To test (1) whether children will consume low-sugar ready-to-eat (RTE) cereals and (2) the effects of serving high- versus low-sugar cereals on the consumption of cereal, refined sugar, fresh fruit, and milk.
Using an experimental design, we randomly assigned children (n = 91) who were attending summer day camp to receive a breakfast that included either the choice of 1 of 3 high-sugar cereals (high-sugar condition) or low-sugar cereals (low-sugar condition), as well as low-fat milk, orange juice, bananas, strawberries, and sugar packets. Participants served themselves and completed a background questionnaire after eating. Researchers measured the amount and calories consumed of each food.
In both conditions, children reported “liking” or “loving” the cereal they chose. Children in the low-sugar cereal condition consumed, on average, slightly more than 1 serving of cereal (35 g), whereas children in the high-sugar condition consumed significantly more (61 g) and almost twice the amount of refined sugar in total (24.4 vs 12.5 g). Milk and total calories consumed did not differ significantly between conditions, but children in the low-sugar condition were more likely to put fruit on their cereal (54% vs 8%) and consumed a greater portion of total calories from fresh fruit (20% vs 13%).
Compared with serving low-sugar cereals, high-sugar cereals increase children's total sugar consumption and reduce the overall nutritional quality of their breakfast. Children will consume low-sugar cereals when offered, and they provide a superior breakfast option.
Comments
Feeding the "Picky Eater"
I would like to congratulate Dr. Harris and colleagues on their recent publication in Pediatrics. In “Effects of Serving High-Sugar Cereals on Children’s Breakfast-Eating Behavior 1”, they demonstrated that children offered only cereal containing a low amount of sugar consumed, on average, less sugar than similar children offered highly sweetened cereal. All children were allowed to add extra sugar to their cereal from sugar packets. Children in both groups had similar caloric intake, but those in the low-sugar group made up for the lower caloric value of their cereal by adding more fruits or fruit juice to their meal.
All pediatricians, myself included, favor a healthy diet and good nutrition for every child. However, not all parents are able to achieve this goal with their children. While we must continue to recommend the best possible eating habits for children, there will always be a small segment of them who will not eat the healthier foods served to them.
In popular culture, it is widely believed that any sweats or added sugar are bad for children. Perhaps this belief originates in the need to keep the message simple and with sharp boundaries between “good” and “bad”.
Primary care pediatricians are well aware of families in which the parents offer and encourage consumption of only low-sugar and highly nutritious foods. In the majority of cases, mild parental insistence is enough to gain compliance from the child; however, in a significant minority, undesirable food struggles arise between the insistent parent and the stubborn child who refuses to eat such foods. For this group of children, we advice parents to compromise on dietary content, since getting enough calories for the child takes precedence over what type of food groups are consumed.
With this in mind, I was happy to see that the authors of the current study acknowledge that there is a group of children who will not eat low- sugar cereals unless sweetened with additional sugar. In fact, they recommend this practice for such “picky eaters”, because they have demonstrated that with added sugar, children often ate the low-sugar cereals (and enjoyed it!), while consuming a better mix of food groups.
Our advice to parents of “picky eaters” has been: encourage the best possible nutrition. If encouraging your child gets him/her to eat healthier foods, then do so; however, if food struggles result or if the child just will not eat such foods, a compromise (such as allowing less desirable choices or adding sugar to low-sugar cereal) is not only acceptable, but is the best decision.
I hope the authors and others will obtain more data on the best ways to feed the “picky eater”.
Sincerely,
Harold S. Raucher, M.D. 1125 Park Avenue New York, NY 10128
1.Harris, JL, Schwartz MB, Ustjanauskas A, Ohri-Vachaspatati P, Kelly DB: Pediatrics 2011; 127:71-76.
Conflict of Interest:
None declared