Posts Tagged ‘ kids ’

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 Your Kids Follow Your Diet Too?

Tuesday, May 19th, 2015

Have lunch with a group of friends and you’ll be hard-pressed to find someone around the table who’s not following a special diet, whether it’s vegan, vegetarian, gluten-free, dairy-free, sugar-free, Paleo, or simply “clean” eating. I get it: We’re all trying to figure out the way of eating that’s best for us, and my own diet has undergone its fair share of tweaking too. But the recent controversy over a Paleo baby food cookbook got me thinking: When we change our diets–whether it’s going meat-free or cutting out gluten–should we take our kids along for the ride?

In some cases, your diet could represent moral, religious, or ethical values that you want to pass along to your kids. “Being vegetarian is part of our moral map, similar to being a gay ally or supporting environmental causes,” says a vegetarian friend of mine. “We want to teach our son why we believe that having a vegetarian diet is a morally conscious choice.” If there’s a person in the family with a food allergy, intolerance, or medical issue like celiac disease, that might also mean everyone in the family must abstain from certain foods (at least at home).

But what about diets we follow because that way of eating simply makes us feel (and, let’s face it, look) better? A friend of mine switched to a Paleo/Primal diet, avoiding processed foods, grains, refined sugar, and dairy. “I eat this way because my body responds the best to this type of diet,” she says. “I have more energy, I’m happier, I sleep more soundly, and it’s easy to maintain my weight.” Though she now serves fewer grains with dinner and cooks more bacon-and-eggs breakfasts, her son and daughter don’t follow her diet (and neither does her husband). “My kids drink milk for protein and simply love bread and cereal. Their bodies seem better able to process those food categories better than mine can,” she says. She’s also okay with keeping some processed foods in the house, including granola bars for their lunchboxes and chips for her husband.

When changing up the family’s way of eating, it’s smart to keep these things in mind:

  • Watch out for signs that your child is distressed or negatively impacted by the diet. If your kids seem fixated on foods that aren’t allowed or are sneaking or hiding food, it’s time to talk with them and think about relaxing the rules. Even “clean” eating, which simply focuses on whole and unprocessed foods, can be hard on children if it’s restrictive. Read my post on the topic, “When Healthy Eating Goes Too Far”.
  • Avoid using extreme language when talking about any food. Words like “poison”, “dangerous”, or “fattening” can be alarming for kids and create negative associations with food.
  • Consider giving your child a choice. “We have been clear with our son that once he is old enough to make his own fully formed moral decision, probably age 10-12, he will be allowed to decide if he wants to eat meat,” says my vegetarian friend.
  • Allow your kids to learn how foods make them feel. You’ve had decades to figure out that soda makes you sluggish or that gluten triggers your headaches–but your child is still learning about food and eating. Obviously, medical issues may make certain foods off-limits, no questions asked. But otherwise, letting a child experience, say, a bellyache from too much candy on Halloween isn’t the end of the world and is actually an important learning opportunity. “As they age, I’m certain my kids will try different ways of eating and settle on one that they like best,” says my Paleo/Primal friend. “I’d rather they experience this for themselves so that they’ll make healthier choices because THEY want to, not because mom said so.”

Sally Kuzemchak, MS, RD, is a registered dietitian, educator, and mom of two who blogs at Real Mom Nutrition. You can follow her on Facebook, Twitter, Pinterest, and Instagram. She is the author of Cooking Light Dinnertime Survival Guide, a cookbook for busy families. In her spare time, she loads and unloads the dishwasher. Then loads it again.

Healthy Snacks: Why Kids Need to Snack
Healthy Snacks: Why Kids Need to Snack
Healthy Snacks: Why Kids Need to Snack

Image: Family eating together via Shutterstock

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5 Things NOT To Say To Your Kids At The Dinner Table

Tuesday, April 28th, 2015

What you say to your kids at the dinner table is just as important as what you serve. The messages you give your children about mealtime and food can have a powerful effect–so make sure you’re sending the right ones. Here are five statements to avoid:

1. “You can have dessert if you eat your asparagus.” No food–including dessert–should be held up as a reward (or withheld as a punishment). Not only does it elevate dessert to super-special status, but it sends the message that you have to eat the “yucky” stuff to get to the “yummy” stuff. If you’re serving dessert, all family members should be given the choice to have it, regardless of how much they ate at their meal. If your child only wants to eat dessert and no actual dinner food, try limiting dessert to only occasionally. You can also try serving dessert WITH dinner–sounds crazy but it works for some kids. Read more about that strategy here.

2. “You’re so picky.” I use the term “picky eaters” in my writing because it’s a catch-all name that parents understand. But I’ve never called my kids “picky”, even though they definitely have habits that could put them in that category. Placing any kind of label onto your child isn’t helpful. Call your child “picky” and this is what they might internalize: “I’m a kid who doesn’t like a lot of foods and is afraid to try new things.”

3. “Eat five more bites of chicken and three more bites of peas.” I understand the intention behind this one: You don’t think your child has eaten enough of the “good” stuff or he’s eaten mostly potatoes and bread and his meal doesn’t feel balanced to you. But it doesn’t help your child to dictate how much they have to eat (would you like it if someone did that to you?). I’m actually a recovering bite-enforcer myself. I stopped several years ago, when my son turned to me at dinner one night and said ‘How many more bites do I have to take?’. In that moment, I realized how unproductive it was. How could my son ever learn how to eat when he was hungry and stop when he was full if I was giving him a bite quota?

4. “You wouldn’t like it.” Even if you’re 99 percent sure your child won’t like something, never discourage her from trying. It’s okay to give a heads-up that something is spicy. Otherwise, be open and encouraging. I learned this lesson on a recent road-trip. My son wanted to order onion rings, and I was convinced he wouldn’t like them (since he doesn’t like onions in anything else). Read what happened next here.

5. “You have to try it.” The “one-bite rule” works great for some kids (like my older son) and encourages them to try things they otherwise may not have. But for other kids (like my younger son), it can create a battle at the dinner table. Read about alternatives to the “one-bite rule” in my post Why I Don’t Make My Kids Take ‘Just One Bite‘.

Is there anything else you’d add to this list?

Sally Kuzemchak, MS, RD, is a registered dietitian, educator, and mom of two who blogs at Real Mom Nutrition. You can follow her on Facebook, Twitter, Pinterest, and Instagram. She is the author of Cooking Light Dinnertime Survival Guide, a cookbook for busy families. In her spare time, she loads and unloads the dishwasher. Then loads it again.

Strategies for Picky Eaters
Strategies for Picky Eaters
Strategies for Picky Eaters

Image: Girl eating via Shutterstock

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Got Dessert-Obsessed Kids? This Solution Sounds Crazy–But It Works!

Thursday, April 9th, 2015

Are your kids fixated on dessert? Do they rush through dinner to get it? Does it drive you bonkers? If so, what I’m about to suggest may change your life—but it may also sound a little nuts at first: Start serving dessert with dinner. Put it on the table, alongside the peas and the chicken and the rice. Don’t make a big deal about it. Let your kids eat it whenever they want. (Will they eat it first? Probably. And that’s okay.)

Serving dessert with dinner comes from the playbook of dietitian Ellyn Satter, an expert on feeding kids and author of Child Of Mine: Feeding With Love and Good Sense, among many other books about feeding. The idea is this: When dessert is taken down from its end-all-be-all pedestal—the grand finale of dinner, the good stuff you get after eating the yucky stuff—it becomes just another part of the meal. It loses its power, including as a bargaining tool (in other words, no more “two more bites of broccoli and you can have a cookie” negotiations!).

I’ll admit, I was a little nervous the first time I tried this several years ago. A neighbor had brought over frosted cupcakes, and as we sat down for dinner, those cupcakes were all my kids could talk about. So I decided to let everyone take a cupcake and put it on their dinner plates. What happened? My older son ate his first and continued on with dinner. My younger son took a bite, decided he didn’t like it, and ate his dinner.

This strategy also works well at parties and buffets, when sweets are often presented on the table along with the other foods. At a birthday party we attended, mini cupcakes were set on the buffet with the dinner foods. My kids each put a cupcake on their plates, ate it, then ate the rest of their food. Other parents spent a lot of time bargaining with their kids and insisting they had a certain number of bites of the dinner food before they could get a cupcake. Their kids were whining, the parents were aggravated (and I’m sure a few people were giving me the hairy eyeball for setting a bad example of eating cupcakes first). But ultimately, it was a much saner solution. My boys each had a cupcake, just like everyone else, but also ate other food too (and I wasn’t stuck at the kids’ table bickering with my children).

One caution with this approach: Make sure the portion of dessert isn’t so big that it wrecks their appetites. Give only one serving. For little kids, that might be one small cookie or a small scoop of ice cream. With my kids’ fresh haul of Easter candy, we’ve decided on two small pieces as a reasonable dessert, which they can have with their meal or after. It’s up to them.

Have you ever tried this approach? I’d love to hear your thoughts!

Sally Kuzemchak, MS, RD, is a registered dietitian, educator, and mom of two who blogs at Real Mom Nutrition. You can follow her on Facebook, Twitter, Pinterest, and Instagram. She is the author of Cooking Light Dinnertime Survival Guide, a cookbook for busy families. In her spare time, she loads and unloads the dishwasher. Then loads it again.

Snow Cone Cupcakes
Snow Cone Cupcakes
Snow Cone Cupcakes

Image: Kid focused on cupcake via Shutterstock

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Do Kids Need To Drink Milk?

Tuesday, March 31st, 2015

I can’t seem to get through my Facebook newsfeed these days without seeing a reference to milk—either somebody denouncing it as a health hazard or extolling the virtues of whole, pastured, raw milk. Granted, I follow a lot of food bloggers and opinionated types. But there seems to be a definite uptick in the chatter from people at both ends of the spectrum, leaving a lot of people in the middle awfully confused.

And speaking of the middle, that’s exactly where I come down on it. Here’s my two cents:

Do kids need to drink milk?

Yes and no. It provides a really nice package of a lot of nutrients kids need, including calcium and vitamin D that are important for building bone. Milk is also an easy way to get filling protein and much-needed potassium. But if your child doesn’t like it, there’s an issue of allergy or intolerance, or your family follows a vegan lifestyle, a well-planned diet can provide these nutrients too.

Do I have to buy organic?

No. Some parents choose to spend their organic dollars on milk because their kids drink a lot of it, and they feel better knowing the cows weren’t given hormones or antibiotics and didn’t eat feed treated with pesticides. But if you can’t swing it, know that research hasn’t found significant differences in hormone levels between organic and conventional. You can also look for conventional cartons labeled “rBST free”, which means the cows weren’t given any synthetic growth hormones.

Is whole healthier than skim?

No. They are both good sources of calcium, vitamin D, and potassium—all nutrients many kids don’t get enough of. The American Academy of Pediatrics recommends fat-free or low-fat for kids older than two, and it’s smart to check in with your pediatrician about your child’s exact needs. If your kids really like whole or two-percent and weight is a concern, I’d first look for other places in the family’s diet (like desserts and fast food) to trim and be sure you’re offering water throughout the day as well. If your kids (over age two) prefer skim or one-percent, that’s fine too. I know there’s a growing trend to return to full-fat foods, but I don’t see evidence that the saturated fat in dairy and meat has health benefits like the unsaturated fat in avocados and nuts does.

Is chocolate milk okay if my child won’t drink white?

Yes—with a few caveats. There are about three teaspoons of added sugar in a serving (ideally, children should get no more than 5-8 teaspoons per day). Personally, I think of chocolate milk as a sweet treat, albeit a nutritious one. So if my kids get it at school, I don’t pack any sweets in their lunchbox. I also don’t stock it at home since they may have it at school or occasionally at restaurants. If your child doesn’t like white milk there are other ways to get calcium too, like yogurt and cheese, and it’s found in smaller amounts in foods like almonds, kale, and edamame.

Is it possible for kids to drink too much?

Yes, especially for toddlers and preschoolers who drink milk all day long (more than three cups). They run the risk of becoming low in iron because their little bellies are too full at mealtime for actual food, and milk is naturally low in iron. According to the USDA, children ages 2-3 need two servings per day of dairy (such as milk, yogurt, cheese, or calcium-fortified non-dairy beverage), children age 4-8 need two and a half, and kids 9 and older need three.

Are non-dairy milks okay for kids?

Yes (though never as a substitute for infant formula!). Keep in mind they’re not one-for-one swaps with regular dairy. For instance, almond and rice milk have just one gram of protein per serving, compared to eight grams in cow’s. When choosing a non-dairy milk, make sure it’s fortified with calcium and vitamin D, and remember that homemade versions won’t have those nutrients in abundance. Shake fortified beverages well before serving, because the calcium can settle on the bottom. And look for varieties labeled “unsweetened”. One brand of “original” almond milk contains almost two teaspoons of added sugar per cup!

What about raw milk?

I know it has its (very passionate) supporters, but I can’t get behind it. Flame me if you want, but I worry about bacterial contamination—especially for young children.

For more about milk, listen to this episode of my podcast The Happy Bite, with food sociologist Dina Rose.

Sally Kuzemchak, MS, RD, is a registered dietitian, educator, and mom of two who blogs at Real Mom Nutrition. You can follow her on Facebook, Twitter, Pinterest, and Instagram. She is the author of Cooking Light Dinnertime Survival Guide, a cookbook for busy families. In her spare time, she loads and unloads the dishwasher. Then loads it again.

Strategies for Picky Eaters
Strategies for Picky Eaters
Strategies for Picky Eaters

Image: Boy holding milk via Shutterstock

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