This is Part 5 of my Kids’ Nutrition Series
One of the goals behind my Kids Nutrition Series is to help calm the worry that I know (firsthand!) most of you go through. In this post, we are getting to the meat of what it really takes to meet your child’s nutritional needs.
Nutritionists set up food guides with nutrient needs in mind. The chart below, adapted from the Pediatric Nutrition Handbook, reviews the food groups and number of servings that kids need to meet their nutritional needs.
Kids’ Eating Guide
| Food Groups | 2-3 Years Portion | Daily | 4-8 Years Portion | Daily | 9-12 Years Portion | Daily |
|---|---|---|---|---|---|---|
| Milk, yogurt, and cheese | 1/2 cup | 2 cups | 1/2 cups to 3/4 cups | 2-3* cups | 1/2 to 1 cups | 3 |
| Meat, fish, poultry, dry beans, eggs, and nuts | 1-2 oz | 2 oz | 1-2 oz | 3 oz | 2 oz | 5 oz |
| Vegetables | 2-3 Tbsp cooked/ few pieces raw | 1 cup | 3-4 Tbsp/few pieces raw | 1.5 cups | 1/4 to 1/2 cups/several pieces raw | 2 cups |
| Fruit | 1/2-1 (small)/2-4 Tbsp canned/3-4oz juice | 1 cup | 1/2-1 (small)/4-6 Tbsp canned/4oz juice | 1 cup | 1 medium pieces/1/4 -1/2 cup canned/4oz juice | 1.5 cups |
| Grains | 1/2 to 1 slice bread/1/4 to 1/2 cup cooked cereal and 1/2- 1 cup dry cereal | 3 oz | 1 slice bread/1/2 cup cooked cereal/1 cup dry cereal | 4 oz | 1 slice bread/1/2-1 cup cooked cereal/1 cup dry cereal | 5 oz |
Adapted from Pediatric Nutrition Handbook 6th Edition*Calcium recommendations increased to 1000mg for 4- 8-year-olds since this chart was developed. Reminders: You can substitute 1 oz meat, fish, or poultry with 1 egg, 2 Tbsp of peanut butter, or 4 Tbsp of cooked beans. Can offer reduced/low-fat dairy after age 2. See our Infant Feeding Guide for details for kids under 2.
This all looks great but what happens when children skip, or skimp on, entire food groups?
I think you’ll find the task of meeting your (imperfect) child’s nutritional needs easier than you imagined, especially after reading the following real-life case studies.
Case Study #1: Shunning Meat
Shannon* was worried that her 4-year-old son, Jack,*didn’t eat many protein foods besides cheese, milk, and hot dogs. He was also lacking a bit in the fruit and vegetable department. He refused to take supplements.
Summary of eating: Breakfast is 1-2 bowls of cereal (sometimes fortified other times not) with milk. Lunch is one slice of whole wheat bread with mayo and a slice of cheese (sometimes with avocado) with fruit like apple sauce, grapes, or melon, and 1 cup of whole milk.
Jack will only eat dinner if it’s a quesadilla, hot dog, mac and cheese, or breakfast for dinner (pancakes or French toast). He will sometimes eat canned green beans, corn/corn cob, cucumber, and carrots. For snacks, he gets Trader Joe’s cereal bars, veggie straws, yogurt, graham crackers, and pretzels.
Nutrition assessment: On days he’s eating fortified cereal (Quaker Oatmeal Squares), he meets most of his nutritional needs except D (33%) and potassium (34%) and he is low on fiber.
On a good food day with no cereal he is still low on vitamin D and potassium, but also iron (50%). He’s getting enough protein as his minimum needs are 19g and he’s consuming 30-50g!
Recommendations:
- Add a liquid vitamin D supplement to his milk (The RDA is 600IU). Provide fortified cereal every other day to meet his iron needs. He doesn’t need a multivitamin if he’s consuming fortified cereal (he would get excess nutrients especially for folic acid and vitamin A if he gets both).
- Use accepted meals to introduce protein sources like mashed beans in a quesadilla and tuna/peas in the mac and cheese. Keep exposing him to different protein sources without pressuring him.
- Serve fruits and vegetables with most meals and snacks to increase his exposure and increase the fiber and potassium. Since he accepts fruit more than veggies, make sure that you vary the fruit (include a source rich in vitamins A (greens, carrots, canteloupe) and C daily (citrus fruits, melon, strawberries, broccoli) and always include a bowl at dinner.
Case study 2: No Dairy
Shauna* wrote in about her 3-year-old daughter, Lori,* who skips dairy except for a small amount of cheese. She no longer takes vitamins or the Viactiv chocolate calcium chews that her doctor recommended.
Lori drinks 16 ounces of calcium-fortified orange juice daily and eats a small amount of cheese, about one ounce.
Nutrition assessment: The recommended amount of calcium for 3-year-olds is 700mg. Between the amount of calcium in the orange juice and cheese, she is getting about 800mg of calcium — more than what is recommended.
Recommendations:
- Continue to offer dairy such as milk, yogurt, and cheese at meals as her food preferences are likely to change.
- Try smoothies made with milk, soy beverages, tofu, and fortified cereal to cut down the orange juice consumption to once daily (preferably only 6 ounces daily).
- Remember that the DV for calcium is 1000mg (what most adults need) so if a food product contains 30% DV, that’s 300mg.
Case Study #3: No Veggies
Jackie* wrote in about her 16-month-old, Charlie,* who eats a variety of foods except for veggies.
Summary of Eating: Breakfast is usually 2 (3-inch) pumpkin pancakes, 1/3 cup of fruit (pears, watermelon, or applesauce), and 1/2 cup of milk. The mid-morning snack is a whole wheat blueberry muffin – 1/2 regular muffin or 2 mini-muffins and 1/2 cup milk.
Lunch is 2 chicken meatballs made with basil and sundried tomatoes, 1/2 slice of whole wheat bread, mixed veggies (refused), 1/3 cup of diced fruit or applesauce, and 1/2 cup milk. The afternoon snack is a homemade smoothie with whole milk yogurt and pureed fruit.
Dinner is the toughest meal because there are only select items Charlie will eat such as a quesadilla with whole wheat tortilla, mozzarella cheese, mashed black beans, 1/3 cup diced fruit, and sometimes yogurt for dessert and 1/2 cup milk.
Nutrition assessment: This boy gets a wide variety of fruit (and food in general) so has no trouble meeting his vitamin and minerals needs. Like everyone who relies on D from their diet, he is only getting 30% of the DV. Another potential problem is that he is borderline low in iron (80%)– a big watch out at this age.
Recommendations
- include iron-rich foods such as iron-fortified cereals (good for snacks), raisins, soybeans, beans, meat, and shrimp.
- Give him a vitamin D supplement (RDA is 600IU) and keep offering the veggies. Continue to vary the fruit with meals.
- Try to eat the same meal at dinner at least a few times per week. Rotate meals he likes with ones he doesn’t. On the nights it’s a meal that he usually doesn’t eat, provide some sides he likes. The nights it’s a meal he usually accepts, provide sides that are new. He needs the exposure to start trying different foods. See How to Make Dinners More Kid Friendly.
Quick Nutrition Tips
• It’s normal for young children to skimp on certain food groups but it’s still relatively easy to meet their nutritional needs. Remember that how they eat over time is what matters, not one day or even a bad week.
• Watch your child’s eating pattern. Are they hungriest at breakfast or lunch? That might be the best time to bulk up on nutrition. For example, a 4-year-old needs 3 ounces of protein. Two eggs (or two slices of French toast) in the morning and 2 Tbsp of peanut butter at lunch gets him there. So making him choke down the chicken at dinner isn’t necessary.
• Don’t leave the most nutritious foods for the end of the day (dinner) when children are tired and don’t eat as well. Offer them fruits and veggies all day long along with the other foods groups so you can relax at dinner –and make it about family time.
• If your child doesn’t eat fish, consider fish oil supplements to ensure they get adequate essential fatty acids DHA and EPA. The U.S. is slow to provide recommended dietary allowances. See this article to determine how much your child needs.
• If your child eats more than the recommended amounts — don’t worry. Just make sure they eat at the table and until they are full. Appetites vary greatly in kids.
Did this post help ease your nutrition worries? Or do you have an issue you still want to discuss?
Don’t miss our last post in this nutrition series where we’ll be reviewing the best vitamins.
*Names have been changed to protect privacy
For more on kids’ nutrition at every stage and age, check out Maryann’s book Fearless Feeding: How to Raise Healthy Eaters from High Chair to High School
I have been receiving your posts via email for quite some time. I’ve have never left a comment…shame on me. I just want you to know that I truly appreciate your knowledge, expertise, recipes and tips that you share. I love your website and articles–amazing. Learning how to feed my children healthy meals has been (is) a challenge…but this this website has helped me in so many ways. Thank you, thank you, thank you.
Thanks so much Evelyn! I appreciate you taking the time to read what I have to say!
What really helped me is your suggestion to watch their eating patterns. That is good advice about offering them healthier foods when they are most hungry.
Unfortunately the nutrition information does not help me much otherwise because I am so strongly against the consumption of dairy and other animal proteins. Maryann, I encourage you to watch the documentary Forks Over Knives (it’s on Netflix streaming and probably on cable On Demand) and read the books written by the two physicians (researchers) featured in it. The work featured in that documentary is what I have been reading/studying for the last 18 months and it’s been life-changing. The Forks over Knives documentary does a great job summarizing it all.
Thanks Goodfountain. I have watched and studied many sides to the nutrition debate — and honestly feel there is not one perfect diet out there. I prefer a Mediterranean-style diet which has a lot good research too — and it matches my taste preferences. I have heard about the documentary and plan to check it out. Will let you know when I do.
Hi Maryann,
Just wondering what to do about a child who really only eats mainly from the dairy and grains group (with the occasional beans, banana, or strawberries thrown in?). Those are the ONLY two fruits he will eat, and he will sometimes eat beans and rice for me. Rarely will he eat a vegetable (spinach mixed with cheese and rice if I’m lucky). He won’t eat eggs, any kind of meat, cheese, or really any other veggies or fruits besides those listed above. He also refuses to eat yogurt or applesauce. We have moved two times in his life (he is 26 months; thankfully we are in our new house to stay), and each time he gave up more food groups…and they have not been added back in.
He SCREAMS bloody murder when I try to introduce new foods; he goes into hysterics if I even let it touch his plate so he can simply look at it, as I’ve heard recommended (not even telling him he has to eat it!). It’s not worth the battle because he cries so much and gets so upset (and scared?) of the new food, that he can’t even calm down to eat the food I know he will eat. So now I rarely offer a new food to him.
I think he has a lot of texture/gagging issues, as well. He frequently spits food out of his mouth (we’re talking even foods he loves he will sometimes “choke” on and spit out, then take another bite), and there are other clues that he has texture issues.
I can’t even tell you how often I just cry because I want him to be such a good eater (and he was an AWESOME eater until we moved when he was 13 months – we jokingly called him the human garbage disposal because he would eat anything you placed in front of him! It was great). I feel like I am at my wit’s end. Every meal time is a struggle and I am sick and tired of making 6 meals a day instead of 3!
Is there any help you can give us?! I am literally willing to pay for a private consultation or something if it will produce results in my son!
Jessica
Jessica,
Sorry late to respond…we were out of town last week. I’m sorry to hear you are having such a hard time. First off, I would visit his pediatrician and get a referral to a speech or occupational therapist to rule out sensory issues with food. This is an often overlooked issue and with the right therapy can improve greatly. If that doesn’t lead anywhere, then seeing a feeding specialist like a pediatric dietitian can be helpful. You can go to http://www.eatright.org to find one near you.
Last but not least, keep the pressure off and serve meals family style so he can see the food without it touching his plate. Find a multivitamin with iron and give it to him. I’ll be reviewing some good ones for my last post in this series.
The best of luck to you!
I do have a question. We have recently become a dairy free household. In addition to making up the calcium in other food groups, would you need to add more protein to account for the missed dairy servings? We are making a lot of adjustments since going dairy free and I struggle with knowing the correct amount of protein for my 18 month old and 4 year old.
Carine, what are you substituting the dairy with? What other protein foods do your children eat?
Thank you so much for this! It confirms that I’m probably doing an okay job of at least meeting his nutritional needs of my very picky, sweet-tooth of a four year old.
I just have to do a better job of keeping him away from the sugar and all will be well.
Love your blog!
Thanks Liisa! Instead of keeping yoru child away from sugar find ways to sensibly fit in sweet treats so it’s a win win. Here are some tips if you haven’t seen it already http://www.maryannjacobsen.com/2011/02/managing-sweets-part-6-10-strategies-for-ending-kids-sugar-obsession/
Thank you SO much for pointing me in the right direction! Even knowing there’s help out there just makes me breathe easier.
Hi, I am a newly Registered Dietitian as well. I am wondering what program/software you use to run your nutrition assessment. For example, what did you use to get the assessments for the summary/usual intake in your case studies above?
Hi Megan
I use Nutrition Works. Hope that helps!
Maryann
I have 13.5 year old special needs son who is also autistic and who didn’t eat well at all because of his condition so being used to his low appetite when my now 5 1/2 year old daughter come along I was a lil taken aback at her healthy appetite… and have admittedly made some mistakes of enforcement of healthy foods versus non-healthy…limiting sweets more than I should after reading your articles…my wise mother has told me on several occasions that I am making over the sweets too much and sadly I realize now she is right. I do NOT want my daughter to crave sweets as I do at times or “worry” when I do eat them and feel guilty…more than anything I want her to have a healthy relationship with food and sweets. I would love it if you could give me some advice on how to handle it when she wants ice cream or cookies for her afternoon snack. Any other advice would be welcome. Thank you so much.
Gena,
I have a managing sweet series that can help especially this post http://www.maryannjacobsen.com/2011/02/managing-sweets-part-6-10-strategies-for-ending-kids-sugar-obsession/
I also wrote about how I teach my kids moderation with food http://www.maryannjacobsen.com/2013/06/how-i-teach-my-kids-moderation-with-food/
Good luck!
Hi Maryann
I came across your site and it’s fabulous! I have been a teacher my whole life and have been very interested in nutrition and started selling supplements etc, read many books and have researched a lot myself. I want to ask you have you ever heard of Mary ann Shearer? also I have joined a company called mannatech and am giving our little granddaughter glyconutrients (Ambrotose). I would love you to look at http://www.mannatech.com and check it out and tell me what you think. I have signed up with them and will be selling this supplement especially the mannabears to many children. It is always a good idea to get feedback from the proffessionals. I have a naturopath who swears by the product and he is sold on it and says it has helped heal hundreds of people. I started my son on the product and after 28years he no longer has asthma. Please would you take the time just to look at it. I would so appreciate your feedback. there are so many thousands of products on the market.
Warm regards Charmaine