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something I learned about this topic is I was always told that sex education encourages students to be involved in this activity and can create bad behaviors but after reading many articles and learning about it, it is actually a myth and is not true. 

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something I learned about this topic is I was always told that sex education encourages students to be involved in this activity and can create bad behaviors but after reading many articles and learning about it, it is actually a myth and is not true. 

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This is an important topic because when you are working with younger children their bodies are changing and being introduced to new sexual concepts weekly which can make them more interested. It's also important because sexual assault happens in kids so knowing the signs of when this is happening can protect them and others as well. 

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This is an important topic because when you are working with younger children their bodies are changing and being introduced to new sexual concepts weekly which can make them more interested. It's also important because sexual assault happens in kids so knowing the signs of when this is happening can protect them and others as well. 

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Something I learned about this topic is that you want to make sure that when you are asking students questions about things that are going on at home you don't want to ask them "Did you tell them to stop" because if you do it makes them feel like they are guilty for this happening when they think that they could stop this.    

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Something I learned about this topic is that you want to make sure that when you are asking students questions about things that are going on at home you don't want to ask them "Did you tell them to stop" because if you do it makes them feel like they are guilty for this happening when they think that they could stop this.    

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This is a really important topic for a teacher because as someone who will be a mandated reporter knowing signs when things should be reported is a very crucial part when becoming a teacher.    

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This is a really important topic for a teacher because as someone who will be a mandated reporter knowing signs when things should be reported is a very crucial part when becoming a teacher.    

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Myths about Sex-Ed | Action Canada for Sexual Health and Rights

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Sadly, many people believe that to be true despite how scientifically inaccurate it is.

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Something that I learned after this course was that Classroom management strategies that assist children with mental health concerns can be implemented for an entire group of students in a way that benefits all learners. 

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Something that I learned after this course was that Classroom management strategies that assist children with mental health concerns can be implemented for an entire group of students in a way that benefits all learners. 

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This topic is probably one of the most important topics that I feel like we talk about because so many children suffer through mental and emotional health during their schooling years. Being a trusted adult can help one of those students so understanding class management can help these students when they are at school. 

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This topic is probably one of the most important topics that I feel like we talk about because so many children suffer through mental and emotional health during their schooling years. Being a trusted adult can help one of those students so understanding class management can help these students when they are at school. 

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The bottom line on student learning today is this: "You can't teach if you're not addressing mental health," says Rene Myers, an intervention specialist in St. Paul, Minn.

Myers has been working in public education for more than 33 years. Over the decades, the mental health needs of her students have grown, and grown, and grown, she says. The pandemic, coupled with decades of inaction by school boards and state legislators, has only made things worse.

About 214,000 U.S. children have lost a parent to COVID-19. They're adrift, grieving. Many other parents and caregivers lost their jobs. Today, 17 million U.S. children struggle with hunger-about 6 million more than before the pandemic. On top of that, recent years have reinforced how much this nation still struggles with racism and antiLGBTQ+ hatred.

So when Myers sat down at the bargaining table this year, seeking to negotiate a new contract between the St. Paul Federation of Educators (SPFE) and her school district, her number-one priority was students' mental health.

"To know what our students and staff have gone through in the past two years ... to say we don't need mental health supports? It's like saying you don't need air. It's unimaginable!" she said.

In February, St. Paul educators voted to strike. Then, in early March, just hours before hitting the streets, union negotiators reached an agreement to preserve the mental health teams that SPFE won during 2020 bargaining. Those teams include counselors, nurses, social workers, and school psychologists in every St. Paul school.

These professionals are essential to providing students with what they need, says Myers.

From Bad to Worse

In the past year, even as the nation has returned to "normal" life, the latest research shows that many students are still living in a state of mental health crisis. This data isn't at all surprising to educators and parents.

"Of course we see advanced need! On top of the pandemic, everything happening with the economy also is impacting our families," says Theresann Pyrett, a Michigan middle school teacher and president of the West Ottawa Education Association (WOEA). "It's like a perfect breeding ground for mental health issues to develop."

In an April poll, nearly three-quarters of U.S. parents said their child would benefit from mental health counseling-up from 68 percent in 2021. Additionally, about a third said their child has recently shown symptoms of mental health issues, including anxiety (19 percent) and depression (13 percent).

Among parents of students with disabilities-including learning, developmental, and physical challenges-almost a third said their child has anxiety, and rates of depression are higher as well.

"The biggest misconception is that COVID makes people mentally ill. From my point of view, COVID unmasked people who have underlying vulnerabilities," said John Walkup, chair of the behavioral health department at Chicago's Lurie Children's Hospital, in an interview with the New York Times.

Before the pandemic, between 2016 and 2019, the number of children diagnosed with anxiety rose by 27 percent, while depression diagnoses rose by 24 percent. But recently, it's worse than ever.

In the past year, 15 percent of teens suffered at least one major depressive episode- that's an additional 306,000 teens over the previous 12 months, according to the 2022 data from Mental Health America. On top of that, nearly two-thirds of teens with major depression say they haven't gotten any help.

Demanding Help for Students

In West Ottawa, the local union is making sure students get what they need. That includes using local property tax revenues to hire 10 additional mental wellness coaches throughout the district and using federal pandemic relief funds to hire 16 additional interventionists.

WOEA leaders work closely with district administrators, all asking the same question: What's best for students?

"One thing I keep repeating, over and again, is that more hands on deck makes for a lighter load," Pyrett says. "We're focused on picking up kids-and if you have more hands to pick those kids up, it's so beneficial for those kids."

The Biden administration's pandemic relief plans have made the largest-ever, single investment in public schools. Now educators are making sure that money is used for the counselors, social workers, school psychologists, behavioral coaches, etc., that students need to be successful.

Unions also are bargaining contracts that include those supports. In Minneapolis, educators went on strike this spring for more than two weeks, finally settling a deal that doubles the number of nurses and counselors in elementary schools and provides a social worker in every school.

"Don't Say Gay" - Or Trans, Either

Maybe the most alarming figure in recent mental health data is this: Nearly half of young LGBTQ+ people have considered ending their lives in the past 12 months, according to a survey of 34,000 young people by the Trevor Project.

Among those young people with suicidal ideas, more than half are transgender and nonbinary youth and nearly half are Black. (Nonbinary is a term for people who do not identify as male or female.)

The numbers are troubling, but not surprising to Palm Beach County, Florida high school teacher Michael Woods. "Especially here in Florida, with the ' Don't Say Gay ' law, which should also be called 'Don't Say Trans,' we have a lot of kids in stress," Woods says. "They're just coming back to the rigors of school [after the pandemic]-and now this!"

The Florida law enables parents to sue school districts if they think their child has had inappropriate instruction on gender and sexuality. The cost of litigation will be borne by districts, which are already beginning to remove curricula on these topics.

Anti-gay laws are also spreading far beyond Florida. In Texas, Gov. Greg Abbott has ordered teachers to report parents of transgender youth for child abuse if the parents seek gender-affirming care for their child. NEA and state educators unions have spoken out against these laws.

For his part, Woods-an educator of 29 years-isn't afraid. He wears his "We're All Human" T-shirt and answers his students' questions. But he worries about younger teachers with less job security, living in more conservative areas.

"I tell the kids, I'm always here for you. I'm always a safe space for you. I'm not giving up on you, and you shouldn't give up on yourself," he says. "When young people don't feel like they have anywhere to turn or anyone to talk to ... well, I know why the stats are the way they are."

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Mental Health in Schools: The Kids Are Not All Right | NEA

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As students' mental health needs rise, so do educators' demands for help.

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something I learned after this topic was that the ages 6-11 years old should have an average of 1800 calories a day to be able to be well nutrients. A lot of children who are under nutrition is due to "picky eating" since a lot of children are very picky when it comes to eating.  

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something I learned after this topic was that the ages 6-11 years old should have an average of 1800 calories a day to be able to be well nutrients. A lot of children who are under nutrition is due to "picky eating" since a lot of children are very picky when it comes to eating.  

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This topic is really important to me as a future educator because nutrition is one of the main aspects when it comes to a child being able to learn. Being able to recognize when a child isn't getting the nutrition they need can affect how they learn.  

# data[].attributes.subject
This topic is really important to me as a future educator because nutrition is one of the main aspects when it comes to a child being able to learn. Being able to recognize when a child isn't getting the nutrition they need can affect how they learn.  

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Cristiana Berti, Academic Editor and Piotr Socha, Academic Editor

Abstract

The first 1000 days is a critical window to optimize nutrition. Young children, particularly 12-24 month-olds, are an understudied population. Young children have unique nutrient needs and reach important developmental milestones when those needs are met. Intriguingly, there are differences in the dietary patterns and recommendations for young children in the US vs. globally, notably for breastfeeding practices, nutrient and food guidelines, and young child formulas (YCFs)/toddler drinks. This perspective paper compares these differences in young child nutrition and identifies both knowledge gaps and surveillance gaps to be filled. Parental perceptions, feeding challenges, and nutrition challenges are also discussed. Ultimately, collaboration among academia and clinicians, the private sector, and the government will help close young child nutrition gaps in both the US and globally.

Keywords: nutrition guidelines, young child nutrition, toddler nutrition, young child formula, nutrient gaps

1. Introduction

The first 1000 days are a critical window to optimize nutrition. This time period includes young children 12-24 months of age [ 1]. During this second year of life, the dietary patterns of young children transition to predominantly table foods. Young children have unique nutrient needs and begin to reach important developmental milestones to support nutrition: motor skills to self-feed, language skills to communicate with caregivers, and social customs acculturation [ 2]. Young child nutrition has both short- and long-term consequences on health, especially brain development. In particular, the adequacy of key macronutrients and micronutrients is important [ 1].

Adequate nutrition during the first 1000 days can have a striking impact on economic outcomes in adulthood too. Fortifying young children's diets during this vulnerable phase has been found to increase their likelihood of completing secondary and college-level education and of early adult employment [ 3]. Other studies have shown adequate young childhood nutrition to increase reading comprehension, cognitive ability, and wages in adulthood [ 4]. The long-term benefits of successful young childhood nutrition can make it a highly cost-effective intervention.

Despite the cost-effectiveness of nutrition, guidelines for and practices related to young child nutrition, including intake of breast milk, food, and young child formulas (YCFs)/toddler drinks, vary substantially across countries. Additionally, the ability of caregivers to implement nutrition recommendations can vary across and within countries. Our perspective paper compares young child nutrition in the US and globally and based on this suggests knowledge and surveillance gaps across the spectrum of young child feeding. A food-based approach is discussed; dietary supplements are not addressed but have been recently reviewed by others [ 5].

2. Breastfeeding Practices

Breast milk is considered the gold standard nutrition for the first year of life. The American Academy of Pediatrics recommends continuing breastfeeding, along with appropriate complementary foods at about six months through the first two years of life or beyond, as long as mutually desired by mother and child [ 6]. However, during the second year of life, only 7-12% of young children in the US still receive human milk, consuming about 320 mL/day [ 7, 8] or 20% of a toddler's energy needs. This percent of energy needs is in contrast to the sole source of nutrition of breast milk and/or infant formula during infancy [ 9]. While inadequate supply and pain are common reasons why women may stop breastfeeding during infancy [ 10], less is known about the discontinuation of breastfeeding in young children.

The World Health Organization (WHO) recommends continued breastfeeding for up to two years of age or beyond along with solid foods. The Global Breastfeeding Scorecard estimates that 70% of young children worldwide are breastfeeding at 12 months of age, which decreases to 45% at 24 months. Globally, breast milk provides one-third of energy needs between 12-24 months of age [ 11]. The few studies that have investigated why women stop breastfeeding early are usually country-specific. Shared factors across countries related to breastfeeding cessation include HIV positive status, more than four children, and employment [ 12].

Knowledge and Surveillance Gaps:

There is an opportunity to expand on data collection for breastfeeding practices between 12-24 months and beyond to include increased frequency, nutritional composition, and reasons for breastfeeding cessation.

Length of maternity leave varies worldwide. Comparison of maternal employment, duration of breastfeeding, and impact on young child nutrition is an important avenue of exploration.

In addition, more prenatal and postnatal education and family support is needed to promote breastfeeding guidelines.

3. Nutrient and Food Guidelines

By about 12 months of age in the US, the largest change in dietary patterns has occurred as infants move into young childhood: breastfeeding or feeding infant formula has decreased, while table food consumption has increased [ 13]. The nutrient density of foods remains a critical focus because, compared to adults, young children's requirements for macronutrients and micronutrients per kilogram of body weight are higher [ 14].

Many current nutrient and food guidelines for young childhood are either undergoing or recently underwent revision. The US National Academies of Sciences, Engineering, and Medicine Dietary Reference Intakes (DRIs) identify specific nutrient levels needed for different age groups, including for young children [ 9]. The US Food and Drug Administration (FDA) used information from the DRIs, National Health and Nutrition Examination Survey (NHANES), and US Dietary Guidelines for Americans (DGAs) to update the Daily Value percentages that are expressed on US Nutrition Facts food labels [ 15]. The DRIs are often cited in the international literature, although the Food and Agricultural Organization (FAO) of the United Nations and WHO have also developed macronutrient and micronutrient guidelines. These FAO-WHO global nutrient requirements for young children up to three years of age are in the process of being updated, starting with calcium, vitamin D, and zinc [ 11].

In addition to helping inform nutrition labeling, DRIs also provide a framework for analyzing the results of food consumption surveys. US surveys, such as the NHANES and Feeding Infants and Toddlers Study, have reported important nutrient gaps, including inadequate/low intakes of fiber, potassium, vitamin D, and vitamin E by toddlers [ 16, 17]. Such data were considered when healthy dietary patterns for young children were included for the first time in the 2020-2025 US DGAs. For a young child in the second year of life, the US DGAs identified multiple dietary components of public health concern: underconsumption of vitamin D, calcium, fiber, and potassium and overconsumption of sodium, saturated fat, and added sugars [ 13]. Globally, although specific nutrient deficiencies vary by country, deficiencies in iodine, vitamin A, and iron are among the most important, particularly for young children [ 11].

Data on the actual diets of young children are often limited, particularly because their dietary patterns substantially change and often vary based on breastfeeding practices. Further, diet-based research tools may not be available. For example, dietary quality can be difficult to assess since the Healthy Eating Index starts at two years of age. The US DGAs summarized food group intake for toddlers ages 12-23 months and found that toddlers in the US mostly consumed every food group each day, although data was limited to percentages of food groups and a few subgroups [ 13]. Globally, it has been reported that one-fourth of young children 6-23 months of age meet dietary diversity and feeding frequency appropriate for age [ 11]. Yet data is still scarce. The Global Dietary Database project documented less than one-third of individual-level dietary intake surveys had dietary intake for 0 to <2-year-olds [ 18].

To help inform the required nutrients and their levels, food-based dietary guidelines have been developed. The US DGAs emphasize nutrient dense foods, a food group/subgroup pattern including vegetables, fruits, grains, dairy, protein foods, and oils, and responsive feeding for 12-23 month-olds. For 2- to 4-year-olds, the US DGAs also encourage nutrient-dense foods, in addition to physical activity and a food group/subgroup pattern encouraging variety and multiple exposures to foods [ 13]. The FAO maintains a global database of food-based dietary guidelines from >100 countries and the United Nations Children's Fund (UNICEF) has a global database of feeding indicators, or standards of data collection, from >100 countries for young children ages 6-23 months old [ 19]. Across organizations, consistent recommendations for toddlers are a diverse diet, including a variety of nutrient-dense foods, to support growth and development.

Further, the US DGAs recommend the introduction of potentially allergenic foods along with other complementary foods [ 13]. Overall, food allergies have been increasing worldwide and are estimated to be 8% in children [ 20]. Less is known in developing countries, but data so far suggests that specific food allergies vary by geographic region [ 21]. In the US, food allergies increased 50% between 1997 and 2011, and 5.6 million children have a food allergy, with 40% of them having multiple food allergies [ 22]. Management of food allergies includes avoiding offending allergens and consuming suitable substitutes. However, micronutrient deficiencies and poor growth frequently occur [ 23]. The burden of food allergies ranges from lower quality of life, increased caregiver burden and greater anxiety, social consequences, and financial costs [ 24].

Knowledge and Surveillance Gaps:

Given recent/ongoing revisions of guidelines, it will take time for healthcare professionals and caregivers to be educated on changes. As such, surveillance methods may need to be updated to reflect these changes. One consideration in the US is better alignment of US DGAs and DRIs: US DGAs separate the toddler years into two groups (12-23 months of age and 2-8 years of age) versus the DRIs for toddlers are based on 12-36 months of age.

Although current surveillance studies do provide valuable insight into the nutritional status of young children, more dietary intake data are needed, particularly regarding at-risk nutrients.

Currently, nutrient and food guidelines are available at the national level in many countries around the world. Identification of subpopulations will help to move guidelines closer toward more personalized nutrition.

4. Young Child Formula (YCF)/Toddler Drink Guidelines

Toddler drinks in the US and YCFs outside of the US are options to help fill nutritional gaps in young children's diets. They have varying nutrient levels and serving sizes, and different names for this category are used globally. Codex Alimentarius (Codex) recently aligned with the term, drink for young children with added nutrients [ 25].

The US DGAs state that there is no clear need for toddler drinks, as nutrients may be obtained from other foods, and toddler drinks may contain added sugars [ 13]. In addition, a US consensus statement on healthy beverages does not recommend toddler drinks for healthy, young children, with the rationale being there is no unique nutritional value beyond what can be obtained by healthy foods [ 26]. A similar rationale has been considered internationally, such as by the European Food Safety Authority (EFSA), although their scientific opinion states that YCFs are one of several ways to increase inadequate/at risk of inadequate status of alpha-linolenic acid (ALA), docosahexaenoic acid (DHA), iron, vitamin D, and iodine in European young children [ 27]. WHO has a statement that YCFs are unnecessary and may negatively impact breastfeeding [ 11].

Yet on a practical basis, YCFs/toddler drinks may be clinically recommended and chosen by caregivers to specifically help meet young child nutrient needs and address feeding and growth challenges. One international expert group published compositional recommendations for YCFs worldwide. They leveraged dietary nutrient intake and biochemical status data from young children in 17 countries and compared it to WHO nutritional requirements, identifying several nutrients often with inadequate intake in young children's diets: vitamins A, D, B12, and C, and folate, calcium, iron, iodine, and zinc [ 28]. The authors proposed that YCFs are one of several options when combined with an age-appropriate diet that can contribute to increasing nutrient consumption, thereby reducing micronutrient deficiencies [ 28]. Similarly, a European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) position paper on YCF included a systematic review, determining that, while routine use of YCFs is not necessary, they can be one of several strategies to increase the nutrient intake of iron, vitamin D, and omega-3 polyunsaturated fatty acids (PUFAs), as well as decrease protein intake from unfortified cow's milk in European young children [ 29]. Additional YCF compositional guidelines and expert statements have been published for specific populations outside of the US ( Table 1 ).

Table 1

Author and Year

Population

Article Type

Main Topic

Age Range

Hojsak et al., 2018 [ 29]

European

Systematic Review ¹

Nutrient Composition

12-36 months

Suthutvoravut et al., 2015 [ 28]

International

Review ²

Composition Requirements

12-36 months

EFSA 2013 [ 27]

European

Review ³

Nutrient Requirements

0-36 months

There are also a growing number of published clinical studies showing value with beneficial short-term effects of YCFs ( Table 2 ). These double-blind, randomized, controlled, clinical trials were of strong study designs, although there were a limited number and heterogeneity in populations, formulations, duration, serving sizes, and ages [ 35, 36, 37, 38]. All but one clinical study demonstrated beneficial effects of primary outcomes that ranged from nutrient status with improved lipid profile, increased folate levels [ 36], and preserved iron status [ 35] to body composition with a lower percentage of body fat [ 37] to immune parameters with increased total blood immunoglobulin A level [ 38]. These findings are encouraging; however, more clinical studies are needed.

Table 2

Author and Year

Population

Comparators

Duration

Serving
Size/Day

Age Range

Rivera-Pasqual et al., 2020 [ 36]

Mexican

YCF with PUFAs vs.
YCF without PUFAs

4 months

480 mL

12-30 months

Leung et al., 2020 [ 39]

Chinese

3 YCFs with bioactive
proteins, 2′-FL HMO, and/or milk fat vs.
Reference YCF

6 months

400 mL

12-30 months

Wall et al., 2019 [ 37],
Lovell et al., 2018/2019/2021 [ 40, 41, 42, 43]

Australian and New Zealand

GUM with reduced
protein and energy vs.
Unfortified cow's milk

1 year

300 mL

12-23 months

Akkermans et al., 2017 [ 35]

German, Dutch, and English

YCF vs.
Unfortified cow's milk

20 weeks

≥150 mL

12-36 months

Xuan et al., 2013 [ 35]

Vietnamese

GUM with synbiotics and fortification vs.
Control GUM

5 months

360 mL
5 days/week

18-36 months

In the US, there are no defined nutrient requirements for toddler drinks [ 15]. Internationally, YCFs for 12-36 months of age are covered by a specific Codex Standard for Follow Up Formulas (under revision), which many countries adopt into their local legislation. This established standard for specific nutrient ranges facilitates the manufacturing, marketing, and trade of products specifically formulated for older infants and young children >6 months of age in Codex-compliant countries [ 25]. Combined, the expert guidelines/statements, clinical studies, and scientific standards provide guidance on the nutritional composition of YCFs, which can help to inform future product development and clinical studies.

One important area that is less well-studied is parental views on how they can best meet their young child's nutritional needs. A recent online survey investigated the parental satisfaction and perceived benefits of toddler drinks of 300 parents in the US with a toddler with a mean age of 16 months. Half of the parents felt that their toddler was a picky eater. Parents rated overall nutritional adequacy as their nutritional reason for providing a toddler drink, and calcium, iron, and B vitamins were the most liked ingredients of toddler drinks [ 44]. Another online survey of 1186 parents in four Latin American countries reported on parental satisfaction/confidence level of their young children's general health. Compared to parents who did not use YCFs, parents who served YCF felt more confident that their young children were getting adequate nutrition, such as protein, vitamins, and minerals ( p < 0.01). In the survey, parents using YCF were providing at least one serving/day (defined as 180 mL accounting for added water and excluding powder displacement), although 50% of these parents were providing two servings/day [ 45].

Knowledge and Surveillance Gaps:

There is a need to better standardize toddler drinks in the US. Both in the US and globally alignment on serving size, nutritional composition, and inclusion or exclusion of powder displacement would be helpful.

Expert statements on YCFs for specific subpopulations are needed.

Clinical studies and added surveillance will help with understanding specific young child subpopulations who may benefit most from YCFs, in conjunction with the promotion of a healthy diet.

A knowledge gap is parental perceptions of young child nutrition and how to support parents in their young child feeding decisions.

5. Feeding and Nutrition Challenges during Young Childhood

Childhood dietary patterns are shaped by various factors, including feeding and nutrition challenges [ 13], and long-term outcomes are at stake. Birth weight triples in the first 12 months, and birth length doubles by the age of five years. Brain volume doubles in 12 months and triples by 36 months. The need for energy and nutrients to support growth necessitates the addition of solid foods to augment the use of breast milk and/or infant formula after the age of six months [ 46, 47]. The increasing provision of table foods during the second year of life exposes young children to similar foods as caregivers and, along with the provision of more complex food combinations, collectively shape young children's dietary patterns by 24 months [ 47]. Deficiencies or imbalances in dietary patterns may lead to malnutrition [ 11]. The highest risk for malnutrition occurs at weaning, around 12 months in the US, but often later in the second year globally. The quality of the diet becomes critical to support growth and development. Typically, dairy milk assumes much of the nutritional foundation that was previously provided by breast milk and/or infant formula [ 47, 48].

Several feeding issues raise the risk for malnutrition, some individual to the young child, such as food neophobia, temperament, and intensity of response to bitter taste, and others related to family demographics, such as education, income, food insecurity, and cultural norms. Young children accept what is familiar and routine. Preferences are "trained" through familiarity. Food acceptance requires that caregivers show patience, persistence, and a willingness to repeatedly offer previously rejected foods. Studies suggest that 8 to >15 exposures may be needed [ 46].

Caregivers who label their young child as selective or "picky" commonly halt the presentation of rejected foods after only 3-5 tries. They also may attribute their young child's limited food acceptance to inheritance, rather than learned behavior. Bribing or pressuring the child to eat, along with a permissive feeding style of catering to the child, fosters food rejection. It is normal for young children to display "food jags" (wanting the same food repeatedly) and to show shifting preferences. Although some young children may demonstrate an exaggerated phobia toward new foods, these are likely not permanent rejections.

Providing a diverse array of nutrient-rich foods at every meal and snack can help overcome these challenges and allows young children to sample and express preferences. The term, "responsive feeding," describes a reciprocal relationship between the child and the caregiver at mealtime and is commonly recommended. Similar guidance is offered by the US DGAs and by the US Centers for Disease Control and Prevention [ 13, 49].

There is no widely accepted definition of "picky" eating, and thus, globally, it appears there is limited consensus on appropriate assessment tools, and prevalence estimates vary considerably [ 50]. In addition, few studies have assessed the association of "picky" eating with pediatric development, although there are indications that such feeding patterns may have negative effects [ 51]. Continued breastfeeding into the second year or use of YCFs may offer dietary support as behavioral issues are addressed [ 46, 47].

Other factors that impact feeding and nutrition challenges during young childhood are social determinants of health. The WHO defines social determinants of health as non-medical factors influencing health outcomes [ 11]. Healthy People 2030 organizes them into five domains: economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context [ 52]. Health inequalities exist throughout the world. In particular, food insecurity affected 14.8% of US households with children in 2020 and has been correlated with childhood obesity [ 53]. In the US, toddlers living in households with limited incomes may be supported by US federal government programs, such as Special Supplemental Nutrition Program for Women, Infants, and Children, and Supplemental Nutrition Assistance Program, among others [ 13].

Screen media time is another important nutrition challenge that especially affects the health of young children in developed countries. In fact, both the WHO and AAP discourage screen time for young children under the age of 18 months, with the AAP only recommending if introducing it to 18-24-month-olds, then ensure it is of high quality and used with parents [ 54]. More screen use has been associated with increased dietary intake, poorer dietary quality, and overweight and obesity in young children [ 55]. Collectively, these feeding and nutrition challenges further impact young child nutrition.

Knowledge and Surveillance Gaps:

A surveillance gap is documentation of various feeding challenges, particularly "picky" eating, and its impact on nutritional status, growth and development, health status, and physical activity level.

There is a need for a consensus definition of "picky" eating and alignment of terminology.

Greater dissemination of simple behavioral techniques to ameliorate feeding challenges will help caregivers work with their young children before needing formal clinical intervention and/or more serious disorders develop and are diagnosed.

Additional research is needed to understand how external factors, particularly food insecurity and excessive screen media time, impact the feeding and nutrition of young children.

6. Conclusions

The first 1000 days provide an opportunity to optimize nutrition. Young children, particularly 12-24-month-olds, are an understudied population. Yet they are at risk for nutritional gaps, as they undergo rapid physical and cognitive growth and social development while transitioning to table foods and the family diet. Although the availability of food and nutrient guidelines are increasing and being updated for this age range, there are multiple surveillance and knowledge gaps to be filled both in the US and globally, notably prevalence and trends for sustained breastfeeding, education of healthcare professionals and caregivers on new recommendations for nutrient needs and dietary guidelines, collection of more dietary intake data especially for young child subpopulations, better standardization of the framework for YCFs/toddler drinks, defining/studying "picky" eating, and understanding the influence of external factors including those related to social determinants of health. Academia and clinicians, the private sector, and the government working together will help to close these knowledge and surveillance gaps both in the US and globally to help better support the nutrition and health of young children.

Funding Statement

This research received no external funding.

Author Contributions

Conceptualization, M.B.A., K.L.W. and E.J.R.; writing-original draft preparation, E.J.R.; writing-review and editing, E.J.R., M.B.A., R.D.M., K.W.K. and K.L.W.; supervision, E.J.R.; project administration, E.J.R. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

Not applicable.

Conflicts of Interest

E.J.R., M.B.A., K.W.K. and K.L.W. are employees and shareholders of Abbott. R.D.M. is an Adjunct Professor of The Ohio State University and is a consultant and speaker for Abbott Nutrition International and the Abbott Nutrition Health Institute.

Footnotes

Publisher's Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Articles from Nutrients are provided here courtesy of Multidisciplinary Digital Publishing Institute (MDPI)

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Young Child Nutrition: Knowledge and Surveillance Gaps across the Spectrum of Feeding

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The first 1000 days is a critical window to optimize nutrition. Young children, particularly 12-24 month-olds, are an understudied population. Young children have unique nutrient needs and reach important developmental milestones when those needs ...

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Something I learned after this module was that there are more benefits to a child being active rather just then being able to learn. It helps promote positive behavior, regulating their moods. There are also so many ways to get them moving in a classroom just by searching things on the internet such as "Go Noodle" 

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Something I learned after this module was that there are more benefits to a child being active rather just then being able to learn. It helps promote positive behavior, regulating their moods. There are also so many ways to get them moving in a classroom just by searching things on the internet such as "Go Noodle" 

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This topic is really important to me because as a future educator making sure my children are active means that I know they can learn better. As a past athlete, I always excelled better in class when I was getting exercise 

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This topic is really important to me because as a future educator making sure my children are active means that I know they can learn better. As a past athlete, I always excelled better in class when I was getting exercise 

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She also teaches a class at NYU called " Can Exercise Change your Brain?" To tap into the brain-boosting effects of movement, she begins each class with an hourlong workout session, followed by a 90-minute lecture and discussion. She has been measuring outcomes of this hybrid teaching method in quantitative and qualitative ways. "One student told me, 'In my other 9 a.m. classes, I am hugging my Starbucks cup. In this class, I don't even need to take notes because I remember what is said.'"

She says exercise is the most transformative thing that you can do for your brain, and she is on a mission to help her students and the public understand the "life-changing," mood-boosting, cognitive-enhancing effects of physical activity.
The Cognitive Benefits of Exercise
Suzuki encourages people to think about the brain like a muscle. Exercise strengthens both the prefrontal cortex (which is involved in executive functioning) and the hippocampus (which plays a key role in memory and learning). In this way, exercise supports our ability to think creatively, make decisions, focus and retrieve key information. In her research, Suzuki found a single workout can improve a student's ability to focus on a task for up to two hours.

Exercise stimulates the growth of new neurons, Suzuki explains, in a process called neurogenesis. In addition, it increases the neurochemical BDNF, which acts as a fertilizer, strengthening neurons and making them less susceptible to breaking down. Physical activity also increases levels of serotonin, norepinephrine, dopamine and endorphins that support emotional well-being, motivation and response to stress. As we age, exercise has a protective effect on the brain, says Suzuki, making it less susceptible to neurodegenerative diseases and normal cognitive decline. With exercise, "you are making synaptic connections, and you are making more synapses grow. Movement will help your brain today and protect you against neurological decay in the future."
The Case for Movement in School
Recess has cascading benefits for children, says Suzuki. "It really has to do with what we know about how the brain works and how we can rejuvenate brain activity - particularly focus, attention and mood. When you cut down recess, you are removing time that kids can run around. And when they run around, their brains are getting a bubble bath of good neurochemicals, neurotransmitters and endorphins. These help memory and mood. A simple burst of exercise helps students focus better - to filter out what they do and do not need to pay attention to in class."

She argues that movement breaks in K-12 classrooms support the deep kind of learning that they should be striving for.

"Adults need this, too," says Suzuki, including teachers. "Even though it takes time from your workday, it will give you back time. You will be more productive if you take that time off. Even if it's just a walk up and down the stairs or a walk around the block. That is a surefire way to make your work more productive. It's how humans were built. We were not built to sit in front of a screen all day long. Our bodies and brains work better with regular movement. It's better than coffee."

Adding more movement to the school day is an attainable goal, says Suzuki. She points to a program called The Daily Mile , an initiative that started six years ago at an elementary school in Scotland. The head of school, Elaine Wyllie, "realized that students weren't looking healthy," says Suzuki, "so she asked teachers to take their students for a 15-minute walk or run every day." More than 8,000 schools in 65 countries - including half of all schools in Scotland - have now adopted this program. The website includes guidelines and tips for making the program accessible to all students with the aim of helping them become "fitter, healthier, and more able to concentrate in the classroom."
Reframing Exercise as Movement
Suzuki recognizes that "exercise can be a four-letter word" for some people - something that feels unpleasant or impractical, given the demands of life. So she has begun to talk about it as simply "movement" in her talks and workshops. One of her favorite "brain hacks" is taking a mundane task and making it more physical - such as "vacuuming like Mrs. Doubtfire."

"The thing is, there are so many ways to move your body," says Suzuki. "It's hard to get someone who does not exercise to move regularly. Once you get over the hump, you can start to be much more mindful and see and feel the immediate effects of exercise - you are literally changing your brain."

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How Movement and Exercise Help Kids Learn | KQED

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Exercising not only helps the body but it helps the brain. Schools are incorporating movement into the school day with activities like "The Daily Mile" to get kids active and prepared to learn.

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Something I learned after this topic was learning more about when and when you cannot come to school. I feel like this is something that isn't really talked about much and knowing when is okay and when it's not can protect their health and everyone around them. 

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Something I learned after this topic was learning more about when and when you cannot come to school. I feel like this is something that isn't really talked about much and knowing when is okay and when it's not can protect their health and everyone around them. 

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This topic is really important to me as a future educator because knowing when a child is experiencing certain side effects from either an illness or disease is important you can either be the first one to notice it or you can be the one to ensure they stay healthy when being around other kids 

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This topic is really important to me as a future educator because knowing when a child is experiencing certain side effects from either an illness or disease is important you can either be the first one to notice it or you can be the one to ensure they stay healthy when being around other kids 

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Committee on Infectious Diseases, American Academy of Pediatrics

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Red Book: 2021–2024 Report of the Committee on Infectious Diseases

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Red Book: 2021–2024 Report of the Committee on Infectious Diseases

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Something I learned from this topic is what to do if a child has a seizure and understand the dos and don'ts of it. 

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Something I learned from this topic is what to do if a child has a seizure and understand the dos and don'ts of it. 

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This topic is really important to be informed on because as a future educator you will have at least 1 child in your classroom that has a chronic condition and being aware of that and knowing what to do can help a child when they need it the most

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This topic is really important to be informed on because as a future educator you will have at least 1 child in your classroom that has a chronic condition and being aware of that and knowing what to do can help a child when they need it the most

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Something I learned from this topic is learning more about the basic principles of first aid, learning more about how to control bleeding, and more about certain emergencies such as Anaphylaxis and Hypoglycemia 

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Something I learned from this topic is learning more about the basic principles of first aid, learning more about how to control bleeding, and more about certain emergencies such as Anaphylaxis and Hypoglycemia 

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This topic is important to know and understand as future educators because emergency care and first aid is something that is a big deal and will have to be dealt with when teaching. Being knowledgeable in this topic could help save a child's life 

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This topic is important to know and understand as future educators because emergency care and first aid is something that is a big deal and will have to be dealt with when teaching. Being knowledgeable in this topic could help save a child's life 

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Something I learned from this topic is that screening can be done by anyone such as parents, teachers, and health care providers. People often think that a screening can diagnose people with a disability but this is not the case the screening identifies how they are developing and if they have any risks for delays in learning. 

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Something I learned from this topic is that screening can be done by anyone such as parents, teachers, and health care providers. People often think that a screening can diagnose people with a disability but this is not the case the screening identifies how they are developing and if they have any risks for delays in learning. 

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This topic is important to know and understand as a future educator because being able to understand how your child develops can affect their learning and that is something that we will always need to be aware of such as how to screen for a disability and what it looks like.

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This topic is important to know and understand as a future educator because being able to understand how your child develops can affect their learning and that is something that we will always need to be aware of such as how to screen for a disability and what it looks like.

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Centers for Disease Control and Prevention

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Healthy Development

The early years of a child's life are very important for their health and development. Healthy development means that children of all abilities, including those with special health care needs, are able to grow up where their social, emotional and educational needs are met. Having a safe and loving home and spending time with family―playing, singing, reading, and talking―are very important. Proper nutrition, exercise, and sleep also can make a big difference.

Effective Parenting Practices

Parenting takes many different forms. However, some positive parenting practices work well across diverse families and in diverse settings when providing the care that children need to be happy and healthy, and to grow and develop well. A comprehensive report looked at the evidence in scientific publications for what works, and found these key ways that parents can support their child's healthy development:

Responding to children in a predictable way

Showing warmth and sensitivity

Having routines and household rules

Sharing books and talking with children

Supporting health and safety

Using appropriate discipline without harshness

Parents who use these practices can help their child stay healthy, be safe, and be successful in many areas-emotional, behavioral, cognitive, and social. Read more about the report here.

Positive Parenting Tips
Get parenting, health, and safety tips for children from birth through 17 years of age
Developmental Milestones

Skills such as taking a first step, smiling for the first time, and waving "bye-bye" are called developmental milestones. Children reach milestones in how they play, learn, speak, behave, and move (for example, crawling and walking).

Children develop at their own pace, so it's impossible to tell exactly when a child will learn a given skill. However, the developmental milestones give a general idea of the changes to expect as a child gets older.

As a parent, you know your child best. If your child is not meeting the milestones for their age, or if you think there could be a problem with your child's development, talk with your child's doctor and share your concerns. Don't wait.

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Parents and others can work together as partners to help children grow up to reach the full potential for his or her health development.