August 19, 2008
Family Meals Focus #29
Interpreting the news and research about feeding and eating

Concern about children and heart disease, which was taking second place to hysteria about children and overweight, has again been activated by an American Academy of Pediatrics (AAP) position statement, ''Lipid screening and cardiovascular disease in childhood.''¹

The AAP recommends that:

1. All children over age 2 years follow a diet based on the Dietary Guidelines, including use of low-fat diary products.
2. Children as young as 2 years who have risk factors for heart disease or whose family medical history is not known be screened for high total cholesterol, LDL, HDL, and triglycerides.
3. Children whose lipid levels are above the 75th percentile for age be referred for nutrition counseling in a diet that is, essentially, the Dietary Guidelines.
4. The very few children 8 or older with very high concentrations of LDL,way above the 95th percentile,be considered for statin treatment to drive levels below 160.¹

Fortunately, only a very few children are in that very-high-risk category. For the rest, my objection to the AAP statement is the naivet, that attends laying out arbitrary guidelines for what and how much children should eat. No child ever ate according to a formula, and parents who try to impose a formula condemn themselves and their child to chaos and conflict.

If your child has a particularly high risk of heart disease, and if you and your doctor have determined that he needs a special diet, I agree with the AAP that you get careful and informed dietary guidance from a registered dietitian to avoid nutritional deficiencies and poor growth. If your child is not in the high-risk category, here is how to help without harming:^2,3

• Don't try to force your child's fat intake down to 30 percent or below.
• Instead, follow the division of responsibility in feeding and have regular and reliable family meals with choices from the five food groups: meat and other proteins, breads and cereals, fruits and vegetables, milk and other dairy and fats and spreads such as butter and salad dressing.
• Vary fat concentrations in meals and snacks by offering some foods that are low in fat, some moderate, and some high. Whole milk is an appropriate high-fat food throughout the growing-up years.
• Vary fat sources by choosing monounsaturated, polyunsaturated, and saturated fats.
• Encourage your child to eat what and how much he wants from what you put before him.
• Enjoy your own food.

Given such meal-management strategies, both you and your child are likely to automatically consume a balanced, moderate-fat, low-saturated-fat diet. But even more importantly, those strategies will preserve your child's positive eating attitudes and behaviors. That will do more for him in the long run than trying to impose a formula on his eating.

References

1. Daniels SR, Greer FR, and the Committee on Nutrition. Lipid Screening and Cardiovascular Health in Childhood. Pediatrics. 2008;122:198-208.

2. Satter EM; Appendix M: Children, dietary fat and heart disease--you don't have to panic. Secrets of Feeding a Healthy Family. Madison, WI: Kelcy Press ; 2008:279-281.

3. Satter EM. A moderate view on fat restriction for young children. J Am Diet Assoc. 2000(100):32-36.

Copyright © 2008 by Ellyn Satter. Published at www.EllynSatter.com.