Children & Sugar Consumption
By Joanna Foley, RD
Vol. 25 No. 8 P. 30
Striking a balance between overrestriction and adherence to current guidelines.
Sugar consumption has been under much scrutiny with regard to children’s diets. Since excessive sugar intake can have negative health impacts, parents and caregivers are told to give their children foods and snacks that contain less sugar.1 While these messages have positive intentions, they may fail to take into account other factors, such as the potential to overrestrict sugar and barriers to meeting the 2020–2025 Dietary Guidelines for Americans (DGAs) for sugar consumption.
Moreover, the way parents and caregivers perceive foods containing sugar inside and outside the home can have a large impact on a child’s relationship with sweets, impacting how much they eat and how they view these foods themselves. When sugar is demonized and/or overly restricted, children potentially can develop disordered eating habits, which parents unwittingly may overlook. What’s more, restricting sugar is challenging for families in today’s food culture, so meeting the DGAs may not be practical. These issues make the topic of sugar intake and children more complicated and one that deserves proper attention.
Thus, it’s important for dietitians to help parents and caregivers better understand how to navigate sugar consumption with their children to enable them to foster a healthy relationship with sugar and support their overall health.
What the Current Guidelines Recommend
Dietitians know that consuming sugar in excess can lead to increased risk of type 2 diabetes, obesity, heart disease, fatty liver disease, and other illnesses.1 For these reasons, many health organizations have developed guidelines for limiting intake of added sugars for children and adults.
The American Heart Association developed stricter guidelines, recommending that children and teens consume less than 6 tsp (or 25 g) added sugars per day and to drink no more than 8 oz of sugar-sweetened beverages per week.3 However, the CDC reports that the average daily intake of added sugars was 17 tsp for children aged 2 to 19 from 2017 to 2018, which is far above these guidelines.4
Obstacles to Achieving Goals
There are many barriers that arise when trying to meet the DGAs for consumption of added sugars for children. These may include the following:
• Shared caretaking. Parents may find it difficult to monitor their children’s sugar intake because they may be at school, at an event, or under someone else’s supervision. “Kids often spend time outside of the home with adults who are not their primary caretakers,” says Erin Shah, RD, CDE, a former leader of high-risk infants at Kaiser Permanente Anaheim Medical Center in Anaheim, California. “Whether it be daycare or school, grandparents or friends’ houses, birthday parties, or other special events, parents aren’t the only ones in control of the child’s food options or choices.” In fact, a 2022 study showed that the caregiver type, especially grandparents, is a significant predictor of a child’s health status, including BMI, diet, and food security.5 So, while parents may be able to control sugar intake in their own homes, their child’s health is still influenced by the world around them.
• Socioeconomic status. A family’s financial status is a significant factor to consider when trying to meet the DGAs. “Sugar is cheap and, as one of the US’s top food preservatives, often finds itself in many processed and shelf-stable foods,” Shah says, adding that families that have lower incomes tend to consume diets higher in added sugars than those with higher incomes.6
• Health literacy. Not all consumers read nutrition labels and ingredient lists, which can be tedious and confusing. And those who take the time to read them may not know that sugar often disguises itself under different names. “Sugar hides under many other names (such as honey and high-fructose corn syrup, maple syrup, or molasses) and can sneak into seemingly healthful packaged and prepared foods,” Shah says. “There’s also the common confusion between natural sugars, such as fructose in whole fruits or lactose in dairy foods, vs added sugars.”
• Practicality. Another reason many families find it challenging to limit their children’s sugar intake is because many convenience and packaged foods and snacks they rely on contain added sugars. In the midst of busy lives, parents and caregivers often find it impractical to prepare most meals and snacks from scratch or use only whole food ingredients.
• Culture and ethnic background. Due to the many different cultural practices, ethnic backgrounds, and eating habits, some populations tend to consume more or less sugar than those of other ethnicities. According to CDC data from 2017 to 2018, non-Hispanic Black children aged 2 to 19 consumed the most added sugars compared with non-Hispanic white children, Hispanic children, and non-Hispanic Asian children.
• Increased desire. Research has shown that children are born with a desire for sweet flavors.7 In fact, most have a stronger preference for sugar compared with adults, which isn’t a result of the culture in which they live. Some researchers believe a child’s strong desire for sugar may be associated with their growing bodies since sugar provides a quick source of energy and calories.8
Dietitians should take these obstacles into consideration when devising a child’s diet and providing recommendations to parents and caregivers.
When Restricting Sugar Backfires
In addition to the many potential barriers that can limit children’s sugar intake comes the issue of problematic eating behaviors when sugar is too restricted. “Because of the volume of fear-mongering messages parents constantly receive about sugar and kids, many caregivers may believe that by restricting sugar in their home, they’re taking steps to improve their child’s health and well-being,” says Crystal Karges, MS, RDN, IBCLC, founder of Crystal Karges Nutrition, a private practice based in San Diego, specializing in intuitive eating for mothers and families. “While well-intended, the potential consequences of restricting sugar cannot be overstated, especially as a child gets older and begins getting exposed to sweets outside the home.”
Some potential problematic eating behaviors that warrant attention may include the following:
• Overeating. Overly restricting sugar can lead to children desiring and consuming more. One study found that girls whose mothers engaged in restrictive feeding practices had higher rates of overeating and eating in the absence of hunger.9
One form of restriction that’s common in many households is reserving sweets for only special occasions or using them as a reward. However, research shows that these practices may cause some children to crave them more and eat them in excess when they’re available.10 “Using desserts as a reward elevates sweets on a pedestal, making them something a child is more likely to obsess over,” Karges says. “It also runs the risk of detaching a child from their innate intuitive eating abilities. This can cause a child to begin to ignore what their bodies need in favor of following external rules for eating, which disrupts their ability to self-regulate their intake,” Karges says.
• Disordered eating behaviors. “Some kids who have diets that are overly restricted may end up engaging in behaviors like hoarding or sneaking food,” says Krystyn Parks, MS, RD, IBCLC, owner of Feeding Made Easy, based in Orange County, California. This can lead to long-term disordered eating habits, emotional eating, or symptoms of eating disorders.11
• Poor relationship with sugar and/or themselves. Children are at risk of internalizing shame, fear, and judgment around eating sweets when they’re “categorized as ‘healthy’ vs ‘unhealthy’ or ‘good vs bad,’” Karges says. And since children are concrete thinkers developmentally, they’re more likely to translate messages around food more literally. For example, a child who hears, “Eating too many sweets is bad for you,” may translate this message to mean, “I am bad for eating sweets,” Karges says.
• Preoccupation with sugar. Children who are restricted from eating sweets may appear anxious when sweets aren’t available or throw a tantrum when requests for sweets are denied. And there may be visible signs of distress when children attempt to access sweets or incessantly ask or nag when sweets become available, Karges says. “Restriction also can lead to intense preoccupation. In this case, a child may be unable to focus on other activities due to the obsessiveness of having sweets. This may make it challenging for [the child] to engage in childhood activities important for development and growth.”
It’s important to keep in mind that some of these troublesome eating behaviors are based on anecdotal evidence and knowledge of the way a child’s brain works and develops. While all of these behaviors may not be supported by research, parents and caregivers should take them into consideration when addressing sugar with their children.
Taking into account the possible consequences of overly restricting sugar and the obstacles to meeting dietary guidelines for sugar consumption in children makes nutrition counseling more complex.
The good news is that sugar doesn’t have to be off limits. It’s possible for children to consume sweetened foods and enjoy desserts while still consuming an amount of sugar that isn’t likely to raise the risk of disease.
Dietitians can share the following tips (based on professional experience and anecdotal evidence) with parents and caregivers to navigate sugar intake inside and outside the household.
1. Keep foods neutral, including sugar. Encourage parents to avoid labeling or categorizing foods as “healthful” vs “unhealthful” and “good vs bad.” Parks suggests, “When talking about sweets and desserts, I usually recommend treating them as you would treat any other food. Refer to them by their name instead of calling them a treat or reward.” Karges adds, “This helps create an emotionally equal playing field for all foods from which children can learn to eat based on the embodied experience of what feels best in their bodies (sans judgment or shame).”
2. Allow frequent access without conditions. While sugar shouldn’t compose the bulk of a child’s diet, RDs should remind parents that they don’t need to overly restrict it. “We want our children to learn to listen to and trust their own bodies. We can communicate this to them by providing them with reliable access to sweets alongside other foods they’re learning to eat, refraining from micromanaging how and what they choose to eat from the foods we provide,” Karges says.
Parks recommends caregivers avoid setting conditions for when their children can have desserts or other sweet foods. She says that “for many families, offering the dessert with the meal, instead of after the meal, can help take some of the obsession [away from] the dessert. Many kids will actually eat more of their other foods when the dessert is available throughout the full meal because they don’t feel the need to save room for it.”
3. Think about the big picture. How much sugar children eat is just one of many factors influencing their overall health. RDs should remind caregivers to also focus on how much physical activity their children are getting and the status of their overall eating habits. They also should be reminded that a healthful eating environment isn’t just about nutrition. It includes feeling safe, comfortable, and connected to others.
4. Be practical. Food needs to taste good in order for kids to eat it.12 So, if parents drizzle a small amount of honey on yogurt or include a dollop of whipped cream on top of berries to encourage their children to eat these nutritious foods, they shouldn’t avoid this practice.
5. Control what you can and not worry about the rest. Because it’s important to encourage children to eat and enjoy foods other than those that are sweet, parents should fill their homes with a variety of healthful and practical foods, such as whole grains, fruits, and vegetables. They can offer these foods to their children regularly without the need for coercion. This will enable parents to relax more when their children attend parties or other activities where sweets will be served. Parents will know they’re doing their part at home and be more inclined to trust their children to self-regulate their appetite for sweets.
It’s important for RDs to remember that each child is unique and that parents have their own opinions about how to address sugar in and outside of their household. Ultimately, RDs should emphasize to caregivers that there isn’t one “right way” to approach sugar consumption and that they don’t have to micromanage sugar intake or overly prevent their children from eating too many sweets. According to Karges, “The main messages caregivers should send to their children around sweets should center around body trust, safety, reliability, and access. We want our children to believe that sweets are safe, that sweets are an enjoyable part of eating—not something to stress over or worry about.” With practice, parents will learn to be attuned to their children’s needs, which will enable them to take a proactive approach to offering sweets intentionally and at a frequency that will help their children build a positive relationship with all foods.
— Joanna Foley, RD, is a freelance health writer and author of two cookbooks, based in San Diego. Learn more about her writing services at joannafoleynutrition.com/press.
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