Children's menu items at popular restaurant chains across Canada contain dangerously high amounts of sodium - in many cases, enough to raise a child's risk of developing high blood pressure, cardiovascular disease and other serious health problems.
It's a troubling reality that is fuelling anger and frustration among a rising number of physicians, scientists and health advocates who have been urging the federal government to take action to prevent food companies from adding excessive amounts of salt to their products at the consumer's peril.
This week, two of the country's prominent hypertension experts described sodium as one of the most urgent public health matters facing Canada in an article published in the Canadian Medical Association Journal.
But it seems the message hasn't gotten through to the restaurant industry.
Many restaurants offer a specialized children's menu, which often contain kid-friendly items such as grilled cheese sandwiches, chicken fingers or French fries, in smaller portions than those offered to adults.
An analysis of children's menus at many of the country's top chains reveals that numerous items, such as chicken strip meals, pizza and hamburger combos, contain enough sodium to exceed a child's daily sodium requirements - and in some cases, surpass the upper daily maximum, beyond which the chance of health risks is increased.
A children's order of chicken tenders with fries and ranch dressing from Milestones Grill and Bar, for instance, contains 2,200 milligrams of sodium, and a kids hamburger meal combo from Harvey's Restaurants contains 1,710 milligrams.
The recommended sodium intake for children ranges from 1,000 milligrams a day to 1,500 milligrams a day, depending on their age. The upper tolerable limit ranges from 1,500 milligrams for children aged 1 to 3 up to 2,200 milligrams for those aged 9 to 13. Exceeding the upper tolerable limit raises a person's risk of developing high blood pressure and serious related conditions or diseases, such as heart disease and stroke.
"It's very shocking," said Kevin Willis, director of partnerships at the Canadian Stroke Network. "Certainly you don't want to be feeding children that age those amounts of sodium."
But it helps explain why nearly all toddlers and children in Canada consume about double the recommended amount of sodium every day. On average, Canadians consume 3,092 milligrams of salt a day.
Up to 80 per cent of the sodium Canadians consume comes from packaged and processed food, including restaurant meals, which is why a chorus of medical experts say the government needs to persuade or mandate the food industry to reduce the amount of sodium they add to their products.
But one of the fundamental problems, according to a leading childhood obesity expert, is that the food industry has "programmed" parents and children to accept that high-sodium items such as hot dogs and pizza are "kid-friendly," without considering the health consequences.
"People are just conditioned. They just dig in without thinking," said Peter Nieman, a pediatrician at the Pediatric Weight Clinic in Calgary.
Dr. Nieman said children usually like the taste of items on the kids menu, even though they often have little nutritional value, making it a challenge for parents to choose healthy alternatives. As a father of four children between ages six and 14, it's a struggle he's familiar with.
"It's a constant battle when we go into a restaurant to get [the kids]to eat healthy foods," Dr. Nieman said.
The brewing health crisis posed by the country's excessive salt intake, particularly its effect on the health of children and adolescents, was the focus of a major series published by The Globe and Mail earlier this year.
The growing presence of health-conscious consumers has helped push many fast-food chains and sit-down restaurants into offering healthier items, such as a growing selection of salads, a trend that has spilled over into the kids menu. Many chains now offer apple or mandarin slices as a healthier alternative to traditional sides.
But less-healthy menu items still make up the majority of menus at most chain restaurants in Canada, posing a major challenge for parents who want to eat out with their children without sacrificing healthy eating. For instance, a report released in August by consumer research firm Mintel International Group Ltd. found French fries were the most common side offered on children's menus.
"It's always very easy for a parent to give a kid a kids meal because it's inexpensive, it's very convenient and it's likely the child will eat it," Dr. Willis said. "[But]food available on the children's menu…[are]often some of the worst choices nutritionally."
He said when his children were small, he would usually choose items from the adult menu for them at restaurants to avoid giving them unhealthy options from the child's menu.
It's no wonder, after looking at the nutrition information of kids meals sold by many popular restaurant chains.
For instance, an all-beef hot dog kids meal with French fries from Dairy Queen has 1,270 milligrams, while an order of kids-sized popcorn chicken from KFC has 900 milligrams. Boston Pizza's pint-sized pizza contains 620 milligrams, and three chicken strips from Swiss Chalet contain 780 milligrams, before any sides are added.
But the high-sodium trend will continue as long as parents continue to buy items loaded with salt, Dr. Nieman said. The challenge is making more parents aware of just how much salt their kids are eating and the potential risks involved.
"The focus is so on the fat and the calories and the trans fat and the sugars," he said. "It's almost as if the salt issue comes in a bit in third, even among the experts."
More than a dozen restaurants were contacted, but none agreed to an interview. McDonald's, Burger King and East Side Mario's each sent an e-mail statement saying they are looking at sodium reduction, but didn't say whether there are concrete plans or timelines for action. Other restaurants, such as The Keg and Cara Operations Ltd., which runs Harvey's, Swiss Chalet, Kelsey's, Milestone's and Montana's restaurants, didn't respond.
The federal government has promised to take action on this issue and appointed a sodium working group to develop a sodium reduction strategy, although the two-year-old task force has yet to produce tangible results.
In the meantime, Dr. Nieman hopes growing awareness about the dangers of high sodium intake help them to make healthier choices for their families. But even then, he says, high sodium foods will continue to dominate the market unless some significant changes are made.
"It starts with awareness, but there's a long road ahead," Dr. Nieman said.