Ask the Nutritionist

First, believe that change can occur – there are healthy foods your child will enjoy. I see eating habits improve all the time! When possible, get your child involved in meal and snack preparation. If he/she plays a role in food preparation at least a couple times a week, he/she will be more willing to try the foods served. Identify which snacks really need to improve or change entirely. If your child is eating cheese puffs every day, take them off the shopping list for a while. Some kids need a snack or mini-meal after school before dinner because lunch is served early in the day. Healthy and tasty suggestions include:

• A piece of fresh fruit or a small box of raisins or dried apricots
• Canned pineapple in its own juices
• Low fat Greek style yogurt with honey
• Low fat laughing cow cheese with whole grain crisp crackers
• Fruit parfaits – A couple layers of low-fat vanilla yogurt, mixed with a low sugar crunchy cereal and colorful fruit (like grapes, orange segments, pomegranate or berries). Frozen berries can be put in the fridge to defrost and eaten the next day in a parfait at a margin of the cost.
• Whole grain cereal with low-fat milk
• Baked blue corn chips with salsa and, if desired, low-fat melted mozzarella and bean dip (canned refried beans without lard, mixed with a tablespoon of salsa, have great texture and taste)
• Crisp orange baby carrots, sugar snap peas, broccoli, or red or yellow sweet peppers with low-fat dip or hummus (try cutting them into clever shapes or arranging them in fun designs on a plate for greater appeal)
• Low-fat cottage cheese and fruit
• Reduced-fat gouda or Swiss cheese and 100% whole grain crackers
• String cheese and grapes
• Walnuts and raisins (just watch the portion size)
• Fruit smoothies, made with low-fat milk (or soy milk), 1 tsp of honey, frozen banana and any other frozen fruit, cinnamon, and vanilla extract

Fruits contain many of the same vitamins and minerals that vegetables contain, but in different proportions. It's ideal for kids to get a mix of both. But if fruit is all your child will stomach, it's certainly a great choice.

The cons of shunning vegetables? Vegetables contain some unique compounds that fight cancer and heart disease and many of these are not available from fruits. Fruit also tends to be higher in calories than vegetables.

Be sure to continue to offer a wide range of colorful fruits and veggies –kids tastes change and you don't want to miss out on your child adding a new food to his/her diet. The key here is experimentation. Try adding a vegetable that you do not typically serve, or offer them in a different form, or shape. Another idea: have your child find a new veggie to try at the grocery store. Less familiar veggies such as jicama (pronounced Hic-a-ma), celery, or sugar snap peas may spark his/her interest.

A slight tweak may change your child's mind about a certain vegetable. For example, he/she may not like cooked broccoli, but he/she may like raw broccoli slaw mixed with his/her favorite low-fat ranch dressing. Another possibility is trying a variation on that cruciferous staple. For example, cauliflower and broccolini are less bitter and kids may be more willing to eat them.

Spring rolls with lettuce and carrots (not fried) or lightly steamed edamame, (which kids enjoy popping out of the pods) served with soy sauce, are also kid-friendly choices. Sometimes it's just a matter of texture over taste. Your kids may not like cooked zucchini cut into coins, but they may like shredded, cooked zucchini.

Consider adding fresh fruit with dinner if your child repeatedly skips veggies. Mandarin oranges, dried cranberries, or chopped apples make good additions to salads, rice or stuffing. Applesauce is a good side dish and don't forget other fruit foods such as mango or pineapple salsa. I've also added cooked butternut squash in fruit smoothies, pumpkin in pancakes and in vanilla yogurt and shredded zucchini in whole grain muffins.

Kids don't miss a beat, and hearing you talk about what they don't like will likely increase their resistance. "Sneaking" veggies into foods is controversial, but my opinion is that you shouldn't be afraid to sneak in veggies. I make a mean turkey meatloaf with all sorts of undetectable vegetables including minced and pre-cooked onions, chives, herbs, carrots, and zucchini.

All of these tips help create an open environment of trying new foods. Always let the choice of whether to try a food rest with your child. With small children, you can even tell them they have to try one bite, but if they don't like it, spit it out. Gently let your child know it can take a few times before they like the taste – so be sure they try it again the next time you're cooking that meal. Think of a food they didn't like before and enjoy now, and use this as an example.

Fast food is a popular choice in the US, for its perceived convenience and appeal, reinforced by advertising. Each day, almost a third of US children and adolescents eat a fast food meal. Keep in mind that the portions sizes are not the same as they were when you were a kid. Fast food can sometimes pack in two to three times as many calories today than it did 20 years ago. But you can choose healthy foods when eating on the go. Most of the chains provide either on-line or on-sight nutrition information, so be sure to use the information to help you make the best choices.

The first thing you want to watch is the calories. A quarter pounder with cheese, large French fries, and a 12 oz soda will cost you around 1120 calories. If you split an order of French fries, skip the soda, and have a regular hamburger, your meal will only be about 440 calories. Of course, all calories aren't created equal. Fruits, veggies, whole grains, and lean proteins are all related to better health and energy, and you're missing out on all of these when you have a fast-food meal. So a hamburger and fries shouldn't be weekly choices, and I don't recommend soda (diet or regular) for kids.

What should you order when fast food is your only option? Opt for a grilled chicken sandwich without the special sauces. Some chains offer meal size salads, which are a good option too, but be cautious of how much dressing you use -some contain upwards of 200 calories. And when those fries are really hard to resist, split a small or medium order as a family.

It's great to encourage independence with your children, but it's best to have a regular schedule when it comes to meals and snacks. Keeping healthy foods in stock and limiting the amount and type of junk that's on hand makes it much easier to regulate kids' choices. Keep your kitchen stocked with washed apples, baby carrots, sugar snap peas, or pre-portioned low-fat cheese and whole wheat crackers. Offering 3 meals a day and ensuring your kids eat a healthy breakfast helps limit unnecessary snacking and encourages healthy meals, snacks, and overall dietary balance.

If you have a 'young wondering chef' continually interested in the new taste adventures waiting to be discovered in the kitchen, try creating some healthy snack adventures together. Homemade whole grain bars, fruit and yogurt parfaits, mini whole grain muffins, corn bread, and making fruits and veggies into fun shapes with cookie cutters are just a few ideas. Make sure you prepare foods together when you're not in a rush. Involving children in food preparation has many benefits, including fostering a healthy relationship with food, enjoyment of cooking, learning math and measuring skills, following directions, and good food safety habits such as proper hand washing. It's also a great way to spend family time.

There are a lot of ways to save on costs today while preserving the integrity of your diet. Quiche is a great low cost meal that can be made more healthful by adding veggies and low fat cheese, and using a whole wheat crust. . It's a great source of protein and calcium. Another low-cost meal is a chicken, vegetable-rice casserole made with reduced-fat soup, California frozen vegetables, brown rice, chopped onion and leftover chicken or canned white meat chicken.

Here are some other cost-saving tips:

• Buy produce that is in season. For example, buying apples locally when they are in season is less expensive, and much more environmentally friendly, than buying ones that have been shipped across the country.
• Be sure to go grocery shopping with a list and to coordinate the list to your family's weekly menu so you don't fall prey to impulse items.
• Avoid buying too many snack foods, even if they are on sale.
• Always compare unit price stickers on different brands of the same food. Sometimes the ingredients are almost identical, and no-name brands offer good cost savings.
• Choose dry beans over canned beans, and don't forget brown rice – it costs less in bulk and offers a good source of complex carbohydrates, fiber, vitamins and minerals.
• When you see a healthy staple on sale, stock up - just don't over-stock to avoid expiration before use.

If you read food labels, you may be surprised by just how many foods contain sugar or high fructose corn syrup.

Also try to choose products that do not have sugar listed as one of the two first ingredients. Sugar is not always listed as "sugar," but can have different names, including:

• Sugar (also known as white table sugar)
• Fructose, glucose, sucrose
• Corn sweetener
• Corn syrup
• High fructose corn syrup
• Dehydrated cane juice
• Fruit juice concentrate
• Honey
• Invert sugar
• Maple syrup
• Molasses
• Raw sugar
• Dextrose

Be sure to avoid added sugars in products not intended to taste sweet, such as tomato sauce, soups, breads, or frozen waffles. Whenever possible, choose foods that contain natural sugars such as fruit juice.

Although not all nutrition professionals agree that some types of sugars are better than others, I recommend choosing food sweetened with sugar instead of food sweetened with high fructose corn syrup (HFCS). Recent research shows a considerable correlation between high fructose corn syrup and obesity. Because of the way it is digested, high fructose corn syrup does not stimulate insulin secretion, a process that tells your body that calories have been consumed. When insulin is not secreted, overeating is more likely. And this can result in weight gain over time.

Even though sugar is a better choice, keep in mind that too much sugar of any kind introduces lots of calories, but few nutrients, into the body. It's better to enjoy sweet treats that are naturally sweet, high in fiber and complex carbohydrates such as fruit salad and healthy versions of desserts like apple pie with whole wheat crust.

Kids are rarely prescribed a diet, unless their weight puts them at a critical or immediate health risk. Changing the types of foods that the child eats and adjusting the portions are better steps to preventing or treating overweight. These approaches work best for growing children, emotionally and physically.

Encourage your child to eat a healthy breakfast, to eat regular meals, and to engage in exercise most days of the week. Some research shows that, especially for teens, dieting can be counterproductive and can increase the risk of eating disorders and weight fluctuations.

It's best to help children create healthy eating patterns for a lifetime rather than teaching them to deny themselves needed nutrients or to ignore their body's hunger signals. To help young children build a healthy relationship with food and to help your family avoid food struggles, focus on helping your child makes small changes, such as:

1. Help your child feel good about him/herself, no matter his/her shape or size, and model good health behaviors. Focus on choosing healthier foods, increasing fruits and vegetables, whole grains, beans, and lean proteins. Encourage more exercise by getting your child involved in sports, cycling (with a helmet and no head phones), dancing, playing outside, or any other activity he/she enjoys. Get moving as a family by taking family walks, playing tag, creating your own games, or hiking together. Be prepared to make several suggestions for food choices and exercises - kids can be reluctant to change at first. Do your best to stay positive and remember that change can happen, but it progresses in small steps.
2. Evaluate the family diet: Give your family's diet an honest look. Start with the pantry. Are sugar cereals, soda, potato chips, crackers (made with enriched white flour), and cookies staples in your home? Look in your freezer – is it packed with packaged frozen meals, French fries, pizza bites, and ice cream? If so, start by creating a staple make-over list, substituting some of these foods for foods for healthier ones.
   
   Healthy Pantry staples include:
   • Canned pineapple in its own juice, mandarin oranges (great in salads, too), natural, unsweetened apple sauce, baked blue corn chips, salsa, bean dip, low-sugar cereals (100% whole grains on the ingredient list), whole grain crackers, and low-fat popcorn.
   Healthy Freezer Options include:
   • Frozen fruit such as bananas, cherries, mango, peaches, berries. Frozen veggies such as broccoli, petite peas, edamame in its pod (kids like to pop them). Homemade frozen soups, homemade leftovers, chicken breast, whole wheat bread, or whole wheat pizza crusts make good meal starters.
   Fresh Options
   • Pre-washed romaine, spring mix, salad, broccoli slaw, shredded cabbage, baby carrots, sugar snap peas, raw cauliflower and raw broccoli, jicama, sweet potatoes (great for baked fries with seasoning and low fat sour cream).
   • Fresh fruit: bananas (when they get too ripe, peal and freeze for smoothies), apples, oranges, berries, pears, Asian pears and kiwi.
   • If your kids frown at fruits and vegetables, try buying them as fresh as possible (at the farmers market). The fresher they are, the most taste and nutrients they retain.
   Other helpful tips Include:
   • Eat as many family meals per week as possible, sitting down, with television off.
   • Limit fruit juice to no more than 6 ounces a day. Ideally choose water, milk, or 100% juice over artificially sweetened beverages. Avoiding liquid calories is a good choice for an overweight child; although low-fat milk can still be included as a good lean source of protein and calcium.
   • Be a good role model by not bringing too much junk into the house and choosing healthy foods for you as well.
   • Talk positively about food, for example, "choosing the fruit salad over the cookies today will help you have more energy so you'll feel good at dance class and can study for your test."
   • Limit TV and video games to no more than 2 hours a day. Don't put a TV in a child's room; research has clearly demonstrated that it's correlated with obesity later in life. When choosing video games, consider dance revolution or games that involve movement. Kids need 60 minutes of physical activity a day for healthy growth, muscle and even brain development! And did you know exercise helps with improving your memory?
   • A serving of fruit can be included at each meal time to help curb sweet cravings and fuel up with a good source of complex carbohydrates and fiber. Fruit consumption is also associated with better overall health.

Keep in mind that in some states 1 out of 3 children is overweight or obese. It could be that your child is at a healthy weight for him or her personally. The same weight on one child may appear too thin or too heavy on another child.

At your child's wellness visits, the physician documents his or her height and weight on a growth chart. If your child is growing on the same growth curve (the percentile is similar as previously documented), your child may be genetically thin. Your child may have a high metabolism or may be very active, but not necessarily unhealthy.

Be careful about demanding "clean your plate" after meals or making comments such as "you're too thin." Bargaining with kids or offering rewards for additional bites can also take the pleasure out of eating and make kids overeat when their bodies may be saying "stop." Remember, children are not adults, so they don't need to finish adult-size portions.

However, if your child is suddenly dropping weight, talk to your health care provider. It could be that his/her activity level has increased substantially or he/she could be going through a growth spurt. If you're offering healthy foods, your child is probably able to regulate his/her food intake. If your child is complaining about being hungry, consider trying dried fruit, nuts, or avocado slices as snacks, which will provide him/her with a healthy source of nutrient-dense calories.

It's also good to be aware when a child consistently shows negative attitudes about food and eating, as this can signal a budding eating disorder. Some key signs of eating disorders, which can begin early in some children, include: over-awareness of portion sizes or calorie content, fear of weight gain, avoidance social gatherings where food is present, or avoidance of certain food groups.

It depends. Some chicken nuggets include the skin, added salt, and batter that can contain twice as much saturated fat .However, chicken nuggets made of white meat chicken breast and baked in the oven instead of fried can be quite healthful. So it's important to read the ingredient list and food label and then prepare foods in the healthiest ways possible.

To save money and ensure healthfulness, try making your own nuggets by cutting up chicken breast (without the skin), dipping chicken pieces in egg whites, and rolling in seasoned bread crumbs. Again, be sure to bake, not fry, to avoid unhealthy saturated fat. Kids like the appeal of bite-size pieces. Pair them with a salad full of bite size grape tomatoes, or serve healthier sweet potato fries (they do exist, just be sure to read the labels), and a yummy low-fat salad dressing.

Your child may see you doing an activity and feel like he/she is missing out. Try to eat as a family whenever possible. Family meals create the opportunity to sit and be together, share stories and concerns, and, as kids grow older, to learn about what problems or challenges they may be facing. If your children see you standing, they are less likely to stay focused on their meal. It's not always possible to eat as a family, but try to commit to eating together a few days a week. Eating together now, when possible, may make life easier later!

It's also important to note that your child may not be hungry at meal time due to too much grazing or snacking throughout the day. Be sure your child is not filling up too close to meal time. Pay attention to when and what he/she is eating. In addition, sometimes small children aren't comfortable at the table. Help little ones sit up straight by giving them a booster seat or a support (a box or step stool, for example) to support their feet if needed.

Teach your children limits. Discuss with them how healthy foods work in the body to create strong bones, a healthy brain, lasting energy, and immunity against diseases. Kids need most of their calories to come from foods that nourish their bodies. Healthy foods protect your child's DNA, which contains an important list of directions that tells your body what to do.

For parties and gatherings, volunteer to bring in a fruit platter with a flavored yogurt dip. Kids like bit-size pieces of fruit like grapes, pineapple triangles, watermelon, and apples (dip in orange juice first to prevent browning). To save on costs, ask another mom or two to help you split the cost or divide the fruit. Other great party snacks include:

• Healthy food art –create an edible holiday scene with fruit, veggies, cheese, and crackers
• Whole grain crackers and low-fat cheese
• Pita and red peppers cut into interesting shapes and served with hummus or another fun dip
• Watermelon is great for cookie cutter shapes too!
• 100% juice pops made in small Dixie cups. Create your own, healthier version of a classic treat!
• Non-food party favors
• Mini-muffins in place of larger iced cupcakes

Fiber is important for more than just regular bowl movements. It can also reduce the risk of blood clots, decrease inflammation, and lower cholesterol (a growing problem in kids).

Good sources of fiber include fruits, vegetables, beans, and whole grains. Lentils are also jammed packed with fiber and contain diabetes and heart disease-fighting compounds.

Foods that are considered to be high in fiber contain at least 5 grams per serving. Foods with a good source of fiber have 2.5 to 4 grams per serving. But don't be fooled by some cereals that add extra fiber but don't actually contain that much whole grain. Read the ingredient list and look for the words "whole" such as whole oats, whole wheat, and whole rye. If the package lists "enriched" or "bleached" flour as a primary ingredient, it's not a source of health-promoting ingredients for your family or child.

Try replacing traditional pasta with some whole grain pastas, such as whole wheat pasta or a whole wheat blend pasta, spelt, quinoa spaghetti (pronounced keen-wa), Japanese buckwheat noodles (also known as soba noodles) or whole wheat pasta.

Unless your in-laws (or parents, friends, etc.) happens to be a medical doctor or dietitian, you should seek real medical advice. Talk to your doctor and get his/her honest opinion. Even healthy kids can go through a chunky stage, but still remain within a normal growth pattern. It's important to look at family history and track weight and height on a growth chart with your physician. If the physician is concerned, you can ask for a referral to see a Registered Dietitian to help you plan quick, healthy meals and snacks.

Evaluate your diet. Are the majority of the food choices your family makes healthy? I usually recommend aiming for about 90% of your food choices and calories to be healthy for your body and 10% to be "fun" calories. Keep in mind that even reduced fat ice cream has calcium, which is good for your bones. Start including more fruits, vegetables, whole grains and beans in your diet. If you haven't made the switch to low-fat or skim milk, or reduced-fat or low-fat cheese, start to gradually make these changes.

If you have young children it's important to know that overweight prevention should start at age four. By the age of six, children of overweight mothers are fifteen times more likely to be obese than children of lean mothers. Looking at today's adult statistics of overweight and obese adults, three out of 4 teens will become overweight or obese adults. This is not a vanity problem, rather a health problem as kids are being diagnosed with diseases such as type 2 diabetes and high cholesterol. Heart disease, sleep apnea, and other problems are also increasing in young adults. Talking to your physician can help you determine whether you should be concerned now and try to prevent weight or health problems later. You want to be careful not to create an unhealthy relationship with food for your kids, which is correlated to eating disorders in tweens or teens.

Sometime kids just aren't hungry when they're leaving for school really early in the morning. If they have a long bus ride, consider packing a meal to eat during the ride. Healthy whole wheat English muffin pizzas or half a sandwich are good options. You can also make a waffle sandwich with low fat Greek yogurt (won't ooze out), nuts, and fruit. Banana or apple slices with peanut butter or fruit smoothies are also good on the go. Granola bars are a popular choice for a mid-morning snack that kids can keep in their backpacks and eat when they become too hungry. (*Just check for nut content in granola bars and obey your school's nut-containing foods policy designed to protect allergic children.)

Remind your kids of the benefits of breakfast: higher energy, better test scores, and an energetic start to the day.