Nutritionists Express Worries About Children Following Adult Diets : Guidelines for Grown-Ups--Harmful to Young?

Public nutrition information, by and large, is addressed to adults. Reducing calories, fats, sugar, cholesterol and sodium has been the battle cry for healthy adults since the government turned out its guidelines for disease prevention and good health in the late ‘70s.

But a shift in focus to children and their diets may be looming as awareness surfaces that diets suitable for adults may not apply to children.

According to nutritionists, a social preoccupation with thinness on one hand and overeating as a result of sedentary habits on the other has created confusion about children’s diets.

Despite good intentions, fear of obesity forces many of today’s slim-minded--and even health-minded--parents to impose adult dietary standards on children. (See accompanying story on Page 10.) For some children, such a practice may do more harm than good if the fact is ignored that children may require more calories than adults for proper growth.

“This could be a problem, depending on the extent to which modifications or restrictions are made,” said Linda Brown, chief therapeutic nutritionist of Childrens Hospital of Los Angeles. “There can be a definite problem if nonfat or low-fat milk is given to children under a year old, both in terms of protein load that is placed on developing kidneys and the normal requirements for essential fatty acids. We advise parents to consult pediatricians on the appropriate age for modifying fat content. Otherwise, a switch to low-fat milk (not nonfat) is probably acceptable at age 2 or more, provided that the child is growing normally and is consuming sufficient calories from other sources.”

Dr. Fima Lifshitz, at Cornell University Medical College cautions parents to “think twice” before modifying milk products in children’s diets. “I don’t think nonfat or low-fat milk is appropriate for children who are normal,” Lifshitz said. “They should be left alone to eat normally and naturally. If a child is overweight, then you might consider low-fat dairy products.”

Nutritionist Dr. Jerzy Meduski suggests maintaining whole milk until the child has achieved puberty as a safety precaution in providing the proper balance of essential fatty acids during the growing years.

It is scientifically known that caloric requirements are greater during children’s peak growing periods than during adult years.

For instance, caloric needs for school-age children 7 to 10 years old averages 2,400 calories per day, compared with about 2,000 for adult women, ages 23 to 50. Growing school-age boys may require as many as 3,300 calories if active, compared with 2,700 for men, ages 23 to 50. Even 2- and 3-year-old toddlers require a calorie range between 900 and 1,800 calories per day--as great as that of a maintenance diet for an adult (1,800 calories).

Resources are available for parents interested in healthful diets for their children.

The California Dietary Assn. is an excellent source for answering consumer questions about nutrition or for referrals to qualified dietitians in your area who can help design diets or offer group or private counseling. The 24-hour referral service telephone number: (213) 459-9343.

The U.S. Government Printing Office offers excellent nutrition information for appropriate children’s diets. For a catalogue list of many free or low-cost pamphlets and brochures on child nutrition, write: Consumer Information Catalogue, Pueblo, Colo. 81009.

A newly released book for parents, “Parents’ Guide to Nutrition: Healthy Eating From Birth Through Adolescence” by Dr. Susan Baker and Roberta R. Henry, registered dietitian of Boston Children’s Hospital (Addison-Wesley: $16.95), is also a good reference book. It explains basic principles of nutrition, including when to start infants on solid foods, how to maintain a balanced diet for school-age children, channeling teen-agers’ diets and other dietary problems.

There are specific dietary concerns to consider within each age group when planning overweight or normal-weight children’s diets or guiding their eating habits.

Brown commented on some of those concerns and provided guidelines for proper meal patterns. (See sample menus on Page 10.)

According to Brown, there should be no dietary problems if the four-food-group formula is used as the base for a good diet, no matter what age or sex.

The Basic Four Food Groups dietary system was devised by the U.S. Department of Agriculture several decades ago to ensure consumption of all the nutrients needed for good health. The groups are: the fruit and vegetable group, the dairy-product group, the meat group (includes fish, eggs, legumes and nuts) and the grains group. Servings from each of the food groups vary with each age group.

Brown advises that parents plan meals according to the food groups even though doing so may pose a challenge, especially with younger children who often prefer the same foods day after day.

Here are Brown’s tips on feeding children from 1 to 18, beginning with the toddlers:

Toddlers (ages 1 to 3)--They require an average of 1,300 calories, with a range from 900 to 1,800 calories, depending on the child’s size and activity level. It is important to offer foods several times during the day to avoid large meals, which toddlers cannot handle. “Overwhelming the child with too much food can dull the appetite,” Brown said.

Brown advises offering no more than four food items per meal. The majority of nutrients will probably come in the form of snacks, such as finger foods.

Finger foods can be used as part of each meal because toddlers are beginning to refine and develop finger skills, Brown said. “Finger foods are easy to eat, more fun and give a toddler a sense of mastery.”

Beware of “choke food,” which sometimes proves fatal.

Beware of ‘Choke Food’

According to Brown, the No. 1 choke food is the frankfurter, which breaks apart easily in the mouth and can plug the esophagus. Other foods not recommended for children younger than 3 are celery, popcorn, nuts, small or hard candies.

Preschoolers (ages 4 to 6)--This age group requires an average of 1,700 calories daily, with a range from 1,300 to 2,300 calories depending on a child’s size and activity level. The requirement for protein increases from 23 grams at toddler age to 30 grams at preschool age (adult average requirement is about 45 grams of protein).

Preschoolers are more receptive to a wider variety of foods, but prefer simply prepared, plain foods. Mixtures are usually shunned. Finger foods are still popular. Snacks become a more important part of getting total nutrient requirements because of increased activity.

Preschoolers are also good television watchers and are beginning to learn rapidly about fast foods. According to Brown, one of the chief problems with fast foods is their high-fat and high-sodium content. Parents should be aware that French fries, hamburgers and chicken entrees contain high percentages of fat in proportion to their nutrients.

A three-ounce bag of French fries, for instance, contains 210 calories with 45% of the calories from fat. Six fried, boneless chicken nuggets contain 350 calories (about 100 calories more than a plain hamburger), with 60% of the calories from fat (roughly three times the fat of a hamburger). A plain hamburger contains 250 calories with 32% of the calories from fat. Half of a 10-inch pizza (about three pieces) contains about 450 calories with 30% of the calories from fat. Add sausages, and the calorie count increases.

“Until recently it was almost impossible to get any fresh fruit or vegetable at a fast-food establishment. Now, however, they are putting in salad bars, although it does not seem to appeal to children,” Brown said.

One way to handle gaps in fast-food dining is to compromise by adding milk or fruit juice to the child’s meal. According to Brown, most fast-food chains are making milkshakes with milk rather than artificial flavors and substances. Many fast-food places will advertise the milk in milk-based products. If not, it’s wise to inquire.

If there is a choice to be made--and especially so if the child is overweight--whole milk is preferable to a milkshake, which in most fast-food places contains excessive sugar. Brown hastens to add that fast foods are fine when consumed in moderation. “It’s when they become a steady diet that makes fast foods a problem.”

Life Is Not a Bowl of Cookies

One of Brown’s pet peeves is the high visibility of sugar-sweetened cereals on television commercials marketed to children. “I am personally offended by cereals that look like chocolate-chip cookies in a bowl. They are more breakfast candy than cereal. It’s unfortunate that many supermarkets position these cereals strategically at children’s-eye level.” Brown appeals to parents and stores selling these cereals to keep them out of children’s reach because they tend to cultivate a preference for overly sweet foods, which is a direct feed-in to candy bars and sugary sweets later on.

What’s wrong with sugary sweets?

“Sugar is not poison. But sugar doesn’t contain any other nutrients beside calories. There is nothing wrong with an occasional high-sugar treat as long as the child brushes (his/her) teeth afterward and maintains appropriate weight,” Brown said. “Our concern is that basic nutritious foods should be the foundation of a good diet, and sugary foods be limited in quantity to make up for extra caloric needs, if any.”

Elementary school (ages 7 to 10)--The average calorie need for this group is 2,400 calories per day. The range is between 1,650 and 3,300, depending on the child’s size and activity.

It is at the elementary-school age when large discrepancies in activity are observed. “It is at this age when children get involved in organized sports, burn more calories and need to consume more food than children who are sedentary,” Brown said.

Where should the increased calories come from?

“They come from large portion sizes and more consumption of snacks,” Brown said.

The requirement for milk increases and calorie requirements exceed those of adults. There are additional servings of fruits and vegetables. A child who has a half-cup of juice for breakfast, one fruit for lunch and a vegetable plus a portion of salad for dinner has met the minimum requirements for the fruit and vegetable group.

A cup of juice for an afternoon snack will provide two servings of fruit from the fruit group. Brown advises parents to favor fruit juice rather than fruit drink or soft drinks.

Brown said soft drinks are high in sugar and calories but contain no other nutrients. They also are high in phosphorus, and, Brown said, some studies have shown that high levels of phosphorus may be detrimental to calcium balance. “Still, it’s clear that soft drinks contain empty calories and the quality of most children’s diets is better served by having fruit beverage than soft drinks.”

Drinking enough milk, Brown said, may be a problem at this age because soft drinks often take its place. “It’s very important to meet calcium requirements throughout childhood, adolescence and early adulthood, because bone mass increases until age 35, with greatest increases during adolescence.”

Dairy products are a primary source of calcium, phosphorus and Vitamin D necessary for calcium absorption and utilization.

If dairy products are difficult to consume because of allergies or lactose intolerance, evaluation of dietary calcium is necessary to ensure that calcium is included in adequate amounts and in forms that the body can utilize.

The classic example of an alternate calcium source that cannot be utilized by the body is spinach. Oxalic acid, which forms insoluble calcium salts, binds calcium so the body cannot utilize it.

Children at elementary-school age should consume at least three eight-ounce glasses of milk daily or its equivalent in the form of yogurt, ice cream, cheese, tofu or puddings.

To consume as much calcium as is contained in a cup of milk, one would need to eat eight ounces of tofu, three cups of cooked, dried beans or three ounces of sardines or salmon, including the bones. Kale, turnip greens and mustard greens are also good sources of calcium, but one would need to consume 1 1/2 cups greens to equal one cup of milk.

Junior high school (ages 11 to 14)--The calorie requirement for girls declines to 2,200, whereas the average for boys increases to 2,700.

Portions begin to increase dramatically, and the Basic Four Food Groups formula becomes a mere minimum for growing boys who need to eat extra portions from all food groups. Extra calories also come from “junk food.”

“At this age, the kids are making their own breakfast, their lunch and choosing their own snacks,” Brown said. “A teen-age boy has room for these foods. Teen-age girls don’t, especially if they are not actively involved in sports.”

“Teen-age girls should not be replacing snack foods, which are low in nutrition, for the four food groups,” Brown said. “The active girl may indulge in occasional junk foods as long as they don’t take the place of important nutrients from the basic food groups.”

Iron requirements for girls and boys at this age increase to 18 milligrams from 10 milligrams. For girls, extra iron needs coincide with menstruation, whereas for boys there is a significant increase in muscle mass and blood volume. The best sources are iron-fortified breakfast cereals and iron from grains, since they are easily absorbed by the body.

“Unfortunately, grain products are the first thing girls at this age try to eliminate, falsely assuming they are watching their weight,” Brown said. “Actually, the calories in grain foods are relatively low. The calories come from things added to grain foods, such as margarine, butter, jam, gravy and sugar. Grain foods are also an excellent source of fiber.”

More Milk Group Servings

Calcium needs for junior high school girls jump to 1,200 milligrams from 800 milligrams at elementary school age. “That’s why we recommend four servings a day from the milk group,” Brown said. Calcium is laid down at the most rapid rate at this time with the growth of the long bones.

If overweight youngsters have been drinking whole milk up to now, it is appropriate at this time to switch to low-fat or nonfat milk to decrease caloric intake.

High school (ages 15 to 18)--Older teen-agers have the same nutritional problems as adolescents, but girls’ calorie requirements decline to close to those of adults, about 2,100 calories per day, with a range between 1,200 to 3,000, depending on the individual’s activity level. Boys’ calorie needs increase to 2,800, with a range from 2,100 to 3,900. Calcium needs remain the same for both sexes.

Sodium intake of Americans is far in excess of that considered safe, and teen-agers are no exception to people who choose snacks that are high in sodium. Brown said it would be wise for parents to limit children’s access to salty fast foods and snacks and to encourage the consumption of relatively low-sodium alternatives, such as unsalted crackers, unsalted nuts and unsalted chips.

Taste Can Be Developed

“It’s wise to help children develop a taste for unsalted foods, just as we want to help them develop a taste for nonsweet foods,” she said.

Meal-skipping is a problem during teen-age years when activities tend to increase, with breakfast the most frequently missed meal.

“Skipping meals presents a challenge of getting needed nutrients from the four food groups,” Brown said. “It’s important to educate teen-agers about the importance of breakfast, even if it must be eaten on the run. Snacks such as peanut butter on toast, a piece of cheese and crackers, juice, yogurt or fresh fruit are considered healthful ‘on-the-run’ snacks. Fruit, however, should be the low-calorie, yet nutrient-dense type such as cantaloupe, papayas, mangoes, nectarines, peaches or strawberries.”

Another good snack that helps meal skippers recoup nutrients missing from the meals is popcorn. It can be nutritious overall, yet is low in sugar and high in fiber. Even with butter added, it contains about 100 calories per cup. Without butter, popcorn contains only 40 calories per cup.