Reducing childhood obesity during the COVID-19 pandemic

We know that all parents want to keep their children healthy and safe. Although COVID-19 affects different people in different ways, research has shown that obesity puts children – and adults – at increased risk of severe illness.

According to 2016 data from the Let’s Get Healthy California task force, 20.2% of children age 0-5 were overweight for their age, 12.9% of children age 6-11 were overweight, and 40.7% of adolescents age 12 to 17 were overweight or obese.

Following your doctor’s advice on nutrition and physical activity can help protect you from severe illness associated with COVID-19 – in addition to physical distancing, washing your hands frequently and wearing a facial covering.

Here are some healthy eating and exercise tips for your family. If you have questions about your family’s health, call your doctor.

Healthy eating tips

Limit the amount of added sugar your child eats or drinks.

  • The American Heart Association recommends that children ages 2 to 18 should have less than 25 grams of added sugar per day, and drink less than one 8-ounce sugary drink per week.
  • 25 grams of sugar equals 6 teaspoons, or about 100 calories. The average American child consumes 19 teaspoons of added sugar daily, or more than 300 extra calories.
  • Here’s tips from a CHOC registered dietitian on limiting added sugar in your family’s diet.

Eat Well on a Budget

Eating healthy does not have to be expensive. A CHOC registered dietitian offers these tips for parents who want to follow a balanced diet and stay on budget:

  • Plan before you shop. Compare prices and read grocery flyers to determine what’s on sale. Create a menu for your family for a week at a time, building on foods you already have at home
  • Eat before you shop. Going shopping hungry can lead to spontaneous and unhealthy purchases.
  • Prepare double or triple batches of meals you can freeze and eat later on days you will be too busy to cook a healthy meal.
  • Here’s more tips on eating healthy on a budget.

Tips for Picky Eaters

Is your toddler a picky eater? Dr. Eric Ball, a CHOC pediatrician, offers these tips:

  • Don’t let toddlers decide what food they are served. Parents control the quality of food offered to children. Toddlers control the quantity that they eat.
  • It’s normal for toddlers to have meals – or even days – when they eat little.
  • Mealtime will be more successful if you avoid letting your toddler fill up on liquid calories or snacks. At snack time, give your toddler two acceptable options.
  • Here’s more tips from Dr. Ball on how to deal with a toddler who is a picky eater.

Meal Prep Tips for Busy Parents

When life gets busy, planning and making homemade meals can easily fall to the bottom of your to do list. These healthy meal prep tips for busy parents, from a CHOC registered dietitian, can help.

  • The USDA’s Choose MyPlate program is a great place for recipe ideas. It also offers tips for meeting your nutritional goals. Find tips to incorporate each food group into your diet, and what foods to limit, such as salt and saturated fat.
  • The website also offers the MyPlate Plan – parents can enter the gender, weight, height and activity for their children and get specific energy needs. Then, you can choose the calorie level and servings and suggestions for each food group to meet your child’s calorie needs. Here’s an example MyPlate Plan.
  • Learn more about the healthy eating benefits of the Choose MyPlate program.

Get kids involved in the kitchen

  • Preparing meals together can help children develop healthy eating habits. Talk about the ingredients, and how they smell, taste, look and feel. Be creative when offering new foods. You can make bugs with fruit kabobs or faces with vegetables on homemade pizza.
  • Children learn by example. If they see parents and siblings preparing and trying healthy food, they are more likely to accept a new food.
  • Make mealtimes family time. Children who eat meals with their families at home have higher quality diets and higher intake of fruits and vegetables.
  • Here’s more tips on developing healthy eating habits in kids.

Drink enough water

How much water should children drink every day? We recommend they drink the number of 8-ounce glasses equal to their age, with a maximum of eight glasses for children age 9 and older. For example, a 3-year-old should drink three 8-ounce glasses of water per day. Here’s a helpful chart to keep track of this advice.

Promote physical activity

Daily exercise helps keeps kids fit. Try to get at least one hour every day. This doesn’t need to be all at once. It can be short bursts of activity for 15 minutes at a time.

Be active with your children. They are more likely to stay active when they are having fun with their parents. Tap into activities or sports they’re already interested in, that you can do while respecting physical distancing, such as waking the dog, playing catch, soccer, riding a bike, or setting up an obstacle course in your backyard.

Limit screen time

Screen time is considered watching TV, playing video games or using a computer, tablet or smartphone. The American Academy of Pediatrics offers these screen time recommendations for kids:

  • 18 months or younger – no screen time is best. An exception is live video c hat with family and friends.
  • 18 months to 2 years – limit screen time and avoid solo use. Choose high-quality education programming and watch along with your kids to ensure they understand what they’re watching.
  • 2 to 5 years – limit screen time to an hour per day. Parents should watch with their kids to make sure kids understand what they’re watching and can apply it to their world.
  • Age 6 and older – parents should place consistent limits on screen time. Don’t let screen time affect sleep, exercise or behavior.

Call your doctor

If you have questions about your child’s weight, speak to your doctor. Doctors use body-mass index charts, based on age and gender, to determine a range of healthy weight for kids.

Food allergies in children: What parents need to know

An increasing number of children are being diagnosed with food allergies. Today, an estimated 10% of children have some sort of food allergy. This translates to one in 13 children, or roughly two kids in every classroom, with a food allergy. Around 40% of children with a diagnosed food allergy are allergic to more than one food.

The most common food allergies for kids include milk, eggs, peanuts, tree nuts, fish, shellfish, wheat, soy and sesame.

When someone has an allergic reaction to food, their body reacts as if that food product was harmful. The body’s immune system, which exists to fight infection and disease, creates antibodies to fight the food allergen. Every time the person eats—or in some cases touches or breathes in—the food, the body releases chemicals like histamine. This triggers allergic symptoms that can affect the respiratory system, gastrointestinal tract, skin, or cardiovascular system. In severe cases this can cause a life-threatening allergic reaction call anaphylaxis. Your doctor will commonly provide an epinephrine injector and advise strict avoidance of these foods.

Read on for advice from pediatric allergist Dr. Warner Carr, on what parents should know about food allergies in children.

Food allergy symptoms

The most common food allergies symptoms that parent should look for in children include:

  • Wheezing
  • Trouble breathing
  • Coughing
  • Hoarseness
  • Throat tightness
  • Belly pain
  • Vomiting
  • Diarrhea
  • Itchy, watery, or swollen eyes
  • Hives
  • Red spots
  • Swelling
  • Lightheadedness or loss of consciousness (passing out)

Food allergy risk factors

Some factors put kids, especially boys, at higher risk for food allergies, including:

  • Vitamin D insufficiency
  • Asian and black race
  • Allergic disease such as eczema and asthma
  • Low consumption of antioxidants and omega-3 fatty acids
  • Increased antacid use
  • Increased exposure to antimicrobial personal care products such as toothpaste and hand sanitizers.

Peanut allergy in children

Less than two percent of children in the U.S. have a peanut allergy. The New England Journal of Medicine published a study in 2016 indicating that feeding peanuts and other allergy-inducing foods to babies is more likely to protect them than to cause problems.

Feeding peanuts to a young child doesn’t guarantee they won’t develop a peanut allergy, but it does decrease the risk. There is a seven-fold increase in the risk of developing peanut allergy if a parent or sibling has peanut allergy, says Carr. There is a 64% risk that a child will develop peanut allergy if his or her twin sibling also has a peanut allergy, he adds.

Food allergy testing

To diagnose food allergies, your child should undergo food allergy testing. Skin and blood tests are commonly done to check for allergies. In these cases, your child’s doctor may prick the skin on their back or arm and expose them to a small amount of the potential allergen. If the skin swells or becomes itchy, that could be a sign of an allergy.

However, parents should be mindful that false positives are common among skin or blood tests for food allergies.

“Many people with positive skin tests to food are not allergic to those foods,” says Carr.

Your child’s doctor will likely evaluate their clinical history and any skin or blood tests before recommending an oral-grade food test. In this case, they will refer you to an allergist who specializes in the treatment of asthma and allergies.

Oral-grade food tests carry the risk of severe allergic reactions and should only be performed by a specially-trained allergist in a clinical setting, Carr says.

During the food test, the allergist will feed your child small but increasing amounts of the suspected food, and closely watch their reaction. If symptoms occur, they will be given medication for relief. If the test confirms a food allergy, they will discuss specific ways you can avoid the food and prescribe any necessary medications.

Can children outgrow food allergies?

It is possible, and somewhat common, for children to outgrow their food allergies at some point.

  • Peanut allergy: Resolves in 20% of cases by age 5, and 16-30% by adulthoods
  • Cow’s milk allergy: Resolves in 42% of children by age 8, in 64% of cases by age 12, and 79% by age 16
  • Soy allergy: Resolves in 45% of cases by age 6, and 69% by age 10
  • Egg allergy: Resolves in 12% of cases by age 6, in 37% of cases by age 10, and 68% by age 16

Fatal food allergies

Every three minutes, an allergic reaction to food sends someone to the emergency department.

Approximately 150 people die per year from food allergies, according to the Food Allergy & Anaphylaxis Network. Several risk factors increase the likelihood of fatality when someone comes into contact with a food they are strongly allergic to:

Delayed epinephrine—Once anaphylaxis, a potentially life-threatening allergic reaction, begins, the drug epinephrine is the only effective treatment. Sometimes anaphylaxis starts as a mild warner-carr-mdreaction and quickly worsens, Carr says. Signs of anaphylaxis can include trouble breathing, throat closing, wheezing or coughing, nausea or abdominal pain, vomiting, racing heartbeat or pulse, and skin itching or swelling. Do not wait until a child has trouble breathing to administer an Epi-pen. If you notice a systemic reaction—inflammation spreading to multiple areas of the body– administer an Epi-pen and seek emergency medical attention. If a child takes beta-blockers for high blood pressure or other health conditions, a doctor needs to reverse that medication before epinephrine may be effective.

Underlying asthma— Children with asthma are more likely to die from food allergies than children without asthma, Carr says. “Accidental exposure means these kids with preexisting conditions are fighting more than one battle,” he says. “They are more likely to have a severe, adverse effect.”

Previous severe reaction—Carr says, “Previous reactions to a food allergy don’t predict the severity of the next reaction unless past reactions have been life-threatening, which will continue.”

Treatment for food allergies:

Historically, the only management of food allergies was to avoid the food and carry an epinephrine injector. However, more treatments are available today, including oral immunotherapy (OIT), which was recently proved effective in a study published in the New England Journal of Medicine

In OIT, the child is fed an increasing amount of the allergy-inducing food (like peanuts, tree nuts, milk or eggs), with the goal being to increase the amount of that allergen that triggers a reaction, Carr says. By decreasing your child’s sensitivity to allergy-causing foods through OIT, any accidental exposure they have to the allergen will produce fewer and less severe symptoms. , While OIT has been linked to long-term remission of food allergies, there is no guarantee of a cure. Not all children are candidates for OIT. To qualify for OIT, a child must have a documented allergy to a certain food. This can be confirmed with a positive skin test or a positive blood test. Your child’s allergist may recommend OIT take place over several months in order to achieve the maintenance dose, or a level ingested that doesn’t trigger an allergic reaction

There are inherent risks with OIT, since the child is being exposed to their allergy-inducing food. OIT should only be performed by a pediatric allergist in a clinical setting.

The standard of care for food allergies remains avoiding the triggering food and carrying an epinephrine auto-injector in the event of an accidental exposure.

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Tips for Healthy Grocery Shopping

By Alyce Watanabe, Dietetic Technician, Registered at CHOC 

Preparing a healthy meal can be next to impossible if you don’t have the right ingredients in your kitchen. Going to the grocery can feel like a burden if you are not prepared. However, with a little preparation, shopping for healthy foods can be a breeze and save you money in the long run.

Do some prep work before you get to the store to keep from having to go back for forgotten items and to help you focus on finding nutritious foods.

  1. Clip money-saving coupons from weekly ads or use coupon apps on your smartphone.
  2. Create your menu for the week and grocery list before going to the store. Stick to your list.
  3. Shop the store perimeter first. That is generally where fresh foods, such as fruits and vegetables, meat and fish, and dairy, are located. Processed foods that often contain added salt, sugar and fat are usually found in the center aisles.

Minimize distractions to make healthy choices.

  1. Try to avoid peak hours when stores are busy. Crowds and stress often cause people to make quick choices instead of taking the time to find the healthiest option.
  2. Avoid shopping when you are hungry. A growling stomach can make it tough to resist some of those tempting treats!
  3. Consider leaving young children at home if possible. A tired or hungry child may make it challenging to take the time to read labels. Often, less-healthy items with packaging that appeals to children are kept on shelves at their eye level, making it easy for them to grab and toss in your cart.

Take time to read labels. A quick glance can help you decide between similar items.

  1. Look for whole foods as much as possible. Choose whole fruit over juices to provide fiber and help you feel full for longer.
  2. Consider canned or frozen fruits and vegetables. They last longer than fresh items and because they are picked and canned or frozen at peak ripeness, they may contain more nutrients. Watch the sodium content of canned vegetables.
  3. Foods with fewer additives, in their more natural state, tend to be healthier. Many people look for foods with a maximum of five ingredients.
  4. Watch the portion size on the package. Sometimes foods are listed as two or more servings even when you would probably eat the entire package in one sitting.

Aim for variety and try something new! 

  1. Make trying new foods fun for your family by selecting a new or unfamiliar fruit or vegetable each week. Search online to learn about the food and find recipes.
  2. Substitute something for your usual routine. Consider using sweet potatoes instead of white potatoes for a new flavor and for extra fiber and vitamin A.
  3. Familiarize yourself with the USDA MyPlate guidelines to make sure you are getting foods from all food groups. While you are planning meals and shopping, think about the foods that will be on your plate.

The MyPlate model shows a great visual way to balance our food groups.

Some hints for a healthier table:

  • Balance Calories
  • Enjoy your food but watch portion sizes.
  • Foods to Increase
  • Make half your plate fruits and vegetables.
  • Choose 100 percent whole grains whenever possible.
  • Children under age 2 should receive whole milk because they need the fat for brain growth and development. However, children over age 2 and adults can switch to fat-free or low-fat milk.
  • Choose lean sources of protein such as lean meats, chicken, fish and beans.
  • Foods to Reduce
  • Compare labels for processed foods such as canned soups and frozen meals. Choose those with lower amounts of sodium (salt).
  • Drink water instead of sugary drinks.

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Answers to Parents’ Most Common Questions on Healthy Eating for Kids

By Vanessa Chrisman, clinical dietitian at CHOC

Healthy eating for kids is an essential part of their overall healthy lives. For children, it’s especially important because their growth and development depends on it. Parents play a large role in providing a healthy diet for their children, as well as establishing lifelong habits when it comes to food. In today’s world of fad diets and conflicting headlines about nutrition and health, it can be confusing for parents to navigate how to feed their children appropriately. Here are some of the most common nutrition questions I get from the parents of my patients.

My child wants to eat the same food every single day. Is this okay? How do I handle this?

Typically, toddlers are the ones who go on food jags – wanting to eat the same food at every meal, day in and day out. It often is a show of independence. This can happen with older children too. While it’s okay to eat the same healthy food every day, it’s the parents’ job to choose what foods to offer at meals. As an example, maybe your child wants cereal at every meal. Rather than provide this, offer other healthy foods and tell your child that she can have cereal for breakfast the next day. Your child then gets to choose whether she eats what is offered at that meal. If she doesn’t, don’t worry. Simply be patient and wait until the next snack time to offer more food. When your child becomes hungry, she will most likely eat what is offered.

My child is a picky eater. How can I convince him to eat more fruits and vegetables?

Start by serving a fruit and a vegetable with every meal. Serve the foods that he already accepts and eats. Introduce one new fruit or vegetable at a time. Make new foods more appealing by cutting them into fun shapes and sizes. Vegetables can be spiralized to look like pasta. Fruits can be cut into stars or dinosaurs with cookie cutters. Set a good example by eating fruits and vegetables regularly as a family. As parents, you are powerful role models for your children who are always watching and listening. Let your child help pick out fruits and vegetables in the grocery store as well as wash them at home. Fruits can be added to smoothies and yogurt and cereal. Vegetables can be cooked into spaghetti sauce or added to stir-fried rice or soups. Sometimes children will want to try new fruits and vegetables if you serve them with a favorite dip or sauce. Consistently serve fruits and vegetables at your meals and be patient. Limit grazing between meals to build hunger and avoid preparing a special meal for your picky eater. Eventually your child will come around and try some of these new foods. Praise the behaviors you want to encourage and give less attention to the pickiness or refusal to try new foods.

I don’t think that my toddler eats enough protein. How much is enough?

Many parents worry that their toddler is not getting enough protein in their diet. The truth is that it is quite easy for a toddler to meet his protein needs. Toddlers ages 1 to 3 need 1.2 grams of protein for every kg of body weight. This means that a healthy 2-year-old boy who weighs 27 pounds (or 12 kg) needs about 14-15 grams of protein per day. His protein needs could be met simply by: drinking eight ounces of one percent milk (eight grams protein) and eating two tablespoons of ground turkey or one large egg (seven grams of protein) in a day. If he drinks sixteen ounces of milk, his daily protein intake increases to 23 grams of protein, which is 150 percent of what he needs. Unless a toddler is eating a very restrictive diet, it’s rare for him to consume a diet low in protein.

My child loves to drink juice and soda but barely drinks any water. How can I get her to drink more water?

This is a challenge that many parents face. The first step is to cut back on the amount of juice or soda that is offered and consumed. Ideally, cut out soda and dilute juice with water. Limit juice to eight ounces or less per day. Provide your child with their own special bottle or cup. Consider using a special straw that they can pick out for themselves. Infuse the water by adding sliced lemons, limes, cucumber, berries, or mint to make a “spa water.” Keep water cold in the fridge. Try using frozen berries instead of ice cubes. Be a role model and carry a water bottle around for yourself. Offer stickers as an incentive for every time your young child drinks a cup of water. On a typical day, kids up to age 8 should drink the number of 8 oz. cups of water equal to their age. For example, a five-year-old should drink five 8-oz. glasses of water every day.

My child is underweight so I let her snack all day long. This will help her gain weight faster, right?

While some parents assume that their child will gain more weight if they are eating all day long, this is not often the case. For underweight children, there can be a tendency for parents to offer food to the child all day long, as well as allow them to ask for food whenever they want it. This does not allow for natural hunger or appetite to build. Instead, the child grazes on food throughout the day, often eating enough to tame hunger but not enough to truly feel full. The best approach is to follow a feeding schedule with planned meals and snacks every two to three hours. Only water should be consumed in between eating times. This helps build hunger. To help with weight gain, added fats and high calorie foods can be offered or used with meals. Sometimes an oral supplement is needed as well if the child is unable to consume enough food to fuel healthy weight gain. Speak with your child’s pediatrician and a registered dietitian for more individualized advice.

My child says he isn’t hungry in the morning and refuses to eat breakfast. How do I get him to eat?

This is a common challenge for many parents. Often, their child isn’t hungry or doesn’t have enough time to eat before heading off to school. To minimize the morning rush and make time for a healthy breakfast, prepare the night before. Close the kitchen by 8:00 p.m. to prevent unneeded late-night snacking. Make sure that your child goes to bed on time so that it’s easier for him to wake up in the morning. Have quick, healthy options on hand like low-sugar cereals with low-fat milk, fresh fruit and string cheese, whole grain muffins, or whole grain toast with peanut or almond butter. Consider offering non-breakfast foods as another way of enticing your child to eat. For those who don’t want to eat, sometimes drinking a fruit and yogurt smoothie works instead. For teens who skip breakfast in the hopes of losing weight, let them know that people who skip breakfast tend to gain weight, not lose. If all else fails, send your child with a healthy snack to be eaten at school.

How to Boost Your Child’s Bone Health

Physical activity, calcium and vitamin D are essential for building strong bones, says Dr. Samuel Rosenfeld, orthopaedic surgeon with the CHOC Orthopaedic Institute. Developing good bone health during childhood helps prevent fractures and osteoporosis later in life.

bone health for kids
Dr. Samuel Rosenfeld, an orthopaedic surgeon at CHOC, offers tips on how to boost bone health for kids.

Bone is living tissue in the skeleton that constantly changes. Old bone gets replaced with new. The greatest amount of bone tissue grows during childhood and adolescence as the skeleton expands in size and density. It is during this period of active growth when calcium is essential. In addition to requiring a great deal of calcium, the young body absorbs calcium more effectively. For this reason, children need to “bank” extra calcium for bone health.

Some of the most common sources of calcium are from dairy products, such as milk, yogurt and cheese. Note, however, that calcium in dairy products are bound by fat and not absorbed. For that reason, children should get their dietary calcium from fat-free dairy products taken at least one hour away from meals. Other sources include calcium-fortified soy milk and juices, canned salmon (with bones) and sardines, and dark green, leafy vegetables, such as broccoli and kale.

For calcium to be effective in bone growth and development, it is also important that children get enough vitamin D. This can be done through careful sun exposure and eating vitamin D-rich foods such as fortified milk and milk products, cod liver oil, red meat, eggs, mushrooms and some fatty fish.

Calcium and vitamin-D supplements are also important to consider, to ensure children, especially those with certain chronic conditions, are getting enough bone-boosting nutrients. Parents should consult their child’s physician before giving supplements. In this video, Dr. Rosenfeld explains that building healthy bones actually starts while the child is still in the womb, and continues through childhood.

Bone Health Recommendations by Age

Age 7 and younger

Calcium intake: 250 mg twice daily

Vitamin D3 intake: 250 IUs twice daily

Ages 8-13

Calcium intake: 500 mg twice daily

Vitamin D3 intake: 500 IUs twice daily

Age 14 and older

Calcium intake: 600 mg twice daily

Vitamin D3 intake: 2000 IUs twice daily

In addition to a calcium and vitamin D-rich diet, children should participate in physical activity, advises Dr. Rosenfeld.

“Ideally, exercise should be part of a child’s daily routine. Parents should help their children find activities and sports they enjoy, so they’ll continue to participate in them,” says Dr. Rosenfeld.

Good bone health is not difficult to achieve and maintain, adds Dr. Rosenfeld.

“It doesn’t take fad pills or fancy supplements,” he explains.
“Establishing a routine of taking calcium and vitamin D, along with a little exercise, is the ‘prescription’ for healthy bones.”