It's hard to imagine how childhood malnutrition can occur in a land of such plenty, until you look closely--as we did recently--at what some children in this country are actually eating.
For several days, we observed the food intake of the 6-year-old daughter of a friend. For breakfast, she alternated between waffles and cold cereal (usually without milk); her lunch rarely included anything but a peanut butter sandwich; for dinner she would accept nothing but pasta with butter and cheese. Other than an occasional box of raisins, this child refused to eat any fruits and vegetables (except for fruit juice, which she drank in lieu of milk).
In fairness, we have to note that this child appeared perfectly healthy. So why are we concerned? Because the "invisible malnutrition" that results from a childhood filled with poor food choices can result in a lifetime of poor health as an adult. Kids whose diets are deficient in calcium and vitamin D have a greatly increased risk of brittle bones and osteoporosis as adults. Children who consume too much dietary fat are more likely to be overweight during their youth and to suffer from diabetes, high blood pressure and heart disease when they grow up.
A lack of fruits and vegetables in the diet is a major contributor to the problem. Pediatricians and nutrition experts recommend that children eat at least five servings of fruits and vegetables daily. Yet one recent survey of children ages 2 to 18 found that, on average, these kids consumed only about 31/2 servings of fruits and vegetables. And French fries accounted for one-quarter of the total. About half of the children surveyed ate less than one complete serving of fruit per day, and nearly three in 10 kids consumed less than one serving of non-fried vegetables.
Soft drinks are another significant cause of nutritional problems for many children. the last 30 years, the consumption of soft drinks has increased dramatically. One recent study found that 12% of preschoolers and more than 30% of school-age children drink at least 9 nine ounces of soda daily, and almost 25% of adolescents drink more than 26 ounces daily.
As every parent quickly learns, you can't force a child to eat. So, what can you do? Start by serving three healthy meals and two nutritious snacks at regular times each day. It's up to you--not your child--to select which foods to serve and when to serve them. It's up to your child, however, to decide how much to eat or whether to eat at all.
Children should be required to come to the table at mealtime, even if they choose not to eat what is being served. If possible, eat meals together as a family and set a good example yourself by eating a variety of foods including lots of fruits and vegetables.
Expose the child to different types of fruits and vegetables until you can identify a few that the child is willing to eat. Then keep those choices available and readily accessible at home. Set a goal of five servings of any fruit or vegetable, and find a way to reward the child who reaches that goal. (Rewarding a child for doing something always works better than nagging a child who falls short).
Concentrate as much as possible on fruits and vegetables that are vitamin-rich. In most cases, darker-colored fruits and vegetables like apricots, oranges, strawberries, broccoli, carrots, spinach and yams are a better source of nutrients than their lighter counterparts, such as cucumbers, celery and iceberg lettuce, or apples and pears, which are pale beneath their colored skins.
Limit the amount of fat and sugar your child consumes by substituting low-fat snacks and desserts for ones that are high in fat. Buy pretzels, baked chips and flavored rice chips instead of chips fried in oil; bring home sorbet or low-fat frozen yogurt instead of ice cream. An occasional sweet snack or dessert is OK but should not be allowed to displace more nutritious food choices.
Limit the amount of high-fat "fast-food" meals you serve your children. A recent survey of Los Angeles residents showed that about 20% of children between the ages of 3 and 17 had eaten fast food the previous day. Although very convenient, many fast-food items are high in fat, especially the selections most children make. If you decide to dine out on fast food, limit your child's choices to the healthier items on the menu.
Do not keep carbonated soda, sugar-sweetened drinks or flavored drink mixes in your home. Natural fruit juices are a better choice but still a poor substitute for milk. While they may be rich in certain vitamins, they are high in calories, low in fiber, and most natural juices contain very little calcium.