A May 2011 study has already changed what I tell parents about nonfat milk. Commonly, parents are counseled to switch their children from whole milk to low fat or nonfat milk by age 2 or 3, in an effort to reduce calories, reduce fat, and reduce the risk of obesity.

For years my take has been that if a child is drinking organic milk from cows grazing on pasture, and the child is otherwise eating healthy amounts of good food, then why not stick with whole milk – closer to the way it appears in nature? But if the child is already getting too many calories or too much fat in the diet already, then switching to nonfat dairy may be one of the easiest ways to cut out excess calories. Was I wrong?

Learn from Diet Soda

One would think that switching from full-calorie soda to diet soda would drop calories and weight, but some studies suggest that the artificial sweetness triggers people to make up those calories in other ways.  Could the same thing be true for milk?

Putting it to the Test

Researchers studied 145 children, half who remained on whole fat dairy foods and half who switched to reduced-fat dairy foods. At the end of six months the investigators compared the BMI, waist size, calories consumed, foods consumed, and blood cholesterol of the two groups.

The two groups ate the same amount of calories overalll, both at the beginning and at the end. The low fat group did reduce their fat intake and their dairy calories, but made up for this by eating more carbs (not necessarily a better choice).

There was no difference in waist size or in BMI between the two groups.

Hendrie GA, Golley, RK. “Changing from regular-fat to low-fat dairy foods reduces saturated fat intake but not energy intake in 4-13 year old children.” American Journal of Clinical Nutrition. May 2011; 93(5):1117-1127.

The diagnosis of ADHD increased 100 percent in just a decade. The percentage of kids who are overweight increased 100 percent between 1980 and 2002 (and increased 200 percent in teens). Is there a link between the two? Are kids diagnosed with ADHD more likely to be overweight? Or more likely to be underweight. It looks like the answer is yes to all three questions. A large study of more than 62,000 kids and adolescents appeared in the July 2008 Pediatrics. The children who had been diagnosed with ADHD, but were not being treated with medications, had about 1.5 times the odds of being overweight compared to their non-ADHD peers. This is consistent with other research linking ADHD and being overweight. These investigators propose that the increased weight may come from increased impulsivity and decreased self control of the kids with ADHD both leading to increased eating, coupled with more time spent watching television or playing computer or video games, leading to decreased physical activity.

In contrast, though, kids diagnosed with ADHD who are taking medications for their ADHD had about 1.6 times the odds of being underweight compared to their non-ADHD peers. Loss of appetite and weight loss are known side effects of some ADHD medications.

To me, the causes and effects of these patterns aren’t so clear cut, but it makes sense for people caring for kids with ADHD to be paying attention to their weight: they may be at greater risk of weight problems than their peers. And it makes sense to pay attention to the behavior of kids who are becoming overweight: they may be more likely to have ADHD than their peers.

Waring ME and Lapane KL. Overweight in Children and Adolescents in Relation to Attention-Deficit/Hyperactivity Disorder: Results from a National Sample. Pediatrics July 2008; 122:e1-e6.

When my wife and I were born, American teenage girls, aged 12 to 17, weighed an average of 118 pounds. Some weighed more and some weighed less. Today, the average has swollen to 130 pounds. And teenage boys have packed on even more weight, going from a healthy 125 pound average up to 141 in such a short span of time.

Meanwhile, school-aged kids between 6 and 11 have swollen by an even higher proportion, up more than 13 percent, from 65 up to 74 pounds. What does this mean? These government statistics, released October 27, 2004, are the latest to come from the National Health and Nutritional Examination Survey, which tracked Americans from 1960 through 2002. The story making the headline news is that the average adult today is 25 pounds heavier than adults were in 1960 while only a bit taller. It’s an important story. But the children’s numbers are even more chilling.

That 25-pound adult increase occurred to a generation that was slim on average when they were kids and teens. But obesity can build like compound interest. The girth (and the diabetes, high blood pressure, heart disease, cancer, arthritis, etc.) awaiting this generation of overweight children when they grow up is frightening – unless we take action now. Today about 31 percent of American kids are at weights that put them at health risk. This isn’t an individual problem; it’s a cultural problem.

Today’s sedentary kids are bombarded with enticing messages to eat super-sizes of artificial, high-sugar, high fat, highly processed nutritional trash. We need to create a culture organized around healthy, fun physical activity and around healthy amounts of healthy, delicious natural foods. This means changes in our schools, our homes, our restaurants, our airwaves, and in our thinking. I hope we heed this wake up call and learn what it takes to start raising the healthiest, not the fattest, generation of kids in history.

Dr. Greene’s Answer:

The last statistic that you gave is the most telling. Where a child is charted on the BMI growth curve predicts whether there will be an obesity problem later in life much more accurately than where she is on the weight growth curve. Your daughter’s ranking in the 95th percentile suggests that this could be a problem for her, and her family historymakes obesity even more likely.

For most kids, the best approach to eating is not to restrict how much they eat, but to keep the foods as healthy as possible. Snack on fruit and vegetables rather than on chips or sweets. Turning the television off as much as possible to keep kids active can make a big difference.

Some children have a problem with the appetite center of the brain and do need their total amount of food to be restricted. This is not very common, but a child who is still very hungry five minutes after a meal should be checked by a doctor for this type of problem.

It could very well be boredom at age 3. Getting outside to play can make a big difference. Three-year-olds can be endlessly curious. Toy pianos or musical instruments are a big hit at that age and active, pretend play can be very fun.

Related concepts:

Over-nutrition

Introduction to obesity:

You’ve probably already heard that we are raising the most overweight, out-of-shape generation of children in history. On January 21, 2011, the Centers for Disease Control and Prevention (CDC) released another round of figures. What is amazing is that the problem isn’t staying the same, but keeps increasing, year after year. There was no increase between 1960 and 1980, but since 1980, the percent of overweight children has been rising dangerously. According to the CDC, 17% or 12.5 million children and adolescents are obese.
Obesity among children is literally an epidemic. Unless we get kids moving and teach them to enjoy healthy foods, the outlook for their long-term health is bleak. But we can change things. Tobacco use was once thought to be inevitable; now its use has fallen by half. Wouldn’t it be wonderful for all of us, children and adults, if weight problems fell by half over the next several years?

What is obesity?

Obesity, or over-nutrition, is the generalized accumulation of fat both beneath the skin and throughout the body. Some children are big, or stocky, because they have large skeletal frames. They are not obese. There are general guidelines for appropriate weight for a given height, but these are only general guidelines.
Obesity is usually caused by an individual’s eating more food than is necessary for him or her. Less activity than the individual needs can also cause obesity, but this is less common in children. Whatever the cause, certain children inherit a genetic predisposition to obesity. They may eat the same diets as thinner children, but store more of the calories as fat.
The body stores new fat either by increasing the number of fat cells or by increasing the size of existing cells. It is particularly important to control childhood obesity since new fat cells are primarily formed during childhood. Each year of adding these extra fat cells makes adult obesity more difficult to fight.

Who gets obesity?

Overweight children are not gluttonous or lazy. In fact, many studies have shown that obese children do not eat more calories than their peers. And by measuring caloric expenditure using the double-labeled water method, investigators have shown that obese children actually expend more energy than their non-obese counterparts. Obese children need less food and more activity than their peers.
A variety of hormonal disorders, including problems with insulin, hypothalamic hormones, and pituitary hormones, can cause severe obesity.
There are also a number of rare inherited syndromes (such as Laurence-Moon-Biedl, Prader-Willi, and Cushing) that produce obesity. If a child’s height is appropriate or advanced for her age, one of these underlying medical conditions is extremely unlikely. On the other hand, an obese child with slow height growth should certainly be evaluated.

What are the symptoms of obesity?

Is your child overweight? Underweight? A study in the July 2000 issue of Pediatrics shows us that, at least when it comes to teens, both parents and children are surprisingly poor at judging appropriate weight. Forty-seven percent of teens who reported that they were very overweight were not obese at all, according to objective body mass index (BMI) calculations. But among teens who were objectively obese, most parents and most children themselves did not recognize it!
Obesity can lead to many other health problems, including diabetes, high blood pressure, and asthma. In fact, with the increase in childhood obesity, we are also seeing an alarming increase in the rate of adolescent high blood pressure, high cholesterol, and diabetes!

Is obesity contagious?

No – but the behavior that leads to obesity can be contagious or cultural.

How long does obesity last?

Obesity tends to get worse over time, unless intentional steps are taken to change basic habits of activity and diet.

How is obesity diagnosed?

The CDC growth charts are an excellent mirror that can help us see accurately how our children are growing. The BMI curve, in particular, can give us an early warning even before a child is truly overweight or underweight. Sometimes we need to take a more objective look at our kids.

How is obesity treated?

Obesity can be very difficult to treat, since it involves permanently changing basic eating and exercise habits. Successes almost always involve changing the whole family’s habits to those that are appropriate for the obese child.
Cutting excess intake is best achieved by first keeping a careful record of food consumed, to identify particular problem areas in the diet. The entire family must learn which foods are healthy. Whole fruit, whole vegetables, and whole grains should make up the bulk of the diet.
Parents need to know that white bread vs. whole wheat is not a trivial question. Whether or not children eat whole grains could have a major impact on their health. A study in the August 2002 issue of The American Journal of Clinical Nutrition analyzed data from the large, ongoing Framingham Offspring Study. The study found that after adjusting for other variables, there remained a strong correlation between the amounts of whole grain consumed over a four year period, and healthier weight, healthier waist-to-hip ratio, and decreased risk for diabetes. This was true no matter how much refined grain was eaten, and no matter how much fiber.
While changing eating habits, the family also will benefit from changing their active play habits. Whatever the daily activity level of the family, it should be modestly increased.
A January 2000 report to the Centers for Disease Control and Prevention (CDC) identified the single most powerful change teens can make to bring their weight under control. “Of all the ways of tackling this problem, TV reduction appears to be the most effective measure in reducing weight gain in this population,” Dr. William Dietz, Director of the Division of Nutrition and Physical Activity, told the CDC Advisory Board. Bike, dance, play ball – have fun being active!
Most families are not able to make these lasting changes on their own, and will benefit from meeting with an independent party at least once a week for 12 weeks. Ideally, this outside individual should be a nutritionist or an expert in weight management, but even a committed friend will do. In many cities, pediatric weight management programs such as Shapedown are available and are very effective. Whatever the source, monitoring should continue at least monthly for the remainder of the first year, and then every 3 to 4 months until the new habits have become very deeply ingrained.
I often ask my patients to think of one healthy change they can make in their lives, starting today. Then, my role is to “cheer” them on, encouraging them every few weeks to add another lifestyle change while monitoring their weight and any associated health problems.

How can obesity be prevented?

Whether your child is a baby or a teen, now is the best time to be sure that active, physical play is a part of her life for at least 30 minutes every day. According to the CDC, childhood obesity in the US has tripled since 1980. Guidelines released by the National Association for Sport and Physical Education draw on evidence of benefit from over 40 scientific studies to urge those caring for children to be mindful each day of encouraging movement and motor skills. The guidelines were updated in 2009 for children under age 5, and in 2004 for children 5-12 years old. School-age children should be engaging in at least 60 minutes of activity each day. Boring calisthenics are not what the doctor orders. Instead, look for anything fun that gets kids walking, running, rolling, balancing, jumping, kicking, throwing, or dancing. If they’re too young for these, engage them in tummy-time or playing with a rattle. One of our important tasks as parents is to teach a lifelong habit of active fun.
A study published in the April 2001 issue of the American Journal of Public Health offers real hope. Children were 400% to 500% more likely to be physically active if they were given an attractive place to play and were supervised by adults. Among middle-school students, basketball hoops and courts, baseball backstops, volleyball nets, tennis courts, and racquetball courts made the biggest impact. Realistic changes in our schools, parks, neighborhoods, and homes can revolutionize the health of our children.
Healthy eating habits can also prevent obesity. Babies who are breastfed have a 30 percent drop in their risk of obesity, according to a study published in the June 8, 2002 issue of The Lancet. This study looked at more than 32,000 children who were 3 to 4 years old. After adjusting for birth weight and socioeconomic status, those who had been breastfed were only 70 percent as likely as their formula-fed peers to have become obese. Breastfeeding is not a guarantee of a good outcome, but it does improve the odds for your child in many areas of life.
Another important early tip: when babies are transitioning to solid foods, avoid putting cereal or solids in the bottle. Also avoid too much juice. For most children up to age 6, fruit juice should be limited to 4 to 6 ounces per day. For those 7 and over, 8 to 12 ounces per day is a good maximum. And juice does not belong in a baby bottle.

Related A-to-Z Information:

Asthma, Depression,Inconspicuous Penis, Sexual Abuse, Tantrums, Type I Diabetes

Related concepts:

Precocious puberty

Introduction to early puberty:

When childhood is ending, it often feels like it has all gone by too fast. It’s bittersweet watching our children’s bodies change into those of young men and women. How much more poignant when puberty arrives earlier than expected!

What is early puberty?

The age of onset of puberty varies widely. In girls, the breast bud is usually the first sign, and is seen on average at 10-11 years. Pubic hair usually begins to appear 6-12 months later. Next comes the pubertal growth spurt. Menstruation begins, on average, 2 to 2.5 years after the onset of puberty. The mean age for a girl’s first period is about 12 years. Wide variations are seen in the sequence and timing of these events, but the peak growth spurt always precedes the first period.
In boys, testicular enlargement is the first sign of puberty and is seen on average at 10-13 years. Further testicular enlargement, pubic hair development, and penile enlargement, follow. The peak growth spurt for boys happens around 6 months after pubic hair development and typically occurs later than for girls.
Precocious puberty is often defined as the onset of true puberty before 8 years of age in girls or 9 years of age in boys. (Isolated breast development that doesn’t progress to the rest of puberty is called premature thelarche, and is a different, benign condition).

Who gets early puberty?

Precocious puberty is 10 times more common in girls than in boys.
Most precocious puberty is simply early maturation. Nevertheless, the Lawson Wilkins Pediatric Endocrine Society recommends evaluating for an underlying medical condition in Caucasian-American girls who have development of breast and/or pubic hair before age seven and in African-American girls before age six (Kaplowitz and Oberfield, Pediatrics 1999 Oct;104(4 Pt 1):936-41). Medical conditions that may be associated with precocious puberty include ovarian cysts, thyroid problems, McCune-Albright syndrome, or external sources of estrogen. In girls over age 6, these other causes are quite rare, but should at least be considered by your pediatrician.

What are the symptoms of early puberty?

In girls, the signs to watch for are the development of the breasts, the growth of pubic hair or underarm hair, a change in the appearance of the external genitals, and the beginning of menstrual periods.
In boys, watch for enlargement of the testicles or penis, the appearance of pubic hair or underarm hair, acne, and the deepening of the voice.
Increased height and weight may be seen in boys or girls.
Early maturation may be divided into three main types: rapidly progressive, slowly progressive, and unsustained. Most girls who begin puberty early (especially those who begin before age 6) have the rapidly progressive variety. They go through each of the stages (including closure of the growth plates of the bones) at a very rapid pace, and thus lose much of their adult height potential. About 1/3 of these girls will end up shorter than the 5th percentile of adult height. Many girls, however (particularly those beginning puberty after their 7th birthdays), will start puberty early, but still go through each of the stages at a more typical pace. While their “adolescent” growth spurts are over early, they will continue to grow until their bones reach final maturity at about age 16.
A few have unsustained early puberty: the changes of puberty begin and then stop.

Is early puberty contagious?

No

How long does early puberty last?

Sexual development may begin at any age. Pregnancy has been reported as early as 5 1/2 years old.

How is early puberty diagnosed?

Early puberty is suspected on the basis of the physical examination. Laboratory tests are important to determine which puberty hormones are present, and where they are coming from. Sometimes X-rays of the hands to look at bone growth help determine the cause of early puberty.

How is early puberty treated?

Medicines are available to slow or stop early puberty. Sometimes surgery is needed to remove ovarian cysts, or other ongoing sources of puberty hormones.
Children with early puberty tend to have the mental development of their chronologic age clashing with the emotional surges of adolescence. These children deserve extra understanding and support.

How can early puberty be prevented?

Often early puberty cannot be prevented. We do know that exposure to puberty hormones such as estrogen can trigger some types of early puberty. Reducing children’s exposure to estrogen or other sex hormones is wise.

Related A-to-Z Information:

Depression, HIV, Inconspicuous Penis, Labial Adhesions, Lanugo, Nightmares, Obesity, Sexual Abuse, Sexual Curiosity in Young Children

Related concepts:

Major Depression, Mood Disorders, Dysthymic Disorder, Childhood Depression, Infant Depression.

Introduction to depression:

United States Surgeon General David Satcher released a report in January 2001 describing a mental health crisis in children. Mental illness severe enough to hinder kids from learning or developing appropriately is quite common — but fewer than one in five affected children get the help they need. Mental disorders are a major untreated problem in children. Recognizing and treating conditions such as depression can be a powerful contribution to children’s lives. Some children’s depression is missed because they appear to have ADHD.

What is depression?

Major depression is a mood disorder that affects sleep, eating, growth, mood, and interest level. Dysthymic disorder is a milder (but often longer lasting) variant, where the child has a depressed mood for at least a year.
Not long ago, people used to think that young children did not suffer from depression. Now we know that depression in children is both real and common – although the symptoms are often different from those seen in adults.
Depression of Infancy and Early Childhood is defined as a pattern of depressed or irritable mood with diminished interest or pleasure in developmentally appropriate activities, diminished capacity to protest, excessive whining, and diminished social interactions and initiative. This is accompanied by disturbances in sleep or eating and lasts for at least 2 weeks.

Who gets depression?

Depression affects up to one in 40 children. It involves the interplay of a genetic predisposition to depression, an imbalance of brain chemicals, and events in the child’s life.
There is a strong link between mental disorders in parents and their children. When parents have major depression, their children are at increased risk for emotional and behavioral problems of their own. Depression in parents is associated with depression, social phobia, disruptive behavior disorder, separation anxiety disorder, multiple anxiety disorder, and/or poorer social functioning in children.
Yet when parents are diagnosed, the children are often not even considered. I hope that this will prompt caregivers to notice whether the children are in any distress and to provide support for them, even at a very young age. And of course, I hope that parents will get the treatment and support that they themselves deserve, both for their own sake and for their children.

What are the symptoms of depression?

Children may have many of the same symptoms as adults. In general, though, children may be less likely to report sadness or depressed mood, and more likely to develop phobias, anxieties, physical complaints, behavior problems and hallucinations. In addition, the pattern of symptoms in children can vary by age.

• Infants and toddlers – developmental regression, increased crying, increased clinginess, increased anxiety, irritability, head banging, increased sleep issues, increased feeding problems, falling off growth curves, developmental delay, limited speech, limited social interaction
• Preschoolers – uncontrollable behavior, hyperactivity, tantrums, breath-holding, biting, kicking, scratching, nightmares, toileting problems (refusal, withholding, smearing, bedwetting, increased “accidents”)
• School-age children – worsening school performance, worsening homework performance, increasing school and homework resistance, headaches, tummy aches, fatigue, lack of motivation, anxiety, increased lying, stealing, masturbation
• Teens – school failure, promiscuity, delinquent behavior, increased aches and pains, suicidal thoughts or attempts, may look more like adult depression

Sometimes ADHD and depression are confused with each other. Many children have both.

Is it contagious?

Depression in parents and caregivers can worsen depression in children, and vice versa.

How long does depression last?

The symptoms of depression usually develop over several days or weeks. Without treatment, the depression usually lasts between six months and a year. About 90% of cases will resolve – some without treatment. However, about 40 to 80% of these children will often become depressed more than once.

How is depression diagnosed?

Whenever there is concern that a child might be depressed, an evaluation is important. This might include rating scales or structured interviews. Sometimes blood tests or EEGs are used to support the diagnosis.

How is depression treated?

Depression in children may be treated with antidepressant medication and/or therapy, such as cognitive behavioral therapy. The response to treatment in children can be quite good.

How can depression be prevented?

Parents taking care of their own needs can help prevent depression in their children. In addition, nurturing attention, exploration and activity, good sleep, and good nutrition can be helpful. Some kids will become depressed, though, even in an ideal situation.

Related A-to-Z Information:

Attention Deficit Hyperactivity Disorder (ADHD), Breath Holding, Head Banging, Headache, Lead Poisoning, Nightmares, Sexual Curiosity in Young Children, Sleep Apnea, Stuttering, Thumb-sucking, Tourette’s Syndrome

Related concepts:

Diabetes mellitus – type I

Introduction to diabetes:

When a child starts drinking more or urinating more frequently, the thought of diabetes often springs into the parents’ minds. When should parents be concerned?

What is diabetes?

In healthy children a hormone called insulin pushes sugar from the blood into the body’s cells where it can be used for fuel. This insulin is produced in the pancreas. Type I diabetes is an attack on the pancreas.
Type 1 diabetes is what we call an autoimmune disease.
When diabetes first begins, the insulin-producing cells of the pancreas are destroyed gradually over months or years. The remaining cells are able to compensate for this by increasing their insulin production. The body can still make enough insulin to keep the concentration of sugar in the blood within a fairly narrow range.
Not until 90 percent of the insulin-producing cells are destroyed is the sugar no longer pushed effectively from the blood into the cells. The blood sugar level begins to rise. Without sugar in the cells, muscle and fat begin to be burned for fuel (evidence of this — ketones — shows up in the urine). The person feels hungry all the time, but loses weight in spite of increased eating. The person is literally starving.
Meanwhile, the concentration of sugar in the blood begins to increase. When the level reaches 180 mg/dL, the sugar begins to spill over into the urine. This causes the person to make more urine and then get thirstier, creating an accelerating cycle.

Who gets diabetes?

Type 1 diabetes most often strikes young people, especially between the ages of 5 and 7 (when viruses run through the schools), or at the time of puberty (when so many hormones change). For this reason, it used to be called juvenile-onset diabetes. This term has now been eliminated, since we now know that it can appear at any age.
People who get type 1 diabetes were born with a genetic predisposition to it. Not everyone born with this predisposition gets diabetes, however. In fact, if an identical twin has diabetes, the other twin only gets diabetes about half the time. Some predisposed individuals are exposed to something in the environment that triggers the diabetes. This is usually a viral infection. The virus misleads the body’s immune system into making antibodies that attack its own pancreatic cells.

What are the symptoms of diabetes?

Type I diabetes generally brews for years, but appears abruptly. Then it rarely goes undiagnosed for more than a few weeks. The classic symptoms at diagnosis are increased urination, increased thirst, increased eating, and weight loss. Anyone with the classic symptoms should have a blood sugar test as well as a urine test. Occasionally people also report fatigue, blurred vision, vomiting, or abdominal pain. If the disease remains undiagnosed, symptoms often progress to include vomiting, labored breathing, and then coma.
Chronic yeast infections (or other skin infections) can be an early warning sign. Healthy kids in diapers commonly get yeast diaper rashes. But if these infections are very frequent, or difficult to clear up with appropriate treatment, diabetes should be considered. If a child is out of diapers, I prefer checking a fasting blood sugar after only one yeast infection, especially if there is a family history of diabetes.

Is diabetes contagious?

No. The viral illness that triggers the disease is contagious, though.

How long does diabetes last?

This is a lifelong condition.

How is diabetes diagnosed?

We call it diabetes when the fasting blood sugar is higher than 126 mg/dL.
Other tests are available for even earlier detection of the diabetes process. People with type 1 diabetes have measurable antibodies in their blood that reveal their autoimmune condition. One auto-antibody found in people with type 1 diabetes is the islet cell antibody. This antibody is often detectable months or years before symptoms appear. Other antibodies include the ICA 512 antibody and the GAD (or 64-K) antibody. The presence of these antibodies is a sign that the body is attacking its own insulin-producing cells. I expect that testing for auto-antibodies will get less expensive and more common over the next several years.

How is diabetes treated?

Children with type I diabetes need insulin to replace what their pancreases have stopped making. The dose and delivery need to be carefully monitored to keep the blood sugars in the appropriate range.
It is important to work closely with a professional skilled in treating this disease to stay on top of the latest developments, and to adjust management as needed, such as during infections or surgery.
Exercise and a healthy diet are important for all children, but even more important for children with diabetes.

How can diabetes be prevented?

Several medicines have been studied for delaying or preventing type I diabetes in high-risk children. Also, avoiding the early introduction of cow’s milk into the diets of children at high risk may delay or prevent diabetes. This may explain why diabetes is less common among breastfed children.
The MMR vaccine may also prevent some diabetes, in that diabetes tends to be more common following outbreaks of mumps or rubella.

Related A-to-Z Information:

Coxsackievirus, Dehydration, Diaper Rash, Enuresis (Bedwetting), Impetigo, Mumps, Pyelonephritis, Rubella (German measles), Thrush, Vomiting

Dr. Greene’s Answer:

Fiber is very important for kids’ health and behavior. Children age 1 to 3 need at least 19 grams a day. By age 4, the minimum goes up to 25 grams.

Try to incorporate some fiber-rich food in every meal and every snack – for the whole family. It’s easy to miss if you’re not thinking about it; it’s an attainable goal if you do. In general, fiber is abundant in foods that come from plants, as long as they have not been over-processed. Fiber is found in nuts and nutbutters, berries and other fruits, beans, vegetables, and whole grains.

Most children in the United States get far less fiber than they need. White-flour snacks, breads, and cereals are major culprits. So are kids’ meals. Chicken nuggets or grilled cheese sandwiches and fries may have almost none. (The skin of the potato is the primary source of its fiber.

Children do not benefit from large amounts of refined white flour. Nevertheless, white flour has become a major part of our diets. This simple carbohydrate acts in our bodies much like white sugar–empty calories that disrupt energy levels and insulin levels and increase body fat. The risk for diabetes increases with consumption of white bread, white rice, mashed potatoes, and French-fried potatoes (Journal of the American Medical Association, February 12, 1997).

Serve as many whole foods and minimally processed foods as you can. When it comes to packaged or prepared foods, look at labels. Because fiber is so important for health, fiber is one of the few nutrients required to be listed on the nutrition label of packaged foods. Get in the habit of looking.

When it comes to grains, make at least half the grains whole. At least. White flour can be replaced with whole-grain flours. For instance, cereals made from white flour can be replaced with whole-grain cereals. But which are whole-grain cereals? Special K? Product 19? Corn Flakes? Cream of Wheat? No. No. No. But the following are: Cheerios, Raisin Bran, Total, Wheaties, Spoon-Size Shredded Wheat, Grape Nuts, and oatmeal. When selecting among whole-grain cereals, try to minimize sugar and chemical additives.

Don’t let the names of products fool you. Names like Pepperidge Farm Light Style Seven Grain and Arnold Bran’ola Nutty Grains Bread sound like they would be made mostly from whole-grain flour. Nope. However, Arnold Country Wheat and Pepperidge Farm Natural Whole Grain Nine Grain breads are. Nabisco Reduced Fat Triscuits and Wheat Thins are primarily whole wheat. Wheatsworth crackers are not!

Check the first ingredient on the ingredients lists of all breads and crackers. It should say “whole wheat” or some other whole grain, such as oats. “Wheat flour” or “enriched wheat flour” are not what you are looking for–they are essentially plain white flour.

If the front label says, “Made with whole wheat” or “Made with whole grain,” get suspicious! Usually the product is mostly refined white flour with a touch of whole grain thrown in to fool you! Front labels can easily deceive. These breads are made with mostly refined flours:

• Cracked wheat
• Multi-grain
• Oat bran
• Oatmeal
• Pumpernickel
• Rye
• Seven bran (or twelve bran)
• Seven grain (or nine grain)
• Stoned wheat
• Wheat
• Wheatberry
• Whole bran (bran is just the outer part of the grain kernel)

(Source: Nutrition Action Healthletter, The Center for Science in the Public Interest, March 1997)

Some of these names are enough to make you think that the manufacturers are trying to fool us into thinking that their products are healthy when they are not.

Dr. Greene’s Answer:

Children do not need to eat large amounts of sugar. In the 1800s, the average American consumed 12 pounds of sugar per year. By 1975, however, after the overwhelming success of the refined-food industry, the 12 pounds had jumped to a world-leading 118 pounds per year, and jumped again to 137.5 pounds per capita (for every man, woman, and child) by 1990. (Food Consumption, Prices and Expenditures, United States Department of Agriculture, 1991).

The effect of sugar intake on children’s behavior is a hotly debated topic in pediatrics. Parents and educators often contend that sugar and other carbohydrate ingestion can dramatically impact children’s behavior, particularly their activity levels. Physicians, on the other hand, have looked at controlled studies of sugar intake and have not found hypoglycemia or other blood sugar abnormalities in children who are consuming large amounts of sugar.

An interesting article appears in the February 1996 edition of the Journal of Pediatrics. In contrast with other research teams, William Tamborlane, MD, et al of Yale University, leaders in child nutrition, reported a more pronounced response to a glucose load in children than in adults.

It is commonly acknowledged that as blood glucose levels fall, a compensatory release of adrenaline occurs. When the blood glucose level falls below normal, the resulting situation is called hypoglycemia. Signs and symptoms that accompany this include shakiness, sweating, and altered thinking and behavior.

Tamborlane and his colleagues demonstrated that this adrenaline release occurs at higher glucose levels in children than it does in adults. In children, it occurs at a blood sugar level that would not be considered hypoglycemic. The peak of this adrenaline surge comes about 4 hours after eating. The authors reason that the problem is not sugar, per se, but highly refined sugars and carbohydrates, which enter the bloodstream quickly and produce more rapid fluctuations in blood glucose levels.

Giving your child a breakfast that contains fiber (such as oatmeal, shredded wheat, berries, bananas, or whole-grain pancakes) should keep adrenaline levels more constant and make the school day a more wondrous experience. Packing her or his lunch box with delicious, fiber-containing treats (such as whole-grain breads, peaches, grapes, or a myriad of other fresh fruits) may turn afternoons at home into a delight.

Refined sugars also affect insulin control, which decides how much fat they will store for the rest of their lives. As a child, I had HoHos, Twinkies, and Ding Dongs as regular parts of my meals because my mother, like so many of that era, wanted to give her children a nice treat. We both shudder now to think of it.

Sugar is not just found in sweets or junk cereal. It’s in almost everything. When you look at labels, you find sugar, sucrose, glucose, dextrose, sorbitol, or corn syrup on almost every label. The more simple meals from whole foods contain much less sugar.

Fruit juices contain lots of simple sugar without much fiber. Many people think of juices as health foods. This simply isn’t true. In small quantities they are fine, but they are mainly a way to get many of the calories and some of the nutrients from a substance, without getting as full and without getting the needed fiber. And children who drink more than 12 ounces of fruit juice per day are, on average, shorter and fatter than those who don’t.