New American Academy of Pediatrics (AAP) guidelines say it's okay to switch certain toddlers directly to low fat milk before the age of two in some cases. For years, the Association has advised giving whole milk because the fat it contains was thought to be essential to proper development of the baby's brain, since milk is still a major ingredient of young toddlers' diets.

Their advice is directed to parents of overweight or obese toddlers or those with a significant family history of obesity, high cholesterol or heart disease. New thinking postulates that these children will get sufficient fat from low-fat milk and that they may already have sufficient levels of fat in their bodies.

"I'm not really surprised that they are reconsidering recommendations regarding kids' diets," says pediatric clinical dietitian Kim Bilger, MPH, RD, LD at Dell Children's Medical Center of Central Texas. "Obesity is a growing concern in our country and people are beginning to focus on it."

The new guidelines were published recently in the medical journal Pediatrics and include numerous recommendations designed to keep children's cholesterol levels under control to protect long term heart health.

What Should You Do?

"If your child is overweight or obese or has a family history of high cholesterol, diabetes or cardiovascular disease, the first thing you should do is consult the child's pediatrician before making any changes in milk," advises Kim. "Fat makes up about 30 percent of a healthy child's diet and previous fat recommendations were as high as 40 percent for children under the age of 2 for proper brain development. There are other areas of a child's lifestyle that could be changed first that would provide benefit to reducing a child's rate of weight gain or high cholesterol. There's a tendency sometimes to focus so much on one specific component of a diet that it is easy to forget about overall calorie intake."

Kim suggests the evaluating the following components of a child's diet:

• Juice. "Juice intake can add quite a bit of calories throughout the day. It can be nutritious, but the recommended daily consumption for a toddler is four to six ounces a day. Many children consume two to three times that amount or more each day."
• Milk. "Like juice, milk is an important diet ingredient, but a toddler should have no more than 16 ounces of milk per day. Children who consume more milk than they need are not challenged to progress to more solid food."
• Sugar-filled Drinks. "Toddlers shouldn't be given soda or Koolaid during the day and encouraged to drink water when they are thirsty. These sugar-filled beverages can be given on occasion but should not be part of a daily or weekly routine."
• Activity Level. "Toddlers should be encouraged to play. A child who watches TV every afternoon will not form habits that will make them more active, increase energy output and help control weight and improve overall health as they grow."
• Fast Food. "Children who consume a lot of fast food (or food prepared away from home in general) have extra fat in their diet. Limiting fast food can reduce the amount of fat your child eats to appropriate levels."

Promoting Good Habits

Toddlers are at a very impressionable age," says Kim. "They are learning to do their own thing and they model behaviors they see. For example, a child is less likely to want to drink sodas during the day if no one else is drinking them."

She also believes parents have control of some things but eventually the child has to make choices of his or her own, so habits learned as a toddler will be important.

"Dietician and social worker Ellyn Satter has written extensively about the importance of division of control between parent and child. In summary, her advice suggests parents are responsible for providing mostly nutritious food, setting limits on meal and snack times and guidelines concerning where to eat such as requiring the family to sit at a table. The child should decide both what and how much to eat of what is offered. They have really good appetite control on their own and we should learn to listen to them about whether or not they are full," adds Kim.

"Obesity has become an epidemic in our society and eating behaviors early on impact weight later on in life. I hope we are turning the corner to making changes in personal lifestyle and encouraging individual responsibility for our health."

For More Information

The AAP Web site has more information on their new guidelines. Other valuable resources include the National Institute of Child Health and Human Development and the American Dietetic Association.

Kimberly Bilger MPH, RD, LD
Pediatric Dietitian
Marni Paul Specialty Care Center

Dell Children's Medical Center of Central Texas

Kim works with the families of infants, children and adolescents who may need nutritional counseling or assessments on an outpatient basis to complete their medical needs or to maintain a healthy lifestyle for proper growth. Marni Paul Specialty Care Center dietitians can provide nutritional assessments and counseling for a wide variety of issues, such as; weight loss, weight gain, high cholesterol, high triglycerides and chronic illnesses. With all the different messages and advice in our society today, a dietitian can help both children and parents establish their own healthy eating program. Specialty Care Center accepts outpatient referrals from area physicians. Call (512) 324-0137 to request a referral form.