Posted tagged ‘feeding children’

The picky eater guide: Part 5. Special circumstances, vitamins, a backup plan, and a muffin bonus

March 19, 2012

The Pediatric Insider

© 2012 Roy Benaroch, MD

We’ve been talking about how to handle mealtimes to help prevent and deal with food pickiness—but without really concentrating on getting the child to somehow eat more of the foods he doesn’t want. That’s because 1) you can’t actually make a child eat something he doesn’t want to eat, and 2) even if you could, it’s still not a good idea. We’re trying to develop healthy habits to last a lifetime, and we’re no longer really worried about how many brussels sprouts are consumed at an individual meal (if you are still worried about that, start over.)

There are some special situations that ought to be mentioned. This discussion has been about developmentally and neurologically normal children. If your child has autism or other developmental challenges, some modifications of these instructions may be needed (though philosophically, it’s even more important to reinforce and teach independent feeding skills to children with developmental disabilities.) Likewise, some medical problems can lead to problems with eating that are beyond the scope of these posts. If your child is not neurologically typical, you ought to get more-specific instructions from your pediatrician or other health expert who knows your child well.

One issue that seems difficult to work around is parent’s worry that a lack of vegetables will lead to serious health problems from vitamin deficiencies. As it turns out, so many foods in the USA are fortified with vitamins that deficiencies are almost unheard of—but still, there’s a worry, and it’s led to a proliferation of overpriced, overhyped supplements that supposedly replace fruit and vegetable intake. Don’t fall for the advertisements. If you can’t help but worry that your kids aren’t getting vitamins, have them take an inexpensive generic multivitamin every day. There is zero benefit to any premium or expensive vitamin—a chemical is a chemical, and your child’s body doesn’t care how much you paid for it.

There also is an understandable need for some parents to have some kind of “back up plan” when a meal completely falls apart. As I’ve said, I think it’s fine for a child to choose anything they want off the table—so if a meal includes spaghetti/meatballs/sauce/broccoli/garlic bread, and all the child wants is plain spaghetti or plain bread pulled off the back of the garlic bread, it’s OK with me. Still, it can be difficult for many parents to let a meal go by without Junior eating much. So, if you’re one to worry, you can offer the following “standing rule”: IF Junior wants to, he can go get a backup meal himself.

The backup meal must be a single item that’s always available, and it should be something the child can prepare himself. A bowl of cereal is a good choice, or plain bread with butter. The backup should be one simple thing, and it’s crucial that mom or dad not have to be the one to get up and deal with it. That would ruin the parents’ meal, and that’s not fair. I’m not sure a “backup” is even needed—kids will in fact eat when they’re hungry—but if parents feel that they need a backup, that’s the way to do it. By the way, we’re talking reasonably-healthy cereal, here. Not one with little marshmallows.

This series started with a question about picky eating, and ended up becoming something much more: a short guide to how to feed your children and your family in a way that will help your children make good food choices for the rest of their lives. At the same time, the “family” meal plan, with separate jobs for parents and kids, should help make mealtimes more enjoyable and fun for everyone. Remember: picky isn’t the problem, and your job is not to get your kids to eat more! Now go cook something fun and enjoyable with your kids, like our family favorite: Banana-Chocolate Chip Muffins!

  1. Cream together 1 stick butter and 1 cup sugar
  2. Mash into the bowl 3 over-ripe bananas
  3. Mix in: 2 eggs, ¼ cup yogurt, 2 tsp vanilla extract, 1 tsp baking soda, 1 tsp baking powder, pinch salt, 1 ½ cups whole wheat flour, a good handful of chocolate chips (cook’s helpers get to eat a few)
  4. Pour batter into about 18 muffin cups. Bake @ 350 for 16-20 minutes. Enjoy with milk!

 

The picky eater guide: The whole enchilada:

Part 1. What’s the problem?

Part 2. The “Don’ts”

Part 3. The Rule

Part 4. The jobs of parents and kids

Part 5. Special circumstances, vitamins, and a muffin bonus

The picky eater guide: Part 4. The jobs of parents and kids

March 12, 2012

The Pediatric Insider

© 2012 Roy Benaroch, MD

There are things you can do, and things you can’t do. Among the fundamental things that parents cannot do are three things that drive us all crazy.

  • You can’t make ‘em sleep
  • You can’t make ‘em poop
  • You can’t make ‘em eat

It’s just true. If you’re looking for a power struggle, go ahead and try to fight one of those three fights. I’ll wait here.

Back so soon? Don’t be discouraged. Remember: the point of parenting isn’t to win, and it isn’t to dominate, and it isn’t actually to make your child do The Right Thing. The point is to raise a child—to help him or her become an adult, capable of making decisions (hopefully the right ones!) To make a decision, it has to be possible to make the wrong decision. Children need to learn to make even the wrong decisions on their own.

This series of posts started with Melissa’s simple question about what to do with her picky eater. In this part, we’ll focus on what the parents’ and kid’s jobs are at mealtimes. Remember: our goal is to reinforce good habits that will help Junior continue to make good eating choices for the rest of his life. The parent’s job is to offer healthful foods in a appropriate manner, following these steps:

1. Parents set the menu.

Choose a handful of different food items for the meal. Once your child is old enough (usually around nine months of age), he or she should be able to eat most of what mom and dad eat (it’s messy, but fun!) If one or more of the items is in the category of “foods Junior usually likes”, that’s fine. For instance, if your child really likes yogurt, it’s perfectly fine to make yogurt part of most—or even every—meal. Just put it on the table. Don’t make any of the foods belong to any of the people at the table—there should be no “Junior food” or “Mommy food.” If Junior wants some of mom’s anchovies, or mom wants a few of Junior’s chicken nuggets, that’s fine. All food comes out of shared serving dishes.

2. Parents sit and eat with their children.

You can’t expect your child to learn table manners and good eating habits if he’s eating alone at the breakfast nook. Mealtimes are together times.

3. Parents turn off the TV and talk with children during mealtimes.

Don’t talk about the food, unless it is to thank the preparer. Talk about other things.

4. Parents set a good example.

Put a variety of things on your plate, eat slowly, and drink water with your meals. Use a fork. Smile and enjoy yourself. Do the things you want your child to do—but remember, you’re teaching by example. Don’t nag your kids during meals.

Kids have it a little easier. They have only three jobs:

1. Children decide which food items to eat, and how much of which to eat.

As long as it’s on the table at the start of the meal, kids can choose to eat it: a lot of it, a little of it, or none of it. What children should not expect is to get things that are not on the table. Parents choose the items in the meal, then kids decide which of those and how much to eat.

2. When old enough, kids should help with the prep and clean up.

This can include shopping for foods, picking out menus, cooking, clearing the table,  cleaning the dishes, everything. Get them to help in the vegetable garden and take scraps out to the compost pile. It’s all work for the family to do.

3. Kids should say “thanks” afterwards. A kiss for the cook is nice, but not required.

There are other benefits to the “family meal.” In addition to reinforcing good meal habits, preventing obesity, and encouraging a variety of foods, family meals help kids be more successful in school and help prevent drug use and family violence. Don’t turn meals into a struggle over whether your child is getting enough rhubarb. Enjoy your meals together by not focusing on just how much is being eaten. You’ll have a better time—and you’ll end up with a healthier-eating child, too.

Next: tying up a few loose ends. And muffins!

 

The picky eater guide: The whole enchilada:

Part 1. What’s the problem?

Part 2. The “Don’ts”

Part 3. The Rule

Part 4. The jobs of parents and kids

Part 5. Special circumstances, vitamins, and a muffin bonus

The picky eater guide: Part 2. The “Don’ts”

February 27, 2012

The Pediatric Insider

© 2012 Roy Benaroch, MD

Last post, the Picky Eater Guide started with some history and perspective. The bottom line: there is a huge nutritional problem in the developed world, and it’s causing huge health problems. But it’s not that kids don’t eat their veggies, or that kids don’t eat what their parents want them to eat. It’s that kids, and adults, eat too much. Unfortunately, some things parents do to try to get their kids to “eat healthy” might in the long run be contributing to the warped sense of appetite that seems to be a major cause of the obesity epidemic. This post is about what parents shouldn’t do—the “don’t” list of things that in the long run may end up doing far more harm than good. Got a picky eater? Let’s not make things worse by creating a picky eater with a weight problem.

Do not make food contingencies. That means, don’t make the availability of one food depend on whether another food is eaten first. Think about this common scene:

Mom: “Boscoe, if you eat your broccoli, you can have a brownie.”

Boscoe eats the broccoli, then eats the brownie.

What mom thinks: Good! I got him to eat the broccoli!

What Boscoe thinks: Wow, a brownie must be extra special—it’s a reward food! And broccoli must be some kind of horror. After all, I got a brownie for eating that dreck. I’ll keep in mind that no one in their right mind would voluntarily eat broccoli. I wonder if I can make some kind of deal to get more brownies?

So, net, after this scene, Boscoe did in fact eat some broccoli. But the cost of this was to reinforce how special and wonderful brownies are, and to encourage him to continue to crave them—while at the same time teaching Boscoe how nasty and unloved broccoli must be.

Remember: the point of a meal isn’t to get a serving of broccoli inside a child. (If that were the case, we could just sedate the kids and feed them through tubes.) The point is to 1) enjoy the meal as a family and 2) help reinforce healthy social and eating habits to last a lifetime.

Another big don’t: don’t force feed anything. You’ll create food aversions and a warped sense of anxiety and power struggles at meal time. If you’re forcing anything, you’re causing problems. Stop it. You also shouldn’t distract and fool children into eating, by, say, leaving a television on while you shovel the food in. Junior might continue to eat (kind of like a little bird, just opening up that mouth), but that’s not a way to teach children how to choose foods and modulate their own food intake. It’s also, well, creepy.

Next: how to reinforce The Rule, a Universal Truth and simple philosophy that should be the guiding principle of mealtime. When you’re hungry, eat. When you’re not hungry, don’t eat.

 

The picky eater guide: The whole enchilada:

Part 1. What’s the problem?

Part 2. The “Don’ts”

Part 3. The Rule

Part 4. The jobs of parents and kids

Part 5. Special circumstances, vitamins, and a muffin bonus

The picky eater guide: Part 1. What’s the problem?

February 20, 2012

The Pediatric Insider

© 2012 Roy Benaroch, MD

Melissa, and many other parents, want to know what to do with kids who don’t eat what we want them to eat: “I was wondering your thoughts on ‘picky eaters’? I spend all day questioning whether I’m doing the right thing for my child (he’s almost 17 months). I’ve heard not to push them to eat because they will eat when they’re hungry. I’ve heard to make them sit there until they eat what you want them to. I’ve heard don’t offer them alternatives to what you’ve prepared. I’m really just confused and so flustered at meal times!”

Some perspective: for thousands of years, there was no such thing as a picky eater. When food is scarce, people ate what they could, and ate when they could. In fact, vestiges of that kind of primal urge to eat still lurk in our cravings for high fat at high sugar foods. We’re programmed to really want food of high energy density—that is, the stuff that gets us the most bang for our chewing buck. When faced with a meal of chewing some kind of celery precursor for 20 minutes, versus chowing down on fire-roasted meat, guess which one gets you more food energy for the effort?

The idea that we ought to eat a variety of things every day is also a relatively new concept. Until a few hundred years ago, people ate what they could grow or kill in their own backyards. Since then, food storage (yay refrigerators!) and food transport (yay roads!) has made it possible for us to have oranges from Chile in June.

In the developed world, we are swimming in food. Thousands of choices, easy availability, and it’s cheaper than ever. The good news: nutrition has never been better. The bad news: nutrition has never been worse.

The “better” aspect of nutrition in the developed world: we’ve got plenty of food, and people are getting plenty of calories. Those with economic disadvantages get free meals in schools and food stamps, and the cheapness of prepared foods makes it possible for just about everyone to afford to eat something. Also, vitamin deficiencies are pretty much a thing of the past. With a few exceptions, our food is so fortified with vitamins and minerals that it’s difficult to find people who aren’t getting the micronutrients they need.

But there’s bad news, too. The over-availability of food has led to a new health problem. About 1 in 3 school age children are overweight, and most of these kids will become overweight adults. Obesity contributes to diabetes and hypertension, and in many cases to short and unhappy lives.

In other words: the problem isn’t that Junior doesn’t eat enough vegetables or enough quinoa. The problem is that Junior is developing lifetime habits that are causing him to eat too much of everything else.

Next time, we’ll talk about those life habits, and how some misguided efforts to “fix” picky eating might make it more likely that obesity will become a problem.

For more perspective on how people used to eat, read Little House in the Big Woods by Laura Ingalls Wilder (featuring the “Pig Bladder” scene!) For a comprehensive and fascinating account of the history of human nutrition, try Terrors of the Table by Walter Gratzer.

 

The picky eater guide: The whole enchilada:

Part 1. What’s the problem?

Part 2. The “Don’ts”

Part 3. The Rule

Part 4. The jobs of parents and kids

Part 5. Special circumstances, vitamins, and a muffin bonus