by Heather Lesage-Horton, MD

As a pediatrician, one of my goals at every patient’s yearly physical is to ask about activity and nutrition. As part of measuring growth we get a height and weight on each patient. We use this to calculate the child’s body mass index (BMI). With a growing number of American children falling into the category of overweight (BMI at 85-94th percentile, 5-10 in 100 same age and sex kids are larger) or obese (BMI ≥95th percentile 5 or less in 100 kids of the same sex and age are larger), providing advice on diet, nutrition and physical activity is becoming a more important part of our job. It is estimated that in our country today nearly 1/3rd of children older than two years of age are overweight with more than 15% of children being obese. With this in mind, the goal of this article is to provide insight on healthy eating, physical activity and screen time recommendations.

Heather Lesage-Horton, MD
Heather Lesage-Horton, MD

A good guide to follow is the 5-2-1-0 rule. This means we should aim for at least five fruits and vegetables per day, on average less than two hours of screen time per day, one hour of physical activity per day and zero sugar sweetened drinks per day.

I often hear, “How can I get five fruits and vegetables per day into my kid? My kid will not eat vegetables.” While trying to meet the goal of five fruits and vegetables per day can be hard, there are some creative ways to introduce fruits and vegetables and many great health benefits. Fruits and vegetables provide fiber and many healthy nutrients necessary for growth. Fiber has a filling effect which helps to prevent snacking on “junk” food. A few ways to “sneak” fruits and vegetables into your child diet are: take something you know they like and add something new. If you know they like chips and dip, substitute veggies for the chips. Adding fruit to cereal or yogurt (plain or vanilla), or making smoothies and soups (especially purees) makes it harder for kids to know they are eating fruits or vegetables. You can shred or puree veggies into sauces for homemade pizza or pasta. Encourage your child, and maybe even yourself, to try one new vegetable or fruit each week.

Setting children up in front of TV or tablets can be a useful strategy when you’re trying to get dinner made or chores done. Keep in mind that screen time is counted as any time a child spends on a computer, in front of the TV, on a tablet or other device. Next to sleeping, screen time is how many children spend most of the hours in their day – in some cases, more than seven hours a day with different types of screens. We recommend, on average, less than two hours of relaxation screen time per day and no screen time for children less than two years old. Media has benefits of teaching behaviors and attitudes such as empathy, cooperation and tolerance, but it is also associated with exposure to images of violence, sex, legal and illegal drugs. Careful choices of screen programs, watching with your children and talking about the program are important. Some ways to decrease screen time are: offer and stress other activities, plan screen time, set limits and stick to them (use a timer if needed). Also, avoid watching TV during family meals as you may be less aware of how much you are eating. It is important to make the children’s bedroom “electronic-media free” to promote healthy sleep habits. Setting up a craft project can give a child something to do during meal prep. Try to make one night a week game night instead of watching TV.

With the changing weather in Vermont and our schedule, it can be hard to meet the goal of one hour of physical activity every day. . As a parent or guardian it is important to set an example. If you are active, your child is more likely to be active! As a family, set activity goals and celebrate successes!! Celebration could involve a family bowling night, family movie night or an extra game night. Make physical activity fun; celebrate special occasions and holidays with activities. When you can’t get outside, try dancing to your favorite music, read a story and then act it out, visit an open gym and use the stairs whenever possible. Toddlers love to play follow the leader – hop like a bunny, jump like a frog, clap your hands, stomp your feet. Set up a treasure hunt inside or outside, build a fort, or make something out of a box. When you can go outside, play outside – visit a farm or playground, go on a picnic, set up an obstacle course, kick a ball around, toss a Frisbee, take the dog for a walk, play your favorite sport, ride bikes, play tag or make up a game. Start a garden and plant your favorite flowers and vegetables, this gives you an activity to do and can help meet your goal of five fruits and vegetables per day. You can make it a habit to have a family walk after dinner or on a weekend morning. You can visit your local parks and recreation to find out about recreation programs or sport leagues.

Getting children to drink enough water can be a challenge. We recommend no sweetened beverages (soda, sport drinks, sweetened teas, etc.) as they contain extra calories that add up over time, contributing to weight gain and causing cavities. Offer water as the primary drink of choice – if your child will not drink “plain” water you can try coloring it with natural food coloring or using a fun cup or straw. You can also flavor it with a slice of lemon, lime or cucumber. Limit the amount of juice; use small glasses/cups and allow it only to be consumed in one sitting. If it is not finished and they are off to do something else, toss it). Serve non-fat or low-fat milk to children over two years old (we recommend three servings a day for calcium and vitamin D intake). Seltzer can be used as an alternative for soda for older kids.

Meeting all of these goals can be a challenge for everyone. Pick one goal, make small changes over time and celebrate your success. Small changes over time add up to a big change. As always, every child and family is different; talk with your child’s provider about suggestions specific to you. Visit and to learn more about portion sizes and a balanced plate of food. You can also visit to learn about our local parks and recreation opportunities.

Heather Lesage-Horton, MD is a board certified pediatrician at Just So Pediatrics, a department of Brattleboro Memorial Hospital. Just So Pediatrics is located at 19 Belmont Avenue, Brattleboro, VT. In addition to regular hours new evening and Saturday hours are available on most Tuesdays and Wednesdays until 8 PM and some Saturdays 8 AM – 12 PM. Just So Pediatrics can be reached at 802-251-8626.