What Kids Should Eat: The Free-Choice Option

Hands-off parenting at the dinner table is currently being promoted by some dietitians. The thinking is that restrictive diets, or those that pressure youngsters into eating healthy foods, can interfere with a child’s innate capacity to regulate calorie consumption. Later in life, this usually results in a preference for high-fat foods, which have been linked to diseases such as heart disease and cancer.

But there are plenty of experts who still believe hands-on parental intervention is vital.

“I think it’s the parents’ responsibility to put the child on the correct eating track,” says Gail Frank, a spokesperson for the American Dietetic Assn. and a Cal State University professor of nutrition. “This (early direction) forms the basis for the child’s taste buds and the child’s perception of what an OK or non-OK eating behavior is.”

After all, as Frank points out, kids don’t live in an isolated environment in which only nutritious foods will be offered, and they aren’t always going to be under a parent’s guidance.

But others feel that parental pressure to eat certain kinds of food can do more nutritional harm than good.

“Rewarding kids for cleaning their plates or pressuring them into eating foods parents believe are nutritionally vital can be a problem,” says Leann Lipps Birch, Ph.D, a University of Illinois professor of human development and nutrition sciences. “When you focus the child on cleaning his or her plate, you limit the child’s ability to use hunger and satiety to control eating, (and inadvertently) contribute to the development of eating disorders and obesity later in life.”

Ellyn Satter, a registered dietitian specializing in children’s feeding and eating, agrees. Force feeding of foods with a perceived benefit, she says, can lead to finickiness, poor growth and battles about food in the short term, and more serious health problems in adulthood.

“Children are capable of regulating their food intake,” Satter says. “They have a wisdom greater than ours about what is good for them and what they need to grow properly. If you present them with a variety of food, they are cabable of picking and choosing and learning to like a nutritionally adequate diet.”

Satter and Birch base their hands-off philosophy on infant research done in the ‘20s and ‘30s by a pediatrician named Clara Davis. She found that kids, up to about age 4 1/2, will eat the right food combinations for good health and sufficient growth--if left to follow their own cravings. She did admit, though, that her data was based on an “artificial environment.” Getting kids to choose a nutritionally adequate diet was dependent upon the parent offering only foods of high nutrient value. Adding sweets would change the results.

Although there’s been no research with older children, Birch believes that the mechanism could be retained as the child ages if parents wouldn’t interfere with the process.

“Given the chance to select from among an array of healthful foods,” Birch says, “children can naturally choose the combinations of foods in amounts consistent with adequate nutrition. (Of course), first they must have access to those foods.”

However, Dr. Ronald Kleinman, associate professor of pediatrics at Harvard Medical School and chairman of the American Academy of Pediatrics’ Committee on Nutrition, questions the existence of this inherent knack to control caloric intake. “I honestly don’t know if (children) have an innate ability to chose healthy food or not,” Kleinman says. “And, I’m not sure that it’s terribly important to know. There are so many other influences on what a youngster eats that an innate ability may not be able to exercise itself.”

Both Kleinman and the ADA’s Frank point to advertisements and peer pressure from siblings and friends that strongly affect what kids eat. Unlike infants, who eat whatever they are given, older children choose what they eat according to the outside cues around them.

“There is enough evidence that the ability is there early on,” Birch insists. “It just gets socialized out. Parents basically teach kids to ignore internal cues.”

She and Satter believe that overambitious parental intervention--usually in the form of pressure to eat fewer foods with fat and cholesterol and more foods with a perceived health benefit, attaches a negative quality to the good-for-you foods.

Food in the “bad-for-you” category, typically are sweet items, serve as pacifiers and treats. This, Birch says, sets up an uncontrollable preference for forbidden food, and a dislike for “health” food. Eventually the sweet is associated with satisfaction in the child’s mind. He or she grows up trying to avoid the prohibited food and adulthood binging and other eating disorders are the result.

“You want kids to eat things that are good for them so you say, ‘OK, eat your broccoli, Johnny, and then I’ll give you some chocolate ice cream.’ It works really well,” Birch says, “but kids learn to like ice cream even more than they did before.

“Yes, kids like sweets,” Birch admits, “but there are some other things that are going on that I think tend to potentiate our liking to sweetness. They are desserts --they come as rewards for having eaten the other things on your plate. And they tend to be associated within a holiday context.”

Rather than an emphasis on “good” and “bad” food, Satter and Birch suggest that parents offer children a wide assortment of wholesome foods selected from among the Four Food Groups: low-fat dairy products, meat and meat alternatives, fruits and vegetables and whole grain breads and cereals.

Satter recommends a division of responsibility between children and parents when it comes to mealtime. The parent should be responsible for what the child is offered to eat and the child for whether and how much of it they eat.

Kleinman tends to agree with Satter and Birch that overly strict early diet rules aren’t necessary, and that providing a balanced diet from a variety of wholesome sources is valid. But, he says, simply supplying these wholesome sources is not the best approach to eliminating eating disorders and chronic disease in adults.

“The notion that you have to stay within a range (of foods) isn’t one worth promoting,” he says. It doesn’t teach the child to interact in a realistic environment. “These (‘bad’) foods are out there,” he says, “and there’s no reason why they shouldn’t be in the home.”

“What is important is that there is a wide tolerance for food in terms of what will permit a youngster to grow and what won’t,” he says. “Some have diets, for example, that are exceedingly rich in protein, more than 15%, or (on the other hand) less than 7%, and in both cases youngsters may grow reasonably well.”

Kleinman’s advice is to expose children to both high- and low-fat foods--especially sweets-- within a balanced diet.

“It’s hard to find any convincing evidence that anyone eating a candy bar is doing themselves any harm, provided they have vitamins, iron and protein in the diet,” he says.

Gail Frank suggests that parents serve as role models--not supervisors. Adults should avoid giving mixed signals and practice moderation too. They should not provide a negative impression for the child.

“Parents beware,” Frank says, “If you are couch potatoes, then your children may become Tater Tots.”

What follows is a three-day menu, developed by the Dairy Council of California, designed to meet the 1989 Recommended Dietary Allowances for vitamins, minerals and protein for a 9-year-old boy. It supplies about 1,700 calories per day and adheres to the American Heart Assn. recommendations for dietary fat and cholesterol.

The American Academy of Pediatrics has stated that that the AHA diet, which supplies about 30% of the total calories as fat, is too restrictive for children older than age two. The Academy recommends a range of 30% to 40% calories as fat.

For flexibility, and to add extra fat recommended by AAP, substitute whole fat dairy products for the low-fat selections given. Or, include a favorite treat to increase the fat intake slightly.

FIRST DAY

BREAKFAST

2 slices whole grain bread 1 teaspoon butter 1 teaspoon jelly 1 poached egg 1 cup low - fat milk LUNCH

Turkey sandwich: 2 ounces light meat turkey 2 slices whole - wheat bread Sliced tomato 1 teaspoon mayonnaise 1 cup low - fat milk 1 banana DINNER

2 ounces lean roast beef 1/2 baked potato 1 teaspoon margarine 1 cornmeal muffin 1/2 cup cooked green beans 1 cup low - fat milk 1/2 cup strawberries 5 vanilla wafers SNACK

1 tablespoon peanut butter 5 whole - wheat crackers SECOND DAY

BREAKFAST

2/3 cup whole - grain cereal with raisins 1 cup low - fat milk 1/2 cup cantaloupe cubes 1/2 cup orange juice LUNCH

Ham sandwich: 2 ounces lean ham 2 slices pumpernickel bread 1 teaspoon mayonnaise Lettuce and tomato 1 apple 1 cup low - fat milk DINNER

At fast-food restaurant:

1 hamburger 1 small serving French fries 1 soft-serve ice cream cone 1 cup low - fat milk SNACK

5 saltine crackers 1 ounce Cheddar cheese THIRD DAY

BREAKFAST

2 whole - wheat pancakes 2 tablespoons pancake syrup 1 teaspoon butter 1/2 cup orange juice 1 cup low - fat milk LUNCH

Beef taco: 1 ounce cheese 1/4 cup refried beans 1 1/2 ounces lean ground beef Lettuce and tomato 1 corn tortilla 1 cup low - fat milk DINNER

3 ounces baked cod 1/2 cup mashed potatoes 1/2 cup coleslaw 1 whole - wheat roll 1 cup low - fat milk SNACK

1/2 cup apple juice 2 graham crackers