From picky eaters to overeating: childhood nutrition in a nutshell
By Charles E. Crutchfield III, MD and Tamiko Morgan, M.D., FAAP
Childhood nutrition has taken the spotlight recently, especially due to the fact that childhood obesity has at least tripled in the past three decades. Many parents are seeking answers to the questions “What should my child eat? How much? Why?”
Although we are currently living in the “information age,” information overload has caused some parents to be confused, making it challenging for them to understand good nutritional recommendations. In this column, we will attempt to summarize some basic recommendations regarding childhood nutrition.
Infants (birth to one year)
Milk is the primary source of food in this age group. Breast milk is preferred, but whether it is breast milk, formula, or a combination of the two, this is the infant’s only requirement for the first six months of life.
Vitamin D supplementation is recommended for breastfed infants, since breast milk alone does not contain enough to meet daily recommended requirements of this vitamin.
Solid foods should be introduced at six months of age. Start gradually and avoid foods with high salt and sugar. Soft pureed foods are recommended (baby cereals/foods, pureed vegetables, etc.) with slow introduction of more textured foods as the infant is able to chew. It’s OK to introduce fruit juice at this age, but no more than four ounces a day. Water is acceptable at this age and preferred over juice, though generally not needed the first year of life.
Behaviors related to eating at this age: Look for feeding cues in young infants. When the infant is able to sit unsupported, placing in a highchair to feed is recommended.
Toddlers/preschool (one to four years)
It is important to offer a healthful selection of foods at this age. Variety is key, especially with fruits and vegetables. Refer to www.choosemyplate.gov for serving sizes and food groups, or get specific recommendations from your child’s medical provider.
Milk can be introduced at one year of age. Most agree that whole milk is appropriate until age two; then transition to reduced fat milk. Depending on the individual needs of your child, however, this recommendation may vary.
Soy, rice and almond milk are also alternatives to those who do not tolerate cow’s milk (or parental preference). Twenty-four ounces (no more than two to three cups a day) is recommended. Calcium and vitamin D are important for strong bones and teeth. Cheese, yogurt, and foods fortified with these are also options.
Foods high in fiber are important for bowel regularity, as well as other important health benefits. Fresh fruits and vegetables are a good source.
Limit processed foods and foods high in fat, salt and sugar. No sodas! Juice is still limited to four to six ounces a day. Drink water.
Behaviors related to eating at this age: You may experience an age-related decrease in appetite in the early toddler years. Don’t force your child to eat. Don’t’ fret about the “picky eater” — some children may need up to 15 exposures of a food before accepting that new food!
Aim to wean off the bottle by 12-15 months. No sleeping with bottles! Healthy modeling by parents on what foods to eat and eating at the table together are key!
School age (five to 13 years)
Continue to offer a variety of foods (following recommended food pyramid for servings and portion sizes).
Three meals and one or two snacks (low in fat, salt, sugar; may need to pack lunch for school to assure healthy selections) are recommended.
Continue reduced fat milk. Limit sugar-sweetened beverages. Fiber and whole grains continue to be important. Drink water.
Behaviors related to eating at this age: We recommend eating at the table with the television off. Your child may go through a “vegetarian phase” once they find out about meat. Just continue to offer healthy alternatives to meet requirements. A vitamin supplement may be necessary.
Generally, follow the same recommendations for school-age children; however, calcium needs are increased due to puberty and growth spurts. An additional serving of milk (or calcium alternative) should be added.
Refer to www.choosemyplate.gov for more information, especially for specific caloric needs based on the individual child and their lifestyle. An additional great resource is the program Letsmove.gov developed by First Lady Michelle Obama to help solve the epidemic of childhood obesity.
Iron is important for menstruating females, so make sure the diet is rich in iron-containing foods. Drink water.
Behaviors related to eating at this age: Recommend eating at table with family, television off. Have healthy “on-the-go” snacks available. Be familiar with signs of an eating disorder, which often present at this age.
Establishing healthy eating habits in childhood is key to building a strong foundation for good health and well-being as an adult. It is important to develop a routine that incorporates five servings of fruits and vegetables per day. This is the very best vitamin found in nature.
Also, five glasses of water per day is important, even more if one is actively perspiring. And don’t forget regular exercise: 20-30 minutes five times per week. As a parent, this responsibility starts with you; however, always remember that you are not alone in this journey, and there are plenty of people, like us, who are here to help you through!
Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He has been selected as one of the top 10 dermatologists in the U.S. by Black Enterprise magazine and one of the top 21 African American physicians in the U.S. by the Atlanta Post. Dr. Crutchfield is an active member of the Minnesota Association of Black Physicians, MABP.org.
Tamiko Morgan, M.D., FAAP, is a board-certified pediatrician and author of VIP Very Important Patient: The African-American Woman’s Guide to Health Care, Healing, & Wellness.