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Mealtime Makeovers

A child's diet is a work in progress. Just when you think you've figured out what he'll eat  -- and won't  -- his preferences change all over again.

So you wonder whether he's eating well enough. As a mother of three, I wonder the same thing. But as a registered dietitian, I know that even if a kid turns up his nose at vegetables, refuses to drink milk, or won't touch any meat except chicken nuggets, it rarely spells dietary doom. Chances are, your child's eating habits are healthier than you think, even if they could use some improvement.

That's what three families found when they participated in our diet makeovers. We asked the parents to write down everything their kids ate for three days. Then we compared each child's average daily nutritional intake against what's recommended by age and found kid-approved ways for him or her to eat better.

Registered dietitian Elizabeth Ward's latest book is Healthy Foods, Healthy Kids.

Sarah: Running on Air?

Janet Zalewski marvels at her 2-year-old's energy level. "I always wonder whether Sarah's eating enough," says the Chicago mom. Although she's encouraged by her toddler's curiosity about food  -- "Like my husband, Mike, she'll try anything once"  -- she worries when Sarah sometimes won't eat what she's served. "If she doesn't like what I make, should I offer other foods that I know she'll eat?" It also bothers her that Sarah loves fatty foods, especially salami, hot dogs, and sausages. "Since I'm always sure she'll eat them, I keep hot dogs in the house for a quick and easy meal," admits Zalewski. (To prevent choking in kids younger than 4, cut hot dogs and sausages into small pieces  -- and avoid hard candies like M&M's.)

Problems  -- and solutions. Sarah drinks milk at most meals and likes ice cream and yogurt, so she's well nourished in calcium and protein. But all those hot dogs and other processed meats give her too much heart-unhealthy saturated fat and sodium  -- without providing enough iron. Switching to leaner cuts of pork and beef will reduce the fat, boost iron, and lower her intake of potentially harmful sodium nitrite. Other good iron sources: eggs and iron-fortified ready-to-eat cereals.

Sarah could also benefit from boosting her intake of dietary fiber. For example, she could, as often as possible, switch from white to whole-wheat bread, from french fries to baked potatoes, and from juice to whole fruit.

There's no need for Sarah's mom to cater to her food preferences; she just needs to continue to offer a variety of nutrient-rich foods. Left to their own devices, 2-year-olds eat when they're hungry, consuming more during growth spurts, which occur less frequently than when they were babies. And Sarah's a remarkably consistent and interested eater for her age.

One month later. Sarah's eating fewer processed meats and more tuna fish, eggs, and PB&J and grilled cheese sandwiches. Zalewski switched her from white to whole-grain breads for toast and sandwiches. She's boosting Sarah's fruit (and fiber) intake with a few fruit smoothies a week. A tougher challenge: limiting juice consumption. "We're both working on it," she says.

 

Sarah's Typical Day

Breakfast

 

     

  • 1/4 cup 100% fruit juice mixed with 1/4 cup water

     

  • 3/8 cup 2% milk

     

  • 1 scrambled egg, made with 2 tablespoons 2% milk and 1/2 teaspoon butter

     

  • 1 slice white bread (1 oz)

Lunch

 

     

  • Sandwich: 1 slice white bread (1 oz) and 1 tablespoon peanut butter

     

  • 3 grapes, quartered

     

  • 2 pretzel twists

     

  • 1 nectarine

     

  • 14 plain M&M's

     

  • 5/8 cup 2% milk

Snack

 

     

  • 1/4 cup 100% juice mixed with 1/4 cup water

     

  • 1/4 cup grapes, quartered

Dinner

 

     

  • 1 hot dog (no bun), cut up

     

  • 7 French fries

     

  • 1/2 cup lemonade

     

  • 1/2 cup soft-serve vanilla ice cream

Snack

 

  • 1 squeezable yogurt (2 oz)

     

  • 3/8 cup 2% milk

    Fernando: Full at Mealtimes

    Fernando Plata, 3, of Miami dawdles at dinner. Lunch and breakfast as well. "He eats very slowly," says his father, Ignacio. He just doesn't seem to be hungry enough to eat much of his meals, Ignacio says. When his mom, Patricia, tries to speed up the pace, mealtime can get tense.

    Like his younger brother, 1-year-old Daniel, Fernando still drinks milk from a bottle, yet he's mastered drinking from a cup. "Even though we don't think he eats a lot," says Ignacio, "his doctor says he's doing fine."

    Problems  -- and solutions. Fernando's not hungry because he drinks too much! He consumes 18 ounces of whole milk (often with cereal added) from the bottle every day  -- plus lots of fruit juice and soft drinks. Frequent snacking with large portions  -- a big bowlful of Goldfish (270 calories) plus a cup of Gatorade (60 calories)  -- also suppresses his mealtime appetite. Over time, this dietary pattern could contribute to a weight problem.

    Fernando eats fast-food hamburgers frequently, which helps him meet his dietary needs for iron and zinc, and all that milk gives more than twice the necessary calcium. But the high-fat foods give him too much saturated fat, not to mention excess protein and calories. It's time to break the bottle habit, for developmental as well as dental reasons; later, he can switch to low-fat milk. Eating smaller, more nutritious snacks (such as whole-wheat pretzels or half a sandwich on whole wheat) would help enhance nutrition without squelching his desire for meals.

    One month later. Fernando's off sugary soft drinks and downs no more than about four ounces of juice (a half cup) twice a day. Instead of chips and crackers, he snacks on child-size portions of yogurt. He's also eating more whole-grain cereals. His appetite at mealtime has improved.

    Breaking the bottle habit will have to wait until the Platas return from a long overseas vacation  -- Fernando's parents don't want to try such a big change until they're back home. He's also still very fond of high-fat fast-food meals.

     

    Fernando's Typical Day

    Snack

     

       

    • Bottle: 8 oz whole milk mixed with 2 tablespoons oatmeal-banana cereal

    Breakfast

     

       

    • 4 mini-waffles with 2 tablespoons syrup

       

    • 1/2 cup Fruit Loops and 4 oz whole milk

    Snack

     

       

    • 2 oz Goldfish crackers (about 100)

       

    • 1 cup Gatorade

    Lunch

     

       

    • 1 cup homemade vegetable soup with 2 oz chicken

       

    • 2 fast-food chicken nuggets

       

    • 1/2 small order of fast-food French fries

       

    • 1/2 cup soft drink

       

    • 1/2 cup cubed melon

    Dinner

     

       

    • 1 cup homemade vegetable soup with 2 oz chicken

       

    • 1 cup macaroni and cheese

       

    • 2 slices of kiwifruit

    Snack

     

       

    • Bottle: 6 oz whole milk mixed with 2 tablespoons oatmeal-banana cereal

    Adrian: Dream Eater

    Adrian Hale, 5, of Bedford, MA, is an adventurous eater  -- in part because his mom, Jean, resists preparing special meals for him and his sister, 3. "I always serve Adrian and Jaqueline what Mike and I are having for dinner because it's important to expose them to new foods." If they don't try them the first time, they may the second  -- or the tenth. One of Adrian's favorite dinners: grilled salmon teriyaki, broccoli, pasta, and milk.

    The family's culinary open-mindedness has a downside: Adrian relies on an ever-changing menu. He's a fickle customer. Says Hale, "It's tough to keep up  -- I never know what he'll reject next."

    Problems  -- and solutions. Variety gives Adrian a big nutritional boost: He gets plenty of iron and zinc even though he takes in fewer calories than suggested for his age. (Because Adrian's growing properly, calories aren't an issue.)

    More milk would give him more calcium and vitamin D. Since plain milk isn't his favorite, he could try low-fat chocolate milk and smoothies made from low-fat milk and fruit. Cheese and calcium-fortified orange juice are also good choices, although they lack vitamin D. Adrian could eat more fruits, vegetables, and whole grains, though he still does better than most kids.

    One month later. Adrian has doubled his whole-grain consumption and cut his juice intake by half. When he does drink juice, it's often orange juice with added calcium. Fortified drinkable yogurt has supplied some missing calcium and vitamin D. Adding chocolate bumped up Adrian's milk intake for a while, but then he lost interest; fruit smoothies didn't fly. Neither did gazpacho or cucumber salad. But Adrian does like sliced cucumbers and celery. He's also increasingly interested in learning about the links between eating right and feeling strong.

     

    Adrian's Typical Day

    Breakfast

     

       

    • 1 hard-boiled egg white

       

    • 1/2 slice whole-wheat toast with 1/2 teaspoon butter

       

    • 5/8 cup 2% milk

       

    • 1/4 cup chopped watermelon

    Lunch

     

       

    • 1/2 peanut butter-and-rhubarb-jelly sandwich on whole-wheat bread

       

    • 1/2 cup 100% grape juice

       

    • 5 jelly beans

    Dinner

     

       

    • 2 oz steak teriyaki

       

    • 1/4 cup edamame (soybeans)

       

    • 1 cup cooked pasta with 1 teaspoon grated parmesan cheese and 1 teaspoon butter

       

    • 1/2 cup vanilla yogurt

    Snack

     

       

    • 1/2 cup Bran Flakes cereal with 1/2 chopped banana and 1/2 cup 2% milk

    A Too-Rich Diet

    Like Sarah, Fernando, and Adrian, most American kids take in more protein than they need, and more than two-thirds of those between ages 2 and 6 consume more saturated fat than is healthy.

    Protein. It's a key building block of all cells, yet it doesn't take much to meet a child's needs. For example, eight ounces of milk (one cup) and one ounce of cooked meat (the size of a third of a deck of cards) supply all the protein a 3-year-old needs in a day. For a 5-year-old, just add one more ounce of meat and another cup of milk. Extra protein won't hurt a child with healthy kidneys, but it can crowd out nutrient-rich vegetables and fruit.

    Saturated Fat. A childhood diet high in this type of fat can raise blood-cholesterol levels and lead to heart disease in adulthood if dietary patterns don't change. Starting at age 2, children should get no more than ten percent of their calories from saturated fat, although it's okay to make the shift gradually. Trans fatty acids (from partially hydrogenated oils) have similar effects. To cut back on saturated and trans fats, choose leaner cuts of meat, switch from whole to low-fat milk and dairy products, minimize fried fast foods, and limit high-fat commercial baked goods and snacks.

     

    Taste-Test Tips

    When introducing new foods:

     

     
  • Offer one new food at a time along with familiar ones. This lets your child approach it without pressure.

     

  • Allow her to explore. She learns about foods  -- especially new ones  -- by touching, smelling, and even playing with them. She might even try a taste!

     

  • Make mealtimes pleasant. It's hard for your child to try something new when he's distracted. Turn off the TV, computer, and loud music, then eat with him or at least sit with him while he eats.

     

  • Cook together. Kids as young as 3 take pride in dishes they've helped create and may be more likely to taste them.

     

  • Relax. It may take ten or more exposures to a new food before your child accepts it. Forcing kids to try something before they're ready just fosters resistance. And don't give up: What's yucky in June may be peachy in July.

     

    Who Needs a Vitamin Pill?

    Nobody's diet is perfect, least of all a child's. That's why a daily multivitamin/mineral supplement can make sense for many kids. Always check with your pediatrician about your child's individual needs. Best bet: a kids' chewable multi (or a liquid for ages 2 and under) that supplies no more than 100% of the Daily Value for the nutrients on the label. Children who don't eat meat or poultry may need one with iron too.

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