Many kids don’t eat enough veggies. Amid a parasite outbreak in the US, what’s a parent to do?

By Katia Hetter, CNN

You know what’s never given someone explosive diarrhea? Cookies, many people say on social media.

While some may be looking for more reasons to eat cookies, many more are simply hesitating to eat salads and other fresh produce amid a multistate outbreak of cyclospora, known for that unpleasant symptom, among others.

The parasite is, unfortunately, not likely to encourage children around the world to eat more fruits and vegetables, which is even more important since a new BMJ Global Health study, published July 8, found they aren’t eating enough. Researchers analyzed dietary surveys from 185 countries to better understand what children are eating and how those patterns have changed over time. The findings come as health officials are also investigating the outbreak.

In case your concerns about foodborne illness change how you think about fruits and vegetables, I spoke with CNN wellness expert Dr. Leana Wen for her expert advice. Wen is an emergency physician and clinical associate professor at George Washington University. She previously served as Baltimore’s health commissioner and is the mother of two young children.

CNN: What have we learned about what kids are and aren’t eating today?

Dr. Leana Wen: The new research found that children in nearly every region of the world are not eating enough fruits, non-starchy vegetables, legumes, nuts and seeds, and starchy vegetables. While intake improved somewhat over the nearly three decades studied, progress has been limited.

This study is one of the most comprehensive analyses to date of children’s consumption of healthy plant-based foods. The goal was to understand how much of these foods children are eating around the world, how intake differs by age, sex and country, and how dietary patterns have changed over time.

Researchers compiled data from more than 1,200 dietary surveys conducted between 1990 and 2018, representing children and adolescents in 185 countries. The team then used statistical modeling to estimate intake of these health foods.

CNN: One of the study’s most surprising findings was that American babies and toddlers were among the world’s highest consumers of fruits and vegetables, but older children and teenagers were among the lowest among high-income countries. Why does that happen?

Wen: The study found that children younger than age 2 in the US ate nearly three servings of fruits and vegetables a day. After that, though, intake dropped to fewer than two servings a day throughout childhood and adolescence. This is a problem because US dietary guidelines recommend increasing fruit and vegetable intake as children grow. Children younger than 4 should eat about 1 to 1 ½ servings of fruit each day and about 1 ¼ to 1 ¾ servings of vegetables per day. By adolescence, the recommendation increases to about 2 daily servings of fruit and 3 of vegetables.

One reason for the decrease may be that parents have substantial control over what infants and toddlers eat. Babies are introduced to fruits and vegetables as they begin eating solid foods, and many parents try hard to offer a variety of healthy foods early on. As children grow older, many other influences come into play. Kids spend more time at school and with friends, eat more meals away from home, and have greater access to junk foods. They are increasingly exposed to marketing for products that are ultraprocessed and are high in added sugars, sodium and unhealthy fats.

These findings suggest that improving children’s nutrition isn’t only about educating parents of babies and young children. We also need schools, communities and food environments that make healthy choices easier throughout childhood and adolescence.

CNN: Why is it so important for children to eat fruits and vegetables?

Wen: Fruits and vegetables are rich in vitamins, minerals, fiber and many other beneficial compounds that work together to support health. During childhood, these foods help provide the nutrients needed for growth and development.

It’s also important for kids to start eating fruits and vegetables early because healthy eating patterns established early in life tend to continue into adulthood. Children who regularly eat healthy foods growing up are more likely to maintain those habits later, which can reduce the risk of chronic diseases including heart disease, type 2 diabetes and some cancers.

CNN: A lot of parents say their children are picky eaters. Is this normal?

Wen: Picky eating is a normal part of development for many children, particularly toddlers and preschoolers. It’s common for children to reject unfamiliar foods or suddenly decide they no longer like something they happily ate the week before. I certainly experienced that with my children, and I know it can be frustrating to prepare a favorite meal and then have it be rejected.

One thing to keep in mind is that one negative response to a food does not mean that the child will never accept that food again. In fact, research suggests that repeated exposure, without pressure, is one of the most effective strategies to broaden children’s palates.

So, keep offering fruits and vegetables regularly, including those that a child may have rejected before. Also, eat them together as a family so that children can see parents and siblings enjoying them, too. Involving children in grocery shopping or meal preparation can also increase their willingness to try new foods.

CNN: Does it matter whether fruits and vegetables are fresh, frozen or canned? What about fruit juice, smoothies and dried fruit?

Wen: The good news is that all forms of fruits and vegetables can contribute to a healthy diet. Fresh, frozen and canned produce all provide important nutrients, and the best choice is often whichever one your family can reasonably afford and will eat.

Frozen fruits and vegetables are often picked and frozen shortly after harvest, helping to preserve their nutritional value. They are usually cheaper than fresh fruits, especially if purchased in bulk, and can be a more economical option. My family, for instance, buys frozen broccoli in bulk; it’s easy to put frozen broccoli florets with a little olive oil in the oven for a quick, inexpensive and very easy side dish.

Canned fruits and vegetables can also be nutritious, though it’s really important to check the label. Vegetables should have no added salt or sodium, and fruits should be packed in water or their own juice rather than heavy syrup.

As for other forms, the recommendations are less clear. Smoothies can be a good option, especially if they include vegetables and don’t contain added sugars, but they shouldn’t replace whole fruits and vegetables. Dried fruit can also fit into a healthy diet, though because the water has been removed, the calories and natural sugars are more concentrated.

Fruit juice is a different story. The American Academy of Pediatrics recommends against giving fruit juice to infants younger than 1 year because it offers no nutritional benefit over whole fruit at that age. For older children, juice should be limited rather than treated as a substitute for fruit. The AAP recommends no more than 4 ounces a day for children ages 1 to 3, 4 to 6 ounces a day for those ages 4 to 6, and no more than 8 ounces a day for older children and adolescents.

CNN: This study comes as health officials are investigating a multistate cyclospora outbreak. Should families be avoiding fresh fruits and vegetables?

Wen: No. It’s understandable that people become concerned when they hear about a foodborne illness outbreak, but they should not stop eating fruits and vegetables because of it. The health benefits of consuming a diet rich in produce are extremely well established.

People should continue to follow safe food handling practices. Always wash your hands with soap and water before handling food. Rinse fresh fruits and vegetables under running water before eating or preparing them. Avoid cross-contamination by keeping fresh produce separate from raw meat, poultry, seafood and their juices. Refrigerate perishable foods promptly. Always follow any food recalls or public health advisories and do not use the specific product that has been recalled.

Most people who become infected with cyclospora develop diarrhea, stomach cramps and other gastrointestinal symptoms that can be quite uncomfortable, but they recover fully with appropriate treatment. Cyclospora is treated with antibiotics, so people should seek care promptly if they have symptoms. Individuals at higher risk for more severe or prolonged illness, including pregnant women, older individuals, and those with weakened immune systems, may wish to take additional precautions during a known outbreak, such as choosing cooked vegetables instead of raw produce when possible.

CNN: What’s your bottom-line advice for families who want to help their children eat more fruits and vegetables?

Wen: My best advice is to aim for consistency, not perfection. Offer fruits and vegetables often, make them a routine part of meals and snacks, and recognize that children may need many opportunities before accepting a new food. And remember that healthy eating is a lifelong journey. The goal isn’t to have children eat perfectly today but to help them develop habits that will support their health for decades to come.

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