The notion that children can and should take charge of their own hunger still makes parents uneasy. After all, who else is going to keep a toddler from eating nothing but Marshmallow Fluff sandwiches all day? But many experts now believe that we’ve badly underestimated kids’ capacities for regulating wisely what and how much they eat. Satter, author of the influential guide “How to Get Your Kid to Eat … But Not Too Much,” advises parents to be gatekeepers, not food police. “Parents are responsible for choosing what foods to have in the house, and what to put on the table,” she says. “Kids are responsible for what they eat.”
Excruciating though it may be to sit calmly through dinner while your toddler ignores the chicken and carrots in favor of two bread sticks and a cookie, research bears out Satter’s dictum. “We’ve done studies over 10 years that show most little kids are pretty good at being responsive to the energy content of the diet,” says Leann Birch, professor of family studies and nutrition at Pennsylvania State University. In one study, children selected their own lunch, but it was preceded by either a low-calorie or a high-calorie yogurt. Sure enough, over a period of days they tended to balance the two courses so that they got roughly the same number of calories every time. “If parents impose too much control over what kids eat, it impedes this ability to self-regulate,” says Birch.
Unfortunately, children’s marvelous regulatory mechanism does not appear to recognize the importance of cauliflower or leafy greens. On the contrary, under-3s have a finely honed “yuck” response that is readily activated by a single bite of any new food, particularly bitter-tasting ones. “We’re omnivores, so we’re programmed to eat lots of different things but to be very suspicious of anything new,” says Linda Bartoshuk of the Yale University School of Medicine. That suspicion, which probably saved many a prehistoric tot from poisoning, now serves merely to drive parents crazy. Nutritionists agree that offering a new food up to a dozen times will usually wear down a child’s resistance. There’s also evidence that breast-fed babies may be a bit more open-minded than formula-fed babies, since the flavor of formula never changes. “We know from animal research that the more varied the mother’s diet during nursing, the more likely a young animal would accept novel foods during weaning,” says Julie Mennella of the Mortell Chemical Senses Center in Philadelphia. A strongly flavored diet, of course, is just what many experts tell nursing mothers to avoid, for fear the babies won’t like the milk. But Mennella found that when mothers consumed garlic, for example, their babies liked the novelty and stayed longer on the breast. “When a new food is introduced in mother’s milk, you don’t see aversions develop,” says Mennella. “Mother’s milk is a flavor bridge to the foods of the culture.”
The most important reason to help kids learn to enjoy new tastes is that a varied diet of foods eaten for pleasure is likely to be a healthful diet. “Children love sweet tastes, and they like salty tastes. That’s all hard-wired,” says Yale’s Bartoshuk. So kids need no encouragement to make fast food and junk food their favorites. Our national addiction to those foods contributes heavily to our rates of chronic disease. “Cancers form over 20 to 30 years, and heart disease builds up over time, too,” says Tara Liskov,a registered dietitian at Yale-New Haven Hospital. “That’s the reason you want to start early with good habits.”
Pediatricians have argued for years about whether to recommend low-fat diets for small children. It’s clear that infants and toddlers grow so fast they need every calorie they can pack in. But a recent Finnish study showed that babies as young as 18 months did fine on a diet slightly restricted in fat. (In their first year, children need fat for neuronal and brain development, so dietary fat intake in the form of breast milk, formula or, later, cow’s milk should not be restricted.) In addition, we know that heart disease can get started at an early age. Researchers at the Bogalusa Heart Study in Louisiana, where more than 17,000 young people have been examined in the past 23 years, conduct autopsies on children killed in accidents. They have found aortic fatty streaks-early precursors of atheroselerosis-in children as young as 3. “And there’s new data that children with high levels of bad cholesterol in their blood have stiffer carotid [neck] arteries,” says Christine Williams of the American Health Foundation in Valhalla, N.Y., where a three-year project is underway to reduce cardiovascular risk among children at nine Head Start centers. Cutting the saturated fat in their diets is a key goal. For children under 2, the American Academy of Pediatrics still recommends no restrictions. After that the AAP encourages a gradual reduction in fat over the next few years, until the child is getting about 30 percent of calories from, fat-the level recommended for adults. ‘With younger children, often all you have to do is change to i percent milk and lighter cheeses," says Williams.
Scientists have long believed that a diet high in fruits and vegetables can help prevent many cancers, and both adults and kids are supposed to be eating at least five servings a day. It’s not hard to do. A serving is only half a cup of cooked anything, or a whole fruit. But according to a recent study by Susan Krebs-Smith of the National Cancer Institute, most kids from 2 to 18 are falling short. Only one in five children under 5 gets the recommended five servings, and nearly half eat less than a single serving of fruit a day. “And we counted everything” says Krebs-Smith. “We counted the raisins in the raisin bread.” More than a third of children eat less than a single serving of vegetables a day, and that includes french fides, which account for nearly a quarter of the total vegetables consumed by kids. These paltry levels of consumption also indicate that children are not getting enough fiber. “We have a new formula-the child’s age, plus five grams, per day,” says Williams. “That’s about double what most kids are taking in.” A 3-year-old could get eight grams of fiber by eating an apple, a slice of whole-wheat bread, a serving of broccoli and a carrot.
Fruit juice, which many kids seem to swig all day, is a poor substitute for whole fruit, water or milk. “Juice is really no different in calories from soda, and some kinds don’t have much more nutrition than soda,” says Liskov. “Apple juice has very few nutrients. I wouldn’t give a child juice until 12 or 18 months, and little kids don’t need more than about four ounces a day.”
But let’s face it, the federal guideline that could persuade a resistant toddler to give the time of day to a lima bean hasn’t been written. Can little kids thrive if they never eat anything green? “I think they can-mine did,” says William Tambolane, chief of pediatric endocrinology at Yale-New Haven’s Children’s Hospital and editor of “The Yale Guide to Children’s Nutrition.” “Look what’s in vegetables: they’re good sources of fiber, vitamins and minerals. But kids can get all that in a balanced diet from other foods. The main thing is not to make it an issue. Don’t force-feed.”
So, yes, it’s important for little kids to eat right. But it’s even more important for them to like food, enjoy being at the table, know when they’re hungry and quit when they’re full. Parents may not be able to exert much control over the consumption of squash, but they have lots of influence over kids’ emotional and psychological associations with food. That’s where healthy patterns starting in childhood will last a lifetime.
Paying attention to the nutrients a baby receives should begin well before conception. Smart prenatal care now means “pre-conceptual care”: because embryonic organ development begins about 17 days after sperm and egg unite–before many women realize they’re pregnant–it is vital to eat the right things and avoid the bad things even before conceiving.
Women should get into shape before becoming pregnant, losing weight if necessary and developing a moderate exercise routine. They need a well-balanced diet with sufficient protein and calcium, and should replace any prescription drugs that could harm a fetus with safer ones. High On the danger list is Accutane (for acne and wrinkles), plus certain medications for high blood pressure, diabetes, epilepsy and manic depression.
The B vitamin folic acid is essential for the developing spinal column. A maternal deficiency can dramatically increase the risk of devastating “neural tube” defects such as spina bifida (the failure of the spinal column to dose completely, with resulting paralysis or even death) and anencephaly (a fatal absence of brain growth). There’s also evidence that folic acid and other vitamins may help reduce the risk of heart defects and cleft lip and palate. Very few women get enough folic acid in their normal diet to prevent such problems. The U.S. Public Health Service therefore recommends that women take an extra 400 micrograms of folic acid daily, either as a supplement or in fortified cereal, starting a month before attempted conception and continuing through the first trimester. (The FDA has approved adding folic acid to baking flour as of 1998, but women will not get enough of the vitamin through bread alone.)
There is no evidence that low intake of alcohol harms a fetus, though heavy drinking is associated with severe problems of growth and brain development. Obstetricians don’t know what a “safe” level of alcohol is, so the easy fallback is to say don’t drink at all. Smoking cigarettes during pregnancy unquestionably increases the risk of pre-maturity and low birth weight. And it’s never too early to kick the habit.
