A recent study from researchers at the Max Planck Institute in Berlin verifies what several University of Louisville physicians and dentists see in their practices: Parents, though well-meaning, are not good judges of the amount of sugar in common foods their children consume.

In the study, published in the International Journal of Obesity, about three-quarters of parents surveyed underestimated the total amount of sugar in foods commonly found in the diets of children: orange juice, pizza, yogurt, ketchup, granola bars and more. The biggest divergences occurred in foods thought to be “healthful”; for example, more than 90 percent of the 305 study participants underestimated the amount of sugar found in yogurt by an average of 60 percent.

More concerning was the fact that parents’ misjudgments tended to be related to their children’s body weight. Those children with the highest body mass index tended to have parents who made the greatest misjudgments of sugar content.

Heather M. Felton, M.D., medical director of the UofL Pediatrics-Sam Swope Kosair Charities Centre, and Hector Martinez, D.D.S., M.Sc., of the UofL School of Dentistry, aren’t surprised. It is a situation they see virtually every day in their practices.

“This happens quite a bit,” said Felton, who is a fellow of the American Academy of Pediatrics (AAP). “Parents simply don’t know how much sugar is in the food they feed to their children. They believe they are feeding healthy meals and can’t understand why their child is overweight.

“Generally speaking, you should limit your younger child’s intake of added sugar to 12-16 grams a day – that’s about 3-4 teaspoons. For pre-teens and teens, it should be no more than 8 teaspoons.”

 Although the German study only examined medical health and sugar underestimation, Martinez says the problem is a contributing factor to dental problems as well.

“Sugar contributes to tooth decay,” Martinez said. “If left untreated tooth decay can be painful -- and painful teeth will affect a child’s performance in school,” Martinez said.

Preventing cavities and decay is the first line of defense, he said. Martinez also urges parents to find a dental home for their child, and schedule a dental exam, cleaning and fluoride treatment. For children experiencing extreme decay, the UofL School of Dentistry offers Silver Diamine Flouride, a 58-percent solution that stops decay in its tracks.

Both Martinez and Felton echo a point made in the study: Food labeling needs improvement. The study authors recommend a “traffic-light system”: a red dot on the label for high sugar content and a green one for minimal sugar. 

“Food labels can be confusing because they list ingredients in terms of percentages of daily recommended values,” Felton said. “Parents may read that a container of yogurt has 25 grams of sugar, but they often do not know how that should fit into their child’s diet.

“Plus, parents are busy and don’t have time to thoroughly read labels, let alone keep track of how many grams of sugar their children consume in a given day. A simpler labeling system would help enormously.”

For now, the providers recommend that parents “assume that there is too much sugar in food and try to cut back where you can,” Felton said. “Instead of buying yogurt with fruit or other flavorings already in it, for example, buy plain yogurt and add your own fresh fruit to it. Don’t add sugar to the breakfast cereal you give to your children. Serve them water or milk instead of highly sweetened juices or sodas.”

“The worse thing parents can do is allow their children to drink juice or anything other than water in a sippy cup all day, which disrupts the ph balance of the mouth,” Martinez said. Better, he says, to drink juice or milk in one sitting rather than over the course of several hours.

Martinez and Felton also reminded parents of juice drinking guidelines released a year ago by the AAP.  The recommendations urge parents, when possible, to feed their children whole fruit rather than juice, where fiber and other nutrition can be gained. And, the Academy has reduced the quantity of fruit juice for children according to age:

•  No juice for children younger than 12 months.
• 1-3 years – Limit fruit juice to a maximum of 4 ounces per day (1/2 cup)
• 4-6 years –  No more than 4-6 ounces (1/2 cup –  ¾ cup)
• 7-18 years – Limit juice to 8 ounces per day (1 cup)

Following these guidelines will at least limit sugar intake and help lead to healthier smiles and bodies, Martinez said.