My Doctor Online The Permanente Medical Group

Focus on Health

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Children and teens come in different shapes and sizes, and they grow at different rates. It's important to remember that there are no "ideal" heights and weights for kids or teens.

The goal for your whole family is to make healthier food choices and increase physical activity instead of focusing only on weight and weight loss. Talk to us if you are concerned that your child is gaining weight too quickly.

We routinely use a tool called body mass index (BMI) to figure out whether your child's weight is within a healthy range. Here are some facts about BMI:

• BMI looks at height and weight together, taking into consideration your child's age and gender.
  
• We start to calculate BMI at age 2.
  
• BMI is only one of the tools used to determine if your child's weight is within a healthy range.
  
• We will also consider your family's history of disease and your child's eating and exercise habits.
  
• We may recommend that you talk to a nutritionist or offer you health classes and programs that you and your child can attend.

Health risks of being overweight

Being overweight and out of shape increases your child's risk for health problems now and later in life. We will regularly screen for signs of these health problems. If your child or teen needs treatment, we will ensure they get the best medical care possible.

If your child is eating foods high in calories, fat, sugar, and salt, this can increase the risk for developing:

• High cholesterol
  
• High blood pressure
  
• Asthma
  
• Type 2 diabetes 

If you are concerned about your child's weight, talk to us so we can help you decide if your child's weight is a healthy one for him or her.

Healthy Eating

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Making changes can be hard. But when it comes to taking care of your child and your family, it's worth the effort. You can help your child by keeping healthy food around the house, eliminating unhealthy food, and setting a good example.

Here are some tips to help you eat smart and make healthy beverage choices:

• Aim for 5 to 9 servings of fruits and vegetables a day.
• Fuel up with breakfast every day.
• Choose water or nonfat milk.
• Limit soda, sports drinks, juice, and sweetened drinks – 1 can is equal to drinking a candy bar!

There are some other changes that can help your family eat a healthy diet:

• Watch portion sizes. For example, a healthy serving of meat is the size of a deck of cards.
  
• Read food labels. Know what you're eating. 
  
• Check in with your child's school or daycare center to make sure that healthy low-fat meals and snacks are provided. If not, pack nutritious foods for your child's lunch.
  
• Eat meals together as a family, even if you need to work around busy schedules. Encourage conversation, sharing, and laughter at meal time.
  
• Limit eating out at fast food restaurants. Fast food tends to be high in salt, fat, and extra calories. If you do eat fast food, order smaller sizes and choose lower-calorie options.
  
• Encourage your child to help with grocery lists, shopping, and cooking.
  
• Turn the TV off during meals and snacks. Eating while watching TV can lead to overeating.
  
• Do not bribe or reward with food. Offer hugs, stickers, praise, or small toys instead.
  
• Teach children to avoid eating when they are not hungry. If kids eat when they feel bored, sad, stressed out, or lonely, they may be using food to deal with feelings. Talk to your doctor if your child fits this pattern.
  
• Don't allow kids to skip meals or go too long without eating. If they get too hungry, they're more likely to overeat or choose unhealthy foods.
  
• Prepare for snack attacks. Keep healthy snacks around for after school or between classes. Pretzels, an orange, half a bagel, a small bag of nuts, low-fat whole-wheat crackers, air-popped popcorn, and baby carrots are all good choices for children and teens.
  
• Help your family eat a diet rich in calcium and high in fiber. 
  

Serving sizes change based on a child's age. Offering children servings that are too large for them can lead to overeating. Some tips to remember:

• Measure food with a measuring cup or kitchen scale to get an idea of serving sizes.
  
• Encourage children to eat when they are hungry and stop when they are full.
  
• Don't force children to eat everything on their plates.
  

These are suggested amounts of servings per day for children based on average activity levels:

Choose water 

Rethink your drink and avoid drinking your calories. Serve nonfat milk or water. We recommend no more than 4 ounces of 100 percent fruit juice per day. Make your own fruity low-calorie drink at home by adding strawberry or melon slices to a pitcher of water.

Keep these facts in mind:

• The average person eats almost 100 pounds of added sugar a year – that's about ¼ of a pound of added sugar a day!
  
• Soda is the number 1 source of added sugar in the U.S. diet.
  
• Over 30 percent of all calories from added sugars consumed daily are from sweetened beverages.
  
• Extra calories from all this sugar lead to weight gain, putting people at risk for lifelong health problems.
  
• Obesity is an epidemic in the U.S.
  

Staying Active

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Many kids today spend a lot of time watching TV, playing video games, and using the computer. Many are not getting enough exercise.

Small increases in physical activity, such as the following, can make a big difference over time:

• Aim for at least 60 minutes of activity each day.
  
• Go for family walks or bike rides.
  
• Take your family to the park or pool.
  
• Walk instead of driving for short trips and errands.
  
• Check local YMCAs, schools, and community centers for exercise programs.
  
• Use a step-counter (pedometer) to help motivate your family to walk.
  
• Walk or bike to school.

Limit screen time

Although some TV, interactive video games, and the Internet can be educational and entertaining for your child, too much screen time (TV, computers, and video games) can have unhealthy side effects. Here are some things you can do to help your kids pull the plug and engage in an active lifestyle:

• Limit screen time (TV, computers, and video games) to 1 to 2 hours each day for children older than 5 years. Less than 1 hour for children under 5 years of age.
  
• Move the TV out of the bedroom.
  
• Turn off the TV during meals.
  
• Designate certain days of the week as screen-free days.

You can break up activities throughout the day. Show your child that physical activity can be fun, as well as healthy. Instead of screen time, try these activities:

• Exercise as a family by walking or riding bikes to a local park or play active sports together.
  
• Read a book, listen to music, or create art projects.
  
• Play board games together.
  
• Go to your local library.

You are your child's most important role model, so set a good example by:

• Being physically active every day.
  
• Not criticizing your own body.
  
• Keeping the focus on health, not weight.

You can help make a difference for everyone in your family by making health the top priority in your child's life.

Especially for Toddlers

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Toddlers are active, curious, and fun. They may also have picky eating habits, which can make them challenging eaters. Feed your toddler like the rest of the family. They can eat most of the foods you eat, as long as these are soft and/or cut into small pieces that are easy to handle. Here are some tips for feeding your toddler:

• You decide what food to serve, and where and when to serve meals and snacks. Then let your child decide whether he is hungry and how much to eat. Don't make your child clean his plate.
  
• Children's appetites naturally go up and down. When your child is sick or teething, she may not eat much. At other times, she may eat a lot. The amount of food a child eats varies from day to day.
  
• Toddlers will sometimes want to "graze" or snack throughout the day instead of eating meals. To encourage your toddler to eat at mealtime, it's okay to limit snacks and just serve water an hour or 2 before a meal.
  
• Avoid offering dessert as a reward for finishing a meal.
  
• Avoid foods that could cause choking: whole nuts, grapes, hot dogs, popcorn, chunks of meat and vegetables, peanut butter, and hard, chunky candy.
  
• Limit juice, candy, and other foods that stick to teeth. This helps prevent tooth decay.
  
• Don't let your child walk around with juice in a cup or bottle. This will help you monitor your child's juice consumption and help prevent tooth decay as well.

Toddlers grow more slowly than babies and may not have as much of an appetite. Your child is becoming more independent and saying "no" to many things, including food. It's helpful to keep in mind that:

• Some toddlers are not interested in trying new foods. All these things are normal but can be frustrating.
  
• Your child will learn to like new foods when they see, smell, and (hopefully) taste them over and over again. Be patient.
  
• Don't make extra work for yourself by making a special meal for your toddler.
  

Especially for Teens

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Being active every day is the best way to keep extra weight off and feel great. Help your teen appreciate his or her changing body. Your teen's body and mind are changing and growing a lot. Teens need healthy foods and exercise for strength and energy.

Make sure your teen stays healthy and gets more energy by serving nutritious meals and making it a goal to:

• Serve breakfast every morning.
• Remember your teen needs at least 4 cups of fruits and vegetables every day.
• Offer 3 cups of low-fat milk or other dairy products.
• Encourage your teen to help with grocery lists, shopping, and cooking.
• Eat at home with your teen at least 5 times a week to improve nutrition and social adjustment.
• Keep healthy snacks in the house.
• Watch portion sizes. For example, a healthy serving of meat is the size of a deck of cards.

Keep the lines of communication open with your teen. Encourage them to avoid:

• Skipping meals or going too long without eating. If your teen is too hungry, he or she may be more likely to overeat or choose unhealthy foods.
  
• "Crash" diets. Your teen may lose some weight (usually water) but will likely gain it all back, plus more. Remind your teen that diet pills and supplements don't work and can be dangerous.
  
• Spending time in front of the screen. Cutting back on screen time (TV, computers, and video games) to no more than 1 or 2 hours a day is beneficial and can prevent snacking in front of the screen.
  
• Drinking calories. Sodas are liquid sugar (up to 12 spoonfuls in a can) and have been linked to weight gain. Sweet teas, juice, and sports drinks are all loaded with sugar and extra calories. Help them cut back or switch to sugar-free drinks or water instead.
  
• Alcohol. Talk to your child about the dangers of drinking alcohol.

Encourage your teen to reduce fat and calories if they eat fast food with friends and follow these simple steps:

• Pay attention to the calories posted and choose items with fewer calories.
• Try ketchup or mustard instead of cheese, sour cream, or mayonnaise.
• Avoid deep-fried foods like fries, chips, onion rings, and chicken strips.
• Drink water or low-fat milk instead of soda.
• Share a meal with a friend or order smaller sizes.
• Order just the sandwich without fries or try a side salad instead.