Expert Tips from Just Ask Children's



Keep your kids healthy with valuable tips and information from experts at Children's Hospital Colorado. Different popular topics are highlighted each month. 

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This month's topic: Nutrition

Good nutrition is important for a healthy life. As a parent, you might have questions about nutrition for your kids, including questions about celiac disease, food allergies or tips for your picky eater. Here are the top 10 questions from parents:

Q: How do I know if my child getting enough fruits and vegetables?  
A: Most children should aim for at least two fruit and two vegetable servings every day. A general rule is that one serving size is equal to the size of the child’s fist. Half of your child’s plate at each meal should be fruits and vegetables. Download this healthy eating place mat (.pdf) to help them see how much they should be eating.

Q: Is it okay to give my child sports drinks to drink daily?
A: Sports drinks are specialized beverages for electrolyte and carbohydrate (sugar) replenishment when needed for long endurance sports. They should be reserved for intense exercise lasting greater than an hour when replacement of these electrolytes is necessary. If your child prefers flavored beverages, try flavoring water with whole fruits (fresh or frozen) to give some flavor without too many extra calories from sugar!

Read more about sports and energy drinks and children.

Q: How do I know if my child is gaining weight appropriately?
A: A child should be expected to follow along his or her growth curve. Ask to see your child’s growth curve each time you visit the doctor’s office. When weights and heights are not following the same curve of lines on the graph is usually when providers will become concerned. Of course, each child is different and your child’s specific case should be discussed with your provider if you have concerns.

Q: How do I teach my child about healthy eating?
A: The best way to promote healthy eating comes from flexible eating. Provide your young children a variety of foods from all food groups (including fruit, vegetables, fats, carbs, proteins and the occasional treat). Allow older children to make choices favoring variety and flexibility. Any eating habits that become too rigid or absolute can turn very quickly into “unhealthy” eating habits. 

Let your child pick combinations of vegetables to create the world's healthiest salad and read more healthy living tips.

Q: My child is overweight and wants to go on a diet – should I allow him/her to do this?
A: No – diets do NOT work. Children and teens can be prompted to be more active and to eat a wider variety of foods. You can work with them on “mindful” eating to pay attention to their body cues. Dieting tends to lead to unhealthy relationship with food and children are more likely to develop unhealthy eating habits and get stuck in a negative cycle if they go on specialized diets. Brandon, a patient at Children’s Colorado, shares his story of getting healthy.

The focus should not be on losing weight, but on being healthy. Focusing on losing weight only could lead to additional issues, such as eating disorders. If you do suspect your child might have an eating disorder, watch this series of videos where our patient, Madi, candidly shares her teen perspective about being treated in Children's Hospital Colorado's Eating Disorders Unit for bulimia.

Q: My kid is a very picky eater and is underweight. How can I get him/her to try new foods?
A: It takes up to 14 times to change your palate to assimilate to new foods – keep introducing them. Try to avoid making a special meal (apart from what the family is eating) for your picky eater. Use nutritional supplements for weight gain (such as boost plus, nutrition shakes) etc. If your child refuses to eat the meal you prepare allow them 1-2 options that are easy to make (i.e. cereal, sandwich) or ideally, something he/she can prepare him/herself so that you do not allow his/her eating habits to control your family.

It may take many tries before a child likes it. Only put a little bit of foods they think they don’t like on the plate and praise them just for tasting it. You can avoid the power struggles with your picky eater. 

Q: How do I make sure my child, who is very active in sports, is eating enough?
A: You need to make sure your child is eating enough to support growth and appropriate weight gain and when he/she is very active, and that sometimes requires you to pay closer attention to how much he/she is eating. Sometimes kids will be hungrier when active, but sometimes heavy activity actually makes kids have less of an appetite. In general, kids should eat 5-6 times per day. More active kids should eat larger, more nutritionally dense snacks in between meals.

The right foods and drinks can help your child as an athlete. Read more about the nutrition needs of athletes and how your child should be eating before playing sports.

Q: My friend’s child has celiac disease and thought my kid might, too. What exactly is celiac disease, and what are the symptoms?
A: Celiac disease is an autoimmune disorder that causes injury to the small intestine. It occurs when someone born with a genetic risk develops an immune reaction to dietary gluten. Gluten is a protein that comes from wheat, rye and barley, and is found in many foods. The symptoms for celiac disease are different for different people. Some children may grow poorly and can be very sick with vomiting, diarrhea, abdominal pain and irritability. Other children may have no symptoms and may not have go to the doctor unless they know they have a genetic risk and want to be screened.

Watch this helpful video about celiac disease, or learn how we diagnose and treat it through the Colorado Center for Celiac Disease at Children’s Colorado. 

Q: If my child has a food allergy, would we see a reaction immediately?
A: Not necessarily. IgE-mediated food allergy symptoms can be immediate, typically occurring within minutes up to 2 hours after exposure. The most common IgE-mediated food allergens are milk, eggs, soy, wheat, peanuts, tree nuts, fish, shellfish. (Note: IgE is an antibody. We make other antibodies that are part of the immune system and protect us from getting sick; for example, when we get a tetanus vaccine, we make IgG antibodies that protect us in the future from a tetanus infection. When IgE antibodies are made to a food, they can cause usually rapid onset allergic reactions including hives, swelling, or anaphylaxis.)

Learning how to recognize an allergic reaction will help you get your child the medical care needed if a reaction occurs. Symptoms might include a runny nose; an itchy skin rash; a tingling in the tongue, lips, or throat; swelling; stomach pain; or wheezing.  

A serious allergic reaction with widespread effects on the body is known as anaphylaxis. This sudden, potentially life-threatening allergic reaction that requires epinephrine include:

  • Hoarseness
  • A sensation of tightness in the throat
  • Difficulty breathing
  • Any symptoms from two or more of the body systems, such as hives and stomach pain, or any other combination of two or more symptoms that affect different parts of the body

Other types of food allergy, called non-IgE mediated food allergy, can  have delayed reactions occur more than 2 hours after ingestion. A common non-IgE mediated food allergy is call food protein-induced entercolitis (FPIES). Patients with FPIES most often develop severe vomiting and/or diarrhea 2-4 hours after food ingestion. Another example of a non-IgE mediated food allergy is celiac disease. 

See more about the signs and symptoms of food allergies and check out this helpful infographic about food allergies. If your child has a food allergy, make sure they are prepared to stay safe at school as well.

Learn more about food allergies and how the pediatric experts at Children’s Colorado can help. 

Q: Should I wait to introduce certain foods to my baby to avoid food allergies?
A: It’s most important to introduce a baby to new foods gradually, one at a time. If not, you may have trouble tying an allergy to a specific new food. 

The type of food or the order in which food is introduced is not much of a concern, as long as the foods you are offering are healthy and well-balanced for the baby. Each time you offer a new food, you should wait three to five days before giving him/her a new food. Don’t eliminate the other foods your baby is eating during that time; you already know these are safe because the child has not had any food reactions up until now. Just don’t add anything else new.

There are new recommendations on when to introduce some of the major food allergens (milk, egg, soy, wheat, peanut, tree nuts, fish, shellfish) into a child’s diet. Introducing these foods as new foods are recommended earlier than previously, as there have been studies showing that earlier introduction (before ages 2-3 years) may prevent the development of food allergy. Some patients with eczema or who have had allergic reactions to a food previously should see an allergist before introducing these foods though. 

If you’re introducing a new food to your baby, keep an eye out for these symptoms:

  • Hives or welts
  • Flushed skin or rash
  • Face, tongue, or lip swelling
  • Vomiting and/or diarrhea
  • Coughing or wheezing
  • Difficulty breathing
  • Loss of consciousness

Some infants may not tolerate certain milk or soy formulas. If you think that your child is not tolerating a formula or you think that your child may have milk or soy allergy, talk with your doctor about testing and alternatives to milk or soy-based formulas.​​ Breastfeeding your child can lower his/her risk of developing a milk allergy over those who are formula fed.