Let HEALTH...: Nutrition for Children and Teens

HELPING YOUR KIDS DEVELOP HEALTHY EATING HABITS

Good nutrition is the bedrock of lifelong health, and it begins in infancy. Healthy eating can stabilize children’s energy, sharpen their minds, and even out their moods. Unfortunately, kids are bombarded by messages that can counteract your efforts. Between peer pressure and the constant television commercials for junk foods, getting children to eat well might seem more futile than fruitful.

However, there are simple steps that parents can take to instill healthy eating habits in their kids, without turning mealtimes into a battle zone. By encouraging healthy eating habits now, you can make a huge impact on your children’s lifelong relationship with food and give them the best opportunity to grow into healthy, confident adults.

Developing healthy eating habits

Children develop a natural preference for the foods they enjoy the most, so the challenge is to make healthy choices appealing. No matter how good your intentions, trying to convince your eight-year-old that an apple is as sweet a treat as a cookie is not a recipe for success! However, you can ensure that your children’s diet is as nutritious and wholesome as possible, even while allowing for some of their favorite treats.

The childhood impulse to imitate is strong, so it’s important you act as a role model for your kids. It’s no good asking your child to eat fruit and vegetables while you gorge on potato chips and soda.

Top tips to promote healthy childhood eating

Have regular family meals. Knowing dinner is served at approximately the same time every night and that the entire family will be sitting down together is comforting and enhances appetite. Breakfast is another great time for a family meal, especially since kids who eat breakfast tend to do better in school.
Cook more meals at home. Eating home cooked meals is healthier for the whole family and sets a great example for kids about the importance of food. Restaurant meals tend to have more fat, sugar, and salt. Save dining out for special occasions.
Get kids involved. Children enjoy helping adults grocery shop, selecting what goes in their lunch box, and preparing dinner. It's also a chance for you to teach them about the nutritional values of different foods, and (for older children) how to read food labels.
Make a variety of healthy snacks available instead of empty calorie snacks. Keep plenty of fruits, vegetables, whole grain snacks, and healthy beverages (water, milk, pure fruit juice) around and easily accessible so kids become used to reaching for healthy snacks instead of empty calorie snacks like soda, chips, or cookies.
Limit portion sizes. Don’t insist your child cleans the plate, and never use food as a reward or bribe.

For information on making smart nutrition decisions for you and your family, see Healthy Eating.

How can I get my picky child to enjoy a wider variety of foods?

Picky eaters are going through a normal developmental stage, exerting control over their environment and expressing concern about trusting the unfamiliar. Many picky eaters also prefer a “separate compartmented plate,” where one type of food doesn’t touch another. Just as it takes numerous repetitions for advertising to convince an adult consumer to buy, it takes most children 8-10 presentations of a new food before they will openly accept it.

Rather than simply insist your child eat a new food, try the following:

Offer a new food only when your child is hungry and rested.
Present only one new food at a time.
Make it fun: a game, a play-filled experience. Cut the food into unusual shapes.
Serve new foods with favorite foods to increase acceptance.
Eat the new food yourself; children love to imitate.
Have your child help to prepare foods. Often they will be more willing to try something when they helped to make it.
Limit beverages. Picky eaters often fill up on liquids instead.
Limit snacks to two per day.

Persuading children to eat more fruit and vegetables

Making mealtimes playful can mean healthier eating for your kids. Here are some fun, creative ways to add more fruit and vegetables to your child's diet:

Top a bowl of whole grain cereal with a smiley face: banana slices for eyes, raisins for nose, peach or apple slice for mouth.
Create a food collage. Use broccoli florets for trees, carrots and celery for flowers, cauliflower for clouds, and a yellow squash for a sun. Then eat your masterpiece!
Make frozen fruit kabobs for kids using pineapple chunks, bananas, grapes, and berries.
Go food shopping with your children. Let them see all the different fruits and vegetables and have them pick out new ones to try.
Try fruit smoothies for a quick healthy breakfast or afternoon snack.
Add vegetables and fruits to baked goods – blueberry pancakes, zucchini bread, carrot muffins.
Add extra veggies to soups, stews, and sauces, grated or shredded to make them blend in.
Keep lots of fresh fruit and veggies washed and available as snacks. Apples, pears, bananas, grapes, figs, carrot and celery sticks are all easy to eat on the run. Add yogurt, nut butter, or tahini for extra protein.

Limit sugar and salt

One of the biggest challenges for parents is to limit the amount of sugar and salt in their children’s diets.

Limiting sugar

The American Heart Association recommends that sugar intake for children is limited to 3 teaspoons (12 grams) a day. Cutting back on candy and cookies is only part of the solution. Large amounts of added sugar can also be hidden in foods such as bread, canned soups and vegetables, frozen dinners, ketchup, and fast food.

Don’t ban sweets entirely. Having a no sweets rule is an invitation for cravings and overindulging when given the chance.
Give recipes a makeover. Many recipes taste just as good with less sugar.
Avoid sugary drinks. One 12-oz soda has about 10 teaspoons of sugar in it, more than three times the daily recommended limit for children! Try adding a splash of fruit juice to sparkling water instead.
Cut down on processed foods, such as white bread and cakes, which cause blood sugar to go up and down, and can leave kids tired and sapped of energy.
Create your own popsicles and frozen treats. Freeze 100% fruit juice in an ice-cube tray with plastic spoons as popsicle handles. Or try freezing grapes, berries, banana pieces, or peach slices, then topping with a little chocolate sauce or whipped cream for an amazing treat.

Limiting salt

One teaspoon of salt contains about 2,300 mg of sodium. Some guidelines for the maximum salt intake for children:

If a child is…	They should eat less than…
1 to 3 years old	1,500 milligrams a day
4 to 8 years old	1,900 milligrams a day
9 to 13 years old	2,200 milligrams a day
14 to 18	2,300 milligrams a day

Avoid processed, packaged, restaurant, and fast food. Processed foods like canned soups or frozen dinners contain hidden sodium that quickly surpasses the recommended limit. Many fast food meals are also loaded with sodium.
Opt for fresh or frozen vegetables instead of canned vegetables.
Cut back on salty snacks such as potato chips, nuts, and pretzels.
Choose low-salt or reduced-sodium products.

Healthy eating for toddlers and young children

Toddlers can be introduced to new tastes and textures as they transition from baby food to “real” food. Keep in mind that toddlers have very small stomachs. It may be better to feed them 5-6 small meals a day, rather than three large ones.

Depending on age, size, and activity level, your toddler needs between 1,000-1,400 calories a day. It is perfectly normal for your child to be ravenous one day and shun food the next. Don’t worry if your child’s diet isn’t up to par every day—as long as he or she seems satisfied and is getting a well-rounded diet.

Nutritional needs of toddlers and young children

An important part of a toddler’s diet is calcium (they need about 500 mg/day), and the best source of this nutrient is milk. Until the age of two they should drink whole milk, but older toddlers can usually switch to 2% or skim milk if approved by your pediatrician. If your kids are lactose intolerant or don’t like dairy, incorporate calcium-rich foods like fortified soy products, cereals, and orange juice.

Toddlers need 7mg a day to prevent iron deficiency, which can affect growth, learning, and behavior. In infancy, breast-milk has a readily-absorbed type of iron, and baby formula and food is usually iron-fortified, so babies don’t need to worry about getting enough iron. After switching to “real” food, it's important to ensure that your child is eating good sources of iron like fortified cereals, small amounts of red meat (like soft meatballs), or eggs.

Dietary guidelines for toddlers and young children
Fruits and vegetables	Two servings each per day. These may be given as snacks, such as apple or carrot slices. Also try adding veggies to soups.
Whole grains	Four daily servings. Can include buckwheat pancakes or multigrain toast for breakfast, a sandwich on wheat bread for lunch and brown rice or another whole grain as part of the evening meal.
Milk and dairy	Three servings, or one pint of whole milk per day. Cheeses, yogurt and milk puddings are useful alternatives.
Protein	Two servings a day. Encourage your child to try a variety of proteins, such as turkey, eggs, fish, chicken, lamb, baked beans, and lentils.
Vitamins and minerals	Check with your child's doctor to be certain their diet is adequately meeting the recommended nutritional needs for this age group

Healthy diets for school-age children

Eating becomes a social activity in this stage of life. Your kids probably spend more time in school than they do at home; eat meals at friends’ houses; and adopt eating habits from their peers. It can be difficult to ensure they are getting adequate nutrition when you are not around to monitor their choices, so try to maintain regular family mealtimes.

For kids aged 5-12, the key word is variety. Creative serving ideas will go a long way towards maintaining the healthy eating habits established in the first years of life.

Not only do family meals provide an opportunity to catch up on your kids’ daily lives, they also enable you to “teach by example.” Let your kids see you eating a wide variety of healthy foods while keeping your portions in check. Refrain from obsessive calorie counting, though, or commenting on your own weight, so that kids don’t adopt negative associations with food.

Nutrition guidelines for school-age kids

As children develop, they require the same healthy foods adults eat, along with more vitamins and minerals to support growing bodies. This means whole grains (whole wheat, oats, barley, rice, millet, quinoa); a wide variety of fresh fruits and vegetables; calcium for growing bones (milk, yogurt, or substitutes if lactose intolerant); and healthy proteins (fish, eggs, poultry, lean meat, nuts, and seeds).

Healthy fats are also important:

Monounsaturated fats, from plant oils like canola oil, peanut oil, and olive oil, as well as avocados, nuts (like almonds, hazelnuts, and pecans), and seeds (such as pumpkin, sesame).
Polyunsaturated fats, including Omega-3 and Omega-6 fatty acids, found in fatty fish, such as salmon, herring, mackerel, anchovies, and sardines, or in unheated sunflower, corn, soybean, and flaxseed oils, and walnuts.

Kids, like the rest of us, should limit:

Trans fats, found in vegetable shortenings, some margarines, crackers, candies, cookies, snack foods, fried foods, baked goods, and other processed foods made with partially hydrogenated vegetable oils.

See Healthy Fats for more information on “good” and “bad” dietary fat.

Dietary guidelines for school age children
Vegetables	3-5 servings per day. A serving might be one cup of raw leafy vegetables, 3/4 cup of vegetable juice, or 1/2 cup of other vegetables, raw or cooked.
Fruits	2-4 servings per day. A serving may consist of 1/2 cup of sliced fruit, 3/4 cup of fruit juice, or a medium-size whole fruit, such as an apple, banana or pear.
Whole Grains	6-11 servings per day. Each serving should equal one slice of bread, 1/2 cup of rice or 1 ounce of cereal.
Protein	2-3 servings of 2-3 ounces of cooked lean meat, poultry, or fish per day. A serving in this group may also consist of 1/2 cup of cooked dry beans, one egg, or 2 tablespoons of peanut butter for each ounce of lean meat.
Dairy products	2-3 servings (cups) per day of low-fat milk or yogurt, or natural cheese (1.5 ounces=one serving).
Zinc	Studies indicate that zinc may improve memory and school performance, especially in boys. Good sources of zinc are oysters, beef, pork, liver, dried beans and peas, whole grains, fortified cereals, nuts, milk, cocoa, and poultry.

The special nutritional needs of teenagers

This is growth spurt time: kids gain about 20% of adult height and 50% of adult weight during adolescence. Because growth and change is so rapid during this period, the requirements for all nutrients increase. This is especially true of calcium and iron.

Eating disorders in teens

Adolescents and teens are at a high risk of developing anorexia, bulimia, or binge eating disorder. To learn the warning signs, see Helping Someone with an Eating Disorder.

Eating habits, however, are pretty well set by now, and if your child's choices are less than ideal, it can be a challenging time for a course correction. The best way to make teen dietary changes is to present information about short-term consequences of a poor diet: appearance, athletic ability, energy, and enjoyment of life. These are more important to most teens than long-term health. For example, “Calcium will help you grow taller.” “Iron will help you do better on tests and stay up later.”

Special nutritional needs for teens
Calories	Due to all the growth and activity, adolescent boys need 2,500-2,800 per day, while girls need around 2,200 per day. It’s best to get these calories from lean protein, low-fat dairy, whole grains, and fruits and veggies.
Protein	In order for the body to grow and maintain muscle, teens need 45-60 grams per day. Most teenagers easily meet this need from eating meat, fish, and dairy, but vegetarians may need to increase their protein intake from non-animal sources like soy foods, beans and nuts.
Calcium	Many teens do not get sufficient amounts of calcium, leading to weak bones and osteoporosis later in life. Encourage teens to cut back on soda and other overly-sugary foods, which suck calcium from bones. The 1,200 mg of calcium needed per day should come from dairy, calcium-fortified juice and cereal, and other calcium-rich foods such as sesame seeds and leafy greens like spinach.
Iron	Iron deficiency can lead to anemia, fatigue, and weakness. Boys need 12 mg each day, and teen girls, who often lose iron during menstruation, need 15 mg. Iron-rich foods include red meat, chicken, beans, nuts, enriched whole grains, and leafy greens like spinach and kale.

A “weighty” problem: children, weight and self esteem

Children who are substantially overweight or obese are at greater risk for cardiovascular disease, bone and joint problems, sleep apnea, and poor self-esteem, as well as long-term health problems in adulthood. While childhood obesity doesn’t always lead to obesity in adulthood, it does raise the risks dramatically. The majority of children who are overweight during preschool or elementary school are still overweight as they enter their teens. Most kids do not outgrow the problem.

Addressing weight problems in children requires a coordinated plan of physical activity and healthy nutrition. Unless directed by your child’s doctor, though, the treatment for childhood obesity is not weight loss. The goal should be to slow or halt weight gain, thereby allowing your child to grow into his or her ideal weight.

Think of exercise as a food group in your kid’s diet

Add physical activity to your child’s day, just as you would add fruit or veggies. To encourage physical activity, play with your kids - throw around a football; go cycling, skating, or swimming; take family walks and hikes; and help your kids find activities they enjoy by showing them different possibilities. The benefits of lifelong exercise are abundant and regular exercise can even help motivate your kids to make healthy food choices.

For ways to help your child reach and maintain a healthy weight, see Childhood Obesity and Overweight Kids

Kids and junk food

No matter how well parents promote healthy eating, it can be difficult for any kid to avoid the temptation of junk food.

Instead of eliminating junk food entirely, which tends to increase cravings even more, try substituting some healthier alternatives.

Kid-friendly junk food alternatives
Instead of…	Try…
French fries Ice cream Fried chicken Doughnuts or pastries Chocolate-chip cookies Potato chips	“Baked fries” grilled in the oven and salted lightly Low-fat frozen yogurt; sorbet; fresh fruit smoothies Baked or grilled chicken Bagels; English muffins; home baked goods with less sugar/fat Graham crackers, fig bars, vanilla wafers, fruit and caramel dip Pretzels, unbuttered popcorn, baked potato chips, soy crisps

Eating out with kids: fast food and restaurant nutrition for children

It might be challenging to persuade your youngster to order a salad instead of a cheeseburger, but you can steer them towards healthier options. Some important tips to remember about fast food and restaurant dining for kids:

Avoid sodas – Kids should drink water or milk instead.
Avoid chicken nuggets – Unhealthy imposters of real chicken.
Skip the fries – Consider taking along a bag of mini carrots, grapes, or other fruits and vegetables to have instead. This will add vitamins and fiber to the meal.
Order the kid's meal with some substitutions – Children often love the kid's meal more for the fun box and toys than for the food. Ask to substitute healthier choices for the soda and the fries if possible.
Opt for chicken and vegetables or spaghetti with tomato sauce in a sit-down restaurant, rather than a big plate of macaroni and cheese.