group. Growth and the need for key nutrients for development during this age group are still paramount, alongside developing positive balanced eating habits. You may also have to apply a little more planning compared to feeding your baby, as now mealtimes may start to be increasingly alongside family and snacks are being introduced between meals. Here’s a guide to key foods groups to include and in what sort of quantities each day for ~1-5 years, adapted from the advice from the British Nutrition Foundation

Don’t forget portion sizes for toddlers and young children day to day are also likely to be unpredictable. As adults, we often overestimate how much toddlers need to eat, so consider starting with offering smaller portions as you can always give more, rather than providing too much on a plate which can over face some children at mealtimes. A guide to toddler portions can be found here.

Fussy eating

As mentioned above, fussy eating is a common concern for parents anywhere from 18 months of age (or just before), up to school age. Due to some of the changes to eating habits discussed above, it’s normal for parents to try and resort to strategies to ‘fix’ a child’s eating, even though behaviours they are demonstrating are very typical for their age, and rarely have a long term impact on a child’s growth or nutritional status. It’s completely understandable to be worried if your child’s range of food starts to decline, or they seem to only be willing to accept foods that are bland or beige. If you’re in the throes of fussy eating, management strategies ideally should focus much more on how food is offered to children rather than what foods are offered. Here are five top tips for managing fussy eaters;

Extinguish any pressure – adding pressure to mealtimes for children when they are refusing foods tends to perpetuate further eating challenges.  Children start to realise they are under pressure, or not meeting adult expectations so can become anxious, angry, disruptive and ultimately don’t enjoy coming to the table. Adult pressure rarely works in the long term to help children eat, and even small wins when children eat after phrases like “just one bite” are often down to people-pleasing behaviour rather than because a child actually wants to eat that food. Forms of pressure to be aware of, and step away from including;

• Questions – “can you just take one bite”
• Bribery “If you eat this, we can ….”
• Putting other foods on a pedestal “If you eat this, then you can have ice cream”
• Guilt tripping “Daddy took ages to make this”
• Excessive praise e.g. over the top clapping or making a big deal out of when a child does eat something
• Force feeding or hovering food in front of children’s mouths 

Role model – The benefits of eating together as a family (even if it’s just two of you) are wide-ranging and very well documented for fussy eaters.  Wherever you can try to sit around the table and eat the same meal together.  Children build confidence and familiarity with foods by watching others eat and interact with them. This is one reason why children can often be more accepting of foods around their peers e.g. at nursery. Not only are they all eating the same meal, but they do so together. Rebecca Wilson chat’s more about the benefits of families eating together too, you can read more here.

Exposure – Whilst it sounds obvious, to learn about anything you need to see it and have an opportunity to learn about it.  It’s common for parents to stop offering children food after they have been rejected multiple times. Whilst it can feel like a fruitless task, and one associated with food waste too, children benefit hugely from regular exposure to foods – this includes at the table, but also during activities like food shopping or preparation. For some foods, children may only need a handful of exposures before they are willing to accept it, for others it could be hundreds! Be patient and stick with it!

Routine – Falling into the trap of top-up meals, rescue meals or more frequent snacking can be common if you’re worried your child hasn’t eaten much during a meal. This however can often lead a child to realise how much control they have over the foods they are being offered and exacerbate rejection of foods at mealtimes. Try to stick with a clear meal and snack routine, as discussed above

Give them the autonomy they want! – For children at an age where they are desperate to control their world, it can be hard when someone else chooses when to eat, what they eat, and how it’s prepared and served. It’s easy to see why some children become frustrated at mealtimes!  To help manage this, provide options for autonomy at mealtimes where you can e.g. offer a choice between preferred foods at mealtime (choices between 2 items work well, instead of an open question) or serving food family style so children can bring the foods they want, in the amounts they want to their plate