Healthy Eating & Your Family

When it comes to keeping kids hydrated, particularly those who play sports, there’s a dizzying array of sodas, juices, iced tea, and bottled waters to choose from. And another category of beverages is causing a buzz: sports and energy drinks.

Sports and energy drinks can include anything from sports beverages to vitamin waters to highly caffeinated drinks. What they all have in common is added ingredients that say they “do” something extra, whether it’s increase energy and alertness, boost nutrition, or even enhance athletic performance. But are they good options for kids?

Evaluating the Choices

Everyone needs to stay hydrated to stay healthy, and you can’t go wrong giving kids plain water. But what about kids who play sports? Do they need something extra to avoid dehydration?

Not necessarily. The average young athlete can and should get all the necessary nutrients and hydration by eating healthy foods and drinking plenty of water before, during, and after exercise. During games and competitive events, drinks should be available at all times and regular water breaks should be scheduled about every 15 or 20 minutes. The amount of water needed can vary depending on the child’s age, weight, intensity of the activity, and weather conditions.

Soda is not recommended for hydration during sports and should be avoided because it contains excess sugar, which can lead to weight gain. What’s more, the carbonation can cause an upset stomach. Soda also often contains caffeine, which should be limited in kids.

Other Choices

Many drink options are out there. Here’s a closer look at the ingredients they contain and how they measure up:

Sports Drinks

Sports drinks may be beneficial for kids who participates in prolonged vigorous physical activity lasting longer than an hour (such as long-distance running and biking, or high-intensity exercise such as soccer, basketball, or hockey).

These drinks contain carbohydrates (sugar), which can provide an immediate source of energy at a time when the body’s stores are becoming depleted. Sports drinks also contain electrolytes like sodium and potassium, which the body loses through sweat, that are necessary to keep the body’s fluid levels in balance and for muscles to work properly.

Sports drinks are sweet, which may aid hydration in kids who otherwise wouldn’t drink during periods of intense activity. Of course, these drinks contain calories, too, and can increase the risk of excess weight gain — if your child is active and drinks these in moderation, this shouldn’t be a problem.

However, sports drinks are not necessary for the casual athlete and should not be consumed on a regular basis. If your sedentary child is a fan of sports beverages, consider sidelining these drinks in favor of plain water.

Vitamin Waters

These drinks, also known as fitness waters or enhanced waters, come in many flavors and contain various combinations of supplemental vitamins and minerals. They also often contain extra calories, artificial sweeteners, caffeine, or herbal ingredients whose effects have not been studied in children (such as ginseng or St. John’s wort).

Vitamin waters may look like a quick way to fill any nutrition gaps in your child’s diet, but these nutrients should come from healthy meals and snacks. Also, they can provide too much of a good thing, particularly for kids who already take a daily multivitamin. Getting more than the recommended daily allowance of some vitamins and minerals can be harmful to a child’s health. Keep in mind that the daily allowances listed on the label are recommendations for adults, not kids.

The best place for kids to get daily nutrients is from balanced meals. If you’re concerned that your child isn’t getting enough, talk to your doctor, who may recommend a daily multivitamin formulated for kids.

Energy Drinks

These are becoming increasingly popular with middle- and high-school students who are looking for a competitive edge. And while some energy drinks are clearly labeled as unsuitable for children, others are specifically marketed to kids as young as 4, promising boosts in energy and nutrition as well as enhanced athletic performance.

Most energy drinks deliver a stiff dose of sugar and caffeine — sometimes as much caffeine as in 1 to 3 cups of coffee. Too much sugar can put kids in the fast lane to the dentist’s office and also contribute to weight gain. Excessive caffeine comes with its own set of problems — especially in younger kids, it can negatively affect attention and concentration.

Few studies have examined the effect of caffeine on children, but consider how you feel when you’ve had too much. Caffeine is indeed a stimulant — though a widely used and accepted one — and because kids are smaller than adults and its effects on them will be more pronounced.

Too much caffeine can cause:

• jitteriness and nervousness
• upset stomach
• headaches
• difficulty concentrating
• difficulty sleeping
• frequent urination (peeing)

Large amounts of caffeine can have even more serious side effects (including fast or irregular heartbeats, high blood pressure, hallucinations, and seizures), especially for kids with certain medical conditions or who take medications or supplements.

Many of these drinks also contain additional ingredients whose safety or effectiveness has never been tested in children — including herbal supplements, guarana (a source of caffeine), and taurine (an amino acid thought to enhance performance and caffeine’s effects).

The bottom line is this: Energy drinks pose a real health risk for kids and teens and should be avoided. Kids who participate in sports should learn that they can improve their game through hard work and practice — values that will serve them well both on and off the field.

Encouraging kids to believe that they need something “extra” to perform at their best is a slippery slope that may lead to the use of other performance-enhancing substances.

Remember that if it sounds too good to be true, it probably is. Be critical when reading labels, and talk to your doctor if you have any questions or concerns. And teach your kids not to be so quick to believe the hype when it comes to sports and energy drinks.

For athletes and non-athletes alike, nothing beats a well-balanced diet. Most kids who eat well, stay hydrated, and get enough physical activity and rest will have plenty of energy — naturally.

During the preschool years, kids go from toddlers who throw tantrums to kids who are more willing to cooperate and want to please their parents. They also want to do things themselves, but are willing to learn from mom and dad. This give-and-take creates opportunities for parents to teach kids about healthy food choices in new and exciting ways.

A balanced diet gives kids the nutrients necessary for healthy growth and development and the energy for exploration. Through eating right and active play, preschoolers can maintain a healthy weight and stay energized as they get ready for the next big step in their young lives: kindergarten.

A Parent’s Role

Guiding a child’s eating habits is delicate work. You want to encourage kids to make good choices, but without hovering or pestering.

Take charge by presenting mostly healthy foods, but don’t teach that certain foods are “bad.” You want your preschooler to eat enough nutritious food, but you don’t want to start negotiating the number of bites of dinner that must be eaten to get dessert.

At a parent’s request, a preschooler may be willing to try new foods — especially if mom and dad are eating the same thing. There’s nothing wrong with serving foods you know your child likes, but they shouldn’t always be on the menu. Serve a variety of foods and don’t cater to a child’s limited palate. Don’t fall into the trap of fixing a meal specifically for your child that is different from your own — before you know it, you will be fixing two dinners every night.

It may seem illogical but it’s better to present a range of foods, even if your child sometimes refuses to eat anything on the plate. It’s normal to want your child to eat at dinner, but it’s also important to know that skipping one meal will not harm healthy kids. Let your child know food will be available at the next regular meal or snack time.

Encouraging a Healthy Diet

To encourage a well-rounded diet:

• Continue offering a variety of foods, even ones the child has rejected in the past.
• Keep healthy foods in the house and limit the availability of high-calorie, low-nutrient foods.
• Involve kids in meal preparation — for example, let them tear lettuce for a salad or help set the table.
• Create a structure for daily meals and snacks so kids don’t graze all day long.
• Have regular family meals and make them pleasant times for the whole family to get together.
• Set a good example by eating a nutritious diet yourself.

Letting Kids Have Some Control

Parents may feel uneasy about giving preschoolers control over how much they eat. But it’s a limited kind of control. The parent is responsible for setting the schedule for meals and snacks and deciding which foods to serve. A child of 4 shouldn’t be getting his or her own snacks but can be given a choice and allowed to decide whether to eat or not.

Preschoolers are old enough to begin understanding the concept of being full, known as satiety. Kids who stop eating when they feel satisfied are less likely to become overweight. Most kids naturally know if they’re hungry or full and can use these cues to properly control their food intake. Kids who are encouraged to ignore these cues may learn to override this internal control mechanism.

If your child chooses not to eat at a scheduled meal or snack time, try to avoid arguing about it or being critical. Staying neutral and calm will prevent the bigger problems that can arise when parents and kids battle over food.

Toddlers are learning to navigate their world, communicate, and control some parts of their lives. They don’t actually have control over much, but eating is one of the first areas they will master.

Parents can help them enjoy their limited power by giving them appropriate amounts of freedom when it comes to choosing foods and eating them.

That’s not to say toddlers are deciding what to have for dinner. Parents have the important job of providing the kinds of foods that an active toddler needs. A parent’s role is to present healthy foods and let a child decide which ones to eat — or whether to eat at all. Parents can steer a toddler toward healthy eating, but might have to do it in a crafty way.

By anticipating problems and offering choices, parents teach kids which behaviors will yield positive results and which ones won’t.

Here’s how to turn common concerns into opportunities to teach healthy eating habits.

Most Toddlers Are Picky Eaters

Many toddlers express their budding independence through eating — or not eating, as the case may be. So nearly all toddlers could be described as picky eaters. If kids don’t like a food, they won’t eat it — no rocket science there.

Does your toddler want to eat only macaroni and cheese? When a child is stuck on one food, a parent might feel forced to serve that food every day so the child eats something. But eventually the child may tire of that food — and then what?

You choose the foods on your toddler’s plate — and you don’t have to serve macaroni and cheese daily. If you do, you miss an opportunity to introduce new foods and increase the number of those your child is willing to eat. Most of these “food jags” won’t last long if parents don’t give in to them.

Kids won’t starve, but they will learn to be more flexible rather than go hungry. Present a variety of healthy foods — including established favorites and some new foods — to make up the menu. Your toddler may surprise you one day by eating all of them.

Your toddler doesn’t like green beans the first time around? Don’t stop serving them. Kids are naturally slow to accept new tastes and textures, so keep reintroducing the beans. Serve a small portion and encourage your child to try a bite without nagging or forcing.

And be sure you’re setting a good example! Serve nutritious foods that you like or eat something new so your kids see you enjoying what you’re asking them to eat.

Don’t Bargain for Bites

You want your child to eat the spinach you serve; your child drops it on the floor. Your well-meaning impulse may be to start talking up nutritious foods, saying how big and strong spinach will make your child. Or you might start bargaining: “Well, if you eat three more bites, I’ll give you a cookie.” The problem is that these tactics don’t work in the long run.

Who hasn’t used the line about spinach making you strong? But this approach may build dislike for the healthy food rather than acceptance. This doesn’t mean you shouldn’t teach kids about the benefits of healthy foods, but don’t push too much by celebrating every bite of spinach your toddler eats or disapproving when he or she refuses.

For some kids, dinner becomes a negotiation session from the very start, and parents have been using dessert as an incentive for decades. But this doesn’t encourage healthy eating. Instead it creates the impression that “treats” are more valuable than mealtime food. Foods like candy and cookies are not essential to a child’s diet and it’s not a deprivation to not serve them during the toddler years.

Threatening a punishment, much like bribing a child with dessert, ultimately isn’t effective either. It creates a power struggle.

To encourage healthy eating, continue offering your child an array of nutritious choices — and keep the mealtime mood upbeat. Also try these tips:

• Serve right-sized portions. Parents often overestimate how much food a child should eat. Especially with foods that aren’t yet favorites, a couple of tablespoons is plenty to start with. Small portions are less overwhelming, while bigger portions may encourage overeating.
• Don’t negotiate. It’s fine to encourage kids to “try one bite” but don’t fall into the negotiating trap. Prepare and serve healthy meals and let them decide what to eat.
• Have family meals together. Set your toddler’s place at the family table — it’s good for kids of this age to see their parents and siblings eating together and eating healthy foods. Kids eat a more nutritious diet, with more fruits and vegetables, when they regularly have family meals.
• Create positive peer pressure. Toddlers are more likely to eat fruits and vegetables if they see their peers eating them, so look for opportunities where they can eat healthy with friends.

Let Kids Feed Themselves

Kids should start finger feeding around 9 months of age and try using utensils by 15-18 months. Provide many opportunities for this, but make sure your toddler eats enough so that the experience doesn’t lead to frustration.

Jump in to help when necessary, but pay attention to hunger cues and signs that your child is full. You can always offer more if your child still seems hungry, but you can’t take the food back if you overfeed. When you’re controlling the fork or spoon, resist the urge to slip in one more bite. And as your toddler gets the hang of eating, step back and let your child take over.

Some parents think that not letting kids feed themselves is for the best, but it takes away control that rightfully belongs to kids at this age. They need to decide whether to eat, what they will eat, and how much to eat — this is how they learn to recognize the internal cues that tell them when they’re hungry and when they’re full. Just as important, toddlers need to learn and practice the mechanics of feeding themselves.

Listen to Your Child

Be alert to what toddlers say through their actions. A child who is building a tower of crackers or dropping carrots on the floor may be telling you he or she is full. Pushing food on a child who’s not hungry may dull the internal cues that help kids know when they’ve eaten enough.

But this doesn’t mean that it’s practical or advisable for kids to eat on demand all day long. Those who eat all day may not learn what it is like to be hungry or full. That’s why structured meals and snack times are important.

Kids can manage their hunger when they come to expect that food will be available during certain times of the day. If a child chooses not to eat anything at all, simply offer food again at the next meal or snack time.

Can Kids Skip a Meal?

Many toddlers need to eat often — as much as six times a day, including three meals and two or three snacks. Keep this in mind as you establish a pattern of meal and snacks. But realize that a food schedule only sets the times that you will present food to your toddler. Your child may not take every opportunity to eat.

Allowing kids to skip a meal is a difficult concept because many of us were raised to clean our plates and not waste food. But kids should be allowed to respond to their own hunger cues, a vital skill when it comes to maintaining a healthy weight. That means eating when hungry — and sometimes not eating, even if it’s time for Thanksgiving dinner.

Set times for meals and snacks and try to stick to them. A child who skips a meal finds it reassuring to know when to expect the next one. Avoid offering snacks or pacifying hungry kids with cups of milk or juice right before a meal — this can diminish their appetite and decrease their willingness to try a new food being offered.

Avoid the Junk Food Trap

Toddlers need to eat healthy to get the nutrients their growing bodies need. Candy, potato chips, and other low-nutrient “junk foods” shouldn’t be part of their diet because they can crowd out the healthy foods needed. Also, food preferences are established early in life, so don’t miss opportunities to help your toddler develop a taste for nutritious foods.

Even if your child likes candy or chips, don’t feel like you must give in. Kids can’t run to the store to buy them, so just don’t keep them in the house.

If your toddler asks for candy, simply say, “We don’t have any candy.” Then present two healthy snack alternatives to choose from. Even a child who mourns the lack of candy will still enjoy the sense of control from deciding which healthy snack to eat.

Is Vegetarian the Same as Vegan?

Lots of people limit their intake of meat — maybe you, your kids, or others in your family don’t eat meat. Maybe you’re a vegetarian and are wondering if it’s a good choice for your kids, too. Or perhaps your teen just expressed an interest in going meat-free and you’re looking for information.

The term “vegetarian” can mean different things to different people:

• To most of us, “vegetarian” means someone who eats no meat at all, including poultry and fish, but who might eat dairy products and eggs (also called a lacto-ovo vegetarian).
• A lacto-vegetarian eats no meat, poultry, fish, or eggs, but does eat dairy products.
• An ovo-vegetarian eats no meat, poultry, fish, or dairy products, but does eat eggs.

And many people don’t eat red meat or pork but do eat poultry and/or seafood.

Less commonly practiced is the form of vegetarianism known as veganism. A vegan doesn’t consume any animal-derived foods or animal byproducts, and eats only plant-based foods. Besides not eating meat, poultry, seafood, eggs, or dairy, vegans don’t use products made from animal sources, such as fur, leather, and wool.

While those are obvious animal products, many animal byproducts are things we might not even realize come from animals. These include:

• gelatin (made using meat byproducts)
• lanolin (made from wool)
• rennet (an enzyme found in the stomach of calves, young goats, and lambs that’s used in cheese-making)
• honey and beeswax (made by bees)
• silk (made by silkworms)
• shellac (the resinous secretion of the tiny lac insect)
• cochineal (a red dye derived from the cochineal insect)

Why Vegan?

Veganism (also known as strict vegetarianism or pure vegetarianism), as defined by the Vegan Society, is “a philosophy and way of living which seeks to exclude — as far as is possible and practical — all forms of exploitation of, and cruelty to, animals for food, clothing, or any other purpose.”

Vegans also avoid toothpaste with calcium extracted from animal bones, if they are aware of it. Similarly, soap made from animal fat rather than vegetable fats is avoided. Vegans generally oppose the violence and cruelty involved in the meat, dairy, cosmetics, clothing, and other industries.

What About Nutrition?

According to the American Dietetic Association (ADA), “appropriately planned vegetarian diets, including total vegetarian or vegan diets, are healthful, nutritionally adequate and may provide health benefits in the prevention and treatment of certain diseases. Well-planned vegetarian diets are appropriate for individuals during all stages of the life-cycle including pregnancy, lactation, infancy, childhood and adolescence and for athletes.”

Vegetarian diets offer a number of advantages, says the ADA, including lower levels of total fat, saturated fat, and cholesterol, and higher levels of fiber, magnesium, potassium, folate, and antioxidants. As a result, the health benefits of a vegetarian diet may include the prevention of certain diseases, including heart disease, diabetes, and some cancers.

But any restrictive diet can make it more difficult to get all the nutrients a person’s body needs. A vegan diet eliminates food sources of vitamin B12, which is found almost exclusively in animal products, including milk, eggs, and cheese. A vegan diet also eliminates milk products, which are good sources of calcium.

Alternative Nutrition Sources

To ensure that “well-planned” diet, vegans must find alternative sources for B12 and calcium, as well as vitamin D, protein, iron, zinc, and occasionally riboflavin.

Here’s how:

Vitamin B12. Vegans can get vitamin B12, needed to produce red blood cells and maintain normal nerve function, from enriched breakfast cereals, fortified soy products, nutritional yeast, or supplements.

Calcium. Everyone needs calcium for strong teeth and bones. Calcium is plentiful in dark green vegetables (spinach, bok choy, broccoli, collards, kale, turnip greens), sesame seeds, almonds, red and white beans, soy foods, dried figs, blackstrap molasses, and calcium-fortified foods like soy, rice, and almond milks; fruit juices; and breakfast cereals.

Vitamin D. Vitamin D helps our bodies absorb calcium and is synthesized by exposing skin to sunlight. But vitamin D deficiency can happen, especially in someone who doesn’t spend a lot of time outside. Vitamin D is not found in most commonly eaten plant foods; the best dietary sources are fortified dairy products. Vegans can also get vitamin D from fortified foods, including vitamin D-fortified soy milk, rice milk, almond milk, orange juice, and some cereals. Vitamin D2 supplements come from plants, whereas most vitamin D3 comes from animals.

Protein. Not getting enough protein is a concern when switching to a vegetarian diet. Protein needs can be met while following a vegan diet by consuming adequate calories and eating a variety of plant foods, including good plant sources of protein such as soy, other legumes, nuts, and seeds.

Iron. Iron from plant sources is less easily absorbed than iron in meat. This lower bioavailability means that iron intake for vegetarians should be higher than the RDA for nonvegetarians. Vegetarian food sources of iron include soy foods like soybeans, tempeh, and tofu; legumes like lentils and chickpeas; and fortified cereals. Iron absorption is enhanced by vitamin C.

Zinc. Zinc plays a role in many key body functions, including immune system response, so it’s important to get enough of it, which vegans can do by eating nuts, legumes, miso and other soy products, pumpkin and sunflower seeds, tahini, wheat germ, and whole-grain breads and cereals.

Omega-3 fatty acids. The omega 3 fatty acids (DHA, EPA, and ALA) are important for cardiovascular health and brain function. DHA and EPA are found in fish, eggs, and algae. Vegans can get these essential fatty acids through a diet rich in alpha linolenic acid (ALA), a plant-based omega-3 fatty acid. ALA is found in flaxseed, walnuts, canola oil, and soy. DHA from microalgae can be found in supplements and fortified foods.

Eating a Vegan Diet

If your child is interested in becoming a vegan, you might be wondering if a vegan diet can be practical and provide sufficient nutrients. It’s important to consider a few things before making any major dietary changes.

Kids can follow a vegan diet and still get what they need to grow healthy and strong, but it will require careful label reading and extra effort to make sure nutrition guidelines are met.

Anyone following a vegan diet has to be a careful label-reader. No federal regulation dictates the use of the words “vegetarian” or “vegan” in the United States. To be sure a food truly is “suitable for vegans,” check the label — what might be vegetarian isn’t necessarily vegan.

Vegans are by no means stuck eating boring foods with little variety. But if someone in your family is considering going vegan or wondering whether it’s realistic to stop eating animal-based foods, it might pay to start slowly.

A wide array of meat alternatives can be found in almost every grocery store. Tasty frozen veggie burgers, chicken and meat substitutes, sausage alternatives, fake bacon, and tofu dogs can help make the transition to a vegan diet convenient and easy.

And many foods you probably already have are suitable — most breakfast cereals are vegan as are many crackers, cookies, and baked goods.

For more information, consider talking to a registered dietician familiar with vegan diets and look for vegetarian cookbooks that can help you plan and prepare healthy meatless meals.

Vegetarianism is a popular choice for many individuals and families. But parents may wonder if kids can safely follow a vegetarian diet and still get all necessary nutrients. Most dietary and medical experts agree that a well-planned vegetarian diet can actually be a very healthy way to eat.

But special care must be taken when serving kids and teens a vegetarian diet, especially if it doesn’t include dairy and egg products. And as with any diet, you’ll need to understand that the nutritional needs of kids change as they grow.

Types of Vegetarian Diets

Before your child or family switches to a vegetarian diet, it’s important to note that all vegetarian diets are not alike. Major vegetarian categories include:

• lacto-ovo vegetarian: eats no meat, poultry, or fish, but does eat eggs and dairy products (what most of us mean when we say “vegetarian”)
• lacto-vegetarian: eats no meat, poultry, fish, or eggs, but does eat dairy products
• ovo-vegetarian: eats no meat, poultry, fish, or dairy products, but does eat eggs
• vegan: eats only plant-derived foods

And many other people are semi-vegetarians who have eliminated red meat, but may eat poultry or fish.

The Choice of Vegetarianism

Kids or families may follow a vegetarian diet for a variety of reasons. Younger vegetarians are usually part of a family that eats vegetarian meals for health, cultural, or other reasons. Older kids may decide to become vegetarians because of concern for animals, the environment, or their own health.

In most cases, you shouldn’t be alarmed if your child chooses vegetarianism. Discuss what it means and how to implement it, ensuring your child makes healthy and nutritious food choices.

Nutrition for All Ages

Your doctor or a registered dietitian can help you plan and monitor a healthy vegetarian diet. Parents should give their kids a variety of foods that provide enough calories and nutrients to enable them to grow normally.

A well-planned vegetarian diet can meet kids’ nutritional needs and has some health benefits. For example, a diet rich in fruits and veggies will be high in fiber and low in fat, factors known to improve cardiovascular health by reducing blood cholesterol and maintaining a healthy weight. However, kids and teens on a vegetarian diet may need to be careful that they get an adequate amount of certain vitamins and minerals.

Here are nutrients that vegetarians should get and some of their best food sources:

• vitamin B12: dairy products, eggs, and vitamin-fortified products, such as cereals, breads, and soy and rice drinks, and nutritional yeast
• vitamin D: milk, vitamin D-fortified orange juice, and other vitamin D-fortified products
• calcium: dairy products, dark green leafy vegetables, broccoli, dried beans, and calcium-fortified products, including orange juice, soy and rice drinks, and cereals
• protein: dairy products, eggs, tofu and other soy products, dried beans, and nuts
• iron: eggs, dried beans, dried fruits, whole grains, leafy green vegetables, and iron-fortified cereals and bread
• zinc: wheat germ, nuts, fortified cereal, dried beans, and pumpkin seeds

Depending on the type of vegetarian diet chosen, kids may miss out on some of these important nutrients if the diet isn’t monitored by the parents. The less restrictive the vegetarian diet, the easier it will be for your child to get enough of the necessary nutrients. In some cases, fortified foods or supplements can help meet nutritional needs.

Vegetarian Infants

The main sources of protein and nutrients for infants are breast milk and formula (soy formula for vegan infants), especially in the first 6 months of life. Breastfed infant vegans should receive a source of vitamin B12 if the mother’s diet isn’t supplemented, and breastfed infants and infants drinking less than 32 ounces (1 liter) formula should get vitamin D supplements.

Guidelines for the introduction of solid foods are the same for vegetarian and nonvegetarian infants. Breastfed infants 6 months and older should receive iron from complementary foods, such as iron-fortified infant cereal.

Once an infant is introduced to solids, protein-rich vegetarian foods can include pureed tofu, cottage cheese, yogurt or soy yogurt, and pureed and strained legumes (legumes include beans, peas, chickpeas, and lentils).

Vegetarian Toddlers

Toddlers are already a challenge when it comes to eating. As they come off of breast milk or formula, kids are at risk for nutritional deficiencies. After the age of 1, strict vegan diets may not offer growing toddlers enough essential vitamins and minerals, such as vitamin D, vitamin B12, iron, calcium, and zinc.

So it’s important to serve fortified cereals and nutrient-dense foods. Vitamin supplementation is recommended for young children whose diets may not provide adequate nutrients.

Toddlers are typically picky about which foods they’ll eat and, as a result, some may not get enough calories from a vegetarian diet to thrive. For vegan toddlers, the amount of vegetables needed for proper nutrition and calories may be too bulky for their tiny stomachs.

During the picky toddler stage, it’s important for vegetarian parents to make sure their young child eats enough calories. You can get enough fat and calories in a vegan child’s diet, but you have to plan carefully.

Older Vegetarian Kids and Teens

Preteens and teens often voice their independence through the foods they choose to eat. One strong statement is the decision to stop eating meat. This is common among teens, who may decide to embrace vegetarianism in support of animal rights, for health reasons, or because friends are doing it.

If it’s done right, a meat-free diet can actually be a good choice for adolescents, especially considering that vegetarians often eat more of the foods that most teens don’t get enough of — fruits and vegetables.

A vegetarian diet that includes dairy products and eggs (lacto-ovo) is the best choice for growing teens. A more strict vegetarian diet may fail to meet a teen’s need for certain nutrients, such as iron, zinc, calcium, and vitamins D and B12. If you’re concerned that your child is not getting enough of these important nutrients, talk to your doctor, who may recommend a vitamin and mineral supplement.

The good news for young vegetarians — and their parents — is that many schools are offering vegetarian fare, including salad bars and other healthy vegetarian choices. Schools publish lists of upcoming lunch menus; be sure to scan them to see if your child will have a vegetarian choice. If not, you can pack lunch.

If your vegetarian preteen or teen would rather make his or her own school lunch or opts to buy lunch, keep in mind that your child’s idea of a healthy vegetarian meal may be much different from yours (e.g., french fries and a soda). Talk to your child about the importance of eating right, especially when following a vegetarian diet.

Also be wary if your child has self-imposed a very restrictive diet. A teen with an eating disorder may drastically reduce calories or cut out all fat or carbohydrates and call it “vegetarianism” because it’s considered socially acceptable and healthy.

Even if preteens or teens are approaching vegetarianism in a healthy way, it’s still important for them to understand which nutrients might be missing in their diet. To support your child’s dietary decision and promote awareness of the kinds of foods your preteen or teen should be eating, consider having the whole family eat a vegetarian meal at least one night a week.

A Healthy Lifestyle

A vegetarian diet can be a healthy choice for all kids, as long as it’s properly planned.

The principles of planning a vegetarian diet are the same as planning any healthy diet — provide a variety of foods and include foods from all of the food groups. A balanced diet will provide the right combinations to meet nutritional needs. But be aware of potential nutrient deficiencies in your child’s diet and figure out how you’ll account for them. With a little exploration, you may find more vegetarian options than you realized.

If you aren’t sure your child is getting all necessary nutrients or if you have any questions about vegetarian diets, check in with your family doctor, pediatrician, or a registered dietitian.

Vitamin D is an important nutrient that works with calcium to help build bones and keep them strong. Vitamin D also plays a role in preventing health problems like heart disease, diabetes, osteoporosis, and thinning bones.

Our bodies naturally produce vitamin D when we’re outside in the sun. So, many kids get enough vitamin D naturally from being outdoors during daily activities, such as walking, biking, or playing sports.

But sometimes the body doesn’t make enough vitamin D. While sunscreen helps protect kids from the sun’s harmful rays, it also blocks some of the sun the body uses to make vitamin D. And it can be hard to get enough of this nutrient from our diets because few foods contain it naturally.

Luckily, many foods are fortified (have vitamin D added), and supplements are available for kids who still need more vitamin D.

Learn how much vitamin D your child needs, and how to get it.

Who’s at Risk for Vitamin D Deficiency?

Things like a lack of direct sunlight and insufficient vitamin D in the diet put these groups at risk for vitamin D deficiency:

• People living where exposure to sunshine is limited. Because of limited skin exposure to sunlight from November to February, kids who live in northern areas like New England and the Pacific Northwest may not get enough sun to meet their vitamin D needs.
• People with dark skin. Because the pigment, or melanin, in darker skin blocks the sun, vitamin D is not effectively produced. When a kid with darker skin is in the sun for the same amount of time as a kid with lighter skin, the one with darker skin makes less vitamin D. This puts kids with African, Latino, Asian, and Middle Eastern backgrounds at risk.
• Babies who are only breastfed. Breastfeeding is wonderful for babies. But one thing that breast milk does not have enough of is vitamin D. Babies who are mostly drinking breast milk should be given a vitamin D supplement.
• People with certain health conditions. Some health conditions, like cystic fibrosis and inflammatory bowel disease (IBD), affect how well the body absorbs nutrients, including vitamin D. Also, studies have shown that obesity increases a person’s risk for vitamin D deficiency.

How Much Do Kids Need?

The Institute of Medicine (IOM) recommends that in the first year of life, babies get at least 400 IU (international units) of vitamin D per day. Kids older than 1 year and teens should get at least 600 IU of vitamin D each day.

For Babies

Babies who are exclusively breastfed (and some who are breastfed but also receive formula) may need supplements to get the recommended amount of vitamin D. Look for vitamin D-only liquid supplements that supply 400 IU. Follow your doctor’s instructions to make sure your child gets the right amount.

Formulas sold in the United States have at least 400 IU per liter, so most formula-fed babies will get the required amount. If your baby gets less than 1 liter of formula a day, use a vitamin D supplement to make up the difference. Talk to your doctor about how much your baby needs.

As babies are weaned off of breast milk, it’s important that they get enough vitamin D-fortified formula (or, if they’re older than 1 year, milk) to reach the recommended daily 400 or 600 IU.

For Kids & Teens

Many kids and teens don’t get the recommended 600 IU of vitamin D each day. Most commonly, vitamin D deficiency affects kids with darker skin and those who live in northern regions with limited sunlight.

Vitamin D-fortified milk can help — 1 quart, or 32 ounces, has about 400 to 460 IU. But most kids and teens drink much less milk than that each day. In that case, they should take a daily multivitamin or vitamin D-only supplement with 600 IU of vitamin D.

Teens might not think that they need that much vitamin D if they’re done growing. But they still need it just as much as younger kids. And it’s especially important for them to maintain a healthy weight, since being overweight seems to keep vitamin D from working properly.

Some kids and teens might need even more than 600 IU, especially if they live in areas with limited sun exposure, have a chronic disease, or have darker skin. Check with your doctor about higher doses.

Getting Vitamin D From Food

Vitamin D can be found in foods, but doesn’t occur naturally in many. The best natural sources are fatty fishes and fish oils. Excellent sources that provide lots of vitamin D include:

• cod liver oil, 1 tablespoon: 1,360 IU
• cooked fatty fishes (trout, swordfish, salmon), 3 ounces: 450-650 IU
• portobello mushrooms, per mushroom: 375 IU

The amount of vitamin D in other foods drops off after those. But the foods below can help make up the difference. Keep them in mind when planning meals and packing lunches:

• tuna packed in water, 3 ounces: 154 IU
• vitamin D-fortified milk, including skim and reduced-fat, 1 cup: 115-124 IU
• vitamin D-fortified orange juice, 1 cup: 137 IU
• vitamin D-fortified yogurt, 6 ounces: 80 IU
• vitamin D-fortified margarine, 1 tablespoon: 60 IU
• vitamin D-fortified cereal, ¾ to 1 cup: 40 IU
• 1 egg (vitamin D is in the yolk): 41 IU
• products made from vitamin D-fortified milk (amount varies)
• vitamin D-fortified fruit juices and drinks (amount varies)

What About Too Much Vitamin D?

Too much vitamin D in the body can be toxic and raise blood calcium levels, which can lead to kidney stones and heart rhythm problems, among other problems. Signs of too much vitamin D include:

• vomiting
• poor appetite
• constipation
• weakness
• weight loss

Talk to your doctor or a dietician about how much vitamin D your child needs. And remember, as kids grow, their diets change. Check with your doctor regularly to make sure your child is getting enough of what’s needed to grow and maintain strong bones.

The best drinks for preschoolers — and for kids of all ages — are milk and water. Whenever possible, discourage your kids from drinking soda and other sugary, calorie-dense drinks as thirst-quenchers because water or milk will do the job just as well.

Preschoolers should have 2 to 2½ cups (480-360 milliliters) of low-fat or nonfat milk (or equivalent dairy products) every day.

Now is the time to get kids into the habit of drinking milk so they can get bone-building calcium and vitamin D and other important nutrients they need. Limit flavored milks, but if you do serve it, avoid premixed chocolate or strawberry drinks, which often contain considerably more calories, sugar, and fat than milk you flavor yourself. For kids who don’t drink milk, calcium-fortified soy milk is a good alternative.

Avoid juice drinks and limit 100% juice — which has a significant amount of sugar — to no more than one serving, about 4-6 ounces (120-180 milliliters) a day. Too much juice can contribute to excess weight gain, diarrhea, and tooth decay.

Soda Gets in the Way

Many kids like cola and other soft drinks, but these have no nutritional value and are high in sugar. One study found that more than 1 out of 3 preschoolers drank soda on the day before the survey. On average, the kids drank over 8 ounces of soda or sugar-sweetened fruit drink, but only drank 12 ounces of milk, which is less than the recommended 16-20 ounces a day.

Kids may be less likely to drink enough milk if soda and other sugar-sweetened beverages are available. Besides calcium, milk offers other important nutrients, including vitamin D, potassium, and protein.

Drinking soda and other sugary beverages has been linked to excessive weight gain and other problems, including tooth decay. And kids tend to drink increasing amounts as they get older.

Caffeine and Kids: a Bad Mix

In addition to calories and sugar, soda often contains caffeine, which can have negative effects on kids. Most parents wouldn’t dream of giving a preschooler a cup of coffee, but might routinely serve cola and other drinks containing caffeine. For kids, the effects of caffeine are similar to those seen in adults.

Too much caffeine can cause:

• jitteriness and nervousness
• upset stomach
• headaches
• difficulty concentrating
• difficulty sleeping

To avoid giving kids too much caffeine, read nutrition labels on food and drinks. And don’t forget about the caffeine found in chocolate, coffee ice cream, and iced tea drinks.

Although the United States has not adopted guidelines for caffeine consumption in kids, Canadian guidelines recommend that preschoolers have no more than 45 milligrams of caffeine a day. This is the average amount in a 12-ounce (360-milliliter) can of cola or a 6-ounce (45-gram) milk chocolate bar.

Water is a caffeine-free, zero-calorie thirst quencher and milk has nutrients to help kids grow up strong. Limit the empty calorie drinks you serve, and teach your kids that water and milk are the best drinks for them.

“What’s the right weight for my child?” is one of the most common questions parents have. It seems like a simple one, but it’s not always easy to answer.

Among kids the same height and age, some are more muscular or more developed than others. That’s because not all kids have the same body type or develop at the same time.

Growth and Puberty

Not everyone grows and develops on the same schedule. During puberty, the body begins making hormones that spark physical changes like breast development in girls, testicular enlargement in boys, and spurts in height and weight gain in both boys and girls. Once these changes start, they continue for several years. The average kid can expect to grow as much as 10 inches (25 centimeters) during puberty before reaching full adult height.

Most kids gain weight more rapidly during this time as the amounts of muscle, fat, and bone in their bodies change. All that new weight gain can be perfectly fine — as long as body fat, muscle, and bone are in the right proportion.

Because some kids start developing as early as age 8 and some not until age 14, it can be normal for two kids who are the same gender, height, and age to have very different weights.

It can feel quite strange for kids to adjust to suddenly feeling heavier or taller. So it’s perfectly normal for a child to feel self-conscious about weight during adolescence — a lot of kids do.

Figuring Out Fat Using BMI

Experts have developed a way to help figure out if someone is in the healthy weight range for his or her height. It’s called the body mass index, or BMI. BMI is a formula that doctors use to estimate how much body fat a person has based on his or her weight and height.

The BMI formula uses height and weight measurements to calculate a BMI number. Though the formula is the same for adults and children, figuring out what the BMI number means is a little more complicated for kids.

For kids, BMI is plotted on a growth chart that uses percentile lines to tell whether a child is underweight, healthy weight, overweight, or obese. Different BMI charts are used for boys and girls under the age of 20 because the amount of body fat differs between boys and girls and body fat changes as kids grow.

Each BMI chart is divided into percentiles. A child whose BMI is equal to or greater than the 5th percentile and less than the 85th percentile is considered a healthy weight for his or her age. A child at or above the 85th percentile but less than the 95th percentile for age is considered overweight. A child at or above the 95th percentile is considered obese. A child below the 5th percentile is considered underweight.

Before you calculate your child’s BMI, you’ll need an accurate height and weight measurement. Bathroom scales and tape measures aren’t always precise. So the best way to get accurate measurements is by having kids weighed and measured at a doctor’s office or at school.

What Does BMI Tell Us?

You can calculate BMI on your own, but consider asking your doctor to help you figure out what it means. Doctors do more than just use BMI to assess a child’s current weight. They also take into account where a child is during puberty and use BMI results from past years to track whether that child may be at risk for becoming overweight. Spotting this risk early on can be helpful because changes can be made before developing a weight problem.

Kids are developing weight-related health problems previously seen only in adults. Type 2 diabetes, high cholesterol, and high blood pressure (hypertension) are now commonly seen in overweight and obese kids and teens. They’re also more likely to be overweight as adults. And adults who are overweight may develop other serious health conditions, such as heart disease.

Although BMI can be a good indicator of body fat, it doesn’t always tell the full story. Someone with a large frame or a lot of muscle instead of excess fat (like a bodybuilder or athlete) can have a high BMI. Likewise, a small person with a small frame may have a normal BMI but could still have too much body fat. These are other good reasons to talk about your child’s BMI with your doctor.

When Kids Are Overweight or Underweight

If you think your child has gained too much weight or is too thin, a doctor should help you decide whether your child really has a weight problem. Your doctor has measured your child’s height and weight over time and knows whether growth is proceeding normally.

If concerned about your child’s height, weight, or BMI, the doctor may ask questions about your child’s health, level of physical activity, and eating habits, as well as your family medical history. The doctor can put all this information together to determine whether there’s a weight or growth problem.

If your doctor thinks your child’s weight isn’t in the healthy range, you will probably get specific dietary and exercise recommendations. It’s important to follow a doctor’s or dietitian’s plan that’s designed for your child. For kids and teens, significantly restricting calories or following fad diets or starvation plans can deprive them of the nutrients their growing bodies need and may actually slow down growth and sexual development.

What if your child is worried about being too skinny? Most kids who weigh less than others their age are just fine. They may go through puberty on a different schedule than some of their peers, and their bodies may grow and change at a different rate. Most underweight teens catch up in weight as they finish puberty during their later teen years, and there’s rarely a need to try to gain weight.

In a few cases, kids and teens can be underweight because of a health problem that needs treatment. If your child feels tired or ill a lot, or has symptoms like a cough, stomachache, diarrhea, or other problems that have lasted for more than a week or two, talk with your doctor. Some kids and teens are underweight because of eating disorders, like anorexia or bulimia, which need medical attention.

The Role of Genes

Heredity plays a role in a person’s body shape and weight. People from different races, ethnic groups, and nationalities tend to have different body fat distribution (meaning they accumulate fat in different parts of their bodies) or body composition (amounts of bone and muscle versus fat). But genes are not destiny — kids can reach and keep a healthy weight by eating right and being active.

Genes aren’t the only things that family members may share. It’s also true that unhealthy eating habits can be passed down. The eating and exercise habits of people in the same household probably have an even greater effect than genes on someone’s risk of becoming overweight. If parents eat a lot of high-calorie foods or snacks or don’t get much exercise, their kids tend to do the same.

The good news is these habits can be changed for the better. Even small changes, like cutting back on sugary drinks and going for a walk after dinner, can add up to make a real difference.

So remember, it’s not a specific number on the scale that’s important. It’s making sure that kids stay healthy — inside and out.