Child Nutrition (5 Years and Up)

So back in my public health days, I worked for the Los Angeles County Department of Public Health’s department of Child and Adolescent Health. Much of my work was dedicated to creating an educational program that supported healthy diets and physical activity of pre-school and school-aged children. I spent hundreds of hours designing a program and performing bill analyses that were written to improve overweight and obesity in the LA Unified School District. So, for a portion of my early adulthood, this topic was my jam. 

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The diet of a 5-year old (and up) is very similar to what our diets, as adults, should resemble: healthy and lean meats, half of the plate consisting of a variety of brightly colored fruits and vegetables, whole grains (not refined white flour that has been stripped of its healthy fiber), etc. It’s hard enough for us to follow, but it is of paramount importance for us to get our kids off on the right foot in these early years. 

If you missed previous Nutrition in a Nutshell posts, click the links below

Nutrition in a Nutshell For Your Sprout: Infancy

Nutrition in a Nutshell For Your Sprout: Toddler & Pre-schooler

So, what should be the focus for these (still) growing sprouts? Here’s a summary:^1-9

• Be a healthy role model for your child! Eat as a family, eat a variety of fruits and vegetables, drink lots of water and limit fast food. Your child is watching your every move and wants to be like you, so make sure they have good habits after which to model their choices and behaviors.
• Start off the day with a good hearty and healthful breakfast! It gets the metabolism revved up for the day and prevents a mid-morning slump.
• Estimated calorie requirements per day, as determined by activity level:⁶
  • Female
    • Ages 4-8: 1200-1400 (sedentary), 1400-1600 (moderate), 1400-1800 (active)
    • Ages 9-13: 1400-1600 (sedentary), 1600-2000 (moderate), 1800-2200 (active)
  • Male
    • Ages 4-8: 1200-1400 (sedentary), 1400-1600 (moderate), 1600-2000 (active)
    • Ages 9-13: 1600-2000 (sedentary), 1800-2200 (moderate), 2000-2600 (active)
  • Activity:
    • sedentary: light physical activity; day-to-day stuff
    • moderate: equivalent of walking 1.5-3 miles/day at 3-4 miles per hour + light day-to-day stuff
    • active: equivalent of walking 3 miles/day at 3-4 miles per hour + light day-to-day stuff
  • Calorie ranges for younger kids follow the lower value and vice versa. For example, a sedentary 4-year old girl would be on the lower end at 1200 calories/day and an 8-year old on the upper end at 1400 calories/day. 
• No more than 1 serving (4 oz) of 100% fruit juice per day up to 6 years old. After 6, no more than 2 servings (4 oz each) per day.
• Healthy lean meats, beans, nuts, seeds for protein intake!
• Remember, to improve efficiency of iron absorption from meats, add a source of vitamin C with your child’s meal! (see “Nutrition in a Nutshell: Toddler and Preschooler” and sources below for more on iron intake)
• Sweet treats should be very limited!
• No caffeinated, sports, or energy drinks!!! Soda, coffee, tea, energy drinks, and sports drinks have no place in children’s diets. These are either riddled with excess sugar (soda, sports drinks), consist of tannins (coffee and teas) that prevent proper iron and calcium absorption, and the acidity in sodas eat away at tooth enamel making vulnerable for cavity growth and tooth decay. Remember, caffeine is a stimulant and triggers negative effects in both brain and heart activity that can be very harmful to your child.⁵ It elevates the heart rate (not in a good way) and can result in abnormal heart rhythms and higher blood pressure, and remember excess sugar results in elevated blood sugar which can lead to Type 2 Diabetes.
  

  “Water, not sports drinks, should be the principal source of hydration for children and adolescents” ~ AAP Press Room⁴ (Source below)

• Rather, offer fat-free/low-fat milk or water instead of other beverages. Amp up the appeal of water by adding fresh cucumber, lemon, lime, raspberries, fresh mint leaves, or strawberries to your child’s water for an extra boost of healthy natural flavor.
• (Again) Water is the best hydration fluid for children of all ages, EVEN ADOLESCENTS. Unless your child is competing in an intense, high-endurance, high-intensity, prolonged (more than a few hours) and vigorous activity like a triathlon, keep sports drinks and anything else away from them. The AAP even concurs on this.⁴
• Calcium and vitamin D in milk is the reason why it is your next go-to fluid for your growing little one.  (luckily I am drinking water as I write this instead of popping yet another piece of chocolate into my “I’m a nursing mother, so I can eat what I want” mouth)
• Consume grains (simple carbs) in the form of whole grain/wheat sources, NOT refined white flours. Whole grains have beneficial fiber, vitamins (B vitamins + folic acid), and minerals that are lost when refined and processed.⁶ 
• Avoid fast-food and junk food – for obvious reasons, these don’t contribute healthy vitamins and minerals to young kids’ calorie intake; rather, they fill up their intake with sodium-filled fatty and saturated calories. Did you know there are 19 ingredients in McDonald’s French Fries? (click here for source) They’re fried twice (which is probably why we think they taste so good), and even include sugar, hydrolyzed wheat and milk, and “beef flavor.” “From farm to restaurant”? I think there’s a lot of stuff that happens in between farm and restaurant: a whole lot of extra ingredients and processing. Don’t feed this crap to your growing kid.
• Remember, poor eating habits created early in childhood SIGNIFICANTLY and most definitely affect eating habits and lead to weight gain, obesity, activity levels, concentration, and high blood pressure (yes, even in young children! Recall from the post “Spice Up Your Sprout’s Meals!” where it is mentioned how high-sodium intakes are on the rise and there is a greater prevalence of pediatric hypertension and kidney disease!).
• I will say it again: Don’t get your kid started down a path to poor eating habits. This is not healthy. This is harmful. Childhood obesity is not something to be shrugged off, it is very serious and crippling even in young elementary school years.
• Boil, steam, or grill fruits and vegetables rather than frying. Grilled fresh pineapple rings and bell peppers sounds really good next to some grilled marinated chicken…
• Use unsaturated cooking fats when needed for meal preparation (those that are liquid at room temperature; I use canola or olive oil but it doesn’t have a high smoke point so it does burn if you’re not watching it) or use healthy coconut oil, which is cited from Today’s Dietitian⁸ as a saturated fat that is unique in that it is instead comprised of healthful and anti-oxidating medium-chain fatty acids (versus long-chain saturated fats).  Check the resource below for expanded benefits of its use.
• Limit their sodium intake. Adequate Intake levels of sodium (the amount designated by the Institute of Medicine, needed to meet the physiological needs) for young children 9 years and up to adulthood is 1500 mg sodium per day. It is 1200 mg/day for 4-8 year olds.⁶ (Even though this post is about 5 and up, it is 1000 mg/day ages 1-3) The average American from age 2 to over 70 years old consumes way more than necessary, on average 2300 mg/day.
  

  Remember, higher sodium intake = higher blood pressure (if you recall osmotic pressures in high school science, water follows sodium. If you have a high sodium intake = increase water retention = more volume for your heart and arteries to work with = heart strain = high blood pressure = heart weakens over time = heart failure = other organs like the kidneys and lungs suffer). This effect is seen in the pediatric population too, so don’t think your kid has “plenty of years to recover.” Start healthy habits early! ~Myself; ICU nursing and well, science. 

  

  Source: Dietary Guidelines for Americans (2010)

  • For example, 1 McDonald’s cheeseburger (680 mg) has more than 50% of the daily allowable intake (1200 mg) of sodium for one entire day for a kid 4-8 years old. Add kids fries (65 mg sodium) = 745 mg = 62% of their day’s sodium.
  • Read your nutrition labels!
• 60 minutes of physical activity each day!
• Servings for Food Groups for 4-8 year old children:
  • Grains: (at least half of your daily grains should be whole grains)
    • 5 ounces per day (1 oz  = 1 slice of bread, 1 cup cereal, 1 cup cooked pasta/rice)
  • Vegetables: (fresh/frozen/canned)
    • 1 1/2 cups per day (1 cup = 1 cup cooked or raw veggies or 2 cups leafy vegetables)
  • Fruits: (fresh/frozen/canned. If frozen, canned or packaged, choose fruit plain or in water or fruit juice, NOT syrup! Read ingredients list for items without added sugar!)
    • 1 1/2 cups per day (1 cup = 1 cup fruit or 1/2 cup dried fruit)
  • Dairy: (milk, cheese, yogurt)
    • 2 1/2 cups per day (1 cup = 1 cup milk or yogurt, 1.5 ounces of natural cheese (size of 6 dice)
  • Protein foods: (meat, poultry, beans, seafood, eggs, nuts, and seeds)
    • 4 ounces/day (1 oz = 1 egg, 1 tablespoon peanut butter, 1 ounce lean meat, poultry, or fish, 1/2 cup cooked from dry beans, 1/2 oz nuts)
• Avoid items that list “high fructose corn syrup.” Bad for the liver and overall health, bad for our kids!
  • Many research studies find a correlative effect of this sugary additive with not only obesity, but also with hepatic (liver) damage, damaging insulin receptors on the liver, suggested to result in (non-alcoholic) fatty liver disease, metabolic syndrome (↑ in blood pressure, blood sugar, abdominal fat, bad cholesterol → heart disease, stroke, diabetes), and obesity.
  • Really everyone should avoid this, but I felt I should mention it here! (The systematic literature review published in the American Journal of Clinical Nutrition here)
  • If you’re interested in a more in-depth review of HFCS on liver function, go to my PubMed search results on HFCS and health to read the many research studies on its effects. 
• As always, make mealtime and fitness/activity FUN! We want kids to keep a healthful attitude towards healthy eating and lifestyle habits, and those values and perspectives start very early in toddlerhood!

Nutrition in a Nutshell For Your Sprout: Infancy

Nutrition in a Nutshell For Your Sprout: Toddler & Pre-Schooler

Sources:

1. National Library of Medicine (National Institutes of Health): Child Nutrition. http://www.nlm.nih.gov/medlineplus/childnutrition.html (Lots of extra resources at this link)

2. USDA NAL (Nat’l Agricultural Library): Child Nutrition http://fnic.nal.usda.gov/lifecycle-nutrition/child-nutrition

3. Branum A., Rossen L., Schoendorf K. Trends in Caffeine Intake Among US Children and Adolescents. Pediatrics. 2014. 133(3): 386-393. http://pediatrics.aappublications.org/content/133/3/386.full.pdf+html

4. AAP Press Room: Kids Should Not Consume Energy Drinks and Rarely Need Sports Drinks, Says AAP. (May 2011) https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/Kids-Should-Not-Consume-Energy-Drinks,-and-Rarely-Need-Sports-Drinks,-Says-AAP.aspx

5. Clinical Report – Sports Drinks and Energy Drinks For Children and Adolescents: Are they Appropriate? Pediatrics. June 2011; 127(6): 1182-89. (published online May 2011) http://pediatrics.aappublications.org/content/early/2011/05/25/peds.2011-0965.full.pdf

6. USDA & DHHS Dietary Guidelines for Americans 2010: http://www.health.gov/dietaryguidelines/dga2010/dietaryguidelines2010.pdf

7. ChooseMyPlate.gov: Health & Nutrition Information for Children over 5 http://www.choosemyplate.gov/children-over-five.html

8. Agalaée Jacob, MS RD CDE “Coconut Oil” – Today’s Dietitian 15(10): 56. Oct 2013 http://www.todaysdietitian.com/newarchives/100713p56.shtml

9. Wanda Koszewski, Nutrition Specialist: University of Nebraska Institute of Agriculture and Natural Resources Nutrition for the School-Aged Child. (reference from USDA) http://www.ianrpubs.unl.edu/epublic/live/g1086/build/g1086.pdf

More on Iron:

Iron Supplementation in Pediatrics: http://depts.washington.edu/nutr/student_projects/dietetic/Supplements/2012/Iron%20in%20Pediatrics_2012.pdf

National Institutes of Health: Iron http://ods.od.nih.gov/factsheets/Iron-HealthProfessional/

UCLA S.N.A.C. http://www.dining.ucla.edu/housing_site/dining/SNAC_pdf/PumpingTheIron.pdf

CDC.gov Nutrition for Everyone – Iron and Iron Deficiency: http://www.cdc.gov/nutrition/everyone/basics/vitamins/iron.html