Eating Habits of Infants and Children Affect Health and Performance

An increasing amount of research shows that kids who eat well-balanced, nutrient-rich meals and snacks seem to have lower health risks and perform better in school.

It's a topic of great interest to Melissa A. Kalt, MD, Medical College of Wisconsin Assistant Clinical Professor of Internal Medicine/Pediatrics, who worries that some of the infants, toddlers and school-age children she treats may be overfed but undernourished. Recent studies have fueled her concerns. The 2003 Feeding Infants & Toddlers Study concluded that children as young as 7 months were overfed - and poised to join the estimated 64% of Americans considered overweight or obese.

"The results were pretty shocking," she says.

That study of more than 3,000 youngsters found significant numbers of infants and toddlers were downing french fries, pizza, candy and soda - but not getting the foods their bodies need to grow and thrive, she says. Among its findings:

• Up to one-third of children under 2 consumed no fruits or vegetables. Many of those who said they fed a vegetable counted french fries as a vegetable, rather than a starch.
• More than 60% of 12-month-olds had dessert or candy at least once a day, and 16% ate a salty snack. Those numbers rose to 70% and 27% by age 19 months.
• Between 20% and 30% of children 15 months and older had a sugary fruit drink each day, and about 10% had soda.

The study also found that parents were ignoring widely accepted feeding practices by allowing:

• 29% of infants to eat solid food before they were 4 months old.
• 17% to drink juice before 6 months.
• 20% to drink cow's milk before 12 months.

Not only do such diets set kids up for premature health risks such as Type 2 diabetes, high blood pressure and high cholesterol, but growing evidence shows their diets affect how they learn and how they behave in school, Dr. Kalt says.

Good Food Helps Kids Perform
"Nutritious food not only fuels the body and provides energy, some studies have shown that kids thrive on it. They're not only healthier, they're less hyper, better behaved and do better in school," says Dr. Kalt. She was impressed by a 1998 five-year study done at an alternative high school in Appleton, Wisconsin, for disruptive students who had been assigned there because of bad behavior, truancy, and low grades in the city's regular high schools.

Once those students were served healthful breakfasts, lunches and snacks, they were transformed, the study leaders reported.

"I don't have the disruptions in class or the difficulties with student behavior that I experienced before we started the food program," one teacher noted. "If you've been guzzling Mountain Dew and eating chips, and you're flying all over the place, I don't think you're going to pick up a whole lot in class. Now, I don't have to deal with the daily discipline issues; that just isn't an issue here. I don't have the vandalism. I don't have the litter. I don't have the need for high security." The principal and school superintendent had similar high praise for the results.

Several other sources caution, however, that more long-term studies need to be done to prove a correlation between diet and school performance and behavior. Meantime, a number of states - Iowa, New Jersey, California, Florida and Vermont among them - have noticed that kids who are served a nutritious breakfast at school have reported seeing improved test scores, better behavior and greater feelings of satisfaction.

A 2007 cost-benefit analysis by the University of Wisconsin Extension's Family Living Program observed that although "studies have shown feeding children a nutritious breakfast increases their school performance, nutrition intake, and overall health while decreasing obesity, discipline problems, and illnesses," Wisconsin "consistently ranks last nationally in its ability to feed children breakfast at school," with school districts citing cost as the reason.

Changing Kids' Eating Habits
Dr. Kalt acknowledges that once kids are used to favorite snacks and their familiar mealtime foods, it might take some effort to convert them to more healthful diets. She offers some advice:

• Don't use food as a reward or as a punishment.
• When school-age kids are home, don't let them "graze" on food throughout the day.
• At mealtimes, do introduce more healthful foods like fresh fruits and vegetables, but offer them along with a variety of at least two other healthful foods, for example: milk, cheese or yogurt, plus a vegetable or fruit, and a slice of whole-grain bread or a serving of lean meat.
• Don't force kids to eat new foods. It's their choice.
• If kids resist eating all foods offered at a meal, don't offer them alternatives. Make them choose between eating the offered foods or waiting until the next scheduled meal time or snack time, even if it's the last meal of the day. They won't starve to death overnight, Dr. Kalt says.
• Continue to offer previously rejected foods from time to time as part of future meals, with the same conditions and consequences. Tell them: "You may eat as much or as little of these foods as you want, but there are no other choices until breakfast," or whichever meal or snack time is next. Don't let them nibble between meals and snack time.
• Let kids serve themselves the portions they want. Do not serve them and then expect them to "clean their plate."
• Keep emotion out of the situation. Avoid a power struggle and let them live by their choices of the foods you offer. But don't give in, or you'll lose that battle.
• Do not make special meals for picky eaters.

"Above all," Dr. Kalt says, "make kids aware that food is fuel that makes your body grow and perform. It's critical to their long-term health. And establish regular times for meals and snacks."

Dr. Melissa Kalt sees patients at the new Froedtert & Medical College Clinic at the Springdale Health Center, located in the Gateway Business Park, 21700 Intertech Drive in Brookfield. She is one of 10 physicians representing specialties in internal medicine, pediatrics, and obstetrics and gynecology.

Barbara Abel
HealthLink Contributing Writer

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.