Academy Position Paper

Position of the Academy of Nutrition and Dietetics:

Nutrition Guidance for Healthy Children Ages 2 to 11 Years
Written by Beth N. Ogata, MS, RD and Dayle Hayes, MS, RD

Kaitlyn Richardson
NFS 4950: Senior Seminar
February 22, 2016

It is the position of the academy of Nutrition and Dietetics that children ages two
to eleven years should achieve optimal physical and cognitive development, maintain
health weights, enjoy food, and reduce the risk of chronic disease through appropriate
eating habits and participation in regular physical activity. The position was adopted on
May 3, 2002 and was reaffirmed on June 11, 2006 and September 9, 2010. It is in effect
until December 31, 2018. Beth N. Ogata, MS, RD and Dayle Hayes, MS, RD wrote the
position.
The development of children is important especially during the early stages and
middle stages. Their development when they are young provides the basis for their health
and learning as they continue to grow throughout life. Kids health during their
development is vital which is why healthy food intake is stressed among kids. Adequate
intake of energy and nutrients is necessary to support their growth as well as their
development. It is also necessary in order to prevent problems related to nutrition as well
as certain diseases. Engaging in physical activity as well as healthy eating patterns can
help to improve learning and it can help children do better in school.
Unfortunately many children fall short of meeting the guidelines for many
nutrients and foods including calcium, potassium, vitamin D, fiber, dairy, whole grains,
and fruits and vegetables. While they are lacking in these foods and nutrients, they are
exceeding the recommended intake of solid fats, sodium, and added sugars. Children
aged two to eleven are only consuming 10-14 g/day of fiber and the recommended intake
is 19-38g/day. Calcium is usually not a problem for young children, but as kids get older
they are consuming less calcium with only fifteen percent of females ages 9-13
consuming the adequate amount of calcium. Increasing calcium in kids is vital for their

bone growth and to prevent osteoporosis. Potassium is another nutrient that most children
do not receive enough of. The adequate intake for potassium in children is 4,700 mg, but
most children are only consuming about 2,000 mg.
Many children are not receiving enough healthy foods and they are consuming
more foods that have fats and sugars which could be contributing to a multitude of
problems like type 2 diabetes, obesity and other chronic illnesses. To fix the inadequate
consumptions of important nutrients, children should be encouraged to eat nutrient dense
foods and beverages. Something that is nutrient dense would be sufficient in vitamins and
minerals, low in calories, and have a low content of starches, sugars, fats, and sodium.
Increasing nutrient dense food intake in children would be positive for their health
especially since most children are low in many nutrients, which could adversely affect
their health and development.
Childhood nutrition can play a role in preventing childhood obesity. Obesity is a
problem among children because of the excessive intake of fats, added sugars, and fast
food. While there has been a decline in childhood obesity, it is still a problem and it is
more prevalent than underweight children. A few trials were conducted, where they
implemented physical activity and nutrition interventions in various settings. The
interventions done at schools helped to reduce weight; interventions done in the
community improved obesity in children; encouraging appropriate portion sizes helped to
avoid overconsumption of food; and lastly no correlation was found between consuming
sugary beverages and childrens BMI. But unfortunately these results were not enough to
show the role of nutrition in preventing obesity, therefore more research is needed to

further understand which intervention would be most successful in preventing childhood

obesity.
Another thing to consider is whether nutrition plays a role in preventing
cardiovascular disease in children. From the trials that were conducted, it showed that
interventions done in schools, including nutrition and physical activity, as well as dietary
counseling and involvement from the parents helped to reduce the risk of children
developing cardiovascular disease. All of these helped to improve the childrens BMI,
weight, and blood pressure as well as the parents knowledge of the effects of nutrition on
their childrens health. Because of the small number of trials that were conducted, there is
still more research to be done to determine which interventions work best for preventing
cardiovascular disease in children.
What about Type 2 Diabetes? Can nutrition help to prevent or improve Type 2
Diabetes in children? Trials were conducted in school and communities and they
incorporated physical activity and nutrition education. Glycemic control, nutrition,
physical activity, BMI, and body compositions, which are risk factors for type 2 diabetes
showed improvements. Unfortunately just like the trials for obesity and cardiovascular
disease, more research needs to be done.
Eating patterns, portion sizes, and the setting can influence and contribute to the
health and nutrition of a child. Specifically eating at home or away from home has an
impact on their dietary intake. The quality of a childs diet is usually better when families
eat together, their fruit and vegetable intake is usually higher, and they tend to eat
breakfast more often. If children skip breakfast they usually end up consuming less
energy and they do not do as well in school. Eating meals together as a family also has a

positive impact on childrens body weights. Unfortunately fewer families eat meals
together and not many eat at home. Eating out is becoming more prevalent especially
from fast food restaurants. This is not good for childrens health because fast food is high
in energy, fat, and sugar, and do not contain many fruits, vegetables, dairy products, or
grains. Another issue is portion sizes, which can be especially problematic when eating
out at restaurants. Serving large portions to children contribute to excessive energy intake
as compared to when children serve themselves. They tend to eat more of the main
portion of the meal and less of the sides like fruits and vegetables when the portion sizes
are large. Milk consumption has also decreased due to more children consuming more
sweetened drinks and fruit juices. This could be contributed to the increase in families
eating out as opposed to eating at home. These drinks provide a high amount of energy
and sugar intake and very little or no fruit and vegetable intake. Milk is being replaced a
lot more for fruit juices which is contributing to childrens lack of adequate calcium
intake.
Parents play a huge role when it comes to childrens dietary intake. Parents are the
ones that provide the food for their kids and they should be encouraging healthier foods
as well as packing healthier options for school lunches. They should also discourage
eating out. While they should encourage and enforce healthy eating habits they should
not be restrictive. Restrictive feeding can cause children to overeat and not regulate their
energy intake appropriately, which could eventually result in kids being overweight.
Children need to recognize their bodys cues to when they are hungry and when they feel
full. Pressuring or forcing them to eat or restricting their food can have negative effects.

The goal is to help build and encourage healthy eating habits in kids so they can continue
to make good and healthy dietary choices all throughout life.
Kids tend to dislike a great number of foods, which can contribute to the lack of
sufficient nutrients in their diet. Preferences to food are not something you are necessarily
born with; it is a result of exposure to foods. Repeatedly exposing yourself to certain
foods will help you to develop your food preferences. Exposing a child to certain foods at
least eight or ten times and encouraging them to try new food will help them become
more acquainted with the food and over time their preference can change. Exposing
children to nutritious foods over and over again can encourage them to eat more foods
that are healthy.
A lot of what kids eat or what they would like to eat is influenced by
advertisements. There is evidence that food intake increases as a result of advertisements.
Kids usually prefer brand names of foods because they saw it on T.V. This is a problem if
most of the foods that are being advertised are not nutritious. Kids might not want the
healthy option over the one that was advertised which could greatly affect their dietary
intake. The studies that were done also showed that influence from advertising is more of
a problem for children who are obese or overweight. The best result to this problem is to
increase the amount of advertisements for healthy foods.
The guideline for physical activity in children and adolescents is at least sixty
minutes as day. Their physical activity regime should include muscle- strengthening,
aerobics, and bone strengthening. Aerobic activities should make up the majority of the
daily physical activity. This should be done at least 3 times a week. Some examples
include dancing and running. The other part of the daily physical activity is made up of

muscle and bone strengthening. This should also be done three days as week and includes
activities like playing on the playground and jumping rope. Unfortunately less than half
of children meet this requirement. Encouraging kids to engage in physical activity and
schools and parents both play a role in helping kids get active.
Food insecurity is a serious problem when it comes to children and nutrition.
Food insecurity is when a familys food intake is decreased due to a lack of money. Not
only does food insecurity have adverse effects on a childs health, it also affects their
cognitive development as well as their emotional wellbeing and their behavior. Food
insecurity can increase a childs risk of developing conditions such as asthma, iron
deficiency, fatigue, headache, colds, and stomach aches. Food insecurity can also affect
how children do in school. Children who are food insecure can have behavioral problems
as well as poor academic performance in school.
There are several programs available that help to promote nutrition in children
and these are especially useful for low-income families. Women, Infants, and Children is
a program that provides food, support, and nutrition education to women and children up
to five years old. This is for women and children who have low-income and have
nutrition related problems such as a deficiency. Data has shown that children who
participate in the WIC program have improved diets and health. Child Care nutrition
programs are also important because these children are in the beginning sages of growth
and development. Most child-care centers do not meet the requirements for many
nutrients. These nutrients include total and whole grains, total and dark green and orange
vegetables, oils, whole fruits, sodium, and legumes, beans, and meat. Most centers are
meeting the milk and total fruit recommendations. The intake of saturated fats as well as

energy intake from solid fat and foods with added sugars need to be decreased. School
nutrition programs have recently been updated to change components such as serving
sizes, the components of the school lunches and breakfasts, and the calorie ranges. School
nutrition programs work to increase the consumption of whole grains, fruits, and
vegetables, and decrease the consumption of sugary beverages and the amount of fat in
dairy products. They also strive to increase physical education and decreasing the mean
BMI of their students as well as decreasing the prevalence of obesity. School nutrition
programs have been shown to be effective in changing and improving the health and
nutrition of the students. The students that participated in school lunch and breakfast
programs usually received an appropriate amount of nutrients daily. Those who
participated the programs had increased intakes of nutrients such as vitamins A and B12,
calcium, protein, phosphorous, potassium, and riboflavin. Those who participated in the
programs also had a higher intake of milk, vegetables including dark green and orange
vegetables, and fruit. Some schools also have a Fresh Fruit and Vegetable Programs also
contribute to the increase in the consumption of vegetables and fruits. School nutrition
and physical activity programs work towards trying to prevent and reduce obesity in
children. The goal of all these programs is to promote healthy eating and physical activity
in children so these habits are used all throughout life and to make sure healthy foods are
accessible to children.
So what can be done to help improve the problem of inadequate nutrition in
children? Children should be receiving the recommended amount of nutrients for their
age group. Forty-five to sixty-five percent of their total energy intake should be made up
of carbohydrates. Fat should be thirty to forty percent of energy for children one to three

years old and twenty-five to thirty-five percent for children four to eighteen years old.
For young children, protein should be five to twenty percent of energy intake and for
older children it should be ten to thirty percent. Children ages one to three years old
should consume nineteen grams of fiber a day. Children four to eight years old should
consume twenty-five grams of fiber a day. Boys nine to thirteen years old and girls nine
to thirteen years old should consume thirty-one grams of fiber a day and twenty-six
grams of protein a day respectively. Childrens consumption of added sugars should not
exceed twenty-five percent of their total energy intake. Cholesterol, saturated fat, and
trans fat consumption should be low. The consumption of milk and dairy products should
be increased and sugary beverage intake should be decreased. Children should be
encouraged to eat more fruits and vegetables, whole grains, and nuts and less of food that
have added sugars and solid fats. The goal is to eat foods that do not contain excess
calories to prevent childhood obesity. More physical activity should be encouraged
especially since children today spend a lot more time in front of the television. As stated
before, schools can also help with the inadequate nutrition in children by improving
school lunches and vending machines, providing nutrition education, and increasing
physical activity.
Registered dietitians should be encouraging children to follow the dietary
guidelines. Dietitians should tell their clients parents to use MyPlate and the Academy of
Nutrition and Dietetics Kids Eat Right so they can learn more about health and nutrition
and dietary intakes for their children. Dietitians should encourage and build confidence in
kids and help to promote a positive body image. Dietitians should help educate parents on

how to build a healthy lifestyle and environment at home. And lastly dietitians should get
involved in making schools a healthier and more nutritious environment.
I think childhood nutrition is very important especially for the development and
growth of a child. The Academys position on decreasing fat and added sugar is very
important and it is something I completely agree with. Working in a day care has opened
my eyes to how bad some children eat. Some of the children would only get Lunchables
for lunch, which is not enough and one of my students got donuts every day for lunch. I
also agree with increasing the amount of physical activity that children are engaging in.
Most kids would rather stay inside and watch T.V. or play video games and are therefore
not getting enough exercise. This is contributing to childhood obesity. I also agree with
schools doing more to encourage and promote healthy eating as well as physical activity
and nutrition education. Lastly, I agree with what the position says about the role of
parents in their childs nutrition. This brings me back to the children at the day care I
worked at. Parents did not pack nutritious lunches for their children and it is affecting
them greatly. Most kids did not get any fruit or vegetables and I never saw a child drink
milk. Most of the kids had sugary fruit juices. Parents have the power to make sure their
child is getting enough nutrients and I think they should be more conscious of that.

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References
1. Ogata, A.D, Hayes, D. Position of the Academy of Nutrition and Dietetics: Nutrition
Guidance for Healthy Children Ages 2 to 11 Years. Journal of the Academy of Nutrition
and Dietetics. 2014;114:1257-1276.

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