As a pediatrician, one of my goals at every patient’s yearly physical is to ask about physical activity and nutrition. As part of measuring growth we get a height and weight on each patient. We use this to calculate the child’s body mass index (BMI).
With a growing number of American children becoming clinically overweight (BMI at 85-94th percentile, 5-10 in 100 same age and sex kids are larger) or obese (BMI ≥95th percentile 5 or less in 100 kids of the same sex and age are larger), providing advice on diet, nutrition and physical activity is becoming a more important part of our job.
It’s estimated that nearly one in three U.S. children older than two years of age are overweight, with more than 15 percent being obese. With this in mind, the goal of this article is to provide insight on healthy eating, physical activity, and screen time recommendations.
A good guide to follow is the 5-2-1-0 rule. This means we should aim for at least five fruits and vegetables per day, on average less than two hours of screen time per day, one hour of physical activity per day and zero sugar sweetened drinks per day.
I often hear, “How can I get five fruits and vegetables per day into my kid? My kid will not eat vegetables.” While trying to meet the goal of five fruits and vegetables per day can be hard, there are some creative ways to introduce fruits and vegetables and many great health benefits.
Fruits and vegetables provide fiber and many healthy nutrients necessary for growth. Fiber has a filling effect that helps to prevent snacking on “junk” food. A few ways to “sneak” fruits and vegetables into your child’s diet include:
- taking something you know they like and add something new. For example, if you know they like chips and dip, substitute veggies for the chips.
- adding fruit to cereal or yogurt (plain or vanilla), or making smoothies and soups (especially purees). This makes it harder for kids to know they are eating fruits or vegetables.
- shredding or pureeing veggies into sauces for homemade pizza or pasta. Encourage your child, and maybe even yourself, to try one new vegetable or fruit each week.
Setting children up in front of the TV or a tablet can be a useful strategy when you’re trying to get dinner made or chores done. Keep in mind that screen time is counted as any time a child spends on a computer, in front of the TV, on a tablet or other device.
Next to sleeping, screen time is how many children spend most of the hours in their day; in some cases, more than seven hours a day with different types of screens. We recommend, on average, less than two hours of relaxation screen time per day and no screen time for children less than two years old.
Media has benefits of teaching behaviors and attitudes such as empathy, cooperation, and tolerance. But it’s also associated with exposure to images of violence, sex, legal and illegal drugs. Careful choices of screen programs, watching with your children and talking about the program are important. Some ways to decrease screen time are:
- Offer and encourage other activities.
- Plan screen time.
- Set limits and stick to them (use a timer if needed).
- Avoid watching TV during family meals as you may be less aware of how much you are eating.
It is important to make your children’s bedroom “electronic-media free” to promote healthy sleep habits. Setting up a craft project can give a child something to do during meal prep. Try to make one night a week game night instead of watching TV.
With the changing weather in Vermont and our schedule, it can be hard to meet the goal of one hour of physical activity every day. As a parent or guardian it is important to set an example. If you are active, your child is more likely to be active! As a family, set activity goals and celebrate successes! Celebration could involve a family bowling night, family movie night, or an extra game night.
Make physical activity fun. Celebrate special occasions and holidays with activities. When you can’t get outside, try dancing to your favorite music, read a story and then act it out, visit an open gym and use the stairs whenever possible.
Toddlers love to play follow the leader–hop like a bunny, jump like a frog, clap your hands, stomp your feet. Set up a treasure hunt inside or outside, build a fort, or make something out of a box. When you can go outside, play outside– visit a farm or playground, go on a picnic, set up an obstacle course, kick a ball around, toss a Frisbee, take the dog for a walk, play your favorite sport, ride bikes, play tag, or make up a game.
If you’re able to start a garden and plant your favorite flowers and vegetables, this will give you an activity to do while helping meet your goal of five fruits and vegetables per day. You can make it a habit to have a family walk after dinner or on weekend mornings. Visit your local parks and recreation to find out about recreation programs or sport leagues.
Getting children to drink enough water can be a challenge. We recommend no sweetened beverages (soda, sport drinks, sweetened teas, etc.) as they contain extra calories that add up over time and contribute to weight gain and cavities. Offer water as the primary drink of choice. If your child will not drink “plain” water you can try coloring it with natural food coloring or using a fun cup or straw. You can also flavor water with a slice of lemon, lime, or cucumber.
Limit juice consumption; use small glasses/cups and make juice available at only one sitting. If it’s not finished and they are off to do something else, toss it. Serve non-fat or low-fat milk to children older than two years . We recommend three servings a day for calcium and vitamin D intake. Seltzer can be used as an alternative for soda with older kids.
Meeting all of these goals can be a challenge for everyone. So pick one and make small changes over time. Celebrate your successes. Small changes over time add up to a big gains. As always, every child and family is different; talk with your child’s provider about suggestions specific to you.
Visit http://www.health.harvard.edu/healthy-eating-plate and www.healthychildren.org to learn more about portion sizes and a balanced plate of food. You can also visit http://www.brattleboro.org to learn about our local parks and recreation opportunities.
Heather Lesage-Horton, MD, is a board certified pediatrician with Brattleboro Primary Care located at 21 Belmont Avenue, Gannett Building, Brattleboro, VT. You can reach Brattleboro Primary Care by calling 802-258-3905.