Young Children: Feed With Care!
This issue of Nutrition Spotlight looks at the many issues surrounding the feeding of the young child. We look at the need for snacks, caution regarding choking, the prevalence of obesity in children and issues about weight. New pediatric growth charts are announced, and the topic of food allergies in children is examined. We look at hydration needs of the young child, and the topic of food security for children is a focus. The needs of the vegetarian child are examined in this issue of the Spotlight. Childhood hunger is an issue in Kansas and across the nation, and the Spotlight takes a look.
Because of the magnitude of issues we need to address, this issue of
Nutrition Spotlight has expanded to 12 pages from its usual eight. We know
you need to know, and we know your time is valuable. We hope this issue assists
you in the role you play in the feeding of the young child.
Water: An Essential Need
There is no doubt that food plays a major role in childhood nutrition. Even more essential to the body than food is water, and it is very important that parents and caregivers pay attention to how much water a child needs and receives each day. Water should be offered to infants regularly once they are eating solid food. If the weather is hot and the caregiver is thirsty, the infant or small child probably is, too. Offer water and let the child drink it until thirst is quenched.
Water is necessary for body structure and as a solvent for minerals and other important compounds. Water is the key to transportation in the body, as it carries nutrients to and waste products away from the cells. The body relies upon water to help regulate body temperature. Water is lost by evaporation through the skin and respiratory tract, through perspiration, and through elimination. Only a very small amount of water is required for actual growth processes.
A healthy recommendation to parents and caregivers is to get your child used to thinking about water. Offer children a drink of water frequently - when they get up from a nap, when they 'pass through' the kitchen, before and after they go out to play. This focus on water will teach your child to check and notice when he or she is thirsty. Encourage children to carry a water bottle to sports practice and when biking or hiking. Carry water along to playgrounds, swimming and all sites of active play - offer water, because children often don't recognize or will ignore their thirst.
Snacks--A Healthy Part of Childhood
Sometimes people believe that snacking is bad for children, because they will "not be hungry at mealtime." Childhood nutrition experts and common logic tell us otherwise. Children have high energy needs, and their capacity for quantities of food is limited, so they need frequent opportunities to replenish calories. What IS important is when a child snacks, and making sure the snack is nutritious.
Offer snacks to children midway between their meals. Time the snack so that the child's appetite has returned after the previous meal, and will return following the snack before the next meal. It is helpful to plan for snacks and snack time as we would mealtimes, so snacks can be offered before the child is overly hungry.
What foods make good snacks? Any food that is appropriate for a meal will make a fine snack. To assure that a snack is satisfying, try to incorporate some protein, some carbohydrate and some fat into the snack food. Many healthy foods fit the snack profile--parents may want to experiment. Often, new or different foods will be accepted more readily as a snack than they might be at mealtime.
It is not necessary and probably not advisable to think of "snack foods" as those often identified in advertisements. Many "snack" beverages and foods are empty calories foods that are high in sugar and/or fat, with little other nutritional value. While it is true that children need energy, these calorie-dense foods may preclude tasty, healthful snacks that contain a variety of needed nutrients. Since snacks provide an important part of a child's total daily intake, it is wise to provide snacks that are delicious AND nutritious!
Don't Take a Chance on Choking
Choking is a concern for people of all ages. Foods that are especially problematic in blocking the air passageway include small hard foods, round-shaped foods, slippery foods that easily slide down the throat before they can be properly chewed, and sticky foods that can get stuck in the throat.
Toddlers and preschoolers are particularly at-risk. Children who are exploring their surroundings often find small objects. They need supervision to avoid a choking incident that could occur if they were to put potential hazards into their mouth.
Use caution and avoid offering young children foods that are:
Choking First-Aid Tips
Sources: Healthy Child Care America Newsletter. Winter 2000. American Academy of Pediatrics. Elk Grove Village, IL The American Dietetic Association's Complete Food and Nutrition Guide. Roberta Duyff. pp 414-415, 424. 1998.
Childhood Weight Issues--Where are We?
Obesity in America's children is an issue of considerable concern today. Nutrition Spotlight vol. 2 Issue 6 dealt with childhood obesity. In fact, the problem is frequently referred to as "epidemic" by government officials and scientists. Why are so many children overweight? What can be done to change the course of the epidemic?
The answer to the question of obesity in children is difficult and multi-faceted. According to an article appearing in Pediatrics, vol. 102, September 1998, data from the National Center for Health Statistics (NCHS) indicate that approximately one in five children in the US is now overweight. Upon examination, the identified problem appears to have many probable causes. The "epidemic" proportion of the problem of childhood obesity stems from the dramatic increase in the prevalence of childhood obesity between 1980 and 1990.
Dr. William Dietz, MD, PhD, Centers for Disease Control and Prevention, spoke on the contribution of diet and inactivity to childhood obesity at a symposium on the subject sponsored by the United States Department of Agriculture (USDA) in 1998. He reported that only about a third of adult obesity begins in childhood, but that obesity in adults that DOES begin in childhood tends to be more severe, with possible adverse effects. These effects include a dramatic ten-fold increase in the incident of non-insulin dependent diabetes in children from 1982 to 1994, according to Michael Goran, PhD, of the University of Alabama at Birmingham. Dietz also reported that there is no longer a regional effect on childhood obesity are now operating countrywide, rather than regionally.
Dietz found that eating patterns over the last 30 years have changed substantially. This is important because increasingly more meals are purchased outside of the home, and this food often has a higher caloric content than food prepared in the home. Portion sizes tend to be substantially larger, and Dietz believes this is integral to the obesity problem.
Decreased physical activity is also a critical part of the energy balance equation, according to Dietz. He cites the loss of safe opportunity for vigorous physical activity over the past 15 years as key in the child obesity dilemma. Increase inactivity is a two-fold concern; no activity is taking place, and often increased food consumption accompanies the sedentary behavior.
Goran concluded his discussion with the observation that nutrition health risk in children is no longer one of hunger or nutrient deficiencies. The risks of this century are going to be mediated by obesity - we are in an obesity-promoting environment with increased food availability and decreased availability for physical activity.
Hunger-- A Real Concern For Many Kansas Children
Many Kansans do not have access to an adequate supply of food, according to the Kansas Health Institute (KHI). The study, released in 1999, reveals that those most at risk for experiencing hunger include children living in households with a single parent, low-income persons, and African Americans. Of particular concern is the finding that Kansas children living in households headed by single females were nearly twice as likely as similar children in other parts of the country to report hunger in their households. Key findings of the study include:
*More than one-third of those reporting hunger in their household - approximately 35,000 - were children. This represents nearly one child out of every 20 in Kansas.
*Children living in households with a single parent were much more likely to lack a secure supply of food than those living with two parents.
*One Kansas child out of every four (27%) living in a single female-headed household reported hunger in their household during the past year. This is nearly twice the national average (14%) of hunger reported by similar children.
The KHI study was conducted at the request of the Campaign To End Childhood
Hunger in Kansas (CTECH). The study reviewed data from 1,418 persons in 571
households in Kansas randomly selected for the Current Population Survey Food
Security Supplement.
My Child Is Heavy-- What Do I Do?
Childhood obesity is on the increase in the US and globally. As more and more children become obese, concerned families and healthcare professionals ask what can be done. What can parents do? Here are some guidelines developed by Joanne P. Ikeda, MA, RD, University of California.
Source: If My Child Is Too Fat, What Should I do About It? by Joanne P. Ikeda, University of California.
New Pediatric Growth Charts Released
Health professionals, government officials and parents have awaited the release of new pediatric growth charts from the Centers for Disease Control (CDC). The new charts, released in late May, 2000, are not only updated and more representative of the US population, according to Donna E. Shalala, Health and Human Services Secretary, but they also now include a new assessment for body mass index (BMI). It is believed that this key tool will help identify weight problems early on in children. These growth charts are used by pediatricians, nurses and nutritionists to monitor children's growth.
Most parents are familiar with the original pediatric growth charts, used by health care providers since 1977. The growth charts consist of a series of curves called "percentiles" that illustrate the distribution in growth of children across the United States. The new BMI measure increase the usefulness of this tool significantly, Shalala says.
"One of the first questions people ask new parents is 'how much did your baby weigh?' From that moment on, growth charts are a reference point for health professionals and parents as their children grow into adolescence and adulthood," Secretary Shalala said at the National Nutrition Summit in Washington, D.C.
The revised pediatric growth charts more accurately reflect the nation's cultural and racial diversity, and track children and young people through age 20. Additionally, there is considerable improvement in the infant growth charts, where new data and improved statistical procedures have been useful in the revision process.
"Obesity is a condition that is difficult to treat clinically in children, so prevention is key," said CDC Director Jeffrey P. Koplan, M.D., M.P.H. "These new CDC growth charts are an important new tool to identify growth problems at an early age so we can better prevent excess weight gain."
The new pediatric growth charts are available from the CDC web site at this address: http://www.cdc.gov/growthcharts
Eating Breakfast Helps Kids Make the Grade!
Most parents realize that children who are well fed are healthier and cooperate, behave, work and learn better than children who are hungry. But it's a challenge to get kids fed before the bus comes and everyone leaves home to meet their morning schedules. And sometimes the family food budget is not enough to offer the nutritious foods that children need.
The School Breakfast Program offers nutritious foods to schoolchildren. Studies have shown that the School Breakfast Program provides one-fourth or more of a child's nutritional needs every school day. And when breakfast is available in their school, low-income children are more likely to eat breakfast then when there is no breakfast program.
A recent State of Minnesota Breakfast Study found that students who ate breakfast before starting school had a general increase in math grades and reading scores, increased student attention, reduced nurse visits and improved student behaviors. Parents felt that they were relieved of some of the stress of morning schedules. Parents also felt that their children were not always hungry before leaving home but often arrived at school ready to eat. The school breakfast was more consistent with their children's routines and nutritional needs.
The Wichita, KS, school district has been chosen as one of six districts across the United States to participate in School Breakfast study. During the next three years, selected schools in the Wichita school district will be offering free breakfasts to all students. Each morning, students will be offered cereal, milk, a bagel or muffin, juice or fruit, and sometimes a protein, such as string cheese. The purpose of this study is to document that children who are well-nourished will learn better. And, at the same time, busy parents (of any income) will appreciate the opportunity for their children to have a nutritious breakfast and to start the school day, ready to learn!
Take an Active Role in School Food Service
Parents can play a role in meals served to children and teens at school. Here are some ways parents can help children and teens choose healthful meals at school:
PB & J Surprise Muffins
Cooking with kids can be fun. Try these moist peanut butter muffins that have a hidden jelly or jam filling. Let the kids pick the flavor and put them in charge of spooning the surprise into the batter.
1. Preheat oven to 3750. Line a 12-cup muffin tin with paper liners. In a large bowl, combine flour, sugar, baking powder and salt.
2. In a separate bowl, mix the peanut butter with the egg; add the milk, a little at a time, then add the butter. Mix well.
3. Pour the wet batter into the bowl with the dry ingredients and stir gently to combine (the batter will be stiff).
4. Put a heaping tablespoon of batter in the bottom of each muffin cup. Use a finger to make an indentation in the center and put a teaspoon of jelly in the hole. Cover with another heaping tablespoon of batter, or enough to fill each cup about two thirds full. Spread the top batter gently until no jelly is visible.
5. Bake for 20 minutes; cool on a wire rack. Be careful - the jelly centers can get hot. Makes 12 muffins. For the perfect snack or nutritious breakfast, add a glass of milk and fruit.
Reprinted with permission by Family Fun Magazine, 800-289-4849.
Easy Breakfasts for Kids to Make
If kids are on their own in the morning, most can make these easy breakfast foods. They go down even "healthier" with juice or milk!
Cooking with Kids
Children enjoy helping in the kitchen and often are more willing to eat foods they help prepare. Children should be involved in all aspects of cooking, from gathering or purchasing ingredients to "reading" the recipe, to measuring, cutting, stirring and serving the completed food. Kids helping with the preparation of foods promotes independence and develops self-confidence.
Another goal in cooking with kids is to expose children to healthy foods. Children may choose nutritionally sound foods if they understand the role of food in good health. Talk about such facts as "milk makes strong bones" or "fruits provide natural sweetness" while cooking to help kids make the best, most nutritious choices.
It is important to give kitchen tasks that are appropriate for each child's age so that the job that can be done successfully. Give clear instructions, show how it is done, and let him practice. When children help with food preparation, remind them to wash hands using soap and water before and after handling food or utensils to prepare food. Expect a few spills, be patient and allow extra time for each task.
Cooking provides many opportunities for using all the senses - tasting, smelling, touching, seeing and hearing. Measuring, weighing and following sequential steps interest the child who is most comfortable with math and logic. The picture cooking method for many recipes is perfect for the child who visualizes things in order to understand and produce them. Cooking in a classroom is a great opportunity for many children who learn best by working with others. The main point of cooking with children is to have an enjoyable time together.
Recommended cookbooks to enjoy with children:
Children and Food Allergies
Few children have true food allergies. Fortunately, most of them who do, outgrow them. For those who don't, living with food allergies can require a special vigilance. In a food allergy, the immune systems overreact when an offending food is eaten, producing chemicals that trigger symptoms which can range from a mild annoyance to severe anaphylactic shock. These symptoms appear anywhere from minutes to two hours after the food is eaten. Some examples are: tingling sensation in the mouth, swelling of tongue and throat, difficulty in breathing, hives, vomiting, abdominal cramps, diarrhea, drop in blood pressure, loss of consciousness, and even death. The most common foods that can trigger a reaction in a sensitive child are: cow's milk, soy, wheat, and eggs. Peanuts, tree nuts, soy, fish ,shellfish, corn, and citrus are also potential allergens. Although most food allergies subside as a child matures, this is not generally the case when a child is allergic to peanuts, nuts or shellfish. In order to minimize the potential for allergies, the Academy of Pediatrics recommends that children who have a family history of food allergies wait until they are 24 months old before eating eggs, and 36 months before eating peanut butter. If a child develops a food allergy after the age of three, it is unlikely that he will outgrow it.
More commonly, children can have intolerances to foods that are often confused with allergies. A good example of this is lactose intolerance- the inability to digest the milk sugar lactose. It produces uncomfortable GI symptoms and is sometimes mistaken for a food allergy. However, since it does not involve the immune system, it is not a food allergy. It is not uncommon after an infection for a young child to have a temporary intolerance that will eventually correct itself.
If a parent suspects his child has food allergies, he should consult the child's physician . If testing confirms food allergies, the best treatment is total avoidance of the allergen. When adjusting a diet for a child with food allergies, it is important to try to substitute foods from the same food group of the Food Guide Pyramid. In that way, he can have a well-balanced diet. This is not easy when milk is the offending food as it is a source of many important nutrients. A calcium-fortified soy milk may be an alternative. In this case it will be important to provide a good source of protein and riboflavin (found in meat), a source of calcium (calcium- fortified juice or cereals) and a source of vitamin D (sunlight). The child's physician will monitor his weight and height to make certain that the restrictive diet doesn't impact his growth. In addition, a dietitian can be an asset in helping a family learn to work around the offending food to assure that the child's diet is nutritionally adequate.
It is important for anyone responsible for providing food for a child with food allergies to become familiar with common sources of food allergens. It is often not as clear cut as it may seem. Derivatives of an allergen may have many different names. Children old enough to read should begin to learn to read food labels. It is important to read the labels each and every time because manufacturers often change ingredients in their products. There is also the possibility that a manufacturer will use the same production line for different products, one of which may be an offending allergen. If in doubt, it is advisable to call the manufacture to ask about their product.
Maintaining a sense of normalcy is an important part of managing food allergies in children of all ages. For young children, this is accomplished, in part, by parents providing a variety of appropriate alternative foods that resemble the food the rest of the family is eating. It is tempting for a parent with a child with food allergies to be overly protective, but it is more beneficial to the child for them to teach him in a very matter-of-fact manner what he can eat and what he cannot eat. It is inevitable that a child will be faced with challenges as his world broadens. He will better prepared to handle difficult situations in coping with his food allergies at school or a friend's house if his parents have taught him age-appropriate responsibility for himself and his food allergy.
Source: Celide Barnes Koerner, Anne Munoz-Furlong. The American Dietetic Association Food Allergies. 1998. Ellyn Satter. Child of Mine: Feeding With Love and Good Sense. 1999.
Healthy Vegetarian Diet for Children
A "well-planned" vegetarian diet for a child can be a lacto-ovo vegetarian diet in which dairy products and eggs are consumed, or a vegan diet where only plant-based foods are consumed.
Adequate calories are important to support growth and development. This can be challenging for a young child as vegetarian diets are often high in fiber and low in fat. This filling effect may prevent a child from eating enough calories to sustain adequate growth. Caregivers can avoid this problem by offering: frequent small meals and snacks, nutrient dense foods such as peanut butter, avocado and dried fruit, and some lower fiber foods along with higher fiber foods. Substituting some fruit juice for whole pieces of fruit is an example of this.
In addition to calories, providing good sources of protein will help ensure normal growth and development. Milk, cheese and eggs are excellent sources for the lacto-ovo vegetarian. Vegans will want to consume legumes (lentils, peas and beans) and grains (whole wheat, rice, barley , corn), seed and nuts. For young children, it is best to offer the nuts and seeds in form of a butter, such as peanut butter, to minimize the possibility of choking and increase digestibility.
Including a good source of vitamin B12 in a child's diet is important for the production of red blood cells and nerve health. B12 is only found in foods of animal origin. If a child drinks milk or eats eggs he is getting B12. However, if he is a strict vegan, he will need to rely on foods such as vitamin B12- fortified cereal, fortified soy milk or nutritional yeast (Red Star T6635, which can be mixed in casseroles or bean dishes to minimize its flavor).
Calcium and vitamin D are vital for a growing child. A lacto-ovo vegetarian will get plenty. The vegan will need to consume plant sources such as calcium-fortified orange juice, calcium- fortified soy or rice milk, dark green vegetables such as collards, mustard greens or kale, and legumes. Incorporating greens in mixed dishes like casseroles may encourage consumption by picky eaters. Almonds and figs are also rich in calcium. Drinking milk is an excellent way to obtain vitamin D. A vegan will need an alternative source, such as fortified cereal or fortified soy milk. Light-skinned children who are exposed to the sun two-three times a week on their face and hands during the warmer months probably will get enough. Dark-skinned children may need a little more. A pediatrician may suggest a multi vitamin as an insurance policy.
Zinc and iron are two minerals essential for children's growth and development. They are found in plant sources, but are less bioavailable than in animal sources. Iron is found in foods such as fortified cereals, lentils, beans, broccoli, raisins, figs, even blackstrap molasses. It can be more readily absorbed if it is eaten with a good source of vitamin C such as citrus, tomatoes, broccoli, even potatoes. Zinc is also found in lentils and beans as well as whole grains, hard cheeses, fortified cereals, and tofu.
Finally, parents should discuss their child's diet with his pediatrician. It may be that she will recommend a multi-vitamin for insurance. If more help is needed, a dietitian can assist in individualizing a healthy vegetarian diet.
Tips for Helping a Vegetarian Child "Fit in" With Peers
As children grow older they will want to eat foods that their peers are eating. To help a child maintain her vegetarian diet and still "fit in" with her friends, it may help to send her to school with a traditional peanut butter sandwich or bologna made from soy. If she has begun eating out in fast food restaurants, a valuable strategy could be to review the menu and point out vegetarian foods like bean burritos. Encourage a child to invite her friends over for a cook-out where veggie burgers are served along with ever-popular guacamole, salsa and bean dip on corn tortillas. Food can be tasty regardless of whether it comes from plants or animals!
Source: Vegetarian Nutrition, A Practice Group of the American Dietetics Association. Vegetarian Nutrition for School-Aged Children. 1996.
Is Your Child a Picky Eater?
It is easy to recognize picky eaters very early in life. They may be the ones who act as though their infant formula just isn't quite what they would choose. As they progress to solid foods, they are even easier to identify. Before a picky eater gets to be a problem eater, there are skills and techniques that may help ease mealtime struggles and encourage even the pickiest eater to try a few bites of new, different, nutritious food at each meal.
Many sources are available to help parents and caregivers cope with the young, opinionated eater, but no one answer will work all the time. Whenever possible, try to include the child in the planning, shopping for and preparation of some meals. This sense of ownership may stimulate interest and curiosity, and could help 'sell' that first bite.
It is important to keep food and eating from becoming a focus of tension between you and your child. Don't worry if she or he skips an occasional meal, or seems to prefer only a single food for awhile. Parents and caregivers will do finicky children no favors by cooking special foods just for them and it might just make the power struggle worse. Instead, try to include some well-liked foods in each meal, along with foods that may be new, different or less popular. Be sure that conversation does not focus on food or the eating of the meal; instead, keep mealtimes positive and rewarding--an event kids would want to be included in!
Ground rules may make the meal go more smoothly. Teach children the polite way to refuse a food, and be sure kids and adults follow the rules. Don't let a child complain about individual dishes served, and make it clear that the meal will proceed for the rest of the family. If a meal is refused, it is important that the child understand there will be no food until the next scheduled snack or meal. Calm, consistent responses can soothe the picky eater's fussiness and allow a normal appetite to take over.
Below are A Dozen Ways to Get Kids to Try New Foods, courtesy of Dairy Council of the Upper Midwest. Try one, two or a few on a picky eater you know!
For a copy of the handout "A dozen ways to get kids to try new foods", contact the Dairy Council in your area, or Dairy Council of the Upper Midwest. 800.642.3895
Here's the latest issue of Nutrition Spotlight, focused on nutrition during childhood. It's part of our series of life-cycle nutrition issues. Next issue: Nutrition and the Adolescent.
To hear more about feeding young children, plan on attending a fall seminar September 27, 2000, featuring Ellyn Satter nationally recognized author and speaker on nutrition and feeding infants and children. The conference, to be held in Manhattan, Kansas, is co-sponsored by the Kansas Dietetic Association Foundation (KDAF) in conjunction with the Kansas Head Start Association and the Child and Adult Care Food Program.