I've noticed lately that items being marketed as "fruit snacks" are taking over the cereal aisle in my supermarket. Despite the claims of being made with "real" fruit juice and "packed" with vitamins, do fruit snacks really have any nutritional value? And, what grocery shopping strategies can I use to avoid these snacks that are, not surprisingly, shelved low at children's eye level?

Dear Worried,

I don't blame you for being suspicious because I am, too. Ever since the food manufacturers started disguising candy as cereal, they've pushed the envelope harder and harder, and, today, they don't even bother to hide the fact that the primary ingredient in kids' breakfast cereals is refined sugar. To add insult to injury, on the same shelves cereal companies now push candy disguised as snacks - so-called "fruit snacks," that is. Let me be completely clear: there's no real fruit in any of the fruit snacks, just "grapes from concentrate," corn syrup and sugar. Some of these snacks, such as the popular "Roll-Ups," also contain corn starch. All have food dyes, artificial flavors and preservatives.

Depending on the age of your kids, you might avoid in-aisle battles by shopping alone, but rather than avoidance I feel it's best to start educating your kids on what choices they should make - and why - from very early ages. Grocery stores offer a perfect venue for these lessons. I advocate pointing out to kids what kind of foods build big muscles, strong bones and otherwise keep them healthy, while also teaching them that sugary snacks are only for special occasions - and never for breakfast! If you do take your kids to the grocery store, make label reading a fun exercise. Challenge your child(ren) to find cereals with the fewest grams of sugar per serving, and the fewest ingredients. Show them that the greater the number of ingredients, the more likely the cereal is to have preservatives and additives. When you go grocery shopping, always have a list (even better, have your child help you make the list), and let your kids find the items that are on the list like a scavenger hunt.

Taking a hard line against junk food needs to be consistent, but make it fun to shop rather than a battle. Also ensure you're buying foods that the whole family will enjoy rather than separate foods "for kids" and "for adults." When the whole family eats the same healthy foods, the kids naturally grow up with a predisposition to eating nutritiously.

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Dear Susan,

With the new school year upon us, I'm looking for quick, easy AND healthy lunch options. I've seen pre-packed foods called "Lunchables," "Uncrustables" and the like, and am wondering if these are good choices relative to nutrition?

Dear Curious,

Lunchables, for the most part, are high in fat and sugar, and low in nutrition. Most of them consist of bite-sized portions of foods kids like to eat - crackers, cheese, lunchmeat, mini-pizzas, hot dogs, burgers and tacos, and "juice drinks." They're high in sodium, full of preservatives and most contain a generous portion of saturated fat. Many of these packages also contain candy or cookies and other sugary and fatty treats. Some of these pre-packaged lunches are labeled as "Sensible Solutions" and may be somewhat lower in fat and sodium than the original, but I feel they are far too expensive for the small amount of nutrition and convenience they provide.

Uncrustables, too, have a litany of preservatives as well as high fructose corn syrup, among other ingredients, contributing to the 10 grams of dietary sugar per serving.

Parents who do not want to teach their kids that eating junk for lunch is OK should make their own lunch packs, even in advance for added convenience, that contains whole grain bread, pita, tortilla wraps or crackers, lean (and possibly even low sodium) turkey breast or ham, and maybe some baked chips or, even better, whole wheat pretzels. For the sweet finish, any fresh fruit will do - squeeze a bit of lemon on apple slices to keep from turning brown. And, since eating well is about moderation and not deprivation, one day a week add one dark Hershey chocolate kiss. Pack all of these items in a fun plastic container decorated with stickers, and viola! Lunchables with love!

Dear Susan,
Is drinking flavored, non-carbonated water the same as drinking plain water in terms of health benefits? Are there any downsides to flavored water?
Signed, Cheryl

Dear Cheryl,
If your child is eating a fair amount of fruits and vegetables, (s)he is getting a lot of fluid there, and beverages, including fruit juice and nonfat milk, are mostly water, too. Sparkling, unsweetened water is perfectly acceptable to count for part of a child’s your fluid intake, but stay away from flavored waters sweetened high fructose corn syrup or any type of sugar because this adds calories and can also contribute to tooth decay. Artificially sweetened beverages are calorie-free and won’t harm your teeth, but don’t forget that they also contain phosphoric acid that, in too high a quantity, can upset the body’s electrolyte balance. Herbal iced tea is a nice plain water alternative, which can be sweetened with a touch of clover honey.

As a rule of thumb, plain water is best for replacing fluids lost in everyday living…in perspiration, elimination, in simple respiration…even breathing. Since our bodies are about 60 percent water, it’s essential to replace fluid daily, and what your child needs depends a lot on his or her age, height and weight, activity level and environmental climate. What kids eat also influences how much they need to drink. All of that said, the old “eight 8-ounce glasses of water” advice still holds true for adults – children need relatively less.

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Dear Susan,
Of all the vegetables out there, what would you classify as the "top 5" that should be served to a child regularly, and why? Similarly, what would your number one fruit pick be, nutrition-wise?
Signed, Hopeful About Getting My Kids Healthy

Dear Hopeful,
I’m not being contrite when I say that the best vegetables for your kids are the ones they’ll eat. Studies show that you need to offer a child a new food item from five to ten different times before they’ll accept it. For veggies, it may take even more face time before kids take the plunge.

If I were to prioritize vegetables based on their nutritional value, at the top of the list would be those kids often shun due to their very strong flavor, such as kale, spinach and cruciferous broccoli and cabbage-family vegetables. When your kids are very young, serve mild-tasting cooked (but not overcooked) green beans and summer squash, and start every meal with a small salad containing mixed greens and tomatoes at the very least.

Let kids snack on crunchy pea pods, celery and baby carrots, and offer them a healthy dip. One made with nonfat yogurt and low fat mayonnaise mixed with some dehydrated chives and a sprinkle of garlic powder is usually a crowd – and kid – pleaser. As they grow older, begin to offer stronger-tasting vegetables such as broccoli, cabbage, Brussels sprouts, and others that are dark green and leafy. Let them try just a little, and never force the issue.

For fruit, the same advice holds true…if your child has a “favorite” fruit, so be it. Serve nutrient-packed fresh berries for breakfast with their cereal; demonstrate how you eat fruit as a snack and always serve fruit for dessert. The best fruits to choose are very colorful, deep orange-colored cantaloupe, peaches and apricots; deeply colored blueberries and raspberries and strawberries; green kiwi and honeydew melon. But again, if your child only likes apples or bananas, that’s fine for now. Just keep offering other alternatives and reward them when they are willing to at least try it – even if the tasting proves futile in the short-term.

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Dear Susan,
Despite my frequent attempts to get him to try new things, my son will only eat a fairly small number of foods – especially dinner items. I’m concerned that he is not getting the nourishment his growing body needs. What should I do?
With Gratitude, Concerned

Dear Concerned,
I believe in letting a child grow into their food preferences, because forcing kids to eat things they don’t like can backfire on the well-intended as this can create poor food “relationship’ issues down the road. This would mean that you never reward behavior - no matter how positive - with food, and never punish your son by withholding food. Don’t force the issue of expanding his food horizons if he refuses to try new things, but do continue to offer them up and react positively when he does. And, don’t overwhelm him by serving big portions.

Be a good role model and eat small portions of different foods yourself throughout the week. By demonstrating your healthy food habits, the ability and desire to make sound food choices will more likely to rub off on your son. It’s important that you don’t make food and mealtime a battle ground, but do let your kids know that the household’s menus are set by you, and they are expected to eat at least part of each meal no matter what. Involving your son in the upcoming week's menu planning can do wonders, too, as he'll then be vested in the process.

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Dear Susan,

My daughter does fairly well eating fresh fruits and veggies each day. Now I’m wondering if it better to eat organic? Organic alternatives are popping up in my grocery store at an increasing rate, and am wondering if it’s better to choose organic foods over non-organic?
From, A Curious Mom

Dear Curious:

Organically raised foods haven’t been proven to be more nutritionally potent than conventionally raised foods, but I can think of other reasons to eat organically. According to the U.S. Department of Agriculture, “organic” foods are those produced without antibiotics or growth hormones, and the soil used to grow organic food is free from synthetic ingredients, sewage sludge, or pesticides. Organic also means no genetic modification or artificial growing method was used to bring the animal or plant food to market.

Now, since organic foods are more “natural” it may also mean more insects than conventionally raised foods, but many prefer natural to foods grown with chemicals that could someday be proven toxic. By the way, organic milk doesn’t necessarily mean that the cows are grazing exclusively on grass, but it does mean that the cows eat organic grains.

Organic foods may cost more, but not always. Buy in bulk, join a co-op, and clip coupons to economize. It’s important that your daughter keep eating her fruits and veggies, whether organic or otherwise. But, some organic varieties do consistently have more pesticide residues. Consumer Reports and the USDA published recommendations based on the amounts of pesticides on different varieties. If possible, buy organic varieties of:

Nectarines – 97.3% of nectarines sampled were found to contain pesticides.
Celery – 94.5% of celery sampled were found to contain pesticides.
Pears – 94.4% of pears sampled were found to contain pesticides.
Peaches – 93.7% of peaches sampled were found to contain pesticides.
Apples – 91% of apples sampled were found to contain pesticides.
Cherries – 91% of cherries sampled were found to contain pesticides.
Strawberries – 90% of strawberries sampled were found to contain pesticides.
Imported Grapes – 86% of imported grapes (i.e. Chile) sampled were found to contain pesticides.
Spinach – 83.4% of spinach sampled were found to contain pesticides.
Potatoes – 79.3% of potatoes sampled were found to contain pesticides.
Bell Peppers – 68% of bell peppers sampled were found to contain pesticides.
Red Raspberries – 59% of red raspberries sampled were found to contain pesticides

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Dear Susan,

Beyond a multi-vitamin, what are your thoughts on other supplementation for a child who needs to lose a fair amount of weight?
Signed, Worried

Dear Worried:

Vitamin/mineral supplements are often advocated for adults on a weight loss program since fewer calories often means inadequate amounts of necessary micronutrients, and the supplements “fill the nutritional gap” as “insurance.” However, The American Medical Association says that, “a diet based on the Food Guide Pyramid provides adequate amounts of all the vitamins a child needs.” If your child is a picky eater and doesn’t eat a lot of iron-rich foods, (s)he may also need vitamins to meet all of their nutritional needs. Ultimately, the child’s pediatrician should make this call.

But, kids should never be put on a “diet” for weight loss. Children who need to lose weight need to eat nutritiously, not diet – and, of course, exercise more. They need playtime, they need to stay active, and they need YOU to be a positive role model. Putting your child on a ‘diet” can backfire in many ways, and even set the stage for future eating disorders.

When you focus on good foods and fun exercise, then your child learns that food is their friend, not the enemy. Make food fun by making fruits and vegetables bite-sized; have tasty but healthy veggie dips available as snacks; serve fruit smoothies, low fat granola sundaes with nonfat vanilla yogurt and cut up melon. By offering a variety of fun, colorful and tasty foods, packing tasty school lunches, stocking the pantry with waistline-friendly snacks, and you demonstrating healthy behaviors at home and when eating out, your kid(s) can develop habits that will allow the extra weight to even out with growth, and you’ll establish a life-long foundation of healthy eating habits.

Dear Susan,

I hear a great deal about the risk of type 2 diabetes among overweight children, but am unsure exactly what this disease is. Can you enlighten me about the condition (it's causes, symptoms and consequences) and what children are "at risk" relative to varying levels of obesity.
Signed, Confused

Dear Confused:

Type 2 diabetes is a disease of lifestyle, as more than 90 percent of those afflicted are overweight. Formerly known as “adult onset diabetes,” today the name change reflects the fact that increasingly younger people, even children as young as 4 or 5 years of age, are diagnosed with type 2 diabetes.

Type 1 diabetes was formerly known as “juvenile diabetes,” and, unlike type 2, it’s a disease of insulin absence. In type 1, the pancreas no longer produces insulin, which is necessary for the absorption of carbohydrates. Although the symptoms and complications of both type 1 and type 2 diabetes are similar -high blood glucose with resulting damage to arteries and nerves - type 1 diabetes must be controlled with injected insulin, usually at least two, three, or more times daily. People with type 2 diabetes, however, are often able to control the disease with exercise and overall weight management.

Type 2 diabetes is a disease of insulin resistance or insulin insufficiency. While the true genetic cause of both types of diabetes is unknown, an overweight condition has been proven as one primary independent risk factor for developing the type 2 variety.

Overweight Moms who contract gestational diabetes while pregnant are more likely to develop type 2 diabetes, and their children are also at higher risk. Reversing or preventing an adolescent overweight condition is one key way to ensure your child will thwart this debilitating disease. Even as they go through growth spurts, kids need to stay within a healthy BMI range by avoiding daily doses of junk food and sweetened drinks, and minimizing sedentary time in front of the TV and computer in favor of at least 2 hours of physically active play time daily.

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Dear Susan,

Is all sugar bad for kids, including "sugar in the raw" or sugar substitutes such as Splenda®, Equal® and others? What's generally best for children, and especially those struggling with a weight problem?
Yours, Curious

Dear Curious:

Despite conventional thinking, sugar is not a “bad” food - it’s just empty calories that taste good. There are, in fact, dozens of ways to say “sugar” – sucrose and fructose, among others. But, they’re all essentially the same calorie-wise, and those labeled as “natural” are not any better or healthier.

Is there room for sugar in a healthy diet? Yes, occasionally, and in small portions. Sugary foods are often also high in fat and calories, and displace appetite for healthier foods. And, encouraging foods sweetened artificially isn’t a good strategy for cultivating your child’s pallet for healthy fare. When everything is sweet, sweetness becomes the preferred taste. Give kids the chance to develop a taste for “real” food from as young an age as possible, irrespective of your personal preference as a now biased adult. Don’t put sugar on a whole grain cereal or sugar-laden jelly on whole wheat bread to “mask” the earthy flavor, which your child will acclimate to.

If your child is struggling with a weight problem, opt for lower calorie treats, such as sugar-free chocolate pudding and hot chocolate, or “Fudgsicles” that have only 50 calories per bar. Remember, even lower calorie treats add up, so monitor portions and be sure to read the nutrition label.

Dear Susan,

With the start of the new year, I'm hoping to turn over a new leaf to help my family eat more nutritiously. For a family such as ours just getting started with this endeavor, how do you suggest I proceed without the change being an unwelcome "shock" to everyone?
Sincerely, Anxious

Dear Anxious:

If you enlist your family to help plan for these lifestyle changes that will affect the entire group, you'll lessen the likelihood that it will turn into a battle of you vs. them. Toward this end, have a family "team" meeting - formally invite your husband and family to a meeting at an appointed date and time. And, take it seriously! Print an agenda, serve healthy refreshments and be prepared to take notes.

Ask your family how they feel about being overweight or out of shape. It's doubtful that anyone would have anything positive to say in response. I'm fairly certain that they'll tell you that, "hey, of course, we want to be fit and trim" (or something along those lines). Use this rhetorical question as an opportunity to invite the whole family to join you in brainstorming and strategizing healthy lifestyle changes for this new year. Clearly convey these changes are to be a team effort, and you'll all work together to make 2007 fun, but fit.

The American Dietetic Association has some suggestions for helping you get your family to eat better:

§ Decide on two or three specific, small changes in eating or physical activity at a time. Don't overdo it all at once.

§ Write down your family's weekly goals and keep track of them.

§ Keep a daily food and activity log.

§ Don't expect perfection.

§ Reward your family for positive change.

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Dear Susan,

With so many types of lettuce and other veggies to choose from, can you detail what you feel the healthiest, well-balanced and palatable salad would be for kids? Also, what do you recommend in the way of salad dressings?Signed, Wondering Mom

Dear Wondering Mom,

I'm always so impressed and excited about the amazing array of convenient salad fixin's in the 21st century grocery store. Packaged salad blends make it easy to enjoy many different lettuce types, and they also make salads more visually interesting and appealing with a variety of textures and colors.

I buy colorful salad blends that include red radicchio, orange from shredded carrots, and different shades of green, from romaine's deep green to bib's softer color. I like to add crunch to salads: a few tablespoons of toasted almonds, pine and/or walnuts add a bit of protein and healthy unsaturated fat and vitamin E; crunchy raw veggies including broccoli florets and sugar snap peas add fiber, plus they're rich in folic acid. And, don't be afraid to add fruit to your green salad! Dice a small apple or pear; add mandarin orange sections, grapes, or a couple of tablespoons of raisins.

Vinaigrettes are a healthier salad dressing selection that comes in a wide range of flavors. Making your own healthy vinaigrette dressing is easy and inexpensive, and ensures you know exactly what is - and is not - in the recipe. In a glass or Pyrex bowl, whisk one part extra virgin olive oil to two parts balsamic vinegar plus a couple of tablespoons of dried salad herbs. Add fresh ground pepper if your kids don't mind and (optional) quarter-teaspoon of sea salt.