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

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 3. The Rule

The Pediatric Insider

© 2012 Roy Benaroch, MD

As we’ve seen, the problem isn’t the picky eating, per se. Kids are getting enough calories, and they’re certainly growing big enough. Even the skinniest kids in today’s world are far healthier and have far better nutrition than most of the kids from previous generations. And I certainly haven’t seen health problems in the slender kids in my practice. What I see very commonly, though, are health problems from overweight: diabetes, high blood pressure, depression, and social isolation.

So, no matter what else, the first principle of healthy family eating should be to help foster a child’s own normal sense of appetite and hunger. This is The Rule of mealtimes. It’s The Truth, and The One Ring to rule them all:

• If you’re hungry, eat.
• If you’re not hungry, don’t eat.

(OK, so it’s two rules. Close enough.)

Humans have a built-in mechanism to control food intake, and it works well at every age. It’s called “hunger.” Often, though, we unintentionally raise our kids in ways that teach them to ignore their appetite cues and eat for all sorts of other reasons.

Think about it. In American culture we don’t just eat when we’re hungry. We eat to celebrate. We eat when we watch a movie, we eat when we’re on the phone. We eat when we’re upset, and we eat when we’re bored. We eat when we’re happy and we eat when we’re sad. Often, we eat because others encourage us to eat. Family and friends ply us with food, and mom loads up our plate. We also have to contend with an ever-present marketing effort to get us to eat even more. Most two-year-olds already recognize “The Golden Arches”, and TV and computer banner ads are a near-constant barrage encouraging us to eat. And eat. And eat.

In a way, I’m surprised obesity isn’t more common.

Let’s not make matters worse. From a very early age, encourage your children to manage their own appetite. This means that a nine-month-old who becomes less interested in nursing should be allowed to wean. And a two-year-old who wants to explore instead of cleaning his plate should be allowed to leave the table. When a child doesn’t have an appetite to eat more, do not try to trick or fool or guilt or otherwise “get him” to continue eating. Lacking hunger means the child has eaten enough. Meals shouldn’t end when mom or dad thinks Junior has had enough; meals should end when Junior thinks he’s had enough.

In fact, from The Rule flows two other rules which guide the roles of children and parents at mealtimes:

• Parents should offer healthful foods in an appropriate manner.
• Children decide which foods to eat, and how much to eat.

Simple! Or at least simple to say, and simple to understand. That doesn’t necessarily mean it’s always easy to do!

Next up: more about the job that parents and kids have at mealtimes.

 

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”

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?

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

Preventing and managing overweight: A family approach

Gretchen is becoming concerned about her daughter’s weight: “She has always high on the height/weight charts (weight a little higher than height), but now she is almost off the weight charts. I think she generally eats healthy foods, but she does eat a lot! So are there any suggestions as to how I should treat this issue? I really don’t want to make things worse by focusing too much on food.”

Weight concerns are common, and rightly so: about 1 in 3 school aged children are overweight, and most of these kids will remain overweight or become more obese as adults. Our children live in a toxic environment with excessive calories galore and far less routine physical activity than kids enjoyed in prior generations. Our portions are too large; we eat too often at restaurants with huge serving sizes; and we inundate our children with media imagery and advertizing that glorifies calorie-dense (and nutrition poor) foods. Few children walk or bike to school, and few children spend their afternoons playing outside.

The good news is that for a preschooler, parents have many years to help form good healthy eating and activity habits. We’re not talking “diet” here—that’s a term that’s never been any help to anyone. The very concept of “going on a diet” implies that you’ll someday “go off a diet.” What you want to instill are healthy habits that will last a lifetime, not a diet that will last two weeks.

As you say, you don’t want to go overboard with this, and you don’t want to over-emphasize food and eating issues to the point where your daughter gets self-conscious. So do not mention weight, and don’t set any sort of “weight goals.” The best ways to help a child learn healthy eating habits don’t focus on individual foods, “diets,” or weight, but rather on healthy habits for the whole family.

Family meals are essential. We know that children who eat with their families make healthier food choices and are far less likely to become obese adults; they’re also more likely to get good grades, and less likely to experiment with drugs.

Beverages can be a hidden source of many calories. Children should routinely drink only skim milk (by age 2, and maybe earlier) and tap water. Save soda and fruit juices for snacks. If you can’t live without flavored drinks, go with a no-calorie substitute. Some people are leery of artificial sweeteners, but I promise for most people they’re far less harmful than high fructose corn syrup. Drink water before, during, and after meals.

Do not watch TV while eating. Kids will absentmindedly eat more, and they won’t even notice or enjoy the food. Eating should not occur anywhere other than at a table in the kitchen or dining room.

Try to cover as much of the plate as possible with foods that have less caloric density. This includes whole grains, fresh fruit, and vegetables. The highest-calorie foods are meats, cheeses, peanut butter, and other protein- and fat-rich items. These should not be the “centerpiece” of any meal.

Eat slowly, and have a nice conversation during dinner. Don’t talk about the food, other than to compliment the chef. Don’t use language that puts extra value on eating and food, like “You’re such a good eater!” People eat far more if they eat quickly—slow it down!

Avoid food contingencies, like “If you eat the broccoli, you’ll get a brownie.” In the long run, these kinds of statements elevate the brownie (making it more attractive) and denigrate the broccoli. What you’re saying sounds like “No one would ever eat that yukky broccoli unless they got a yummy brownie afterwards!” Kids who grow up in households with food contingencies are very unlikely to continue to eat the healthy food, but will continue to crave the reward food.

Snacks are fine, as long as they’re the same healthy kinds of foods offered at mealtimes. Avoid using the phrase or buying into the marketing concept of “Snack Food.” There is no snack food—it’s just food. Unfortunately, the term “Snack Food” really means “Crap Food”, and you don’t need to help the advertising companies get your children addicted to it.

Think about portion sizes when you shop. Huge bulk purchases may seem like a money-saving idea, but not if they encourage parents to prepare and serve more food than is healthy to eat.

This may sound looney, but it works: use smaller plates. A normal-sized portion on a dinner plate will look small, especially to those of us used to restaurant portions. Studies have shown that people will serve themselves less, eat less, and be fully satisfied with eating less if they use a smaller plate.

What other healthy eating tips have been helpful for your family? Post a comment here!

The Anti-Clean-Plate Club

A study published in the October, 2008 issue of Archives of Pediatric and Adolescent Medicine reinforces two important principles that can encourage healthy eating habits in preschoolers.

The researchers studied 63 children, offering them as much cereal as they wanted in two different-sized bowls. They had also asked if each child’s mother had been asking them to clean their plates. They found that children asked for much more cereal if it were served in a bigger bowl, and also asked for more cereal if they were from households where mom encouraged them to clean their plate.

Food Fights Fixed: How to have a successful family meal

Eating together as a family has tremendous health benefits. Kids who regularly eat with their families do better in school, watch less television, and are less likely to struggle with obesity. They also tend to get more exercise and eat a more healthful diet, including more vegetables and fewer processed foods.

But a healthy, relaxing family meal may not come easily. Parents say the kids just won’t eat what they’re served, and get whiney and surly. Mom inevitably heads back to the kitchen to make something separate for every child, and the nice relaxing family meal becomes a frustrating experience that no one enjoys. Needless to say, those vegetables sit untouched on their plates.