A Healthier You - Chapter 12. Healthier Children

Many of us touch the lives of children in some way. We have an opportunity to give children the building blocks they need to lead a healthy lifestyle. As parents, doctors, educators, extended family, or friends—we are all in a position to set good examples. By teaching children the importance of good nutrition and regular physical activity early, they’ll learn good habits to last a lifetime. Whether it’s a family effort or simply taking advantage of the time spent with children, healthy choices start with all of us.

Since children are growing, sometimes it’s hard to know their weight status—are they overweight or will they "grow" out of it? We know that maintaining a healthy weight throughout childhood and adolescence may reduce the risk of becoming an overweight or obese adult. Just as you determined your own Body Mass Index (BMI) in chapter 4, "Where to Start," the same can be done for children and adolescents. However, their BMI is age- and gender-specific using growth curve charts. You can get an idea of the weight status of your child by looking at the growth chart for boys 2 to 20 years in part V, "Dietary Guidelines for Americans, 2005," figure 3, or at: www.cdc.gov/growthcharts for additional growth charts. This is best done with the help of your child’s doctor.

Always check with your child’s health care provider about your child’s rate of growth and development before starting him or her on any type of weight-gain or weight-loss diet. A health care provider can give you good nutrition and weight management approaches that take into consideration that your child is growing and developing. This is especially important if your child has a medical condition or is on medication.

For children 2+ | A smart start
Eat smart. | Play time can be physical activity time.

For children 2+

The keys to healthy eating are variety, balance, and moderation. Just as you determined the amount of food from each food group that was right for you, children and adolescents have amounts that are right for them, too. You can estimate the amount of calories your child should be eating each day as you did for yourself. Turn to page 16 in chapter 4, "Where to Start," and compare your child’s age and gender with his or her activity level to determine the approximate number of calories she or he should be eating each day. Then, you can look at the eating plans in appendix A and choose one that fits your child’s calorie needs. Be sure to check with your doctor to get his or her advice before you make any specific changes.

Here are some additional considerations to take when finding a healthy eating plan for your child.

Whole grains: Everyone, including kids, should consume whole-grain products often, and at least half the grains they eat should be whole grains. Think whole-grain cereals and sandwiches made with whole wheat bread, but be sure to check the ingredient list for "whole wheat."

Calcium: Because calcium is important for growing bones, children 2 to 8 years should consume 2 cups per day of fat-free or low-fat milk or equivalent milk products. Children 9 years and older should consume 3 cups per day of fat-free or low-fat milk or equivalent milk products.

Fruits and Vegetables: The number of fruits and vegetables children should eat is determined by their calorie needs. Figure this out the same way you did for yourself. First, estimate your child’s activity level and compare that to the table found in chapter 4, "Where to Start." From there, you’ll be able to determine how many calories your child should be eating, along with what is the best healthy eating pattern to follow—including the right number of fruits and vegetables. (See appendix A, for Eating Patterns.)

Fats and Salt: It’s important for us to know how much total fat and the types of fat we eat (for example, saturated and trans fats) and the same holds true for children. When kids reach 2 years, it is time to start watching the types of fat and how much salt they eat. Children who eat high saturated fats or salt (sodium) diets can be at risk of high blood cholesterol and high blood pressure just like adults. That’s why total fat intake should be kept between 30 and 35 percent of calories for children ages 2 to 3 years, and between 25 and 35 percent of calories for children and adolescents ages 4 to 18. Most fats should come from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts, and vegetable oils. Following the eating plans, at the calorie needs for your children, will help them get the nutrients they need to grow up healthy.

Cavity (caries) prevention: Consider how many sugary snacks (think cavities!) your children are eating. Sugary snacks contain calories, but few or no essential nutrients, and may increase the chance that your kids will get cavities. Some helpful tips to reduce cavities: regular brushing, fluoride toothpaste, and fluoridated water. Also replace sugary snacks with healthy snacks—fruits, vegetables, and whole grains can make a difference.

Food Safety: In addition to the general food safety precautions you’ll find in this book, there are a couple of special considerations when it comes to children and food safety. Infants and young children should not eat or drink raw (unpasteurized) milk or any products made from unpasteurized milk, raw or partially cooked eggs or foods containing raw eggs, raw or undercooked meat and poultry, raw or undercooked fish or shellfish, unpasteurized juices, and raw sprouts. (For more information, visit www.cfsan.fda.gov.)

CARLOS IS A STAR!

I’m Carlos’s mom. My son is a fifth grader and doing well at school. He loves soccer—his room is covered with posters of his favorite team and his idol, David Beckham. He comes straight home from school every day and does his homework. Good, I thought? A couple of weeks ago, I asked him about soccer. He looked at me with tears and said, "The kids play soccer after school, but I never get picked. They all run faster than me and I get tired—I can’t keep up. Some of them teased me saying that I’m too fat." It just hurts me to see him so down on himself. He’s such a good kid.

I wanted to do something. I took him to the pediatrician for a checkup. The pediatrician examined Carlos and asked him how he was and a lot of questions about what he eats—sodas, french fries, other stuff…and what he likes to do— it was clear that the issue was Carlos’s weight. Our pediatrician reassured him that we could work on this together—including me! The pediatrician told us that overall, Carlos was healthy and would grow more, and that would help a lot. But he also explained that it would be helpful if Carlos paid more attention to what he was eating each day. The pediatrician emphasized, eyeing me—that it would be a good idea if the whole family tried to eat better as well—more fruits and vegetables…and low-fat milk instead of sugar sodas.

We started grocery shopping together so Carlos could pick out foods he liked and that are good for all of us. The pediatrician said Carlos needs at least 60 minutes of physical activity most days of the week, so we tried to come up with things to do each day—we kept a list in the kitchen for the entire week. It was hard at first, but now, Carlos is playing more and says he feels like he has more energy—and so does the whole family.

Yesterday, Carlos kicked his first field goal! His buddies jumped all over him. Carlos may not be a soccer star yet, but he’s my star! Just hearing him talk about his goal—and even seeing him head out the door to play in the afternoon, is worth it all.

A smart start

We’ve all had to balance, at one time or another, what children want with what’s best for them. Nobody wants to feel like they are denying a child certain types of food. Making smart choices doesn’t have to come down to this. Here are some tips and strategies that might help reach a healthy balance:

Try to keep track of children’s meal/snack and physical activity patterns so you can encourage a healthful lifestyle.
For younger children, the family setting is a good place to encourage them (along with the rest of the family) to eat a variety of differently colored vegetables and fruits each day. You can start their day with 100% fruit or vegetable juice. Slice fruit on top of a whole-grain cereal. Serve a salad with lunch and an apple as an afternoon snack. Include vegetables with dinner.
Remember: Fill your shopping cart with fruits, vegetables, nuts, and fat-free or low-fat milk and limit candy, soft drinks, chips, and cookies. Children will soon learn to make these types of smart food choices outside the home as well.
Choose a variety of foods. No single food or food group supplies all the nutrients in the amounts that you need for good health. If you plan for pizza one night, include other food or food groups by adding a salad, serving fat-free or low-fat milk, and having fruit for dessert.

Eat smart

Eating together is an ideal way for family and friends to spend time together and enjoy each other’s company. Whether you’re eating at home or eating out on the go, it’s important to eat smart. Check off some of the tips you can easily put into action. Try one or two at a time. Don’t bite off more than you can chew!

Be consistent. Establish a family meal routine, and set times for breakfast, lunch, dinner, and snacks. Eat together whenever possible.
Take charge of the foods children eat. When you serve a meal, a child can choose to eat it or not; but don’t offer to substitute a less healthy alternative when the child refuses to eat what you’ve served.
Limit children’s access to the refrigerator and snack cupboards.
Turn off the TV during meals, and limit children’s snacking when watching TV. It is easy to lose track of how much they are eating, especially if the snack is a bag of pretzels instead of a small bowl.
Serve a vegetable or fruit with every meal and at snack time.
Reward children with praise and fun activities rather than food.
Involve children in meal planning and food preparation. They are more likely to eat what they help to make.
While shopping and cooking, teach children about the food groups and the importance of a healthy eating plan. Throughout the day, help them choose the types and amounts of foods they need from the different food groups.
Teach children how to read food labels and use the quick guide to the percent Daily Value (% DV): 5% DV or less is low; 20% DV or more is high.
Use low-fat cooking methods such as baking, roasting, and grilling; and when you use oil, select those such as olive or canola oils.
Serve water and fat-free or low-fat milk, with and between meals. Children over 2 years should be encouraged to drink fat-free or low-fat milk. Whole milk is recommended for children from 1 to 2 years old. Check with your health care provider for feeding recommendations for younger children and those with special needs.
Teach children how to make wise food choices away from home—at school cafeterias, restaurants, and vending machines.
Teach children to pay attention to both the quality and quantity of their food choices. More food is not always better; they need to understand appropriate portion sizes.

Good nutrition and regular physical activity should be part of an overall healthy lifestyle. To grow healthfully, children must balance the calories they eat with what they use up being physically active.

Play time can be physical activity time.

Play is an important part of growing and developing. It allows children to learn, explore, and be physically active. All of this is critical for children to help strengthen muscles, bones, and joints, and it gives them the opportunity to gain confidence while having fun! Children need to get at least 60 minutes of physical activity on most, if not all, days of the week. Playing hopscotch, tossing a ball back and forth, and dancing, in addition to organized sports, are some good ways for your child to be active and learn important life skills along the way.

Moderate	Vigorous
Light yard work	Running
Walking	Swimming
Bicycling	Basketball

Some examples of activities listed by intensity of physical activity (see box). Your children can always step up the intensity by working harder!

Be a physically active role model and have fun with children. Since adults need 30 minutes of daily physical activity, play together! Then, make sure the child gets in another 30 minutes for a total of 60. Another 30 minutes is probably good for you, too.
Walk with children at every available opportunity—if possible to school or to the store on errands. Take a walk with family or friends after dinner instead of watching TV or playing computer games.
Plan active weekends. Include biking, hiking, skating, walking, or playing ball. Take a trip to the park, swimming pool, or ice skating rink. If you work on weekends, arrange a physically active play date for your child.
Offer to join children in their favorite physical activities, or enroll children in a group exercise program.
Include children in active chores such as dog walking, house cleaning, car washing, and yard work.
Limit physically inactive behavior such as TV watching and computer time.
Avoid using TV as a child-sitter or pacifier. Offer active alternatives to screen time—jumping rope, playing hide-and-seek, or running an errand. Children love it when you are active with them and share in what they do.
Keep TVs out of children’s rooms.
Give your children gifts that encourage physical activity—active games or sporting equipment.
Talk with your schools about ways to incorporate non-competitive physical activity during the day.

An easy and fun way to keep children active and eating right is to create a weekly calendar of healthy lifestyle activities. Use some of the ideas in this chapter to start building a healthy family (or "friends") plan that works for everyone’s schedule. Let everyone choose a weekly activity and take charge of it. Also, check out the kidfriendly recipes in part IV, "Recipes and Resources," to help empower children to prepare their own foods, with adult supervision, of course!