The number of restaurants offering fresh fruits and vegetables with their children’s menu has increased from 1% in 2008 to 3% in 2012, but the Washington, D.C.-based Center for Science in the Public Interest isn’t smiling.

Labeling the uptick a “disappointing improvement” in overall nutrition, the organization said in a study released in late March that 97% of the nearly 3,500 combinations available on kids’ menus from 34 major restaurant chains did not meet nutritional criteria for 4- to 8-year-olds based on recommendations in the Dietary Guidelines for Americans from the U.S. Department of Agriculture.

Nor did 91% of kids’ meals meet the requirements for the National Restaurant Association’s voluntary Kids LiveWell program.

“We need restaurants to do a lot more to give parents a fighting chance to find healthy things for their kids to eat,” said Margo Wootan, nutrition policy director for CSPI.

Finding healthful kids items is like “finding a needle in haystack,” she said.

Despite the fact that 1 in 3 American children is obese, she said, “most chains seem stuck in a time warp, serving up the same old meals based on chicken nuggets, burgers, macaroni and cheese, fries and soda.”

Wootan scoffed at the notion that adding fruits and vegetables makes kids’ meals cost-prohibitive.

“An apple is cheaper than a bag of chips and a grilled chicken leg isn’t more expensive than a fried one,” she said. “Almost any meal is improved if you pair an entree with a fruit or vegetable.”

Among the kids’ menu no-no’s that CSPI found was one offering that included grilled cheese on sourdough with fries and 2% chocolate milk that totaled 1,210 calories, 62 grams of fat and 2,340 milligrams of sodium.

Another was pepperoni pizza with homestyle fries and soda that packed 1,010 calories, 45 grams of fat and 2,020 milligrams of sodium.

At 19 chains, no possible combination of the items offered for children met CSPI’s nutrition standards. At nine of those 19 chains, no single kids’ meal met the NRA’s Kids LiveWell standards.

Subway was the only restaurant chain to have all of its kids’ meal combinations meet the CSPI’s nutritional criteria.

“They far and away had the healthiest options for kids,” Wootan said.

Subway also recently earned recognition from the Produce for Better Health foundation.

CSPI encouraged chains to make some changes by taking part in NRA’s Kids LiveWell program and reformulating kids’ meals to meet those standards.

Restaurants also should offer more fruit and vegetable options, CSPI said, and make them default sides, rather than french fries.

The study’s lead author, Ameena Batada, assistant professor in the Department of Health and Wellness at the University of North Carolina at Asheville, said the chain restaurant industry is conditioning kids to accept a narrow range of foods.

“More chains are adding fruit, like apple slices, to their menus, but practically every chain could be adding more vegetable and whole grain options,” she said.

“And given the impact of sugar drinks on children’s health, those should be eliminated from kids’ meals at restaurants.”

Meanwhile, NRA’s Kids LiveWell program now includes more than 135 restaurant brands representing more than 40,000 locations nationwide, the association said.

The program was launched in 2011 in collaboration with Healthy Dining, a San Diego-based company that promotes healthful lifestyles, to help restaurants highlight their better-for-you menu choices for children.

Participating restaurants agree to offer and promote a selection of qualifying menu items.

The initiative focuses on increasing consumption of fruit and vegetables, lean protein, whole grains and low-fat dairy, and limiting total calories, unhealthy fats, sugar and sodium, NRA said.

A list of participating restaurants and their qualifying items can be found on, and also via a free Kids LiveWell App.