Health Supervision Visit, 15 Months

Assess

• Anthropometric measurements
• Physical examination.
• Appropriateness of energy intake for an individual child is best judged by appropriateness of growth rather than monitoring daily intake.
• Screen for iron deficiency and iron deficiency anemia.
  • Babies who are breastfeeding beyond 1 year of age may need addition iron screening if iron intake is inadequate.

Discuss

• Encourage foods, whether home or commercially prepared, with no added salt or sugar; particularly important for commercial foods marketed for toddlers.
• Encourage mono- and polyunsaturated fatty acids (eg, avocado, ground nuts or nut butters, olive and canola oils).
  • Nonfat and lowfat milks are not recommended in children < 2 years.
    • 28% of toddlers 12 to 23 months of age consume less fat than recommended. 
    • Children between 12 months and 2 years of age with a history of or concern for obesity and/or a family history of obesity, dyslipidemia, or cardiovascular disease should be offered reduced-fat milks and dairy products.
• Sugar-sweetened beverages (SSBs), beverages with low-calorie sweeteners, and caffeinated beverages are not recommended. Avoid formulas designed for older children unless medically indicated.
  • Give plant-based milks only when medically indicated or to meet specific preferences for plant-based milks.
  • Children 1 to 3 years of age should consume no more than 4 oz (120 mL) of 100% fruit juice.
  • Almost 1/3 of toddlers consume SSBs daily.
• Explain the 2 domains of encouraging healthy eating: structure and autonomy. Tips for families regarding each domain are listed here:

Two Domains of Encouraging Healthy Eating

Adapted from Fisher J, Lumeng J, Miller L, Smethers A, Lott M. Evidence- Based Recommendations and Best Practices for Promoting Healthy Eating Behaviors in Children 2 to 8 Years. Durham, NC: Healthy Eating Research; 2021. Available at: https://healthyeatingresearch.org

Calculations

Estimated energy requirements (kcal/d) for infants 6 months to 3.99 years (weight in kg; height in cm):

• Males: −716.45 − (1.00 × age) + (17.82 × height) + (15.06 × weight) + 20
• Females: −69.15 + (80.0 × age) + (2.65 × height) + (54.15 × weight) + 20/15
  • Energy cost of growth for girls: 6 to 11.99 months: 20 kcal/d; 12 to 35.99 months: 15 kcal/d.