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The Yale Guide to Children's Nutrition

The Yale Guide to Children's Nutrition

William V. Tamborlane EDITOR IN CHIEF
Janet Z. Weiswasser MANAGING EDITOR
Teresa Fung
Nancy A. Held
Tara Prather Liskov
Foreword by Jane E. Brody
With recipes from famous chefs of the James Beard Foundation
Copyright Date: 1997
Published by: Yale University Press
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  • Book Info
    The Yale Guide to Children's Nutrition
    Book Description:

    What is the healthiest diet for an infant? What constitutes a nutritious school lunch? How do I deal with my adolescent's eating needs and habits? Will my children receive proper nutrients if they are sick, very athletic, or vegetarians? This authoritative resource answers these and dozens of other questions, not only presenting the latest scientific knowledge about nutrition but also providing recipes from famous chefs for delicious and healthy dishes. The book, written by physicians and dietitians at the Yale University School of Medicine, an international leader in pediatric teaching, research, and clinical care, as well as by dieticians, nurses, and social workers at the YaleNew Haven Children's Hospital, is the most authoritative, comprehensive, and informative guide to childhood nutrition ever produced.The Yale Guide to Children's Nutritionincludes:• information about nutritional needs at the different stages of childhood and adolescence;• advice on how to cope with a picky eater and what to feed a sick child;• special nutritional requirements for children with high cholesterol, eating disorders, allergies, diabetes, cystic fibrosis, metabolic disorders, and other conditions;• explanations of such nutritional components as calories, proteins, carbohydrates, fats, and vitamins-and examples of foods that are sources for each of them;• suggestions for healthy snacks;• ideas for eating in restaurants with children;• recipes provided by restaurants and chefs from all over the United States.

    eISBN: 978-0-300-17489-2
    Subjects: Health Sciences

Table of Contents

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  1. Front Matter
    (pp. i-v)
  2. Table of Contents
    (pp. vi-viii)
    (pp. ix-xii)
    Jane E. Brody

    This book can help you develop and execute guidelines that can be readily incorporated into family life, regardless of the structure and circumstances of your family. It contains recipes with child appeal from some of the best chefs in the United States, as well as wisdom from some of the leading scientists in the field of children’s health. Not only will your children benefit, but in all likelihood you will too. There is no better time to get yourself on a sensible nutrition track than when your children are learning from your example.

    Of the many things I have produced...

    (pp. xiii-xiv)
    William V. Tamborlane
    (pp. xv-xvi)
  6. PART ONE From Infancy to Adolescence:: Developmental Nutrition

    • 1 Measuring Up: Normal Growth and Development
      (pp. 3-8)

      Over the course of fifteen to eighteen years, remarkable changes occur in the human body: small, helpless newborn infants are transformed into physically mature young adults. It is particularly important to discuss the normal processes of growth and physical development in children because virtually any disease that a child develops can adversely affect growth and development. Moreover, normal growth and development depend on good nutritional practices, which vary according to the age and developmental stage of the child.

      The termgrowthusually refers to increases in the weight or length of the child as a whole or of a specific...

    • 2 The Digestive Process: What Happens after You Swallow?
      (pp. 9-15)

      Food provides the body with all the fuel, nutrients, and raw materials it needs for growth, physical activity, maintenance of tissues, metabolic processes, and fights against infections. But if food is to be of any value to the body, it must first be transformed, mechanically and chemically, by the process of digestion, as the food is propelled along the gastrointestinal (GI) tract. Food must then be transported from the intestine, or bowel, to the bloodstream by the process of absorption. Most nutrients in undigested food, however, are bound in large molecules that are too big to pass through the lining...

    • 3 Taste, Smell, and Food Preferences
      (pp. 16-24)

      Parents hope their children will have a positive attitude toward eating and will like foods that are healthy. They may wonder why their children like some foods and not others. Children are born liking sweets and disliking bitter tastes. The ability to taste sweetness and bitterness varies genetically, so this may explain some differences in food preferences among children. Learning also plays a large role. Children develop food preferences through positive and negative interactions with their environment. A positive interaction could be regular, relaxed family meals, while negative experiences could include the use of food as a reward or the...

    • 4 Pyramid Power: A Guide to Healthy Eating
      (pp. 25-29)

      The first dietary guidelines for Americans were published in the 1890s. Those early guidelines recommended the consumption of adequate protein, fat, carbohydrate, and calories. Through the years the content and emphasis of subsequent guidelines have shifted considerably, as new knowledge was obtained and socioeconomic conditions changed. At one time as many as twelve food groups were identified. In the 1920s and 1930s, as the importance of vitamins and minerals became recognized, dietary guidelines changed from recommending an adequate intake of macronutrients (protein, fat, and carbohydrate) to advocating an adequate intake of micronutrients (vitamins and minerals). In 1941, the first Recommended...

    • 5 Infancy: Eat, Sleep, and Be Happy
      (pp. 30-44)

      Infancy (the first 12 months of life) is a time of great change; the changes that take place in both growth and development occur at a rate that will never be equaled in future life. By 4–5 months of age, for example, an infant will have doubled his or her birth weight, and the birth weight will have tripled by 12 months. Newborn infants, who are unable even to hold up their heads without support or to reach out for food, develop into 1-year-olds who can walk and feed themselves. During this first year, the digestive tract and immune...

    • 6 Toddlers and Preschoolers: Emerging Independence
      (pp. 45-59)

      PSYCHOLOGICAL DEVELOPMENT AND FOOD Nutrition and eating concerns are never more prevalent than during the toddler phase of childhood (between 1 and 3 years of age). Babies enter toddlerhood approximately when they celebrate their first birthday or take their first steps. It is generally safe to say that if a child has begun to utter “no” with some regularity or has had a temper tantrum, the child is in the throes of toddlerhood.

      The transition from infancy to toddlerhood is often difficult for parents. The once docile, smiling, cooing infant is now an ambulatory, opinionated risk taker with a short...

    • 7 School-Age, Preadolescent Children: An Apple a Day
      (pp. 60-63)

      The school-age child presents new nutritional challenges for parents. According to a national survey, most school-age children in the United States eat at least five times a day, and almost all eat at least three times daily. The challenge, then, is for parents to influence their school-age child’s food choices even though the parents are no longer able to control the choices directly. Parents must ensure that their children eat a balanced diet at home and at school, and also avoid battles over food selection and mealtimes. In many ways, the school-age preadolescent child is the ideal child to parent....

    • 8 Adolescence: Life in the Fast Lane
      (pp. 64-74)

      Diversity characterizes the growth patterns, the sequence of sexual maturation, and the nutritional requirements and choices of adolescents. At no other point in their lives are two people of the same age likely to be so different. The most consistent difference among adolescents is that girls’ growth spurts begin about two years before those of boys. The growth spurt of adolescent boys and girls can occur at an average age or as much as two years earlier or later than average. Such a growth spurt occurs in no other phase of life and is closely linked to the process of...

  7. PART TWO Common Concerns

    • 9 Food and the Family
      (pp. 77-83)

      Children begin to develop a relationship to food in early infancy, and many of the patterns children establish will remain with them throughout their lives. Parents need to remember that children grow at different rates and that all are capable of regulating their food intake. When parents understand this, they can maximize the possibility that their children will develop a healthy, positive relationship with food.

      The family table should be a place for communication and comfort, a place for socialization as well as enjoyment of tastes. A happy table is often indicative of a happy family. It is important for...

    • 10 Not All Vegetarians Are Created Equal
      (pp. 84-87)

      Vegetarianis a general term used to describe people who exclude meat, fish, poultry, or animal-derived foods from their diets. Vegetarian diets have become increasingly popular in recent years. The increase in popularity may be due to philosophical, religious, ecological, or health-related concerns, or to some combination of these. Both vegetarian and meat-containing diets can be beneficial, if they are well planned and combined with a healthy lifestyle. But both kinds of diets can also lead to nutritional problems if a balanced combination of foods is not eaten.

      Just as there is diversity in people’s reasons for becoming vegetarians, there...

    • 11 Feeding the Sick Child
      (pp. 88-91)

      Most childhood ailments are accompanied by a loss of appetite and therefore a decreased intake of fluids and solid foods. There are no hard and fast dietary rules regarding these illnesses. Instead, feed children as much as they want without forcing food or forcing the issue.

      Fluid intake must be maintained in a child who is nauseous or vomiting, has diarrhea, or is refusing to eat. Basic fluid requirements are given in table 11.1; every attempt should be made to get the child to drink at least this amount of liquid in a day. If vomiting and diarrhea persist, extra...

    • 12 Too Fat? Too Thin?
      (pp. 92-96)

      Many parents worry about their child’s growth and weight gain during the course of development from earliest infancy through the end of adolescence. Depending upon the child’s characteristics and the parents’ attitudes, parents may be as concerned about excessive weight gain as they are about inadequate weight gain. Further complicating these issues are the child’s eating patterns and the parents’ approach to food.

      Parents are not the only people who worry about weight and weight gain. Although many people assume that our society’s emphasis on leanness affects only adolescents, a surprisingly large proportion of young children develop concerns about their...

    • 13 Energizing the Young Athlete
      (pp. 97-107)

      Participating in athletics and physical activity offers a refreshing alternative to the typical American’s sedentary lifestyle, and children who are interested in sports should be encouraged to be as active as their schedule will allow. Children have different dietary needs from adults, and special attention should be given to the nutritional requirements of the active child. In addition to training and talent, the foods athletes use to fuel their bodies can make the difference between sitting on the bench or being on the starting team.

      The optimal sports diet for children builds on the basics of proper nutrition set forth...

    • 14 Acne and Diet: Is There a Connection?
      (pp. 108-111)

      Adolescence is a time of stress for both parent and child; the parent is learning to limit advice to significant issues, and the adolescent is striving for independence. This struggle can spill over into the physician’s office when the family seeks treatment for teenage acne. Acne is, as parent and teenager both agree, an unwanted marker of the transition from childhood to adulthood. Acne may also become the focus of disputes over behavior modification, with the parent invariably looking to the physician to support the notion that the adolescent’s “terrible eating habits” are at least making the acne worse, if...

    • 15 Alcohol Use and Abuse in Adolescents
      (pp. 112-117)

      Alcohol is one of the most readily available and commonly abused drugs. Problems with drinking and alcohol abuse often begin early. A 1994 survey of high school students found that 92.2 percent had consumed alcohol at least once, and 66.4 percent admitted to drinking in the previous month. It is estimated that by the eighth grade, more than 300,000 children in the United States are binge drinkers, and this number doubles by tenth grade. Use and abuse of alcohol in teenagers is associated with failing grades, dropping out of school, serious accidents and injuries, violent crimes, and death. Alcohol is...

    • 16 Diet Tips to Keep That Winning Smile
      (pp. 118-122)

      Dietary factors are known to affect oral health in three major ways: (1) a balanced diet provides the essential nutrients needed for the growth and development of healthy gums and teeth, which in turn provide resistance to oral disease; (2) fluoride, a trace mineral, is known to protect tooth surfaces from destruction and demineralization; and (3) various foods play a role in the promotion or prevention of dental caries (cavities or tooth decay).

      A nutritionally adequate diet is an essential ingredient for the growth and development of healthy teeth, gums, and jaws. Children need essential minerals, including calcium, phosphorus, and...

  8. PART THREE Beyond the Basics:: Special Challenges in Nutrition

    • 17 Eating Disorders
      (pp. 125-132)

      Most children go through at least a brief episode of giving their parents a hard time about food and eating. Food refusal, eating only a very narrow selection of foods, sneaking food, eating at the “wrong” time, and exhibiting rituals around food are among the more common complaints parents report about their children’s eating habits. What sets eating disorders apart from more minor eating-related concerns is the fact that they represent enduring patterns of behaviors that are associated with serious health problems and marked psychological disturbance. Although eating disorders are most often associated with girls, they do occur in boys...

    • 18 Childhood Obesity
      (pp. 133-139)

      Obesity is becoming the most common and serious nutritional disorder in children in the Western Hemisphere. It is estimated that 10–25 percent of children in North America are substantially overweight, and the prevalence of this disorder is on the rise (see chapter 12 for the definition of obesity). Most important, an obese child has a much higher likelihood than a nonobese child of becoming an obese adolescent and adult. Furthermore, studies have shown that adults who were overweight during adolescence had a twofold greater risk for coronary heart disease than those who were not overweight. Prevention and treatment of...

    • 19 Food Allergies
      (pp. 140-147)

      The many kinds of adverse reactions to foods have led to confusion and controversy over food allergy. Food allergy has been blamed for a wide variety of symptoms, including hyperactivity and learning disabilities, chronic fatigue syndrome, behavior disorders, asthma, and anaphylaxis, though in most instances there is no scientific evidence for such an association. Much of the popular press that discusses food allergy relates to anecdotal experiences which do not stand up to rigorous examination.

      The broad term used to describe these reactions isadverse reactions to foods. These may be classified as allergy if they are mediated by the...

    • 20 High Blood Cholesterol
      (pp. 148-160)

      Cholesterol and triglycerides are fats, also called lipids, which are carried in the bloodstream. Individuals in whom these values are abnormally high have hypercholesterolemia, or hyperlipidemia, respectively. This is an inherited disorder, although occasionally hyperlipidemia may be due to some secondary causes like certain illnesses, medications, or dietary habits. Both dietary and medical treatment can help to correct elevated lipid levels.

      The most frequent cause of death among adults in the United States is atherosclerosis (thickening of the arteries due to accumulation of lipids in the artery walls). Such thickening leads to coronary heart disease, stroke, and circulation problems in...

    • 21 Diabetes
      (pp. 161-169)

      Diabetes mellitus (derived from the Greek words for sweet urine) is one of the most common chronic childhood illnesses, affecting 1 in 500–600 children under 18 years of age in the United States. Diabetes in childhood presents parents, children, and physicians and other clinicians with special challenges. On the one hand, diabetes is a very difficult condition to treat, involving daily insulin injections and multiple ringer pricks to test blood glucose levels. On the other hand, the more effectively diabetes is regulated during childhood, the fewer health problems the child with diabetes will have when he or she reaches...

    • 22 Cystic Fibrosis
      (pp. 170-174)

      Cystic fibrosis (CF) is an inherited disease that affects the secreting glands (exocrine glands) of the body. These glands are located in the respiratory tract, the digestive tract, the reproductive tract, and the skin. The exocrine glands produce watery secretions such as mucus, digestive juices, saliva, and sweat. These secretions are essential for normal bodily functions. In CF, instead of producing thin, watery secretions the exocrine glands in the respiratory and digestive tracts secrete thick, sticky mucus which often clogs up the glands. When these glands get plugged up they do not work efficiently or correctly. Consequently, the body processes...

    • 23 Gastrointestinal Disorders
      (pp. 175-180)

      Children with gastrointestinal disorders often exhibit poor growth, poor weight gain, or other evidence of nutritional deficiencies. Such children often have specific nutritional needs, and their symptoms may improve with special dietary management. The first part of this chapter will focus on common, everyday problems in this area in children, and the latter part will discuss more serious chronic illnesses that can affect the gastrointestinal tract in children.

      CONSTIPATION Constipation is a common problem in childhood and may be exacerbated by the tendency of younger children to withhold stool for fear that passing it will hurt. If stool is retained...

    • 24 PKU and Other Metabolic Disorders
      (pp. 181-187)

      The chemical processes that govern food use by the body are known collectively as metabolism. Inborn errors of metabolism are inherited conditions that affect the normal use of food by the body after the food has been digested and absorbed. These disorders can involve the production or breakdown of carbohydrate, fat, or protein, which results in accumulation of toxic compounds or a deficiency in a crucial compound (table 24.1). The liver, brain, kidneys, bone, and heart can be damaged as a consequence. Fortunately, many of these conditions can be successfully treated with special diets that regulate the intake of the...

    • 25 Feeding the Infant with Cleft Lip and Palate
      (pp. 188-194)

      Clefts of the palate are relatively common facial disorders which occur in approximately 1 in 1,000 children born in the United States. Clefts of the palate may be associated with other anomalies including cleft of the lip or the small lower jaw (mandible). Because the cleft involves distortion of the mouth structure, it can affect a child’s ability to feed. Some babies have few feeding problems, whereas others experience significant difficulties, particularly when clefts are associated with an underdevelopment of the lower jaw. Children with clefts present a challenge to parents and health care professionals alike in achieving the goal...

    • 26 Attention Deficit Hyperactivity Disorder
      (pp. 195-198)

      Attention deficit hyperactivity disorder, or ADHD, is one of the most common neurobehavioral disorders that affect children. As many as 15–20 percent of children may be affected by ADHD, and four to five times as many boys as girls are affected by the disorder. ADHD’s broad range of symptoms generally pertain to both learning and behavior. Symptoms related to learning problems include difficulties paying attention and concentrating, and a tendency to distractibility, particularly in group settings. Symptoms that reflect behavior problems include indications of hyperactivity, fidgetiness, and impulsivity. These are the children who are always in motion, cannot sit...

  9. PART FOUR Building Blocks for Good Nutrition

    • 27 Calories: The Key to Energy Balance
      (pp. 201-204)

      Food is the fuel the body uses to maintain its essential functions and to grow and perform physical activities. Food is converted into chemical energy for use by the body. Energy from food is expressed in kilocalories or, as they are more commonly called, calories. A calorie is a standard unit for measuring energy produced by food or energy expended by the body. Technically, it is the amount of heat energy required to raise the temperature of 1 gram of water by 1 degree Celsius.

      Different foods provide differing amounts of energy (calories). All foods contain varying proportions of the...

    • 28 Protein: The Bodyʹs Building Blocks
      (pp. 205-208)

      Variety and moderation are the foundations of a well-balanced diet. In addition to adequate amounts of carbohydrate, fat, vitamins, and minerals, the body also needs protein. This chapter answers common questions about protein: what is protein, what does it do, and how much protein is enough for a young growing body?

      Proteins are complex chemical compounds found in every living cell in the body. Human body proteins are built from 22 different units called amino acids, of which the body can manufacture only 13. The other 9 are called essential amino acids because they cannot be synthesized by the body...

    • 29 Cash in on Carbohydrates
      (pp. 209-214)

      Foods are composed of 3 major nutrients: carbohydrates, protein, and fat. Of these, carbohydrates, which are found in grains, vegetables, fruits, and milk, provide the major source of energy in most diets throughout the world. By weight, each gram of carbohydrate (regardless of type) contains 4 calories of energy. For example, a teaspoon of refined sugar, weighing about 5 grams, provides 20 calories of energy. Protein also provides 4 calories per gram, whereas fat provides 9 calories per gram. Carbohydrates give sweetness, texture, thickness, and emulsifying properties to food.

      Authorities generally agree that carbohydrates should comprise a large proportion of...

    • 30 Whatʹs the Skinny on Fats and Cholesterol?
      (pp. 215-228)

      In contemporary times, dietary fat has been viewed as the cause of many ills. Yet we need to remember that fat in the diet is both an essential nutrient and adds to the enjoyment of eating. Without fat, many foods would not be as tasty and would lack texture, satiety, and structure. In the body, fats are necessary for cell membrane structure and important blood-clotting functions. Once fats are digested and absorbed, they become carriers for the fat-soluble vitamins A, D, E, and K. Cholesterol is a necessary component of various hormones that the body must produce for good health....

    • 31 Facts and Myths about Vitamins and Minerals
      (pp. 229-239)

      Although vitamins do not provide energy to the body, they are essential nutrients that allow critical metabolic processes to occur. Vitamins are essential in the diet because the human body usually cannot manufacture them. Over the years functions have been ascribed to vitamins by observing what happens in various states of vitamin deficiency. Vitamins are grouped into two major classes: fat-soluble vitamins, including vitamins A, D, E, and K, and water-soluble vitamins, including the B complex vitamins and vitamin C.

      FAT-SOLUBLE VITAMINS Vitamin A was discovered in the early twentieth century. Investigators discovered a fat-soluble substance that, when deficient, appeared...

    • 32 Water: Drinking for the Health of It
      (pp. 240-243)

      This chapter is about water—the soup stock of life. It explains why water is important and what happens when too little or too much water is consumed. Water is even more essential to the body than food. A person can live without food for several weeks, but a person can survive without water for only several days. Water is by far the largest component of the body, as well as the most plentiful substance in the diet. The body of a baby is 70–85 percent water, whereas the body of an average adult is 60–70 percent water....

    • 33 Salt: The Spice of Life or the Taste of Doom?
      (pp. 244-251)

      In the past three decades a number of divergent and often contradictory trends have surfaced in the dietary habits of Americans, especially regarding the intake of salt. These diverse trends have led to such extreme manifestations as, on the one hand, the practice of salt loading in athletes, and on the other, the production of salt-deficient formula for infants. The contribution of a high-salt diet to high blood pressure and heart disease has led some to pursue a low-salt diet with near religious zeal. For certain people, this is quite appropriate, but the application of this approach to everyone, especially...

    • 34 Fantastic Fiber
      (pp. 252-256)

      Fiber is an essential part of the diet and has many beneficial characteristics, even though it is not digested or absorbed, and it does not provide any calories, vitamins, or minerals. Fiber influences the digestive system in many ways. It helps regulate the bowel and has been shown to have protective effects against the development of many diseases. A high-fiber diet is thus good for a child’s health, both now and for the future.

      Dietary fiber is the part of fruits and vegetables that cannot be digested by humans. It is also commonly referred to as “roughage.” Only plants contain...

    • 35 Fresh Facts about Pesticides and Food Additives
      (pp. 257-264)

      Food additives are very important to our food supply, and without them, the wide variety of foods that are available today would not be possible. The use of pesticides has dramatically increased the production and year-round availability of fresh produce, Many people are concerned about pesticides and food additives, however, and they wonder if purchasing organically grown foods is a reliable way of ensuring that they are providing “safe” foods for their children. In this chapter we address these issues in an effort to allay fears and enlighten perspectives.

      The use of pesticides in the agricultural industry has improved and...

    • 36 Making Sense of Food Labels
      (pp. 265-270)

      In the United States, food labeling is regulated by two government agencies, the Food and Drug Administration (FDA) and the Food Safety and Inspection Service (FSIS) of the U.S. Department of Agriculture. The FDA regulates almost all food products with the exception of meat and poultry, which are regulated by the FSIS. Regulations for food labeling in the United States were first issued in 1906. Since then a number of additions and changes have been made in laws that regulate food labeling, but by far the most sweeping change was the Nutrition Labeling and Education Act (NLEA) of 1990. The...

  10. PART FIVE Eating In, Eating Out

    • 37 From the Grocery Store to the Home: Stocking the Kitchen
      (pp. 273-276)

      Stocking a kitchen with children in mind can be challenging! But with a few key appliances, utensils, and some food staples, the job can be dramatically simplified. The first appliance that is particularly useful in a home with children is a food processor. Homemade baby food and breakfast shakes, as well as such snacks as vegetable pieces (carrot coins, pepper rings, celery discs), can be easily prepared in a food processor. Food processors are available in a variety of price ranges; an expensive model is not necessary. In fact, a small model is often more useful for preparing single portions....

    • 38 Whatʹs for Lunch?
      (pp. 277-282)

      The simple question, “What’s for lunch?” can create quite a dilemma for parents who are trying to instill healthy eating habits in their children. The school lunches preferred by children are often higher in saturated fat, total fat, and sodium than is desirable, but at least children will eat them and not go hungry. Brownbag lunches have the potential to be healthier, but not if children throw food away or trade healthy food for other items. When trying to ensure that children eat nutritious lunches, the principles to remember are variety, balance, and moderation. Keep in mind the following guidelines:...

    • 39 Fast Foods and Restaurants: Are You Speeding Past Good Nutrition?
      (pp. 283-288)

      The great diversity of ethnic cultures in the United States provides the opportunity to enjoy a variety of international foods as part of our daily diet. Pizza is often ordered by phone, or Chinese “take-out” is picked up on the way home from work. Fast foods are particularly popular because of their accessibility and convenience. Attractive television commercials and promotional ploys make them especially appealing to children.

      Adults need to find their own way to obtain nutritious meals and to teach children to make healthy choices at fast food establishments. Fast foods have commonly been labeled unhealthy, but many fast...

  11. PART SIX Recipes

  12. Appendixes

  13. List of Contributors
    (pp. 399-402)
  14. INDEX
    (pp. 403-415)