Ask The Expert is a weekly column on Littlestomaks.com. The idea is to have a reader-submitted question answered by a nutrition expert or a pediatrician. Feel free to submit your question in the comments section below.

This week, Family Physician Dr. Michelle May offers a few tips to help you raise a healthy child by providing unconditional love, encouraging physical activity and promoting healthy eating habits.

Question: How can I encourage my kids to eat well and follow a healthy lifestyle?

Answer:

With the launch of Michelle Obama’s Let’s Move campaign, unprecedented attention has been paid to healthy eating and physical activity in children. There’s a huge potential for benefit but two potential pitfalls that parents need to be aware of.

First, the focus really shouldn’t be on childhood obesity. All children (and adults!) benefit from increased awareness about their lifestyle choices. Singling out overweight children contributes to the stigma and shame they already face—and may cause parents, doctors, and others to mistakenly believe that the information doesn’t apply to normal weight children.

Second, restrictive diets haven’t worked in adults and they don’t work in children. Studies have shown that children who are restricted from certain foods at home and are exposed to those foods elsewhere are more likely to choose the food, overeat it, and feel guilty afterward. Sounds just like the last diet you were on doesn’t it!

Let’s look at the keys to the development of lifetime healthy eating and exercise habits:

Build Healthy Attitudes

• Demonstrate your unconditional love for your child. Children—especially overweight children—need support, acceptance, and encouragement from their parents.
• Build self-esteem by focusing on all of your child’s positive qualities, unique talents, and individuality. By developing interests and skills that increase their success and pleasure, they will be less likely to turn to food for fulfillment.
• Help your child develop good communication skills, encourage them to express their feelings, and teach them effective coping skills to decrease the chance that food will serve that purpose.
• Emphasize the importance of good health, not ideal weight.
• Never tease or criticize a child or adolescent about their weight. Such comments are hurtful and can stick with a person for a lifetime.
• Be a positive role model. When your child observes you enjoying healthful foods and physical activity, they are more likely to do the same.
• Most importantly, sit down and eat together as a family. Family mealtimes are a wonderful way to reconnect with one another and share your day. Mrs. Obama talks about playing “Roses and Thorns” – taking turns telling about the best and worst part of your day.

Enjoy an Active Lifestyle

• Help your child build a lifetime exercise habit by making consistent physical activity a high priority in your family.
• Reduce the amount of time your family spends in sedentary activities like TV and video games. Instead, plan fun family activities that provide everyone with exercise and enjoyment.
• For children who have been relatively sedentary, physical activity should be initiated gradually to avoid injury and discouragement.
• Encourage active play like biking, swimming, and playing ball.
• Participation in individual and team sports can be a great way to build coordination, athletic skills, and self-confidence.

Develop Healthy Eating Habits

• Children have the instinctive ability to regulate their intake to meet their needs. Respect these internal cues of hunger and satisfaction.
• Do not force children to clean their plates or bribe them with dessert for finishing their meal.
• Never use food as a reward. Reward desired behavior with praise, extra attention, and privileges.
• Do not comfort your child with food. Hug them and listen to them instead.
• Do not impose stringent food rules since this may lead to rebellious eating when the child is away from parental control.
• Don’t say or imply that some foods are good while others are bad. Instead, teach children that some foods are healthier than others. This will help them learn to balance eating for nourishment with eating for enjoyment.
• Provide a variety of delicious healthy choices for snacks and mealtimes. Suggestions include fresh or dried fruits, vegetables with tasty low fat dips, reduced fat cheese or peanut butter and whole grain crackers, yogurt, fruit smoothies, whole fruit ice pops, granola bars, turkey roll-ups, or snack mixes made of cereal, dried fruit, and nuts.
• A healthy breakfast is a great way to start the day and is important for optimal performance in school. Include protein and whole grains for energy and nourishment.
• Encourage children to drink water and fat free or low fat milk instead of sugary sodas, fruit drinks, and sports drinks.
• Promote a high fiber diet by giving your child whole wheat breads and pastas, brown rice, and five servings of fruits and vegetables daily. They will prefer these types of foods if that is what they’re used to.
• Since children (and adults!) have a natural preference for sweet and high fat foods, it’s reasonable to limit the amount of sugary and fatty foods that are readily available to encourage intake of more nutrient rich foods.
• Involve children in shopping, meal planning, and preparation. This is a great opportunity to teach them about nutrition—and they will be more likely to try new foods if they helped make them.

Download Keys to Raising Healthy Children flyer by Dr. Michelle May.

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Disclaimer – Information provided in Ask The Expert column on Littlestomaks.com is intended to give you general guidance on a question related to toddler nutrition. It is not meant to be treated as medical advice. You are welcome to contact this expert for a detailed consultation on your specific situation to determine what actions, if any, you should take regarding nutrition and health of your toddlers. We do not recommend you to take any action based solely on the information presented in this column. Experts have agreed to provide their professional opinion on toddler nutrition related questions on a voluntary basis and no compensation is offered to them by Littlestomaks.com.

The media was abuzz this week with screaming headlines warning us of widespread vitamin D deficiency in kids. It followed a recent paper in the Pediatrics journal by researchers at the Children’s hospital in Boston, Massachusetts General Hospital, Harvard Medical School and the University of Colorado. The paper presented their research based on the 2001-2004 NHANES survey and posed the question Do Children Need More Vitamin D?

That the mainstream media latched on this latest research and gave it prime time coverage is not a surprise to me. I have written about such attention grabbing headlines on vitamin D before. I am so intrigued by the popularity of this topic in the press that I decided to look at this week’s news in more detail for today’s Five for Fridays. I would love to hear your comments and concerns about vitamin D for your children.

Here are 5 reasons why I believe we don’t need to let the mass media engulf us in mass hysteria about vitamin D:

There is no consensus on healthy levels of vitamin D in children

The Pediatrics paper correctly points out that:

There is controversy, however, about what a healthy level of 25-hydroxyvitamin D is for children and even what level of 25(OH)D should be used to define vitamin D deficiency

25-hydroxyvitamin D is what they measure in the blood to determine the level of vitamin D. Different agencies have defined vitamin D deficiency as blood levels less than 27.5 to 37.5 nmol/L. Many experts today believe that these levels are too low and should be revised to less than 50 nmol/L or even 70 nmol/L. By raising the number on the “safe” level, these experts suggest that a lot more people should be considered vitamin D deficient compared to current standards.

While there is some data to suggest various benefits of higher levels of vitamin D in adults (75 to 100 nmol/L), there is no such evidence and consensus for children. When even experts cannot agree on “safe” levels of vitamin D in children, I am not sure if it makes sense to raise a red flag based on this week’s report.

Average vitamin D levels in children are much higher than currently recommended

Amazingly, the Pediatrics paper reports that the average blood level of 25-hydroxyvitamin D was 70 nmol/L. Further, prevalence for levels less than 25 nmol/L was only 0.7% and that for levels less than 50 nmol/L was 15%. It is only when you consider a level of 70 nmol/L as the “safe” level that the prevalence goes up to 65%. Basically that means that most children have a sufficiently high level of vitamin D.

I am not suggesting that we should not worry about the 15% or so who had levels lower than 50 nmol/L. It is a cause for concern, but probably not as much as the rate of childhood obesity. The problem I have with these studies is that they tend to look at only one thing at a time and lose the big picture on our children’s health.

Perceived risks based on geography and ethnicity do not justify broad changes

We have all heard the usual reasons for low vitamin D – children do not get enough time in the sun which makes things worse for dark-skinned children of Hispanic and African-American background. Also children who live in the Northern altitudes do not get enough sun particularly in the winter months.

These observations are all true. However, aside from skin color and average sun exposure there is also an effect of poor nutrition in general. It is probably not a conincidence that children in these same demographic groups have also been reported as either overweight or obese. Under these circumstances, even if these children were put on vitamin D supplements, I am not convinced that it will do anything to improve their prospects of future health. I think that a narrow focus on vitamin D misses the big picture on children’s nutrition.

Based on these studies alone, I don’t think a sweeping across the board recommendation of higher vitamin D can be justified.

There is no evidence for preventive powers of vitamin D by large randomized clinical trials

A fascinating article appeard in last week’s Financial Times which posed the question To D or not to D? Recent research reports a link between higher vitamin D and lower risk of certain types of cancer. On the flip side, low levels of vitamin D have been reported to increase the risk of osteoporosis, heart disease, multiple sclerosis, type 1 diabetes, depression and rheumatoid arthritis. One recent review of health records of over 13000 Americans found that people with the lowest vitamin D levels were 26% more likely to die in an 8 year period compared to those with the highest levels.

How can you not have the sense of urgency about recommending everybody to have higher vitamin D? It seems like a no brainer.

Not so fast say the international health authorities! Even the International Agency for Cancer Research of the WHO issued a report last year that basically concluded there was no need to raise vitamin D recommendations. The Institute of Medicine in the US also does not appear to be in any hurry to change the current recommendations.

The main reason for this reluctance is that the preventive power of vitamin D has not yet been proven by large scale randomized clinical trials. The Financial Times article provides a good understanding of why such clinical trials may never take place. There are some clinical trials going on for senior citizens, but nothing on the horizon for children or young adults.

I am impressed by the commitment of today’s vitamin D researchers. However, I think there ambitions are out of proportion with their findings. I have nothing against targeted intervention in high risk groups, but it is meaningless to stretch the recommendations to everybody across the board.

These studies imply relying on supplements instead of nutrition and active lifestyle

Finally, this is the main reason why I am not a big fan of these studies. The underlying implication is that we can easily solve this problem by vitamin D supplements. The Pediatrics paper asks the question:

Considering these prevalence data, would there be risks associated with recommending that all children have vitamin D supplements until the short- and long-term health outcome data are elucidated?

It does address the concern about vitamin D toxicity but suggests that it is rare and happens only when really excessive doses of vitamin D are taken. Clearly, their agenda is to promote vitamin D supplements for children:

As suggested recently by the Canadian Pediatric Society and a recent stateof-the-art review on vitamin D, higher supplement doses may be required for children to reach the safe and potentially healthier levels of 25(OH)D of <50 or <75 nmol/L.

I think there is a real danger in such linear thinking. Instead of promoting healthy nutrition and physical activity first, and nutritional supplements second, the supplements are considered a primary means to good health. I reject that notion even though these studies get very high profile coverage in the press.

I am glad that a few Moms I talked to on Twitter about this topic calmly suggested that the real solution is to get your children to eat well, drink plenty of milk and play outdoors. At least they are not falling for this propoganda!

Have a good weekend and do let me know what is on your mind.

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