Seed to Sapling Nutrition - Blog

Snack Swap Series: Fruity Snacks

Fri, 18 Nov 2022 15:10:31 GMT

Depending on the ingredients, these can provide some fiber, vitamins and minerals, but many are just candy in disguise! Fruit leathers are a better bet, but can contain high concentrations of pesticides(1), so choose organic where possible. Look for ones made from whole fruit (not concentrates) and free from additives.

To give the numbers below some context, the American Academy of Pediatrics recommends limiting kids' (aged 2-18 years) added sugar intake to no more than 25 grams per day (~6 tsp). In the UK these recommendations are broken down by age, with 4-6 year olds limited to 19 g per day, and 7-10 year olds having no more than 24g per day. The UK guidelines indicated that babies and toddlers (under 4 years old) should avoid added sugars altogether, while the US suggests none for those under 2 years old.

If made from real fruit, the sugar in the items below is not considered 'added', but the use of fruit juice concentrates in some products is a grey area - the FDA does consider this 'added sugar' in most cases.

Fruit snacks

Mott’s fruit snacks: (22g package). They tout not having artificial colors or flavors and containing real fruit and vegetable juices, but these are basically glorified gummy bears! The main ingredients are corn syrup (GMO) and sugar (10g of sugar total and the vitamin C is added).
Annie’s organic bunny fruit snacks: (23g package) While these are organic, meaning no GMOs and minimal pesticides, the basic facts remain the same: these are fruit-flavored candy, rather than a fruit-based snack. 12g of sugar and not much in the way of nutritional value.
Welch’s fruit snacks: (25g package) slightly better than Mott’s (in terms of ingredients) as they do contain real fruit purees, but they also have corn syrup (GMO), and artificial flavors and colors. 11 grams of sugar, no fiber, and a small amount of synthetic vitamins are added.

Fruit leathers

Whole Foods Market Organic Fruit Strips are made with mostly whole fruits, have no additives, and one of the lowest pesticide residues. One strip has ~9g of sugar and 2g of fiber.
Solely Organic Fruit Jerky: 10-12g of sugar, 1g fiber, just one or two dried, cold-pressed fruits. Low pesticide residue.
Bear Yo Yos: 8g of sugar and 2g of fiber, and just made from fruit. They use non-organic fruit, but the pesticide residue is moderate.
Walmart Great Value Fruit Strips: not organic, but lower than average pesticide residue so a good option at a lower price point. Made from concentrates rather than whole fruit.
Bob Snail Stripes: just two ingredients, both fruit, 6-12g of natural sugar, negligible fiber; high pesticide residues.
Stretch Island: highest pesticide residues, made with concentrates rather than real fruit.

Other options!

Cosmic Carrot Chews: these are organic dehydrated carrot chews with a little sweetness from apple juice concentrate - they have an earthier flavor and the texture of a fruit leather. 11g of natural sugar, 2g fiber, and packed with vitamin A, plus little potassium boost.
Organic dried fruits: consider dried or fresh fruits for more fiber, vitamins and minerals. Organic will have lowest pesticide residues (these chemicals tend to concentrate in dried fruit vs. fresh fruit). All are a great source of potassium and fiber (~3g for a 1/4 cup), and some offer a boost of certain hard-to-get nutrients that make them worthy of a special mention:
- Apricots contain a good amount of vitamins A and E, and the minerals copper and iron. A quarter cup (~5 pieces) has a good percentage of the RDA in these nutrients for children 4-8 years old:
  - ~20% of vitamin A
  - ~25% of vitamin E
  - ~30% of copper
  - ~10% of iron
- Figs are mineral-rich option with calcium, copper, magnesium and iron, plus a vitamin K. A quarter cup (~5 pieces) has a good percentage of the RDA in these nutrients for children 4-8 years old:
  - ~25% of copper
  - ~20% of magnesium
  - ~11% of vitamin K
  - ~8% of iron
  - ~6% of calcium

Snack Swap Series: Granola Bars

Fri, 04 Nov 2022 14:44:40 GMT

A few clients have recently asked me for my favorite brands of various kids’ snacks, so I thought I’d put together a few lists for you all. A short rationale is included for those who want to know why, and also to help you make your own choice at the store, because this list is by no means exhaustive. For those of you who don’t have the time, I’ve color-coded the brands so you can simply skip ahead and get on with your day - green are your best bets!

Let’s start with a reminder that the primary reasons we feed our kids are 1) to provide fuel to get them through the day, and 2) to provide adequate nutrients for them to grow and develop well over time. They have little stomachs (about the size of their fist) and short attention spans, so we can expect them to need refueling every couple of hours, typically with three meals and two snack times over the course of a day.

Ideally, snack time would be a nutrient-dense mini-meal, with a balance of carbs (for energy) protein (for growth) and fats (for brain development). And, ideally, these would be from minimally processed whole food sources: whole grains, fruits and vegetables for the carbs, and nuts, seeds, beans, cheese, yogurt and eggs for the fats/proteins. The reason for this is that minimally processed foods contain the most fiber, water, vitamins and minerals, and this is what our children’s bodies need to operate and develop optimally. Processed foods tend to strip these things out and replace them with sugar, salt, and artificial additives.

A simple whole food snacking plan is to offer a fresh fruit or vegetable at every snack, paired with a protein source and/or whole grain. For example, carrots and hummus, apple slices and cheese, celery sticks with peanut butter, yogurt and berries, chia pudding and mango, almonds and a piece of fruit, 100% wholewheat toast with nut/seed butter and a clementine, and so on - the combinations are endless! This is also much more cost-effective than packaged snacks.

Providing these types of snacks is easier at home; when we are packing snacks for school or outings, it isn’t as easy to offer these foods. Enter packaged snacks! Every kid’s favorite way to fuel up, and a welcome shortcut for most parents. However, as parents, we still want to find that balance between convenience and nutrition, and it’s a minefield out there. So, without further ado, I will offer my suggestions in each of the main snacking categories, to help you navigate the sugar traps, sodium bombs, and artificial additives!

Image by Silvia from Pixabay

Granola bars (AKA cereal bars, chewy bars) can be a good source of whole grains, fiber and some micronutrients - watch for added sugar and artificial ingredients. Brands with nuts, seeds and a variety of grains will provide more fiber, protein and minerals. Look for less than 25% sugar by weight, 3+ grams of fiber, and 3+ grams of protein per bar. Smaller (24g) bars are a good size for preschoolers; bigger kids might need a bigger bar, or a second snack item to keep them going.

Kelloggs Nutrigrain bars: 37g bar, 13g sugar (35% by weight), 1g fiber, 2g protein. Over 40 ingredients, around seven of which are sugar under different names, and GMO corn syrup and soy. Highly processed; synthetic vitamins and minerals added.

Quaker Chewy bars: 24g bar, 7g sugar (29% by weight), 1g fiber, 1g protein. Contains 40+ ingredients, GMO corn syrup and soy, artificial flavors and preservatives.

Trader Joe’s chewy chocolate chip bar: 24g bar, 8 grams of sugar (33% by weight), 1g fiber, 2g protein. Lots of ingredients, many of which are sugar sources, but all are organic. Smaller bar is a good size for smaller kiddos.

CLIF Kid Z bars: 36g bar, total of 10g sugar (28% by weight), 2g fiber, 2g protein. More processed ingredients than some other options, lots of different sugar sources, but organic/non-GMO and no corn syrup.

Nature Valley Crunchy Oats & Honey: 42g bar, 11g sugar (26% by weight), 2g fiber, 1g protein. 10 relatively simple ingredients, three of which are sugar; does contain GM soy. Bigger bar, better for bigger kids.

Made Good granola bars: 24 bar, 6 grams of sugar (20% by weight), 1-2g fiber, 2g protein depending on which flavor. Quite a few ingredients, but they include a vegetable extract blend which contributes some natural food sources of vitamins and minerals. Good for little kids due to smaller size.

Kind Healthy Grains: 35g bar, 6-8g of sugar (~20% by weight), 2-3g of fiber, and 2-3g of protein, depending on the flavor. This bar has recognizable ‘real food’ ingredients (although there are 20 of them, and 5 are different sugar sources). Mixture of whole grains (buckwheat, amaranth, quinoa, millet, oats, rice) contribute some micronutrients and diversity.

88 Acres seed bar: 45g bar, 7-10g sugar (~18% by weight), 3g fiber, 5-7g protein, depending on flavor. Double the weight of some other bars, but more nutrients with less sugar proportionately (AKA more nutrient dense). Lots of micronutrient-rich seeds add important minerals. A more substantive option, good for bigger kids (and adults).

Kind Nut bars: 40g bar, 5-9g sugar (12-22% by weight), 3-7g fiber, 4-6g protein. Whole nuts, and a fairly short list of simple ingredients. Packed with fiber and protein. Substantive enough to keep bigger kids full (and also sold as ‘minis’ for smaller kids). Non-GMO, and a good source of healthy fats.

Health Warrior Chia bars: 25g bar, 3g sugar (12% by weight), 4-5g fiber, 3g protein. Packs a nutritional punch for a smaller bar and the lowest in sugar. Made with nuts, seeds and whole grains; rich in essential fatty acids, as well as the fiber and protein, and non-GMO.

Easy homemade option: trail mix
Trail mix is essentially a deconstructed granola bar. Consider mixing together some nuts, seeds, and unsweetened dried fruits (and perhaps a sprinkle of dark chocolate chips) for a DIY trail mix: you can make a batch in minutes and portion it out into mini reusable snack pots for grab-and-go convenience.

Try this combo:1 cup of almonds, 2/3 cup of dried unsweetened cherries, 1/2 cup of pumpkin seeds, and 1/3 cup of semisweet chocolate chips in a large bowl. This is much more cost effective than buying bars, as well as more nutritious! A 1/4 cup serving (35g) of the trail mix above has 7g of sugar (20% by weight), 3g of fiber, and 5g of protein, plus offers a spectrum of minerals like iron, calcium, copper, zinc and magnesium.

Back To School (with Covid-19)! Nutrition for immune support

Sat, 28 Aug 2021 19:07:19 GMT

As many of us prepare to send our children back to school and with Covid-19 showing no sign of abating, I’m getting requests for tips on how to keep kids’ immune systems in good shape this fall. The good news is, kids are probably less likely than usual to get the standard sniffles this semester due to enhanced cleaning protocols, social distancing, and masking measures in place to prevent the spread of Covid-19. However, their immune systems may be a little out of practice after a year and a half of relatively sterile living (e.g. limited contact with peers and endless hand sanitizing). Thankfully, kids are at very low risk of serious illness from SARS-CoV2, and masked exposure would reduce the viral load, which may mean a milder or asymptomatic case (1).

Aside from these external prevention strategies there are a few key nutrients that support healthy immune defenses and may offer an additional layer of protection (to be clear, I am not claiming that diet and supplements can prevent or cure Covid-19!). Most of these nutrients can be obtained from food, but if some are in limited supply in your child’s diet due to allergies, dietary restrictions or picky eating, you might consider supplementing.

#1: Vitamin D

Vitamin D is a key player in regulating immunity and inflammation. During the pandemic a lot of research has looked vitamin D status and the risk of catching Covid-19, as well as links to outcomes of the virus: one study found that those with vitamin D deficiency were 70% more likely to test positive for Covid-19 than those with adequate D status (2), while another found that patients hospitalized with Covid-19 were significantly more likely to be deficient in vitamin D than controls (3). Vitamin D deficiency is widespread, with approximately half the population having inadequate levels - those who are obese, have darker skin tones, and the elderly are at even greater risk (these groups are also hardest hit by Covid-19).

Children tend to have higher levels of vitamin D (perhaps because they spend more time in the sun), but 10% of children are still estimated to be deficient (<15 ng/ml), and these rates are even higher among kids in the aforementioned high risk categories. On top of this, a further 60% of children may have suboptimal levels (≤20 ng/ml; 4), putting them at risk for deficiency. Older infants and toddlers who are breastfed may also be at higher risk of deficiency due to low vitamin D levels in breastmilk (this can be rectified with maternal supplementation). Your pediatrician can test for vitamin D levels; some experts at Hopkins believe this should be routine for at-risk groups (5).

All children aged 1-18 years old need at least 600 IU (15 mcg) per day to maintain adequate levels; the Endocrine Society suggests that up to 1000 IU (25 mcg) may actually be needed for certain subgroups. As you probably know, the main source of vitamin D is the sun - our skin makes it when exposed to sunlight. Ten to fifteen minutes of sun on the arms and legs a few times per week is typically adequate for light-skinned individuals to get enough vitamin D, but those with darker skin tones may need double the exposure. Also, if you live in the Northern states, there’s not enough sun outside of the summer months to synthesize vitamin D (and if you routinely apply sunscreen to your child in the summer, it’s going to be limited then too).

As for food sources, oily fish is the best source of vitamin D3 (3 oz of salmon = 570 IU), and a little bit can be found in egg yolks (I large egg = 45 IU) and cheese (1 oz cheddar = 12 IU). Plant sources like mushrooms contain D2, an inferior form that the body has to convert (1/4 cup white mushrooms = 180 IU). Most milks in the US have added vitamin D (1 cup = 100-140 IU), which is where most kids are going to be getting it from, but check that it’s D3, not D2. Also know that vitamin D needs fat to be absorbed, which means that whole milk is going to be a better source for your child than fat-free milk.

Vitamin D is one nutrient that should probably be supplemented for most kids due to low availability from food and limited exposure to sun as we head into fall and winter. Look for a supplement that contains D3, in an oil (drops like this from Carlson Labs are good for kids); give 400-800 IU per day for maintaining levels (more if the child is deficient).

#2: Zinc

Zinc is a mineral and an immunity all-star; low zinc status puts us at greater risk for various infectious diseases. A recent study found a significant link between patients’ zinc levels on admission to hospital with Covid-19 and disease outcomes, concluding that low zinc was a risk factor for greater severity and higher mortality (6). Zinc deficiency can present as a loss of sense of smell and taste, which is also recognized as a symptom of Covid-19 infection. This makes physiological sense: when we catch a virus our zinc levels drop in the acute phase, as the body uses it to fight the infection (7). Preventive zinc supplementation has been shown to reduce the incidence of infectious diseases like pneumonia and diarrhea in children in developing countries (8), and maintaining adequate levels of zinc is important for optimal immune function.

Your child needs different amounts depending on their age group:

Toddlers (1-3 years) need at least 3 mg/day
Young children (4-8 years) need 5 mg/day
Tweens (9-13 years) need 8 mg/day
Teens (14-18 years) need ~10 mg/day

Most kids in the US get adequate zinc from food. The best sources are protein foods like meat and seafood, nuts, beans, and dairy products, which the majority of US children eat plenty of. Good animal-based sources are beef (3 oz = 7 mg), crab (3 oz, cooked = 6.5 mg), and chicken (3 oz, dark meat = 2.5 mg). Dairy sources include Swiss cheese (1 oz = 1.2 mg), milk (1 cup = 1 mg) and yogurt (1/2 cup = 0.8 mg). Top plant-based options are baked beans (1/2 cup = 3 mg), pumpkin seeds (1 oz = 2.2 mg), cashews (1 oz = 1.6 mg) and oatmeal (1/2 cup = 1 mg).

If you have a particularly picky eater, or a vegetarian or vegan child, you may want to consider a supplement. Look for something that offers at least half of the recommended daily allowance for your child’s age group (above). I don’t recommend supplementing with more than the RDA or for extended periods - this can upset the balance of other minerals like iron and copper.

#3: Vitamin C

Vitamin C is a water-soluble vitamin and a powerful antioxidant; it is important to get enough for healthy immune function. There is some evidence (9) that it may reduce the severity of colds and other upper respiratory infections slightly when taken preventively (it doesn’t seem to stop people from getting colds, but they’re less serious when they do). However, there isn't strong evidence supporting ongoing preventive supplementation with vitamin C, and it hasn’t really lived up to it’s promise against Covid-19 (10).

How much your child needs depends on their age group:

Toddlers (1-3 years) need at least 15 mg/day
Young children (4-8 years) need 25 mg/day
Tweens (9-13 years) need 45 mg/day
Teens (14-18 years) need ~70 mg/day

These are the minimums needed to prevent scurvy, not necessarily the amount needed for optimal functioning, so getting more is definitely not a problem! The majority of kids in the US get adequate vitamin C from foods - fruits and vegetables are the best sources. Whole fruits are better than juice, and raw fruits and veggies have more vitamin C than cooked (because some is destroyed in the cooking process). Vitamin C can be found in oranges (1 medium = 70 mg), kiwi (1 medium = 64 mg) and strawberries (1/2 cup = 49 mg), plus vegetables like bell peppers (1/4 cup = 47 mg), broccoli (1/4 cup = 25 mg), Brussels sprouts (1/4 cup = 25 mg) and cauliflower (1/4 cup = 13 mg).

Looking at these numbers you can see that most kids will be meeting the minimums, but picky eaters who don’t get enough fresh produce each day might be at risk for vitamin C deficiency (and other vitamins and minerals too). Supplements may be helpful while working on improving dietary diversity; you can safely go from the RDA up to 250 mg. Vitamin C is water soluble so supplementing is low risk - the worst-case scenario is looser stools if an excess is consumed.

#4: Omega-3s
These fatty acids are essential and have a regulatory effect on the immune system, bringing it back into balance: most of the fats in the Western diet are inflammatory (omega-6s), while the omega-3s are anti-inflammatory. Both are important, but most people are getting way too much of the former and not enough of the latter. Omega-3s up-regulate the activity of neutrophils (our first line of defense against pathogens), help activate T cells, and can modulate cytokine responses (11). Whether or not they’re useful in the fight against respiratory diseases is unclear, but they’re important for general health and have few downsides.

The omega-3 fatty acids (EPA and DHA) can only be found in oily fish (e.g. salmon, mackerel, rainbow trout, sardines and tuna), while their less-potent precursors (ALA) are found in nuts and seeds (e.g. flax, chia, walnuts). Most children get adequate ALA but very little DHA, because most kids aren’t eating fish on a regular basis! If this is true for your child, consider a high-quality supplement with at least 200-300 mg of DHA/EPA per serving from low mercury fish. Nordic Naturals are a reliable brand with all different options for kids including liquids, gummies and chewable soft gels.

#5: Probiotics
These friendly microbes also play a role in our immune health, and may reduce the risk of respiratory diseases (12). Particular strains of interest include Lactobacillus species L. planetarium, L. paracasei and L. reuteri. Research in this area is ongoing, but there are general health benefits and no known drawbacks to getting more good bacteria into our kids’ lives, especially in the fight against pathogenic microbes.

Common food sources are yogurt, kefir, pickles (truly pickled, not in brine or vinegar), kombucha and kimchi. If your child doesn’t enjoy many of these foods, consider a probiotic supplement with a few different strains, especially if they have a history of antibiotic use.

Last but not least: SLEEP!
Kids need to be getting adequate sleep in order for their immune systems to function optimally (we all do). As they get back into the school routine, make sure they’re getting enough for their age group:

Toddlers (1-3 years) need12-14 hours per day/night, naps included
Preschoolers (3-5 years) need 10-13 hours per day/night
Grade schoolers (6-12 years) need 10-12 hours per night
Teenagers (12-18 years) need 8-10 hours per night

To wrap up: offer your child plenty of fresh fruits and vegetables, a variety of protein foods (animal- and plant-based) and include fish a couple of times per week. If they drink milk, make sure it’s fortified with D3 and not fat-free. If you need to plug some dietary gaps, supplements can help. Round off with a healthy dose of sunshine, fresh air, and plenty of rest. Here’s to a healthy and happy school year!

Raising Healthy (and Happy) Eaters: How and Why

Tue, 12 May 2020 14:58:23 GMT

The information in the previous article is all well and good, you know WHAT children need to be eating, but HOW do you get your kids to eat more of things they need? In my experience, a few things are key: exposure, small switches, structured choices, getting kids involved, and a no-pressure approach.

The Logistics

Exposure
The first and most important factor is exposure - they can’t eat what they aren’t offered. Presenting new foods in plain sight enough times will eventually desensitize the child to them, but most of us lose heart and give up too soon. It can take 10-15 exposures for a child to like a food (usually fewer for younger kids, more for older kids), but more than 90% of caregivers stop offering after 3-5 tries (1). Exposure can include looking at, touching, licking or eating a food; this method is used successfully in pediatric feeding clinics for the most picky of eaters, so stick with it.

Small switches
Rome wasn’t built in a day. Chances are your child has had a limited palate for a while, so it may take a while to adapt it. Try making small changes to already accepted foods and build from there, one step at a time. Starting from familiar territory and making minor variations can make the process of change more manageable for your child. Slow and steady wins the race!

If your child strongly favors pasta, try switching to a wholewheat variety, or better yet, a legume-based pasta (e.g. Tolerant or Explore Cuisine). The lentil varieties hold up better than bean-based ones, in my experience; they offer plenty of fiber and iron, and most children don’t notice the difference.
If your child is attached to chicken nuggets, have them work with you in the kitchen to make a homemade version (like this one), with wholegrain breadcrumbs, then branch out to incorporating ground chickpeas or almond flour in your crumb mixture.
If your child’s favorite food is pizza, try switching to a wholewheat crust or even a cauliflower crust (available at the store, or homemade).

Structured choices
Feeding children can be exhausting, especially if they tend to reject most of the foods that you offer. We can quickly resort to becoming a short order cook, making each child whatever they’d like for dinner, to avoid the drama. Offering choices is good - choices empower a child, and we want that, but they shouldn’t disempower the adult. As the parent, you can set the boundaries and let them choose freely within those parameters. For example, rather than the open-ended “what would you like for dinner?”, try “would you like salmon or chicken for dinner?” You’re setting the options, they make their choice. Or instead of giving them an opt-out “would you like vegetables with that?” (I’m guessing, NO!), try “which vegetable would you like with that”? Whether they want veggies isn’t up for debate, the decision is centered on which one they’d like. You could narrow this further with “would you like baby carrots or baby tomatoes for snack?”. These simple linguistic tweaks can work wonders with younger children - they still have a choice in what they’re eating, but you’re in charge of the options.

Kids in the kitchen
When children (and adults!) get involved in the preparation of meals, they are more invested. In my experience, kiddos are much more likely to try a meal that they’ve played a part in making, and they often sample the ingredients along the way. There’s something about being away from the dinner table - especially if it’s a battleground in your house - that makes them more open to trying things. Kids of all ages can play a part in meal prep:

2-3 year olds can tear lettuce for a salad, wash vegetables, help mash potatoes, stir ingredients in a bowl, sprinkle salt and sugar, sort silverware and set the table.
4-5 year olds can help weigh, measure and mix ingredients, squeeze citrus, make toast, roll and shape dough, and drain and rinse beans.
6-7 year olds have better fine motor skills so they can use measuring spoons, cut herbs with scissors, form meatballs or falafel, scoop cookies, peel potatoes, whisk eggs and learn to use a knife for cutting soft foods.
8-9 year olds can read well enough to follow simple recipes, and are usually trustworthy enough to be taught how to use knives for dicing and slicing most foods. They can operate can openers, graters, blenders and food processors, with supervision. They can find ingredients (and reach most of them), make sandwiches and pack their own lunches.
10-12 year olds can often work independently in the kitchen, especially if they’ve been working along side a parent up to this point. You can engage them in meal planning, and, assuming they’re tall enough (and responsible enough), they can do hands-off tasks at the stove top, like putting rice and pasta on to cook, and more (depending on the child.)

**However old your child is, supervision is needed - accidents can happen in kitchen at any age.
Kids can also help with the growing of foods, if you have a spot for a small vegetable garden or a window box for herbs, and with shopping for them at the grocery store - it’s an opportunity for them to have some autonomy e.g. let them choose which color peppers to buy this week, or pick out a fruit they’re curious about trying.

The Approach

Bribery and rewards
When dinner is a contentious issue it’s common to fall into rewarding and/or punishing children for their eating habits. Who among us has not promised dessert if the vegetables are eaten, or threatened to withhold it if they aren’t? Most of us probably experienced this growing up ourselves! The research shows that this actually backfires most of the time (2): the promise of reward foods may increase the amount that the child eats in some instances, but it actually decreases the amount that they like the target food (while increasing their liking of the reward food). It increases the status of the reward food (which is usually something sweet and less nutritious) and diminishes the status of the food you want them to eat more of. What this means is, all that they get out of it in the long run is that ice cream is worth the unpleasant task of eating vegetables. In later life this ‘food as reward’ mentality can translate into “I am treating myself to a pint of ice cream tonight because I had a hard day”, or “I haven’t earned dessert because I haven’t been to the gym today”. (For the record, you are always absolutely entitled to eat ice cream, without having to ‘earn it’ by way of a good or bad day!) Bottom line: incentivizing food consumption with other more favorable foods seems to be universally negative, according the research. Incentivizing with non-food rewards, like stickers or verbal praise, may be a bit more effective: it can increase the number of times a child is willing to try a food, meaning that they get more exposure to it, so if stickers or high fives get you there, go for it.

At the end of the day, carrot and stick methods might get your kids to eat more of the foods you want them to eat (or might not), but ideally we want dinner time to be a pleasant experience for all, free of tantrums and free of cajoling. When kids feel pressure, most of them dig their heels in, and before you know it you’re in a power struggle over food. Plus, rewards have been shown to undermine intrinsic motivation in kids (the desire to do something for its own sake) (3), so you have to ask yourself what your ultimate goal is. If - as I suspect - you want them to grow up to make nutritious food choices, so that they can lead healthy lives, then intrinsic motivation is ultimately more important than whether they eat three more bites of butternut squash tonight.

Divide and Conquer
To avoid food fights there are some tried and true methods you can employ, the most important being Satter’s ‘Division of Responsibility’ around meal times. This method is endorsed by the American Academy of Pediatrics and the Academy of Nutrition and Dietetics, among others. It works like this: parents are responsible for the What, When, and Where of meals, and children are responsible for How Much, and Whether they eat. For example, the parents decide that it is chicken soup for dinner, served at the dinner table at 6pm, and the child decides whether or not they’re going to eat it, and how much they’re going to eat. Sounds simple? It can be! The hard part is for all parties to stick within their own lane: children can’t dictate what/where/when dinner is, and parents can’t dictate how much the child eats (which includes not physically feeding them). When I implement this with families, the first thing I usually hear is, “but what if they don’t eat anything?” It’s difficult, but you have to trust that your child will not starve themselves (this is a widely used model and I haven’t seen any reported cases of starvation yet!). If you’re providing regular meals and snacks throughout the day, they aren’t ever going too long without the opportunity to eat.

It is important that eating times stay pleasant, and messaging stays positive: e.g. “I trust that you’ll eat if you’re hungry”, rather than “I’m not giving you anything else tonight so don’t blame me if you’re hungry later!” Then move on to a new topic of conversation. Power struggles take two - don’t engage. Even if they don't want to eat anything, they can still sit at the table and talk about their day; there is more to family meal time than the food.

In my experience, this method works best with some preparation: hold a family meeting and acknowledge that meal times are hard, for everyone, and let the children know that you have a new plan to make dinner more relaxed and enjoyable. Lead with the things that you’re going to do to let them be in control at the dinner table (“you can eat as much or as little as you like, we won’t pressure you”), and then follow with what you are going to do to simplify your own life (“I am going to make one meal for everyone”, and “I’m not going to offer snacks close to dinner”). Then you can all brainstorm a list of favorite meals together - this way, everyone knows that their favorites will be in the rotation, so even if tonight’s dinner isn’t something you child likes particularly, they know that their preferences are as valid as other family members’, and their turn will come. You can even have this be a regular occurrence, with a weekly family meal planning meeting; this can be a great way to track progress on evolving preferences too.

Stealthy strategies
There are plenty of recipes out there showing you how to hide vegetables in food so that your kids won’t notice them (e.g. puréed veggies in a pasta sauce, or fruit smoothies disguising greens). That’s not necessarily a bad thing - if you can feed them something more nutritious without drama, great. However, I don’t advocate working too hard at it, or being actively deceptive - ultimately, we want to teach the child to enjoy different foods, and to empower them to make their own food choices. If they find out you’ve lied to them they might not take it well, and it may undermine their trust around eating even further. Plus, I mentioned that multiple exposures are a reliable way to increase liking for a food: if spinach is hidden away in a fruit smoothie, they aren’t really getting exposed to it.

Finally, when children know what they’re eating they can also vocalize their opinions (beyond yum or yuck!), and start to articulate their preferences. For example, one of my children strongly prefers their vegetables crunchy, which means they like raw carrots much more than cooked, and kale chips much more than kale salad. It isn’t that they don’t like kale or carrots, it’s that they don’t really like them prepared a certain way. I can work with that! Building vocabulary around food helps everyone.

Sensory explorers
It might seem to make sense to emphasis the health benefits of eating more vegetables, after all, health is one of the main things that motivates adults to eat a balanced diet. Unfortunately, kids aren’t particularly responsive to health messaging (they have little understanding or interest in the state of their future arteries) and it can actually backfire: if you’re being told to eat something because “it’s good for you”, the implication can be that it isn’t enjoyable, it’s just something you have to eat for health reasons. We are familiar this phenomenon as adults: if someone offers us ‘healthy’ cookies vs. regular cookies, many of us assume the healthy ones are less palatable.

So how do you sell it? Focus on sensory information. Little kids are learning their colors and building their vocabulary, food is a great space to exercise those skills. Talk about the visual properties like color and shape, talk about texture (bumpy vs. smooth, juicy vs. dry, crunchy vs. soft), flavor (salty vs. sweet, strong vs. mild), temperature, smell, etc. Older kids can kick this up a notch, making taste predictions based on appearance, using more descriptive vocabulary, comparing new foods to other foods they’ve eaten. The goal isn’t to eat a certain quantity of the food, or even to enjoy it, the goal is to approach it with curiosity. This also builds on the last point, about them getting better at articulating their preferences - they can start to tell you that they like the flavor but not the texture, or they like the texture but not the smell, and so on. This allows them to voice dislikes, but in a constructive manner: keep things focused on the specific qualities of the present meal and away from generalizations, for example, “I don’t really like these refried beans because they’re smooshy” gives you both more room for exploration moving forward than the blanket statement of “I don’t like beans”, period. Let them play with their food - it's all part of the exploration process!

Tasting charts
Weaving together the concepts of food exploration and non-food rewards like stickers, I find that tasting charts can be helpful, for all involved. Ones that encourage kids to eat a rainbow of fresh fruit and vegetables every day are great, like the one below from Raddish Kids, a cooking club for kids with meal kits, and I also love the veggie discovery chart (at the end of the article) from CookSmarts, a family-friendly meal planning service). The former is great for younger kids, who are learning their colors: for each color of vegetable that they eat, they get a sticker (or check mark) on their chart, with the aim of eating as many different colors as possible in a given day or week. The CookSmarts veggie discovery table is more detailed, providing an extensive list of veggies to explore, with a slightly different stickering approach: each time the child tries a vegetable they can place a red, yellow or green sticker next to it, to indicate whether they liked it. If they don’t like it they use a red sticker, if it’s okay, a yellow sticker, if it’s pretty good, a green sticker. There is space for five stickers next to each vegetable: regardless of whether something gets a red, yellow or green, the assumption is that you will try it again, and again, and again (and again, and again!). This gives children exposure and also tracks how their taste preferences develop: things that start out with red stickers may evolve into yellow sticker foods, and so on. This is also a helpful chart for the adults in the household, because it lets you keep track of which vegetables are preferred, as well as just being a helpful prompt when it comes to making a shopping list.

Don’t judge
Try to avoid value judgements around food. While our intentions are pure when we tell kids that foods are good for them or bad for them, it can lead to disordered eating down the line if the messaging is too heavy-handed. Restricting junk food excessively can lead to secretive eating, or overeating those forbidden foods when the parent is not around (4) (something I’ve experienced firsthand). Secretive eating behaviors can also be accompanied by feelings of guilt, shame, or being ‘bad’. Some professionals prefer to use the concepts of go foods vs. slow foods with kids, to indicate that some foods promote health while others don’t; I think this is probably fine, as long as the latter aren’t overly restricted. Value judgements around food often spill over into negative self-talk, which we have all seen in adults, e.g. “I’m going to be bad and eat another slice of cake”. This type of thinking is a hallmark of diet culture and is something we want to avoid. Also avoid having these types of conversations about your own food choices in front of your child - they are always watching and learning. If they see you making a big deal about turning down the same dessert that you’re encouraging them to work for, that’s a confusing message. Food is meant to nourish us and to be enjoyed; if food sparks feelings of guilt or fear for you, or your find yourself obsessing over food choices, it might be worth talking to someone about your relationship with food.

Lead by example
One of the most reliable ways to get kids to eat a diverse range of nutritious foods is to do it yourself. If children see others enjoying those foods - caregivers and peers - they are more likely to enjoy them (5). You’re going to have a hard time selling the salad if one of the parents is avoiding it, even more so if they are actively discussing their dislike for it. You don’t have to put on a performance, but if your children see you enjoying your food, they’re likely to be more enthusiastic eaters themselves. For many of us, this might mean making shifts in our own eating habits (most adults don’t eat the recommended amount of fruits and vegetables each day either). This can be an opportunity to explore foods with your child - try new produce items, try new ways of preparing familiar ones, find what you like and your children may well follow. Getting a CSA or veggie box delivered can be a good way to get out of shopping ruts (I too end up buying the same vegetables from the store each week, out of habit, despite the variety available!).

Why?

This might all sound like a lot of work, and you might be asking yourself if it’s really necessary. Eating well isn’t just about getting adequate nutrients, a healthy relationship with food is key. Many of us grew up with the ‘clean your plate’ approach, but in today’s society with oversized portions and an endless supply of food, this isn’t necessarily helpful anymore. Really, we want to be teaching our kids to listen to and honor their bodies - to identify their hunger and fullness cues, and to respond to them appropriately. This means stopping eating when you’re full, without being forced to finish your plate, and having second helpings if you’re hungry, without being restricted arbitrarily or being admonished for being ‘greedy’. Kids grow in spurts, so their appetites will ebb and flow accordingly.

Ultimately, we want to raise competent eaters who follow internal cues of hunger and satiety, have a good relationship with food, and can continue to feed themselves well outside and beyond our homes. That is more likely to happen if we encourage autonomy and create a pleasant atmosphere around eating. As with many things in parenting, our short term goals (eat the broccoli!) may be at odds with our long term goals (raising competent eaters). If you are offering your child a variety of nutritious foods without pressure, and modeling healthy eating (both in terms of what you eat and how you talk about food), you are doing your part. Don’t stress about them starving, or whether you could be doing more to persuade them - that part is up to your child. Trust that they will eat, that they will grow on track, and that they're developing healthy eating habits that will last them a lifetime.

If you would like some help implementing these methods with your children, including specific guidance for your family’s unique challenges (e.g. how to adapt their favorite foods, step-by-step support to set up the Division of Responsibility, ways to present meals to increase the odds of them being eaten, and scripts for dinner time meltdowns), or if you would like to address your own relationship with food, please reach out to me for a remote consult.

Raising healthy eaters: WHAT do they need?

Sun, 10 May 2020 21:16:45 GMT

I am often asked what to feed kids and how to get them to eat more healthful foods. Some kids are super picky eaters from the get-go, while others have just got used to having a certain set of options every night and aren’t really willing to stray beyond those. In other families, kids are fairly open to new flavors and parents simply want ideas for kid-friendly foods, while others need guidance on providing a more balanced diet. So, there’s a what and a how of feeding children, and I’ll address both. In this article I’ll start with what to feed kids to help them grow and thrive, and in the next part I’ll talk about how.

Six types foods and nutrients are consistently lacking in kids' diets, two nutrients that you might be mindful of are usually adequate, and two more are often excessive (and hidden everywhere). Here's a quick run down!

Often insufficient

Fruits and vegetables
A national survey in the USA found that 93% of children aren’t eating enough veggies each day. Of those the vegetables they did eat, about 1/3 were white potatoes, most of which were in the form of French fries (1). Similarly, in the UK, a survey found that only 18% of 5-15 year olds manage to eat the recommended five servings of fruits and vegetables each day (2). Ideally, kids should get a variety of fruits and veggies totaling about 2 cups each day for toddlers (2-3 years old) and 2.5-3 cups for 4-8 year olds. Older children (9-13 years) should be aiming for 3.5 cups per day. One cup of fruit is equivalent to one apple, or eight strawberries; one cup of vegetables is around 12 baby carrots or three spears of broccoli. The reason they need all this fresh produce is because it provides fiber, vitamins and minerals that children need to grow and thrive (see below). Some kids eat plenty of fruit and not many vegetables - that’s okay, but vegetables provide a much wider range of nutrients than fruit, without the sugar, so try and shoot for 50:50 fruits and vegetables.

Offering a fruit or a vegetable at every snack and meal will get you to five servings a day: for example, berries or banana with breakfast, carrots with morning snack, spinach in scrambled eggs for lunch or baby tomatoes with a sandwich, apple slices with afternoon snack, and a couple of veggie options at dinner
Easy snacking veggies include: carrots, snap peas, bell peppers, cherry tomatoes, cucumbers, pickles, kale chips, seaweed snacks, olives, avocado (‘on the half shell', with a spoon) etc.
Try keeping sliced veggies in a mason jar in the fridge that kids are free to access throughout the day
If kids want a snack right before dinner because they’re too hungry to wait, offer salad or vegetables (consider it an appetizer!). If they're hungry they'll eat them, if not, they can wait til dinner.
Don’t forget that beans and legumes count as vegetables too! Edamame are easy to nibble on, and hummus is great for dipping vegetables and crackers, or in a sandwich with shredded carrots and avocado.

Fiber (fruits & veggies, whole grains, beans & legumes)
Most kids need more fiber. The average child in the US consumes less than half the adequate intake each day (3), which is 19g per day for 2-3 year olds, 25g for 4-8 year olds, 26g for girls aged 9-13 years, and 31g per day for boys aged 9-13 years. Fiber regulates bowel movements and feeds our friendly gut microbes. Constipation is a common issue in children and inadequate fiber intake is the first thing to address. The easiest way to increase fiber intake is to eat more fruits and vegetables (see above), to choose whole grains in place of refined grains (e.g. wholewheat pasta, brown rice), include more beans and legumes (e.g. refried beans in a cheese quesadilla, Chipotle-style burrito bowls), and nuts and seeds.

One slice of whole wheat bread typically has 2 grams of fiber, 1/2 cup of brown rice has 2 grams, 1/4 cup of beans has 3-4 grams, 1/2 cup of raspberries or blackberries has 4 grams, one orange or apple has 4 grams, 1/2 cup of cauliflower or broccoli has 2.5 grams, 1/2 cup of leafy greens has 2 grams, and an ounce of almonds has 4 grams. Fiber also needs water, so make sure your child is well hydrated. If you feel the need to add supplementary fiber, opt for oat or wheat bran (12 grams per ounce) or ground flax seed (8 grams per ounce), sprinkled on hot cereal or yogurt, or incorporated into pancake, muffin or cookie recipes.

Iron (red meat, shellfish, beans, whole grains)
Iron deficiency is the most common nutritional deficiency in children, with toddlers (9%) and teenage girls (9-11%) being particularly at risk (4). Toddlers aged 1-3 years need 7mg/day; in this age group excess milk consumption is a major contributor to iron deficiency (calcium blocks iron absorption), so limit milk to 16 oz per day. Beyond toddlerhood, 4-8 year olds need 10mg/day, and older kids (9-13 years) need 8mg/day. Iron is important for making red blood cells which carry oxygen around the body; signs of deficiency include fatigue, weakness, difficulty concentrating and pale skin. If it advances, iron deficiency will lead to iron deficiency anemia (IDA), which can cause delays in cognitive development and physical growth.

We all think of meat when we think of iron-rich foods, and it is a good source of easily absorbed iron (2 oz of red meat = 2 mg of iron), but other foods can also make a substantial contribution: 1/4 cup of white beans has 2mg, 1 oz of dark chocolate has 2 mg, 1/4 cup of lentils has 1.5 mg, 1/2 cup of spinach has 1.5 mg, 3 shrimp have 1 mg, 1/3 cup of oats has 1 mg, and 1/4 cup of quinoa has 0.7 mg. Fortified breakfast cereals are another supplementary source, with Cherrios having 3mg of iron in a 1/2 cup serving. It is not unusual for kids to need an iron supplement to get their daily recommended amount; talk to your doctor or health professional if you suspect a deficiency.

Calcium (dairy products, soy products, leafy greens and seeds)
Calcium is important for children’s bone growth in the younger years and for achieving peak bone mass in adolescence, yet 1 in 5 kids don’t meet the recommended intake. Per day, 1-3 year olds need 700 mg, 4-8 year olds need 1000 mg, and 9+ years need 1300 mg. Toddlers usually get adequate calcium, mostly from milk (275-300 mg per 8 oz cup), and are less likely to be deficient than older children. Older kids get close to the recommended amount, but most could use a little extra: they tend to get their calcium from other dairy products like cheese (1.5 oz of cheddar has 300 mg, 1 string cheese has ~200 mg) and yogurt (1/2 cup of plain yogurt has ~200 mg).

Non-dairy sources of calcium include canned salmon (with 180 mg per 3 oz), tofu (1/2 a cup has ~ 250 mg), chia seeds (1 tbsp has 75 mg) and leafy greens (1/2 cup of kale has 50 mg, 1/2 cup of boy choy has ~35 mg). Calcium supplements may be necessary if your child doesn’t eat dairy products. Needs are high in childhood and it can be hard to meet them with a restricted diet; talk to your healthcare practitioner.

Vitamin D (sunshine, fish, eggs, dairy, mushrooms)
Almost all children get inadequate vitamin D. It mainly comes from sun exposure and modern life sees children indoors much of the day, and covered in sunscreen when they’re not. Vitamin D plays a role in immune function as well as bone health - calcium needs vitamin D to build bones. Children aged one and over need at least 600 IU per day to maintain adequate levels; overweight children and those with darker skin tones are at greater risk of deficiency.

There aren’t many dietary sources of vitamin D: oily fish like sockeye salmon and trout have around 600 IU per 3 oz serving, but aside from that, mushrooms (175 IU per 1/4 cup) and eggs (45 IU in one large egg yolk) are the only other foods that naturally offer significant amounts. Some foods have vitamin D added, particularly cow’s milk and other alternative milks, typically around 120 IU per cup. Most fortified products use D2 (ergocalciferol) instead of D3 (cholecalciferol) - D2 is cheaper, but D3 is the best form for raising blood levels of vitamin D (5). Also, bear in mind that vitamin D is a fat-soluble vitamin, so if your fortified milk is fat-free, you’re probably not absorbing much of that vitamin D. Supplements are probably the best option for most kids - go for an oil-based suspension with D3; 400-800 IU per day to maintain levels (especially through the winter), and more if deficient, as directed by your healthcare provider.

Omega-3s DHA & EPA (fish & seafood, nuts & seeds)
Children who don’t eat fish probably don’t get enough omega-3 fats in their diet. There are plant sources of omega-3s (ALAs), but these need to be converted into DHA and EPA in the body, and this conversion rate is fairly low. These essential fatty acids are important for brain development and building new cells, and lower levels have been linked to ADHD and other neurodevelopmental disorders (6). Recommended amounts are set for ALA (the precursor), but not EPA and DHA. For ALA, toddlers 1-3 years old need 0.7 grams per day, 4-8 year olds need 0.9 grams per day; for tweens, 9-13 year old girls need 1 gram and boys need 1.2 grams per day. Good sources of ALA include chia seeds (1 oz has 5 g), walnuts (1 oz has 2.5 g), and flaxseed oil (1 tsp has 2.4 g). For DHA and EPA, 500-1000 mg per day (altogether) is probably ideal. Aim to get omega-3s from food first: 3 oz of wild salmon has ~1,500 mg, 3 oz of rainbow trout has ~850 mg, and 3 oz of shrimp has 240 mg. If your child doesn’t eat much fish, a supplement would be beneficial. Look for fish oil supplements with at least 300 mg of EPA and DHA; they come as gummies for younger kids, easy to swallow soft gels for older kids, and liquid formulations, all flavored to be more palatable to children.

Restricted diets
Certain subgroups will be at risk for nutritional deficiencies beyond the ones mentioned above. Some picky eaters might be also be deficient in potassium, zinc, and vitamins A or E. If your child follows a vegan or vegetarian diet they may be at higher risk of all the main deficiencies (except perhaps fiber), as well as zinc and B12. If you have your child on a gluten-free diet, they are at higher risk of the above deficiencies as well as inadequate B vitamins, and magnesium (7); most grain products are enriched with these but gluten-free ones are not. If your child has multiple food allergies they are also at increased risk for various nutrient deficiencies; consult with your healthcare provider for personalized support.

Almost Always Adequate

Protein
Many parents pay close attention to their child’s protein intake - this is generally not something to worry about. While children’s protein needs are higher than adults per pound of body weight, the overall amount needed is easily covered by all but the most limited diets. Kids need approximately 1 gram of protein for every 2 lbs of body weight, so a 40 lb child needs around 20 grams per day (divide their weight in pounds in half). Considering that 3 oz of beef or poultry has 25-28 grams of protein, 3 oz of fish has 22 grams, half a cup of beans has 7-10 grams, one egg has 6 grams, and 1 oz of mozzarella has 7 grams, kids can easily meet their minimums.

The majority of children I’ve worked with are getting double the minimum needed, and some whose families are on protein-heavy diets (e.g. paleo) can actually be getting too much, which can compromise kidney function, so don’t overdo it. Kids need carbohydrates for energy and fats for brain and hormone heath, so make sure they get an age-appropriate balance.

Vitamins
In the US, most children meet the recommended daily amounts of the majority of vitamins and minerals (8) from foods, with the main exceptions discussed above. On top of this, around 1/3 of children nationwide take a multivitamin as well (9), and most children I work with are taking one. To be honest, I don’t really recommend multivitamins, for a couple of reasons: Firstly, most kids don’t need one, as mentioned, so it’s just unnecessary expense and sugar (~ 2-4 grams per serving), and the children that need them most aren’t likely to be the ones taking them. Secondly, most don’t contain the commonly lacking nutrients discussed above, like iron, calcium and omega-3s - calcium is too bulky for manufacturers to include, fish oil can't be easily blended into a multi, and iron has a strong flavor. Many of them do contain vitamin D, but it isn’t always D3 (cholecalciferol), so look out for that. Multis often have synthetic forms of B vitamins like folate too, which aren’t well absorbed by a large chunk of the population. Another reason I’m not a fan is that they can provide a false sense of security in terms of making up for a limited diet: they really can’t replace the nutrients from food, in terms of the range offered or the quantities of those nutrients that they do include.

I’m not against multivitamins entirely - some kids do need all the support they can get while working on dietary improvements, and some children with restricted diets may need one on an ongoing basis. Personally (and professionally) I prefer supplements to be targeted the individual child’s needs (for example, a stand alone zinc, iron or calcium supplement where needed). Stand alone supplements are often higher quality and offer therapeutic quantities of the needed nutrient.

Typically Too Much

Sugar
The vast majority of children get too much added sugar, even if they never eat candy. The US government recommends that added sugar comprises no more than 15% of daily energy intake, while the World Health Organization suggests half this, just 5-10% of daily calories. The US guidelines translate to 16 grams per day for 2-5 year olds (4 tsp), 12 grams per day for 6-11 year olds (3 tsp), and 20 grams per day for middle schoolers (5 tsp). The actual average sugar intake for US children is at least triple this: 2-5 year olds average 52 grams (13 tsp) per day, 6-11 year olds average 80 grams (20 tsp), and 12-19 year olds average 96 grams (24 tsp) (10). For British readers, these numbers are a little lower in the UK, but still exceed the recommended amounts (11).

This might surprise you, but sugar is hidden in almost all children’s foods, even the apparently healthy ones. The average kids’ cereal, the most popular yogurt tubes, and the average granola bar all have around 10 grams of sugar per serving. Then there’s the hidden sugar added to bread, pasta sauces, dressings, ketchup, peanut butter and yogurts (12), before we even touch on obvious sources like juice drinks, sodas, sweet snacks and desserts. While there is a socioeconomic disparity between adults’ added sugar intake, there is not between children - children in higher income families consume just as much sugar as those in lower income families (13). Too much sugar spikes blood sugar levels and can lead to energy crashes; over time, this blood sugar rollercoaster ride can lead to type 2 diabetes, as well as increased triglycerides and lowered HDL cholesterol. Rates of type 2 diabetes (previous called ‘adult onset’ diabetes) in children are steadily rising (14), and 13% of children has low HDL cholesterol (15). Added sugars are also the leading cause of tooth decay in children, and contribute to both obesity (excess calories) and malnutrition (crowding out more nutritious foods).

To reduce sugar intake, avoid packaged and processed foods in favor of fresh foods where possible. If you are buying packaged snacks and cereals for your kids, look for less than 7 grams of sugar per serving, and stick to the serving size. If your children are used to sweetened yogurts, buy plain and add your own sweetness with a teaspoon of jam (3 grams of sugar) or honey (6 grams of sugar) - even two teaspoons will be less added sugar than a store-bought sweetened yogurt, and you can slowly reduce as your child’s palate adjusts. If they like to drink juices, try diluting 50:50 with water and scaling back from there, if they like to drink sodas, try flavored sparkling water or kombucha for less sugar. When doing your grocery shopping, look out for added sugars in staples like sauces, condiments, bread, etc, and opt for brands with lower or no added sugars when available. Your kids are sweet enough already!

Sodium
Around 90% of US children eat too much sodium daily (16), mostly from processed and store-bought foods. It is recommended that toddlers get no more than 1500 mg per day (most eat more than 2000 mg), and older children should get less than 2300 mg per day (average intake is more than 3300mg) (17). Although we all think of the salt shaker when we think about sodium, packaged and prepared foods are the most significant contributor, with pizza, breads, processed meats, cheese, savory snacks and chicken nuggets topping the list.

Too much sodium can raise blood pressure, leading to hypertension: one in six school-aged children in the US has elevated blood pressure. Eating more fresh foods in place of packaged foods will reduce sodium intake; additionally, fruits and vegetables are loaded with potassium, which acts as a counterbalance to sodium. There is emerging evidence that eating more potassium-rich foods, even with minimal reduction in sodium intake, can lower blood pressure and reduce risk of hypertension and stroke (18). One note on sodium: it is an essential electrolyte, so the goal is not to eliminate it entirely, and if you have low blood pressure to start with, don’t worry too much about getting excess sodium.

So, there you have it! You now know what most kids need to eat more of, and less of, and have some idea which foods provide those nutrients. Obviously nobody’s child is the statistical average, they are each unique, as are their nutritional needs; if you want personalized nutrition recommendations for your child, particularly if they have a restricted diet, please feel free to reach out to me for a consult.

Part two will talk about how to get kids to eat more of these nutritious foods, without tears, tantrums, or bribery!