Tot+it+Up%3A+Frequently+asked+questions

As an on-line resource Tot It Up has been developed for parents and healthcare professionals (HCPs) with internet access. Healthcare professionals can use the tool with clients who do not have internet access, in clinical or childcare settings. Many HCPs have told us they plan to use it in this way to engage parents to talk about a balanced diet for a toddler. Clients who do not speak English can use Tot It Up in conjunction with an English speaking interpreter.

We are keen to receive feedback from HCPs who use Tot It Up with their clients.

A range of portion sizes has been chosen because toddlers (1-3 years) who are growing and developing normally do not all eat the same portion sizes of food. Some eat more, some eat less. The portion sizes are based on reported measurements from national surveys and our own clinical experience.

Toddlers should be offered a balanced diet composed of a variety of nutritious foods. However they should be allowed to eat sufficient food to satisfy their appetites, rather than forced to eat set amounts. Some days they will eat more and on other days they will eat less. It is better to assess toddlers’ intakes over a week or month rather than daily.

The appropriate balance of the five food groups can be represented in a number of ways. The plate format is used in the EatwellPlate by the UK Food Standards Agency for children five and over and is a very precisely calculated representation of how to combine the food groups for adults and children over five years. The pyramid format is used in several other countries and is less precise because there are no calculated angles. We chose the pyramid format because it is less precise and is a visual approximation of how to combine the food groups for toddlers.

Tot It Up has been designed to give parents guidance on how to offer a balance of the five food groups to their toddlers. Salt is an ingredient or additive, not a food, and is therefore not listed within any food group. Advice on choosing foods that are low in salt for toddlers is outside the remit of this resource. Our Factsheets ‘How to choose nutritious fresh and convenience foods’ and ‘Understanding food labels’ can be used in conjunction with this resource.

The number of portions recommended for each food group is based on a balanced combination of foods providing adequate nutrients, as recommended by the Paediatric Group of the British Dietetic Association (BDA)¹. An exception is the group of foods high in fat and sugar for which the Paediatric Group of the BDA and other agencies simply recommend small amounts. Because this tool assigns each food eaten by the toddler to one or more food groups it can be used to calculate the number of portions of foods high in fat and sugar, as well as those in the four other food groups. About seven small portions of foods high in fat and sugar are included in a healthy balanced diet for toddlers, and these are best included as part of other nutritious foods, for example, butter on bread and sugar in puddings based on eggs, flour and fruit.