Nutrition: Childhood and Adolescence
Nutrition: Childhood and Adolescence
A few months ago I wrote about nutrition in infants and toddlers. Now I would like to address some nutritional issues in childhood and adolescence. To most of us it’s not news that obesity is one of our nation’s biggest health problems. It’s not just what we eat, it’s our sedentary lifestyle.
The school year is half over. We are between two high calorie holidays. The weather is changing making outdoor activities even more challenging for some.
I share the following information knowing full well that life-stye changes are among the most difficult to accomplish. But if you are looking for New Year’s Resolutions, you might consider the following. I am speaking of family life-style changes, not changes for an individual child, tween or teenager. Asking a child to make changes while the family continues unhealthy habits, even if weight is not an issue, is patently unfair and, moreover, doomed to failure. If any of the following suggestions appeal to you as a family, fine. Go for it! If you find them difficult to implement, ask your doctor for referrals to professionals who can help you with family life-style changes (counselors, psychologists, dietitians, personal trainers, etc).
SOME GOOD NEW YEAR’S RESOLUTIONS & BASIC PRINCIPLES:
- Make every effort to have at least one family meal together every day.
- Create a house-rule: NO electronics during meals. That includes TV, texting, cell phone, I-pad, computers, etc.
- Parents’ meal-time responsibility is to put out a healthy variety of foods on the table for the meal and to create a pleasant atmosphere. It is not to monitor, advise, or choreograph what a child or teenager eats. There is much research to show that people over time eat what they need, perhaps not at every meal, but certainly over a few days to a week or so. Humans rarely create a nutritional deficiency with odd eating behaviors. If you feel your humans-at-the -able consistently eat an inadequate variety of food-stuffs, get help from your doctor.
- Teach table manners and health hygiene: how to wash hands and clean nails, set a table, bus the dishes to the dish-washer after a meal, etc. We are not born with this knowledge. Your future sons-in-law and daughters-in-law will certainly appreciate basic etiquette in their family lives.
- Teach and implement 5-2-1-0: At least five servings of fruits and veggies a day; no more than two hours of electronic entertainment a day of what parents approve of (TV, computer, electronic games, texting); at least one hour of physical activity a day, whether sport, play or house/yard chores; and ZERO sugary sodas. Encourage nutritional liquids at meals & snacks__ milk or milk substitutes (soy, yogurt drinks, etc.). Limit juices to less than 6 ounces a day. Allow water ad lib between meals.
- Provide fruits and veggies the colors of the rainbow at meals and snacks for a full diversity of minerals and vitamins.
- Reduce refined flour white breads and increase whole grain breads and pastas; more brown rice and less white rice to increase intestinal fiber which is sorely lacking in most of our diets.
- Teach food shopping, kitchen skills and safety as your children mature. If you allow them to prepare a meal or prepare a meal with your child, be polite and consume it with them at mealtime.
- Keep meal-time full of pleasant family conversation and avoid hot-trigger topics that will predictably lead to contention and indigestion.
- If you are not certain what a healthy snack or dessert is, ask your pediatrician for a dietitian referral to learn the real scoop. Not every snack or dessert has to be sugary and calorie rich.
Now for some extreme and challenging suggestions for the strong-of-heart and those fully committed to a family life-style change.
- If there is no time in a family for physical activity and too much sedentary activity consider this family challenge: Box up your TV’s and put them in the basement, or get electronic locks for the TV’s (yes, they do exist) and do other activities__ walk, play, clean, read, share, etc. Offer the family a significant family reward, perhaps a vacation trip, for a NO TV Contract for 6-12 months.
- Walk your kids to the school bus stop, instead of driving them there (weather permitting, and I am not talking about cold temperatures). It will be good for all of you. If there are no side walks to do this safely, get political and lobby for them in your neighborhood.
- If your child’s school has soda and food dispensing machines with less than healthy content, get political and lobby your school and school board for healthier alternative food-stuffs in the machines (milk, water, OJ) and for salad-bars for a lunch alternative.
- If your child packs a lunch to school, create its content wisely. To minimize excessive warming of food in the lunch box, wrap food with bubble wrapping and include more than one ice pack. One freezer pack has been found to be inadequate to prevent growth of bacteria in packed lunches.
- Wouldn’t it be nice if our kids could ride their bikes to school, but traffic and the road system being what they are, this is not possible to do safely for most kids. But once again parents could wax political and lobby our city governments for wider bike lanes, safer street crossings, etc.
So take from this list and do what you can for the health benefits to you and your kids. If you find it difficult to implement even in part, do not be surprised or disheartened. A family meeting to discuss the pros and cons of life-style changes will be appreciated from kids who are old enough to have an opinion. If your plan is met with resistance or outright rebellion, talk with your doctor to find helpers to smooth out the bumps in the road on the way to a healthier family life-style.
I am sure there will never be a pill to make it all better. Vitamins are only vitamins; they are not protein, carbohydrates, fats, minerals, fiber, etc. There is no “belly buster” way other than physical activity to burn calories. Personal trainers are not for everybody, even though they work. But when the trainer goes away, often so do the life style habits that are good for us and have not been internalized as routine daily positive behaviors.
With a little planning and creativity and some help from your health advisers, creating a healthier family life-style can even be fun. Good luck, Happy New Year and may the Force be with you this Holiday Season.
Marc A. Tanenbaum, MD/ Dr. T
404-654-0426
INFANCY:
- Pediatricians highly endorse breast feeding through the first year of life. There is growing evidence that breastfed babies have less overweight problems in later life. They learn to control their appetite more effectively than bottle fed babies. Besides an optimum source of nutrition, breast milk has immune benefits. Breast milk contains living white blood cells and antibodies, which although not perfect, can lead to less illness in nursing babies. Only vitamin D needs to be supplemented daily using infant drops, available as Vitamin D alone or in combination with Vitamins A, and C.
- Solid foods are encouraged starting at about 5 to 6 months of life. Babies really aren’t developmentally ready to chew foods much before then. Although traditionally babies have been started with iron-fortified infant cereals as their first foods, many pediatricians are now suggesting starting with pureed meats as first foods because meats are a superior source of iron. Believe it or not, iron-deficiency anemia is still a problem in older infants and toddlers. Iron is essential for healthy brain growth and development.
- Pediatricians still advise against putting pureed foods or cereals into infant bottles or bottle-feeders for many reasons. Firstly babies can’t say NO to finishing the bottle. As a result, they can receive excessive calories. We prefer parents offer baby pureed foods by spoon. Babies can say NO to this by turning their heads away, closing their mouths tightly, or spitting it out. Feedings from bottles are generally swallowed even if baby is full, but are often burped up later.
- Variety is the spice of life and the basis of sound nutrition. A parent’s duty is to offer a variety of cereals, fruits, veggies, meats, eggs and grains as the infant and toddler grows. Pediatricians differ in their specific dietary instructions but most follow the same general principles. Your doctor will be happy to discuss the “how to” with you.
TODDLERS:
- Parents should encourage their toddlers to feed themselves. Fingers are just fine__ messy, but OK. Parents can still supplement with the occasional spoon feeding, but let your toddler hold food pieces in his/her own hands. Many parents just spread an old shower curtain under the high chair to catch what’s thrown on the floor and facilitate the clean-up.
- Making your child finish everything on the plate is no longer the goal! A parent’s duty is to put out a safe variety of finger foods, in moderate amounts (so not much is wasted if not finished), colorfully and attractively presented on the plate or tray. “NO” is often not only the first word uttered by toddlers; it’s also often the body language expressed over food. When your toddler says no to a food item (taste, color or texture), just keep presenting the same food 10-15 times in subsequent meals. Usually it will be eventually taken and enjoyed. No lectures or explanations of health benefits to your toddlers, please! Stay calm, no bribes, keep smiling and re-offer. It’s the way of the world.
- So what’s safe food at this stage? PIECES, bite sized, soft, easily held, crushable and chewable (gummable), usually the size of your child’s thumb nail. Store bought is expensive, but convenient. Homemade is inexpensive, but a bit more work. It’s that simple. Until your child is 4-5 years of age it would be wise not to serve chokable items, e.g. whole nuts, raw veggies, or large chunks that can be aspirated into the lungs. If this sounds extreme, it isn’t. A few weeks ago, I sent a 2 ½ year old to the ER because his breath sounds were uneven when I listened with my stethoscope. He saw me for some minor reason, had minimal cough, seemed happy, but I could not explain his uneven breath sounds. He seemed generally well. On further questioning, Mom and Dad said that he had just started eating almonds 3 days earlier. He did not choke at all! The ER docs confirmed my observation and called in the ENT (ears, nose, throat) doc to consult. At 3 a.m. our friendly pediatric sub-specialist removed 3 almond pieces by bronchoscopy from the child’s windpipe. He did fine thereafter.
- Pureed nuts are fine. Yep, you heard me. The effort to prevent nut allergy by delaying nuts until after two years of age has been a total failure. The newest information is that offering pureed nuts in small amounts weekly during the first year of life (after 6-7 months of age) is more likely to prevent nut allergy than withholding nuts until the child is older. Now that’s a fascinating concept and worth talking to your pediatrician about.
More to come in future installments on nutrition in children and teenagers, and we’ll talk some about dental care too. Why not?? Any questions or comments, I’d love to hear from you.
Dr. T/ Marc Tanenbaum, MD
