By John Messmer, MD

Most children have visited a McDonald's at least once by age 8. Considering all the fast food franchises in the United States, it's a fair bet that just about every child has been to a McDonald's, Burger King, or Wendy's. Opinions about fast food and children are almost as numerous as the number of fast food restaurants. Is fast food an acceptable part of a child's diet?

A closer look at the Happy Meal

Let's consider a McDonald's Happy Meal since McDonald's tends to be the focus of much of the criticism of fast food. A Happy Meal with either chicken nuggets or a cheeseburger, French fries, and 1% milk has roughly 650 calories with a little over a third of that coming from fat. That is about the recommended proportion of fat and the total calories are about right for a healthy, active 6-8 year old for one meal. Nuggets carry about 700 mg of sodium and a cheeseburger about 1000 mg of sodium--quite a bit even for adults, but excess sodium is not restricted to McDonald's. Just about all prepared food has too much sodium.

Happy Meals turn into Big Macs and Large Fries

When children get older, however, they might order a Big Mac, large fries, a large Coke and an apple pie for 1700 calories--almost the entire day's need. Add that to a day's diet that includes other empty calories such as more soda plus a lack of activity, and obesity is likely. Indeed we are seeing what could be considered an epidemic of obesity and type 2 diabetes (see "Juvenile Diabetes"), both of which is all too often seen in overweight children.

Consider French fries. A potato is a reasonably good food and a good source of fiber. All frying does is add fat. We like them because we are programmed to like fat, but fries are not nutritious. Avoid ordering large portions unless the entire family is sharing. Large burgers, such as Big Macs and Whoppers, are a lot of food. If lunch is fast food, have a lighter supper with emphasis on vegetables to balance the day's nutrition.

Parental supervision is key to getting children to eat healthily

The problem is not the fast food itself, but parental supervision. We must guide our children and help them choose properly, even if it means refusing them a choice. A child who eats a balanced diet most days can eat fast food once or twice a week with attention to choices and quantity.

Read about the nutritional content of the foods you and your family like. You might be surprised to learn that the McDonald's Deluxe Breakfast has a half a day's calories and a full day's sodium in it for an adult! It's clearly too much for a child.

Except for the sodium content, fast food is not inherently bad if eaten occasionally. Our children depend on us to teach them good food choices and to set limits throughout their childhoods. Choosing a menu is just part of being a parent.