Early nutrition has long-lasting health effects from infancy into adulthood.1,2The nourishment received in childhood has a profound influence on physical growth, cognitive and behavioral development, and the ability to learn, communicate, think analytically, socialize effectively, and adapt to new people and environments.1,3

Conversely, insufficient or inadequate nutrition can delay physical growth and motor development, impair cognitive development, increase the likelihood of behavioral problems and inadequate social skills, and negatively impact attention, learning, and achievement.1,2Therefore, it is critical that health-care providers who manage the care of infants and young children understand and support the nutritional needs of these patients.3

Although cow’s milk protein allergy (CMPA) is typically diagnosed in infancy, up to 50% of children older than age 1 year remain intolerant of cow’s milk. Ensuring adequate nourishment overall is particularly challenging during the toddler years; the nutritional needs of these children increase rapidly while they often become very choosy about what they eat. This article will review the diagnosis and management of CMPA, areas of deficiency in toddler nutrition, and strategies to promote healthy eating habits and behaviors. 

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Good infant nutrition begins at birth

Case in point: Ryan P. is an 18-month-old toddler who was breastfed from birth until age 4 months. Once his mother returned to work, she began giving Ryan traditional, ready-to-feed infant formula.

In a 2012 policy statement, the American Academy of Pediatrics (AAP) reaffirmed its earlier recommendation that all infants should be exclusively breastfed for the first six months of life.4Furthermore, the AAP cites the importance of adding complementary foods beginning at approximately 6 months of age, while the infant is receiving only breast milk and not a combination of breast milk and infant formula.5 

The AAP recommendations are based on documented improvements in health outcomes in infants who are exclusively breastfed.4Breastfeeding provides numerous immunoprotective effects against such conditions as otitis media, bacterial and viral respiratory tract infections, allergic respiratory and skin conditions, childhood leukemia, sudden infant death syndrome (SIDS), type 1 and type 2 diabetes mellitus, and obesity (Table 1).4

Table 1. Correlation between duration of breastfeeding and health benefits.4

Condition Duration of breastfeeding Risk reduction
Otitis media >3 months* 23%–50%
Upper respiratory infection >6 months* 63%
Lower respiratory infection >4 months* 72%
Asthma >3 months 40% if atopic family history
26% if no atopic family history
Respiratory syncytial virus (RSV) bronchiolitis Neonatal intensive care unit (NICU) stay in preterm infants 77%
Atopic dermatitis >3 months* 27% if negative family history
42% if positive family history
Gastroenteritis Any 64%
Celiac disease >2 months 52% when exposed to gluten
Acute lymphocytic leukemia (ALL) >6 months 20%
Acute myeloid leukemia (AML) >6 months 15%
Sudden infant death syndrome (SIDS) >1 month 35%
Type 1 diabetes >3 months* 30%
Type 2 diabetes Any 40%
Obesity Any 24%

In addition, consumption of human breast milk has a positive effect on infant neurodevelopment.4One large, randomized study found higher IQ scores and higher ratings from teachers among children who had been breastfed for three months or longer as infants, particularly if they were exclusively breastfed.4A similar neurodevelopmental outcome was found in preterm infants who had been fed human milk while in the neonatal intensive care unit.4