Friday, August 12, 2011

The Top 5 Nutrition Pitfalls in Feeding Children and What Parents Can Do Instead

Last month I was fortunate to have a graduate student intern, Natalia Stasenko. Natalia is a MS and RD candidate at Teachers College, Columbia University, New York. Her professional interests include pediatric nutrition, including food allergies and feeding problems such as picky eating. In her work she combines her knowledge of the science of behavioral nutrition with her experience as a mother to help parents improve their children’s eating habits. She wrote the following article as part of her internship experience.

The Top 5 Nutrition Pitfalls in Feeding Children and What Parents Can Do Instead

By Natalia Stasenko

1. Juice, juice everywhere…..
Made from fresh fruit, fortified with important vitamins and minerals – what can be bad about it?  The amount! Children like it because it tastes good and parents are happy to keep pouring because they think it is healthy. However, the American Academy of Pediatrics recommends only 4-6 oz a day of 100% juice for children 1 to 6 years old and up to 12 oz for children 7-18 years old.[i]

What happens when children drink more? Too much juice leads to poor diet quantity, dental caries, diarrhea and BOTH overweight or underweight in children.  Children prefer sweet foods to pretty much everything else, and juice can replace other important sources of nutrients in their diet such as milk, whole grains, vegetables and, of course, fruit.  Fruits juice is neither superior not equal to real fruit – it lacks fiber and other nutrients found in the fruit skin. 

Solution: Avoid juice drinks and offer only 100% juice in recommended amounts. If you choose to water the juice down, do not exceed the limits appropriate for your child’s age and try to the “weaning” technique by adding less and less juice to their water every time.

2. Milk – the more, the better?
“Milk is good for you” – this is what we are used to hearing from our parents and grandparents. And research shows that is definitely is – milk is a major source of important nutrients such as calcium, protein, magnesium, and phosphorus in our diets. However, it is important to keep in mind that children between 2 and 8 need only 2 servings of dairy a day to meet their needs while the rest of us need 3 servings. A serving of dairy is 1 cup of milk or yogurt, 1.5 oz of cheese or 1 ½ cup ice cream. According to the report published in American Family Physician, toddlers drinking more than 24 oz of milk a day are at a higher risk of developing anemia. [ii]  There are a few reasons for it. First, cow’s milk is low in iron. Further, calcium found in milk impedes absorption of iron from other foods. Finally, too much milk fills up small tummies and replaces other nutritious foods in the diet.

Solution: Offer 2-3 servings of milk and other dairy products a day, depending on your child’s age.  If your child is used to “snacking” with milk throughout the day, switch to fruits, vegetables, wholegrain crackers or popcorn accompanied with a glass of water and serve them at regular times between main meals. If your doctor determined that your child is at risk for anemia, do not serve dairy and iron-rich foods, such as meat, poultry, eggs and dark leafy greens, at the same meals. A good idea would be to wait for 1-2 hours after iron-rich meal before offering a glass of milk. To increase iron absorption from foods, serve them alongside fruits and vegetables, rich in vitamin C.

3. To add fat or not to add fat?
Cheerios for breakfast, pretzels and fruit for snack, turkey sandwich with vegetables for lunch, pasta, peas and chicken for dinner.… What is missing in this seemingly healthy diet?  Fat! Parents are often hesitant to include fat in their child’s diet, often out of fear of obesity and overweight. However, fats should cover 30 to 40% of caloric needs for children aged 1 to 3 years old and up to 35% for older children and adolescents. This means that parents can be more liberal with fats, especially when planning meals for younger children.

Solution: Don’t fear including different types of fats into your child’s diet.  Starting the day with some nut butter is a good idea as it is full of beneficial polyunsaturated fats.  A slice of avocado alongside a few pretzels will boost fiber and provide more energy for an active morning. Some butter melted over vegetables will win over the taste buds of even the pickiest eaters and, of course, fatty fish like salmon and tuna offer the critical Omega-3 fatty acids to fuel the brainpower of the whole family.

4. Fortified vs Whole Foods Meets 500% of vitamin C needs! High in protein! An excellent source of (fill in the gap)! All these nutritional claims are typically found on boxes of processed products, such as some breakfast cereals, granola bars, fruit snacks, chips and crackers. They may make us believe that processed foods fortified with vitamins and minerals or having additional whey protein incorporated into their recipes are somehow superior to natural unprocessed foods such as meat, fish, dairy, grains, fruits and vegetables. The truth is, our children are not very likely to get deficient in the nutrients typically added to processed foods. What their diets typically score low in is a group of nutrients found in whole unprocessed foods: vitamin E, calcium, magnesium, potassium, and fiber. [iii] It is also important to remember that very often processed foods are made of ingredients with low nutritional value, such as processed grains or fruit juice and alongside with some vitamins and minerals, may be “fortified” with plenty of sugar and salt.

Solution: Unless advised otherwise by your doctor, stop “buying” the nutritional claims on the boxes of processed foods and focus on the food our grand parents would recognize without any problem: fruits, vegetables, whole grains, milk, meat  etc. When buying cereals and other packaged foods, read the nutrition labels carefully and choose products with less than 10g of sugar and/or 140mg of sodium per serving.

5. Vegetables – a part of a bigger picture.  With the abundance of information on benefits of vegetables for our health it is hardly surprising that we try hard as we can to make sure our children eat enough of them. However, it is also easy to lose the big picture when we worry too much about just one food group.  Vegetables are poor competitors to chicken nuggets, chocolate milk, juice and cookies, from the standpoint of the taste buds of an average American toddler. Not surprisingly, research shows that children who eat a lot of sweet, salty and crunchy foods – standard “kids friendly” fare - are less likely to like fruits and vegetables.[iv]

Solution: Look at the diet as a whole and try to reduce amount of highly processed foods by replacing them with whole grains, dairy products and fresh fruits. This will greatly increase the chances that your child will munch on raw carrots, snack with baby tomato and pile up broccoli on his plate at dinner.  The change is not likely to happen overnight and patience works better than pressure. Most importantly, enjoy a variety of healthy foods yourself in order to be a good role model for your child and get creative serving harder-to-like vegetables in a variety of ways: raw, stir-fried, steamed, roasted, accompanied by favorite dips or sprinkled with cheese.

[i] Committee on Nutrition, The Use and Misuse of Fruit Juice in Pediatrics (2001) Pediatrics 107: 1210-1213
[ii] Kazal L. Prevention of Iron Deficiency in Infants and Toddlers. Am. Fam. Physician.  2002 Oct 1;66(7):1217-1225.
[iii] Position of the American Dietetic Association: Nutrition guidance for healthy children aged 2 to 11 years. (2008)  J Am Diet Assoc. 6:1039-1047
[iv] Cornwell, T. B. and A. R. McAlister. 2011. “Alternative Thinking About Starting Points in Obesity. Development of Child Taste Preferences.” Appetite 56: 428-39.


  1. Thanks for this smart, no-nonsense post.

  2. Thanks for these great tips! I have a follow-up question about the fortified foods. I understand that we are generally better off with whole foods. If your child is a picky eater and doesn't get certain nutrients on a regular basis (ex. my son does not eat any protein other than dairy so I worry about his iron) - are fortified foods as good as vitamin supplements? - Ava

  3. Thanks Ava and Jenna for your comments. Ava, I will make sure that Natalia sees your question and ask her to respond.

  4. Thank you for the question. Both supplements and fortified foods differ in the amount of iron they provide, and I would definitely recommend speaking to your doctor before starting your child on supplements or large amounts of fortified foods. It is important to remember that pasta, bread and rice can be also fortified with iron. As far as cereals are concerned, they provide anywhere between 2 and 21 miligrams of non-heme (plant) iron per serving (recommended amount for children 4 to 8 is 10 mg of iron daily). Adding fortified dry cereals to a balanced diet could be a good idea if your child needs to boost iron and does not eat meat, seafood or poultry. When choosing cereal, it is better to choose the ones with less sugar and more fiber. Usually the more sugar a cereal has the less fiber it contains. Aim for those with 5 g of sugar per serving (1.5 teaspoons) or less and at least 3 grams of fiber and serve them alongside some fruit to enhance the absorption of iron. Some parents mix sugary cereals with less sugary ones to “wean off the sugar” gradually. Another option is to place fortified sugary cereals where they belong – in the dessert team! In my kitchen there is a box of chocolate puffs that the kids eat for dessert when they are craving something sweet.

    In general, iron from meat and poultry (heme iron) is absorbed 2 to 3 times better than from plant foods (non-heme iron). Some ways to increase iron intake and absorption from plant sources include:
    - Serving more beans and lentils, tofu, nuts and greens such as spinach, which are high in non-heme (plant) iron.
    - Serving plant foods rich in non-heme (plant) iron together with foods high in vitamine C: tomato, strawberries, citrus fruit, broccoli etc. to increase absorption of iron.
    - Cooking non-heme iron foods in cast iron skillet or other iron pot.
    - If it works for you, add a small quantity of heme iron foods to non-heme iron foods, eg. a little bit of meat to a lentil soup or turkey bacon to sautéed spinach. This will also increase absorption of non-heme iron from plant foods.

    Finally, the amount of calcium in the diet may affect iron absorption from foods. Sticking to the recommended 2-3 servings of diary products a day would be a good strategy to prevent iron deficiency.

    More information:


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