Eating meals from restaurants has become routine for many American children, often contributing excess calories, solid fats, sodium, and added sugar to diets already lacking in fruit, vegetables, and low-fat dairy. Many restaurants have made voluntary changes to their kids' menus, including reducing the calories in new items, in advance of menu-labeling legislation that will mandate printed calorie counts. However, many kids' menu items are still high in fat and sodium, leading researchers to question how well children's meals at top restaurants match national nutritional recommendations.

Using the 2014 Nation's Restaurant News Top 100 Report, researchers identified the top 10 quick-service restaurants (QSR) and full-service restaurants (FSR) that offered a kids' menu, made nutrition information publicly available, and provided calorie information for all children's entrees. Using this information, researchers compared calories, fat, saturated fat, and sodium from children's meal combinations with national dietary recommendations to understand the nutritional value of these offerings. They found that many meals met calorie recommendations, but failed to meet recommendations for fat, saturated fat, and sodium levels.

"Improving the availability of healthier kids' meals is a critical step toward increasing children's exposure to healthier foods, but that alone is not enough," said lead author Sarah Sliwa, PhD, an instructor at Tufts University Friedman School of Nutrition. "We encourage restaurants to look holistically at the nutritional value of their children's meals, and to market healthier options in ways that emphasize taste and appeal to parents and children alike."

Although 72% of the meal combinations researchers studied at QSRs and 63% at FSRs met nutritional recommendations for calories, less than one-third of children's meal combinations at QSRs and one-quarter at FSRs met the recommendations for fat, saturated fat, and sodium as well as calories. Most meals exceeded the sodium recommendation, but there are reasons to be optimistic. At two of the QSRs included in the study, over 90% of meal combinations had less than 770 mg of sodium, which demonstrates that large, successful restaurant chains can meet this recommendation.

Based on the nutritional values from QSR and FSR, the researchers concluded that improvements in children's meals are feasible. Calorie counts are expected to be published on menus at many FSRs and QSRs nationwide by December 2016, potentially spurring additional calorie decreases. It is unclear whether menu labeling will encourage improvements in other areas, such as sodium content.

"Restaurants should be commended for their progress to date, but no single step will reverse the childhood obesity epidemic and there is still much work to do," said Christina Economos, PhD, vice chair and director of ChildObesity180, who is the senior author on the study. "Everyone has a role to play in providing healthier meals for kids. Restaurants can make healthy, appealing options more prevalent and prominent. Parents can educate and guide their children toward healthy choices, and speak up to demand healthy meals where they don't exist. We need to combine more nutritious children's meal offerings with stronger education to drive both supply and demand to support healthier choices."