Developmental milestones and nutrition for babies aged 18-24 months - Little Étoile Malaysia

Developmental milestones and nutrition for babies aged 18-24 months

Brain development

Between 18-24 months the brain continues developing nerve connections and pathways, and there is a rapid development of the cerebral cortex which is responsible for the ability to regulate behaviour and emotions involved in self-awareness and self-consciousness [1]. The frontal and temporal lobes of the brain are developing, improving language, memory and hand-eye coordination.

This is a time of rapid developmental milestones, and you can expect to see your toddler’s language skills improve dramatically over the next few months. Neurotransmitter synthesis is active until about 2 years of age, effecting the development of your toddler’s mood and behaviour. Nutrition during this critical time effects how your toddler’s brain develops, and a deficiency of any key nutrients involved in brain development may lead to reduced cognitive function [2-3].

At this age, it is normal for toddlers to have difficulty expressing their emotions which often leads to temper tantrums. Feeling such as anger and frustration, guilt, shame, possessiveness and excitement are all common at this age, and may cause outbursts in behaviour such as crying or screaming, throwing or breaking things, running away or even holding their breath [4-5].

However, amongst the temper tantrums, your toddler is also developing a sense of empathy and you may notice they feel sad or guilty when they have done something wrong. They also show affection by giving you lots of hugs and kisses, or by showing affection to their toys or dolls [5].

Nutrient Function Dietary Sources RDI
DHA Brain development and function: structural component of grey matter, maintenance of myelin.


Breastmilk or Infant Formula.


Fish: Salmon, tuna, sardines, marine algae/algal oil

AI: 10-12mg / kg of body weight [14]
Choline Needed for cell division & growth continuing until 3-5 years of age. Provides structural integrity of membranes and neurotransmission [13]. Breastmilk or Infant Formula.


Eggs, salmon, meat, broccoli.

Iron Brain development, neurotransmitter function & red blood cells.


Breastmilk or Infant Formula


Red meat, spinach, lentils, fortified cereals.




Folate Brain development, neurotransmitter function & cell division.


Breastmilk or Infant Formula.


Spinach, kale, broccoli, chickpeas

Zinc Brain development, neurotransmitter function & myelination. Behaviourally, early life zinc deficiency results in poorer learning, attention, memory and mood [2].


Breastmilk or Infant Formula.


Meat, seafood, pumpkin seeds, nuts.

Vitamin D Deficiency may cause behavioural, memory, and learning disorders later in life [15].


Breastmilk or Infant Formula. (Breastmilk contains low levels of vitamin D. Sunlight exposure is needed)


Sunlight exposure.


Eggs, fish, mushrooms.

Vitamin B12 Brain development & nervous system function. Meat, fish, eggs, dairy. 0.9mcg [16]

RDI = Recommended Daily Intake

AI = Average Intake

Eye development

By now your toddler can focus on objects both near and far, and hand-eye coordination and depth perception are well developed. Drawing and painting is likely to be a favourite activity as your toddler is able to scribble with a crayon and hold a paint brush. It is likely that your walls by now have pencil or crayon all over them, as your toddler may not be able to stay on the paper [6].

Key nutrients for eye development

Nutrient Function Dietary Sources RDI
Vitamin A Required for vision and retina development. Breastmilk or Infant Formula


Retinol (active vitamin A): meat, dairy, eggs.


Beta-carotene (precursor to retinol): pumpkin, sweet potato, mango, kale, broccoli.

300mcg [16]
Lutein A carotenoid that accumulates in the retina where it prevents damage from reactive oxygen species. Breastmilk or Infant Formula


Kale, spinach, broccoli, egg yolks.

No RDI set
DHA Needed for the growth and development of the brain and retina, where it accumulates [17]. Breastmilk or Infant Formula


Fish: Salmon, tuna, sardines, marine algae/algal oil

AI: 10-12mg / kg of body weight [14]


Intestinal and gut microbiota development

The development of the microbiome continues with the first few years of life being a crucial period. The establishment of the gut microbiota influences the maturation of the immune system, nutrient absorption, and metabolism as well as preventing the colonization of pathogenic bacteria.

An unfavourable gut microbiota composition (typically less beneficial bacteria and diversity) has been associated with short- and long-term health conditions, such as overweight and obesity, asthma, metabolic syndromes, and chronic inflammatory diseases. The first years of life offers a unique window of opportunity for modulating the gut microbiota to promote long term health [7].

During this time, offering a wide variety of pre and probiotic foods will help to create a diverse colony of beneficial microbes that can influence your toddler’s life-long health and immunity. While probiotic foods are important to introduce beneficial bacteria, of equal importance is the addition of prebiotic fibre which helps the bacteria to colonize and reside in the gut.

If your toddler has taken a course of antibiotics, it is important to repopulate the gut with beneficial bacteria, ideally by supplementing with an infant probiotic as well as increasing pre and probiotic foods in the diet.

Immune development

Your toddler’s immune system is developing and getting sick is a normal and frequent part of childhood. Offering your toddler a variety of nutritious foods such from fruits, vegetables, protein, whole grains and omega-3 will provide the immune system with the nutrients needed to mount an appropriate immune response.

High dose vitamin C (greater than 200mg per day) has been shown to be significantly beneficial in reducing the severity and duration of the common cold virus in children [8].

Beta-glucan, a compound found in oats and baker’s yeast has been shown to support immunity by improving the functioning of immune cells and the killing and clearance of pathogens. Beta-glucan has been shown to reduce the incidence of upper respiratory tract infection symptoms and improve overall well-being [9].

A clinical study of children aged 12-48 months who took a beta-glucan supplement showed decreasing episodes of upper respiratory tract infections. Children taking a beta-glucan supplement also reported fewer sick days in a day care setting [10].

Key nutrients for digestive and immune development

Nutrient Function Source RDI
Vitamin A Formation and maintenance of mucous membranes (intestines), immune system development and function. Breastmilk or Infant Formula


Retinol (active vitamin A): meat, dairy, eggs.


Beta-carotene (precurser to retinol): pumpkin, sweet potato, mango, kale, broccoli.

Zinc Formation and maintenance of mucous membranes (intestines), immune system development and function.


Breastmilk or Infant Formula


Meat, seafood, pumpkin seeds, nuts.


Vitamin C Formation of collagen and connective tissue, immune system development and function. Breastmilk or Infant Formula


Cirtus fruits, kiwi fruit, mango, apple, pear

35mg [16]
DHA Immune system development and function. Breastmilk or Infant Formula


Fish: Salmon, tuna, sardines, marine algae/algal oil


AI: 10-12mg / kg of body weight [14]


Prebiotics Prebiotics – help to feed beneficial bacteria that colonize and reside in the gut.


Breastmilk or Infant Formula


Chickpeas, lentils, beans, banana, onion, asparagus, chicory, leek, berries.


No RDI set
Probiotics Digestive health and immune system development and support. Yoghurt, kefir, kim chi, sauerkraut, miso, tempeh.


No RDI set
Lactoferrin Stimulates the immune system, promotes growth of gut microbes; antibiotic properties. Breastmilk or Infant Formula




No RDI set

Bone and teeth development

From 18-24 months your toddler is highly active. Walking has been established and your toddler is starting to run, jump and climb everything. The bones continue to grow rapidly, and bone strengthening nutrients like calcium and vitamin D are essential to support normal growth and development.

By 24 months your toddler will have almost a full set of teeth, although the second molars will not come in until about 25-33 months [11]. This makes biting and chewing much easier for your little one, and most foods can now be easily eaten.

Key nutrients for bone and tooth development

Nutrient Function Dietary Sources RDI
Calcium Mineralization and growth of bones and teeth. Breastmilk or Infant Formula


Dairy, kale, broccoli, tofu.

Vitamin D Supports tooth and bone maturation (assists the absorption of calcium).


Breastmilk, Infant Formula or infant supplement


Sunlight exposure.


Eggs, fish, mushrooms.


Vitamin K Absorption of calcium within bone during development and elongation.


Breastmilk or Infant Formula


Dark green leafy vegetables such as spinach and kale.

Phosphorus Maintain bone mineralisation. Breastmilk or Infant Formula


Meat, dairy, wholegrains.

Manganese Bone maturation and maintenance. Breastmilk or Infant Formula


Legumes, Nuts, seeds, wholegrains.

80mg [16]

Developmental milestones 18-24 months

Gross motor skills: throw a ball, try to catch ball, jump with a galloping motion, walk up and down stairs when holding hand with parent.

Fine motor skills: turn pages in book one at a time, build towers using four or more blocks, scribble and draw lines up, down and across a page as well as circles.

Self-help skills: feeds elf using spoon or fork, suck through a straw, assist with getting dressed (eg; push arms through t-shirt holes), understand common dangers such as hot or sharp objects (and stay away from).

Cognitive skills: explore cabinets and drawers (empty entire contents of drawers!), name six body parts, sort objects by shape and colour, understand and participate in turn-taking [12].


  1. Hodel AS. Dev Rev. 2018;48:113-144.
  2. Cusick et al. J Pediatr . 2016 August; 175: 16–21.
  3. Fox SE, et al. Child Development. 2010; 81:28–40.
  7. Muriel Derrien, et al. Tren Microb. 2019;27(12)997-1010.
  8. S Maggin Swadh. J Inter Med Res. 2010;38:386-414.
  9. Hong F, et al.J Immunol. 2004 Jul 15;173(2):797-806
  10. Meng, J Nutr Food Sci. 2016, 6:4
  12. /search/?q=Developmental+Milestones+18-24+Months&site=
  13. Derbyshire E, Obeid R. Nutrients. 2020 Jun 10;12(6):1731.
  15. Cerdó T, at al.Curr Opin Clin Nutr Metab Care. 2019 Nov;22(6):434-441.
  17. Huang HL, et al. Lipids Health Dis. 2013 Mar;12:27.







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