With 1 in 5 U.S. youngsters already overweight or obese by the time they start school, a new report urges steps to help prevent babies, toddlers and preschoolers from getting too pudgy too soon.
Topping the list: Better dietary guidelines to help parents and caregivers know just how much toddlers should eat as they transition from baby food to bigger-kid fare. And preschoolers need at least 15 minutes of physical activity for every hour they spend in child care.
Thursday's recommendations, from the prestigious Institute of Medicine, are not about putting the very young on a diet.
But contrary to popular belief, children don't usually outgrow their baby fat, and that can lead to lasting bad effects on their health as they grow, says the new report. It urges the government, day care centers and preschools to adopt policies that promote healthier weight before tots get on that path.
"It's a huge opportunity to instill good habits at a time when you don't have to change old ones," said Leann Birch, director of Pennsylvania State University's Center for Childhood Obesity Research, who chaired the institute's panel.
Consider: Babies drink milk until they're full and then turn away. But children as young as 2 or 3 are sensitive to portion size, important in not inadvertently training a child to overeat.
"If you give them larger portions, they eat more," Birch explained.
Pediatricians generally give pretty explicit directions on how to feed babies. The nation's dietary guidelines include a special section for preschoolers, the 2- to 5-year-olds, that includes such information as a portion size generally is about 1 tablespoon of each food type per year of age.
But overall, those national guidelines are aimed at ages 2 and older - even though surveys show even very young children eat too few of the fruits and vegetables they need both for health and to develop a taste for something other than junk food. So the institute called on the government to create consumer-friendly dietary guidelines for birth to age 2.
That would capture the "dramatic dietary transition that occurs, from consuming one single food to, by the time they're 2, ordering up things from McDonald's and, we hope, having also learned to eat a lot of healthy foods," Birch said.
Of course, parents have the biggest influence over whether healthy eating and being active become a child's norm.
But the report makes the case that children's habits are influenced by far more than their parents, and thus it is time to expand obesity prevention to more of the other places youngsters spend time. For example, nearly three-fourths of children ages 2 to 5 spend at least part of their day in some form of child care.
Among the recommendations:
Day care and preschool operators should be trained in proper physical activity for young children, provide at least 15 minutes of it per hour the child spends there, and avoid withholding physical activity as a punishment.
Child care regulations should limit how long toddlers and preschoolers sit or stand still to no more than 30 minutes at a time -- and limit holding babies in swings, bouncy seats or other equipment while they're awake.
Day care and preschools should practice what's called responsive feeding: Providing age-appropriate portion sizes, teaching children to serve themselves properly, requiring adults to sit with and eat the same foods as the children, and following babies' satiety cues.
Breastfed infants are less likely to become obese later in childhood, so doctors and hospitals should encourage breastfeeding and limit formula samples aimed at new moms.
Checkups need more than plotting a youngster's growth. Doctors also should consider the parents' weight in assessing which children are at risk of later obesity, and then alerting parents early that preventive steps are needed. About 10 percent of infants and toddlers already weigh too much for their length.
To increase healthy eating among the poorest children, the government should take steps to get more families eligible for federal nutrition-assistance programs to sign up.