Optimum Nutrition for Babies and Young Children | What's Right & Wrong

If you’re a parent, you probably tend to question yourself every time you make a decision about your child’s care. Bringing-up-baby questions start swirling around like tornadoes well before your baby is even born. And it’s quite likely that many of these questions center on how you’ll feed your child.

This subject produces more questions than do many other aspects of child care, and sometimes even a few guilty feelings. Your very first choice, breast milk or formula, (see “Giving Your Baby an Ideal Diet”) will be followed by other nutrition decisions: How much sugar? How much fat? How much milk?

The discussion that follows covers these and other important nutritional issues for kids, based on their needs during the toddler, school age, and teenage years. It also covers such topics as allergies, food-related behavioral problems, the young athlete, and helping an overweight child.

Feeding Your Children: A Guilt-Free Approach

Every time you buy a breakfast cereal, you may wonder about sugar, about added colors, and if it’s even possible to find a nutritious cereal that your kids will eat. If you find that a fast-food restaurant is your most convenient lunch option, you’ll worry about how much fat is in that burger, how much salt is on those fries, and what in the world is in those shakes.

Making decisions about feeding your children is further complicated by experts who have inflexible and often contradictory points of view. And, for every conflicting theory you read, there seems to be another medical study to prove it right…or wrong.

Some experts will suggest that you impose severe limits on your children’s fat intake, making them virtual vegetarians. Others mention that you can significantly improve your child’s intelligence and concentration by following a specific, restrictive diet plan. You’ll read that behavior and behavioral problems can be directly linked to diet. Some blame food allergies for everything from earaches to hyperactivity.

There are even a few pediatricians who will actually admit that you can become too stressed-out about feeding your kids. They’ll tell you to take a deep breath, relax, and stop worrying. In moderation, they’ll say, even junk food can be nutritious.

The most reliable friend you have for guiding your child’s nutritional path is your own well-informed common sense. Educate yourself about what’s new; be cautious about extreme theories. Whenever an “expert” advises you to completely overhaul your child’s diet, think twice, unless there are compelling reasons for a change, such as food allergies or serious behavioral disorders. Finally, weigh the nutritional benefits of a particular philosophy against how it will make your child feel. Even if a drastic, restrictive diet plan is physically healthy, it could inflict an emotional toll on your child that could undo all of its nutritional benefits.

Avoiding Extremes

Your child’s nutritional needs are best met by a balanced diet with a broad variety of foods from the basic food groups, served in age-appropriate portions. (See Daily Menu Plans throughout this discussion.) The proportions needed from each food group are the same as for adults:

What To Do, Now that Your Child is Two, Three, or Four

As your child approaches the age of 2, it’s up to you to set the stage for a lifetime of healthy eating habits. Start at the top—with you and the other adult members of the family serving as good examples. Don’t expect your child to eat right if you don’t: If you munch on potato chips, you can’t possibly elicit your child’s interest in carrot sticks.

Two is the delightful age of contrariness, the age when it might seem as if your child has a vocabulary of one word: NO. And this is the time when you might easily resort to using sweets as a reward or an enticement. One day, you may hear yourself saying, “Sweetie, get in your stroller and you can have a Twinkie.” Or, “If you finish all those carrots, you can have a candy bar.”

Is it wrong to use food as a reward? Not completely—but be careful about rewarding the eating of one food with another. In fact, most experts agree you should think twice about rewarding eating, period.

Be especially careful about rewarding toddlers and pre-schoolers with food. They really don’t think the same way you do. Here’s what your toddler thinks: “A Twinkie’s my prize? Wow! It must be pretty special!” Or, “A candy bar for eating carrots? Must be really good food.” Those kind of messages can get a kid’s food sense off to a shaky start.

A study of pre-schoolers’ food preferences yielded some amusing results. The study found that kids believe that if something can be eaten at all, it can be safely consumed in any amount, and will help them grow (that is, will be healthy). So, to the very young mind, a diet consisting only of lollipops is perfectly sound, logical, and indeed, even good for you.

The study also found that little kids believe that if two foods, say, orange juice and chocolate are acceptable, then it’s equally acceptable to make a meal of them. And when an edible food touches a disgusting food (bugs) or an inedible substance (paint), that may not necessarily render the edible food disgusting or inedible. (However, most kids over the age of 3 will probably avoid eating anything that crawls, although this has not been substantiated by scientific testing).

Daily Menu Plan for Pre-Schoolers
Milk and dairy products (2 servings): One serving equals: • 1 cup low-fat, or skim milk • 2 ounces low-fat cheese • 1 cup low-fat yogurt or cottage cheese • 2 tablespoons powdered skim milk Fruit (2 servings): One serving equals: • A quarter of a banana or apple • 1/2 cup of canned or mashed fruit • In addition, serve at least 3/4 cup of orange juice daily (or equivalent source of vitamin C) Vegetables (2 servings; plus 1 serving of yellow or leafy green vitamin A-rich vegetables): One serving equals: • 1/2 cup cooked • 1 cup raw Meats, fish, poultry, legumes (2 servings) A serving at this age is 2 to 3 ounces. Limit hot dogs and lunch meats to no more than once or twice a week or switch to the new low-fat lunch meats and hot dogs. Breads, cereals, and grains (6 servings): One serving equals: • 1 slice whole grain or enriched white bread • 1/2 roll, muffin, or bagel • 3/4 cup ready-to-eat unsweetened cereal • 1/2 cup cooked cereal, pasta, rice, barley, or other grain • 2 to 5 crackers Try to use whole grains as much as possible.

Do They Eat Enough?

What you serve your children, and what they actually eat, may be two different things—but that’s almost entirely beside the point. By offering toddlers and pre-schoolers a broad selection of healthy foods from the five basic food groups, you are educating them to a lifetime of delicious possibilities. Indeed, your own positive attitude about food will go a long way toward assuring a healthy approach to food among your kids.

Bear this in mind: No matter how little food they seem to consume, or how temporarily bizarre their eating habits, starvation and malnutrition are practically nonexistent among children who, during a happy and relaxed mealtime, are offered a balanced selection of healthy foods.

Throughout the growing years, there’s an easy way to tell whether your child is getting enough to eat: If the child grows and gains weight normally, looks healthy, and stays active, you can be fairly certain that he or she is consuming enough food.

Remember, though, that “normal” growth for a pre-schooler takes place at a slower pace than it did during infancy: During the first 12 months of a baby’s life, a weight gain of 12 to 15 pounds is typical; between the ages of 3 to 5, a child will probably not gain more than four pounds a year, or about a third of a pound a month. The decreased growth rate might explain why pre-schoolers seem to have a decreased appetite and less interest in food.

Should there be any question in your mind as to what “normal” growth or weight gain means, check with your pediatrician.

Do Kids Really Need Three Glasses of Milk a Day?

Many parents are concerned about making sure their children get plenty of calcium to insure healthy bone strength and growth. Although 3 glasses of milk a day supply enough calcium to meet children’s needs, other foods besides milk are equally good calcium sources, including cheese, dark green leafy vegetables, broccoli, and dried beans. Most experts agree that once a child is over the age of 2, the milk you serve should be skim, 1, or 2 percent.

The Two Golden Rules of Feeding Your Children

By the time your child is 2, you will have to learn how to relinquish a certain amount of control over the way he eats. According to Ellyn Satter, author and registered dietitian, there is one golden rule about feeding your children:

Parents are responsible for what foods are served to children and how they are served; children are responsible for how much—and even whether—they eat.

Another “golden rule” shared by many nutritional experts is:

Never, ever allow food to become a battleground or power struggle between you and your child.

Avoiding a battle over food is frequently difficult during a child’s earlier years. One tactic you may find helpful is to serve the meal, then physically leave the room for 5 or 10 minutes while the child decides what to eat. And when asking the child for a choice, don’t leave it open-ended: Rather than saying “What would you like for breakfast?” present a couple of options, for instance “Would you like cereal or a bagel?”

Coping With Picky Eaters

There’s no medical definition for a picky eater, but if your child is one, you’ll know it. With pre-schoolers, foods can come in and out of favor with breathtaking rapidity for no apparent reason whatsoever. Sometimes, children can become attached to just a single food, or to weird combinations of foods.

Coping with a picky eater may strain your patience, but take comfort in knowing that most such kids become normal eaters in a matter of time, and rarely does “pickiness” affect their health. Your picky eater may eat better than you realize. The book, Let Them Eat Cake, cites the example of 2-year-old “Josh,” whose insistence on a scrambled egg, catsup, and juice every night for dinner until he was about three and a half drove his parents crazy. But when they kept track of his all-day food intake, it became clear that in the course of 24 hours Josh ate a wide variety of other healthy foods, and so was in no danger of suffering nutritionally because of his strange evening meal.

Your child’s pickiness may have nothing to do with food preferences and everything to do with the pre-school struggle for independence. If you accept pickiness as a temporary phenomenon and refuse to make a big deal about it, the problem, in all likelihood, will disappear in time.

In some cases, however, a picky eater is right. Some children may instinctively avoid certain foods because they know these items make them uncomfortable. If your child refuses to eat a particular kind of food, it may signal an allergy or intolerance. For example, if the child won’t take milk, try substituting yogurt, cheese, or cottage cheese; cultured dairy products are sometimes better tolerated. If that doesn’t work, just make certain you supply other calcium-rich foods; you may also want to have the child tested for a milk allergy or lactose intolerance.

If picky eating becomes perverse and persistent, or if your intuition tells you something is unhealthy about the way your child eats, consult your pediatrician. Although real eating disorders are rare in pre-schoolers, they could be an indication of more serious concerns or conditions.

Daily Menu Plan for School Children, Aged 7-10
Milk and dairy products (2 to 3 servings): One serving equals: • 1 cup low-fat, 2% milk • 1 ounce low-fat cheese • 1 cup low-fat yogurt • 3/4 cup low-fat cottage cheese • 3 to 4 tablespoons powdered skim milk Fruit (2 to 4 servings with at least 1 of citrus fruits): One serving equals: • 1/2 cup fruit juice • 1 small raw fruit • 1/2 cup canned fruit Vegetables (3 to 5 servings with at least 2 vitamin A-rich vegetables): One serving equals: • 1/4 cup cooked • 1/2 cup raw Meats, fish, poultry, legumes (2 to 3 servings): A serving at this age is 2 to 3 ounces. Limit high-fat hot dogs and lunch meats. Breads, cereals, and grains (6 to 11 servings): One serving equals: • 1 slice whole grain or enriched white bread • 1 bagel, muffin, or roll • 1 cup ready-to-eat, unsweetened cereal • 1/2 cup cooked cereal, pasta, barley, or rice • 4 to 6 crackers

Now That They’re In School …

Call them the grazers. When your children enter elementary school, they enter an age of new independence. Now, more than ever, it’s important to stock your kitchen with an assortment of healthy foods and snacks, for most children this age always seem to be hungry.

Make healthy eating easier for your children by keeping healthy foods handy. When kids want to snack, they’ll grab whatever is most available:

What About School Lunches?

The need for improvement in some school meal programs made headlines recently when the USDA convened “Healthy Kids: Nutrition Objectives for School Meals,” a series of hearings in Washington, D.C. The hearings were held to explore new ways to upgrade the nutritional content of school meals. Seventy experts testified.

Of particular interest to concerned parents were four food manufacturers who make healthier food products than those now being served in school cafeterias. One was Lucille Farms, Inc., a Vermont maker of traditional Italian cheeses. Their new low-fat cheeses could make pizza—the number one school lunch choice—healthier.

Since parental involvement is a factor that directly affects whether or not a specific school district serves nutritious meals, find out what your kids eat at school. If you don’t like what you learn, become involved, ask questions, and demand healthier foods.

Do They Still Need Their Vitamins?

Of course! But the consensus among professional medical and dietetic associations seems to be that vitamin and mineral supplementation is unnecessary for children who eat well-balanced diets. It’s far healthier to encourage your child to eat properly than it is to suggest that a pill can take the place of sound eating habits—especially since vegetables, fruits, and other nutritious foods contain a wide variety of health-promoting substances that aren’t found in vitamin supplements.

Children who subsist on high amounts of “junk food” however, may suffer ill effects, notes Dr. Derrick Lonsdale of the Cleveland Clinic in Ohio. He treated 20 such children whose diet produced a vitamin B1 deficiency. As a result, the children exhibited the classic symptoms of beriberi, including neurotic tension, diarrhea, nausea, and excessive sweating—symptoms that might not be immediately obvious to parents. The children improved when they were given vitamin B1 supplements.

Does vitamin supplementation in excess of RDAs have any beneficial effects for children? Medical studies show conflicting results: One study reported improved reasoning ability in children who received vitamin and mineral supplementation; another study, specifically designed to confirm or refute the first, did not corroborate the findings.

Nevertheless, if you’re unsure how adequate your child’s diet really is, providing a daily multivitamin is something to consider.

Daily Menu Plan for Adolescents and Teens, Aged 11-17
Milk and dairy products (3 servings): One serving equals: • 1 cup low-fat, 2% milk • 1-1/2 ounces low-fat cheese • 1 cup low-fat yogurt or low-fat cottage cheese • 4 tablespoons powdered skim milk Fruit (2 to 4 servings with at least 1 or more of citrus fruits): One serving equals: • 1 cup fruit juice • 1 medium raw fruit • 1 cup canned fruit Vegetables (3 to 5 servings with at least 2 or more vitamin A-rich vegetables): One serving equals: • 1/2 cup cooked • 1 cup raw Meats, fish, poultry, legumes (2 to 3 servings): A serving at this age is 2 to 6 ounces. Keep limiting high-fat meats. Breads, cereals, and grains (6 to 11 servings): One serving equals: • 2 slices whole grain or enriched white bread • 1 large bagel, muffin, or roll • 1 to 1-1/2 cups ready-to-eat, unsweetened cereal • 1 cup cooked cereal, pasta, barley, or rice • 4 to 6 crackers

The Teen Years

Despite their increased nutritional needs—teenagers gain the final 20 percent of their adult height and the final 50 percent of their adult weight during this period—these kids are the least likely people to eat a balanced diet. And it is at this point in their life that you are least able to impose your dietary guidance.

How can parents make sure their teenagers eat well? If you’ve instilled your child with a sense of healthy eating during early childhood, he is likely to continue eating well as a teenager—and lapses are likely to be temporary.

Teens’ bodies are changing rapidly and dramatically, and they often react to the changes with confusion, especially when it comes to their appearance. One study indicates that 70 percent of teenage girls want to lose weight, but only 15 percent of them are too heavy. The same study indicates that 59 percent of teenage boys want to gain weight, although only 25 percent of them are too thin.

This is the time of life when, in girls, such eating disorders as anorexia or bulimia begin; some athletically-inclined boys, trying to “bulk up,” may turn to the very dangerous use of steroids.

Does Puberty Affect a Teen’s Nutritional Needs?

Early puberty can seem like a time of non-stop eating for teens, as they constantly seek to fuel their unprecedented growth.

Most boys begin puberty somewhere between the ages of 10 and 14. Other than consuming a well-balanced diet that provides adequate energy and nutrients to accommodate their adolescent growth spurt, boys have no additional nutritional demands at puberty.

Girls who are deficient in iron and vitamin A may experience a delay in the onset of menstruation, as may girls who are very athletic or very thin. Studies have shown that when a girl reaches a certain “critical body mass” of about 105 pounds (in girls of average height), menstruation will shortly follow. A girl’s percentage of body fat may also be a factor determining when menstruation begins; a certain amount of fatty tissue may be needed for the hormonal changes that initiate its onset. This is supported by the fact that young female athletes and girls who have a low percentage of body fat generally begin to menstruate later than normal.

How to Buy a Breakfast Cereal Your Kids Will Eat

The new “Nutrition Facts” labels make comparison shopping easier. They list nutrient values based on a 2,000 calorie-a-day diet, showing the share of total and saturated fat, cholesterol, sodium, potassium, carbohydrates, dietary fiber, and protein a serving supplies.

But if the task of picking a nutritious breakfast cereal is made easier by the new labeling, it certainly isn’t helped by cereal manufacturers, who aim directly at children their most intriguing TV commercials and print advertisements for artificially-colored and flavored, highly-sugared cereals.

So, when you’re shopping the aisles looking for a nutritious cereal, your kids are liable to be begging for the one with the free toy, or the one that’s a spin-off of their favorite cartoon show, or the one with the new wild colors. It’s up to you to deliver the message that what the cereal contains is more important than the ads.

According to the Center for Science in the Public Interest, here are tips for choosing a good breakfast cereal:

How Much Sugar is Too Much?

Unfortunately, there’s no easy answer to this question. The issue of exactly how much sugar you should allow your child is confusing for two main reasons:

According to Bonnie Liebman, director of nutrition for the Center for Science in the Public Interest, the issue is not how much naturally-occurring sugar your child eats, but rather how much added sugar your child takes in.

“When children eat lots of sugary foods, like candy, soda, or sweetened snacks, they eat empty calories that contain little nutritive value. They then have no room left to eat healthier, nutrient-rich foods.”

This is especially noticeable when it comes to a child’s drinking habits. Notes Liebman, “the biggest source of sugar in our diets is soft drinks.” She concurs with children’s nutritional experts who say that when children drink soda, all they get is a fast dose of sugar, maybe caffeine and artificial flavors or colors.

But when children slake their thirst with orange juice, they get a healthy blast of vitamin C along with their sugar; with milk they get a hefty protein and calcium dividend.

The answer to the how much sugar question is basically: Don’t let the child ruin his appetite. The USDA Food Guide Pyramid puts sweets in the category of fats and oils, and recommends a “sparing” amount of servings each day. Likewise, the U.S. Department of Agriculture advises people to eat no more than 10 teaspoons (50 grams) of added sugar a day, roughly half the amount consumed by a typical American.

Still, there are plenty of healthy ways to satisfy a sweet tooth: You can serve your child at least 4 servings of fruit a day. There are also many cookbooks chock-full of deliciously sweet snacks that pack a nutritional punch.

Try reading: American Academy of Pediatrics Guide to Your Child’s Nutrition: Making Peace at the Table and Building Healthy Eating Habits for Life, edited by William Dietz and Loraine Stern (Villard Books, 1999).

Feed Me, I’m Yours, by Vicki Lansky (rev. ed., Meadowbrook, 1994).

What About Fat?

If you read the literature on nutrition, a strong voice emerges, urging us to sharply reduce the amount of fat in our diet—and our children’s diet.

The generally accepted consensus among most experts, and the standard adopted in 1988 by the National Institutes of Health, calls for an adult diet in which no more than 30 percent of total caloric intake is supplied by fat. This 30 percent figure is also recommended for children by the American Heart Association; and in 1992, the American Academy of Pediatrics also adopted 30 percent.

However, some experts, notably Dr. Charles R. Attwood and Dr. Michael F. Jacobson, the executive director of the Center for Science in the Public Interest, believe this figure is too high.

They argue that since coronary heart disease begins in childhood, prevention with low-fat diets should also begin in childhood. They point to studies showing the appearance of fatty deposits in the coronary arteries of children as young as three years (when they consume high-fat diets and have elevated levels of cholesterol). Fatty deposits become much more common in children as they approach their teens.

Dr. Attwood, one of the most vociferous opponents of dietary fat, argues that powerful political lobbying by the Beef Industry Council and the National Dairy Council has indoctrinated practically every adult, including physicians and dietitians, in the healthful benefits of red meat, milk, and cheese. He believes that no more than 20 percent of calories in anyone’s diet should come from fat; a better amount, he says is 10 to 15 percent.

CAUTION: All experts agree that under no circumstances should fat be reduced for children under the age of two. Restricting or limiting fat or caloric intake for infants under 24 months severely inhibits normal growth and development.

The Center for Science in the Public Interest is more moderate in their recommendations about dietary fat, suggesting that 25 percent of calories come from fat.

Saturated vs. Unsaturated, Polyunsaturated vs. Monounsaturated

For children over the age of 2, limit saturated fats to no more than about 5 to 10 percent of their daily calories. Saturated fats are those that are usually solid at room temperature; they come primarily from animal sources (although palm and coconut oils are saturated fats). These fats can raise cholesterol levels and contribute to heart disease.

Polyunsaturated fats, found in vegetables, fish, corn, cottonseed, sesame, soybean, and safflower oils (and margarine if it is made mainly from a liquid vegetable oil) are less harmful; and polyunsaturated fatty acids found in fish may help to lower blood fat levels. Countries like Japan, where people eat less meat and more fish, have lower rates of heart disease. Fish especially high in “good” fatty acids are salmon, mackerel, herring, anchovies, trout, catfish, and sardines. Still, it’s wise to limit your child’s intake of polyunsaturated fats to no more than 8 to 10 percent of the day’s total calories.

Monounsaturated fats are found in olive oil, peanuts, avocados, some nuts, and canola oil. These fats help to lower the low-density lipoprotein (LDL) cholesterol that can build up in the blood vessels and contribute to heart disease. These should make up about 10 percent of your child’s daily calorie intake. (Watch out for peanut butter: It often contains large amounts of added saturated fat.)

What if Your Child is Too Heavy?

We live in an age of TV, multi-media computers, and video games. Perhaps partially as a result of their inactivity, our children constitute the “fattest generation of kids and teens in the entire history of the United States,” according to Dr. Peter M. Miller.

Dr. Miller, executive director of the Hilton Head Health Institute, reports that recent studies show that over the past 20 years, obesity in children aged 6 to 11 has increased by 54 percent; in teens, the increase is 39 percent. Twice as many children now fall into the “super-obese” category and weigh over 40 percent more than they should.

An obese child is almost certain to become an obese adult. Worse, the kid who’s too fat is likely to carry an additional burden—disapproval from teachers, friends, and sometimes even members of his or her own family. This can be a real problem: Studies show that even very young children perceive fat people to be less intelligent, sloppy, dirty, untrustworthy, and less likable than other people. Having this kind of image among friends and even strangers is a heavy burden for a youngster to carry.

What Can You Do for An Overweight Child?

Check the charts. If your child is significantly over his or her ideal weight, it’s time to intervene. Many experts recommend a “no diet” approach, especially for children who still have a lot of growing to do. The “no diet” approach means no reduction in the amount of food your child eats, but it does mean changes in the kind of food you serve. In addition, you must make lifestyle changes that increase your child’s activity level.

CAUTION: Children under the age of eight should not be placed on diets. Never restrict calories or fat for a child under the age of 2.

As your child gets older, he or she will grow, and eventually will weigh the right amount for his or her height—as long as you help maintain a well-balanced diet. That means serving plenty of low-fat foods, including lots of fresh fruit, vegetables, grains, and lean proteins. On an “all-you-can-eat” diet, as long as you strictly limit or, better yet, eliminate all fatty and sugary foods (including most “fast food” meals), your child need not feel terribly deprived.

The best way to help your child lose weight is to subtly revamp your whole family’s lifestyle so that everyone gets more fit—especially if there are other overweight family members. Since temporary diets don’t give lasting results, it’s wise not to refer to your family-wide fitness program as a “diet.”

Instead, create ways to get your family moving again, since exercise is the best defense against extra pounds. Begin serving delicious, low-calorie meals and snacks that the whole family can enjoy. Consult “Best Strategies for Losing Extra Pounds”, for specific information about weight-loss and fitness programs. “Fitting Health into Your Everyday Meals” offers a host of ideas for preparing healthy meals the family still can enjoy.

Consider your weight-loss program as a new team approach to family fitness and a healthier, happier lifestyle. Make sure that the elements you introduce—new foods and new activities—are fun for all. If anyone perceives them as “punishment for pounds,” your program is doomed before it starts.

The Allergic Child

Food allergies are often blamed for a wide variety of children’s ailments, including behavioral disorders, congestion, asthma, and skin eruptions. But, according to the American Academy of Allergy and Immunology (AAAI), less than five percent of children are truly allergic. Instead, says the AAAI, adverse reactions to food are usually caused by the inability to digest certain ingredients, like lactose in milk or gluten in wheat. Sensitivities to substances may also be a factor: Some children react adversely to salicylates and food additives; other children (though fewer than we’ve been led to expect) are especially sensitive to sugar.

It’s easy to confuse food allergies with digestive intolerance—both are evidenced by some kind of discomfort after eating particular foods. However, they are caused quite differently. Food-intolerant people lack the enzymes needed for the digestion of certain foods; allergic people react to a food as though it were a foreign invader. The confusion is exacerbated because the word allergy is often used to describe food intolerance.

Putting semantics aside, if your child has a problem, how do you determine whether or not your child is sensitive or allergic to certain foods?

Behavior Problems

If your child is hyperactive, prone to temper tantrums or is generally regarded as being a “difficult child,” food is only one of many possible causes. But if you’ve ruled out disruptions in home life (a move, new job, death of close friends, or relatives), marital tension, problems within the school, and the like, your child may have one or more food sensitivities or allergies that cause the “acting out.”

In 1973, the late Dr. Ben Feingold presented his observations on diet for hyperkinetic and learning-disabled children to the Allergy Section of the American Medical Association in New York. The enormous interest in the topic led him to write Why Your Child Is Hyperactive.

Dr. Feingold spent years studying the reaction of children to various foods. His research led him to believe that some children are sensitive to salicylates (a group of organic compounds related to aspirin), certain food additives, and sugary foods. Dr. Feingold insisted that children sensitive to these substances can react with such behavior disorders as hyperactivity. For them, he devised the Feingold Diet for additive- and salicylate-free meals.

The Feingold diet is the object of considerable controversy. One independent study involving 59 children between the ages of 6 to 14 years, confirmed that some children do react badly to foods containing salicylates and additives. Of the 32 children who were able to tolerate the very rigid diet, 11 showed remarkably improved behavior. However, another study found no beneficial effect; and many experts speculate that any improvement in behavior is simply a response to the extra time and attention the diet requires. One thing is certain: the diet is extraordinarily restrictive. You must completely eliminate all foods containing artificial colors and flavors, including U.S. certified, FD&C approved, or USDA approved colors or flavors, and all foods containing vanillin or caramel coloring and flavoring. Also on the hit list are all foods that contain the common preservatives BHT and BHA, which are widely used in dairy products, cooking fats and oils, and even food packaging materials.

Finally, most fruits, all berries, tomatoes, peppers, coffee, and tea are all out of bounds at the start of the diet. These forbidden foods ordinarily supply a wealth of vitamins, but you can’t make up for them with vitamin supplements, because any that contain artificial colors and flavors must also be eliminated.

Clearly, this is a diet that you’ll want to discuss with your pediatrician before going further, since many experts regard it as completely discredited. Nevertheless, according to Dr. Feingold, 60 to 70 percent of those children who follow the diet precisely will see a marked improvement in behavior. For additional information, see Your Child’s Food Allergies, by Jane McNicol (John Wiley & Sons, 1992) which offers recipes and sample menus and details a test diet for hyperactive children. Why Your Child Is Hyperactive, by Dr. Ben Feingold (Random House, 1985), outlines the pioneering doctor’s plan.

If neither you nor your child notice an improvement after you strictly follow a special behavior diet, and if your child’s behavior problems are so severe that they make peaceful co-existence impossible and inhibit his or her ability to learn, then ask your doctor about scheduling your child for a comprehensive physical and emotional evaluation to determine the roots of the trouble.

Other Tip-offs of Food Sensitivity

Sensitivities to certain foods announce themselves with distinctive sets of symptoms:

Congestion; frequent runny nose, ear aches, colds; bad breath; headaches. Cow’s milk—the most commonly reacted-to food—can cause upper-respiratory symptoms; a lactose-intolerant child might show an excessive love or hatred of milk. Try eliminating all milk products from your child’s diet for two weeks; keep a log daily and note any changes. Then, if you see improvement, you can try re-introducing foods like yogurt, low-fat cheese, or cottage cheese; very often children sensitive to milk are not sensitive to its cultured forms. If all milk products are eliminated, be sure to provide adequate calcium substitutes.

“Jitteriness” or other notable signs of hyperactivity. Your child may be reacting to chocolate or cola, second only to milk as “reactable” foods. Eliminate these, and note whether jitteriness disappears or behavior improves. Caffeine could also be the culprit. Try eliminating all caffeine, found in many sodas, chocolate, and, of course, coffee.

Extreme “sweet tooth,” frequent eating, parents with a history of diabetes, hypoglycemia, or alcoholism (or low tolerance for alcohol). Your child may have a sugar reaction, or may be allergic to specific sugars, such as cane or beet sugar. The chemicals used in processing can also spark reactions. However, most experts agree that sugar has been overrated as a cause of hyperactivity, and most children will tolerate at least small amounts. Few will react to lightly sugared foods eaten with other foods or for dessert.

Repetitive behaviors, bold or aggressive behavior, family history of MSG intolerance; unexplained gastrointestinal upsets or headaches. The ubiquitous MSG (monosodium glutamate), a flavor enhancer found in many processed foods and Chinese food (hence, the “Chinese Restaurant Syndrome”) is a potential cause of behavior problems. People sensitive to MSG may also be sensitive to other flavor enhancers such as hydrolized vegetable protein (HVP) and hydrolized plant protein (HPP).

These substances are difficult to eliminate from your child’s diet because they are so common. However, both books mentioned above have excellent recipes and strategies for coping, should you find your child is MSG, HVP, or HPP-sensitive.

When Your Child is Sick

When your child is down for the count with a cold, flu, or intestinal bug, it’s time for TLC. Here are some tips about what to feed your sick child—and what to avoid.

FIRST: If your child has a fever, has vomited more than a few times, has diarrhea that doesn’t abate after a few hours, is in pain—or if your child is droopy, very quiet, and just not him or herself—call your pediatrician.

Dr. Michael Mitchell, a prominent Manhattan pediatrician and author of The Pill Book Guide to Children’s Medications (Second Edition, Bantam, 1994), offers these suggestions for feeding an ailing child.

If you’re uncertain as to whether your child has something serious, check with your doctor.

Nutrition for Young Athletes

Nutrition for a young athlete differs very little from nutrition for adult athletes: All should eat a well-balanced diet, high in complex carbohydrates, lean protein, and plenty of fruits and vegetables. (For details, see “Boosting Energy and Fitness: Which Foods Really Work?”)

Parents need to watch over their children when they excel at a particular sport or sports, especially if they’re extremely committed to achieving winning results. These children need extra guidance to help them avoid dangerous fad diets and unhealthy food supplements.

If your son plays football, lifts weights seriously, or engages in any other activities that require special muscular strength, caution him about the dangers of anabolic steroids. (Very rarely do girls abuse steroids; however, if your daughter engages in sports that require extra muscular strength, be sure to counsel her against steroid use).

A 1993 survey by the Journal of the American Medical Association revealed that over one million Americans aged 12 and older are steroid users; nearly half are under the age of 26. It’s been estimated that between 5 and 10 percent of high school students may be steroid abusers. Steroid abuse puts young and old alike at serious risk of permanent mental and physical impairment, and can even lead to death. In addition to these dangers, steroid use in children can stunt their growth. (For more information, see “Boosting Energy and Fitness.”)

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What About Salt?

Although the right level of salt for adults is a subject of major controversy, salt is much less of a concern for kids. Among salt-sensitive adults, excessive amounts can lead to high blood pressure, one of the major risk factors for strokes and heart disease. However, there is no evidence of such a problem in children.

A lifelong diet high in sodium has recently been linked to an increased risk of osteoporosis, the “brittle bone” disease. According to the Center for Science in the Public Interest, eating an extra teaspoon of salt each day causes the body to lose enough calcium to dissolve about one percent of bone annually—a frightening statistic at first glance. However, since most of us reach retirement without losing two-thirds of our bone mass, it seems likely that this particular problem may be over-rated. If you keep salt at moderate levels and make sure the kids get plenty of calcium, there’s no reason to be concerned.

Extremely salty foods have been implicated in stomach cancer. It is said that salt acts as an irritant to the stomach lining and causes cells to reproduce more rapidly, and victims of stomach cancer tend to have consumed high-sodium diets. However, once freezing and canning replaced preservation with salt in the U.S., the odds of stomach cancer plummeted. Moderate amounts of salt as used today seem to pose little threat.

Finally, a study reported in 1993 in the British Medical Journal linked high salt consumption with deaths from asthma in men and children. Though the results of the small-scale study were by no means conclusive, they did demonstrate a relationship between high-sodium diets and asthma that should not be overlooked by parents of asthmatic children.

Experts estimate that children probably take in between 5 and 10 times the recommended allowance of sodium each day, mostly from the sodium-containing chemicals found in processed foods. You might suspect that salty-tasting snacks like potato chips would be at the top of the high-sodium list, but they’re not: One ounce of potato chips has about 135 milligrams of sodium; the average hot dog weighs in at about 500 milligrams. Currently, the National Research Council of the National Academy of Sciences recommends a daily allowance of 2,400 milligrams of sodium for everyone over the age of 2.

How to Promote Good Nutrition in an Era of TV

You now have a good idea of what constitutes a good, healthy, tasty diet for your kids. But kids, especially young ones, often get different ideas from what they see on television.

According to the Center for Science in the Public Interest, every time your child sees a food commercial on TV, it’s as though you let a door-to-door huckster into your home who said, “I’d like to beguile your children and lure them into bad habits that will harm their health. Please leave the room so I can speak to them directly without your interference.” The average American child sits in front of a TV set between 3 and 4 hours every day. By the time high school graduation rolls around, your child is likely to have seen well over a million TV commercials.

Of those commercials, many for sugary, artificially colored breakfast cereals focus on contests or free toys instead of the cereal itself. Fast-food restaurant commercials hype toy giveaways rather than the content of kids’ meals. Snack food commercials promise a child painless popularity.

Most of these commercials focus very little of your child’s attention on the nutritional content of the advertised food, and can leave children with a skewed idea of what’s really good for them, food-wise.

Do you have to turn off the TV to see that kids get better balanced, healthier food messages? Not necessarily—although limiting TV time and encouraging active recreation is probably a good idea anyway. Here’s a much easier way to balance the commercial food messages your kids get: Get in the habit of occasionally watching TV with your kids, especially while they’re little. Make a game out of helping them sift through commercial messages for the facts. Let them decide what is accurate, unbiased information and what is a paid-by-the-product commercial message.

You are your child’s best role model. If you impart the facts about foods and other advertised products in a humorous, well-informed way, you’ll go far to help your child differentiate substance from hype. Inevitably, it will be your values your child chooses to emulate, not the values he or she sees on TV.

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