What's the Matter With Kids' (Diets) Today?

by Jennie McCary, MS, RD, LD on Mar 01, 2005

Here are the answers to the most frequently asked questions about children's nutrition.

Childhood is the time when kids establish eating patterns that can last a lifetime. Parents and caregivers can help nourish their children's growing bodies and teach children how to make informed, nutritious food choices. Unlike many adults, young kids are eager to learn and copy what the grownups around them are doing. This affords parents a great opportunity to instill possible attitudes toward food and impart important lessons about portion control, moderation and balance. This article examines the questions that parents most frequently ask nutrition experts on how to build healthy eating habits in children and adolescents.

How important is breakfast for my kids, and how can I get them to eat it?

Simply stated, breakfast is the most important meal of the day. After an 8- to 10-hour fast, a child’s growing body needs nourishment. A morning meal provides the energy and nutrients needed to fuel the body—especially the brain—to perform daily activities. Breakfast supplies one-fourth of the daily calorie and nutrient needs of kids. So those who skip their morning meal may have lower nutrient intake for the day, putting them at increased risk for undernourishment.

In children and adolescents, undernourishment can impact the ability to learn. Proper nutrition plays a critical role in cognitive development and academic performance in children. Imagine a kid trying to pay attention in class or to take an exam while distracted by a growling belly. Studies on how nutrition can impact a child’s learning abilities have found that eating breakfast improves attention and behavior in class and results in higher test scores (Pollitt & Mathews 1998).

Sadly, breakfast is the most frequently skipped meal. It can be a challenge to get kids to eat in the morning because they are rushed or just aren’t hungry. Because children mimic adults, it is vital that parents be role models for their kids. Parents who eat breakfast demonstrate that it is an important part of the daily routine. Get kids to buy into it by involving them in the planning and preparation, and remember to make it fun! For young kids, this can be as simple as having them set the table or pour the cereal or milk. Empower your children by giving them a decision to make. For example, give them a choice between two nutritious foods each day (you may want to do this the night before to reduce morning madness!).

Keep in mind that what you serve kids in the morning does matter. For instance, a breakfast that is high in sugar will leave children hungry by midmorning. A basic breakfast should offer a balance of carbohydrate, protein and fat from two to three food groups: for example, try serving a whole grain, low-fat milk and fruit. But don’t get overwhelmed by the task of making a traditional breakfast. Leftovers or grab-and-go items, such as squeezable yogurt and a granola bar, work just as well as more conventional fare.

Kid-Friendly Tip. For kids who just can’t eat breakfast before leaving the house, skip the drive-thru window and instead have them help prepare a sack breakfast the night before. A mini bagel with cream cheese, a peanut butter and jelly sandwich or a piece of fruit and a bag of dry, unsweetened cereal can be eaten on the school bus or during morning recess. Alternatively, many schools now offer a breakfast before the bell rings.

Should kids be given a daily vitamin-mineral supplement if they don’t eat vegetables or drink much milk?

Each food group supplies kids with a unique mix of vitamins and minerals. So children who don’t get these vitamins and minerals miss out on essential nutrients needed for growth and development. But the fact that your kid cringes at the sight of broccoli doesn’t necessarily mean you should resort to a supplement as a substitute. Most nutrition experts still recommend whole foods in place of supplements for healthy, growing children. According to Cynthia Chall-Silva, MS, RD, LD, a pediatric dietitian at Presbyterian Healthcare Services in Albuquerque, New Mexico, “Although a vitamin supplement is likely harmless, it will not contain fiber or sufficient amounts of calcium to meet the needs of a growing child.”

Kids who don’t drink milk or eat the recommended daily amount of vegetables may be getting inadequate amounts of calcium and vitamins A and D. Calcium and vitamin A are two of the major nutrients of concern during childhood and adolescence; inadequate intake can affect bone building and energy production, as well as overall health.

Three to four servings of low-fat dairy foods, including milk, yogurt and cheese, will meet the daily calcium needs of children and adolescents. For children diagnosed as lactose intolerant, lactose-free milk is now readily available in most areas. Some kids are even able to tolerate cheese and yogurt despite having trouble with milk digestion. Another option is to give kids calcium-fortified foods, such as 100% fruit juice and cereal.

Getting your kids to eat their veggies may take a bit more effort and creativity. The best way to introduce vegetables to kids is to start when they are young and to offer a variety of foods and preparations. Don’t give up if a vegetable is refused at first, as it sometimes takes a dozen attempts before a child accepts it. As with any behavior that parents want their kids to learn, adults must lead by example. “Parents who eat vegetables have kids who eat vegetables,” says Chall-Silva. She recommends involving children as much as possible in meal preparation, since some veggies may be less offensive when kids have a hand in the washing, tossing or chopping.

Kid-Friendly Tip. Have your kids create a list of their favorite veggies categorized by color. Teach them that each color provides different vitamins, minerals and powerful plant components (for more on this, see “Color Me Healthy” on page 71 of this month’s Food for Thought section). Adding colorful foods is a great way to make meals and snacks more exciting while teaching kids about nutrition.

How do I make sure my kids are getting enough protein?

Eating a variety of foods from plants and animals will ensure that your children get the protein they need for growth, development and maintenance. Choosing 3–4 servings from the dairy group will also contribute to their daily protein needs and supply the calcium required for bone building.

Meats, poultry, fish, eggs, beans and nuts are excellent sources of protein. It is recommended that children and adolescents get 2–3 servings a day from these types of foods. The servings should be spread throughout the day, with a good source of protein provided at every meal.

Even parents who are vegetarians can meet the protein goals of their children by serving them dairy foods and eggs. However, it can be a challenge to meet daily requirements for vitamin B12, calcium and iron when all animal products are eliminated from a child’s diet. In such cases, daily consumption of beans, nuts, seeds, peanut butter and soy products, paired with grains, fruits and vegetables, will supply plenty of protein, but careful menu planning is needed to meet overall nutrient needs.

Kid-Friendly Tip. To make meal planning fun and educational for your kids, compare recommended serving portions of protein sources to the sizes of common items that kids play with. Here are some examples:

  • 3 ounces of meat, poultry or fish (the size of a deck of cards)
  • 1/2 cup of beans (the size of a tennis ball)
  • 2 tablespoons of peanut butter (the size of a table tennis ball)
    Do active teens need special foods for extra energy? How do I keep them hydrated?

In general, an athlete’s performance can be enhanced by a healthy diet, and the growing teen is no exception to this rule. According to Jenna A. Bell-Wilson, PhD, RD, LD, IDEA’s nutrition contributing editor and assistant professor of medical dietetics at Ohio State University, “It’s not so much that active teens require special foods for extra energy, but they do need ample calories, carbohydrates and protein to support their active lifestyles and demands during growth.” Nutrition experts recommend that to grow properly and prosper in their sports, active teens consume a high carbohydrate intake from whole grains and other fiber-dense foods, along with lean protein sources and healthy-fat options.

It is also important that parents pay attention to when their teen athletes consume meals and snacks. “Performance will suffer if teenagers train ‘starved,’ and they will not achieve optimal results in an event if they are running on empty.” The pre-event meal, which should be high in carbohydrate, moderate in protein and low in fat, is best consumed 1–3 hours before the event. Bell-Wilson also suggests giving teens a high-carbohydrate snack with protein immediately after an event or a workout, to aid recovery.

It is vital that active teens drink enough water to avoid dehydration. To ensure adequate fluid intake, they should get in the habit of carrying a water bottle around and drinking water before, during and after an event or a training session. Here are the latest recommendations as to what and when active teens should drink (Kundrat 2005):

  • 2–3 cups of water 2 hours prior to the event or workout
  • another cup 10–15 minutes prior to exercise
  • at least 3/4–1 1/2 cups every 15 minutes while exercising
  • at least 2–3 cups after exercise for every pound of weight loss

Sports drinks are popular among teens and are appropriate during long bouts of physical activity (i.e., longer than 90 minutes) to replace lost water, glucose and electrolytes.

Kid-Friendly Tips. After an event, offer teens tasty but portable high–carb snacks with protein, like yogurt cups, small packets of cheese and crackers, or a peanut butter and jelly sandwich on whole wheat; for more ideas, see “Quick & Healthy After-School Snacks,” above. To prevent dehydration, teach teens to monitor their hydration status by checking the color of their urine, which should be light and clear (dark urine indicates the need for more fluids).

What are the healthiest options for kids when we eat at a fast-food establishment?

The busy lives of families today have dictated a change in priorities, with many parents reduced to making dietary choices based on convenience, cost and taste. As a result, fast foods have become a regular part of our children’s diets. Unfortunately, these easy foods are loaded with calories, saturated fat, sodium and sugar and few, if any, vitamins and minerals.

That’s bad news for kids who eat a steady diet of fast foods. But there is hope on the horizon, says Monique Derricote, MBA, registered dietitian with San Juan Unified School District in Carmichael, California. More and more fast-food chains are beginning to recognize the importance of good nutrition and are responding to the childhood obesity dilemma by revamping their menus. Many are now offering fruit and vegetables instead of fries, and milk instead of soda.

These are positive changes, but will kids who are left to their own devices really choose apple slices over fries? They will if parents set strict limits and expectations for their kids. One way to teach young kids how to make healthy fast-food choices is by talking to them about what they will order before you arrive at that drive-up window. For example, suggest that they skip the sweetened beverages and opt for plain milk. This is also an opportunity to teach kids about serving sizes and to discourage ordering “supersized” portions. According to Derricote, “Most kids’ meals provide smaller portion sizes that are more appropriate for a child than regular menu items.”

Teens present a greater challenge, as they have more freedom and make more food choices out of the house. They also want to get the most bang for their buck. Teach them the value of making nutrient-dense choices, such as a turkey sandwich on wheat with a small bag of pretzels and unsweetened iced tea or a grilled chicken salad with low-fat dressing, baked potato and milk.

Kid-Friendly Tip. Derricote recommends that families eat fast food no more than three times per week and fill the remaining evenings with quick, easy meals like soup and sandwiches. She adds that it takes just 15 minutes to plan weekly meals—an easy step that families can do together to eat more nutritiously. (For more on healthy fast food, see “Cooking Quick, Healthy Meals at Home” in the October 2004 issue of IDEA Fitness Journal.)

My slim 12-year-old daughter complains about the way she looks, and she refuses to eat certain foods because she’s afraid of getting fat. What do I do?

In a culture obsessed with weight and dieting, it is not surprising that what kids see and hear can give rise to a fear of eating. But such fear can lead to a lifetime of unhealthy eating practices and fad dieting. Avoiding certain foods during adolescence can be risky, since teenagers need a variety of foods to supply the nutrients they need for growth, bone building and learning. During puberty, teens—especially girls—can become preoccupied with their appearance and set unrealistic expectations for how they should look.

Take any opportunity available to encourage discussion of body image and dissatisfaction with your own teen. Stress the importance of proper nutrition during puberty by connecting a healthy diet to the types of things that matter most to kids (again, especially girls)—for example, a healthy complexion or athletic or school performance. Puberty is also a good time to dispel myths about disordered-eating practices. If a teenage girl is avoiding carbohydrates because she fears they will make her fat, describe the positive role that carbs play in providing the energy she needs to participate in school and sport activities. Being supportive and understanding will help keep the dialog open.

Kid-Friendly Tip. None of these dialogs will matter if parents themselves harbor negative body image or resort to disordered eating. Parents or older siblings who are dieting, preoccupied with weight or constantly talking about how fat they feel will instill those attitudes and fears in their children or younger siblings. On the other hand, parents who have positive relationships with food teach their children that meals are meant to be a source of nourishment as well as enjoyment.

I always thought that my son would “grow out of his weight” like his father, but he keeps gaining. What should I do?

According to the Centers for Disease Control and Prevention (CDC), more than 16% of American kids are now considered overweight (CDC 2003). Unfortunately, overweight children and adolescents are also more likely to be overweight as adults, which increases their risk for developing a host of life-threatening diseases (Freedman et al. 2001).

Poor eating habits, physical inactivity and family history all play a role in childhood weight gain. While some kids will “grow out” of their weight during the adolescent growth spurt, this is not the case with all children. An appropriate goal for children and adolescents who are growing in height is weight maintenance or slow weight gain. Diets are not recommended for growing kids and teens. That’s because calorie restriction can be harmful if kids don’t get the energy and nutrients they need for proper growth and development. (In rare cases, a physician will prescribe a certain food plan for an adolescent with a serious medical condition, such as high blood pressure; a dietitian will then monitor the plan.) Instead of weight loss, parents should emphasize positive eating and physical activity changes.

Here are some other suggestions for parents:

  • Eat dinner together as a family so you can monitor what your kids are eating daily.
  • Sit down at the table, where you can teach kids how to eat more slowly, pay attention to their hunger and avoid the mindless eating that can occur when watching television.
  • Involve kids in planning the weekly menu, shopping for food and preparing the meals.
  • Make high-fiber fruits and vegetables a part of every meal.
  • To prevent kids from sneaking food or overeating, focus on offering lower-calorie, nutrient-rich meals and snacks without severely restricting food intake.
  • Buy healthier foods and keep them easily accessible in the fridge and cupboards and on the counter.
  • Because most kids eat the first thing they see, keep sweets, chips and soda out of sight or out of the house.
  • Limit consumption of sweetened beverages, including soda and fruit drinks, to once or twice a week. A 12-ounce can of regular soda contains 150 calories and 10 teaspoons of sugar. Three cans of regular soda a week contribute 450 sugar calories, which can add up to 7 extra pounds a year!
  • Reduce television watching and computer/video time to no more than 2 hours a day, as recommended by the American Academy of Pediatrics.
  • Promote physical activity as a family by taking walks, playing outdoor games and riding bikes together.
  • Purchase toys that require movement rather than gifts that cultivate inactivity.

Kid-Friendly Tip. Teach kids about appropriate portion sizes by downloading an online quiz prepared by the National Institutes of Health (see http://hin.nhlbi.nih.gov/portion/); this test illustrates for kids (and adults) how many servings they are eating in a typical portion.

Teach Your Children Well

Getting kids and teens to eat well isn’t always easy. The best way to build positive eating habits and teach your children about nutritious foods is to serve as a good role model in your own right. Plan meals and snacks together as a family unit to increase kids’ acceptance of foods and underscore the importance of meal planning.

The lifestyle of your children will have an incredible influence on their current and future health. Encouraging and supporting kids can empower them to build healthy physical activity and eating habits that will last a lifetime.

References

Centers for Disease Control and Prevention (CDC). 2003. Statistics on overweight children and adolescents 6–18 years of age, according to sex, age, race and Hispanic origin. www.cdc.gov/nchs/hus.htm; accessed November 14, 2004.

Freedman, D.S., et al. 2001. Relationship of childhood obesity to coronary heart disease risk factors in adulthood: The Bogalusa heart study. Pediatrics, 108 (3), 712–18.

Kundrat, S. 2005. 101 Sports Nutrition Tips. Monterey, CA: Coaches Choice. Scheduled for release in 2005.

Pollitt, E., & Mathews, R. 1998. Breakfast and cognition: An integrative summary. American Journal of Clinical Nutrition, 67 (Suppl.), 804S–13S.

IDEA Fitness Journal, Volume 2, Issue 3

© 2005 by IDEA Health & Fitness Inc. All rights reserved. Reproduction without permission is strictly prohibited.

About the Author

Jennie McCary, MS, RD, LD

Jennie McCary, MS, RD, LD IDEA Author/Presenter

You can pose your own question to our contributing editor Jennie McCary, MS, RD, LD, a registered dietitian and worksite wellness consultant with Presbyterian Health Plan. Please send your questions, ...