As candy buckets fill up and trick-or-treating season begins, Halloween serves as a great reminder for families to start thinking more about sugar, sweets and their little ones’ health. Rising sugar consumption can increase the risk of tooth decay, weight gain, stomachaches and long-term health complications.

To better understand how parents can prepare, I spoke with Dr. Jacquelyn Crews, a pediatrician and clinical assistant professor in the University of Florida Department of Pediatrics, to answer common questions about sugar, sweets and childhood health.

What are the current recommended daily guidelines for added sugar intake in children? Could you give us a practical visual/example of what that allowance looks like in daily meals or treats?

The current recommendations are for children over 2 years old, limiting intake to 25 grams of added sugar per day. Children under 2 should aim for no added sugar.

Replacing sugar-sweetened drinks like juice and soda with water or milk helps take a good amount of sugar out of kids’ diets. 25 grams (or 6 teaspoons) of added sugar could look like a packet of flavored oatmeal (12 grams), a turkey sandwich on whole wheat bread (6 grams) and pasta with store-bought red sauce (8 grams). That meal list had no sugary drinks, between-meal snacks, sides or desserts — it can add up fast!

What are the most common “hidden sugar” traps — foods or drinks that parents routinely offer thinking they are healthy, but are actually loaded with added sugar?

Sugar can hide in very unexpected places. Yogurt is a common one because there are so many benefits of yogurt, but flavored varieties often have lots of added sugar. Breakfast cereals are often marketed as a healthy meal or snack because they have vitamins and minerals added, but they also tend to have lots of sugar per serving. Even pasta sauce and ketchup can have sugars added!

That’s not to say you have to totally avoid these products, but be mindful when serving them and consider what’s on the label in terms of your child’s total daily sugar intake.

Parents often talk about a “sugar rush” when kids are bouncing off the walls after eating sweets. Is there a medical/scientific explanation for this behavior?

That’s a great question, and surprisingly, there is evidence to suggest the “sugar rush” does not happen in real time. Kids who are otherwise healthy and don’t have trouble processing their foods will regulate their blood-sugar levels to be kept in a normal range, regardless of how much sugar they eat or drink in one sitting. This myth might be brought on because you can imagine a birthday or holiday party (where sugar is loaded on the menu) is overstimulating anyway, which could also cause behaviors that are blamed on lots of sugar.

Now, there is some weak link between an overall high-sugar diet and symptoms of ADHD, but that evidence is not strong, and it doesn’t mean the same as once-in-a-while high-sugar intake.

Beyond immediate energy spikes or tooth decay, what are the primary long-term physiological risks of high sugar consumption during early childhood development?

You hit the nail on the head with the one about tooth decay; that’s a known connection. Being overweight in early childhood can lead to later-on issues like heart problems, diabetes and blood pressure issues.

And having a diet high in sugar can replace higher-quality nutrition. We’re still learning if there is a connection between sugar and brain development.

Are “sugar-free” alternatives safer or better for growing children, or do they carry their own health risks?

I wouldn’t make a blanket statement that if all sugar is replaced with “sugar-free” alternatives, everything will be fine. Sugar-free alternatives can certainly help with tooth cavity concerns, and in kids with diabetes or pre-diabetes, they may be helpful with preventing weight gain, and possibly even a small amount of weight loss.

We just don’t know enough about their long-term effects yet. They might change the makeup of “good” bacteria in the gut, some may potentially be linked to some types of cancers and they basically reinforce a preference for a sugary taste.

Beyond just added sugars, what concerns exist regarding ultra-processed sweets and artificial additives, such as food dyes or synthetic preservatives?

This is still a topic of lots of research, but there seems to be a link between some food dyes and preservatives and behavior concerns, mainly hyperactivity. The research is ongoing, but if a parent tells me they avoid these things in their child’s diet because they see the behavior change, I believe them.

From a pediatric perspective, are there specific types of candies (like gummies, ultra-sour treats or hard candies) that should be strictly limited? If so, why?

I always try to take into account that each family has its own story, culture and preferences, so I give advice about “strictly” limiting things like this differently depending on certain situations.

Hard candies are a choking risk for anyone, but around age 5, kids can start to better handle them. Put a stick on it and it becomes a lolli-pop and may be easier to handle. Gummies are very sticky on the teeth and can cause dental issues, like cavities. Same with ultra-sour treats. In general, candies don’t add anything to the diet and can certainly cause issues, so they should be eaten in moderation.

How can parents effectively teach young children the concept of moderation, like understanding they don’t need to finish a treat all at once, without creating an unhealthy fixation or obsession with “forbidden” foods?

One of the easiest ways to prevent a child from constantly asking for treats is to not keep them in the home. That makes them only available on special occasions. Also, practicing these habits yourself can demonstrate to your kids healthy diet habits without having to explicitly say anything about it.

I would recommend serving portions you would be OK with the child finishing and not requiring finishing any meals. Letting the child listen to their body tell them when they are satisfied is a skill that can be learned or unlearned.

What are some nutritious, low-sugar alternatives or simple food pairings (like combining fruit with fat or protein) that parents can use to help satisfy a child’s sweet tooth while maintaining stable blood sugar?

Fruits have natural sugars and come in so many flavors and colors that it’s easy to keep things from getting boring by offering a variety. Swapping ice cream for frozen yogurt takes out some sugar, and you can add fresh fruit as a topping to make it extra sweet.

Smoothies make a great treat, and you can add protein with yogurt and nut butters, and usually get some veggies like spinach in there.