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Early Childhood and School Age


During early childhood and school-age years, children begin to establish habits for eating and exercise that stick with them for their entire lives. If children establish healthy habits, their risk for developing many chronic diseases will be greatly decreased. On the other hand, poor eating habits and physical inactivity during childhood set the stage for health problems in adulthood.

Unfortunately, many children living in the United States have unhealthy eating and exercise habits, as evidenced by the growing number of overweight children. Since the late 1980s, the number of overweight children in the United States has more than doubled, so that currently approximately 11% of American children are overweight and an additional 14% have a body mass index (a ratio of weight to height) between the 85th and 95th percentiles, which puts them at increased risk for becoming overweight.

In addition, a survey conducted by the Centers for Disease Control and Prevention showed that 48% of girls and 26% of boys do not engage in vigorous exercise on a regular basis. Overweight children are more likely to become obese adults, and are, therefore, at increased risk for developing cardiovascular disease, hypertension, diabetes, gallbladder disease, osteoarthritis, and some cancers in adulthood.

Childhood obesity also has emotional consequences, as many overweight children suffer from psychological stress, poor body image, and low self-esteem. Parents can help children establish healthy eating habits by making nutritious foods available, by limiting the consumption of junk foods, by turning off the television during mealtime, by allowing children to participate in food preparation, and by controlling the amount of food they eat.

Care should be taken to ensure sufficient intake of calcium, vitamin D, fiber, and calories. Dietary fat and cholesterol should be limited to no more than 30% of total calories and 300 mg per day, respectively.

Physical Factors

In contrast to the rapid physical growth and development experienced during infancy and adolescence, the childhood years, loosely defined as the years between 2 and 11, are typically characterized by much slower and more stable physical growth.

On average, children gain 4 to 7 pounds and gain 1 to 4 inches per year. At approximately age 10 or 11 the rate of growth once again begins to increase, an indication that the child will soon enter puberty.

As a result of this slower physical growth and development, the body's needs for certain nutrients, most notably calories and protein, is not as high as during infancy. Interestingly, the body naturally compensates for this, and, as a result, it is not at all uncommon to see a young child with a decreased or inconsistent appetite.

On the other hand, as children enter school and begin to participate in organized sports and other activities that result in an increase in physical activity, their appetite and food intake usually increases.

Starting school and participating in other structured activities places new social, emotional, and mental demands on children. Consequently, the school-age years are characterized by intense development in social and cognitive skills.

Without adequate nutrition, children will experience physical and mental fatigue, have difficulty concentrating on learning tasks, and will ultimately exhibit slower cognitive and behavioral development.

Nutrient Needs

It is important for school-age children to meet the recommended intake levels of all essential vitamins and minerals. The Dietary Reference Intakes for this age group are shown in the table below. The nutrients highlighted below are of special importance:


Caloric needs vary depending on the child's current rate of growth, the amount of physical activity, and the child's metabolism. It is important that children consume enough calories to ensure proper growth and to spare protein from being used for energy. However, many children, especially those who are not physically active, tend to consume too many calories. Children aged 2 to 3 years, 4 to 6 years, and 7 to 10 years require approximately 1300, 1800, and 2000 calories, respectively.


The amount of protein needed per kilogram of body weight decreases after infancy and early childhood, from 1.2 gram/kg at 3 years to 1 gram/kg at 10 years. On average, children in the United States consume considerably more protein than is required for health. Protein deficiency is relatively rare in children living in the United States, but may be seen in children with severe food allergies, in those on strict vegan diets, or in those who have limited access to food.


Many children consume too much dietary fat, which can lead to excessive calorie consumption and weight gain. As a result, nutrition experts believe that by the age of 5, children should follow adult recommendations for the consumption of fat. These recommendations suggest that total fat intake not exceed 30% of calories and saturated fat should account for no more than 10% of total calories. In addition, cholesterol intake should not exceed 300 mg per day.


With the growing recognition of the importance of dietary fiber to health, children, like adults, are encouraged to increase their dietary fiber intake. Children should consume their age plus 5 grams of fiber per day.


In 1997, the National Academy of Sciences increased the recommended intake amount of calcium, a mineral necessary for proper bone growth and maintenance of bone density, for school age children from 500 mg per day to 1300 mg per day. This change was made in recognition of the fact that childhood is an important time for increasing bone density, and increasing bone density during childhood can help prevent osteoporosis later in life.

Although many foods contain calcium, milk is the primary source of calcium in the diets of children in the United States. So, children who do not drink milk, must take care to include a variety of food sources of calcium in their diet. In addition, adequate intake of vitamin D is necessary for proper calcium absorption and to ensure calcium deposition in bone tissue.

Nutrient 1-3 years 4-8 years M 9-13 F 9-13
Vitamin A (mcg RE 300 400 600 600
Vitamin D (mcg) 5 5 5 5
Vitamin E (mg alpha-TE) 6 7 11 11
Vitamin K (mcg) 30 55 60 60
Thiamin (mg) 500 mcg 600 mcg 900 mcg 900 mcg
Riboflavin (mg) 500 mcg 600 mcg 900 mcg 900 mcg
Niacin (mg NE) 6 8 12 12
Pantothenic Acid (mg) 2 3 4 4
Vitamin B6 (mg) 500 mcg 600 mcg 1 1
Folate (mcg) 150 200 300 300
Vitamin B12 (mcg) 900 pcg 1.2 1.8 1.8
Choline (mg) 200 250 375 375
Biotin (mcg) 8 12 20 20
Vitamin C (mg) 15 25 45 45
Calcium (mg) 500 800 1300 1300
Phosphorus (mg) 460 500 1250 1250
Magnesium (mg) 80 130 240 240
Iron (mg) 7 10 8 8
Zinc (mg) 3 5 8 8
Iodine (mcg) 90 90 120 120
Selenium (mcg) 20 30 40 40
Copper (mcg) 340 440 700 700
Manganese (mg) 1.2 1.5 1.9 1.6
Chromium (mcg) 11 15 25 21

Dietary Choices

The eating habits and attitudes about food displayed by parents have tremendous influence on the food choices of children. In fact, the food likes and dislikes that become firmly established during childhood are, to a large extent, shaped by the food likes and dislikes of parents.

It is important for parents who are concerned that their children eat too few vegetables or too many junk foods to take a look at their own eating habits and reevaluate the example they are setting for their kids.

As any parent knows, instilling healthy eating habits in children is challenging and requires patience. Here are a few suggestions to help turn a picky eater into a healthy eater:

  • Allow your child to respond to their internal cues for hunger. Prepare healthy snacks and meals, but do not demand that your child eat a certain amount of food at one sitting. Parents often make the mistake of forcing a child to clean his/her plate, which can set the child up for a lifetime of overeating.
  • Limit high-calorie, high-fat, and sugary snacks. These foods lack essential nutrients and will diminish your child's desire to eat at mealtime.
  • Make the mealtime environment fun and relaxing, and allow your child to eat at his/her own pace. It will be easier for your child to stay focused on eating if you can limit distractions and stressful situations during mealtimes, such as television, family arguments, and discipline.
  • Many children like to work in the kitchen. Allow your child to help prepare snacks and meals.
  • Constantly encourage your child to try new foods and continue to make available those foods that are not well-liked. Your child will respond to these foods more favorably if they are given when the child is hungry. So, begin the meal by serving your child's least favorite foods.
  • Many school-age children do not like different foods on the plate to touch each other, and will often refuse to eat mixed foods, such as casseroles. Whenever possible, keep your child's food idiosyncracies in mind when preparing meals.
  • Avoid using food to reward or punish your child. Many parents reward their children with sweets or snack foods or punish them by not allowing them to eat such foods. This practice serves only to firmly establish these foods as desirable to your child.

It is an understatement to say that television influences the food choices of children. On average, today's children spend more time watching television than they spend at school, or doing any other activity besides sleeping. Consequently, children are bombarded with commercials, many of which advertise food.

The foods most frequently advertised during programs for children are sweetened breakfast cereals, fast foods, candy, soda pop, and snack foods. It is well-known by nutrition experts and parents alike that most children are very responsive to these commercials and that, in response to media messages, children will try to influence their parents food buying decisions.

As a result, a connection can often be made between a family's hours of television viewing and the number of snack foods purchased. And, for many kids, watching television leads to weight gain and ultimately obesity, caused by excessive snacking and lack of physical activity.

Unfortunately, television negatively impacts the health and nutrition status of children in other, less obvious ways. In television programs and commercials, food is used for many activities besides the satisfaction of hunger.

Also, very few overweight people are used in television programs, and, in fact, many actors could be considered underweight. As a result, children are repeatedly given the message that what we eat, how much we eat, or when we eat has no impact on our weight, health or nutrition status.

During the schoolage years, children begin to spend more time away from home, either at school or at the homes of their friends. Consequently, factors outside of the home start to influence food choices, which can have either a negative or positive impact on nutrition.

In many cases, peers reinforce poor food choices and contribute to negative body image. In fact, research suggests that the preoccupation with weight and body shape that is typically characteristic of the adolescent years may actually begin in elementary school.

On the other hand, school age children are capable of understanding the role of nutrition in health. As a result, nutrition education messages provided at school can help children understand the importance of good nutrition.


  • American Dietetic Association. Dietary guidance for healthy children aged 2 to 11 years - Position of the ADA. Journal of the American Dietetic Association 1999; 99:93-101. 1999.
  • Boris M, Mandel FS. Foods and additives are common causes of the attention deficit hyperactive disorder in children. Ann Allergy 1994 May;72(5):462-8. 1994. PMID:7130.
  • Campbell K, Waters E, O'Meara S, Summerbell C. Interventions for preventing obesity in children. Cochrane Database Syst Rev 2001;(1):CD001871. 2001. PMID:18440.
  • Carter CM, Urbanowicz M, Hemsley R, et al. Effects of a few food diet in attention deficit disorder. Arch Dis Child 1993 Nov;69(5):564-8. 1993. PMID:7140.
  • Cavagni G, Piscopo E, Rigoli E, et al. "Food allergy in children: an attempt to improve the effects of the elimination diet with an immunomodulating agent (thymomodulin). A double-blind clinical trial". Immunopharmacol Immunotoxicol 1989;11(1):131-42. 1989. PMID:7170.
  • Hirai Y. [Recommended dietary allowances and nutritional assessments in infants and children]. Nippon Rinsho 2001 May;59 Suppl 5:749-56. 2001. PMID:18400.
  • Jequier E. Is fat intake a risk factor for fat gain in children?. J Clin Endocrinol Metab 2001 Mar;86(3):980-3. 2001. PMID:18460.
  • Mahan K, Escott-Stump S. Krause's Food, Nutrition, and Diet Therapy. WB Saunders Company; Philadelphia, 1996. 1996.
  • Pipes PL, Trahms CM. Nutrition in Infancy and Childhood, Fifth Edition. Mosby: St. Louis, 1993. 1993.
  • Robinson TN. Television viewing and childhood obesity. Pediatr Clin North Am 2001 48(4): 1017-25. 2001.
  • Serdula MK, Alexander MP, Scanlon KS, Bowman BA. What are preschool children eating? A review of dietary assessment. Annu Rev Nutr 2001;21:475-98. 2001. PMID:18420.
  • Serra-Majem L. Vitamin and mineral intakes in European children. Is food fortification needed?. Public Health Nutr 2001 Feb;4(1A):101-7. 2001. PMID:18450.
  • Styne DM. Childhood and adolescent obesity: Prevalence and significance. Pediatr Clin North Am 2001 48(4): 823-54. 2001.
  • Tomkins A. Vitamin and mineral nutrition for the health and development of the children of Europe. Public Health Nutr 2001 Feb;4(1A):91-9. 2001. PMID:18430.
  • Twisk JW. Physical activity guidelines for children and adolescents: a critical review. Sports Med 2001;31(8):617-27. 2001. PMID:18390.
  • Uchiyama M. [Hypertension in children and adolescents]. Nippon Rinsho 2001 May;59(5):927-31. 2001. PMID:18410.

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