If your kids don't sleep well, often seem out of sorts and struggle to follow simple instructions, their diet might explain it — especially if they have a sweet tooth.

Poor sleep, moodiness and inattention are signs they may be eating too much sugar, according to Dr. Kaylan Edwards child health specialist at Novant Health Pediatrics Brunswick in Supply, North Carolina. But those are only a few of the consequences for their health and well-being.

Dr. Kaylan Edwards

"The big concern about sugar is linked to obesity, diabetes and high blood pressure, which increase their overall risk later for heart disease, including coronary artery disease, stroke and heart attack" — and even premature death, Edwards said. Too much sugar over long periods also puts kids at higher risk for anxiety or depression.

That's why the American Heart Association recommends children between ages 2 and 18 consume no more than 6 teaspoons of sugar a day — including no more than 8 ounces of sugar-sweetened drinks a week. The American Academy of Pediatrics agrees. On average, American kids consume more than 65 pounds of added sugar a year.

"I have some patients who are eating insane amounts of sugar every day," Edwards said. "We want kids to develop good eating habits and good routines in their life from an early age."

Sugar and the brain: Research has linked sugar with short-term memory difficulties, which may affect learning, she said. If Jimmy is inattentive and struggling in school, too much sugar could be to blame. "We know having too much sugar in one day will impair memory temporarily," Edwards said. "The question is whether exposure to it every single day for years and years can lead to impaired memory chronically." Animal studies are trying to tease out the answer.

For babies and toddlers: Avoid all sugar before age 2 — especially fruit juice, Edwards tells parents. "There is no nutritional value in it," she said. "This is the time when a child is learning what an apple or a peach tastes like — and the juice has a lot more sugar per serving than the fruit would." Besides protecting emerging teeth from cavities, limiting sugar also helps prevent a preference for sweets.

Food rewards: Treats like fruit gummies, M&Ms and ice cream are popular "prizes" for good behavior. Bad idea. Instead, let Emma paste a sticker on a chart when she uses the potty or meets another goal and offer a reward for repeated success. For good measure, make activity part of the incentive, Edwards suggests, for instance by pairing a new bicycle helmet with permission to ride on the sidewalk with the "big kids."

Lighten up: Instead of ice cream and cake, cookies and candy, offer kids healthy alternatives. Good choices include trail mix with dried fruit, seeds and nuts; apples and peanut butter; and your favorite fruit with a dipping sauce. Avoid store-bought dips, which may be high in sugar and fat, Edwards recommends. To make your own, mix Greek yogurt, honey or maple syrup, a sprinkle of cinnamon and a swirl of vanilla. It's nutritious, tasty and fun for kids to eat.

Set an example: Family meals establish good habits that can last a lifetime. "I always say, 'We prepare one meal, and you can eat it or not,' " Edwards said. "When you start introducing food at 4 or 6 months old, if you get excited about eating prunes, they'll get excited about eating prunes. It's about creating healthy habits from infancy." Dining together also teaches kids they can't eat whenever they feel like it.

For older kids: Sooner or later, most kids make friends from homes with more lenient approaches to diet — and once they're able to drive, they can grab junk food on the sly. Even as they become more independent, sugar saturation isn't inevitable, Edwards said. "I've seen kids who won't touch soda at all because it tastes like straight molasses to them," she said. "If we can set those habits in place early, we hope as teenagers, they will make good choices."

Choose water: Marketed as a way to replenish fluids and/or electrolytes, sports drinks are wildly popular with teens, but the American Academy of Pediatrics says few teens are so active that they need them. If they insist, compare labels — many sports drinks are high in sugar. "As soon as that sugar kicks in, it's a click-on-click-off effect: Sugar can rapidly give them energy and rapidly deplete it," Edwards said. "Teenagers should be drinking water almost exclusively — eight 8-ounce glasses a day — and a glass of skim milk every day for bone development."

Read food labels: Beverages (including soft drinks, fruit drinks and energy drinks) are the No. 1 source of added sugars, followed by snacks and sweets. So take the time to read food labels. Watch out for high-fructose corn syrup and for sugar molecules ending in "ose" (such as dextrose, maltose and sucrose). Beware when a package is labeled "reduced fat," Edwards recommends. "A dietitian taught me that often means more sugar."

If your family is consuming too much sugar, it's smart to cut back — but take it one step at a time, Edwards said. First, stop buying sugary products like cookies and cake. Next, focus on one food habit every day for two weeks — replacing apple juice with water, for example. Then get active — walking 15 minutes a day, for instance.

"Over the course of a month, you will have built two healthy habits," Edwards said. In six months or a year, the goal is a more balanced, less sugary diet.

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