NEAT-R Long Assessment

EHS Toddler Nutrition Questionnaire—Long Action Version

(Intended for use with toddlers 12-36 months)

Child’s Name ______Sex: M F

Age ______months/years Birth date______

Current weight______Percentile _____Current height______Percentile _____

Action message:

Plot the height and weight on the appropriate growth chart.
Determine where the toddler is:

Less than or equal to the 10th percentile = at risk for underweight

Greater than or equal to the 85th through the 95th percentile = at risk for overweight

Greater than or equal to the 95 percentile = overweight

Recent sudden changes or consistently under- or over-weight may be cause for concern.
Refer to a nutritionist and follow-up with the parent regarding the prescribed plan of care.

Is your child on WIC?YesNo I would like to learn how to enroll______

Are you on the FOOD STAMP program? YesNo I would like to learn how to enroll______

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Current Dietary Intake

1)In a typical day, how many servings does your child eat from each of the following food groups?

Action message:Be sure to specify child-sized servings. Refer to your tool kit for portion sizes.Although maximum servings are not given, if you feel a child is eating too much of any food, speak to a nutritionist.

Cheese, cottage cheese, yogurt, milk0123456+

Action message:

These foods will help your child have healthy bones and teeth. Your child should eat two servings a day. All childrenunder 2 years of age should be drinking whole milk.

Meat, poultry, fish, eggs; dried beans/peas, tofu0123456+

Action message:

These foods will help your child have healthy growth. Your child should eat two servings a day.

Fruits0123456+

Action message:

These foods will help your child get the right amount of important vitamins and minerals. Your child should eat two servings a day.

Vegetables (not potatoes)0123456+

Action message:

These foods will help your child get the right amount of important vitamins and minerals. Your child should eat three servings a day,with at least one being a dark green or deep yellow vegetable.

Bread, grits, cereal, noodles, rice, tortillas, bagels, crackers0123456+

Action message:

These foods will help your child grow properly. Your child should eat five to six servings a dayof heart-healthy whole grains, such as whole wheat bread, brown rice, and oatmeal.

2) In a typical WEEK, how often does your child eat from each of the following food groups?

Margarine, butter, lard, oil1234567+

Action message:

Eating too much added fats and oils or fatty/oily foods can lead to overweight children, who will have a greater chance of diabetes or heart disease later in life. Try to limit fried food and use small amounts of added fats in cooking and on food.

Cakes, cookies, pie, candy, ice cream, donuts1234567+

Action message:

Eating too much added sugar, sweets, or sugary foods may lead to overweight and dental cavities. Try to eat small portions of sweet foods and then eat them less than 3 times a week.

Fast food1234567+

Action message:

Fast food often contains a large amount of fat and/or salt. Eating too much of these foods may lead to overweight children and/or high blood pressure. Try to eat small portions of fast foods and then eat them less than 3 times a week.

2)Does your child eat any of the following foods? (Circle ALL that apply.)

raw vegetableshotdogschips popcorn nuts marshmallows

hard candyraisins seeds grapes pretzels peanut butter on a spoon

Action message:If any of the above foods are circled

These foods can cause small children to choke, because theycannot swallow these types of food as easily as adults. You should not feed these foods to children under two years old to prevent choking.

3)On a typical day, how many cups (8 oz, sippy cup) of each of the following does your child drink:

Action message:

Too much of any beverage can fill a child’s tummy and they may not have room for their food.

Regular soda-pop, such as Mt. Dew or Pepsi, or Diet soda-pop, such as Diet Coke, or Diet 7-Up ------0 1 2 3 4 more

Action message:

Drinking too much of these types of drinks is not healthy for your child. Both diet and regular soda-pop may lead to tooth decay. Regular soda may lead to childhood overweight. 100% fruit juice can be a good alternative to soda, but no more than 1/2 cup or 4 oz of 100% fruit juice per day.

Water, bottled or from the tap, do not include ice ------01234more

Action message:

Water should be given to your child throughout the day. You should not add ice to your child’s water because ice can cause choking.

100% Fruit Juice, such as Libby’s or Juicy Juice ------01234more

Action message:

100% fruit juice is a good alternative to fruit drinks and soda, but don’t give your child a lot of fruit juice because it has a high sugar content. 1/2 cup or 4 oz of 100% fruit juice a day is about the right amount.

Other fruit drinks, such as Gatorade, Kool-Aid, ------01234more Hi-C Punch, Lemonade, Iced Tea

Action message:

Drinking too much of these types of drinks may lead to childhood overweight or tooth decay. 100% fruit juice can be a good alternative to soda, but no more than 1/2 cup or 4 oz of 100% fruit juice per day.

4)How many meals and snacks does your child have in a typical day? _____meals _____ snacks

Action message:

Emphasize the importance of healthy foods and portion sizes are different for toddlers and adults. Toddlers’ appetites change from day to day, so tell parents not to force a child to eat if the child is clearly not hungry.
Because of their small stomachs, toddlers are limited in the amount of food they can eat at any one time. In a typical day, children should eat about 6 times a day (3 meals, 3 snacks). A healthy snack could be ½ banana or a peach with 1/4 cup of yogurt.

5)Do any of the following interfere with you providing healthy meals and snacks for your child and your family?

a)Cost?YesNo

b)Transportation?YesNo

(no way to get to store)

c)Don’t know how to cook?YesNo

d)Lack of time?YesNo

e)Don’t know what food YesNo

to buy?

f)Don’t know how to feed a toddler?YesNo

g)Don’t know how much YesNo

to feed a toddler?

h)Other: ______

Action message: Sources of Help

WIC, EFNEP/FNP, Budget assistance, Nutritionist, Food bank, MSUE

Car pool, EHS home visitor

EFNEP/FNP, MSUE, EHS home visitor, cookbooks from library

EHS home visitor, MSUE

EFNEP/FNP, Nutritionist, MSUE

EHS home visitor, MSUE

EHS home visitor, nutritionist, MSU

Eating/Feeding Behaviors

1)Does your child usually feed himself?YesNo

Action message:

As children grow and are able to do more things for themselves, they like to pick up finger foods and try to use child sized spoons or forks. You can help your child learn to feed him/herself by giving your child practice in picking up foods and using spoons. Try to be patient as your child learns to eat independently. It might be a little messy, but practice is how your child learns.

2)Does your child still take a bottle?YesNo

Action message:

Children older than 12 months should not be getting anything other than water in a bottle, including formula or juice. NEVER give a bottle in bed because it may cause them to choke or can promote tooth decay. Children at this age are developing important muscle skills, including self-feeding. When children drink from a bottle, they suck instead of sip. They do not have to hold the bottle carefully to prevent spilling. Drinking from a sippy cup is very similar to drinking from a bottle. Sippy cups are good for transitioning from a bottle to an adult cup, but should not be used exclusively. Children should be encouraged to drink from a small glass or cup to develop gross motor skills, both through holding the cup and drinking from it. Bottles and sippy cups should only be used if child is sitting (as with any eating or drinking). Sippy cups should generally only contain water. Remind parents that children are expected to be messy at this age, and the sooner they develop these self-feeding skills, the sooner the child will be able to drink without making a mess.

3)Do you feel your child is a picky eater?YesNo

Action message:

Toddlers are sometimes "picky" eaters. Toddlers may prefer particular food colors, tastes, and textures. These preferences often fade over time when they are offered new foods, especially if you keep offering many kinds of foods. It helps if you eat a variety of foods too. Your toddler will be watching to see what you eat too! Remember that new foods often have to be offered up to 20 times before toddlers accept them. Try serving new foods along with familiar foods. Your toddler is more likely to try something new when hungry, and if other family members are eating these foods too. Also, your child’s appetite will change as they grow and develop. Your toddler may be especially hungry just before and during a big growth spurt.

4)How would you describe a typical mealtime with your child?

Usually Pleasant Sometimes Pleasant Rarely Pleasant

Action message:

If mealtimes feel stressful to you, think about what parts of the meal are most challenging. Knowing about toddlers' appetites, common mealtime behaviors, and toddlers learning to feed themselves (which can contribute to messiness) can improve understanding of the overall mealtime experience. Toddlers also have short attention spans, so remember that toddlers are likely to eat for a short period of time, and then become interested in something else. When adults and toddlers sit and eat together, toddlers are more likely to stay at the table and focus on the meal.

5)Does your child sit and eat at a table with the family during most mealtimes? YesNo

Action message:

Mealtimes are important times for your family. Mealtimes are also a great time to sit down for a few minutes with your child. As your child grows up, this time of checking in with your child each day becomes an important part of knowing how your child is doing, how things are going and so on. Sometimes, it is tempting for parents to give toddlers something to eat while they are playing or walking around the house. Eating while moving around and playing can cause toddlers to choke on their foods. Sitting down at the table is the safest way to eat, and it helps toddlers develop healthy eating habits.

6)How long do mealtimes with your child usually last?

5-10 minutes11-20 minutes21-30 minutesmore than 30 minutes

Action message:

Remember that toddlers need time during meals to explore their foods. They like to smell, touch, and taste food. This is how they learn! Toddlers need time not only to eat, but also to learn to use forks and spoons, and this takes a lot of practice. Try to avoid battles over food and eating. Toddlers know when they are hungry and when they are full. If you offer your toddler a variety of foods, he/she will probably get enough of each kind over the course of a few days. NEVER force a child to eat! Trying to get the toddler to eat just one more bite will only create a problem.

7)What do you do if your child regularly won’t eat at your planned meal or snack-times?

a)Make him/her eat?

YesNo

b)Offer different food?

YesNo

c)Offer food later?

YesNo

d)Offer dessert if he/she will eat?

YesNo

e)Other: ______

Action message: **If the child is over or underweight, these actions may not be beneficial. Please follow the directions of a health care provider in these instances. Also, be sure to give food before drinks at mealtimes.

a) If YES: Children should decide how much they are going to eat. It is important to NEVER force a child to eat or “clean his/her plate”.

b) If YES: You don’t help your child by fixing a different meal or food. If you serve something else, your child will get the message that you don’t expect him/her to eat it. Make one meal for everybody with a variety of healthy foods and let your toddler decide what to eat. If they don’t eat at this meal, they’ll make up for it at another meal.

c) If YES: Sometimes your child may not be hungry. Remember to offer healthy meals and snacks at regular times throughout the day. This will allow your child to become hungry in between regular feeding times.

d) If YES: You should never use food as a reward or punishment because it could lead to bad food habits. Try to talk positively to your child instead of giving food as a reward or punishment.

e)Action: Help parents understanding typical toddler eating habits to decrease parents' worrying about their children's food choices at mealtime and decrease the chance that parents will force or bribe children to eat.

Allowing your child to choose what and how much he or she eats from what you serve teaches important skills. When you follow the "parent provides, child decides" approach, children learn to eat as much as they need. They learn to listen to their own hunger and feelings of fullness. This typically leads to healthier eating habits.

8)Does your child usually watch TV during mealtimes at home? YesNo

9)Does your child usually watch TV during snack times at home? YesNo

Action message:

When adults watch TV while they are eating, they tend to lose track of what they are eating. They often keep eating even when they are full. The same thing can happen with toddlers. If toddlers are watching TV while they are eating, they don’t learn to pay attention to their own feelings of being full. This can lead to overeating.

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Eating/Feeding Concerns/Problems

1)Does your child have any food allergies? YesNo

a)If yes, describe: ______

b)How do you know your child has food allergies?

did you figure it out yourself

did a doctor tell you?

Action message:

Only 6-8% of children develop true allergies. so it is important to talk to your doctor if you think your child has a food allergy. If a close family member (parent or sibling) has food allergies it’s a good idea to wait to introduce foods that are known to cause allergies into your child’s diet until he or she is at least 3 years old. Food that usually cause allergies in children are eggs, milk, peanuts, soy, and wheat. These are the main foods children may be allergic to. Other foods include tree nuts (walnuts, pecans) fish, and shellfish.

c)Has a health care provider identified any eating problems your child has (e.g., Failure to Thrive)

YesNo

Action message:

If YES: determine what the eating problem is. Determine what the health care provider recommended and the parent’s follow through. Identify if additional assistance is needed. A feeding observation may be helpful.
For mild malnutrition: parents need to work on ways to increase the toddler’s oral intake, including dietary supplementation with high-calorie foods and food additives, such as sour cream, butter and cheese, an also the use of a multivitamin. Provide parents with assistance on feeding techniques such as decreasing excessive juice intake (if more than 4-6 oz a day), reducing between meal grazing, and ensuring that there is adequate food in the home.
For moderate to severe malnutrition: refer, then help parents adhere to the prescribed medical and dietary regime.
For overeating: Parents need to encourage moderation in dietary portions and feeding rather than over-consumption. Parents also need to emphasize healthful choices rather than restricted eating patterns. Remind parents to avoid (DO NOT BUY) calorie dense foods and substitute fruit and vegetable snacks and water for sugared sodas, juices, and cookies. If possible, the obese child and the entire family should adhere to a similar diet plan. Some good tips include: