Fortunately, incidents like this are rare, but in 2007 an estimated 3 million U.S. children under 18 years of age had a reported food allergy and 150–200 children died as a result. “Although any child can be at risk for food allergies, children are at greater risk if they are younger than age 3 or have a family history of asthma and allergies, a genetic predisposition to allergic disease, or elevated allergen-specific serum immunoglobulin levels (IgE concentrations),” says the Centers for Disease Control and Prevention (CDC). Eight foods account for 90 percent of all food allergies—cow’s milk, eggs, peanuts, tree nuts, fish, shellfish, soybeans, and wheat. Peanut is among the most common food allergens, along with milk and shellfish.

What is peanut allergy?
Peanut allergy, like most allergies, is an over-reaction of the immune system to a protein that would otherwise be harmless. When individuals with peanut allergy are exposed to peanut protein through ingestion, skin contact, or inhalation, they make allergic antibodies known as immune globulin E (IgE).  These antibodies attach to the surface of cells in the nose, eyes, skin, throat, stomach, and lungs. Peanut protein binds to the IgE antibodies, which in turn release histamine and other chemicals into the surrounding tissues causing allergic symptoms such as runny nose, watery eyes, itching, sneezing, wheezing, swelling of the throat and tongue, and hives.

How does my child get peanut allergy?
It’s unclear why some children develop peanut allergies but genetics play a role. Children whose parents or siblings have food allergy may be at greater risk for developing peanut allergy and may be tested prior to eating peanut products. The allergy community previously recommended that children at high risk for food allergy avoid cow’s milk for the first year of life, egg for the first two years, and peanuts, tree nuts, fish, and shellfish for the first three years. However, there is no strong evidence that these recommendations successfully prevent food allergy in these high-risk children. As a result, in 2008, the American Academy of Pediatrics (AAP) revised its recommendations. “We just do not have the studies to back this up. If a child is going to be allergic to peanuts or eggs, it doesn’t seem to matter [after 4 to 6 months] when you introduce these foods,” says study co-author Frank Greer, MD.

Similarly, the American Academy of Allergy, Asthma, and Immunology does not recommend that breastfeeding mothers (even those with a family history or allergy) change their diets in an effort to reduce their babies’ risk of food allergy. Although not fully understood, several recently published studies imply that earlier exposure to common food allergens (around 6 months) may actually help prevent food allergy in newborns.

What are the signs/symptoms of food allergy?
Food allergic individuals typically experience stomach upset or nausea within 30 minutes to two hours after ingestion. Hives or red, itchy welts are probably the second most common symptom to develop but may occur along with:

• difficulty breathing and wheezing
• red, itchy eyes
• swelling of the hands and face
• difficulty swallowing
• hoarseness
• light-headedness

Small children might grab their tongue or make comments like “there’s a bug in my throat” to communicate their symptoms. In more severe cases, children may experience a loss of consciousness and even death, a rare but devastating occurrence. If symptoms begin more than two hours after ingestion, food allergy becomes less likely. Most food allergy symptoms resolve within 24–36 hours.

What is the treatment?
Peanut avoidance is currently the recommended treatment for patients with peanut allergy. Several academic centers are successfully desensitizing children with peanut and other food allergies but this process involves a high risk of allergic reaction and is not recommended as a routine treatment. In these special centers, children and adults with food allergy are fed their culprit food in gradually increasing amounts until they can tolerate significant portions. Patients continue to eat the food on a daily basis to ensure that an accidental ingestion will not result in allergic symptoms. It’s not known how long an individual may have to continue to eat the culprit food before they actually become tolerant and lose their allergy.

How is peanut allergy diagnosed?
If you want to know more definitively whether your child may be allergic to peanut or other food allergens, skin or blood testing by a pediatrician or a board certified allergist is advised. Unfortunately, both of these tests are plagued by a high false positive rate (up to 50 percent!). However, these tests are quite sensitive, which means that a negative result rules out food allergy with better certainty.

A food challenge (having the child eat a small amount of the culprit food) is the gold-standard method for diagnosing food allergy. However, it presents significant risk for an allergic reaction, therefore it should be conducted by a board certified allergist. Up to 20 percent of patients with peanut allergy will outgrow the allergy, but the real challenge is to determine at what age. Skin or blood tests every 1–2 years may help patients and their allergists figure out when would be a safe time conduct a food challenge.

How can peanut allergy be prevented?
Most allergists advise peanut allergic children to avoid all nuts, including tree nuts such as almonds, pecans, walnuts, etc. Peanuts are actually part of the legume family but approximately 35 percent of peanut-allergic patients may also be allergic to tree nuts.  Parents often find a policy of total nut avoidance easier to follow for their peanut allergic children, especially given the chances for cross-contamination in cafeterias, restaurants, or factories. Breastfeeding mothers with peanut-allergic infants must avoid peanut protein themselves to avoid transfer via their breast milk, as well as oral to oral transfer. (Transfer of peanut protein can occur when a mother eats peanut products and then kisses her baby.)

You can come up with a crazy name for just about any food. Get your child involved in the naming process. Once a food gets a fun name go ahead and call it that whenever it’s on the menu. Funny names often get the best results, such as calling melon balls Little Pixie Basketballs or kidney beans Dinosaur Eggs.

Adding your child’s name to any food or meal gives him a reason to try it and love it. Experiment with something like these: Sloppy Joans, Ben’s Belly-icious Beans, Sophie Soup, or Lillian-burgers. Or name food after the dog or your child’s favorite cartoon characters.

A great way to get younger children engaged in mealtime is to have the food actually “talk” to him. The spaghetti can call your child to the table for dinner. The beans can “ask” to climb into his mouth and visit his tummy. But whenever a food “talks” make sure you use a funny, disguised voice—beans never sound exactly like Mom or Dad, you know.

In addition to fun names you can make any food more interesting by changing the presentation. Try some of these ideas:

• Use cookie cutters or a knife to make fun shapes out of sandwiches, pancakes, and cheese. Shapes, strips, circles, or funny shaped bits can be more fun than a plain old square.

• Use anything other than a kitchen plate to serve up food. It’s so easy to use colorful containers, toy dishes, an ice cube tray, or a muffin tin as dishes. These platters often make a meal or snack more interesting to a child.

• Get artistic! Instead of neat piles on the plate make designs or separate the peas all over the place. While we adults are used to seeing food in tidy designs, lots of kids find a fun disarray more appealing.

• There’s no reason for your child’s food to always be boring beige or white. You can use food coloring to create pink mashed potatoes or purple mashed cauliflower. You can also add a color to water when boiling pasta or potatoes and have green pancakes or orange pasta. Your child can participate by choosing the colors or adding the drops. Foods create color, too—so add blueberries to oatmeal or strawberries to yogurt for more color.

• Get out the craft supplies and help your kids design and make their own placements, a table centerpiece, or napkin holders. If this project is a hit, make it a monthly routine, perhaps decorating the table for each holiday. Once your children have decorated the table they may be more interested in sitting there.

• Purchase a dinner plate set decorated with your child’s current favorite TV or movie character. Or take them to the store and let them choose their own dishes, even if they don’t match your set.

• Use a plate as a canvas and arrange the food as a face or in the shape of an animal. You can even let your child build his own creation then dare him to “eat the nose” or “take a bite of the foot.”

• Get creative with presentation. Your child’s plate doesn’t always have to look the same—with a pile of each different type of food neatly arranged. You can string beans or noodles around the edge of the plate. Try alternating veggies, meat and grain in mini-piles or stripes all over the plate, or combine them to make a design. Get creative when you’re dishing out the next meal and see what happens!

• Combine fun names and interesting presentations to make a meal irresistible.  Stand up broccoli pieces in a bed of mashed potatoes and sprinkle on bits of meat to make an edible forest. Pick a fun name, such as “Dinner Forestville”, or name the forest after your child.

• Have a formal “taste test” as a great way to clear your refrigerator of the week’s leftovers and get your kids to eat. Put out an assortment of foods in small bowls or dishes and invite everyone to take small tastes of various dishes and comment on their flavors. You can also ask your child to be your official taste-tester when you prepare a meal. Ask formal questions, “Do you believe that this contains enough salt, kind sir?” This game can be played over and over!

• Try a different configuration of a regular food. For example, instead of spaghetti with meatballs serve spaghetti with one mega-meatball in the middle of the plate, or instead make mini-meatballs—have lots of them surrounding the spaghetti. Instead of carrots cut in circles make one very long, skinny strip from one end of the carrot to the other, instead of apple pieces make long spirals using a potato peeler.

• Kids love foods they can pick up by hand and dip—so anything that comes with a sauce can be served separately with the sauce in a bowl. Here are a few dipping ideas: fruit in mashed cottage cheese or yogurt; apples in peanut butter; pita bread in hummus; carrots, celery, zucchini and other veggies in ranch dressing; chicken pieces or beef cubes in marinara sauce; meatballs on toothpicks dipped in mashed potatoes.

• Take a look at the presentation of your child’s favorite fast food and present his dinner in a similar arrangement. Fold the chicken into a paper wrapper, serve applesauce in a mini-cup, and stand green beans in a paper cup to achieve an interesting French-fryish appearance.

When you make mealtime more fun your picky eater just might become a lot less picky!

By Elizabeth Pantley; text excerpted with permission by McGraw-Hill Publishing from The No-Cry Picky Eater Solution: Gentle Ways to Encourage Your Child to Eat—and Eat Healthy (McGraw-Hill, 2011).

It can be hard—almost impossible, sometimes—to change your child’s rigidly held eating habits. Instead of trying to overhaul every meal and snack, begin by making a few small changes, one at a time, toward a more nutritious diet. Pick just a few items to start with. Once these become routine, then change another couple of items. If you follow this process, you’ll find that within a year you will have improved your child’s overall diet significantly.

Here are some ideas for some small changes you can make; experiment with them until you find substitutes that your child will accept willingly and watch your child’s diet gradually transform and improve:

1. Replace soda with homemade lemonade or a flavored water drink, and then, over time, begin to substitute plain water as the main beverage.
2. Substitute high-fat beef or pork sausages, hot dogs, or lunch meats with similar versions made of turkey, chicken, or soy.
3. Instead of non-nutritious snacks, chips, or crackers, try pita and hummus, whole-grain pretzels with peanut butter, or veggie sticks with dip.
4. Add a healthy side dish to a typical meal. Raw veggies, applesauce, mixed fruit, or a serving of yogurt can share the plate with everyday favorites.
5. Add sliced fruit, berries, or chopped nuts to a favorite cereal or oatmeal.
6. Serve the same foods as usual, but modify the portion sizes to increase the healthy foods and decrease the less nutritious ones. Slightly increase the amount of lean proteins, vegetables, and whole grains, and slightly decrease the servings of less healthy foods and desserts.
7. Slowly reduce the amount of salt, sugar, butter, cheese, and oil that you use in preparing food. Your child won’t notice small changes, and you can gradually move toward using much less of these ingredients.
8. Examine your child’s favorite foods and make subtle changes to create healthier versions. By making small adjustments over time, your child’s taste buds will adjust until you can finally replace the old version with a healthier alternative. For example, in a peanut butter and jelly sandwich, replace one slice of white bread with whole wheat, mix one-half sugar-based jelly and one-half fruit-only spread, and replace a portion of the processed peanut butter with a low-sugar, non–trans fat version. Over time, increase the amount of the healthier ingredients.

By Elizabeth Pantley; text excerpted with permission by McGraw-Hill Publishing from The No-Cry Picky Eater Solution: Gentle Ways to Encourage Your Child to Eat—and Eat Healthy (McGraw-Hill, 2011).

• Put vegetables on a pedestal. It’s an odd fact that while vegetables are a healthy cornerstone of any diet, they are usually relegated to a back corner side dish. While interesting recipes appear for main dishes, the vegetables are often steamed or boiled in a routinely boring presentation. Start treating vegetables as the star of the meal and your kids will too.

• Name the star of the show. Vegetables rarely get the spotlight. When kids ask, “What’s for dinner?” we name the meat and starch—”Chicken and rice” or “Steak and potatoes”—and don’t even mention the vegetables. From now on, name the veggies first. Create a fun name for the vegetable of the day you can help your children view them in a different light. So, what’s for dinner? “We’re having Brilliant Bunches of Broccoli along with chicken and rice.”

• Search out new recipes for veggies. Try stir-frying a mix of veggies with olive oil to give them an attractive presentation and a unique flavor. Add a sprinkling of nuts or seeds or a dribble of sauce. Mix two or even three kinds of vegetables together for a colorful dish.

• Get artistic. It can be fun to serve vegetables in interesting containers or arranged colorfully in patterns or shapes.

• Let them dip ‘em. Serve a platter of raw veggies with dipping sauce such as ranch dressing, yogurt, or hummus. Kids often prefer raw vegetables over cooked, especially if they can dip.

• Give kids a choice. Routinely serve two vegetables at dinner so that you double the chance your child will eat at least one. Plus, seeing two vegetables will build an expectation that vegetables are important.

• Get sneaky. While you are teaching your child about nutrition, go ahead and hide some vegetables within other recipes to up your child’s daily quota. It’s easy to add chopped spinach to hamburgers, pureed squash into macaroni and cheese, crushed cauliflower into mashed potatoes, or bits of carrots and broccoli into spaghetti sauce. That way your kids get the benefits of vegetables no matter what.

By Elizabeth Pantley; text excerpted with permission by McGraw-Hill Publishing from The No-Cry Picky Eater Solution: Gentle Ways to Encourage Your Child to Eat—and Eat Healthy (McGraw-Hill, 2011).

Is your child unwilling to taste a new food? A picky eater often has to be exposed to something new as many as 10 to 15 times before even tasting it! Children trust familiar things in their lives and are often suspicious of something new and different—this applies to food too. A food that has an unusual appearance, color, smell, or texture can be off-putting to a young child. That’s why repeated exposure helps. Eventually the unusual food becomes familiar, and at that point, the child becomes open to the idea of tasting it and giving it a fair evaluation. Knowing these facts gives us insight into how to introduce new foods and what to expect when we do. Here are a few tips:

• Begin by putting a tiny bit of the new food—such as two chickpeas or one Brussels sprout—on your child’s plate along with regular favorites. Don’t expect him to eat it, and don’t make a comment if he pulls it apart, smells it, or smashes it. Allow the experimentation to occur—it’s the first step to acceptance. If you’ve displayed the new food on your child’s plate 8 to 10 times and he still hasn’t eaten any, then gently encourage him to take “just one bite.”

• Pick one or two new foods at a time and put one on your child’s plate three or four times per week for several months. When he sees it enough times he’ll eventually give it a taste.

• Let your child observe you eating the new food. Mention to your spouse or a friend that you enjoy the food so that your child’s hears your comment. Studies tell us that when children are certain their parents or other important people in their lives really like a food (not just eat it out of duty, but actually enjoy it), they decide it’s a good thing to try for themselves.

Melissa, mother of of 5-year-old Brenna, 4-year-old Gianni, 2-year-old Giulio, and 9-month-old Brydie shares her idea: “To introduce my kids to some new foods, I create a food treasure hunt. I have the kids play in their room so I can put out the food and make a map to each place with clues to the next food spot. They don’t get the next clue unless they try the food at each spot. I try to have only two new or not-so-keen-on foods along with about three things they do like along the way. The treasure at the end is dessert!”

• If you are eating with another adult, offer that person a taste of the new food. Ask her in advance to try it willingly and declare it tasty. When a child sees someone else being adventurous, he may be more willing to do so himself.

• After your child has tried the food and found it at least minimally acceptable (meaning he doesn’t spit it out or gag on it!), try putting it out as an appetizer before dinner is served. If your child is hungry, and it’s the first thing offered, he may actually eat a bite or two.

Catherine, mother to 8-year-old Ben and 4-year-old Birdy tells her tale: “I put kale on his plate and put kale on his plate and put kale on his plate. My son tried it and grimaced, and we praised him for trying it. Pages flew off the calendar, and his beard grew down to the floor, and then one day he ate it without comment. And then one day he ate it and said, ‘This is actually not as bad as I thought.’ After which a pair of bluebirds draped the banner of joy around my shoulders!”

By Elizabeth Pantley; text excerpted with permission by McGraw-Hill Publishing from The No-Cry Picky Eater Solution: Gentle Ways to Encourage Your Child to Eat—and Eat Healthy (McGraw-Hill, 2011).

The more you breastfeed, the more milk you make. By giving your baby water to quench her thirst you can actually cause your milk supply to drop. Since human milk provides not only calories and nutrients, but also protects against a wide range of illnesses, it’s always best to satisfy your baby’s thirst through breastfeeding.

Giving too much water to your baby can actually cause a rare but serious condition known as hyponatremia (read more about hyponatremia here). What is unclear is how much water is too much.

When and how to introduce water
Water lacks nutrients and calories and should never be used as a substitute for breast milk or infant formula. While it may be safe to give a baby who is already eating a wide variety of foods small sips of water in a cup, until more information is available on quantity, parents may find the following suggestions helpful:

• Wait at least six months, and until your baby is eating a variety of foods. The American Academy of Pediatrics (AAP) recommends that solid foods not be given until about 6 months of age. Until then, babies should receive only breast milk or, if that’s not possible, infant formula. Once babies are consuming a variety of foods in addition to breast milk or formula, giving your baby small sips of water in a cup is likely safe. Since there is no evidence to show a safe, upper limit, however, it is best to stick with sips of water rather than ounces of water.
• Recognize foods high in fluids. Babies who eat a variety of foods are likely getting more fluids than their parents realize. Examples of foods high in fluids include fruits, vegetables, and purees.
• Know your water source. Check with your local water supplier or go to My Water’s Fluoride to find out if your local tap water is fluoridated or contains a substantial amount of natural fluoride. If the fluoride level exceeds 0.7 parts per million (ppm) for warmer climates or 1.2 ppm for cooler climates, consider using low-fluoride or fluoride-free water when giving your baby sips of water in a cup or when mixing concentrated liquid formula or powdered formula. If the risk of fluorosis is high, parents are encouraged to use a ready-to-feed formula eliminating the need for added water. While too much fluoride can lead to fluorosis, too little fluoride can lead to tooth decay. The AAP recommends that all children between the ages of 6 months and 16 years receive fluoride supplements if local drinking water contains less than 0.3 ppm.
• Know your plumbing. Since many older homes have lead in their plumbing pipes, parents are urged to run the cold water for 15–20 seconds before putting it in your baby’s cup. Cold water picks up less lead than hot water, and running the water for several seconds ensures you’re not giving your baby the water that has been standing in the pipes, absorbing potential contaminants.
• Give water at mealtimes. Offering small amounts of water at mealtimes can ease a bottle-fed baby’s transition from the bottle to a cup and reduce the risk of tooth decay. Make sure, however, that your baby continues to eat an adequate amount of nutritious foods, since water intake can diminish appetite.
• Start small. Once your child is eating a wide variety of solid foods, you can offer your child small sips of water in a cup. And don’t be surprised if your baby gets more water on herself than in herself!
• Forgo water when your baby is sick. Sick babies are at greater risk for dehydration due to vomiting or diarrhea. Breast milk or formula can usually satisfy your baby’s fluid needs, but sometimes your baby’s health care provider will recommend an oral rehydration solution (ORS) such as Pedialyte. ORSs are designed to replace lost fluids, as well as important electrolytes such as sodium and potassium.
• Check with your baby’s health care provider. Small amounts of water are unlikely to harm your baby, but until researchers determine exactly how much water is safe, parents are encouraged to check with their baby’s pediatrician for specific recommendations based on the baby’s age, weight, and overall health.

If you are concerned that your baby is not getting adequate fluids (i.e., fewer wet diapers or signs of dehydration), contact your baby’s health care provider right away.

Water is the perfect thirst quencher on a hot day—unless you’re a baby under 12 months of age. Breast milk (or formula) provides all the water babies need, even those living in hot climates. Water also lacks the nutrients found in breast milk, and puts babies at greater risk for a serious condition called hyponatremia.

What is the problem with water?
Hyponatremia or “water intoxication” is one of the leading causes of seizures in infants, second only to fever. When babies are given too much water, it dilutes the level of sodium (salt) in the blood. Sodium controls blood pressure and helps nerves and muscles work properly. Sodium is found in the body fluids outside the cells. If the sodium level is low, nearby cells take in water (swell) in an attempt to restore the sodium balance. Most cells can hold the added water. Brain cells, however, are confined within the skull. When brain cells swell, symptoms including hyponatremic seizures can occur resulting in brain damage or even death.

Hyponatremic seizures occur most often in infants under 1 year of age. Their diet contains very few foods, making it hard to replace lost sodium. Also, their kidneys are still developing, so they can’t filter large amounts of water.

Symptoms of water intoxication in infants include:

• irritability or drowsiness
• low body temperature
• swelling of the face
• seizures

Any child who consumes too much water can experience water intoxication, however, the risk is greatest among children who are already dehydrated from a bout of vomiting or diarrhea.

Formula stretching and hyponatremia
A common risk factor for hyponatremia is formula stretching—diluting formula with more water than is recommended. Researchers investigating food insecurity found that some formula-feeding mothers, in an effort to stretch their food budget, water down formula (or skip feedings altogether). Families from two pediatric clinics in Cincinnati, where 45,000 patients from under-served neighborhoods are seen each year, participated in the study. Despite receiving public assistance, about 30 percent of these families (twice the national average) were unable to afford enough food to meet their basic nutritional needs. Among those who couldn’t purchase adequate amounts of food, 27 percent admitted to formula stretching.

Restricting nutrients during a period of rapid brain development, increases the risk for hyponatremia as well as the risk for learning, behavioral, and psychological problems, the researchers caution.

Because formula that is improperly mixed can lead to water intoxication, the American Academy of Family Physicians cautions caregivers to follow the directions on formula containers exactly—always measure carefully and never add extra water.

“Recent evidence suggests that mixing powdered or liquid infant formula concentrate with fluoridated water on a regular basis may increase the chance of a child developing the faint, white markings of very mild or mild enamel fluorosis,” says the Centers for Disease Control and Prevention (CDC).  If your drinking water has high levels of fluoride, the CDC and the American Dental Association (ADA) recommend that parents use either low-fluoride or fluoride-free water when mixing powdered or concentrated formula, or use ready-to-feed formula. Ready-to-feed formula contains little fluoride, reducing the risk for fluorosis. But it also eliminates the need for added water reducing the risk for water intoxication from either improper mixing or intentional stretching.

A 1991 study published in the American Journal of Diseases in Children analyzed 34 cases of water intoxication in infants over a period of 15 years. The researchers found that 24 of these incidents occurred between 1987 and 1990, a sizeable increase for a “previously rare condition.”

Nearly all of the infants (31 of 34) were living in poverty and were given excessive amounts of water by a caregiver. Most often, the water was used to satisfy thirst when the family’s supply of formula had run out.

While cost can be a factor, babies are given water for other reasons. The CDC reports that, in 1993, two infants in Wisconsin were hospitalized for water intoxication associated with bottled water.

Although one of the infants was given several ounces of water for several days because it was less expensive than infant formula, the second baby was given water to help relieve symptoms of an upper respiratory infection. Both mothers reported the labeling on the water they gave their babies led them to believe the products were safe and specifically designed for infants.

Experts from Johns Hopkins Children’s warned in 2008 about recurring cases of hyponatremia in the summer months. They cite that 3–4 otherwise healthy infants are rushed to the hospital each summer after suffering a seizure caused by too much water intake.

Although the seizures may have no lasting effect on the children’s health, the experts from Johns Hopkins noted seizures are “quite dramatic and completely preventable.”

Preventing hyponatremia
During your baby’s first year of life, breast milk or properly prepared infant formula is the best fluid source.

“There is no safe amount of free water for infants,” according to board certified pediatrician and neonatologist, Dr. Angela McGovern, M.D. from The Washington Hospital Center, Washington D.C. “Too much water can not only dilute the salts in the body putting infants at risk for seizures, it can make babies feel full without providing them any nutrition. For best health and nutrition in the first year of life, the only fluid an infant needs is breast milk or properly prepared formula.”

Once your baby is eating a variety of solid foods, McGovern adds, small amounts of water can be mixed with purees to get the right consistency. She noted, however, thinning foods with breast milk or formula is ideal.

By following these simple guidelines, parents and caregivers can reduce the risk of hyponatremic seizures. Water intoxication is a scary condition, but fortunately it is completely preventable.

A final caution—juice is not a substitute for water. Juice should not be given to babies under 6 months of age and should be limited to no more than 4 ounces a day in older babies and young children. Juice is also a poor substitute for breast milk or formula and a major contributor to obesity and tooth decay.

For more information on the safe use of water in babies and young children see “When Is It Safe To Give My Baby Water?”

Mary Elizabeth Dallas is a NY–based journalist with more than 15 years of experience, including CNN and ABC News. She is also relishing her newest challenge… motherhood. Today, she is using her experience to help inform parents on the key challenges and issues they face every day.

Ben’s and Katie’s school day ends at 4:00 p.m. Their participation in assorted afterschool activities a few evenings each week plus Michael’s long work day and commute means that we may not be ready to sit down to a family dinner until much, much later. Take Mondays, for example. Ben has orchestra at school until 5, Katie has dance from 5:30 to 6:30, and Ben has soccer from 6 to 7:30. If we waited for the ideal family dinner—all of us gathered together at the table—no one would eat until 8 p.m. The children would be completely famished, and by the time dinner was inhaled and the dishes were cleared, it would be time to start the bedtime routine.

Challenged by a tight schedule, we resorted to take-out on Monday nights for the first few weeks. But that “solution” set off my parental nutrition radar. Plus, there’s no one catch-all type of take-out that appeals to all of the children, so it seemed like one or more of them was returning home to cruise the countertop for something to fill them up, usually a snack masquerading as a poorly-planned “second dinner.”

So, I’ve started “boxed dinner Mondays.” I pack each child a kid-friendly dinner dominated by veggies (e.g., baby carrots, strips of peppers, cucumber slices, grape tomatoes, broccoli) and fruits (e.g., grapes, bananas, apples) with some other finger foods thrown in (e.g., a wrap, crackers, string cheese, blueberry bread, yogurt tube). In truth, it’s the sort of meal they’d typically find when they opened their lunchbox at school, but in this case we call it dinner.

“It’s a picnic!” Sam declared, during our first boxed-lunch Monday and, really, it almost was. The mild weather let Sam and Katie take their lunch to a picnic table next to the park while we waited for Ben to finish up his musical activity.

I still want to get the “family” back into Monday dinners. But for now I am content with getting the “dinner” back into them.

These mealtime changes I am committed to making aren’t simply due to Monday madness. I’m also working on improving dinnertime overall. I like Dina Rose’s ideas about talking to toddlers with specific messages about “proportion, variety, and moderation.” I think her observations have a lot to offer to parents who want to encourage healthy eating habits in their older children too.

I need to make 2012 the year to improve our eating habits and I could use all the inspiration I can get. So, tell me, what strategies do you use to support healthy eating habits in your children?

Parenting four children between the ages of 47 weeks and 8 years keeps Heidi Green busy! Add in husband Michael, paid work and volunteer work, and life becomes a juggling act. Check in with us every week to find out how she manages (or not), and what she learns in the process.

However, a recent study suggests that banning junk foods from schools wouldn’t have a significant effect on students’ health.

Research
Sociologists Jennifer Van Hook and Claire Altman from Penn State University’s Population Research Institute conducted a longitudinal study to investigate the influence of what they call “competitive foods” (that is, those sold at school that compete with the lunch and breakfast programs) on children’s weight. They drew their data from a nationally representative sample known as the Early Childhood Longitudinal Study, Kindergarten Class of 1998–1999. Van Hook and Altman limited their analysis to the 19,450 children who attended school in the same county in both fifth and eighth grades, the years during which the survey collected data on competitive food sales in the schools.

The researchers looked at:

• children’s age and body mass index (calculated from children’s height and weight)
• competitive food sales venues at school, with data provided by school administrators
• types of competitive foods sold
• school characteristics (e.g., amenities, free and reduced-price lunch recipients, school size)
• family characteristics (e.g., parental marital status, maternal employment, family socioeconomic status, school involvement, and school choice)

Results
The researchers expected “to find a definitive connection between the sale of junk food in middle schools and weight gain among children between fifth and eighth grades,” Van Hook explains. In fact, they found no such connection. Although the percentage of overweight and obese children in the U.S. has quadrupled during the past 25 years, and the availability of junk foods in schools has increased as well, there appears to be no association between the two.

For example, 59.2 percent of fifth graders in this study attended schools where competitive foods were sold; by eighth grade, that figure rose to 86.3 percent. In spite of the significant increase in the availability of competitive foods, Van Hook and Altman found no rise in the percentage of students who were overweight or obese. In fact, the percentage of students who were overweight or obese actually decreased during this timeframe, from 39.1 percent to 35.4 percent.

According to Van Hook, these findings seem to suggest that controlling access to junk foods at school is not an effective way of reducing childhood obesity. Rather, efforts to reduce childhood obesity should focus elsewhere, such as children’s homes, families, and neighborhoods.

This research does have some limitations. First, study tools did not collect specific information about school food sales, such as locations, hours, or rules and policies. It is possible that specific types of policies (i.e., aggressive marketing, sales at events) may be associated with student weight gain. Second, this study is particular to middle school students and cannot be generalized to high school students. Third, it is a report of population-level findings; individual students may gain weight when they have the opportunity to buy competitive foods at school. Finally, this study is not a randomized controlled trial and cannot prove cause and effect.

Recommendations
Although this study fails to find a connection between junk food at schools and children’s weight gain, parents should continue to pay attention to promoting healthy eating habits at home.

Parents of young children should pay close attention to their children’s eating habits. Research supports that children “develop eating habits and tastes for certain types of foods when they are of preschool age,” Van Hook explains, “and that those habits and tastes may stay with them for their whole lives.” Many researchers believe taste develops even in infancy, through the flavors babies experience in their mother’s milk, or even during pregnancy. In other words, the die may be cast long before middle school.

As Van Hook explains, “[s]chools represent a small portion of children’s food environment.… They can get food at home, they can get food in their neighborhoods, and they can go across the street from the school to buy food. Additionally, kids are actually very busy at school… [and] have certain fixed times when they can eat.” School, then, doesn’t provide ‘a lot of opportunity for children to eat’ or ‘eat endlessly, compared to when they’re at home.’”

Parents should provide healthy snack foods at home instead of junk foods. With more free time at home—and more time to eat—children might very well be prone to eating unhealthy snacks and bigger portions if they are readily available. Make it easy for children to grab something healthy by having fruit and vegetables (carrot sticks, green peppers, apples, etc.) washed, sliced, and plated in the fridge.

And lead by example. Display healthy habits at home that the whole family can model.