N° 85 | January 2014

Strategies for Healthcare Providers to Increase Fruit and Vegetable Consumption in Children

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The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Fruits and vegetables (FV) provide many important nutrients1. Higher intake of FV is associated with a reduced risk for heart disease1, stroke1, diabetes2, and some cancers1. Replacing energy-dense foods with FV may assist in healthy weight management3. Eating habits developed early in life impact dietary behaviors in adolescence and adulthood4,5. Because most children do not consume the recommended amounts of FV6, it is important to understand strategies to increase children’s consumption of these foods.

Healthcare providers can be an important influence on children’s consumption of FV. This article summarizes strategies that healthcare providers can use, which were detailed in a previously published paper7. Through counseling during clinic visits, providers may be able to directly influence children’s food selections, encourage caregivers to create a home environment supportive of healthy choices, and recommend community resources that improve access to FV. Health care providers can also create a healthy food environment in the clinical setting where they work to serve as a role model for patients and the community.

Below, we summarize some specific activities health care providers can engage in at the patient level, healthcare facility level and community level to create healthier communities and empower patients and families.

Opportunities at the patient level, healthcare facility level and community level for healthcare providers to influence children’s FV consumption

Patient level: assess, counsel, and provide resources

  • Integrate assessment of, and counseling on, FV consumption into clinical practice. The American Academy of Pediatrics provides a guide for billing8.
  • Give a FV prescription on a prescription pad to document and emphasize the importance of consuming recommended FV servings each day9.
  • Develop referral guides to resources, e.g., Special Supplemental Nutrition Program for Women, Infants and Children [WIC], WIC Farmers Market Nutrition Program [FMNP], and the Supplemental Nutrition Assistance Program [SNAP], farmers markets, cooking classes, and community gardens.

Healthcare facility level: create a healthy environment

  • Be a role model by providing healthy foods and beverages for patients, visitors, and employees.
  • Host a farmers market or community-supported agriculture program.
  • Create guidelines for increasing FV in vending, food service venues, hospital shops, and inpatient meals. Consult the Health and Sustainability Guidelines for Federal Concessions and Vending Operations for an example10.

Community level: support healthy food environments where children spend time

  • Work with community stakeholders and partners, such as health departments, schools, child care and early care and education (ECE), and community organizations to improve FV access and consumption.

Patient visit: strategies healthcare providers can advise caregivers to
use to encourage children’s FV consumption

Individual level: get kids involved

  • Garden, cook, and grocery shop with kids.
  • Take kids to a local farm or community garden so they can see where their food comes from.

Social environment: have positive feeding interactions with children

  • Expose children to a variety of FV.
  • Avoid controlling feeding practices like overly pressuring children to eat certain foods and overly restricting food.
  • Eat together regularly as a family.
  • Role model healthy behaviors.

Physical environment: make FV readily available

  • Make FV accessible by having them washed, cut, and ready to eat on a counter, or at eye level in the refrigerator.
  • Incorporate vegetables into dishes such as breads, pasta, chili, soups, casseroles, and pizza.
  • Pack FV for kids to take to school, ECE, the playground, pool, or camp.
  • Provide FV when bringing snacks to school or sports events.

Health care providers can engage in many strategies in and outside the clinic setting at the individual, social, and physical environment levels to positively influence children’s fruit and vegetable consumption.

  1. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2010. Washington, DC: US Government Printing Office; 2010.
  2. Montonen J, Knekt P, Jarvinen R, et al. Dietary antioxidant intake and risk of type 2 diabetes. Diabetes Care 2004;27(2):362–6.
  3. Rolls BJ, Ello-Martin JA, Tohill BC. What can intervention studies tell us about the relationship between fruit and vegetable consumption and weight management? Nutr Rev 2004;62(1):1–17.
  4. Lien N, Lytle LA, Klepp KI. Stability in consumption of fruit, vegetables, and sugary foods in a cohort from age 14 to age 21. Prev Med 2001;33(3):217–26.
  5. Wang Y, Bentley ME, Zhai F, et al. Tracking of dietary intake patterns of Chinese from childhood to adolescence over a six-year follow-up period. J Nutr 2002; 132(3):430–8.
  6. Krebs-Smith SM, Guenther RM, Subar AF, et al. Americans do not meet federal dietary recommendations. J Nutr 2010;140:1832-1838.
  7. Kim SA, Grimm KA, May AL, Harris DM, Kimmons J, Foltz JL. Strategies for pediatric practitioners to increase fruit and vegetable consumption in children.2011 Dec;58(6):1439-53
  8. American Academy of Pediatrics. “Prevention and Treatment of Childhood Overweight and Obesity – Practice Management Resources” http://www2.aap.org/obesity/practice_management_resources.html?technology=0
  9. American Academy of Pediatrics. “Prevention and Treatment of Childhood Overweight and Obesity – Clinical Resources – Clinical tools.” http://www2.aap.org/obesity/clinical_resources.html?technology=0
  10. Centers for Disease Control and Prevention. “Chronic Disease Prevention and Health Promotion – Health and Sustainability Guidelines for Federal Concessions and Vending Operations.“ http://www.cdc.gov/chronicdisease/resources/guidelines/food-serviceguidelines.htm
  11. National Initiative for Children’s Healthcare Quality. “Be Our Voice – Resource Guide for Healthcare Professionals Interested in Advocating for Children’s Health.” http://www.nichq.org/advocacy/obesity_resources/toolkit.html
  12. American Academy of Pediatrics. “Prevention and Treatment of Childhood Overweight and Obesity – Policy Tool.” http://www.aap.org/obesity/matrix_1.html
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