Clinical Reference Systems: Pediatric Advisor 10.0

INTRODUCTION

A common misconception suggests that eating sugar is harmful or at least a weakness. Many well-educated parents worry needlessly about sugar, candy, and desserts. For purposes of discussion, sweets can be defined as any food where sucrose, fructose, glucose, corn syrup, honey, or other sugars are listed as the first ingredient on the packaging. Sweets are not bad. The body needs sugar to function. The brain needs glucose to think. Sweets just need to be eaten in moderation. If you want to protect your child's health, worry about cholesterol, not sugar and sweets.

THE NORMAL SWEET TOOTH

Soon after birth infants show a preference for sweet solutions (such as breast milk). Many people are born with a "sweet tooth." Most adults also naturally seek and enjoy sweets. Giving candy as a gift for holidays and birthdays is a common symbol of affection. Even some members of the animal kingdom show a craving for sweets.

Sugar is naturally present in most foods except meat. The recommended daily allowance of calories from carbohydrates (sugar and starches) is 55 percent. Of this, no more than 10 percent should come from refined sugar (sucrose).

Lactose is the type of sugar found in milk, fructose is the sugar in fruits, and maltose is the sugar in grain products. Sucrose, the sugar refined from sugar cane and sugar beets, has no greater adverse effect on body function than any of the other sugars.

SIDE EFFECTS OF SUGAR

The main risk associated with sugar is increased tooth decay. This is the only permanent harm caused by consuming too much sugar. This risk can be greatly reduced if your child drinks fluoridated water and brushes his teeth properly after eating foods that contain sugar. Foods that cause the most dental cavities (caries) are those that stick to the teeth (for example, raisins and caramels).

Your child is at greatest risk of tooth decay if he falls asleep or walks around with a bottle of sugar solution in his mouth. The solution may be fruit juice, Kool-Aid, or milk. This type of tooth decay is called "baby-bottle caries."

A temporary side effect of sugar may be seen 2 to 4 hours after excessive sugar consumption. A reaction is probably due to a rapid fall in blood sugar and consists of sweating, hunger, dizziness, tiredness, or sleepiness. This reaction is brief and harmless and can be relieved by the passage of time and by eating a food containing some sugar, such as fruit juice. These symptoms do not occur after eating a normal amount of sweets; nor do they occur in everyone.

MYTHS ABOUT SUGAR

Eating sweets is basically not harmful. Candy does not cause cancer, heart disease, or diabetes. The following are some common issues many parents are overly concerned about.

1. Obesity

   Obesity is caused by overeating in general and is not specifically related to eating sweets. In fact, fatty foods contribute much more to obesity than sugary foods because fatty foods have twice the calories of sugary foods per given amount. Recent studies have found that lean people tend to eat more sugar than overweight people.

2. Hyperactivity

   Extensive research has shown that sugar does not cause or worsen hyperactivity. In fact, consuming a lot of sugar such as a 12-ounce soft drink (containing 10 teaspoons of refined sugar) may cause a relaxed state or even drowsiness.

3. Junk food

   The term "junk food" has led to considerable confusion in our country. Some people consider any kind of sweet or dessert to be junk food. Others define fast food as junk food. It's not true that just because a food is sweet or purchased from a fast-food chain, it's bad for your health.

RECOMMENDATIONS FOR THE SAFE USE OF SUGAR

Note: These guidelines may not apply to children who have diabetes.

1. Allow sugar in moderation.

   In general, eating any food in moderation is healthy. However, eating too much of any one kind of food is unhealthy.

   One precaution is to avoid giving your child sweets before he is one year old. If sweets are included in your child's diet too early, they may interfere with the child's willingness to sample new foods that are unsweetened.

2. Don't forbid sugar completely.

   Some parents forbid sweets in hopes of preventing a preference for them. However, because this preference is present at birth, we have little influence over it. Forbidding sweets completely may increase a child's fascination with them. With candy and other sweets so readily available in stores and vending machines, sugar consumption can't always be monitored. A taboo against sugar becomes unenforceable as a child grows older. If a parent makes an issue of it, it becomes an unnecessary battle.

3. Limit the amount of sweets you buy.

   The more sweets there are available at home, the more your child will eat. Try to purchase breakfast cereals and cookies in which sugar is not the main ingredient.

4. Limit the amount of sweets your child eats.

   While one candy bar is fine, eating an entire bag of candy is unacceptable. Try to eliminate binging on candy and sweets. You can best do this by setting a good example. Make exceptions and allow extra candy on Halloween and other holidays, birthdays, and at parties. The worst that could happen is your child could become extra sleepy or have a mild stomachache.

5. Allow sweets for desserts.

   Sweets cause physical symptoms only if they are eaten in excess. As long as they are eaten after a well-balanced meal, they cause no symptoms. An acceptable dessert can be just about anything, including candy.

6. Discourage sweets for snacks.

   Candy, soft drinks, and other sweets are not good choices for snacks. Because very little else is eaten with a snack, consuming mainly refined sugar alone may cause some rebound symptoms several hours later. Teach your child that if he has a soft drink or Kool-Aid as a snack, he should eat something from the grain or fruit food groups along with it. An occasional sweet drink containing a sugar substitute is fine. Keep plenty of nutritious snacks and drinks (such as fruits juices, yogurt, graham crackers, oatmeal cookies, and popcorn) on hand, and set a good example yourself. Most cookies are OK for snacks because the main ingredient is flour.

7. Insist that the teeth are brushed properly after eating sweets.

   Unless you encourage this good habit, a "sweet tooth" can become a decayed tooth.

SPECIAL BENEFITS OF SUGAR

Giving candy occasionally as a reward is not harmful. The joy of eating sweets is natural and is not increased by this practice. Candy and other sweet treats are a powerful incentive. Whether we like it or not, the best motivators are always things children crave. Candy is inexpensive and offers a child many choices. Using sweets as a reward may bring success with a negative child who doesn't respond to other approaches. In such cases, use star charts and praise simultaneously for improved behavior and continue to do so after the use of candy as a reward has been phased out.

Sugar can be useful in helping a finicky eater try an essential new food. Some children who have breast-fed until almost a year of age will not accept any cow's milk products. One way to help them make this transition is to sweeten cow's milk with something such as honey. (Caution: Avoid giving honey to children before age 1, because of the slight risk of botulism.) When the child is drinking enough cow's milk, gradually phase out the sweetener.

Some children will take bitter medicine more easily when it is mixed with something sweet, such as Kool-Aid or chocolate pudding.

AN OVERVIEW

Let's be honest. Most adults and children enjoy sweets. Most children spend part of their allowance on sweets. And eating sweets in moderation is fine. A well-balanced diet can include some daily sweets.

CALL YOUR CHILD'S PHYSICIAN DURING OFFICE HOURS IF:

• Your child frequently binges on sweets.
• You find yourself repeatedly nagging your child about sweets.
• You think your child has a problem with sugar.
• You have other questions or concerns.