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Good Nutrition for Kids
By Benjamin Spock, M.D.

This article appeared in Good Medicine Magazine, Spring/Summer 1998 (Volume VII, Number 2)

Dr. Benjamin Spock never lost the enormous compassion that marked his work for children and for the adults they become. His book Dr. Spock’s Baby and Child Care has been a key reference for parents since it first appeared in 1946. With nearly 50 million copies in print, it has sold more than any book other than the Bible. In its seventh edition, which appeared May 2, 1998, Dr. Spock added new emphasis to the power of foods for health. He was a member of PCRM’s Advisory Board, participated in our press conferences, and was always a strong supporter of our work. His death on March 15, 1998, meant the loss of one of the world’s most compassionate and ethical physicians.

Good nutrition is vital for our children’s well-being, as well as our own. Research has shown that many health problems, particularly heart disease, some forms of cancer, high blood pressure, diabetes, and others are to a great degree caused by diet. Many of these conditions have their roots in childhood. The beginnings of artery changes are often found before age 3. By age 12 they are present in 70 percent of children, and by age 21 they exist in almost all young adults. Weight problems are worsening among our children and contributing to so many difficulties later in life.

Although we know we need to bring up our children with the best possible diet, this can be quite a challenge to parents. Children are not particularly concerned about remote-seeming health problems. Meals served in school or at fast-food restaurants are often not what you would offer at home. Television advertisements push potato chips instead of baked potatoes, and hamburgers instead of vegetables and fruit.

Even so, when parents offer healthy foods—vegetables, fruits, whole grains, and beans—at home, and when the whole family, including the parents, makes these foods front and center in the diet, children learn tastes that can help them throughout life.

Plant-Based Diets
What are the best choices? Our understanding of nutrition has grown enormously in recent years. Not so long ago, we thought of vegetables, grains, and beans as nothing more than side dishes, and favored meat and dairy products without much worry about the fat and cholesterol our children were getting. All that has changed. We now know that vegetables, grains, beans, and fruits should be at center stage. In a nutshell, here is how parents might think about building healthy meals for children:

• Eat plenty of green leafy vegetables, at least two to three servings every day. They are loaded with the absorbable calcium, iron, and many vitamins that children need.
• Have plenty of other vegetables, too, selecting the freshest organic vegetables at a farmer’s market or a local garden or, if you can, grow your own. It helps to offer more than one vegetable at a meal and to avoid pushing children to eat vegetables they do not care for. Overall, vegetables should make up 25 to 30 percent of the diet.
• Beans and bean products, such as tofu or tempeh, should be a regular part of the diet. They are rich in protein, calcium, and many other nutrients.
• Fruits, seeds, and nuts can be delicious additions to the diet. They are easier to digest when cooked.
• Whole grains, such as brown rice, barley, oats, millet, whole wheat pasta, or whole grain bread, are filling and nutritious. Their complex carbohydrates are a great energy source for growing children, and they also have protein, fiber, and important vitamins. Whole grains could easily be 50 percent of your meal.

If these four groups—vegetables, beans, fruits, and grains—make up your child’s daily routine, you have the main nutritional bases covered. There are a couple of other key points:

• Vitamin D is needed for strong bones. Although it is normally formed by the sun on the skin, children in northern latitudes or who tend to stay out of the sun may not get enough vitamin D. Fortified cereals and all common children’s multivitamins provide a healthy source of vitamin D.
• Vitamin B₁₂ is essential for healthy nerves and healthy blood cells. It is made by bacteria, and in less developed countries, traces of bacteria in the soil or on plants appear to produce a significant amount of it. However, we cannot rely on these sources in the modern world. Animal products contain vitamin B₁₂ formed by bacteria in the animals’ intestinal tracts, but fat and cholesterol come along with it. Better sources include fortified soymilk or cereals, such as Product 19 or Total, and all common children’s multivitamins contain more than enough vitamin B₁₂.

Foods to Limit or Avoid
Most families have become concerned about the fat content of meats and are choosing the lower-fat cuts. I would encourage them to go a step further and get their nutrition from vegetables, grains, beans, and fruits, rather than from meats, poultry, fish, or dairy products. Children who grow up getting their nutrition from plant foods have a tremendous health advantage and are much less likely to develop health problems as the years go by.

Seven years ago, I made major changes in my own diet. At 88 years of age, I began a nondairy, low-fat diet. Within two weeks, my chronic bronchitis went away after years of unsuccessful antibiotic treatments. I know many people who have used nutritional changes to deal successfully with very serious conditions, including heart disease and cancer.

Small diet changes are not nearly so effective as more major ones. Switching from “red meat” to chicken or fish, for example, does not help very much. Chicken actually has about as much cholesterol as beef—about 25 milligrams per ounce—and almost as much fat. Researchers have also learned that the cancer-causing chemicals that form on beef as it cooks also tend to form on chicken and fish, to say nothing of the bacterial contaminants that cause bouts of serious illness, especially in very small children. I would encourage families who are still including meats in their routine to explore vegetarian meals and have as many meatless meals as possible.

Cow’s milk has become a point of controversy among doctors and nutritionists. There was a time when it was considered very desirable, but research has forced us to rethink this recommendation. While there are still disagreements among scientists, there are several points that most everyone agrees on.

First, most green leafy vegetables and beans have a form of calcium that is absorbed as well or even a bit better than that in milk. They also have iron, vitamins, complex carbohydrate, and fiber which are generally lacking in milk.

Second, dairy products contribute to a surprising number of health problems. They can impair a child’s ability to absorb iron and in very small children can even cause subtle blood loss from the digestive tract. Combined with the fact that milk has virtually no iron of its own, the result is an increased risk of iron deficiency.

Cow’s milk proteins are a common cause of colic, and now the American Academy of Pediatrics has concluded that there is evidence that cow’s milk may well contribute to childhood-onset diabetes. Some children have sensitivities to milk proteins that show up as respiratory problems, chronic ear problems, or skin conditions.

Human breast milk, of course, is perfect for infants. Older children enjoy soy or rice milk products, and the nondairy “ice creams” are well worth tasting.

Regarding oils, I recommend using sesame oil, olive oil, corn oil, flax seed oil, and polyunsaturated vegetable oils. However, the amount used should be minimal, such as brushing the bottom of the skillet with a few drops of oil or using a vegetable oil spray.

It makes sense to avoid refined sugars. For a sweet treat, the healthiest choices are fresh fruits and fruit juices.

Regarding salt, I cook grains with a pinch of sea salt and don’t use salt at the table. The only advantage of typical table salt is that it contains iodine, which is an essential nutrient, although sea vegetables are also rich in it.

It is wise to avoid caffeinated beverages for children, and that goes for adults, too. Children need pure, clean water, rather than sodas. For variety, they can have juice, or teas from grains or herbs.

The Eating Environment
A word about helping children to acquire good eating habits: I encourage parents to avoid struggling with their children over what they are eating, but that does not mean being a doormat. It’s reasonable to expect children to come to meals on time, to be pleasant to others at the table, to refrain from making unpleasant remarks about foods they may not like, and to eat with age-appropriate table manners. It’s sensible for parents to put a limit on candy, sodas, and other less wholesome foods. All this can be done without argument as long as the parents act as if they know what they are doing.

It helps to keep mealtime free of distractions such as the television and telephone. And even though spills and lapses of manners inevitably occur at mealtime, scolding should not be part of the dining experience. A certain amount of politeness and respect, both for everyone present and for the food, creates a better atmosphere for your child.

Parents spend a great deal of time and energy on their children’s education, their moral values, and the environment they will live in. Helping them learn tastes for healthy foods will stand them in good stead for the future, too.

Questions: The Transition to Solid Foods

Good Medicine: How would you advise parents who want to help their children eat right?

Spock: As babies start eating solid food, parents have a once-in-a-lifetime opportunity to introduce eating habits that will keep them in good health in the years to come. The preference for salty or fatty foods starts very early, so parents who introduce healthy foods do their children a lasting favor.

GM: When and how should parents start with solid foods?

Spock: There is no set age for starting solid food. At the beginning of this century, solid foods were usually given around one year of age. Later on, people began starting earlier and earlier, and there are a couple of advantages to starting in the first six months. First, younger babies are a bit less opinionated and fussy about what they eat. Second, solid foods can add some helpful nutrition, particularly iron.

It is easiest to try solid foods an hour or so after a regular breast- or bottle-feeding and to begin with only one meal of solid food a day until you’re both used to this new adventure. I wouldn’t suggest more than two solid meals a day until the baby is at least six months old because the breast milk or formula is so important in the early months.

A baby tasting solid food for the first time is really a little pathetic. She is puzzled and disgusted and wrinkles up her nose, and you can’t blame her. After all, mother’s milk or formula gets to the right place automatically. Moving solid food back into the throat requires a totally new experience. Most of it ends up on her chin, and you have to shave it off her chin and scoop it back into her mouth.

GM: Is there a certain order for introducing foods?

Spock: The first solid food is usually cereal, often mixed with either expressed breast milk or formula, whichever the baby is used to. It’s a good idea to mix it thinner than the directions on the box say. It will seem more familiar to the baby and be easier to swallow. You’ll start with a teaspoonful or less and work up gradually to two or three tablespoonfuls if your baby wants it. Just give a taste for several days, until your baby shows signs of enjoying it. Take your time, there’s no rush.

Cereals may start with rice, oats, corn, or barley. Wheat is usually deferred until later since it causes allergy more often than other cereals.

If your baby is not keen on cereal, we often recommend starting with fruit instead. Babies are puzzled by fruit, too, at first, but within a day or two they love it.

After a baby has gotten used to cereal or fruit, strained cooked vegetables are commonly added to the diet, usually string beans, peas, squash, carrots, beets, and sweet potatoes. Other vegetables such as broccoli, cauliflower, cabbage, turnips, kale, and onions are so strong-tasting that some babies don’t like them. Corn is not given initially because of the large husks on the kernels.

Once your baby is familiar with cereals, vegetables, and fruits, other foods can be introduced. Try very well-cooked beans such as lentils, chickpeas, and kidney beans. Tofu is also a good choice, in small cubes or mixed with applesauce, other pur¹ed fruits, or vegetables.

Foods for your baby can be cooked, then ground in a hand foodmill for softer texture and easier swallowing.

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