Report on Oral Health in America (DHHS, 2000b) has documented that despite progress in reducing dental caries, children and adolescents in families living below the poverty level experience more dental decay than those in higher socioeconomic levels. In addition, the proportion of teeth affected by dental caries varies by age and race/ethnicity. Poor Mexican-American children ages 2–9 have the highest proportion of untreated decayed teeth (70.5 percent), followed by poor African-American children (67.4 percent), as compared to poor white children (57.2 percent). Poor adolescents ages 12–17 years in each racial/ethnic group have a higher percentage of untreated decayed primary teeth than their peers who do not live in poverty (DHHS, 2000b). Changes in dietary patterns of younger children ages 2–5 years (e.g., increased frequency of sweetened snacks) may also contribute to the reversal of oral health benefits of fluoridation observed since the 1980s (Dye et al., 2004).


A healthful diet for children and adolescents provides recommended amounts of nutrients and other food components within estimated energy requirements (EER)4 to promote normal growth and development, a healthy weight trajectory, and energy balance.5 A healthful diet also reduces the long-term risk for obesity and related chronic diseases associated with aging, including type 2 diabetes and the metabolic syndrome (IOM, 2005b).

Thirty years ago, diet quality for children and youth focused on the consumption of a sufficient and balanced intake of foods providing calories, protein, and micronutrients to prevent deficiency diseases. Today, by contrast, dietary quality emphasizes the principles of adequacy, variety, proportionality, and moderation, as well as reinforcing recommendations for a high intake of fruits, vegetables, and whole grains; nutrient-dense foods providing sufficient calories that are balanced with daily physical activity levels; and limited consumption of total fat, saturated fat, trans fatty acids, cholesterol, sodium, and added sugars (DHHS and USDA, 2005).

The average healthy child ages 2 to 5 years gains 4.5 to 6.5 pounds and grows 2.5 to 3.5 inches each year (Story et al., 2003). Child growth continues at a slow and steady rate until the onset of puberty in late middle childhood or early adolescence. A healthy child’s appetite and food intake


Estimated energy requirements (EER) are available for children and youth ages 2–18 years and calculated based gender, age, and three different activity levels (IOM, 2002–2005; Appendix D-1).


In this report, energy balance in children and youth refers to a state in which energy intake equals energy expenditure; energy balance supports normal growth and development without promoting excess weight gain and body fat.

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