Posts Tagged ‘ children ’

What To Do When Picky Eating Is “Extreme”

Tuesday, June 2nd, 2015

A certain amount of picky eating is a natural part of development—but in some cases, it can go well beyond what’s typical. We asked Katja Rowell MD, and Jenny McGlothlin, MS, SLP, the authors of the new book Helping Your Child With Extreme Picky Eating, what parents need to know.

Q: What are some of the main differences between garden variety and extreme picky eating (EPE)?

A: A typical toddler may throw a tantrum if he wanted plain rice instead of brown rice with peas. But he’s consolable and might pick the peas out and try a few bites, or eat other foods. A child with EPE may panic or get overly upset around challenging foods. His attitude is a critical clue. Is he preoccupied with what and how much he has to eat at mealtimes? Would you use words like ‘anxious’, ‘terror’, or ‘scared’ to describe how he feels about eating?

If a child’s physical, social, or emotional development is affected by his eating, we call it “extreme”. Another reason it would be considered extreme is if there is significant family conflict or worry about a child’s eating. For example, a child who doesn’t eat enough quantity or variety for growth, a child who becomes anxious about attending parties, camp, or going out to eat, or a child who becomes upset or even gags when at the table with food he doesn’t enjoy.

Q: What is your first recommendation for parents of extreme picky eaters?

A: The immediate goal is to support appetite and decrease conflict and anxiety. Our first tip is generally to establish structured meals and snacks. In our book, each of our five STEPs gets its own chapter to walk parents through scary transitions when it feels like children can’t be trusted with eating.

Q: What is one common thing that parents do around feeding that can make EPE worse?

A: Anything that triggers resistance or pushback will make it worse— and that will be different for every child. Obviously, holding a child down or otherwise making them eat while they cry or gag is harmful, but far less pressuring tactics can undermine eating: bribes, negotiating, one-bite rules, or using toys or screens as distraction to get a few bites in. Trying to “GET” children to eat tends to slow the process of learning to enjoy eating and tuning in to cues from inside their bodies. In general, if what you are doing increases anxiety, gagging, or conflict, it is not helping.

Q: What would you say to parents who worry that EPE is somehow their fault?

A: There is almost always an underlying reason that starts a family down the path of feeding difficulties: pain with eating (reflux), sensory-motor problems associated with developmental delays, autism spectrum diagnoses, temperament mismatch and others. It’s never simply “their fault”. Understanding why a child struggles makes letting go of guilt and moving forward possible. Shifting the focus to what parents can do is the answer. We provide tools to support appetite, decrease anxiety and conflict, support oral-motor and sensory development, and improve variety and nutrition. When parents feel understood and listened to, and empowered and confident with specific steps to take— that helps most with the guilt.

Q: Do kids with EPE need help from a feeding therapist?

A: The term “extreme” picky eating includes a variety of diagnoses and labels (feeding disorder, selective eating, avoidant/restrictive food intake disorder, food aversion, etc.) and a spectrum of experiences. A child might benefit from therapy if they have difficulty with transitioning to table food, chewing food well enough to swallow safely, or handling a variety of textures without gagging. Feeding therapy can vary widely, but our approach to therapy targets sensory-motor skills needed for eating, support of the feeding relationship between the parent and child, and empowerment of the family to provide a structured, peaceful mealtime. Our book helps parents decide if they need an evaluation or therapy, describes different approaches and red flags for counterproductive therapy, and offers guidance for finding a therapy partner.

Establishing a supportive and nurturing feeding relationship between parent and child goes much farther than direct intervention can. We want to empower parents to offer gentle facilitation when needed that helps children develop skills at their own pace, and it won’t feel like therapy! Families can come together at the table and enjoy mealtimes.

Katja Rowell, MD, and Jenny McGlothlin, MS, SLP, are the authors of Helping Your Child With Extreme Picky Eating. Learn more on their website.

Family Dinners: 4 Tips To Make Them Better
Family Dinners: 4 Tips To Make Them Better
Family Dinners: 4 Tips To Make Them Better

Image: Picky eater via Shutterstock

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Should Kids Pass on Pizza?

Sunday, January 25th, 2015

According to a recent article in the Atlantic, the U.S. pizza industry serves about 100 acres of pizza daily. That’s enough pizza to fill about 77 football fields.

Of course the popularity of pizza among grownups and kids alike is no surprise. Not only does the concoction of dough, sauce, and cheese taste great, but it’s such an easily accessible food—something we can easily grab and go with (no utensils required). And as any parent or child knows, pizza is probably the most popular staple at kids’ birthday parties and other celebrations at school or otherwise.

Despite its popularity, some researchers believe that pizza is something that should be limited in kids’ diets. According to a new study in Pediatrics, national survey data revealed that although total calorie intake from pizza has declined 25 percent from 2003-2004 to 2009-2010, on days kids ate pizza they also consumed more calories, saturated fat, and sodium that they did than on days they didn’t down the doughy delight. The study also found that on pizza-eating days, children 2- to 11-years old consumed an extra 84 calories, 3 grams of saturated fat, and 134 milligrams of sodium than they did on non-pizza-eating days.

Researchers also found that having pizza as a snack or consuming pizza purchased at fast-food restaurants had the greatest impact on total calorie intake.

Because of the possible adverse dietary effects of pizza intake, the researchers recommend curbing pizza intake and improving the nutrition content of the beloved dietary staple.

I love pizza as much as the next parent and give it to my kids, usually once or twice weekly. In my opinion, the key to consuming pizza is to keep an eye on portion size. Less is more, and pairing a fast-food pizza slice with a colorful salad (with a tablespoon or two of an oil-based dressing), steamed or lightly sautéed vegetables (on the side or on top), or a reduced- or low-sodium soup are great ways to limit any possible perils associated with pizza intake and to help kids increase their intake of fruits and vegetables.

Blotting pizza is also a good way to make it less oily—it may even save some calories without taking away from the nutritional value of the meal. And instead of eating pizza by folding it in half, slicing it into two halves or cutting it into small bites and eating it with a fork also can help kids eat more slowly and mindfully and pace themselves better at their meal.

Limiting intake of pizza you order or take out from anywhere—a restaurant, a movie theater, a ballpark—and making it a once- or twice-a-week or once-in-a-while treat probably not a bad idea to help kids eat less and better. Making it more often at home can also help you have more control over portion sizes. Using more nutritious ingredients e.g. whole grain dough, low- or no-sodium sauces, and lower fat cheeses and having your kids help make the pizza can also help your kids not only eat better but have fun with you in the kitchen.

Perfect pizza toppers

According to culinary nutritionist Rachel Begun, MS, RDN, “Roasting vegetables brings out their sweetness, which kids particularly like.” Some of her favorite “sweet” toppings include roasted garlic and peppers, roasted squash or sweet potatoes (with sautéed spinach). She also recommends tasty herbal combinations to top pizza including pesto sauce with roasted tomatoes, or a bruschetta sauce made with tomatoes, onions and herbs, like cilantro or basil. And for kids who want the meaty, salty, crunch of bacon bits atop their pizza, Begun recommends this alternative which tastes remarkably similar: Thinly slice cremini or shiitake mushrooms, coat with olive oil, soy sauce and sweet smoked paprika, and bake at 375 degrees Fahrenheit until the mushrooms are browned and have shrunk. Let them cool for a few minutes until they are nice and crispy. Add them to your pizza in the last few minutes of cooking.

“I love to top pizza Roman style—with eggs,” says culinary dietitian and cookbook author Jackie Newgent. For simplicity, she suggests frying them separately in a little grapeseed oil and then adding on top of cooked pizza. She also likes to top prepared pizza with Haas avocado cubes, a squirt of lemon juice, and an optional sprinkling of organic bacon bits. And when it comes to white pizza—the kind made without red sauce—Newgent suggests black sesame seeds as a topper. “They act as “confetti” on pizza and give it extra crunch,” she says. An added bonus: kids can have fun shaking the seeds on. According to Newgent, a little bit of orange zest (grated orange peel) also works great as a flavor accent on white pizza. “Think of it like you might sprinkle on parmesan cheese, but it’s fresher and fruiter,” she adds.

Cookbook author and culinary instructor Robyn Webb also recommends the following combinations to give a spin to pizza: caramelized onions (in the smallest amount of olive oil) with walnuts (see photo); arugula with chopped tomatoes and parmesan shards; or roasted red, yellow and orange peppers with fresh thyme.

How often do you eat pizza with your kids, and what are your favorite toppers? 

Image of caramelized onion and walnut pizza via Robyn Webb.

 

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Is BPA Less Dangerous Than We Thought?

Tuesday, January 20th, 2015

The U.S. Food and Drug Administration (FDA) recently reaffirmed its position on Bisphenol A (BPA), stating that the chemical—a structural component in polycarbonate beverage bottles (e.g. reusable water bottles) and a component in the coatings of metal cans—is safe at current levels that occur in foods. The FDA asserts that, based on its ongoing safety review of scientific evidence which included a four-year review (completed in the Fall of 2014) of more than 300 scientific studies, the available information continues to support BPA’s safety for currently approved uses in food containers and packaging.

In response to two petitions, the FDA recently amended its food additive regulations to no longer provide for the use of certain BPA-based materials in baby bottles, sippy cups, and infant formula packaging because these uses have been abandoned. According to the FDA, amending such regulations is not based on safety, but is based on the fact that the regulatory authorization is no longer necessary for the specific use of the food additive because that use has been permanently and completely abandoned.

Not everyone agrees that BPA is safe. According to the Environmental Working Group (EWG), BPA is a synthetic estrogen that can disrupt the endocrine system, even in small amounts. The EPA asserts that BPA has been linked to a lot of ills including infertility, breast and reproductive system cancer, obesity, diabetes, early puberty, behavioral changes in children and resistance to chemotherapy treatments. In a recent article, the EWG criticized the FDA for its reliance on traditional methods of studying the toxicity of chemicals like BPA. It also asserted that the study upon which the FDA based its recent safety determination “suffered from methodological problems and unintentionally exposed its control animals to low doses of BPA, making it impossible to draw any conclusions about the safety of everyday BPA exposures for Americans.” (To read more about the EWG’s position on this, click here.)

As mentioned in a previous Scoop on Food post, recent studies suggest that BPA exposure in childhood can contribute to health risks including obesity in girls and accelerated growth in some young children. Being exposed to BPA prenatally also has been linked with diminished lung function and wheezing in young children as well as with increased behavior problems in school age boys. Another study posited that prenatal exposure to BPA and high-molecular-weight phthalates—chemicals used in hundreds of products including plastics—might also increase the risk of asthma symptoms and respiratory tract infections throughout childhood.

Although the FDA vows to continue to learn about BPA and to consult with federal agencies including the EWG, the National Institutes of Health (and the National Toxicology Program) and the Centers for Disease Control and Prevention as well as international regulatory and public health counterparts, as a parent you may very well have concerns about BPA, especially when it comes to your children  We have a lot left to learn about BPA and its potential effects and it’s prudent to at least be aware of its presence in food packaging and to limit the exposure our families—especially growing children—have to it.

To reduce exposure to BPA, the EPA recommends the following:

  • Buy baby formula in plastic, glass or other non-metal containers. When possible, choose powdered formula because the packaging contains less BPA and because the powder is diluted with fresh water. If your baby needs liquid formula, look for brands sold in plastic or glass containers.
  • Limit intake of canned foods, especially if you are pregnant. If you do buy it, look for cans labeled as BPA-free or buy food packed in glass jars or waxed cardboard cartons. A few small companies sell cans lined with non-BPA alternatives (although findings from a recent animal study suggest that BPA-free products are not necessarily safer).
  • Repurpose old hard plastic containers including baby bottles, cups, dishes and food containers marked with the letters “PC,” for polycarbonate, or recycling label #7. (Not all #7 products are polycarbonate, but they may be.)
  • Do not microwave food in plastic containers.
  • Because store receipts can contain BPA, say no to them if possible. If you do keep receipts, put them in an envelope and don’t allow kids to hold or play with them. Wash hands before preparing or eating food after handling receipts. And don’t recycle receipts and other thermal paper to avoid contamination of recycled paper with BPA residues.

The FDA also recommends not putting very hot or boiling liquid that you intend to consume in plastic containers made with BPA since levels of the chemical rise in food when containers/products made with the chemical are heated and come in contact with the food. The agency also suggests discarding all bottles with scratches, as these may harbor bacteria and, if BPA-containing, lead to greater release of BPA.

Do you avoid BPA?

Image of BPA sign via shutterstock.

 

 

 

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Experts Offer 12 Tips to Help Kids Eat Better in 2015

Sunday, December 28th, 2014

Since 2015 is here, I thought I’d put together a list of some great ideas to help you help your kids eat better during the upcoming year.

Don’t worry—I’m not suggesting any kind of complete dietary overhaul. But I do recommend all of these no-fuss strategies suggested by some top dietitians to help move kids’ diets and habits in a more healthful direction.

Whether you choose several strategies at once or one for each month in 2015, all are sure to help your kids incorporate more nutrients in their diets. And they’ll certainly make your meals even more delicious.

Read on for 12 expert tips to help your kids eat better in the New Year and beyond.

1. Create a produce calendar. Creating a produce calendar can help organize meal planning and help kids feel like they’re part of the process. It can also help them feel like they have some control over what is served and get them excited about produce. To do this, you can assign each family member one or two days a week to choose the daily fruit and veggie meal stars. For instance, Mom might have Tuesdays and Thursdays, and Bobby might have Wednesdays and Fridays (you get the drift). You can then write up a calendar and let each person choose the fruit and veggie star for his or her day. You can choose whatever fruit or vegetable you like or use a seasonal list like this one to guide your choices. Kids can help wash the fruit or vegetable and observe or help with their preparation depending on their age.

2. “Cook” in class. You can volunteer at your kids’ school by offering a hands-on no-cook cooking class. It’s a great way to highlight the fun you can have even if you’re not baking, but instead making nutritious items like fruit kebabs with yogurt dip or an edamame salad.

3. Take the rainbow challenge. For the game lover in all of us, Healthy Kids Concepts (HKC)*, a non-profit that encourages healthy eating habits through color-inspired lessons in pre-K and grade school children, offers check sheets (they can be downloaded for free here) to help kids keep track of how many different colors of fruits and veggies they eat each day. The goal is to eat the rainbow every day for an entire month.

4. Just dip it. Kids love to dip things, and studies suggest they may eat even more vegetables if they use them as dippers. So, why not make some tasty and affordable dips to offer the kids with their meals and snacks. You can buy canned chickpeas or garbanzo beans, rinse, and whir in a blender or food processor with some olive oil and a squirt of lemon. Frozen, thawed green peas plus olive oil, lemon juice and some minced garlic, salt and pepper can also work. You can also serve new dishes or foods previously disliked with a dipping sauce. For example, you can serve steak strips with no sugar added cranberry sauce or grilled chicken strips with some honey mustard.

5. Make your own fruit fantasy. Create your own edible fruit arrangement by slicing watermelon into popsicle shapes on popsicle sticks or fan orange segments out on a plate in a pattern that looks like the sun with a banana circle center. Making fruit look good can certainly make it more appealing to kids.

6. Let ‘em eat with their hands. Add edamame sprinkled with a little sea salt to your kid’s lunchbox. It’s a fun, hand-held, easy to eat food that’s rich in filling protein not to mention other key nutrients (it also counts as a vegetable).

7. How ‘bout veggies before dinner? Because so few kids meet their daily quota for vegetables, how about making it a rule to eat veggies in the hour leading up to dinner? Noshing on baby carrots, cucumber slices, celery sticks, plum or cherry tomatoes, plain or with a little Italian dressing or a tablespoon or two of dip can help kids eat enough vegetables to meet their needs and prevent them from noshing on nutrient-poor snacks that will fill them up and spoil their appetite before you can even say, “Dinner’s ready.”

8. Plant a garden. You can do this in your backyard or, if you live in an apartment, in a box on your terrace. Planting, watering, and picking vegetables, herbs and spices can teach your kids where food comes from and give them a sense of ownership and pride when the planted items are ready to be incorporated into meals.

9. Swap some usual foods. Once in a while, instead of offering the same old same old, mix things up a bit. For example, instead of carrots, offer parsnips. They offer myriad nutrients and have a similar taste and texture to carrots. Try them anywhere you’d use carrots, like in a stir fry dish or in a winter vegetable chili. And how about replacing some of the broccoli in dishes with cauliflower. You can buy it fresh or frozen and serve it in a mixed dish or by itself, chopped and steamed.

10. Rate your plate. Ask your kids to do a taste test at one meal each week. You can offer them several food options and have them give each a score of 1 to 5 on their color and taste.

11. Shape ‘em up. Because kids love pizza, spaghetti, French fries and pancakes, why not encourage them to try more vegetables by having them help you make new versions of each of these. For example, you can make matchstick parsnip fries; portabello mushroom, eggplant or cauliflower-crusted pizza; beet or carrot pancakes; or zucchini muffins. You can also use a veggie spiralizer (the kids can even help) to make colorful, nutrient-rich “pasta” out of steamed or grilled zucchini, baked sweet potatoes or fresh cucumber. If you don’t want to make the switch to all veggie noodles, try mixing some in with pasta noodles.

12. Go fish! Kids and parents tend to not eat recommended amounts of fish in their daily diet. That’s a shame, especially since fish is a key source of high quality protein and potent omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). These essential fatty acids are important for development and health of the brain, nervous system, heart, skin, and immune system. Current Dietary Guidelines for Americans recommend anywhere from 3 to 8 or more ounces of fish weekly depending on kids’ needs and total calorie intake (see my recent Scoop on Food post for more information). Because that really isn’t that much, why not simply replace one or two of your family’s weekly meat dishes or one family meal and one of your child’s lunches with fish. Lower mercury fish options include salmon, shrimp, pollock, tuna (light canned), tilapia, catfish, and cod. White (albacore) tuna can also be consumed, but should be limited to no more than 6 ounces a week.

Sources: Patricia Bannan, MS, RD; Stephanie Clarke, MS, RD & Willow Jarosh, MS, RD co-owners of C&J Nutrition and board members of HKC*; Jessica Fishman Levinson, MS, RDN, CDN founder of Nutritioulicious; Sally Kuzemchak, MS, RD, author of Cooking Light Dinnertime Survival Guide; Lindsay Livingston, RD; Tammy Lakatos Shames, RDN, CFT and Lyssie Lakatos, RDN, CFT, a.k.a. The Nutrition Twins, authors of The Nutrition Twins’ Veggie Cure; Carolyn O’Neil, MS, RD, LD, author of The Slim Down South Cookbook and nutrition advisor to www.BestFoodFacts.org; Rebecca Scritchfield, MA, RD, HFS; and Rebecca Subbiah, RDN.

Image of 2015 written with food via shutterstock.

 

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Marketing Junk Food to Kids

Tuesday, December 9th, 2014

In an effort to stop marketing unhealthy foods to children and curb childhood obesity in America, the Washington, D.C.-based Center for Science in the Public Interest (CSPI) recently asked five candy companies including Tootsie Roll Industries, American Licorice Company, Haribo of America, Perfetti Van Melle, and The Topps Company to join the Children’s Food and Beverage Advertising Initiative (CFBAI).

According to CSPI, letters to the five candy companies were also signed by prominent organizations including the American Heart Association, the Campaign for a Commercial Free Childhood, The Yale Rudd Center, Prevention Institute, MomsRising.org as well as other physicians and public health experts.

On the plus side, CSPI reports that three of the nation’s largest candy companies—Hershey, Mars, and Nestle—already belong to the CFBAI, a voluntary self-regulation program founded in 2006 and administered by the Council of Better Business Bureaus (BBB).

As described on the BBB website, the CFBAI “is designed to shift the mix of foods advertised to children under 12 to encourage healthier dietary choices and healthy lifestyles.” Currently, the three biggest candy companies in the United States—The Hershey Company, Mars, Incorporated, and Nestle USA—currently participate in the initiative. More than a dozen companies including The Coca-Cola Company and Burger King Corporation have also signed on.

According to Maureen Enright, Deputy Director, CFBAI, as part of the initiative, candy and other companies voluntarily agree to use CFBAI’s uniform nutrition criteria to govern what foods are in child-directed advertising (CFBAI covers advertising on TV, radio, print, on the internet, and in mobile ads and apps) or do no child-directed advertising. Currently, CFBAI participants that make candy, including Hershey, Mars, Nestlé and Ferrero, don’t advertise directly to children.

In a press release, CSPI notes that according to both the National Academies’ Institute of Medicine and the American Psychological Association, children under age eight aren’t mature enough to understand the persuasive intent of advertising. The press release states that, according to the Institute of Medicine, television food advertising affects children’s food choices, food purchase requests, diets, and overall health.

I fully support this initiative as well as the encouragement of CSPI to have candy companies (and all food companies, for that matter) to do more to protect the health and well being of children. I’m all for anything we can do to better the environment to encourage kids to eat more healthfully and moderately, especially since kids fall short on many foods including fruits and vegetables and whole grains and tend to over consume foods made with solid fats and added sugars (collectively, these are called SoFAS according to current dietary guidelines).

According to national survey data, kids’ between the ages of two and eighteen consume an average of 646 calories from SoFAS—or about one third of their total calorie intake. Current guidelines suggest up to five to 15 percent of daily calories from SoFAS. For a child or adolescent who consumes anywhere from 1,000 to 1,800 calories daily, that’s about 137 to 161 calories, the amount you’d find in 5 to 6 Hershey kisses.

Besides focusing on advertising of unhealthy foods to kids, I strongly believe that we have to rethink our ubiquitous access to such nutrient-poor foods. Why is it that so many checkout counters at places ranging from gas stations to electronic stores are decorated with shelves of candy wrapped in colorful wrappers? And what about all those coolers, many also at checkout counters, packed with sugary beverages? And vending machines…they’re everywhere, and they’re usually packed with a range of snack foods, many of which fare more like dessert (fortunately, those with 20 or more locations are now required to follow new federal calorie labeling guidelines).

It’s hard to resist the urge to buy impulse items, and what parent hasn’t given in to their kids’ demand for something at a checkout counter or vending machine at least on occasion? It seems to me that besides limiting or altogether obliterating candy and other nutrient-poor food advertisements, especially those that are geared to impressionable children, we also need to have rules about what and how stores sell food.

You might argue that businesses of all kinds have a right to sell what they want and to position such items where they want. But isn’t it wrong on some level to sell candy and other such items at a store that’s not really in the business of selling food? Or to sell food on low shelves, at eye level, where it entices kids? If we are going to make any progress in helping to teach our children to eat well, we need to create an environment—not just at home, but outside the home—that doesn’t sabotage practicing healthy eating and lifestyle habits and teaching them to our kids.

CSPI has been extremely successful in many of their initiatives, and I hope this latest attempt to get candy companies to step up to the plate to limit potentially harmful advertising of less than healthy foods to children catches on. I’m not sure the rules will ever become mandatory, but achieving this would at very least be a big step in helping our kids eat and live more healthfully.

What’s your opinion?

Image of chocolate bar with caramel via shutterstock.

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