October 2021 Issue

Children’s Health: Healthful Snacking — A Practical Guide for Parents of Young Children Through Adolescents
By Toby Amidor, MS, RD, CDN, FAND
Today’s Dietitian
Vol. 23, No. 8, P. 16

For the first time, the 2020–2025 Dietary Guidelines for Americans (DGAs) were developed for all age groups and life stages, including infants and toddlers from 0 to 23 months, and pregnant and lactating women.

In this article, Today’s Dietitian discusses the updated recommendations for children aged 2 to 18 and provides a variety of snack ideas designed to promote health and meet nutrient goals. In addition, tips for parents on how to prepare these snacks for young children are included, along with strategies to help older kids make their own snacks or select healthful options when purchasing them in stores.

State of Childhood Health
Childhood sets the stage for dietary patterns that tend to continue into adulthood. In the United States, 41% of children and adolescents have overweight or obesity, with the prevalence being higher among Hispanic and non-Hispanic African American children and adolescents compared with non-Hispanic Asians and whites.1 Youths with obesity are more likely to have immediate health risks including high blood pressure, high cholesterol, and impaired glucose tolerance than those who don’t have obesity. Suboptimal dietary intake patterns among this age group along with inadequate physical activity contribute to overweight and obesity and an increased risk of chronic diseases (eg, type 2 diabetes, CVD) beginning in adolescence and continuing into adulthood. Furthermore, psychological issues, such as anxiety and depression, and social challenges, including experiencing bullying and weight stigmatization, are more common in children and adolescents who have overweight or obesity.

The Healthy Eating Index (HEI) 2015 scores the diet quality of this age group. Total scores are out of a possible 100 points, with a higher total score indicative of higher diet quality. A score of 100 means recommendations were met or exceeded. According to the HEI-2015, ages 2 to 4 scored highest at 61, while scores of subsequent age groups declined. Ages 5 to 8, 9 to 13, and 14 to 18 scored 55, 52, and 51, respectively, showing that when adolescents begin to make their own food choices, diet quality decreases.1

There are many opportunities for health professionals to help prevent or manage overweight and obesity throughout childhood. The goal is to reduce the rate of weight gain while allowing for normal growth and development. Dietitians can encourage these clients to eat nutrient-dense foods from all food groups, including beverages, and minimize foods high in added sugars and saturated fat. They also can recommend regular physical activity.

Nutrient Needs in Childhood and Adolescence
What follows is a review of the current intakes of children and adolescents and the areas of intake deemed adequate vs inadequate. The age brackets are divided into two groups: ages 2 to 8 and 9 to 18.

Ages 2 to 8
Daily calorie needs for females aged 2 to 4 range from 1,000 to 1,400 kcal and, for males, 1,000 to 1,600 kcal. For females aged 5 to 8, calorie needs range from 1,200 to 1,800 per day and, for males, 1,200 to 2,000 per day. Page 74 in the 2020–2025 DGAs provides the daily amount of calorie needs per food group (vegetables, fruits, grains, dairy, protein, oils, and other uses) in a Healthy US-Style Dietary Pattern for 1,200, 1,400, 1,600, 1,800, and 2,000 kcal.

The HEI-2015 score for those aged 2 to 4 and 5 to 8 show an overall poor diet quality. Only 60% of children aged 2 to 4 are meeting total daily fruit recommendations. This age group also has a total vegetable intake at or above recommended levels. Intake of dairy foods is close to or at recommended levels for those younger than 9, while whole grain consumption is below the recommended daily intake in this age range. Children aged 2 to 8 are close to meeting the recommended daily amount of total protein but fall far below recommendations for seafood intake.

Ages 9 to 18
Calorie ranges for children aged 9 to 13 are between 1,400 and 2,600 per day. Page 81 in the 2020–2025 DGAs provides the daily calorie amount per food group for this range in 200-kcal increments within the Healthy US-Style Dietary Pattern.

For those aged 14 to 18, calories range between 1,800 and 3,200 per day. Page 84 in the DGAs also provides the daily calorie amount per food group for this range in 200-kcal increments within the Healthy US-Style Dietary Pattern. By late adolescence, the average fruit and vegetable intake is about one-half the daily recommended amount. At age 9, the amount of dairy foods increases from 2 1/2 to three cup-equivalents per day to support increased calcium needs. However, the average intake of dairy foods at age 9 through adolescence typically is below the recommended daily intake.

Whole grains also are below recommended daily amounts. Most individuals aged 9 to 18 meet the recommendation for total protein, except adolescent females aged 14 to 18. But those aged 9 to 18 get far below the recommend intake of the protein subgroup seafood, which contains beneficial fatty acids.

Adolescents aged 14 to 18 have the greatest gaps between recommended food group intakes and current intakes than any other age or life stage. As a result, adolescent males and females are at greatest risk of nutrient gaps. Adolescent males and females have low intakes of grains, dairy and dairy alternatives, and fruits and vegetables, leading to low intakes of phosphorus, magnesium, and choline. Adolescent females also consume less meat, poultry, and eggs compared with adolescent males. Combined with the fact adolescents also have suboptimal consumption of seafood and other proteins, including beans, peas, and lentils, the result is underconsumption of total protein. Adolescent females also have low intakes of iron, folate, and vitamins B6 and B12.

Special Considerations for Childhood and Adolescence
Underconsumed nutrients. Just as with those at every life stage, calcium, vitamin D, fiber, and potassium are underconsumed in childhood and adolescence.1

Sugar-sweetened beverages. According to the 2020–2025 DGAs, sugar-sweetened beverages, such as fruit drinks, soda, and sports and energy drinks, are an unnecessary part of the diet for children and adolescents. And they aren’t part of any USDA dietary pattern. Intakes of added sugars increase throughout childhood and adolescence. Average consumption of added sugars is 11% among young children and adolescence and peaks at 15% during adolescence.

Dairy and fortified soy alternatives. Milk as a beverage, which has 13 nutrients, is less frequently consumed. Adolescents typically consume cheese in mixed dishes more often than do younger children.

To improve their dietary pattern, children and adolescents should increase intake of underconsumed food groups, while decreasing overconsumed foods such as sugar-sweetened beverages and foods high in saturated fat and sodium. If dietary patterns are improved in childhood, they’ll have the foundation for a more healthful dietary pattern in adulthood that can help prevent chronic disease later in life. One of the ways to increase intakes of underconsumed nutrients is through healthful snacking—nutrient-dense snacks that can improve nutrient shortfalls and overall health.

Healthful Snack Ideas
The following snack suggestions for those aged 2 to 8 and 9 to 18 are in accordance with the 2020–2025 DGAs. These snacks contain nutrients that may be lacking in the diets of children and adolescents and therefore will fill several nutrient gaps. Parents have to make snacks for children aged 2 to 8, but they can involve them in the preparations (eg, assembling ingredients, mixing batters, measuring) so they’ll know how to make their own when they reach adolescence. It’s also important for parents to plan and make snacks ahead of time to ensure they’re ready and available when kids feel hungry in between meals. Here are some healthful snack ideas for children and adolescents.

Ages 2 to 8
• reduced-fat or nonfat vanilla yogurt topped with fresh berries;
• a smoothie made with nonfat plain Greek yogurt, 100% fruit juice, a banana, and strawberries;
• celery sticks topped with nut butter;
• a small baked potato topped with shredded reduced-fat cheese;
• a mini pizza on a whole wheat English muffin with tomato sauce and part-skim mozzarella cheese;
• whole grain crackers topped with mashed avocado;
• whole wheat pita triangles dipped in hummus; and
• seaweed snacks served with sliced cucumbers and avocado.

Ages 9 to 18
• sliced banana topped with nonfat vanilla Greek yogurt or frozen vanilla yogurt and 1 tablespoon of chopped almonds or walnuts;
• one tablespoon of peanut or almond butter paired with an apple or pear;
• veggies (carrots, bell peppers, cucumbers) dipped in hummus;
• air-popped popcorn topped with 2 to 3 tablespoons of grated Parmesan cheese;
• a yogurt parfait made with nonfat vanilla Greek yogurt, berries, and 1 to 2 tablespoons of granola or chopped nuts;
• trail mix made with nuts, dried fruit, and pretzels;
• roasted chickpeas seasoned with garlic powder; and
• in-shell edamame sprinkled with a touch of salt.

Recommendations for RDs
When counseling children and adolescents, dietetics professionals should evaluate their current dietary patterns and snack intake. They also should discuss the number and timing of snacks, which should include foods and food groups they usually underconsume using the list of underconsumed foods from the DGAs mentioned previously. For younger children, dietitians should recommend caregivers choose snacks they’re culturally familiar with and are within their budget and involve their children in the preparation and cooking process. When counseling older children and adolescents, discuss their likes and dislikes with their caregivers and encourage them to independently select and prepare their own healthful snacks. If the adolescents purchase store-bought snacks, RDs should review the options available and provide several more healthful choices to consider.

— Toby Amidor, MS, RD, CDN, FAND, is the founder of Toby Amidor Nutrition (tobyamidornutrition.com) and a Wall Street Journal bestselling author. She’s written several cookbooks, including The Best Rotisserie Chicken Cookbook and The Family Immunity Cookbook: 101 Easy Recipes to Boost Health. She’s also a nutrition expert for FoodNetwork.com and a contributor to U.S. News Eat + Run and other national outlets.

1. US Department of Agriculture; US Department of Health and Human Services. 2020–2025 Dietary Guidelines for Americans. https://www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf. Published December 2020.