Poor nutrition in babies and young children can lead to many negative outcomes such as failure to thrive, obesity, anemia, restrained eating, poor eating habits that become lifelong, lack of school readiness and inability to learn at school. Further investigation, including possible referral to a registered dietitian (RD) for nutrition assessment and ongoing follow-up may be warranted for infants and children who present with Red Flags.

 

 

 

 

 

 

 

if one or more of the following risk factors are present, considered this a red flag:

 

General nutrition risk factors

• Growth measurements plot below the third or above the eighty-fifth percentile on the World Health Organization (WHO) Growth Charts

• There is a sharp incline or decline in serial growth measurements or the growth-line remains flat on the WHO Growth Charts

• If provided, infant formula is prepared and/or stored incorrectly

• Uses a propped bottle or is not supervised during feeding

• Unsafe or inappropriate foods are given, e.g. raw eggs, unpasteurized milk and foods that are choking hazards

• Feeding is forced or restricted

• Is pressured to eat through prodding, scolding, punishment, pleading, bribing or coercing, e.g. “clean your plate” or “come on, you’ve tried it before”

• Diet is restricted e.g. food allergy, vegan, gluten-free

• Food storage or cooking facilities are inadequate

 

General nutrition risk factors

0-6 months

• After five days of age, has less than six wet diapers each day

• Within the first two weeks, loses more than 10 per cent of birth weight

• By two weeks, does not regain birth weight or does not gain 20 grams or more per day

• Not fed based on baby’s cues, e.g. not fed on demand, day and night

• Not receiving vitamin D supplement of 400 IU daily if breastfed or receiving breastmilk

• Drinks cow’s or goat’s milk, vegetarian beverages (e.g. soy, rice, almond), homemade evaporated milk formula, water, juice, herbal teas or other liquids

• Consumes infant cereal or other pureed foods before 4 months, including cereal or pureed foods in a bottle

• Consumes honey, including pasteurized or cooked

​

6-9 Months

• Does not eat iron-rich foods daily, such as meat, meat alternatives and iron fortified cereal

• By nine months, does not eat two to three larger feedings (meals) and one to two smaller feedings (snacks) daily

• Not receiving vitamin D supplement of 400 UI daily if breastfed or receiving breastmilk

• Drinks cow’s or goat’s milk, vegetarian beverages (e.g., soy, rice, almond) or homemade formula as milk source

• Drinks fruit drinks/punch, sports drinks, pop or beverages containing artificial sweeteners or caffeine (e.g. coffee, tea, hot chocolate)

• Drinks more than 175 mL (six oz.) juice a day

• Consumes honey, including pasteurized or cooked

​

9-12 Months

• Does not eat iron-rich foods daily, such as meat, meat alternatives and iron fortified cereal

• By nine months, foods with lumpy textures have not been introduced or consumed

• By 12 months, does not eat a variety of family foods with various textures

• By 12 months, does not eat two to three larger feedings (meals) and one to two smaller feedings (snacks) daily

• Not receiving vitamin D supplement of 400 IU daily if breastfed or receiving breastmilk

• Drinks skim or low-fat cow’s or goat’s milk, vegetarian beverages (e.g. soy, rice, almond) or homemade formula as main milk source

• Drinks fruit drinks/punch, sports drinks, pop or beverages containing artificial sweeteners or caffeine (e.g. coffee, tea, hot chocolate)

• Drinks more than 750 mL (24 oz.) of cow’s or goat’s milk a day

• Drinks more than 175 mL (six oz.) of juice a day

• Consumes honey, including pasteurized or cooked

​

12-24 Months

• Does not eat iron-rich foods daily, such as meat and meat alternatives

• Does not eat a variety of family foods with varying textures such as ground, mashed or chopped foods with a tender consistency, including finger foods

• Does not eat three small meals plus two to three nutrient-dense snacks a day, generally following the advice in Canada’s Food Guide

• Dietary fat intake is restricted

• Not receiving vitamin D supplement of 400 IU daily if breastfed or receiving breastmilk

• Consumes mostly breastmilk and little solid food

• By 18 months, has not transitioned from bottle to an open cup

• Drinks more than 750 mL (24 oz.) of cow’s or goat’s milk a day

• Drinks more than 175 mL (six oz.) of juice a day

• Drinks skim or low-fat cow’s or goat’s milk, vegetarian beverages (e.g. soy, rice, almond) or homemade formula as main milk source

• Drinks fruit drinks/punch, sports drinks, pop or beverages containing artificial sweeteners or caffeine (e.g. coffee, tea, hot chocolate)

• By 24 months, often coughs and chokes
  when eating

• Scores “high nutrition risk” on Toddler NutriSTEP® nutrition screen nutritionscreen.ca​

 

Toddlers & Preschoolers (2-6 Years)

• Does not eat a variety of foods from the four food groups in Canada’s Food Guide

• Does not eat three small meals plus two to three nutrient-dense snacks each day

• Drinks large amounts of fluids and little solid food78, 88 (e.g. more than 750 ml or 24 oz. of milk a day74, 88 or more than 175 mL or six oz. of juice
  a day)

• Consumes mostly breast milk and little solid food

• Drinks most of their milk and other beverages from a bottle or sippy cup

• Regularly drinks fruit drinks/punch, sports drinks, pop or beverages containing caffeine, e.g. coffee, tea, hot chocolate

• Rarely or never eats meals with their family

• Depends on vitamin/mineral supplement vs. variety of foods

• Scores “high nutrition risk” on Toddler or Preschooler NutriSTEP® nutrition screen nutritionscreen.ca