Supporting Good Nutrition in Children

February is National Children’s Dental Health Month, a time when oral health professionals focus on children’s dental health, including comprehensive oral care for infants, children, adolescents, and children with special health care needs. This vital effort begins by establishing a dental home by the first birthday so preventive and restorative dentistry is provided on a continuous basis, including care for oral trauma and other emergencies. Of course, a cornerstone of effective care is providing preventive oral health education to children and their parents/caregivers.

As health care professionals, the dental team should focus on the overall health of children, as well as their oral health. Nutritional choices are critical to a growing child’s development; therefore, proper nutrition should be encouraged in the dental setting, particularly in age groups spanning infancy through age 5, when parents/​caregivers have the greatest control over what their children eat and drink. With one in every three children in the United States either overweight or obese, all health care professionals should offer nutritional advice.

In October 2019, consensus statements were released on “Healthy Beverage Consumption in Early Childhood.”¹ These statements were created in response to the confusion of parents/caregivers, teachers, and health care providers regarding appropriate beverages for specific age groups. With support from Healthy Eating Research and funding from the Robert Wood Johnson Foundation, representatives from the American Academy of Pediatric Dentistry, Academy of Nutrition and Dietetics, American Academy of Pediatrics, and the American Heart Association met to formulate healthy beverage recommendations for infants and children up through age 5.

AGES BIRTH TO 1 YEAR

During the first 6 months of life, a baby should obtain nutrition from breast milk or infant formula.¹ From 6 months to 1 year, small amounts of water (4 ounces to 8 ounces per day) may be introduced, preferably during mealtimes when solid foods are added to the diet.¹ If the infant is diagnosed with a dairy allergy or lactose intolerance, fortified soy milk is recommended. Other plant-based milks, sweetened beverages, or juice are not advised. When solid foods are introduced between 6 months and 1 year, iron-fortified infant cereal and strained fruits, vegetables, and pureed meats are recommended.²

AGES 1 YEAR TO 2 YEARS

As infants enter their second year of life, pasteurized whole milk (at 16 ounces to 24 ounces per day) should be introduced.¹ This is when additional fluoridated water (8 ounces to 32 ounces per day) should become part of the daily diet.¹ Fiber is also recommended, and fruits and vegetables are encouraged. In addition, whole grains and beans are healthy for children and provide fiber and ­protein.² Over a lifetime, fiber can help prevent heart disease and enhance digestion. This second year of life is when 100% fruit juice may become a part of the diet, but no more than 4 ounces per day is recommended, and parents/caregivers need to ensure the juice does not include any added sugars.¹

AGES 2 YEARS TO 3 YEARS

During the third year of life, solid foods enter into the diet to a greater extent. These are important because they provide protein and fiber.² Eight to 24 ounces of water per day is recommended for 2-year-olds, as well as 16 ounces of skim or low-fat (1%) milk per day.¹ Four ounces of 100% fruit juice per day can be added to the diet at age 2.¹ Please note this is a small amount of juice, so having a sippy cup of juice throughout the day is inappropriate.

AGES 3 TO 5 YEARS

Children ages 3 to 5 should have a diet primarily consisting of solid foods and milk or water. Vegetables should be a part of the diet, as they provide critical nutrients (and ideally become a daily habit).² Again, fiber and protein are important for optimal nutrition. Meats, rice, beans, eggs, and peanut butter all contain protein.² Carbohydrates are needed, but should be eaten in moderation. The US Department of Agriculture recommends a daily intake of approximately 1,000 calories for 3-year-olds, and 1,200 calories to 1,400 calories daily for children ages 4 and 5. Water and milk remain the beverages of choice. Daily water intake for this age group ranges from 12 ounces to 40 ounces.¹ Milk is important for protein, calcium, and other nutrients. Low-fat (1%) or skim milk is recommended in the amount of 16 ounces for 3-year-olds and 20 ounces for 4- and 5-year-olds.¹ In addition, 100% fruit juice can be provided at 4 ounces to 6 ounces per day.¹

Please note that while fortified soy milk is recommended for children with dairy allergies or lactose intolerance, other milks are not advised at any age. This includes flavored milks and plant milks.¹ Flavored milks contain added sugars, so only plain pasteurized milk is recommended.¹ Likewise, sugar-sweetened box juices, diet and nondiet sodas, and beverages with low-calorie sweeteners are not recommended due to added sugar or no nutritional value.¹

CONCLUSION

During a typical preventive dental appointment, appropriate nutritional recommendations can easily be included in educational discussions with young patients and their parents/caregivers. These efforts are critical because helping children off to a healthy start through a proper diet can initiate a lifetime of healthy eating.

As clinicians celebrate National Children’s Dental Health Month, it is important to remember oral health affects general health, and that nutrition is a critical component of overall wellness. Discussions with parents/caregivers and patients about nutrition, particularly at a young age, can help children establish optimal oral health and a lifetime of good habits.

REFERENCES

1. Lott M, Callahan E, Welker Duffy E, Daniels S. Technical Scientific Report. Healthy Beverage Consumption in Early Childhood: Recommendations From Key National Health and Nutrition Organizations. Available at: ​healthyeatingresearch.org/​​research/​​technical-scientific-report-healthy-beverage-consumption-in-early-childhood-recommendations-from-key-national-health-and-nutrition-organizations. Accessed January 14, 2020.
2. American Academy of Pediatrics. Childhood Nutrition. Available at: healthychildren.org/​​English/​​healthy-living/​​nutrition/​​Pages/​​Childhood-Nutrition.aspx. Accessed January 14, 2020.

From Dimensions of Dental Hygiene. February 2020;18(2):16—17.