With high cholesterol levels (dyslipidemia)Who are overweightWith high blood pressureWith high-risk medical conditions, such as having type 1 or type 2 diabetes, having had a kidney transplant or heart transplant, chronic kidney disease, end-stage renal disease, or Kawasaki disease and still having coronary artery aneurysmsWith a family history of early cardiovascular disease, dyslipidemia (high cholesterol levels), obesity, primary hypertension, diabetes mellitus, or exposure to smoking in the home.
Most children with risk factors should transition to a CHILD-1 diet when they are two years old. Parents and pediatricians should then continue to reinforce CHILD-1 diet messages as these children get older.
CHILD-1 Diet
So what is a CHILD-1 diet? The CHILD-1 diet works to:
Limit or avoid sugar-sweetened drinks Encourage kids to drink water Avoid trans fat Encourage high-fiber foods Limit sodium and avoid foods high in salt Encourage kids to drink fat-free unflavored milk Teach kids about appropriate portion sizes, which will be partly based on the estimated number of calories they need each day based on their age, gender, and how active they are Encourage daily physical activity Limit cholesterol intake to less than 300 mg each day Teach healthy eating habits Encourage a DASH-type diet rich in fruits, vegetables, low-fat or fat-free milk and other dairy products, whole grains, fish, poultry, beans, nuts and seeds, and lower in sweets and added sugars, fats, and red meats
You don’t necessarily need to wait until your child is two to start CHILD-1 though.
CHILD-1 for Younger Toddlers
Although some of the CHILD-1 recommendations for infants between the ages of 12 to 24 months are a little technical, others are fairly simple:
Limiting juice to no more than 4 ounces of 100% fruit juice each day If not breastfeeding, consider transitioning to reduced-fat unflavored cow’s milk, from 2% to fat-free milk, if your child is overweight, at risk for obesity, or if he has risk factors for cardiovascular disease Transition to table foods that provide 30% of their daily calories from fat, but only about 8 to 10% from saturated fat, with the rest coming from monounsaturated and polyunsaturated fats Avoid trans fat
If your child doesn’t have any risk factors, he can transition to fat-free milk when he is two-years-old.
CHILD-1 for Toddlers to School-Age Kids
By the time your child is two, his or her primary drink should be fat-free unflavored milk. As compared to infants, these older kids need a little less fat in their diet - about 25 to 30% of their total calories. The majority of those fats should still be monounsaturated and polyunsaturated fats, though, with a smaller proportion of saturated fat. This is a good age to start teaching children about portions sizes and encouraging regular physical activity.
CHILD-1 for Preteens and Teens
In addition to continuing to drink fat-free unflavored milk, water, and limited amounts of sugar-sweetened drinks, older kids should be encouraged to follow healthy eating habits, such as:
Eating breakfast every dayEating meals as a familyLimiting fast-food meals
Continuing to eat high-fiber foods, watching portion sizes, and being physically active every day is also still important at this age.
CHILD-1 Next Steps
It is important to keep in mind that CHILD-1 diet is just the first step for children with high cholesterol. If after a 3- to 6-month trial of CHILD-1 dietary changes a child continues to have high cholesterol, they should then be moved to a CHILD-2 diet with:
Only 25% to 30% of calories from fatLess than or equal to 7% of calories from saturated fatAbout 10% of calories from monounsaturated fatLess than 200 mg/d of cholesterolAvoid trans fats as much as possible
And depending on their lipid profile, they should follow a CHILD-2-LDL vs. a CHILD-2-TG diet. The CHILD-2-LDL diet encourages the use of plant sterols, plant stanol esters, and water-soluble fiber psyllium to replace some fats in the child’s diet. In contrast, the CHILD-2-TG diet encourages the replacement of simple sugars with complex carbohydrates and increasing omega-3 fatty acids. Keep in mind that a registered dietitian should likely help your child plan and follow their CHILD-2 diet, and may even be helpful for the CHILD-1 diet, too.
