Protect kids from heart disease by teaching them to eat well
BY JENNIFER MOTL
Nine-year-olds should be checked for high cholesterol levels, according to controversial new guidelines. In years past, doctors screened children with a family history of high cholesterol or heart disease but did not routinely check the cholesterol levels of child patients.
But with heart disease the leading cause of death in America and evidence showing that arteries can begin clogging even in toddlers, a panel of experts recently advised screening all kids starting at age 9.
Proponents say that kids with untreated cholesterol problems are prone to heart attacks as adults. But some physicians aren’t sure it’s safe to use cholesterol-lowering drugs in kids.
Most agree that eating well and exercising are the first line of defense before trying medications.
Pediatricians nationwide are just starting to implement the guidelines, released several months ago by a panel of experts at the National Heart, Lung and Blood Institute.
Keep reading for details on what foods best protect young hearts, plus tricks on how to introduce “lifestyle changes” to kids without battles. I’ll share the panel of experts’ recommendations and also offer my perspective as a dietitian.
For infants, the NHLBI says:
- Offer breast milk only (or formula) for six months, then begin giving solid foods. There is some evidence that breast-feeding can protect children’s hearts somewhat later in life.
- Do not restrict fat for infants—they need a higher percentage of fat than adults.
- Limit juice to less than 4 ounces daily; encourage babies to drink water. Avoid sugar-sweetened beverages such as sodas and Kool-Aid.
- Give supplemental vitamin D, 400 units daily.
For 1-year-olds, the panel advises that you begin offering 2 percent or fat-free cow’s milk from a cup. Discuss your choice of milk with your doctor or dietitian. There may be exceptions to the low-fat rule.For example, for now, I am giving whole milk to my 1-year-old son. He is very slender and comes from a family with low rates of heart disease. I will offer low-fat milk when he gets older.
Continue offering water and supplementing vitamin D in 1-year-olds. Also for 1-year-olds, the NHLBI recommends offering finely chopped table foods and following a DASH-style eating plan rich in fruits, veggies, whole grains and low-fat or fat-free dairy products. You may have heard of the DASH plan before—it’s been proven to reduce blood pressure and cholesterol in adults.
Some other NHLBI advice will sound familiar:
- Limit sodium.
- Limit fat to 30 percent of calories. (I take slight issue with specifying percentages or counting calories and will explain why later in this column.)
- Avoid trans fats (partially hydrogenated oils).
- Limit saturated fats and cholesterol found in meats, poultry, eggs and whole milk, cheese and butter. Instead, provide more heart-healthy fats such as mono- and polyunsaturated fats found in olive oil, canola oil, nuts and fish.
After age 2, the NHLBI recommends not just the above guidelines but also encouraging children to eat high-fiber foods. Fiber helps reduce cholesterol. Shoot for a goal of your child’s age plus 5 grams of fiber daily; for example, a 9-year-old needs 9 plus 5 or 14 grams daily.
Families should encourage healthy eating habits overall—breakfast every day, eating meals as a family, and limiting fast-food meals.
LET KIDS HELP COOK
As a dietitian, I agree with the above recommendations. I am a little concerned about NHLBI guidelines that specify calorie levels and recommended portions. It’s difficult to calculate exact calorie needs for a growing, active child on any given day.
I think it’s more effective to encourage parents to provide a variety of healthy foods and to let the kids decide how much or how little to eat. (The exception would be junk foods and desserts—I think it’s good to limit dessert to one portion on most days.)
Teaching kids to listen to their own sensations of hunger and fullness reduces overeating and weight problems in the long run. It also reduces mealtime power struggles. Research shows it doesn’t work to point a finger at a child and tell him or her to eat better.
It’s important for the whole family to eat from the same healthy menu, including plenty of choices of fruits and/or veggies and protein at every meal. Your child learns how to try foods by watching you. So turn off the TV and make some fun conversation together over dinner. Even if you’re worried, try not to criticize what your child is or isn’t eating—you can’t force a kid to eat well.
Instead, involve kids in planning and preparing meals—indirectly, it helps them relax and enjoy fruits and veggies. Toddlers can wash and tear up lettuce for a salad; kindergartners can help set the table. School-age kids can peel onions and grate cheese. By middle school, many children can chop and sauté veggies, with supervision.
Consider gardening or taking children to farm to pick berries or apples. Farmers’ markets are fun, too. I read somewhere about a family that filled a small album with photos of fruits and veggies from a seed catalog. Their small children carried the album to the farmers market, and it sparked competitive scavenger hunts for them to find as many veggies as possible. The kids even agreed to eat some.
ACTIVATE YOUR HEART
Physical activity powerfully protects your child’s heart. Try to do physical activity as a family at least once a week. According to the NHLBI, kids over age 5 should play for at least an hour every day. And at least three times a week they should play vigorously.
Experts at the NHLBI say we should not let kids under age 2 watch any TV. For older children, limit screen time on TV, videos and computers to 1 to 2 hours of “quality programming” daily—and keep the TV out of your child’s bedroom.
As parents, we can protect our children’s hearts by planning good meals and scheduling playtime. It sounds corny, but it truly can be fun for the whole family.
Jennifer Motl is a registered dietitian. Formerly of Fredericksburg, she now lives in Wisconsin. She welcomes reader questions via her website, brighteating.com, or by email at firstname.lastname@example.org.