Nutritional needs change as children leave the toddler years. From ages four to eight, school-aged children grow consistently but slower than infants and toddlers. They also experience the loss of deciduous, or “baby,” teeth and the arrival of permanent teeth, which typically begins at age six or seven. As new teeth come in, many children have some malocclusion, or malposition, of their teeth, which can affect their ability to chew food. Other changes that affect nutrition include the influence of peers on dietary choices and the kinds of foods offered by schools and afterschool programs, making up a sizable part of a child’s diet. Food-related problems for young children can include tooth decay, food sensitivities, and malnourishment. Also, excessive weight gain early in life can lead to obesity in adolescence and adulthood. A healthy diet facilitates physical and mental development at this life stage and helps maintain health and wellness.

During early childhood, children’s attitudes and opinions about food deepen. They begin taking their cues about food preferences from family members and peers, and the larger culture.

Caregivers also significantly impact their child’s nutritional choices. This time in a child’s life provides parents and other caregivers an opportunity to reinforce good eating habits and introduce new foods into the diet while remaining mindful of their preferences. Parents should also serve as role models for their children, who will often mimic their behavior and eating habits. Parents must continue to help their school-aged children and adolescents establish healthy eating habits and attitudes toward food. Their primary role is to bring a wide variety of health-promoting foods into the home so that their children can make good choices.

Energy

Children’s energy needs vary, depending on their growth and level of physical activity. Energy requirements also vary according to biological sex. Girls ages four to eight require 1,200 to 1,800 calories a day, while boys need 1,200 to 2,000 calories daily, and, depending on their activity level, maybe more. Also, recommended intakes of macronutrients and most micronutrients are higher relative to body size than nutrient needs during adulthood. Therefore, children should be provided nutrient-dense food at meal- and snack time. However, it is important not to overfeed children, leading to childhood obesity, discussed in the next section.

Factors Influencing Intake

Several factors can influence children’s eating habits and attitudes toward food. Family environment, societal trends, taste preferences, and messages in the media all impact children’s emotions with their diet. Television commercials can entice children to consume sugary products, fatty fast foods, excess calories, refined ingredients, and sodium. Therefore, it is critical that parents and caregivers direct children toward healthy choices.

One way to encourage children to eat healthy foods is to make the meal and snack-time fun and interesting. Parents should include children in food planning and preparation, such as selecting items while grocery shopping or preparing part of a meal, like making a salad. At this time, parents can also educate children about kitchen safety. It might be helpful to cut sandwiches, meats, or pancakes into small or interesting shapes. Parents should also offer nutritious desserts, such as fresh fruits, instead of calorie-laden cookies, cakes, salty snacks, and ice cream. Also, studies show that children who eat family meals frequently consume more nutritious foods.

Two children cooking together. [Image by the Air Force Medical Service is in the public domain]

Tips for Establishing Healthy Eating Patterns

1. Don’t try to force your child to eat or fight over food . Of course, it is impossible to force someone to eat. But the real advice here is to avoid turning food into some kind of ammunition during a fight. Do not teach your child to eat to or refuse to eat in order to gain favor or express anger toward someone else.
2. Recognize that appetite varies. Children may eat well at one meal and have no appetite at another. Rather than seeing this as a problem, it may help to realize that appetites do vary. Continue to provide good nutrition, but do not worry excessively if the child does not eat.
3. Keep it pleasant . This tip is designed to help caregivers create a positive atmosphere during mealtime. Mealtimes should not be the time for arguments or expressing tensions. You do not want the child to have painful memories of mealtimes together or have nervous stomachs and problems eating and digesting food due to stress.
4. No short order chefs . While it is fine to prepare foods that children enjoy, preparing a different meal for each child or family member sets up an unrealistic expectation from others. Children probably do best when they are hungry and a meal is ready. Limiting snacks rather than allowing children to “graze” continuously can help create an appetite for whatever is being served.
5. Limit choices . If you give your preschool aged child choices, make sure that you give them one or two specific choices rather than asking “What would you like for lunch?” If given an open choice, children may change their minds or choose whatever their sibling does not choose.
6. Serve balanced meals . This tip encourages caregivers to serve balanced meals. A box of macaroni and cheese is not a balanced meal. Meals prepared at home tend to have better nutritional value than fast food or frozen dinners. Prepared foods tend to be higher in fat and sugar content as these ingredients enhance taste and profit margin because fresh food is often more costly and less profitable. However, preparing fresh food at home is not costly. It does, however, require more activity. Preparing meals and including the children in kitchen chores can provide a fun and memorable experience.
7. Don’t bribe . Bribing a child to eat vegetables by promising dessert is not a good idea. For one reason, the child will likely find a way to get the dessert without eating the vegetables (by whining or fidgeting, perhaps, until the caregiver gives in), and for another reason, because it teaches the child that some foods are better than others. Children tend to naturally enjoy a variety of foods until they are taught that some are considered less desirable than others. A child, for example, may learn the broccoli they have enjoyed is seen as yucky by others unless it’s smothered in cheese sauce.

Children and Malnutrition

Malnutrition is a problem many children face in both developing nations and the developed world. Even with the wealth of food in North America, many children grow up malnourished or hungry. The US Census Bureau characterizes households into the following groups:

• food secure
• food insecure without hunger
• food insecure with moderate hunger
• food insecure with severe hunger

Millions of children grow up in food-insecure households with inadequate diets due to available food and food quality. In the United States, about 20 percent of families with children are food insecure to some degree. In half of those, only adults experience food insecurity. In contrast, in the other half, both adults and children are considered food insecure, which means that children do not have access to adequate, nutritious meals at times.

Growing up in a food-insecure household can lead to many problems. Deficiencies in iron, zinc, protein and vitamin A can result in stunted growth, illness, and limited development. Federal programs, such as the National School Lunch Program, the School Breakfast Program, and Summer Feeding Programs, address the risk of hunger and malnutrition in school-aged children. They help fill the gaps and provide children living in food-insecure households with greater access to nutritious meals.

Food Allergies and Food Intolerance

A food allergy occurs when the body has a specific and reproducible immune response to certain foods. The body’s immune response can be severe and life threatening, such as anaphylaxis. Although the immune system normally protects people from germs, in people with food allergies, the immune system mistakenly responds to food as if it were harmful. Recent studies show that three million children under age eighteen are allergic to at least one food type.

Some of the most common allergenic foods include peanuts, milk, eggs, soy, wheat, and shellfish. An allergy occurs when a protein in food triggers an immune response, which results in the release of antibodies, histamine, and other defenders that attack foreign bodies. Possible symptoms include itchy skin, hives, abdominal pain, vomiting, diarrhea, and nausea. Symptoms usually develop within minutes to hours after consuming a food allergen. Children can outgrow a food allergy, especially wheat, milk, eggs, or soy allergies.

The Threat of Lead Toxicity

There is a danger of lead toxicity, or lead poisoning, among school-aged children. Lead is found in plumbing in old homes, lead-based paint, and occasionally soil. Contaminated food and water can increase exposure and result in hazardous lead levels in the blood. Children under age six are especially vulnerable. They may consume items tainted with lead, such as chipped, lead-based paint. Another everyday exposure is lead dust in carpets, with the dust flaking off of paint on walls. When children play or roll around on carpets coated with lead, they are in jeopardy. Lead is indestructible, and once it has been ingested, it is difficult for the human body to alter or remove it. It can quietly build up in the body for months, or even years, before the onset of symptoms. Lead toxicity can damage the brain and central nervous system, resulting in impaired thinking, reasoning, and perception. Treatment for lead poisoning includes removing the child from the source of contamination and extracting lead from the body. Fortunately, lead toxicity can be prevented. It involves identifying potential hazards, such as lead paint and pipes, and removing them before children are exposed to them.

Oral Health

Tooth decay (cavities) is one of the most common chronic conditions of childhood in the United States. Untreated tooth decay can cause pain and infections that may lead to problems with eating, speaking, playing, and learning. The good news is that tooth decay is preventable.

Fluoride varnish, a high concentration fluoride coating that is painted on teeth, can prevent about one-third (33%) of decay in the primary (baby) teeth. Children living in communities with fluoridated tap water have fewer decayed teeth than children who live in areas where their tap water is not fluoridated. Similarly, children who brush daily with fluoride toothpaste will have less tooth decay. [Note: as of 2019, all water supplied to Broward County is fluoridated]

Applying dental sealants to the chewing surfaces of the back teeth is another way to prevent tooth decay. Studies in children show that sealants reduce decay in the permanent molars by 81% for 2 years after they are placed on the tooth and continue to be effective for 4 years after placement.

The first visit to the dentist should happen after the first tooth erupts. After that, children should be seeing the dentist every six months.

A dentist checking a child’s teeth. [Image by Keesler Air Force Base is in the public domain]