foods. Parents need to provide a structured, pleasant
mealtime environment to help their child develop
healthy eating behaviors. Parents are responsible for
what, when, and where the child eats; children are re-
sponsible for whether they eat and how much they
eat. Older preschool children may learn to like new
foods more by participating in their preparation. Fat
should not be restricted before age two; by age five,
children should eat fewer high-fat foods and their
total fat intake should not exceed 30 percent of total
daily calories. Children under age two should be pro-
vided whole milk; after age two lower-fat milk options
are appropriate. Parents should encourage the child
to eat enough iron-rich foods, such as lean red meat
or fortified cereals with juice that contains vitamin C,
at the same meal. Daily regular activity is important
to build a healthy habit and to balance a child’s weight
and food intake.
Middle Childhood
During middle childhood, regular food habits
should be established. This includes eating three
meals and two snacks every day. A variety of foods
should be chosen with special attention to foods high
in calcium (such as low-fat dairy products and dark
green vegetables), and zinc and iron (such as low-fat
animal products and fortified breakfast cereal). Over-
consumption of foods high in fat (such as whole milk,
table spreads, and cooking oil), saturated fat (full-fat
dairy products, animal products, and solid cooking
fats), and sodium (salt and cheese) need to be avoid-
ed. Participation in regular physical activity is impor-
tant to reduce the risk of obesity and development of
chronic disease such as coronary heart disease or hy-
pertension.
During and just before a growth spurt, a child’s
appetite and food intake will increase. The percent-
age of body fat in older school-age children increases
in preparation for the growth spurt during adoles-
cence. Parents should be aware that a child’s body
image becomes very important at this time. The in-
creased fat mass that naturally occurs during these
periods, particularly among girls, can be alarming
unless the family realizes that this is normal develop-
ment. Some preadolescent children may become con-
cerned that they are overweight and may begin to eat
less, therefore compromising their normal growth
and development. It can also lay the foundation for
future psychological issues, such as eating disorders.
Adolescence
Adolescence is the second most rapid period of
growth and development (the first being the first year
of life), which leads to increased energy and nutrient
Adequate nutrition during adolescence ensures sexual maturation,
linear growth, and peak bone mass. (UPI/Corbis Bettmann)needs. Physical activity influences adolescents’ growth
and body composition as well as their propensity for
obesity. Inadequate nutrition can delay sexual matu-
ration, slow or stop linear growth and compromise
peak bone mass as well as cognitive development,
with the latter possibly affecting learning, concentra-
tion, and school performance. Studies continue to
show that students achieve higher test scores if they
consume a meal before the test. A boy’s physical mat-
uration tends to increase his satisfaction with his body
because of increased size and muscular development.
In contrast, a girl’s physical maturation tends to de-
crease body satisfaction. Reassurance that fat accumu-
lation in the hips, thigh, and buttocks is normal
during adolescence will help to allay this anxiety.Healthy eating habits, such as eating breakfast
and not skipping meals, should continue to be pro-
moted. Healthful food choices that are based on the
Dietary Guidelines for Americans and the Food
Guide Pyramid should be encouraged. Adolescents
become more independent and make more of their
own food choices. Parents should be encouraged toNUTRITION 285