Healthy Snacking

Snacking is important for children and adolescents to help meet their energy and nutrient needs for growth and development. However, many parents and health professionals are concerned that snacking is undermining the nutritional quality of children's diets and contributing to childhood overweight.

To ensure that snacking - consuming foods and beverages between regular meals - is nourishing without being a source of excess calories, parents/care providers should be aware of when and where children snack and what snacks they consume. Studies indicate that children and adolescents snack more frequently today than in previous decades. Unrestricted access to snacking can lead to excess calorie intake and an increased risk of overweight. For this reason, snacks should be offered to children at regularly scheduled times of the day, preferably a couple of hours before the next meal to stave off hunger and avoid spoiling their appetite.

Children also are obtaining more of their snacks away from home - at schools and fast food establishments. At home, snacks should be consumed at a designated place and, to avoid mindless overeating, not consumed while watching television or engaged in other activities.

Many children obtain snacks at school. The U.S. Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity recommends that healthy snacks be provided in vending machines, school stores, and other venues within the school's control. Efforts are being made to provide and promote nutritious snacks wherever snacks are available in schools. For example, fluid milk in well-chilled, single-serve resealable packages in a variety of flavors and fat levels is being offered in some school vending machines as an alternative to high energy, low nutrient beverages. Also, USDA's Afterschool Snack Program for Children through age 18 is an effort to provide students with nutritious snacks and the opportunity to practice skills learned in classroom nutrition education.

Because many popular snacks consumed by children are high energy, low nutrient foods obtained from the tip of the Food Guide Pyramid (fats, sweets), they should be eaten sparingly. When offering snacks to children, the best approach is to make foods from the five food groups of the Food Guide Pyramid - the Milk, Meat, Vegetable, Fruit, and Grain groups - readily available and teach children how to balance their food choices throughout the day. Parents/care providers can positively influence children's snacking behaviors by consuming nutritious snacks themselves and by making these snacks readily available.

Intake of dairy foods as snacks can have nutritional and health benefits. Because of their nutrient density, consumption of dairy foods can improve the overall nutritional quality of children's diets. Also, because dairy foods are a rich source of calcium and provide other essential nutrients needed for bone health, consuming at least three servings/day of milk, cheese, or yogurt during childhood may reduce the risk of bone fractures in childhood and osteoporosis in later adult years. Milk and several varieties of cheese (e.g., aged Cheddar, Swiss, process American) may also protect children's teeth from dental caries.

 

Why Kids Need Snacks

Snacks can help meet children's energy and nutrient needs. Because they are growing and are usually quite active, children need more calories per pound of body weight than do adults (1). Recommended calorie intakes to support children's growth and development are based on gender, age, height, weight, and level of physical activity (15). Energy (calorie) recommendations for moderately active children are as follows:

• 1,742 kcal/day for boys and
  1,642 kcal/day for girls ages 3 through 8
• 2,279 kcal/day for boys and
  2,071 kcal/day for girls ages 9 through 13
• 3,152 kcal/day for boys and
  2,368 kcal/day for girls ages 14 through 18 (15).

Lower energy intakes are recommended for less active children (15). For teenagers whose active lifestyles (e.g., school, part-time jobs, athletics) interfere with regular meals, snacks can help meet their energy and nutrient needs (1). Studies indicate that snacks contribute over 20% of the daily energy intake of children aged 19 years and under (2,11,13). In addition to helping to meet energy needs, healthful snacks can help close nutritional gaps such as that for calcium (6). A recent study found that fewer than 50% of children aged 6 to 8 years and most all females aged 9 to 18 years had calcium intakes below current dietary recommendations (16).

Offering children a variety of nutritious snacks and showing them how to fit snacks into their daily diets may help instill a balanced approach to snacking (1). Overly restricting children's access to energy dense, nutrient poor foods such as cookies, cakes, chips, and regular soft drinks can lead to preferences for and over-consumption of these foods (17,18). For this reason, it is best to serve these foods in moderation as occasional treats.

How Often Children Snack

Over the past 20 years, the prevalence of snacking has increased among children aged 2 to 18 years, according to a recent study of snacking behaviors from nationally representative surveys (2). The majority of children 19 years of age and under snack each day and they are snacking more frequently (10,11).

Because of young children's high energy needs, their stomachs' small capacity for food, and their fluctuating appetites, young children need to eat 4 to 6 times a day (19). If children are allowed unrestricted access to snacks, nutrition problems such as excess calorie intake, weight gain, inability to distinguish hunger and fullness, and inadequate nutrient intake may result (1). It is therefore important for adults to offer children snacks at consistent times of the day, ideally one to three hours before a meal to help prevent hunger and overeating without spoiling their appetite for foods served during meals (1). For older children, it is important to have nutritious snacks readily available and teach them how to make healthful food choices (1).

 

Where Children Snack

Although children consume snacks at home, an increasing number of snacks are being eaten away from home, at schools and fast food establishments (12,13). At home, snacks should be limited to specific locations such as the kitchen to keep snacking a purposeful eating experience (1). Serving snacks to children while they are engaged in other activities such as watching television is associated with increased intake of high energy, low nutrient foods which may lead to unconscious overeating and unwanted weight gain (20).

Awareness of when and where children snack and what foods and beverages they consume as snacks is important when weighing the benefits of snacking.

Schools are an important site for children's snacking. Students, especially those in middle/junior and high schools, can choose snacks from vending machines, snack bars, school stores, a la carte, and other venues (21). Although snacks from these sources vary greatly in their nutritional content, many are high in energy, fat, added sugar, and sodium and are of minimal nutritional value (21-23). Recognition that snacks consumed at school can make a major contribution to students' daily nutrient intake (24-26) has increased efforts to ensure that healthful snacks are available to children throughout the total school environment.

The U.S. Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity recommends that healthy snacks be provided in vending machines, school stores, and other venues within the school's control (25). Also recommended is adoption of policies to ensure that all foods and beverages throughout the school and at school events be consistent with the Dietary Guidelines for Americans (27) and that food options low in fat, calories, and added sugars, such as fruits, vegetables, whole grain, and low-fat and nonfat dairy foods be provided most often (25).

As a result of exclusive pouring rights contracts, many students have ready access to soft drinks as snacks in schools (21). To provide students with more nutritious choices, fluid milk in well-chilled, single-serve, resealable packages, in a variety of flavors and fat levels, is readily available in some school vending machines (26). Throughout the nation, Action for Healthy Kids State Teams, an outcome of the "Healthy Schools Summit: Taking Actions for Children's Nutrition and Health" (www.ActionForHealthyKids.org), are identifying goals and developing action plans to improve child nutrition and fitness within the school environment (28). One goal is to ensure that healthy snacks and foods are provided in vending machines, school stores, and other venues within the school's control.

 

Healthful snacks can help provide children with the energy and nutrients needed for growth and development and may help lay the foundation for healthful eating behaviors throughout life.

 

USDA's Afterschool Snack Program, signed into law in 1998 (P.L. 105-336), offers students healthy snacks and the opportunity to practice skills learned in classroom nutrition education (29). This program, available as part of USDA's National School Lunch Program and the Child and Adult Care Food Program, provides cash reimbursements for snacks provided to children through age 18 years in certain afterschool programs. The afterschool snack meal pattern is based on the nutritional needs of children ages 6 to 12 and must provide two of the following: 1 cup of fluid milk, 1 ounce of meat or meat alternate, 1/2 cup fruit or vegetable or 100% juice, or 1 serving grains/bread (29). Additional foods may be needed to meet the calorie and nutrient needs of children ages 13 to 18 years. Many school administrators who participated in focus group research stated that the Afterschool Snack Program contributed to meeting children's daily nutrient needs (30).

During the summer months when school is not in session, it is important for parents/child care providers to make healthy snacks available to children. This is especially true for children who are ineligible to participate in the Summer Food Service Program (SFSP) or who are from communities that do not offer this program. The SFSP provides children from low-income areas a choice of two of the following four components as a snack free of charge: fluid milk, meat/meat alternate, vegetable/fruit/juices, and bread/bread alternate (31).

Snack Foods and Influences on Snack Food Choices

Snack food choices can affect children's nutrient intake and ultimately their health. Many popular snack foods consumed by children are obtained from the tip of the Food Guide Pyramid (fats, oils, sweets) and include chips, candy, cookies, and regular soft drinks (10,13,14,22). Because these foods can be high in calories, fat, sugar, and/or salt and low in essential nutrients such as calcium, they should be eaten sparingly.

A recent study of 8th grade students found that nearly half of the students' energy intake from snacks was contributed by simple sugars (32). A high intake of sugar, especially from foods that remain in the mouth, stick to teeth, and are eaten between meals, may contribute to dental caries and displace more nutrient-dense foods in children's diets (27,33-35). Excessive intake of regular soft drinks has been associated with an adverse effect on children's nutrient intake (e.g., calcium) and an increased risk of bone fractures, overweight, and dental problems (36-42). As children become older, consumption of soft drinks increases and milk decreases (43,44).

When offering snacks to children, the best approach is to provide a variety of foods from the five food groups of the Food Guide Pyramid (9) - the Milk, Meat/Beans, Vegetable, Fruit, and Grain groups. Parents need to make healthful snacks readily available in children's environment. Snacks should supplement, not replace, meals for children and be offered in appropriate serving sizes.

To foster healthful patterns of snacking, parents/care providers need to be positive role models by consuming nutritious snacks themselves and by providing children with a wide variety of snacks from the Food Guide Pyramid in moderate portions.

Factors such as a child's age, the location and availability of snacks, and parents can influence children's snack choices. A recent focus group study of preadolescents (11-12 years old) and adolescents (16 to 17 years old) found that children's age influenced their calcium-rich snack food choices (45). Younger children were more likely to consume milk as a snack than older children who indicated that they were more likely to select soft drinks, water, punch and/or juice (45). The authors suggest that the eating location and availability may have influenced children's snack choices. Younger children snacked mostly at home where milk was readily available, whereas older children consumed more snacks away from home where other less nutritious beverages were more often found (45).

Parents' own snacking behaviors may influence children's snack food choices. Parents and other care providers can serve as role models by consuming and providing healthful snacks to children. A recent study found that mothers can positively impact their young daughters' calcium status, bone health, and overall diet quality by setting a good example, such as drinking milk and increasing opportunities for children to consume milk (46). Parents need to moderate children's snacking, but overly restricting their access to palatable energy dense nutrient poor foods may lead children to prefer and consume more of these foods, even in the absence of hunger, when given the opportunity to freely choose (17,18,47).

Healthy snacking during childhood and adolescence can help support adequate growth and development, and may help lay the foundation for lifelong healthful eating behaviors (1). However, many parents and health professionals are concerned that children's snacking has contributed to the rising prevalence of childhood overweight (2-4) and decrease in the nutritional quality of children's diets (5,6). Fifteen percent of children aged 6 through 19 years are overweight (7) and only 2% of U.S. children aged 2 to 19 years meet the Food Guide Pyramid serving recommendations for all five food groups (8,9).

Studies indicate that more children are snacking and snacking more frequently today than in past decades and snacks are increasingly being obtained away from home (2,5,10-13). Between 1977 and 1996, the contribution of daily energy intake by snacking increased 30% (2). Popular snacks tend to be energy dense, nutrient poor foods such as chips, cookies, candy bars, and regular soft drinks (10,14).

The challenge is to provide children and adolescents with snacks that help meet their nutrient needs without contributing to excess energy intake (overweight) or poor eating habits. This Digest reviews kids' snacking, including when and where they snack, what foods are selected as snacks, and influences on their snack food choices. Strategies for encouraging healthful snacks for healthy kids are presented. Also discussed are the nutritional and health benefits of dairy foods as snacks for children and adolescents.

 

Improving the Nutritional Quality of Children's Diets

Snacks can make a substantial contribution to children's nutrient intake depending on the type and amount of foods and beverages consumed. A concern is that an increase in total energy intake due to the high energy density of some snack foods and supersized portions may predispose children to weight gain (3).

Milk and other dairy products are nutrient dense foods providing abundant amounts of nutrients necessary for children's growth and development (48). For example, milk, including low fat versions, is an excellent source of calcium, vitamin D, riboflavin, and phosphorus and a good source of protein, potassium, vitamin A, vitamin B12, and niacin. Because of dairy products' nutrient density, increasing their intake can help improve the overall nutritional quality of children's diets (36,37,49).

Not only are foods from the Milk Group nutrient dense, but also their intake need not contribute to excess body weight or body fat (50,51). Flavored milk is a well-liked beverage which has been shown to increase children's calcium intake without increasing their proportion of daily calories from total fat or added sugars compared to children who do not consume flavored milk (52). A wide variety of calcium-rich dairy products - milk, cheese, and yogurt - of varied calorie and fat content (whole fat, reduced fat, low fat, nonfat) are available as healthy snacks for children (47,53). Emerging research suggests that increased calcium/dairy food intake is associated with decreased body weight or body fat (54,55). In a five-year study of preschool children, higher intakes of calcium and dairy foods were associated with lower body fat (54).

 

Improving Bone Health

Consuming at least three servings a day of milk, cheese, or yogurt, including low fat versions, during childhood may protect against bone fractures in childhood (56) and osteoporosis in later adult years (53,57,58), as well as lead to adoption of a lifestyle that supports bone health (59). Milk and other dairy foods are an important source of nutrients such as calcium, vitamin D (if fortified), protein, magnesium, and vitamin A needed for bone health (60). Calcium is the most important nutrient to maximize peak bone mass, which may help to reduce the risk of osteoporosis in later adult years (53,57). Unfortunately, a large majority of children and adolescents have usual calcium intakes well below recommended dietary intakes (16,61).

Low intake of milk and other dairy foods contributes to children's calcium shortage (11,37,53). In a policy statement urging pediatricians to recommend milk, cheese, yogurt, and other calcium-rich foods for children's daily diets, the American Academy of Pediatrics recommends that children meet their calcium needs from food first because eating patterns developed during childhood tend to be followed throughout life (53).

Consuming calcium-rich dairy foods such as milk, cheese, and yogurt as snacks can help improve the nutritional quality of children's diets, improve their bone health, and may protect against dental caries.

 

Protecting Against Dental Caries

Frequently consuming sugar- or other fermentable carbohydrate-containing foods and beverages such as candy, cookies, snack chips, and carbonated soft drinks between meals may promote dental caries (42,62). In contrast, consuming milk and especially several varieties of cheese as snacks may help protect against dental caries (63-67).

Several cheeses, including aged Cheddar, Swiss, blue, Monterey Jack, Gouda, Muenster, mozzarella and process American cheese, have been demonstrated under experimental conditions to help prevent dental caries by reducing acid demineralization of tooth enamel and enhancing remineralization of caries lesions (63-66). Cheese's texture, which stimulates salivary flow, and its protein, calcium, and phosphate content contribute to this food's protective effect against tooth decay (63-66).

The American Academy of Pediatric Dentists (AAPD) recommends that children be served snacks no more than three or four times a day and that these snacks contribute to children's overall nutrition and health (67). Cheese, vegetables, yogurt, and chocolate milk are identified by the AAPD as nutritious snacks for children (67). To reduce risk of dental caries, children should also limit their intake of sugar-containing foods to mealtime and practice good daily oral hygiene (e.g., brush teeth with fluoride toothpaste after eating snacks) (27).

Nutrition experts agree that there are no "good" or "bad" foods and that all foods in moderation can fit into a healthful diet (68,69). Children's snack choices should include a variety of foods from the five food groups of the Food Guide Pyramid with minimal selections from the tip of the Pyramid (e.g., fats, oils, sweets).