Who should read this chapter? Parents who want to understand basic nutritional food groups and how they affect a child's potential for growth and obesity. If your child is active, growing well without being overweight and they eat a variety of foods (proteins, carbohydrates, fruits and vegetables), then there is no need to change anything. But if your child is not growing as well as you'd like or if your child is overweight or showing a tendency toward overeating, then the diet modification factors suggested in this chapter may be helpful. Parents of toddlers who don’t want to eat should read the latter part of this chapter.

Summary: Dietary intake and eating habits during childhood play an important role in obesity, height potential and overall health. Intake and eating habits established during childhood have important consequences upon their future adult lives. Don't restrict children from eating. Adult methods of dieting may reduce their growth potential and possibly place some psychological stress on them. It is preferable to modify their diet to suit their needs. Children who do not eat well and grow poorly should be encouraged to preferentially eat high protein foods. Children who over eat and are becoming obese should be given vegetables first before they are allowed to eat what they want to eat. Toddlers who don’t want to eat should be given three regular meals per day and they must especially avoid between meal snacks.

Growth occurs during the childhood years. Height is determined largely by one's genetic potential and diet. Hormones can also affect height. Anabolic steroids can accelerate growth initially, but they may ultimately shorten one's ultimate growth potential. Growth hormone treatments can make children taller. It is currently used for very short children, but it has the potential to make any youngster taller. While height growth only occurs during childhood and adolescence, our potential to grow sideways will always be with us. Most experts believe that obesity is unhealthy and most experts agree that obesity acquired during childhood is most likely to result in obesity for life.

Avoiding childhood obesity is not as easy as it sounds. Dieting during childhood is not universally recommended because the wrong type of dieting may reduce their growth potential and excessive focus on dieting may predispose youngsters to the development of eating disorders such as bulimia and anorexia nervosa.

Dieting & Nutrition Basics

Foods can be classified as predominantly protein (meat, chicken, fish, eggs), starch (potatoes, corn, rice, pasta, chips), fats (oils, animal fat), and roughage (fruits, vegetables). Sweets are elementary sugars (carbohydrates) which are similar to starches (starches are complex carbohydrates). Milk is mostly water but it contains large amounts of fat, protein, sugar (milk sugar lactose), and calcium.

One way to think of dieting is to understand what your body does with each of these food categories. By understanding this, you can understand how to get the most out of what you eat. Restricting total food intake is difficult because eating is enjoyable. But by adjusting the mix of what we eat, we can still enjoy some foods and optimize the mix to fit our nutritional needs.

Starches, like all carbohydrates including sugar, are primarily used for energy storage. The human body has a limited ability to store carbohydrate energy. In the human body, carbohydrates are stored as glucose (simple sugar) and as glycogen (a type of animal starch) largely in the liver and muscles. The amount of sugar and glycogen that the human body can store is very small. Since the body needs energy in order to survive, the human body wants to store all the energy it can get. Since it can't store much glycogen, it converts the remainder of the starch and sugar into body FAT.

Proteins make children grow. The body is made largely of protein (muscle, skin, heart, liver, brain, intestines, etc.). Even bones are largely composed of protein in addition to calcium. The limiting factors to one's ultimate height, are one's genetic potential and protein intake. When growing children eat protein, the body processes it to add to body structure (muscle, organs, bones, etc.). Adults don't need as much protein as growing youngsters. When non-growing adults eat protein, this protein is used for some body repair, healing, immunity, skin turnover, hair growth, and other normal body maintenance functions. Because adults are not growing, adults do not need as much protein as children and we (adults) generally eat more protein than we need. The excess protein is capable of conversion into carbohydrate sugars. Like any other carbohydrate, these can be utilized for energy, storage into glycogen (the limited amount of animal starch that we have) or ultimately stored as FAT.

When fats are eaten, these fats are digested into molecules which enter the energy pathways similar to those fueled by carbohydrates. Any digested fats not used for energy use will be stored as body fat. To "burn" body fat, the body must exercise to consume carbohydrates and fats. Unfortunately, the human body prefers to "burn" fat only as a last resort. No wonder it's difficult to lose weight. As we exercise, the body burns fuels in the following sequence: glucose (elementary sugar), glycogen (muscle and liver starch which we have in limited quantities), protein (muscle tissue is broken down to generate sugar in a process called gluconeogenesis), then finally, fat breakdown. Note that even in a dieting state, the body prefers to breakdown some of its own muscle (protein) before burning up fat. This is why fat is so difficult to exercise off. To avoid obesity, the best strategy is to avoid putting the fat on in the first place because burning it off is extremely difficult.

Fruits and vegetables consist mostly of water and roughage fiber which the body cannot absorb well. Most of this roughage ends up in the stool contributing to its bulk. Diets high in roughage fiber result in less constipation and a lower risk of intestinal cancer. While fruits and vegetables fill up the stomach and satisfy hunger, only a small percentage of these are absorbed by the body. Most of it passes through the intestines and into the stool. This is why diets high in fruits and vegetables generally result in weight loss.

There are a few fruits and vegetables that are very high in carbohydrate and fat that should be noted. Avocados and coconuts are high in calories. Olives are high in fat. Corn, potatoes, rice and grains are actually starches and thus, high in calories. Similarly, beans and peas are higher in calories than most vegetables. These should not be considered "vegetables" like carrots, celery and lettuce are.

Fruits are often sweet and because of this, some believe that fruits are high calorie. Not true. Just because something is sweet, does not necessarily mean it's high calorie. What's even more true is that most high calorie items are NOT sweet; such as starches (rice, potatoes, pasta, bread, corn, etc.) and fats (butter, bacon fat, oil, etc.). Most highly sweet foods (frosting, candy, chocolate, etc.) are high calorie, but fruits are a notable exception to this. Fruits are mostly water and fiber. In general, crunchy and watery fruits (eg., apples, oranges, watermelon, etc.) will be lower in calories than soft, fleshy fruits which contain more starch (eg., mango, dates, avocado, etc.).

Dietary cholesterol has little to do with growth. Its major concern is its effect on increasing the risk of heart disease and stroke. Of interest is that cholesterol is found only in animals and is not contained in any plants. While high fat foods may be high in cholesterol, such as prime rib and bacon, some high fat foods have no cholesterol at all, such as potato chips and French fries. Potatoes and vegetable oil both originate from plants (in other words, no cholesterol). My mother once was thrilled to find a bag of potato chips labeled as "no cholesterol". She bought ten bags and distributed some to all the family members. She was a bit disappointed when I told her that "no cholesterol" potato chips are nothing new. Nearly all potato chips have no cholesterol. It is true that the types of fats in plants can affect the body's cholesterol. For example, olive oil is associated with a benefit in the body's cholesterol profile, while palm oil is associated with a worsening of the body's cholesterol profile. However, both oils (originating from plants) contain no cholesterol of their own. Cholesterol is not good for the body. Regardless of what your personal cholesterol level is, you and your children should be on a low cholesterol diet.

With the understanding of these nutrition basics, it should be evident that growing children should not be restricted from protein since this is a major factor in determining their height potential. Excess starch and fat intake in adults result in increases in body fat. Children are very active and this high activity level requires a lot of energy fuel. Inadequate amounts of starch and fat intake in children to fuel their energy level results in the burning of protein for fuel. Thus, limiting starch and fat in children results in the use of protein for fuel and a compromise in height growth. On the other hand, intake of starch and fat in excess of their energy needs results in increases in body fat.

For children who are thin and are not growing well, parents should focus on feeding them protein and high calorie substances (starches and modest amounts of fat). These children should drink whole milk (not 2% or skim milk). At meal time, these children should have protein on their plate. Once they finish their portion of protein, they can be given some starch. If they are to be given fruits or vegetables as a treat or as part of a balanced diet, these should be given last. You don't want the child's stomach to fill up with fruits and vegetables so that there is less room for protein and high calorie foods. Fruits and vegetables are good for other reasons, but they do not contribute much to growth. Ice cream or yogurt can be given for desert (high protein).

For children who are overweight, it is important to increase their physical activity level AND to reduce their calorie intake. From a psychological standpoint, it may be unwise to adopt a strategy of restricting the quantity of food they eat. My preference is to modify what they eat. I usually put some vegetables on my overweight child's plate at the beginning of a meal. I tell her that she can eat whatever she wants after she finishes her vegetables. By adjusting the amount of vegetables she eats first, the amount of high calorie foods can be modified. She must finish eating all the vegetables FIRST. You can introduce this by starting with a small serving of vegetables, then increasing this serving size gradually. After awhile, they may begin to like vegetables and fruits. Use low calorie, high fiber fruits and vegetables. Such fruits include oranges, apples, watermelon, plums, tangerines, strawberries and pears. Use crunchy vegetables such as lettuce, celery, carrots, sprouts, cucumbers, broccoli, cabbage, okra, tomatoes, asparagus, squash, string beans, peas (with the pods), pickles, etc. Avoid high calorie fruits and vegetables such as beets, avocados, coconuts, corn, nuts, peas (without the pods), olives, etc. When beans are served without the pods, they are fairly high in calories and although they are beneficial for many reasons (high fiber, low fat), there are better vegetables to use for this purpose when calorie reduction is the goal. Gelatin or fruit (peaches, fruit cocktail with the syrup drained off) can be served for desert.

For children who are "just right" (neither thin nor overweight), parents should guide them to a diet of variety. Since eating too much of anything can be harmful in some way, eating smaller amounts of a variety of things would make the most sense. Even foods which have a bad reputation such as fast food, pizza, hot dogs and French fries are all OK if eaten in moderation as part of a diet with a lot of variety. For example eating a hamburger and fries once a week is OK, but eating a hamburger and fries twice a day for the whole week is unwise. Fruits, vegetable, grains, beans, meats, poultry, starch, etc. should all be part of a high variety diet.

Being a vegetarian is good for many reasons, but not for height growth. Vegetarian children may be getting only modest amounts of protein depending on whether their vegetarian practice includes eggs and dairy products which are both high in protein. A purely plant vegetarian who excludes eggs and dairy products from the diet, has very limited options to take in large amounts of protein. If maximizing height growth of the children is important to a family, then this protein limitation will have a significant impact in limiting their height growth potential. Protein supplements can counter this limitation and increase a child's height growth potential. Many of these protein supplements contain eggs, fishmeal, dairy products or other animal products that may not suit a vegetarian. Protein supplements consisting purely of plant based proteins, often from soy beans, are available to help maximize the height growth potential of children who are strict plant vegetarians.

Although most infants are excellent eaters, it is common for them to become poor eaters near the age of 2 years. Parents feel sorry for their young child who doesn't eat much. To make up for this, parents give them snacks between meals to supplement their diet. When you think about it, this is a bad idea since this practice "rewards" the child for not eating well. He/she will learn that if I eat poorly at mealtime, I will get to eat chips and cookies between meals. Chips and cookies have minimal amounts of protein compared to the meat, chicken, fish and eggs that are usually served at breakfast, lunch and dinner. When parents provide between meal snacks, children will eat less protein at mealtime.

If your child is already in the habit of not eating at mealtime and munching on snacks to make up for this, you should train your child to eat at mealtime. Perhaps at lunch or dinner, he/she does not eat much. They must now learn that there won't be any snacks until the next meal. If they do not eat much dinner, they must learn that they will starve until breakfast. If they don't eat lunch, they will starve until dinner. They will only need a few days of this type of starvation to learn that they cannot count on between meal snacks to take care of their hunger. They should eat well at mealtime when the best food is prepared rather than rely on the junk food snacks. Eating well at mealtime will improve their overall nutritional intake and promote good eating habits as well.

Even for children who eat too much or just right, between meal snacks should be avoided. First of all, they don't need between meal snacks since they are already eating enough and also, they should be encouraged to eat vegetables and fruits which are generally served at mealtime and not between meals.

What about vitamins? This topic is covered in more detail in a later chapter covering a few medical topics. We know that vitamins prevent vitamin deficiency diseases such as scurvy, beriberi and pellagra. Do you know anyone with such diseases? Probably not. These diseases are almost unheard of in this country because our diets are generally not vitamin deficient. So taking vitamin pills are usually not necessary to prevent vitamin deficiencies. Iron might be important for menstruating women (excessive iron loss) or for those with only modest iron intake (such as some vegetarians).

However, most Americans consider vitamins for other potential benefits such as to retard aging, prevent cancer, prevent heart disease, cure the common cold, prevent the flu, become smarter, be more athletic, feel younger, etc. There is a lot of medical research investigating whether vitamins can do some of these things. We might find out in the future that vitamins may have some of these benefits. At this time, vitamins taken in moderate amounts to supplement the diet are not harmful and they may have some other benefits. For more information on this topic, review the chapter on vitamins. For the latest information and developments, discuss the benefits of vitamins with your child's physician.