Getting the right balance of nutrients is challenging because children’s nutritional needs will change as they grow – along with their food preferences, eating habits and activity levels. A child’s nutritional needs will vary based on age, size and metabolism, existing health conditions and other factors.

Newborn infants receive all of their nutritional requirements either through breastfeeding or formula. The age at which a child is ready for “solid” food varies. Good nutrition for children over age 2 is essentially the same as for adults, with the exception of the amount of calories required. Like adults, children need the right assortment of nutrients, vitamins (e.g., vitamin C) and minerals (e.g., calcium, iron) to grow, develop and function. Nutrients include the following:

• Carbohydrates. The primary source of calories for the human body. Nutritional experts generally recommend that between 50 and 60 percent of an individual’s total daily calories come from carbohydrates, primarily complex carbohydrates.
  
  
• Protein. Found in meat, poultry, fish, beans, nuts, eggs and dairy products. Protein is crucial to building and repairing most body tissues (e.g., muscles, skin, organs) as well as the immune system. It is generally recommended that about 10 to 20 percent of an individual’s daily calories come from protein.
  
  
• Fats. Also called lipids, the proper amount of fat is vital to good health. Fat is part of all cell membranes and makes up the sheathing around nerves, which is important to efficient nerve conduction. It is recommended that no more than 35 percent of the daily calories in the diet of a child over age 2, adolescent or adult come from fat.
  
  
• Fiber. A filling nutrient that helps move food through the digestive tract and prevents constipation. Whole grains, fruits and vegetables are good sources of fiber.

The American Academy of Pediatrics (AAP) recommends that parents and other caregivers use the MyPyramid’s nutritional guidelines as a reference to ensure that children are getting all the nutrients, vitamins and minerals they need. MyPyramid was developed by the U.S. Department of Agriculture (USDA) as a dietary guideline for children, adolescents and adults. It is composed of six different-colored steps, each representing a specific food groups: grains, vegetables, fruits, dairy, protein sources (e.g., meat, fish, beans, nuts), and fats and oils. MyPyramid also encourages regular physical activity as an essential part of any healthy dietary regimen.

A combination of good nutrition and exercise helps keep the body healthy and fit. Poor nutrition and lack of exercise can lead to numerous health problems, including obesity, malnutrition, and iron deficiency anemia.

New parents and caregivers ask a pediatrician about nutrition in the first few years of a child’s life more than any other care-related question. Getting the right balance of nutrients is challenging because children’s nutritional needs will change as they grow – along with their food preferences, eating habits and activity levels. A child’s nutritional needs will vary based on age, size and metabolism, existing health conditions and other factors. It is important to discuss any questions or concerns about a child’s nutritional needs with a pediatrician.

Newborn infants receive all of their nutritional requirements either through breastfeeding or formula. By eating a healthy diet, a mother who breastfeeds can help to ensure her child receives proper nutrition.

Good nutrition for children older than 2 years old is essentially the same as for adults, with the exception of the amount of calories required. Good nutrition is the right balance of nutrients, which contain different amounts of calories. For instance:

• A gram of carbohydrate provides 4 calories
• A gram of protein provides 4 calories
• A gram of fat provides 9 calories

Fats, proteins and carbohydrates are broken down into smaller molecules that are then carried through the bloodstream to all the cells in the body. For example, carbohydrates are broken down into glucose, which is used by all cells and organs. Protein is broken down into amino acids, which are needed for the continuous process of muscle and tissue growth and repair, as well as for making enzymes, hormones, antibodies and more.

Obesity and poor nutrition in children have been growing concerns among health professionals in the United States for several years. About 13 percent of children between the ages of 6 and 11, and 14 percent of children aged 12 to 19, are overweight, according to the U.S. Department of Health and Human Services. These figures have tripled over the past two decades. Teenagers who are overweight have a much greater likelihood of remaining overweight or obese in adulthood.

Long-term, poor eating habits are hard to break. By encouraging good nutrition and food choices from the beginning, a child has a better chance of avoiding obesity, cardiovascular diseases and type 2 diabetes, all of which are rising among children.

Like adults, children need the right assortment of nutrients, vitamins and minerals to grow, develop and function. Nutrients include the following:

• Carbohydrates. The primary source of calories for the human body. Nutritional experts generally recommend that between 50 and 60 percent of an individual’s total daily calories come from carbohydrates, primarily complex carbohydrates. There are two different types of carbohydrates:
  
  
• • Complex carbohydrates. These starches are found in whole grain cereals and breads, rice, potatoes, pastas, fruit and vegetables. They require more time than simple carbohydrates to process and use, so they do not build up as quickly.
    
    
  • Simple carbohydrates. Also called simple sugars, these are found in large amounts in some fruits, as well as in snack foods, candy and soda. An apple is an example of a nutritious food that contains simple carbohydrates. The carbohydrates in soda, however, provide empty calories. High sugar foods that replace whole foods (such as drinking soft drinks in place of milk) can lead to nutritional deficiencies, especially in children who have higher nutritional needs for these nutrients.
    
    
• Protein. Found in meat, poultry, fish, beans, nuts, eggs and dairy products, protein is composed of amino acids. They are crucial to building and repairing most body tissues (e.g., muscles, skin, organs). It is generally recommended that about 10 to 20 percent of an individual’s daily calories come from protein.
  
  
• Fats. Also called lipids, the proper amount of fat is vital to good health. Fat is part of all cell membranes and makes up the sheathing around nerves, which is important to efficient nerve conduction. In addition, fat absorbs and carries vitamins A, D, E and K, and affects cholesterol levels. It is recommended that no more than 35 percent of the daily dietary calories of an older child, adolescent or adult come from fat. Infants and younger children (under the age of 2 years) require additional fat intake for the production and development of brain and other nerve cells. Parents and caregivers should be aware of the types of fats that affect a child’s health:
  
  
• • Saturated fats. These fats are solid at room temperature. They come from animal products, such as butter, cheese, whole milk, ice cream and meat. Too much saturated fat can lead to high cholesterol and heart disease.
    
    
  • Unsaturated fats. These fats are liquid at room temperature. They come from vegetable oils, nuts and fish. Unsaturated fat does not raise cholesterol levels in the blood and may reduce them. Unsaturated fat can be monounsaturated or polyunsaturated (found in canola, flaxseed, peanut and olive oils). Omega 3 fatty acids are a type of polyunsaturated fat that research has found to be especially important to childhood development. The most common source for omega 3 (fish oil) also carries a risk of mercury toxicity, but it can be found in oils (such as canola and flaxseed oil) as well.
    
    
  • Trans fats. These fats are created from unsaturated fats that have been processed (hydrogenated) to make them solid at room temperature, such as in stick margarine. They may also be found naturally in similar products as saturated fats. Excess consumption of trans fats can lead to high cholesterol and heart disease.
    
    
• Fiber. A filling nutrient that helps move food through the digestive tract and prevents constipation. It may also reduce LDL cholesterol (bad cholesterol) levels in the blood and reduce the risk of diabetes and heart disease. Grains, fruits, vegetables and cereals are good sources of fiber.

Vitamins are also essential to good nutrition. Important vitamins include vitamin A, C and D. Vitamin A is important to eyesight and skin health and can be found in orange vegetables (e.g., carrots, squash) and dark green, leafy vegetables. Vitamin C, found in many fruits and some vegetables, is important for healthy teeth and gums as well as helping the body to heal wounds and fight infections. Vitamin D helps the body absorb calcium. Most vitamin D is provided by skin exposure to natural sunlight, but many dairy products are now enriched with it, as well.

Calcium is important for building healthy bones and teeth. Insufficient amounts of calcium can cause rickets (a skeletal disease), low bone density and an increased risk of fractures. Calcium is found in milk and other dairy products (e.g., yogurt, cheese). Lactose-free and low-lactose varieties of many of these products are available for children with lactose intolerance. Many other foods (e.g., orange juice, cereals) are also fortified with calcium.

The MyPyramid food guide was developed by the U.S. Department of Agriculture (USDA) as a dietary guideline for children, adolescents and adults. This interactive tool is composed of six different-colored steps, each representing a specific food group. The steps are used to emphasize the importance of exercise, which goes hand in hand with nutrition for good overall health. The suggested amounts of each food group are merely guidelines. On some days, a child may have more or less of a recommended food group. What is important is that the long-term (e.g., weekly) intake averages out.

Suggested Daily Intake By Age & Gender

The six food groups represented in the pyramid include:

• Grains. These include breads, cereals, rice, pasta and similar foods. Whole grains are high in complex carbohydrates and other important nutrients. No more than half of the grains consumed each day should come from refined grains (e.g., white bread, white rice). Refined grains have been processed and many nutrients, including the fiber, have been removed. Whole grains (e.g., oatmeal, brown rice, rye bread) are much more nutritious. MyPyramid measures grains by ounce. One slice of bread or half a cup of cooked rice, pasta or oatmeal equals 1 ounce.
  
  
• Vegetables. A variety of vegetables in the diet provide numerous vitamins and minerals. Vegetables are also an excellent source of fiber. They should be scrubbed before cooking or eating to remove dirt, pesticides or other contaminants. Vegetables are best eaten raw, steamed or microwaved.
  
  
• Fruits. These are a superb source of vitamins, especially vitamin A and vitamin C, as well as potassium, carbohydrates and fiber. Fruits are best eaten raw. They should be scrubbed before cooking or eating to remove dirt, pesticides or other contaminants. For fruit juice to replace whole fruits, it must be 100 percent fruit juice. No more than half of the daily amount of fruit consumed should come in the form of fruit juice. Fruit juice does not provide the fiber found in whole fruits.
  
  
• Dairy. Includes milk and milk products (e.g., yogurt, cheese). These foods provide plenty of calcium, protein and vitamins, particularly vitamins A and D.
  
  
• Meats, fish, beans and nuts. These are the primary sources of protein. They also provide iron and vitamins. MyPyramid measures protein sources by the ounce. One egg, 1 tablespoon of peanut butter, ½ ounce of nuts or seeds, or 1.4 cups of cooked dry beans equals about 1 ounce.
  
  
• Fats and oils. These essential nutrients must be consumed in moderation. However, they are very important for infants and young children, and should not be restricted until the age of 2 years. Although sugar is neither a fat nor an oil, it is often included with these two because dietary intake of refined sugar also needs to be limited.

Infants will grow more in their first year of life than at any other time. Although breast milk and/or formula will provide all the nutrition they need to grow, infants will eventually begin eating other types of foods. The age at which a child is ready for “solid” food varies. The American Academy of Pediatrics (AAP) recommends starting to introduce supplemental foods between the ages of 4 months and 6 months. The first foods to be introduced are semi-solid and often include ground rice or oat cereal mixed with a little breast milk or formula. Sometime around 7 months, an infant might begin eating strained or mashed foods.

The speed in which food should be introduced varies greatly; some children take to new textures and tastes readily whereas others (especially premature infants) may not be as receptive. The AAP recommends not forcing or rushing an unwilling infant to try new foods. Foods should be introduced one at a time to help detect allergies and intolerances (which are most likely to occur within the first year of life), and avoid overwhelming an infant with new textures. New foods may need to be introduced many times (e.g., 10 or more times) before they are accepted.

Between the ages of 6 months and 8 months, caregivers may want to introduce fruits, other types of cereals (such as Cheerios) and vegetables. Between the ages of 9 months and 12 months, soft foods such as pasta, yogurt, cheese and beans may be introduced. After one year, whole cow’s milk can be given. After age 2, low-fat milk is recommended.

According to the AAP, the recommended minimum daily intake for a child between 12 months and 18 months should resemble the following:

• 16 to 24 ounces of whole milk
  
  
• 4 to 8 tablespoons of fruits and vegetables
  
  
• 4 servings of bread and cereals (1 serving equals ¼ slice of bread or 2 tablespoons of rice)
  
  
• 2 servings (½ ounce) of meat, poultry, fish, eggs

After the first year, it is normal to see a sharp drop in a child’s appetite as their rapid rate of growth slows. The calorie intake of a toddler will vary widely, depending on the child’s activity level and body type. In general, each inch requires roughly 40 calories every day for children between ages 1 and 3 years, according to the AAP. This means a 32-inch child would need to eat 1,300 calories a day.

Although this means that different toddlers have different caloric needs, the AAP recommends that a child aged 1 to 3 years consume a diet that is similar to the following:

• 6 servings of grains (1 serving equals ¼ to ½ slice of bread, 4 tablespoons of cooked rice, cereal or pasta, ¼ cup of dry cereal, or 1 to 2 crackers)
  
  
• 2 to 3 servings of vegetables (1 serving equals 1 tablespoon of cooked vegetables for each year of the child’s age)
  
  
• 2 to 3 servings of fruits (1 serving equals ¼ cup of cooked or canned fruit, ½ piece of fresh fruit, or 2 to 4 ounces of juice)
  
  
• 2 to 3 servings of dairy (1 serving equals ½ cup of milk, 1/3 cup of yogurt, or 1-inch cube of cheese)
  
  
• 2 servings of protein (1 serving equals 1 ounce of meat, ½ egg, 2 tablespoons of soaked and cooked beans, peas or legumes, or 1 tablespoon of smooth peanut butter spread thin on bread, toast or a cracker)

Fruit juice is a good source of many vitamins and minerals. However, it is also an ample source of sugar and calories. All of the same vitamins and minerals as well as additional nutrients can be obtained from eating whole fruits. The Food and Drug Administration (FDA) requires that products labeled as “fruit juice” contain 100 percent juice. Products with less than 100 percent juice may be referred to as fruit drinks, beverages or cocktails. It is generally recommended that children and adolescents consume no more than half of their suggested fruit intake in the form of fruit juice (and not fruit drinks).

Although mealtimes can become a frustrating test of wills, it is normal for a child’s appetite to decrease. The AAP suggests avoiding cajoling, begging, bribing or threatening to get a child to eat more. If a child continually refuses to eat, the AAP recommends offering only the foods that have been put on the table rather than cooking an entirely new meal to a child’s liking. If the child refuses to eat all foods, calmly end the meal. Although parents often worry a child is not eating enough, healthy children will not starve as long as nutritious food is available.

Children benefit from predictable routines. It is best to have each meal and snack at the same time every day. For young children, small, frequent feedings (three meals and two to three snacks) are best. Portions should remain small.

On average, school-age children grow a little more than 2 inches (5 centimeters) and put on about 6 ½ pounds (3 kilograms) per year. However, individual children may grow much more or less. At this age, children may be introduced to numerous challenges to good nutrition. Commercials and other advertisements can persuade children to become interested in snacks and foods that are often high in fats and sugars. Highly advertised foods are also purposefully placed at a child’s level in supermarkets. Educating children on health and nutrition can help them choose healthy foods instead of highly advertised foods.

At this age, children may also become more aware of what their peers are eating. Children may feel deprived if certain foods (e.g., chocolate, candy) are banned to them, particularly if the foods are not banned to their friends. Instead of banning a particular food entirely, the American Academy of Pediatrics (AAP) recommends that it is offered only occasionally, such as during special occasions (e.g., birthdays, a weekly “treat day”).

Older children often continue to display many behaviors seen in the toddler years, such as refusal to eat or refusal to eat a certain food. Similarly, the same guidelines, such as not forcing the matter or offering bribes, remain. Healthy children will not starve as long as nutritious food is available.

The AAP recommends that parents and other caregivers use MyPyramid as a reference to ensure that children are getting all the nutrients, vitamins and minerals they need. In general, the AAP recommends that half of a child’s daily calories come from carbohydrates. According to the AAP, children typically can and should receive all the nutrients they require through their diet. Vitamin supplements are not generally necessary. As a general guideline, boys between the ages of 4 and 18 and girls aged 4 to 8 need about 25 grams of fiber daily, and girls aged 9 to 18 need between 31 and 38 grams of fiber every day.

The AAP stresses the importance of breakfast. Research suggests that skipping breakfast can affect children’s intellectual performance. If scheduling problems make it difficult to have breakfast at home, many children can eat breakfast at school. It is important to note that not all school meal programs meet standard nutrient requirements. However, school meal programs must serve a balanced diet that includes a selection of fruits, vegetables and grains, if they receive federal assistance funds. The amounts and types of fats in foods are also restricted.

Many schools also offer a much wider selection of non-regulated food choices. Snack and beverages from student stores and vending machines are often very high in sugar and fat and low in other nutrients. The AAP recommends that parents and caregivers advocate for healthier food choices throughout schools, including in student stores and vending machines.

As children near adolescence, they may begin to grow in spurts. These spurts become more frequent in adolescence. During these spurts, the child may grow as much as 4 inches (10.1 centimeters) per year.

Adolescents are much more mobile than children and often have their own sources of money. Because of this, it can be difficult for parents to guide the adolescent’s food choices. However, good habits established during childhood may continue during adolescence.

Eating disorders (e.g., anorexia nervosa, bulimia nervosa, binge eating) are a common concern during adolescence, particularly among girls. Contact a physician if any adolescent displays signs of an eating disorder. Furthermore, the AAP does not recommend weight-loss diets for children or teenagers. Teens who follow weight-loss diets and use unhealthy methods to control their weight are at increased risk of becoming overweight and developing eating disorders, according to new research. Parents and other caring adults who are concerned about a child’s weight are encouraged to speak to a pediatrician.

The number of calories adolescents need every day varies widely between individuals. However, the AAP recommends, as a general rule, that moderately active adolescent boys consume about 2,700 calories per day, and similarly active adolescent girls consume about 2,300 calories each day. It is recommended that between 55 to 60 percent of these calories come from carbohydrates, and 35 percent or fewer come from fats. Protein is also important. The AAP recommends that 10 to 12 percent of daily calories come from protein. The recommended daily amount of iron for adolescent girls is 15 milligrams, and the recommendation for boys is 12 milligrams daily. However, some girls may need more iron to compensate for blood lost during menstruation.  

Calcium is also increasingly important. Bone mass peaks at some point during late adolescence or early adulthood. After this point, it only decreases with time. In order to maintain long-term bone health (and reduce the risk of osteoporosis [weak, brittle bones] in later adulthood), the peak bone mass needs to be as high as possible. This goal is reached by consuming plenty of calcium during childhood and adolescence. The AAP recommends that adolescents consume at least 1,300 milligrams of calcium every day. This is generally attainable through four servings of dairy products daily.

Family meals are important for both children and teens. Involving the child in age-appropriate tasks in the kitchen can be a learning experience and motivate them to eat healthy. For example, young children can set the table or pour beverages while older children grate cheese. Adolescents can help with the actual cooking. Children and adolescents may also be involved in planning the meal, such as choosing ingredients at the grocery store. If a child or adolescent resists family meals, it may help to allow them to invite a friend.

A combination of good nutrition and exercise helps keep the body healthy and fit. Poor nutrition and lack of exercise can lead to numerous health problems, including obesity, malnutrition and iron deficiency anemia. Poor nutrition and lack of exercise can also increase the risk of heart disease, cancer, stroke and osteoporosis (weak and brittle bones associated with insufficient amounts of calcium) later in life.

Early signs of atherosclerosis (a condition in which fatty material collects along the walls of arteries), a common cause of heart disease, may be noticed during childhood and adolescence. This condition is related to poor dietary habits that lead to high levels of cholesterol in the blood. More and more American children are overweight or obese than in years past. In addition, an increasing number of children are being diagnosed with high cholesterol (also called hypercholesterolemia). High cholesterol was not even screened for or tracked in children until recently. Poor dietary choices can also cause cavities.

The Centers for Disease Control and Prevention (CDC) reports that 67 percent of United States youth aged 6 to 19 years old consume too much total fat, 72 percent consume too much saturated fat and 80 percent of American youth do not eat enough fruits and vegetables. Furthermore, only 39 percent of American youth aged 2 to 17 consume enough fiber.

According to the American Academy of Family Physicians, 70 percent of American adolescents – especially females - do not consume enough calcium. The CDC reports that 85 percent of teenage girls do not consume a sufficient amount of calcium. This may be because many female adolescents mistakenly believe that all dairy foods are high in fat. However, low-fat milk contains as much calcium as whole milk. Mineral supplements may be considered for children and teens who cannot or will not consume adequate amounts of calcium.

Caffeine is present in many foods and beverages, including chocolate, sodas, coffee and tea. It is a stimulant and a diuretic (increases urine production) that can cause many problems when consumed in excess, including nervousness, upset stomach, headaches and difficulty concentrating and sleeping. Excessive urination due to caffeine may lead to dehydration. Young children may be particularly susceptible to these effects. In addition, caffeine interferes with calcium absorption, which can result in less bone formation in children who consume it in excess.

According to the CDC, the average daily consumption of sodas in adolescent girls increased from 6 ounces (177 milliliters) to 11 ounces (325 milliliters) between 1978 and 1998. Over the same period of time, average daily soda consumption increased from 7 ounces (207 milliliters) to 19 ounces (561 milliliters) among adolescent boys. Sodas are full of caffeine, sugar and empty calories. They are not nutritious and may replace healthier foods and beverages in the child’s diet. Health experts recommend that children and teenagers limit their consumption of sodas.

Preparing questions in advance can help patients and parents have more meaningful discussions with physicians regarding their or their child’s conditions. Patients and parents may wish to ask the doctor the following questions about nutrition during childhood and adolescence:

1. Is my child eating enough and getting enough of the right nutrients, vitamins and minerals?
   
   
2. Is my baby ready to start eating solid foods?
   
   
3. When should my child no longer receive a bottle?
   
   
4. How much calcium and other nutrients does my child need every day?
   
   
5. Where can I find information on the local school lunch programs and other foods and beverages offered in local schools?
   
   
6. My child loves sodas or some other type of unhealthy food or beverage. How might I wean him/her off of these?
   
   
7. How can I prevent my child from making unhealthy food choices when I’m not around?
   
   
8. What meal preparation steps are appropriate for my child’s age and abilities?
   
   
9. Would a sports drink be beneficial for my child while participating in his/her sport or activity?
   
   
10. Could my child have an eating disorder?