Dallas, TX - The American Heart Association has issued new dietary recommendations for children and adolescents—endorsed by the American Academy of Pediatrics—which appear in the September 27, 2005 issue of Circulation [1].

This is the first update on cardiovascular nutrition for youngsters since 1982, and the guidelines are the first to give comprehensive advice on feeding children under two.

Cochair of the writing committee, pediatrician Dr Barbara A Dennison (Columbia University, New York), told heartwirethat much has changed since the 1982 document was published."During this timethere has been a tremendous increase in the rates of obesity, fueled by a snacking culture and more sedentary lifestyles," she says, adding, "The norm has changed—so many kids are overweight." She points to studies that have shown that most children eat cookies every day, but only a third have vegetables daily.

The norm has changed—so many kids are overweight.

The aim now is to encourage good nutrition from birth, Dennison stresses, with exclusive breast-feeding recommended for the first four to six months of life. There is much that can be done to help mothers achieve this goal, she notes.

"The social milieu does not support breast-feeding for women in the US. We need to be more encouraging—for example, by providing working women with somewhere appropriate to pump breast milk." She contrasts poor breast-feeding rates in the US with the situation in Scandinavian countries, which have better maternity benefits. In Norway, for example, 80% of mothers are still breast-feeding when their child is three months old, whereas rates decline significantly in the US at this time, when many women return to work.

Dennison says that it is now known that there are critical time periods when any excess weight gained will be very difficult to lose—these include infancy as well as adolescence, early adulthood, and pregnancy. Nutrition during the first two years of life is thus vitally important, she adds. "The earlier the problem manifests, the more severe it's going to be."

Physicians should identify infants who are gaining weight rapidly and/or whose weight-to-length ratio exceeds the 95th percentile, the guidelines state. Advice is given on improving nutritional quality after weaning—for example, by introducing healthy foods and continually offering them to infants, even if they are initially refused.

Other things that have changed include the whole "supersizing" culture of the US, says Dennison. "People don't even know any more what is a normal serving for kids—everything is bigger, from sippy cups to dinner plates." Also, the concept of "kids' meals" is something that the AHA wants to discourage, she says. "There is no reason why children can't eat most 'adult' foods," she notes.

People don't even know any more what is a normal serving for kids.

Cardiologists can help patients and their children by encouraging them to eat healthily and participate in physical activities that the whole family can enjoy, such as taking walks together, while urging a reduction in sedentary activities such as TV viewing, she adds. The guidelines recommend no more than two hours of "video screen" time a day and one hour of moderate to vigorous physical activity daily. And ideally, children should not have TVs in their bedrooms, they advise.

Other steps that can be taken include having regular family meals to promote social interaction. "Adults need to learn that they lead by example," says Dennison.

The new guidelines include tips for parents to help implement the recommendations and improve nutrition in young children. They also list daily estimated calories and recommended serving for grains, fruits, vegetables, and dairy products by age and gender, as well as strategies for schools to help them develop better nutrition programs.