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Eating Well

Children’s nutrition is a wide-ranging topic that may well seem overwhelming to a new mother, or to a family looking to make a change to a healthier lifestyle.  What follows are some tips to get you started, but please consult some of my references for more detailed and interesting information.  Remember that one of the best ways to help your child learn to eat a healthy diet is to have parents do so, as well.
 
FATS: 

These are necessary for energy (9 cal per gram), brain development, use of fat-soluble vitamins, healthy skin, production of hormones, and to carry foods’ flavors.  We all need fat in our diets, but choose wisely - look for the “good” monounsaturated and polyunsaturated fats (liquid fats, found in canola, olive and nut oils) rather than the “bad” saturated (or hydrogenated) fats found in meats, dairy, margarines and many processed foods (the solid fats). The omega-3 fatty acids, found in canola, soy, flax, walnuts and seafood are particularly beneficial in reducing heart disease and contributing to brain development. 

*Infants require about 50% of calories from fat, children around 30% and adults 10-25% with less than 10% coming from saturated fats.
*Look for natural peanut-butters, avocado, hummus, pumpkin/sunflower seeds, soy products, nuts, eggs (in moderation), low fat dairy products.
*Beware of “non-fat” treats - these often have a lot of added sugars to improve taste and texture.
*Try to pair carbohydrates with a protein or small amount of fat - the snack will be more satisfying and longer-lasting.
*Don’t ban favorite high-fat, high-calorie snacks, try to find acceptable replacements (i.e. low fat frozen yogurt for ice-cream) or limit potion size and pair with a healthier alternative (one oreo with graham crackers)
*Poach, broil, or bake foods with a light spray of canola or olive oil instead of sautéing or frying.
*DO NOT put children on very low fat diets (concentrate on the good fats).
 
CARBOHYDRATES:

The body’s main source of energy, carbohydrates may make up over 50% of your daily calories.  Try to maximize complex carbohydrates (starches and fibers) which take longer to digest and avoid “sugar highs”, while minimizing simple carbohydrates (sucrose-table sugar, corn syrup, glucose/dextrose, lactose, and honey.) 
*Sorbitol, a common sugar replacer, can cause gas, bloating and diarrhea.  It is also found in prunes, pears and cherries (good for constipation!)
* A food’s glycemic index (GI) is a measure of how quickly a carbohydrate is absorbed.  Foods with a low GI are absorbed into the bloodstream more slowly and trigger a slower insulin response, giving a steadier blood-sugar level and a steadier mood.  A low glycemic diet may decrease the risk of diabetes.  Low GI foods include soy, beans, lentils, dairy, chickpeas, oatmeal, sweet potatoes.
*The fructose in fruits, while a simple sugar, is digested more slowly because of the fibers in fruit- therefore fruit is a great sweet snack (while fruit juice, without the fiber, is NOT.)
 
PROTEIN:

Proteins are needed to grow and repair organs, muscles, antibodies, hormones and enzymes.  Infants need at least 14 grams per day, children ages 1-6 need 16-24 grams, and ages 7-15 between 28-75 grams.  However, it is rare, even in picky toddler diets, to not get enough protein.  While protein is also hard to overdose, we do not recommend the “high-protein, Atkin type” diet for children (ask your MD about individual cases.)
Proteins are made up of amino-acids, of which there are the non-essential form (the body can make these) and the essential form (which the body must obtain from foods.) A complete protein contains all of the essential amino acids (i.e.animal proteins, soybeans).  Plant proteins are incomplete, meaning you must mix and match these sources to obtain all of the essential proteins (important in a vegetarian diet).

Common combinations include whole grains plus legumes (rice and beans), grains plus dairy (pizza), and vegetables plus dairy (broccoli with cheese sauce).

*Vegetarians should get special dietary guidance to ensure they receive “complete” proteins as well as adequate vitamins and minerals. 
*Great protein sources - fish, egg white, low or nonfat dairy products, skinless poultry, beans, tofu, peanut butter, nuts/seeds, whole wheat products.
 
CALCIUM:

Most children do not get nearly enough calcium in their diets.  Calcium is needed for bony growth, nerve and muscle function, and proper blood clotting.  The best way to avoid osteoporosis of the bones is to combine a calcium-rich diet and exercise early in life. 

Daily minimum calcium requirements are:
  •         Infants to 1 yr: 400-600 mg
  •         Children 1-10 yr: 800 mg
  •         Preteen, teens: 1,200-1,500 mg
  •         Adults: 1,200 mg

*Calcium is best absorbed in small frequent amounts (do not take large supplements once a day.)  Lactose, found in dairy, and vitamin C facilitates absorption of calcium (OJ with calcium).  Soft drinks actually decrease calcium absorption.
*Best calcium sources:  Dairy products, sardines, Ca fortified OJ and cereals/breads, tofu, salmon, beans, broccoli, spinach, greens, almonds, papaya, oranges.
 
IRON:

Iron is necessary to make hemoglobin, which helps red cells carry oxygen throughout the body.  Iron also helps nerves function.  Iron deficiency can cause both mental and physical fatigue.  Iron is found in animal tissue (the darker the meat, the more iron-rich), as well as egg yolk and dairy.  Iron is also found in plant foods, but is much harder to absorb.  Vitamin C and meats can enhance absorption of plant iron. 
Babies are born with large iron reserves, which last between 6-12 months, however, without breastmilk or iron-fortified formula these reserves are quickly outgrown.  We check childrens’ hemoglobin levels at 9 mos, 1/2/4 years of age since picky toddlers often do not get enough iron.  Infants, if not breast-fed, should always receive iron-fortified formula with rare exception.  Teens and menstruating females also need extra iron.

*Best iron sources:  meats and poultry, seafood, beans, chickpeas, potatoes with skin, lentils, artichoke, sweet potato, tomato paste, whole wheat bread, Cream of Wheat, amaranth, barley and quinoa (grains), dried apricots, peaches, prune juice, raisins, tofu, blackstrap molasses, nuts.
 
VITAMINS:

Vitamins provide no calories yet are vital in helping your body metabolize foods.  Most children eating a reasonable diet do not need vitamin supplements.  Fruits contain mostly the same vitamins as vegetables, so maximize fruits for your picky eaters.  You cannot overdose on vitamins in food (other than vitamin A, in extreme cases.)  However, overdoing vitamin supplements in children can be harmful- treat these as medications, not “healthy candies.” 
 
GENERAL HEALTHY EATING TIPS
 
Don’t use the word “diet” - we try to eat healthy foods to feel good, have energy and stay well - not just to lose weight.
 
Try to limit TV and computer time to 1-2 hours per day (more if needed for homework) and focus on physical activities; limit snacking/meals in front of TV (mindless eating).
 
Don’t force child to finish meals (although limit between-meal snacks to healthy alternatives).
 
Don’t use food as a reward, or make dessert contingent on finishing dinner (try to make dessert a part of a healthy dinner-i.e. fruit, yogurt with mix-ins, milkshakes).
 
Encourage children to cook with you, they will usually eat/try something new if they helped prepare it.
 
Challenge your child to eat a “rainbow” everyday (each color fruit and vegetable contains different vitamins).
 
 
SNACKING IDEAS
 
Breads:
Low fat crackers      graham crackers
Bread sticks            pretzels
Bagels                    baked chips
Vanilla wafers          trail mix
Rice cakes              air-popped popcorn
Low fat muffins
Cereal (cheerios, special K. bran flakes, rice krispies…if child used to sugared cereal, add a small amount of sugar variety to healthier option)
 
 
Dairy:
Low fat milk                     low fat cheese
Low fat cottage cheese     yogurt (try plain/vanilla with granola, fresh fruit)
Low fat ricotta cheese        fruit smoothies
Low fat frozen yogurt         string cheese
 
 
Fruit/vegetable:
All fruits
Non-sugared frozen fruit pops
Unsweetened juices (fruit or vegetable)
Veggie plate (carrot, celery, cukes, broccoli, grape tomatoes) - add low fat dip/ peanut butter
Snow peas/snap peas
Frozen grapes/bananas
Corn-on-the-cob
 
Protein:
Hard boiled eggs
Turkey/lean ham slices
Peanut butter/nuts
 
Examples of fun/healthy snacks:
Milkshake with ¼ cup low fat frozen yogurt, fat-free milk and ½ chocolate sandwich cookie.
Trail mix (use low sugar cereal, dried fruits, granola, nuts, few carob chips)
Fondue (melt low fat cheese with fat free milk, serve cubes apple/pear and whole wheat bread on sticks)
Homemade baked goods (use canola oil or applesauce for fat)
Vegetable soup
Wafer cones with sorbet and berries.
Chicken nuggets baked with skinless chicken breast
Homemade pizza with whole grain English muffin, reduced fat cheese, veggies
Macaroni and cheese with reduced fat cheddar, fat-free milk, and frozen veggies
Smoothie with low fat yogurt, calcium fortified orange juice and berries
Apple/pear slices with cheese or peanut butter
Pretzels with peanut butter
“Ants on a log”-Celery sticks with peanut butter or cream cheese and raisins
Tortillas with lean chicken breast, reduced-fat cheese and reduced fat sour cream
Juice with seltzer instead of soda
Baked fries (slice potatoes, shake in plastic bag with small amount canola oil, salt, pepper and other seasonings, roast at 400 degrees)
Omelets made with 1 whole egg to 1-2 egg whites- add low fat cheese, veggies
 
RESOURCES:
 
The Yale Guide to Children’s Nutrition, edited by William V. Tamborlane M.D.
The Family Nutrition Book, by William Sears M.D. and Martha Sears R.N.
Good Enough to Eat- a kids guide to food and nutrition, by Lizzy Rockwell
Ending the Food Fight, by David Ludwig, M.D., Ph.D.
In Defense of Food, by Michael Pollan
Cooking Light magazine