Recommendations for Healthy Eating

There are a number of recommendations for healthy eating.  When choosing what recommendations to follow, it is important to consider the following:

• Are the recommendations based on evidence-based research studies?
• Has the research on the recommendations been replicated over a long period of time?
• Are the recommendations free from bias or vested interests?

The Earliest Nutrition

Breastfeeding is the best source of nutrition for most infants. It can also reduce the risk for some short- and long-term health conditions for both infants and mothers. Most mothers want to breastfeed, but stop early due to a lack of ongoing support.1

Benefits of Breastfeeding:  Infants who are breastfed have reduced risks of asthma, obesity, type 2 diabetes, ear and respiratory infections, sudden infant death syndrome (SIDS). Breastfeeding can help lower a mother’s risk of heart disease, type 2 diabetes, ovarian cancer, breast cancer.

While human milk provides the most complete form of nutrition for infants, including premature and sick newborns, there are rare exceptions when human milk or breastfeeding is not recommended.

Mothers should NOT breastfeed or feed expressed breast milk to their infants if the infant is diagnosed with classic galactosemia, a rare genetic metabolic disorder, if mother is infected with HIV, (Note: recommendations about breastfeeding and HIV may be different in other countries), mother is infected with human T-cell lymphotropic virus type I or type II, mother is using an illicit street drug, such as PCP (phencyclidine) or cocaine (Exception: Narcotic-dependent mothers who are enrolled in a supervised methadone program and have a negative screening for HIV infection and other illicit drugs can breastfeed), mother has suspected or confirmed Ebola virus disease.

When your child is about 6 months old, you can start introducing him or her to foods and drinks other than breast milk and infant formula. The foods and drinks you feed your child are sometimes called complementary foods. You can think of these as “complementing,” or adding to, the breast milk or infant formula that you continue to feed your child.

When What and How to Introduce Solid Foods

The American Academy of Pediatrics recommends children be introduced to foods other than breast milk or infant formula when they are about 6 months old. Every child is different. How do you know if your child is ready for foods other than breast milk or infant formula? You can look for these signs that your child is developmentally ready:

• Your child can sit with little or no support.
• Your child has good head control.
• Your child opens his or her mouth and leans forward when food is offered.

What Foods Should I Introduce to My Child First?

The American Academy of Pediatrics says that for most children, you do not need to give foods in a certain order. Your child can begin eating solid foods at about 6 months old. By the time he or she is 7 or 8 months old, your child can eat a variety of foods from different food groups. These foods include infant cereals, meat or other proteins, fruits, vegetables, grains, yogurts and cheeses, and more.

If your child is eating infant cereals, it is important to offer a variety of fortified infant cereals such as oat, barley, and multi-grain instead of only rice cereal. Only providing infant rice cereal is not recommended by the Food and Drug Administration because there is a risk for children to be exposed to arsenic.

Encourage Your Child to Eat

Offer your child a variety of fruits, vegetables, whole grains, (protein), and yogurt or cheeses. Make a rainbow of different colored foods on your child’s plate. Here are a few examples:

• Fruits: bananas, strawberries, pears, oranges, melons, or avocados.
• Vegetables: cooked spinach, carrots, peas, sweet potatoes, or beets.
• Whole grains: whole grain breads, crackers, or pastas.

Encourage Your Child to Drink

When your child is between 6 and 12 months old, you can offer your child:

• Water (4 to 6 ounces per day).
• Breast milk (if you are still breastfeeding) or infant formula.

Once your child is 12 months old, you can begin offering fortified cow’s milk.

How Should I Introduce My Child to Foods?

Your child needs certain vitamins and minerals to grow healthy and strong. Now that your child is starting to eat food, it is important to choose foods that give your child all the vitamins and minerals he or she needs.

Let your child try one food at a time at first. This helps you see if your child has any problems with that food, such as food allergies. Wait 3 to 5 days between each new food. Before you know it, your child will be on his or her way to eating and enjoying lots of new foods.

The eight most common allergenic foods are milk, eggs, fish, shellfish, tree nuts, peanuts, wheat, and soybeans. Generally, you do not need to delay introducing these foods to your child, but if you have a family history of food allergies, talk to your child’s doctor or nurse about what to do for your baby.

Foods to Limit or Avoid

Healthy eating is all about balance. There is no need to add salt or sugar to your child’s food. There are also some foods and drinks that are not safe for your child to eat and others that are not as healthy choices as other foods.

Foods to Avoid

Here are examples of foods and drinks that you should avoid giving to your young child because they may be harmful:

• Honey: may cause a serious type of food poisoning called botulism for your young child under 12 months old. Before your child is 12 months old, do not give him or her any foods containing honey, including yogurt with honey and cereals and crackers with honey, such as honey graham crackers.
• Unpasteurized drinks or foods (such as juices, milks, yogurt, or cheeses): may put your child at risk for E. coli, a harmful bacteria that can cause severe diarrhea. Do not give your child unpasteurized drinks or foods like juice, milk, yogurt, or cheeses. Unpasteurized milk can also be called raw milk.
• Fortified cow’s milk: may put your young child under 12 months old at risk for intestinal bleeding. It also has too many proteins and minerals for your infant’s kidneys to handle and does not have the right amount of nutrients your infant needs.

Foods to Limit

Here are some examples of foods to limit (or give in small amounts) to your child:

• Foods with added sugars: Foods such as candy, cakes, cookies, and ice cream are often high in added sugars. The American Heart Association recommends that children younger than 24 months old are not given any added sugars.
• Foods high in salt, also known as sodium: Foods such as some canned foods, processed meats (such as lunch meats, sausages, hot dogs, ham), and frozen dinners can be high in sodium. Some snack foods are high in sodium. Check the Nutrition Facts Label to find foods with less sodium.

Drinks to Limit

Here are some examples of drinks to limit (or give in small amounts) to your child:

• Juice

• o Before 12 months old: The American Academy of Pediatrics recommends that children should not drink 100% juice before they are 12 months old. Do not provide drinks like juice drinks with added sweeteners. Fruits are healthier options for your child than fruit juices.

• • After 12 months old: For children older than 12 months who drink juice, pediatricians recommend 4 ounces or less of 100% juice a day. Drink 100% fruit juice only. Do not provide drinks like juice drinks with added sweeteners. Fruits are healthier options for your child than fruit juices.
• Cow’s Milk
  • After your child is 12 months old, too much fortified cow’s milk can mean he or she may not be hungry for other foods that contain important nutrients. Some experts say that consuming too much fortified cow’s milk can make it harder for your child’s body to absorb the iron they need from foods.
• Soda, pop, fruit drinks, flavored milks, or other sugar sweetened beverages
  • These drinks contain a lot of added sugars. The American Heart Association recommends that children younger than 24 months old are not given any added sugars.

 Picky Eaters and What to Do

Your child might not like every food you give him or her on the first try. Give your child a chance to try foods again and again, even if he or she does not like them at first. Children may need to try some foods many times before they like them. Here are some tips that might make trying foods again and again easier.

• Try freezing small bites of different foods. You can use these later and it avoids throwing a lot of food away.
• Wait a week before you try the new food again.
• Try mixing the new food with a food your baby likes, such as breast milk.

As your child gets older, he or she may start refusing foods he or she used to like or he or she may start showing signs of picky eating. Favoring just a couple of foods or not wanting foods to touch each other on the plate are normal behaviors. These behaviors often go away by the time your child is about 5 years old.

Tips to Help

• Try again: Wait a couple of days before offering the food again. It can take more than 10 times before you toddler might like it.
• Mix it up: Mix new foods with foods you know your child likes.
• Be silly: Make funny faces with the foods on your child’s plate. It might help your child get excited to eat it.
• Me too: Try eating the food first to show your child you like it. Then, let your child try it.
• Choices: Give your child a choice of different foods to try. Let your child decide which one to try today.

 Overeating – Previously, picky eating was discussed, and there is sometimes concern as to whether or not a child is getting enough to eat.  On the other hand, many people have been socialized to eat more calories than needed.  Even people without much money can tend to eat too many calories.  Many “cheap” food items are high in calories even if they are not high in nutrients.  Thus, individuals can be overweight, yet not “well” fed, with a diet lacking in nutrients. This is called “The Paradox of Hunger and Obesity”.  Overeating can also be a result of emotional eating or other habitual eating behaviors that are rooted in mental and emotional health needs.  Obviously, if these eating patterns are to be successfully addressed, then the root of the behavior must be determined and addressed.  For basic, everyday, overconsumption, a strategy that can be beneficial is “Mindful Eating”.

Evidence Based Dietary Recommendations

Keeping it Simple – Whole vs. Processed 

.  The strongest evidence-based recommendations across the board are to:

• choose more plant-based foods, including an abundance of vegetables and fruits and
• eat more whole foods and fewer processed foods.

Whole foods are foods that have not been manipulated with additives and preservatives.  Examples of whole, unprocessed foods would be foods such as: apples, oranges, bananas, carrots, celery, and nuts. Foods are the healthiest in their freshest, most basic form, and are considered whole foods in this form.  On the other hand, processed foods have been manipulated and many times have additives and preservatives and may have had beneficial nutrients removed.  Eating a variety of foods that are “nutrient dense” (contain a significant amount of nutrients) with few or no negative components such as sodium, sugar, saturated fat and Trans fat is recommended.  Making the move to increase whole foods and decrease processed food intake is one basic step that could make a significant difference.

Research-Based Dietary Models

The following models have been selected for inclusion as they are evidence-based and with recommendations that have been studied over long periods of time.  This would be in contrast with “fad diets”, which have not shown safe or effective long term outcomes. See the section on Fad Diets toward the end of the chapter for more information.

Kid’s Healthy Eating Plate – Harvard

The Kid’s Healthy Eating Plate is a visual guide to help educate and encourage children to eat well and keep moving. At a glance, the graphic features examples of best-choice foods to inspire the selection of healthy meals and snacks, and it emphasizes physical activity as part of the equation for staying healthy.

The Kid’s Healthy Eating Plate was created by nutrition experts at the Harvard T.H. Chan School of Public Health, based on the best available science, to enhance the visual guid­ance provided by the U.S. Department of Agriculture’s MyPlate icon. The Kid’s Plate reflects the same important messages as the Healthy Eating Plate, with a primary focus on diet quality, but is designed to further facilitate the teaching of healthy eating behaviors to children.

 

Building a Healthy and Balanced Diet

Eating a variety of foods keeps our meals interesting and flavorful. It’s also the key to a healthy and balanced diet because each food has a unique mix of nutrients—both mac­ronutrients (carbohydrate, protein, and fat) and micronutrients (vitamins and minerals). The Kid’s Healthy Eating Plate provides a blueprint to help us make the best eating choices.

Along with filling half of our plate with colorful vegetables and fruits (and choosing them as snacks), split the other half between whole grains and healthy protein:

• • The more veggies – and the greater the variety – the better.
  • Potatoes and French fries don’t count as vegetables because of their negative impact on blood sugar.

 

• • Eat plenty of fruits of all colors.
  • Choose whole fruits or sliced fruits (rather than fruit juices; limit fruit juice to one small glass per day).

 

• • Go for whole grains or foods made with minimally processed whole grains. The less processed the grains, the better.
  • Whole grains—whole wheat, brown rice, quinoa, and foods made with them, such as whole-grain pasta and 100% whole-wheat bread—have a gentler effect on blood sugar and insulin than white rice, bread, pizza crust, pasta, and other refined grains.

 

• • Choose beans and peas, nuts, seeds, and other plant-based healthy protein options, as well as fish, eggs, and poultry.
  • Limit red meat (beef, pork, lamb) and avoid processed meats (bacon, deli meats, hot dogs, sausages).

It’s also important to remember that fat is a necessary part of our diet, and what matters most is the type of fat we eat. We should regularly choose foods with healthy unsaturated fats (such as fish, nuts, seeds, and healthy oils from plants), limit foods high in saturated fat (especially red meat), and avoid unhealthy Trans fats (from partially hydrogenated oils):

• • Use healthy oils from plants like extra virgin olive, canola, corn, sunflower, and peanut oil in cooking, on salads and vegetables, and at the table.
  • Limit butter to occasional use.

 

Dairy foods are needed in smaller amounts than other foods on our plate:

• • Choose unflavored milk, plain yogurt, small amounts of cheese, and other unsweetened dairy foods.
  • Milk and other dairy products are a convenient source of calcium and vitamin D, but the optimal intake of dairy products has yet to be determined and the research is still developing. For children consuming little or no milk, ask a doctor about possible calcium and vitamin D supplementation.

Water should be the drink of choice with every meal and snack, as well as when we are active:

Water is the best choice for quenching our thirst. It’s also sugar-free, and as easy to find as the nearest tap.

• • Limit juice—which can have as much sugar as soda—to one small glass per day, and avoid sugary drinks like sodas, fruit drinks, and sports drinks, which provide a lot of calories and virtually no other nutrients. Over time, drinking sugary drinks can lead to weight gain and increase the risk of type 2 diabetes, heart disease, and other problems.

Finally, just like choosing the right foods, incorporating physical activity into our day by staying active is part of the recipe for keeping healthy:

Trade inactive “sit-time” for “fit-time.”

• • Children and adolescents should aim for at least one hour of physical activity per day, and they don’t need fancy equipment or a gym—The Physical Activity Guidelines for Americans suggest choosing unstructured activities for children such as playing tug-of-war, or having fun using playground equipment.

Overall, the main message is to focus on diet quality.

• The type of carbohydrate in the diet is more important than the amount of carbohydrate in the diet, because some sources of carbohydrate—like vegetables (other than potatoes), fruits, whole grains, and beans—are much healthier than sugar,  potatoes, and foods made from white flour.
• The Kid’s Healthy Eating Plate does not include sugary drinks, sweets, and other junk foods. These are not everyday foods and should be eaten only rarely, if ever.
• The Kid’s Healthy Eating Plate encourages the use of healthy oils in place of other types of fat.

The USDA’s Choose My Plate

Healthy eating in childhood and adolescence is important for proper growth and development and to prevent various health conditions. The Dietary Guidelines for Americans recommend that people aged 2 years or older follow a healthy eating pattern that includes the following

• A variety of fruits and vegetables
• Whole grains
• Fat-free and low-fat dairy products
• A variety of protein foods
• Oils

These guidelines also recommend that individuals limit calories from solid fats (major sources of saturated and Trans fatty acids) and added sugars, and reduce sodium intake. Unfortunately, most children and adolescents do not follow the recommendations set forth in the Dietary Guidelines for Americans.

The Mediterranean Diet, inspired by the diets of Greece, Southern Italy, coastal Croatia and Spain, consists of

• relatively high consumption of legumes, unrefined cereals, fruits, vegetables, and olive oil,
• moderate to high consumption of fish,
• moderate consumption of dairy products (mostly as cheese and yogurt),
• moderate wine consumption, and
• low consumption of meat and meat products

 

Vegetarian Diet

There is increasing evidence that vegetarian diets offer health advantages. Well-balanced vegetarian diets can be healthful for all stages life. Vegetarian diets focus on plant-based eating and do not include meat, poultry, fish or seafood. In numerous cases, vegetarian diets are beneficial in the prevention and treatment of certain diseases, such as cardiovascular disease, hypertension, diabetes, cancer, osteoporosis, renal disease, dementia, diverticular disease, gallstones and rheumatoid arthritis. Individuals may choose a vegetarian diet for health reasons or do it for economic, environmental and social concerns.

There is no single type of vegetarian diet. Instead, vegetarian eating patterns usually fall into the following groups:

• The vegan diet, which excludes all meat and animal products
• The lacto vegetarian diet, which includes plant foods plus dairy products
• The lacto-ovo vegetarian diet, which includes both dairy products and eggs

People who follow vegetarian diets can get all the nutrients they need. However, they must be careful to eat a wide variety of foods to meet their nutritional needs. Nutrients vegetarians may need to focus on include protein, iron, calcium, zinc and vitamin B12.

“It is the position of the American Dietetic Association that 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. A vegetarian diet is defined as one that does not include meat (including fowl) or seafood, or products containing those foods”