Preventing Eating Problems in Kids: The Power of Parenting

Max,face,eyes,blueI remember the first time I saw a 10 month old baby manipulate his mother. I am guessing I was also subtly controlled by my children at times too, but that was so long ago that I forgot. Anyway, it was in a multidisciplinary visit to the “Feeding Team” where I work at a children’s hospital. The session takes place in a kitchen because the “team” needs to observe the child eat. They are referred by their pediatricians for various eating problems, ranging from fears of aspiration, picky eating, sensory issues, and other reasons. The team consists of a psychologist, Occupational Therapist, Speech and Language Pathologist and dietitian (moi). Anyway, after the initial background questions and history, for this one particular child it appeared the concern was that little Suzy Q was “refusing to eat” food. She will only drink the bottle. So the Occupational Therapist proceeds to gently have Suzy interact in a fun way with some purees. After a few minutes of this she puts some food on a spoon and feeds it to the child, who happily takes it in and appears to enjoy it. The mom is flabbergasted. “I swear, I am not lying! She won’t do this at home!” We say, “we know, we hear it all the time”. So then, it’s mom’s turn. She takes the spoon, and with an entirely different face than she had before, proceeds to try to offer the exact same food…..and, you guessed it, just like in an exaggerated cartoon, that baby turns her head and looks away (twisting her head as far away in the other direction as she could, so dramatically, it was almost funny). And although her face was in the opposite direction of her mother, her eyes were straining to watch what her mom was doing. Little Suzy appeared to love the dance mom was performing. Mom continues to get in her face with that spoon, more intense by the moment……she might as well have stood on her head, that is how much energy she was expending. Needless to say, mom’s extreme and intense attempts at getting her baby to eat was backfiring.

Babies are one thing, toddlers are another. That second year of life is pretty interesting as you watch your sweet baby transform into a little tyrant. It is so hard to watch them throw themselves on the floor when they don’t get what they want. Who wouldn’t pick them up to make them feel better? Or just give them the darn cookie, does it really matter?

Another common scenario is the older child who “does not eat”. It always strikes us funny that these kids often are growing off the charts… does that work? When we pry a bit further, it appears the child actually DOES eat, just not what mom wants. There may be several boxes of juice, gobs of milk, lots of gold fish crackers, macaroni and cheese, and of course, McDonald’s chicken nuggets (the yellow diet). Or, you get the kid who “can’t chew” and parents are worried about choking. “When he eats meats or vegetables or fruits, he gags.” But somehow, miraculously, the kid can eat chips. And cookies. No gagging there. HHmmmmm.

And then of course we have the older kid whose parents are worried because according to the doctor,  little Johnny is “obese”. They don’t know what to do. The doctor has made a big deal about it, so they feel the need to do something. They try to limit portion sizes, they push healthy food, but the kid still sneaks the chips and soda. Not only that, he stays up until all hours of the night and only wants to play video games. The family has a treadmill but Johnny doesn’t like it.

The list goes on and on. You may be thinking about someone you know who struggles with these issues with their children. How does this happen? And more importantly, is there a way to fix it?

The reality is that some children truly are born with issues from the start. They may have spent time in the NICU with a tube down their noses. Or, they may have suffered from reflux or food allergy or some other digestive issue that is sure to turn anyone off of putting anything in their tummy. Children with sensory issues, such as those with autism, often have trouble with textures or tastes. Sometimes children have real chewing issues because of some developmental delay or genetic disorder. The sad truth is that some children will never eat.

But for the typically developing full-term baby without any other issues, then a parent’s approach to feeding is critical. We see feeding problems all the time that could have been prevented had parents known how to respond when the going gets tough. Without giving any specific nutrition advice (as children’s needs are different at each stage of life, and even individually), there are some basic things to know if you want to promote healthy eating and a decent relationship to food for your children. Here are the 10 top things to know when it comes to feeding your child that may help prevent some typical feeding problems:

  1. The human body is programmed to stay alive. Our bodies naturally know how many calories to eat every day. When we have not had enough, we will be hungrier and want to eat more. When we have had too much, we may want to eat less. As soon as we start taking in food (breast milk, formula, purees, table foods, pepperoni pizza) our bodies go to work to let us know how much to eat. Our children will not starve themselves. If they can’t finish their plate, making them finish teaches them to go against these natural signals and creates a disconnect. Not only that, being forced to eat creates a very negative experience making the table a not-so-fun place to be. Adults don’t want to eat the exact portion size of a food every time they have it, and neither may your child. Instead of forcing a kid to eat more than they want (which leads to misery) why not wrap up and refrigerate the leftovers and offer at another meal or snack?
  2. Sometimes you feel like a nut, sometimes you don’t. Remember that commercial? I think it was for Almond Joy and Mounds (no nuts) candy bars. You may find that your child loves a certain food (say, yogurt) and will eat it almost daily. Then, suddenly, they may refuse it. We have seen parents totally stop offering a food just because a child does not want to eat it one day, or even for a week. Don’t you have foods that you sometimes love, but other times just couldn’t make yourself eat? Eggs are like that for me. And chicken. I love them both…..but sometimes the thought of them make me gag. I am guessing that happens to kids, too. Don’t give up on a food and assume your child will never eat it again just because they refuse it for awhile.
  3. Children eat what you eat. If you seriously want your kids to eat vegetables, and you hate them, it won’t work. You are their best role model. They trust your judgement. Even adults have their eating issues (pretty much every member of our Feeding Team can relate to our patients because we all have that one food that makes us gag….for me it’s beets). But, when we have children and truly want them to grow into healthy eating adults one day, we need to face our fears. You can live without a vegetable or two (I get by without beets), but if your plate only includes brown foods then, over time, there may be health consequences. We always talk about the “Rule of Twenty” (however, in reality, it may be much higher than this). Meaning, you really need to try something at least 20 times to know if you like it. It may feel funny in your mouth, you may not like the taste of it, but over time, after enough exposures, you may find you really enjoy a food. I can personally say that I have had this experience with a few foods. When I was young, I would never touch a tomato. Tomato sauce, yes, but the taste and texture of a raw tomato repulsed me. Over time, I had tomato on a sandwich, maybe salsa, or in a salad, and eventually I grew to love them. In fact, I have tried to grow them myself (without much luck) and always have a container of grape tomatoes in my fridge, because I add them to everything. Who would have known? The same thing happened with mushrooms and sushi. Anyway, the bottom line: if you want your children to be healthy, they need to learn to eat a variety of foods, especially fruits and vegetables. If you don’t eat them, they probably won’t. Be brave.
  4. Don’t give in to a 2 year old tyrant. I remember reading every book there was about bringing up children when I was pregnant with my first child. When Jennifer was born, she was the perfect baby. Sleeping through the night from the day she came home from the hospital (although I woke her at 3 am to nurse because I thought I was supposed to). She nursed like a champ and did everything right. She was a happy, easygoing little girl. But then she passed her one year mark and was toddling all around, still easy. Until one day, she wanted something she could not have (scissors?). She literally threw herself on the ground in the hallway, screaming and crying. It was torture for me to watch. But thankfully, I had just read about tantrums in the second year of life in a book written by a child psychologist. The bottom line is, when a child throws a tantrum they learn right away if this behavior is going to work by how you react. It was real hard for me, but I stepped over her and said “I will be on the couch when you are done” and totally ignored her. Of course, I could see her and knew that she was safe (although by the sounds coming out of her you would think someone was pulling out her fingernails one by one). Eventually, she stopped, and came to me. She quickly moved on to a different activity. I don’t remember if she ever did it again, but I know she learned that tantrums did not work. I admit, it is not easy to ignore your screaming child. Your instinct is telling you to comfort and make them happy again. You just want to pick them up and make them feel better! But, giving in to a child who is demanding something that is not appropriate only makes it worse. In the world of feeding, this happens with food refusal. You may have prepared a delicious meal of meatloaf, mashed potatoes, corn and salad (that your child normally likes) but one then one day your child does not want anything to do with it. A tantrum results and food is thrown. Your instinct is to just give in and get the preferred food for them (typically chicken nuggets, macaroni and cheese, etc). This is called “short-order cooking”. When you do this, however, your child quickly learns that the tantrum works. Instead of falling into giving in to this bad behavior, teach your child to eat a variety of foods by sticking to your guns. Offer bread and butter, fruit, milk but DO NOT make their favorite food. They will NOT starve to death, but instead will learn to eat what you offer.
  5. Be the boss when it comes to when and where to eat. We know that structured meals and snacks work best to promote healthy habits, but this is hard when parents themselves are chaotic eaters. It seems to me the “modern family” has a very different lifestyle than many of us older folk had growing up. Life was very different. Without cable TV, internet, cell phones or video games, well, family dinners were kind of the highlight of the day. Even when my kids were young, sitting at the table (with friends often included) was a fun time. Now, however, it isn’t that easy. Parents have to work harder to afford what their family needs. Children seem busier, with outside activities such as sports, music lessons, or even just after school programs to keep kids busy until parents get out of work. There isn’t much time. Picking up a pizza is easier than coming home to cook at 7 pm. And then, kids want to go play their games, parents want to relax and catch up on shows (we only had 3 channels, no Netflix, no “On Demand”, it was easier back then). So families tend to split apart, drift off to the living room or bedroom while they mindlessly much on their pizza. Their “screens” tend to absorb everyone into their own worlds. Not only does this contribute to mindless eating, it also takes away from important family bonding and connection. If this lifestyle rings a bell with you, why not try something different? You may want to start with letting your family know that they are no longer allowed to eat in their bedrooms or in the living room. Instead, even if it is pizza or take out, try having everyone sit at a table. If you are one of those families who have let your table become a collecting ground for everything in the world (backpacks, mail, dog food) then you will need to take some time to reorganize and make the table your new “eating place”. Try having fun with it by creating some “ambiance”. You can even get some inexpensive place mats at a dollar store (or you may have some already that you only use for company?), get a candle or two, then have older children help with setting the table. This creates jobs, responsibility, and a feeling of accomplishment. Not only that, kids tend to truly love the connection with their family. But remember, if your children are in the habit of going in their rooms or eating with the TV, they will rebel and try to refuse. Like I said, you gotta be the boss. They will love it in the end. And the memories you create will last a lifetime.
  6. If you are worried about your child’s weight, don’t talk about weight. I don’t care what your doctor says about BMI. I don’t care what age your child is. If you talk about weight you will cause trouble. There is lots of evidence that focusing on health for the entire family is the way to go. If you single out a child because of weight it will only make it worse. A skinny kid is not necessarily a healthy kid. Ignore body size and take a look at your lifestyle. If you want to have a healthy body, the reality is you DO have to make some choices….and likely some changes. There are a few things that have nothing to do with food that really affect your child’s health (and weight). Sleep is one of those things parents really need to be firm about since lack of sleep contributes to cravings for junk food, decreased energy and physical activity as well as lower metabolism.  I see kids that tend to stay up way too late for a multitude of reasons. Too much caffeinated soda, older siblings who come home late, parents who have a later schedule, a screen in the bedroom…all of these things make it worse. If you want your child to have a healthy weight (which means THEIR genetically determined healthy weight, which has nothing to do with a BMI chart) then they need to get enough sleep. They won’t do it on their own so you as a parent need to step up and be firm. Besides sleep, physical activity is critical. Unfortunately, our schools don’t always provide the opportunity for kids to move. This is really hard, because lots of parents truly do not have the time or the resources to get kids active. Remember, being active does not have to cost money. It can be time set aside after dinner for a dance video or martial arts video, a fun active video game, a punching bag, a trip to the school playground after dinner in the warm months, playing in the snow in the winter, cleaning up after dinner, house cleaning chores, shoveling snow or mowing a lawn, raking leaves or a family hike on the weekends. Getting kids involved in being active and developing physical activity skills not only adds to their confidence level, it promotes a healthier body. Instead of thinking your larger size child should not eat the cookies every other member of your family is eating (NOT FAIR) if you focus on healthy habits for the entire family, then everyone will grow up learning that it is important to eat healthy and have healthy lifestyle habits. I fear that focusing on your child’s weight by trying to restrict food only results in a food obsession, sneak eating and a low self-esteem….stuff that contributes to weight gain and eating disorders. Instead, be the role model for healthy eating and a healthy lifestyle, for the entire family. Don’t focus on your child’s weight.
  7. One huge mistake I see parents make is not controlling their child’s screen time. Too much screen time greatly affects a child’s health because it leads to extreme inactivity. I have seen parents have really good intentions, and try to limit their children to the recommended 2 hours or less of screen time daily. Unfortunately, kids lie. They may keep their cell phones with them in bed, or Ipads or laptops. They log on and play their games with their friends or watch You Tube. They end up staying up until the wee hours. I have seen parents think they are limiting screen time, only to find out their kids are logging on behind their backs while in bed. If you have a child or teenager with a cell phone or Ipad or computer, don’t expect them to be honest with you. YOU need to take control. Take the phone, the Ipad, the laptop, the controller or whatever and don’t give them the temptation.  They will not be able to resist, and it WILL affect their health. They may not like it, but TOO BAD. You care about them, and this is what parenting is all about. They are not going to be happy all the time.
  8. Don’t be weird about food. By that I mean, please don’t jump on the latest fad bandwagon and go on and on in front of your children about why you are never going to eat gluten again. Or never going to eat sugar. Or carbs. Keep your dieting stuff to yourself. If you have issues with your body or your weight, please don’t share your issues with your kids. Don’t jump on the scale in front of them (or how about not having a bathroom scale? Kids don’t need to learn that the force of gravity on their body is important….because it isn’t).  If you are struggling yourself with concerns about your weight, ask your doctor for a referral to a health professional (such as a dietitian or a therapist) who can help you with your issues, but try not to talk about these things in front of your children because they will listen.
  9. Take care of YOU. This has nothing to do with eating and food, but everything to do with health. I have met so many parents who have so much on their plate that eating vegetables has to be the last thing on their list. You know yourself and your family and children best. If there are other things in your life that are stressing you out it is not only OK to focus on that first, but essential. There is always time to work on eating healthy. Getting happy first is more important.
  10. Don’t be perfect. Eat cookies. Go to the drive-through at McDonald’s sometimes. Eat popcorn in front of the TV while watching a movie, stay up late, forget to brush your teeth. But don’t make a big deal about it. Talking about “being bad” or “why did I eat that!” or expressions of guilt when we don’t eat perfectly or skip the gym or choose chicken wings and fries instead of the salad insinuates that we need to be perfect. And we don’t because we can’t. Remember, it is all about moderation, and most of the time trying to be as healthy as we can be. Get enough sleep, eat fruits and veggies, be active. But it is never perfect and that is ok. And not being perfect, and being ok with that is a real important lesson to teach your children.

For more great information on dealing with feeding issue with children see the websites:

Ellyn Satter and Give Peas a Chance  by Kate Samela, MS, RD, as well a recent article by the American Academy of Pediatrics regarding how to prevent health problems starting at birth-First 1000 Days

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