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Saturday, November 30th, 2013
We all know that feeding kids in a healthful way that takes into account their individual tastes and preferences can be a challenge at any time. But with increased entertaining, celebrating and traveling this time of year, the challenges can mount—especially for a child who is considered “picky” or who has (or is at risk for) a feeding disorder. Of course being out of a normal eating routine and being exposed to unfamiliar foods can turn an otherwise joyful holiday party or family gathering into a battleground. To prevent this, it’s up to parents to find ways to help kids stay on track when it comes to eating so that they—and the entire family—can get the most joy out of the holiday season.
To help parents move in a better direction when it comes to feeding their kids this time of year—or at any time—I interviewed Peter A. Girolami, PhD, Clinical Director of the Pediatric Feeding Disorders Program at Kennedy Krieger Institute. Below are some highlights from our conversation.
EZ: What is the difference between a picky eater and a child with a feeding disorder? Are there any red flags parents need to look for?
PG: Many young children demonstrate eating behavior that can be considered “picky” including distinct food type or texture preferences and episodes of limited intake. Although for many children this is a perfectly normal phase of development, sometimes being picky develops into a more serious feeding problem (or disorder). In general, a child has a feeding disorder when he/she has significant difficulty consuming adequate nutrition by mouth. Feeding disorders are caused by a variety of factors including medical, developmental, psychosocial and environmental factors and they often leading to problematic feeding/eating behaviors. Feeding problems can contribute to poor weight gain, malnutrition and abnormal development when it comes to feeding skills. It can also cause a lot of disruption, especially during mealtimes, for the family.
EZ: Now that the holidays are here, parents of picky eaters may feel extra pressure when feeding their children with relatives and friends around. Should parents surrender to the situation and accept that all bets are off or should they still try to help their kids have better and more nutritious eating habits?
PG: Great question. Parents often report that they feel some pressure during the holidays and/or special events to get their kids to eat a well-balanced meal. I can relate. I come from a family where eating is one of the main activities of the holiday and for the most part we (the adults) probably eat too much. However, as both a parent and practitioner, I do not recommend using holiday dinners or special events as the setting to initiate the trying of new foods/textures or increase consumption. First, if you are having trouble with your child’s picky eating and it’s become a battle, it may be increasingly difficult to implement any plan with all the relatives sitting around the table adding their two cents and encouragement. If you have been using some strategies successfully and want to generalize them to the group gathering, that’s great. But I’d suggest having an “exit” plan so that the holiday meal doesn’t become all about children not eating their food.
EZ: You suggest offering kids who are picky/selective small portions. I, too, think this is a good rule of thumb for all kids, whether they’re picky or not. Why do you think offering small portions is so important for kids?
PG: I once worked with a child who was reported to be very anxious about trying new foods so we prepared such a small bite of food that I was worried it would blow away. Eventually, we were able to increase the size of the bites of food and gradually introduce new foods using smaller bite sizes.
EZ: You also say decreasing texture and blending food can help. How so?
PG: Sometimes referred to as “sneaking food in,” blending and mixing non-preferred foods into preferred foods can be an effective way to expose a child to new tastes and smell and open up the variety. Similar to the idea of smaller portions, start with small amounts that may not be detectable and gradually increase the ratio. This can also be applied to condiments. You may not get to 100% of the target food, but consumption of the target food(s) in smaller amounts may be enough to lay the foundation for future gains.
EZ: You’re not a big fan of grazing, which is something so many kids—and parents—do. Why don’t you recommend it for kids?
PG: I think it’s important to limit grazing. It’s difficult to get someone (including typical eaters) to try something new if they aren’t hungry, especially if you’re asking them to try something they report they don’t like. In some more serious feeding situations, this may be difficult to apply because parents may feel that the only way to get in enough calories is to offer food/drink throughout the day. However, trying to set scheduled meals and limiting food in between is a strategy that could at least be tried (if it doesn’t work, you can always go back to the old system) since it may contribute to hunger and encourage the child to eat the food that’s offered.
EZ: You also recommend making kids part of the feeding process. What are your tips parents can use to do this?
PG: I’m a firm believer in modeling, sharing, and involving kids in eating and feeding as much as possible. There’s something to be said about trying to set a good example for your child. If you’re not eating the targeted foods, there’s a good chance the child’s exposure to the food may be more limited. Sometimes getting kids involved in the preparation of the food and cooking may also be associated with increased interest and squeezing in an extra bite or two.
EZ: Although many nutrition experts (present company included) have always urged parents to not use food as a reward, you encourage them to. Please explain.
PG: Some people are against providing some incentive to children to encourage them to try new foods/textures because they feel that children should intrinsically like food so they don’t provide reinforcement for eating. However, many children have increased their variety by systematically being given access to something preferred contingent on trying something novel. If you think the issue is “you’ll never know unless you try it” and exposure to new tastes and textures is important, then using a reward-based system to get them to try something new may be worth a shot. Keep in mind that for many children reinforcement can be faded out over time.
EZ: You encourage parents to be calm and patient when feeding kids—and I think that’s great advice as it keeps mealtimes more pleasant and enjoyable. You also think it’s important to have a plan and stick to it. Why is that so vital?
PG: It’s important for kids to have some predictability, especially if trying new foods seem to be distressing to them. I encourage parents to try to avoid excessive coaxing, wheeling-dealing, and verbal battles. Typically, these strategies don’t work and may make things worse. Getting kids to try new foods can be a long process. If parents do see some gains, they can then try to think about where they could be down the road if some of that progress continues on its current trajectory.
EZ: Finally, what should parents do if they suspect their child has a feeding disorder? Can you recommend any resources?
PG: Feeding problems are a source of great stress for parents because of the potential negative impact they may have on their child. Also, parents whose children have more severe problems often find it hard to relate or connect with other parents whose children’s issues are more of the traditionally “picky” variety. Parents of children with severe feeding problems often report that they are given advice from “everyone under the sun” and provided with suggestions that they’ve already tried. Parents who have tried all kinds of strategies and have had limited success, or see that things have gotten worse, may need some extra specialized help with your problem, such as the Pediatric Feeding Disorders Program at the Kennedy Krieger Institute. An evaluation may be a good first start to determine if your child’s problem meets the criteria of a feeding disorder. Generally, I would recommend finding a feeding clinic/program that encompasses a full team of professionals to rule out the variety of factors that may be associated with the onset and maintenance of the feeding problems. You also want to make sure that the feeding clinic/program has experience with the problems you’re reporting and can discuss various outcomes—aka “success stories”—they’ve had with similar children.
For more advice about how to raise healthy eaters, whatever their feeding style, check out the book Fearless Feeding as well as The Picky Eating Solution.
Image of Multi Generation Family Celebrating With Christmas Meal via shutterstock.
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Monday, July 29th, 2013
A few years ago, I co-wrote a book to help families eat and live better and manage their weight. Originally called Fitting Into Your Genes, my publisher nixed what I thought was a catchy title in favor of Feed Your Family Right!. Although I won’t ever subscribe to the idea that there’s just one right way for parents to feed their children, adopting certain eating and lifestyle habits—especially early in life—can help children grow optimally. It can also protect the health and well being of the entire family.
To help parents do just that, the new book, Get Your Family Eating Right, by Lynn Fredericks, founder of Family Cook Productions, and registered dietitian Mercedes Sanchez—provides a road map to help families spend more quality time in the kitchen. The book is jam-packed with recipes to make cooking and enjoying more family meals a reality, no matter how busy everyone’s schedule is.
Here are some highlights of my recent conversation with Fredericks:
EZ: In your book, you recommend that families eat foods that come in all the colors. Why is that so vital, and how can families move in that direction?
LF: Colorful foods attract children, and focusing on color is a playful way to engage them with fruits and vegetables. Before modern food preservation and refrigeration, nature ensured that humans could ingest a healthy diet by providing a wide spectrum of colorful fruits and vegetables each season. Since nutritional science shows us more and more how the substances in plant foods benefit our health, paying attention to the colors in your diet is important. It’s also a way to draw children in. I recommend that parents take their kids to farmers markets where the season influences the produce that’s available. Usually, what’s available changes weekly, and that helps parents stay out of a rut. Parents can keep small bowls of colorful fruit around the house. And at meals, they can serve two vegetables of different colors on plates whose color enhances the appearance of the vegetables.
EZ: Eating seasonally is another recommendation you make in your book. What are some ways families can do this come fall?
LF: Visit a farmers market. Foods don’t come in cellophane there, so you can see there’s dirt on roots or within the leaves. Seeing food this way helps kids realize that food actually needs to be grown! When at the market, parents can encourage their kids to pick out something that intrigues them. If they find that they’ve never used or prepared the food their kids pick, they can go online for preparation tips, or simply ask the farmer. One of my favorite fall vegetables are winter squashes, with their thick ‘winter’ coats. A simple way to prepare them is to scoop out the seeds and place a pat of butter and drizzle of maple syrup on each half and pop in the oven or microwave.
EZ: How do you suggest families eat well and, at the same time, save money when shopping for food?
LF: Our book shares a myriad of recipe concepts that can be varied by the season. Meat is also used as a condiment rather than the star of the meal. The recipes rely on legumes and other plant proteins to add flavor, fiber, and other key nutrients. Parents can designate a meatless day a week as one way to include more plant protein. They can also do tastings of various beans and salads with their kids to see which are a hit. Kids also enjoy shelling beans, and may find they love the sweet taste of freshly shelled legumes.
EZ: What are some ways families can enjoy whole grains?
LF: I like to recommend that parents incorporate underutilized grains like barley. They can add barley to salads, or have it (or quinoa, buckwheat, or steel-cut oats) for breakfast. They can also use brown basmati (instead of white basmati) in recipes and sprinkle it with cumin for a delicious side dish.
How do you feed your family ‘right’?
Image of mother and her son buying fruits at farmers market via Shutterstock.
Full disclosure: I received a complimentary copy of the book from the publisher.
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Thursday, July 25th, 2013
A recent report by the CDC shows that food allergies in children are on the rise. Based on national survey data, the report reveals that among children between the ages of 0 and 17, the prevalence of food allergies rose from 3.4% in 1997 to 1999 to 5.1% in 2009 to 2011. According to the nonprofit Food Allergy Research and Education (FARE), food allergies currently affect up to 15 million people in the United States, including one in 13 children.
If you have a child with a food allergy, it’s likely an enormous challenge to keep him or her safe, especially in the current landscape of full-time access to processed and packaged foods. Helping your child eat out safely when at school or at a restaurant is also something that requires considerable thought and planning. But it can also be a challenge to raise a food-allergic child when other children or family members don’t have food allergies.
To get some perspective on this, I turned to Susan Weissman, author of Feeding Eden: The Trials and Triumphs of a Food Allergy Family. In her book, Weissman poignantly chronicles how she discovered her son’s multiple anaphylactic food allergies. Eden is ten years old and has life threatening allergies to dairy, soy, peanuts, tree nuts, sesame seeds, egg whites, and a variety of fish, shellfish, and legumes. He also has oral allergies to some fruits and spices. Eden’s older sister, Dayna, does not have any food allergies. While Feeding Eden narrates many universal challenges of parenting, a specific takeaway for readers is how food restrictions of any kind can transform families. Weissman points out that sometimes, it can even make families stronger.
Here are some highlights of my conversation with Weissman:
EZ: How does your family accommodate the needs of your food-allergic child?
SW: When feeding my family, I balance three concerns—safety, nutrition, and the emotional dynamic in the family. Obviously, when you deal with anaphylaxis—a severe reaction to an allergen that can be life-threatening—making sure your child stays safe is paramount. But keeping a peanut-free household can be rather simple. Realistically, I know I cannot “ban” all of Eden’s allergenic foods while providing adequate nutritional support for my daughter. For example, she is a growing teenager and needs accessible forms of calcium. So I do give her dairy products. But we also follow certain rules and take a few precautions as a family. For example, I use separate spoon rests while cooking to avoid cross-contamination. We run all our plates through a high-powered dishwasher. We also make sure to thoroughly wash our hands before and after eating.
EZ: Can you elaborate about your concern about the “emotional dynamic” in your family.
SW: If you come over to my home for dinner, you might often see different foods on our plates. Our intimacy is not about sharing specific foods. Instead, our family solidarity comes from focusing on our shared experiences, routines, and conversations.
EZ: Of course it’s a necessity to change family habits to accommodate one child or family member’s needs, but does it ever feel like a burden?
SW: In short, yes. I cook from scratch more often than many parents. I can’t take shortcuts like popping frozen chicken nuggets in the oven when I feed Eden. It’s especially a challenge when we’re away from home and need to eat in restaurants while traveling, or when we eat at other people’s homes. Besides finding or preparing safe foods, another challenge is helping Eden meet his nutrient needs within his restrictions. I really need to think about what he is not getting enough of, and how I can help him compensate through supplementation or balanced portioning. For example, in addition to the calcium deficiencies in dairy- and soy-free diets, nut- and fish-free diets can lack in essential fatty acids and vitamin E. I’m always on the lookout for ripe avocados to make up for that. On the flip side, my daughter has been under-exposed to fish because the smell of those cooking fumes are uncomfortable for Eden to breathe in and can trigger an asthma attack. Possibly, as a result, my daughter doesn’t care for fish at all.
EZ: I’m sure it can feel unfair at times to you and your daughter who don’t have food allergies.
SW: It is. I might be able to bake a “safe” cake that looks and tastes close to a dessert my daughter might eat, but Eden also sees that his sister has far more choices at every given meal and snack. His sister’s diet is less repetitive and we can find her favorites foods easily both inside and outside our home.
EZ: How does the your daughter cope with Eden’s allergies?
SW: Besides adhering to our safety measures, my daughter is careful of our emotional dynamic too. She is sensitive about Eden’s feelings and tries not to make a big show of enjoying special foods that she knows he would love to taste. And now that she is a teenager living in New York City, I encourage her to try new and tantalizing foods with her friends outside of our home.
EZ: Can you offer any perspective or solutions for others in a similar boat?
SW: Parents who have kids with food allergies should consider thinking outside the box when it comes to nutrition and family traditions. When my husband and I were children growing up in Manhattan, we often ate Chinese food on Sunday nights with our families. Eden can’t eat Chinese food (sesame, peanuts, soy ingredients.) But he has developed a genuine interest in cooking for himself and using safe substitutes. So we bought Eden a wok and he has been re-creating stir fry dishes based on recipes he reads, Food Network demos, and his own imagination! Lately, as a busy family, since there is more time to shop and chop on weekends, come Sunday nights, Eden might make us all Asian inspired food that even his sister has preferred to the real deal.
Full disclosure: I received a complimentary copy of Feeding Eden from the publisher.
For more information about Weissman and her book, Feeding Eden, click here.
For more information about food allergies, check out the American Academy of Allergy Asthma and Immunology.
Image of no peanuts allowed via Shutterstock.
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Friday, June 14th, 2013
If you’re like most harried parents, getting dinner on the table—and your family to the table—is no small feat. But having regular family meals has so many benefits for kids and parents alike.
Studies suggest that regular family meals helps kids of all ages maintain a healthy body weight, consume higher quality diets and have better eating habits. Older children who eat with their families may also be less likely to use alcohol or tobacco or abuse drugs. Teen girls are also less inclined to binge, purge, diet or otherwise engage in disordered eating behaviors. A recent study even suggests that children who have family meals during which they talk more as a family in a more pleasant atmosphere have less depressive symptoms.
Parents can also reap some benefits from family meals beyond feeling more in touch and connected with their children. One study found that parents who had more family meals ate more fruits and vegetables–something many of us lack in our diets. The study also found that more family meals were associated with less fast food intake among fathers, and less dieting or binge eating among mothers.
To help families reclaim dinnertime, Aviva Goldfarb, author of The Six O’Clock Scramble, created the Family Dinner Challenge—even Jamie Oliver has become a fan! Here are some highlights from our recent conversation.
EZ: What drove you to start the Family Dinner Challenge?
AG: Ten years ago I launched The Six O’Clock Scramble to help families get healthier, homemade dinners on the table with a lot less stress and expense. Although the idea has caught on with tens of thousands of people, families still tell me that they don’t have time to make dinner a priority or don’t know where to start. In honor of The Six O’Clock Scramble’s 10th anniversary, I launched the Family Dinner Challenge.
The goal of the challenge is to have 10,000 families commit to eating dinner together at least three times a week for four weeks between now and September. Each family that takes the challenge will receive all the tools needed to be successful in the challenge—weekly menus, recipes and grocery lists, a chart to keep track of their dinners eaten together, conversation starters, and more. We’re also offering incredible prizes from Vitamix, Cuisinart, Zojirushi Rice Cooker and Dole for those who complete the challenge.
EZ: What do you tell parents who think their families are too busy to eat together?
AG: I understand that work and extracurricular activities make it a challenge for families to eat together. But because of the endless nutritional and emotional benefits family meals provide, I encourage families to find a way to tweak their schedules and have dinner a bit later or earlier on some nights. Families can also benefit by making it a point to sit down together for a bowl of fruit when everyone is home. For families who find it impossible to have meals together during the week, I encourage making Sunday dinners a special occasion. At these meals, families can agree to disconnect from technology, turn off the TV and just make quality time to connect with each other over a nourishing meal. If they can manage more than one night together, even better—it’s not an all or nothing proposition. Also, some families find it much easier to sit down together for breakfast rather than dinner—that can also have so many health and other benefits for families.
Does the whole family have to eat together to be successful in The Family Dinner Challenge?
Families can define the “family dinner” as any dinner that includes at least one parent or caregiver sitting down for a meal with at least one child. Having everyone together every night is not always possible for many families, so it’s perfectly fine to redefine the family dinner to suit your family’s needs. The simple act of sitting down together, making eye contact with one another, and having conversation or playing silly games provides huge benefits for kids and their parents.
For more information on The Family Food Challenge and to learn more Aviva, go to the Six O’Clock Scramble web site here.
What’s your biggest obstacle when it comes to eating as a family?
Image of family smiling at the dinner table via Shutterstock.
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