Pediatric Annals

CME 

The CHILD 1 Diet: From Strategy to Practicality

Adrienne Regis, MS, RD, CSP

Abstract

CME Educational Objectives

1.Understand the key components of the Cardiovascular Health Integrated Lifestyle Diet (CHILD 1).

Determine food choices that make for a successful CHILD 1 diet.

Identify strategies to help educate families to prepare foods consistent with a successful CHILD 1 diet.

As described by the Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents report, the Cardiovascular Health Integrated Lifestyle Diet (CHILD 1) is the first-step diet for all children with elevated cardiovascular risk. Although the diet is specifically designed for cardiovascular disease risk reduction, it can also be used for the promotion of healthy dietary habits for children (older than the age of 2 years) and adolescents while still continuing to provide adequate nutrition for optimal growth and development. The diet provides guidance on caloric distribution, offers appropriate beverage and snack choices, and highlights the importance of adequate fruit and vegetable intake. Although the guidelines presented in the CHILD 1 diet provide a framework on which a healthy diet can be built, it can be challenging for some patients and families to put the recommendations into practice. This article focuses on explaining the key nutrition messages within the CHILD 1 diet and includes practical suggestions for meal planning.

Abstract

CME Educational Objectives

1.Understand the key components of the Cardiovascular Health Integrated Lifestyle Diet (CHILD 1).

Determine food choices that make for a successful CHILD 1 diet.

Identify strategies to help educate families to prepare foods consistent with a successful CHILD 1 diet.

As described by the Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents report, the Cardiovascular Health Integrated Lifestyle Diet (CHILD 1) is the first-step diet for all children with elevated cardiovascular risk. Although the diet is specifically designed for cardiovascular disease risk reduction, it can also be used for the promotion of healthy dietary habits for children (older than the age of 2 years) and adolescents while still continuing to provide adequate nutrition for optimal growth and development. The diet provides guidance on caloric distribution, offers appropriate beverage and snack choices, and highlights the importance of adequate fruit and vegetable intake. Although the guidelines presented in the CHILD 1 diet provide a framework on which a healthy diet can be built, it can be challenging for some patients and families to put the recommendations into practice. This article focuses on explaining the key nutrition messages within the CHILD 1 diet and includes practical suggestions for meal planning.

Q: The CHILD 1 diet includes healthy foods and is recommended in the National Heart, Lung, and Blood Institute guidelines for children who have a family history or if they themselves have risk factors for heart disease including dyslipidemia and overweight/obesity. What is the CHILD 1 diet and what foods should be included for breakfast, lunch, dinner, and appropriate snacks?

As described in The Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents report, the Cardiovascular Health Integrated Lifestyle Diet (CHILD 1) is the first-step diet for all children with elevated cardiovascular risk.1 Although the diet is specifically designed for cardiovascular disease risk reduction, it can also be used for the promotion of healthy dietary habits for children (older than the age of 2 years) and adolescents while still continuing to provide adequate nutrition for optimal growth and development. The diet provides guidance on caloric distribution, offers appropriate beverage and snack choices, and highlights the importance of adequate fruit and vegetable intake.

The CHILD 1 diet advocates a positive lifestyle through the following: encouraging intake of high-fiber foods; consuming a diet rich in fruits, vegetables, and whole grains; limiting intake of sugar-sweetened beverages; encouraging water intake; encouraging the intake of fat-free, unflavored milk; avoiding trans-fat intake as much as possible; limiting total cholesterol intake to < 300 mg/d; limiting the total fat intake to 25% to 30% of total calories with saturated fat intake limited to 8% to 10% of total calories; and limiting sodium intake.

Although these guidelines presented in the CHILD 1 diet provide a framework on which a healthy diet can be built, it can be challenging for some patients and families to put the recommendations into practice. This article focuses on explaining the key nutrition messages within the CHILD 1 diet and includes practical suggestions for meal planning.

Key Nutrition Messages of Child 1

Parents instinctively want to feed their children healthy meals. However, many families lack the education and resources to do so. To improve dietary adherence, it is beneficial to provide parents with adequate nutrition education, which further explains the CHILD 1 diet recommendations.

The CHILD 1 diet encourages consuming a diet high in fruits and vegetables. Fruits and vegetables provide many substances essential to good health, including vitamins, minerals, and fiber. In addition to providing many health benefits, most fruits and vegetables are also low in calories and high in dietary fiber and can serve as excellent snack options. Children and adolescents should consume a minimum of five servings per day of fruits and vegetables. This can be achieved by involving children in food preparation and selection as much as possible and can include taking them to farmer’s markets or attempting to grow a simple backyard garden as a family. To be successful in increasing their overall consumption, it is imperative to continue to expose children and adolescents to a wide variety of fruits and vegetables on a regular basis.

The CHILD 1 diet also promotes increasing the consumption of whole-grain foods. Whole-grain products contain the entire grain kernel and have increased nutritional value when compared with refined grain products. Some suggestions for increasing whole grains in the diet can include using whole-wheat bread, whole-wheat pasta, brown rice, and whole-grain tortillas. Eating more whole-grain foods provides the opportunity for improved vitamin and mineral content as well as increased satiety because of high-fiber intake.

It is crucial that health care providers and parents also focus on the beverage choices of children and adolescents. The primary drink choices should be water and fat-free, unflavored milk. It is especially important to avoid fruit juices, soda, sports drinks, and other sugar-containing beverages because they can contribute a large amount of empty calories, which can promote weight gain and poor dietary habits. Ideally, most children and adolescents should be consuming two to three servings per day of fat-free dairy products to meet nutrient needs. Children should also be encouraged to drink water throughout the day. This can be supported by having children or adolescents purchase their own reusable bisphenol A–free water bottle and carrying it with them throughout the day to promote adequate intake.

Moreover, it is imperative to limit the intake of fatty foods and cholesterol and to avoid trans fat intake for overall health. A few practical suggestions for achieving this are to choose lean protein sources, use healthy cooking methods to prepare them, as well as to limit the intake of non-whole-grain-based desserts, and limit the intake of fast food. Encouraging families to avoid frying foods and instead to bake, broil, or grill their food can assist in lowering fat intake. Trans fats can often be found in commercially baked goods (including cakes, cookies, and crackers), margarine, microwave popcorn, and many of the cooking oils used in fast food restaurants. Parents should beware of foods that list partially hydrogenated oil in the product ingredients because this indicates that the product contains trans fat.

The Table shows a sample menu that meets the CHILD 1 diet recommendations for a school-aged child; it shows many of the nutrition messages discussed. Please note that these meal suggestions can be modified for an adolescent by making adjustments to the portion-size recommendations.

A Sample Menu Meeting the CHILD 1 Diet Recommendations for an Elementary School-Aged Child

Table. A Sample Menu Meeting the CHILD 1 Diet Recommendations for an Elementary School-Aged Child

Physical Activity

Although making dietary changes is essential in the quest for sound pediatric nutrition, it is also important to consider the role that physical activity in the equation for good health. In conjunction with the CHILD 1 diet, it is prudent to encourage families to ensure that their children are physically active at least 1 hour per day.2 This can be difficult for many families because of barriers such as unsafe neighborhoods, economic challenges, and balancing the hectic schedules of working parents. Assisting families in overcoming these barriers is crucial and can be achieved by referring them to community-based programs (such as the local YMCA) and providing resources for home-based exercises. Parents can serve as role models for their children by participating in regular physical activity themselves and limiting their sedentary behaviors. It is crucial to provide education regarding the benefits of regular physical activity for the prevention of cardiovascular risk as well as the promotion of overall health and wellness in children and adolescents.

Conclusion

The CHILD 1 diet provides clear recommendations with regard to dietary composition for children who have a family history or they themselves have risk factors for heart disease including dyslipidemia and overweight/obesity. Furthermore, these messages can also be used to promote dietary changes and healthy behaviors in the general pediatric population. Providing families with initial and ongoing nutrition education and meal planning suggestions is an essential component for avoiding cardiovascular comorbidities and achieving healthful outcomes.

References

  1. Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Summary Report. Bethesda, MA: National Heart, Lung, and Blood Institute; 2012. Available at: www.nhlbi.nih.gov/guidelines/cvd_ped/summary.htm. Accessed May 1, 2013.
  2. Physical Activity Guidelines for Americans. Washington, DC: US Department of Health and Human Services; 2008. Available at: www.health.gov/paguidelines. Accessed June 01, 2013.

A Sample Menu Meeting the CHILD 1 Diet Recommendations for an Elementary School-Aged Child

Breakfast:
½ to 1 cup whole-grain cereal* with ½ cup fat-free, unflavored milk
½ cup fruit (suggestions include sliced banana, sliced strawberries, or blueberries)
6 oz fat-free, unflavored milk
Lunch:
2 oz low-fat, low-sodium turkey breast
1 oz low-fat cheddar cheese
1–2 slices of whole-grain bread
1 small piece of whole fruit (suggestions include an apple, pear, or orange)
4 oz nonfat yogurt (choose yogurt with little or no-added sugars)
½ cup raw vegetables (suggestions include sliced cucumbers, celery sticks, or snap peas)
8 oz water
Snack:
8 oz fat-free, unflavored milk
½ cup raw vegetables (suggestions include baby carrots, celery sticks, or sliced cucumbers)
4 baked whole-wheat crackers
2 oz hummus
Dinner:
2 oz lean protein (suggestions include baked chicken breast or baked tilapia)
½ cup whole-grains (suggestions include brown rice, quinoa, or whole-grain pasta)
½ cup steamed vegetables (suggestions include broccoli, cauliflower, green beans, or carrots)
½ cup mixed fruit
Snack:
½ cup fat-free frozen yogurt (other snack ideas include fresh fruit, nonfat yogurt, whole-grain cereal, or air-popped popcorn)
Authors

Adrienne Regis, MS, RD, CSP, is Senior Clinical Nutritionist and Dietitian to the Preventive Cardiology Program, Ann and Robert H. Lurie Children’s Hospital of Chicago.

Address correspondence to: Adrienne Regis, MS, RD, CSP, Ann and Robert H. Lurie Children’s Hospital of Chicago, 225 East Chicago Avenue, Chicago, IL 60611; email: aregis@luriechildrens.org.

Disclosure: The author has no relevant financial relationships to disclose.

10.3928/00904481-20130823-08

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