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by Rebecca Forbes


Responding to children’s growing waistlines — and the ensuing medical problems — the National Association of Pediatric Nurse Practitioners (NAPNAP) has launched a Healthy Activity and Eating Together Initiative (HEAT).  These are recommendations for parents, divided into age categories — although they point out that many of the recommendations span multiple age categories:

Infancy (birth-12 months)
—Breastfeeding exclusively from birth to 6 months and throughout the first year of life after complementary foods are introduced.
—Feeding infants who do not breastfeed up to 32 oz. a day of iron-fortified formula.
—Ensuring that infants up to 6 months old get 210 milligrams of calcium and 200 International Units of Vitamin D per day, and that infants 7-12 months old get 270 milligrams of calcium and 200 International Units of Vitamin D per day.  Infants who receive adequate sunlight and drink at least 500 milliliters of breast milk or formula each day may not need any additional Vitamin D.

Beginning at 4-6 months

—Introducing iron-fortified cereal into the diets of children between 4-6 months old, beginning with one to two servings a day and decreasing that to one serving as other iron-rich foods are introduced.
—Gradually increasing the number of fruit servings daily from one to three.
—Gradually increasing the number of vegetable servings daily from one to two.
—Eliminating night-time bottle feedings at six months and transitioning to a cup for drinks between nine months and a year.
—Feeding older infants (9 months or older) three meals a day and two or three healthy snacks.
—Giving children no more than 6 oz. of 100 percent fruit juice a day, and avoiding soda and fruit drinks altogether.
Early childhood
(One to Four Years)

—Not providing children with a bottle during bedtime and weaning them by 15 months.
—Ensuring that children get 500 to 800 milligrams of calcium daily.
Children One Year and Older
—Limiting fast food to no more than twice a week and educating children about healthy food choices and portion control when eating out.
—Limiting fat intake to 30 to 35 percent of daily calories: avoiding cookies, baked goods, donuts and French fries; using soft margarine rather than butter or stick margarine; using low-fat or fat-free dairy products for children older than 2; and choosing polyunsaturated or monosaturated fats like those in fish, nuts and vegetable oils.
–Encouraging children to eat five servings a day of fruit and vegetables.
—Encouraging children to eat whole grain foods.
—Limiting fruit juice to 4-6 oz. a day and encouraging children older than 2 to drink water and low-fat milk rather than sweetened drinks.
—Eating together as a family as often as possible.
—Encouraging children to eat a healthy breakfast every day.
—Avoiding the “clean plate” policy or using food as a bribe or reward or as comfort.
—Encouraging children to try new foods and praising them when they do.
Physical Activity
—Turning off the TV during mealtimes, and not allowing children under 2 to watch television at all.   
—Limiting television watching to two hours a day or less and not having television in children’s bedrooms.
—Encouraging children to get at least 60 minutes of active play or vigorous exercise daily.
  More information about the NAPNAP’s HEAT Initiative is available online at www.napnap.org. 

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