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

Instilling Fear in Children to Prevent Obesity: Have We Gone Too Far?

Little boy and soap bubblesDo you remember what you were doing when you were 4 years old? Hopefully, you weren’t getting terrified about becoming fat. I hope you were doing what I was doing, making an awesome worm castle out of mud. I loved when it rained and all the worms would come out, more soldiers for my mud castle.

These days, there are other things to think about apparently for our babies….preventing obesity.  We are so wrapped up in our fear of fatness that we are missing the big picture. I can’t share details however can tell you that I was horrified this week when I saw a patient for an eating disorder…..the child was 5. Last year, apparently, this child had seen a puppet show in NURSERY SCHOOL about nutrition and somehow got the message that if you ate the wrong food and got fat, you would die. So the child stopped eating. Granted, most kids might miss this subtle message, but I don’t care. This kid didn’t miss it, and acted on it and lost 10 pounds. The child was diagnosed with ARFID (avoidant/restrictive food intake disorder, a new diagnosis created to include disordered eating without the typical body image concerns). Maybe this kid would have developed an eating issue later in life, who knows, but all I know is that the attempt to prevent obesity with nutrition education of preschoolers is insane.

For those of you with children, I am pleading with you to believe me. I have been in this field for almost 40 years and I have spent the majority of my years working and learning from people with weight issues and eating disorders. I have spent the last decade working with obese kids as well as children with eating issues (such as ARFID) and their families. I am here to tell you that young children don’t need to know squat about nutrition. They also don’t need to think about their weight and should NEVER have access to a scale or worry about their weight. What they really need is role models that are healthy eaters, exposure to healthy foods, especially fruits and vegetables, and opportunities to move and be active and have fun. They also need all of the adults in their lives to accept and love them for exactly who they are, no matter what their body size or weight.

I have shared examples from my older patients I saw in the past. For example, the very intelligent nurse who was a yo-yo dieter, lost and gained the same 50 + pounds over the past 3 decades of her life. She lost her weight through restrictive dieting and she gained it back through binge eating. She finally came to the conclusion that she was binge eating to get back at her mother who restricted her food intake as a child. She became a closet eater because she could not let her mom catch her eating. Apparently, her mother was quite body-image conscious and my guess is she had an eating disorder of her own. Anyway, it was very difficult for this woman to allow herself to eat normally because the fear of fat was instilled in her by her mother. And even though she could cognitively figure it out she struggled with stopping her behavior…even after her mother passed away. Do I think fear of fat helped this woman in any imaginable way? No, it didn’t.

At the other end of the spectrum, we often see infants and children who struggle with weight gain and growth, or who are referred to as “failure to thrive”. We often recommend adding what we call “calorie boosters” to foods, such as melting extra butter into a food, adding in a teaspoon of oil, mixing is some heavy cream to milk, yogurt, etc. I can’t tell you how many times well-meaning parents have returned with their child who has failed to gain weight because of the parent’s fear of adding calorie boosters. Yes, it is great that parents are health-minded, cook healthy foods, etc, but when fat is avoided like the plague everyone suffers. Children need fat for proper brain growth. Saturated fat is a precursor to cholesterol which many important hormones are made of (yes, we need cholesterol!) And children need calories to grow (steamed veggies won’t do it).

Here’s another brain teaser: have you ever had a health issue, or known another adult who has had a health issue and needed to make a healthier choice, yet didn’t? Let me start with a very simple example, constipation. Have you ever experienced this very uncomfortable situation or known someone with chronic constipation that was caused simply by not drinking enough water and not eating enough fiber? “Eat more fruits and vegetables and drink 8 glasses of water a day” the doctor probably says. Do adults follow advice just because they know it is the healthy thing to do? It’s not that easy, is it? If most adults can’t do it then why on earth do we think educating preschoolers is going to teach them to make healthier choices?

If you want my opinion on the bottom line, here it is:

  1. What snack your child chooses at school, whether they decide to take the cookie at lunch or have the chips with their sandwich will have NO affect on their weight. The calories in one cookie, one bag of chips or a bowl of fruit salad are similar. Yes, the fruit has more nutrients, but hopefully, you are offering fruits and vegetables at home (right?). Having a cookie for dessert or a serving of chips with a sandwich is normal eating. I might predict that if you don’t allow children to eat normally, they may be destined to be that closet, sneak eater when they become an adult and nobody is there to restrict them anymore.
  2. Your 4 year old can’t drive. Therefore, it is you who is doing the grocery shopping (mom and/or dad). What you buy to have in your home matters more than if your child knows which snack is healthier. If you want your child to grow into the healthiest body he is supposed to then having access to healthy foods and a structured eating schedule (3 meals and 2-3 snacks) is what matters more.
  3. Don’t become obsessed with the fat on your child’s body. It just baffles me when a parent worries about a toddler’s “tummy”. Think about it for a minute. A 2 year old, a 4 year old, even an 8 or 10 year old is short. They have lots of time to get taller (hopefully). Do you really think when they are 3 feet tall they have the tummy they are going to have as an adult? Their little bodies are going to change so much as time passes,however much body fat they have today will be different tomorrow. But if you talk about it, point at it or worry about it you run the risk of affecting your child in a negative way (making them worry and stop eating, triggering food obsession and abnormal weight gain or just feeling scared (or sad) that you think something is wrong with them). Their natural little bellies should not be a topic of conversation. Ever.
  4. Your children probably won’t eat what you won’t eat. I have seen many picky eating adults who want their child to eat veggies even though they don’t. Probably not happening. Remember the Rule of Twenty: it takes 20 tries to really know if you like something. Model the behavior you want your child to do, so that means going through the process of taking that bite with a smile. Talking about how good veggies are for you won’t work (we adults know that, yet we don’t care…I still don’t cook beets).
  5. It is ok to talk in a fun way about foods being good for you, but you should not talk about getting fat. Talking about being fat, instilling fear of getting fat, making it seem shameful to have a fat body just contributes to the growing insanity and body shaming and discrimination that permeates our society today. I plead with you to avoid being a part of this problem by accepting your child’s body and your own body without judgement (at least don’t talk about your body insecurities in front of your child if you can help it). This does not mean ignoring health and fitness. It means focusing on health instead of body size and weight. You can tell kids that carrots have vitamin A and that helps you see, that whole grain cereal is good for your tummy and oranges have vitamin C and will help you fight colds. But don’t say “that will make you fat” because that is not true. No particular food makes anyone fat. Learning to eat ALL foods in a normal way (a few cookies, not the entire box) is really important and this may not happen if you villainize a particular food.
  6. Find out what your school does as far as nutrition education. Talk to the health teacher or whoever it is that is doing the teaching. Find out what their philosophy is then voice your concerns if you have any. We need to speak up to protect our children.

Don’t blame yourself if you have done the natural thing a good parent does at times. Sometimes, we do worry about our children and we also want to show the doctor that we care. Often that translates into a parent leaving the pediatrician’s office, having been told their child’s BMI is out of range and so the good parent does something. Unfortunately, what they do is focus on the child which does not work. Instead of ever mentioning weight to a child, we need to look at ourselves. I recommend the entire family focus on being healthier, not just the singled out kid. Everyone needs to get off those devices and get outside to play. We all need more fruits and vegetables. We all need to get enough sleep.

Another sad fact is that healthy food is expensive. One mom told me how much WIC gave her for fresh fruit (not much) and this made me wonder how on earth she was going to increase the fiber in this kids diet. I am addicted to grapes and a week ago noticed that my one bag of grapes actually cost almost 9 dollars. How do people do it? Maybe, instead of funding programs to teach 3 year olds how to pick a healthy snack we should figure out how to help poor families have access to more healthy foods. Maybe we should focus on educating parents on how to cook healthy on a budget.

I am thankful all I had to think about was mud castles when I was 4. I hope you keep your child’s life simple, too. And if you can prevent even just one child from developing an eating disorder, it is worth it.


Do We Need to Measure Body Fat in Children?

Children 3Because I am a member of the Academy of Nutrition and Dietetics (AND) as well as the Weight Management Practice Group, I receive regular emails and updates from them, many very informative. But this week I was floored by one that advertised this: “Join us for our November Pediatric Weight Management Webinar: Measuring adiposity in children – what’s the best method? 

Really? OK, is it me, or is this crazy? Am I missing something? To make it clear, I am not referring to evaluating body fat to determine level of malnutrition. I was fortunate to receive training from the hospital where I work in diagnosing malnutrition based on different criteria. It is the thought of using various methods to determine body fat in children that you already know you are going to treat for “obesity”. Yes, I get it, those people who equate perfect weight with perfect health. The whole “obesity epidemic” and those who worry about kids health because of this (as if weight alone or even body fat is the cause of disease, it is not). When I worked full time at an outpatient children’s hospital, yes, there were children with pre-diabetes and hyperinsulinemia or Nonalcoholic steatohepatitis (NASH) who had gained too much weight (according to their individual growth charts, they had veered off which was not normal for them). But focusing on the body composition of a child like this does nothing but continue to label and villainize the poor child even more. The problem is inevitably not the weight, it is the lifestyle change that led to the abnormal (key word=abnormal) weight gain. You cannot, I repeat cannot know if a child’s weight is “normal” or not just by looking at them. Or weighing them.You absolutely need to see their growth chart.

I have ranted on and on about reasons I am not a fan of BMI (Body Mass Index, determined by calculating out a number based on weight and height). Just as a reminder, this number is meaningless when it comes to measuring muscle mass verses fat mass or even water weight so that athletes who tend to be heavier due to all that muscle often have BMI’s in the “obese” range. I am sure I have told the story that always sticks in my mind of the little boy who was about 10 years old and referred to us for “obesity”. How I went to the waiting room to find a very fit looking young man with a very worried look on his face. How when I asked his mom what brought them here, he blurted out “I have obesity. Am I going to die?!” It absolutely broke my heart. I just came out and told him (after looking at his growth chart and seeing that he had been plotting along a certain percentile for weight and height since he was an infant) that his doctor made a mistake. “Your doctor must have forgotten to look at your growth chart! You are fine!” Phew. He literally wiped his forehead as if he just escaped a close call. Come to find out, he was an athlete and very competitive in more than one sport, and he was as healthy as any kid could be. BMI, obesity, see why I hate the terms?

Anyway, after looking into the research a bit, it seems we are more obsessed with getting the “numbers” right instead of figuring out how to actually help people. I was trained decades ago to use the triceps skin-fold method of determining body fat. I hated it because I never felt I could get it right (“am I pulling out muscle or skin or fat? this doesn’t feel right”). Maybe it is just me, but I just never felt confident in it (and have never used it). There are other methods to determine body fat, and I am guessing many people have seen (or own) those scales that supposedly can tell your body fat in addition to the force of gravity on your body. I remember my son telling me back when he was a high school athlete that he was 80 percent fat because his friend’s mother’s scale said so. I just laughed and thankfully he just shrugged it off because it was blatantly inaccurate. But still, I am imagining a lot of people believe those scales and are thrown into a self-deprecating tizzy every morning. But according to that upcoming webinar, we dietitian’s and other health care professionals should be not only paying attention to body fat but learning the best way to measure it.

So now all I can imagine is adding one more invasive scary thing to an already traumatized and singled out chubby kid. It is bad enough to be openly labeled by your trusted pediatrician but then to have someone pulling and squeezing calipers on your body, or measuring your waist or running a weak electric current through you to see how fat you are because we don’t already know by your weight or BMI we just figured out, no,we need to do a few more things to your poor innocent body to see just how horrible you really are. Oh, and at the end of your visit, don’t you feel like going home and eating your vegetables?

OK, I get it, and we all know that a certain kind of body fat is more dangerous. And it is not the fat on our thighs…. for a good explanation as to why experts are concerned, see this article Body fat Types. While we can’t ignore the fact that increasing visceral fat does affect our health, I just don’t get why we need to measure it because in the end, aren’t we still going to have to figure out how to help people? Does it really help to tell someone what percentage body fat they have? And when it comes to children, why on earth do we need to subject them to anything like this? If we are talking about your otherwise healthy child going to the pediatrician’s office for a yearly visit, if BMI is useless, why would this add anything helpful at all? In the end, it boils down to what kind of lifestyle a parent is able to provide for their child. Right? I understand time is very limited at the doctor’s office, and they really need to cover a lot. I have heard the stories, and that is what affects my opinion. From what I hear from parents, most doctors really don’t have time to get the details of what their barriers are as far as achieving a healthy lifestyle. So they just have to resort to handing out the typical advice: Don’t buy soda. Limit juice to once a day. Limit screen time to 2 hours or less. Get 60 minutes of physical activity. Make half your plate vegetables and fruit. Eat at the table. Have family meals. Well, that is great if you have the means and ways to achieve these goals. But lots of families I know just can’t do this. They may not have the income to afford those veggies and fruits and that giant jar of chip/Cheetos/pretzel mix for a few dollars at Walmart will feed your 3 children for longer than 3 apples. Maybe grandma is watching your children after school in a neighborhood where you can’t safely go for a 60 minute walk, and so video games really come in handy. Does your pediatrician ask about these things? The good news, at least in Connecticut, is that some pediatricians are hiring dietitians who actually do have the time to find out all the details of a family’s life and who then can help with the barriers. Yes, these doctors must understand that achieving a healthy lifestyle is more complicated that the healthcare experts think. We are not all created equal and our lives and resources are not the same.

That is why I keep hoping the madness will stop. We will eventually get it that focusing on BMI is not helpful at all. Did I get it wrong, or didn’t the American Academy of Pediatrics just come out with the paper on focusing on health and NOT weight loss? I shared it a few posts ago. I was happy. So then why am I getting these emails about measuring body fat in children? Even if we figured out a way to accurately and in a noninvasive way know what a child’s body fat was….would it change our intervention? Aren’t we supposed to just be focusing on promoting health? Then how can this help?

Frankly, I don’t care what someone’s body fat is. I want to help people be healthier. Whether someone has a lot of the dangerous kind of fat, or the other kind of fat, or no concerns about fat at all. I think we all could benefit from doing all the things we can to be healthier. More sleep, less screen time, less stress, more family meals, more fruits and vegetables, less McDonald’s, more water, more fun movement…..more sanity.

I won’t be attending that webinar. No offense, dietitians, I know the intentions are good. I know the goal is not to humiliate children, and we all say we need to focus on families and parenting, but from my experience, kids are smarter than you think. If you talk about their BMI and then start pinching their arms with calipers, they will get the message, no matter what you say or how you say it. Is it really necessary?

I say no. How about handing out free hula hoops? Now that sounds like progress….compared to calipers.

Promoting Healthy Eating and Natural Body Weight for Kids:Number One Mistake You Should Not Make

Let me eat my cookie in peaceMy children are all grown up now, and to tell the truth, I can’t remember all of their early feeding struggles (except for my oldest daughter refusing to eat Cream of Wheat unless it was perfectly smooth). Oh, and needing to hide the jar of mayonnaise when I made tuna because my youngest daughter decided she hated mayonnaise and would not have eaten the tuna had she known. My son ate everything. I may have paid more attention to my first child, but by the time I had my third, well, I was lucky they all miraculously grew……anyone with a few kids knows you kind of lose track of things after that second one.

Anyway, the one thing I do clearly remember with my first child was reading every book I could about raising children. This was my first baby, and I really wanted to do things right. When Jennifer was born, except for deciding to arrive 2 weeks late, she was the perfect, easy baby. She slept through the night on her first day home (and silly me woke her up to nurse because they said she would be nursing at night, so shouldn’t I wake her up?). After that she woke every night at exactly 3 am, but quickly eliminated these feeds and was sleeping through the night. I never let her cry, and picked her up the minute she started to do that beginning cry, when it kind of sounds like a cough….so I would comfort her before the actual cry even started. Soon, she learned to basically just let out a little cough, and I would come. It was actually pretty funny, because people wondered what she was doing…..Why does she cough to get your attention?! Smart child.

So, before her second year of life this little girl was a piece of cake. I did read however, in one of my books, that the second year of life typically begins the notorious “terrible twos”. The book said a child may start to have tantrums and throw themselves down in fits of anger when they are upset. Supposedly, this horrifying behavior would likely start even before the age of 2. Not my daughter, or so I thought. And then, one afternoon, my perfect little 22 month old sweetie wanted some scissors.

Down she went. Right in the middle of the hallway, she threw her entire body down in a full blown, perfect demonstration of a classic temper tantrum. I was stunned. I stopped in my tracks, my instinct screamed “go pick her up! your poor little girl is so unhappy! You need to comfort her, that is what a good mother does!”

But I didn’t. The words I just read a month earlier or so stuck in my head:

“If they have a tantrum, and get what they want, they have learned a powerful lesson. It works!”

And they will do it again. And so, I did one of the hardest things I ever did, and I stepped over her, continued down the hall to the living room and sat on the couch. As I stepped over her I calmly said “you can’t have the scissors. I will be in the living room”.Of course I could see her from where I was sitting, and I knew she was safe. It only took a few minutes until she got up and came into the living room and started playing with her stuffed animals. She no longer seemed to even care about the scissors. And I honestly don’t ever remember her having a tantrum like that again. Phew. Not to say the next two children were as easy, my son especially had a lot of energy to put up a long fight, and yes, it was exhausting at times. But he also did not get what he wanted. With my third (poor Kara) I had it down. It actually came to the point where I just would start humming that Rolling Stones song, one of my favorites. You Can’t Always Get What You Want.

What does this story have to do with promoting healthy eating and “natural” body weight. Notice I didn’t say “healthy” or “thin” because, remember, all children, just like adults, are not supposed to be the same size. But, we all have basic nutritional needs and need for sleep and movement and peace in our lives. To teach children what a healthy lifestyle is, well, we need to work on it ourselves. Think about these three areas involved in being healthy:

  1. Sleep
  2. Eating
  3. Fun movement

I think most of us agree we all need to work on getting more sleep, eating more fruits and vegetables, eating at the table (family meals) instead of while watching TV or in bed, and playing less video games. Most adults I know are wanting to be more active and get more exercise. What happens when it is bed time and your child has a fit? Or maybe your kids put up a fight and don’t want to sit at the family dinner table. Are they absolutely glued to their hand-held device, refusing to give it up even at the dinner table? How do you handle it? Do you feel as I did at first, that seeing your child so upset is hard to handle? Yes, it is hard to see your child sad. I think it is a natural instinct to want to protect your kids and make them happy.

But what if you knew that letting them get away with whatever they want (even if it feels unimportant) may have long lasting health consequences? In my job where I see kids referred for food refusal and picky eating, the story is almost predictable. The parents are usually absolute sweethearts. The child, a tyrant. They weren’t born that way, they just probably have evolved into this obstinate kid who refused to eat anything but chicken nuggets. From McDonald’s only, of course. Granted, there are many kids with sensory issues, but these are not the kids I am referring to. These are the legit, controlling little people who run the household because they have learned what works. It is not easy to undo, but it can be done. Parents need to get on board and agree to gradually change things, no matter how upset little Susie or Joey gets. I always say, a two year old tantrum is easier to deal with than a sixteen year old tantrum. Nip it in the bud.

So what is the number one mistake you should not make if you want to have a healthy child and promote a healthy lifestyle?

Refuse to let your child rule the house.

Try to accept that being sad and NOT getting what you want every day, in every situation is a much bigger gift in the long run, because it builds coping skills. When something happens in the real world, when things do get tough and you are no longer there, your grown up child will know “I can deal with this”.

We are all different and we all have a right to live whatever kind of life we want when it comes to food, where you want to eat, when, what, how much sleep you want to get, how much TV you want to watch, and even if you feel the need for physical activity. But if feeling good and teaching your family healthy habits is important to you, then this is for you.

My advice: learn the song. You can’t always get what you want. But if you try sometimes, you just might find….you get what you need : )

For more information on promoting a healthy feeding relationship, see Ellyn Satter Institute

Your Child’s Chubby Belly: Should You Worry?

hoola-hoopLast week I saw a little boy in the Feeding Team where I work at a children’s hospital who was referred for food refusal, picky eating, failure to gain weight and a host of other issues. We went through the visit, did our assessment and made our recommendations. At the end of the visit, the mom said to me “I probably should bring my daughter here. I am worried about her, she is only 9 years old and she has cellulite on her stomach! What should I do?” Seriously….my veins actually got this weird feeling. I really understand how they got the expression “that makes my blood boil”.  My blood boils a lot these days….

Anyway, I could tell this poor mom was really concerned, and I was pretty sure she bought into the cultural mantra that being fat is bad and thin is good. And here she was, with her one and only daughter, at the ripe old age of  9 with a chubby belly. And she was worried, but I was not sure why. Was she worried about her health, or that she may end up with a fat child and wouldn’t that be horrible? I did not want to lose this chance to possibly have an impact on a young girl’s self-esteem and body image, and I knew I had to control myself. I needed this mother to buy in to what I had to say in these last few minutes of our appointment time.

So I took a deep breath and asked “How old is your daughter?” and she told me. I then went on to explain normal development and how all children are different in the way they gain weight and grow. Some kids are scrawny much of their young lives, even into their teen years, and only gain weight in their 20’s or even later. Others tend to be a bit chubby and often that fat can be in the tummy, but this is very normal. “Just remember” I said, “how small your daughter is, and how much she will be growing in the next ten years…..her body needs some fat so she can produce the hormones that are going to transform her into a young woman.  Do you really think having a chubby belly at her age is important?” That mom stopped to think. So true! She has a lot of years to go before she ends up with an adult body. So if she should not worry about her daughter’s belly fat, then what should she worry about?

I went on to introduce her to the idea of promoting family health. NOT focusing on one child’s body or weight, but instead, caring about the health and happiness of everyone in the family. That includes dad who is in the habit of drinking soda, and the skinny brother who lives on potato chips and Oreo cookies. How can the entire family be healthier? I gave her a few handouts and websites on promoting a healthy feeding relationship ( is my favorite). I suggested that she try not to talk about her daughter’s belly, or her body, or anyone’s body in the household and instead work on family health. Getting enough sleep. Limiting screen time to 2 hours or less. Cooking more at home with more family meals, less eating out, more fun outdoor play. That kind of thing. Giving your children the gift of a healthy lifestyle is something we all can work on. Trying to change someone’s genetics is fruitless at best, and worse, so damaging to self-esteem and body image (yes, we are all different, look around you, even elite athletes have different body types, yet all healthy). Your child may indeed turn out looking too thin or too large by cultural standards, but don’t you want them to be themselves? They can still be healthy, depending you what you teach them.

Anyway, I am not sure if I had an impact, or if she bought into the message I was trying to send, but at least I tried.

So, to answer the question: should you worry about your child’s belly? The answer is NO. Non. Ne. Nei. Nie. Nada.

FYI I am the champion

Instead, go Hula Hooping. Now that is important.


Does Your Teenager Have an Eating Disorder? Signs and Symptoms You Should Not Ignore

scaleThey came to their visit together. Jessica (not her real name) did not want t be there. I let her stay in the waiting area fixated on her cell phone (she made up her mind she hated me, at least that is what her facial expression conveyed). Instead, I took her mother into my individual counseling room to get the story before I met with Jessica. It was one I have heard before. In fact, the entire scenario became predictable. Mom was all over the place, at first angry that her teenager was being so rebellious, she was driving them all crazy. She refused to go anywhere with the family, she hid out in her room, refusing to sit at the family dinner table. Vacations were a night mare. “She used to be such a sweet girl, so happy and care free, she LOVED helping me in the kitchen and really enjoyed going out for pizza with the family, but now she is like someone else. We don’t know what to do”. Next, after the anger, comes the crying. “She looks horrible. She passed out the other day and it was so scary. Yet, she won’t stop this. It does not make sense!”Jessica took to wearing very loose and baggy clothes, and it wasn’t until her mother walked in on her changing that she noticed her protruding ribs and the obvious weight loss. After lots of threatening, Jessica agreed to go to her pediatrician’s and was then referred to us. How did it get to this point, and how did this family miss it?

Eating disorders can happen at anytime, but transitions are especially tough. Back to school, back to college, back to normal life. Simple, predictable, or is it? Not for everyone. Times of transition and change, such as starting a new school, going away to college, new teachers, different friends, all of it can be a challenge for some kids. Times like these can be risky when it comes to falling into the grip of an eating disorder. Couple that with society’s obsession with losing weight and it is pretty easy to understand why lots of eating disorders often go unnoticed until it is almost too late. As a parent, what signs or symptoms should you look for? Some things that you should not ignore:

  • Weight loss. Sounds obvious, but actually, especially in teenagers who are larger or fatter, parents mistakenly tend too think the weight loss is a “good” thing. Even doctors make the mistake of automatically praising weight loss, especially if it brings a child closer to a “healthy” BMI (gag).  That meaningless number does it again…….clouds the judgement of otherwise smart and well-meaning people (parents and professionals alike). The great news is the American Academy of Pediatrics came out with a new report in August highlighting the risk of treating obesity in adolescents with disordered eating as well as the importance of focusing on health verses weight. See this article in American Academy of Pediatrics for the specifics. The bottom line is that we need to get off the losing weight bandwagon, fight the cultural message that everyone needs to be thin, or a certain BMI, and NEVER EVER praise weight loss in a teenager. Yes, there are times when a kid may lose weight. A teenager who is very sedentary who goes away to college and finds themselves having to walk 9 miles a day just to get to all their classes may indeed lose some weight. This is not what I am talking about. But even then, making a big deal about weight loss is never good. Even this kid, if they get lots of attention for losing weight may decide they like the attention, and start doing things to purposefully lose weight (I have seen this happen many times). Don’t do it. Don’t compliment weight loss in a kid. Instead, compliment growing up and being successful.
  • Food refusal. When your teenager has always loved your home-made macaroni and cheese, and even begged you to make it, but now refuses to eat it, NOT GOOD. Unless there is a really good reason for refusing a favorite (recent stomach bug, stomach ache, cramps, etc) don’t ignore this red flag. Should you try to force your kid to eat it, or pressure them to answer you as to why they don’t want it? Like I said, one refusal because they don’t feel good is normal, but a few times in a row is just not normal, however responding with anger is not helpful. Instead, I have found those parents who are able to open up a caring dialogue with their teen have a better chance at getting to the bottom of it. It is important to pay attention to all signs and symptoms so you can then make a plan to address it. Forcing food or anger does not help.
  • Decreased socialization. For a teenager with an eating disorder, any situation that involves food and eating is threatening. You will start to notice they don’t want to go to their friends houses, or to birthday parties, and they especially will try to get out of family functions (those typically aren’t a teen favorite anyway, but they are doubly horrifying because of the food involved). They may lose interest in going to what once was a favorite restaurant and a big treat. They will refuse to eat the family’s favorite pizza on “pizza night”. Red Flag.
  • Loss of menstrual period. Not that you need to keep track of your teenage daughter’s cycle, but if you notice she does not ask you to buy feminine hygiene products the way she usually does, ask. Don’t ignore it as this can be a sign of weight loss and inadequate calorie intake.
  • Obsession with exercise. If you notice your teen going out for long runs, or running both morning and night, or if you notice the bedroom door is always closed and when you walk in she just so happens to be exercising, this could be a sign that something is not right. Yes, being active is good for all of us, but if doing calisthenics is something new and different, and especially if your teenager seems to be hiding it, then this is also a red flag.
  • Going to use the bathroom after every meal. If this has always been normal for your child that is one thing, but if it is a new behavior, it could mean they are purging or throwing up their food. You can check the bathroom for evidenced or you may hear it, but don’t ignore this. Vomiting on a regular basis is an eating disorder behavior and could leads to electrolyte imbalances that can be deadly.
  • Body checking. Do you notice your teenager looking at her body, especially her stomach obsessively? Does she tend to squeeze her arms as if to check for fat? This is a common behavior for people with body image issues and should not be ignored, especially if other signs are present.
  • Obsession with food labels, writing food in a journal, or counting calories. I can’t tell you how many food journals complete with calorie counts I have seen in my life. It is NOT normal. It is NOT a good thing. Yes, there are apps and websites and even the My Plate site has trackers for this. I hate them.This is as far away as normal, intuitive eating as you can get.

So what should you do if you notice any of these symptoms? Remember, your teenager is not doing this on purpose. They can’t stop. It is a very complicated disease and the triggers and causes are different for each person. It is important to be empathetic, kind and loving and to avoid blaming as this will not help. The first step might be to call your pediatrician and share your concerns. They will probably want to see and evaluate your child and may recommend therapy and a visit to a dietitian. Be sure that both specialize in treating eating disorders. Your teenager probably won’t be happy, but you can also get support from the therapist as far as how to handle resistance. The sooner you address the issue, the better chances for recovery. Remember, it does not matter what size your kid is, if they are fat or thin. It is very easy to ignore some of these red flags, like I said, some are so socially acceptable and desirable that it is sometimes hard to see what is going on. Don’t ignore these signs. They won’t go away on their own, and the longer you put off getting help the harder it will be.

There is hope. You can get your old teenager back.But you gotta move fast.

For more information and for great resources, check out the website: Eating Disorders Awareness and Prevention.

Plea to Parents of Fat Kids

lookHave you ever been in a situation where you witnessed a parent doing or saying something to a child that you felt was wrong? Did you say something, or did you bite your tongue? Sometimes, don’t you just want to say “are you kidding me? You did not just say that. Do you not realize how stupid that is???” Well, I have felt that way, many, many times when I worked almost exclusively with “obese” children and teenagers as an outpatient dietitian. I felt like saying not-nice things to parents, siblings. and even other health care professionals (such as the pediatricians who referred them). I just could not believe the stupidity (not a nice word, and I never use it, however it is how I felt at the time). But, it is not stupidity at all as most of the people and a majority of the parents I worked with were very intelligent. Really smart. But when it came to how they treated their children, or how they treated their patients, well, they just were not wise. Not wise at all. And it truly broke my heart…..I wanted to scream, but I couldn’t because, well, I would have lost my job and then I could never help anyone at all.

This is a topic I am passionate about, and I already vented a bit in 5 Things You Should Never Do if your doctor tells you your child is overweight. But I want to take it a step further. I think it was something I saw in a little girl’s face that touched something in me last week, and I can’t forget it. I was leaving the Nutrition Office where I am temporarily covering an afternoon here and there, and as I was walking out at the end of the day I noticed a little girl sitting in the waiting area. She was with her mom, kind of clung to her, waiting to see the dietitian. She was probably 6 or 7 years old and was likely starting the weight management group program (or maybe was already going and just coming for a follow up, I don’t know….but from the look on her face, she looked as if she was on death row). Just to be clear, this “weight management program” does NOT focus on losing weight for children. It is expertly organized and run under the guidance of a very experienced, sensitive and wise psychologist. The focus is on the family as a whole with an emphasis on everyone improving their lifestyle to get healthier. The name of the program has absolutely nothing to do with weight, which is a good thing. The problem is what happens when the child goes home.

Just as with picky eaters, parents of “overweight”or “obese” or “chubby” or “fat” kids (however they are labeled by family, friends, doctors) tend to get treated in an “old-school” way of thinking. For picky eaters, for instance, we learned way back when to make a child “clean your plate”, or “finish those peas” or you won’t get dessert. Just because parents have been doing that for decades does not mean it works or is the right thing to do. We now know this promotes even pickier eating, kids growing up to be adults obsessed with sweets (because when you are 32 you can skip the darn peas and go straight to the dessert). It doesn’t work.

The same holds true for children and weight. The minute the child gets wind that a parent is concerned about his weight or body size, things change. The first mention of “do you really need that?” starts the ball rolling. Sometimes parents start making comments like this after a yearly check up when the pediatrician may mention something about BMI. Sometimes it is just the parent noticing a change in their child’s body. Often times, I have encountered parents, usually those with body image concerns of their own who are the worst offenders. They “don’t want their child to go through what I did” so they are going to make them skinny NOW. Or upper class, professional parents where it is important to portray a certain image, and having a larger size child or teenager does not reflect well on them. Everything needs to be perfect, including everyone’s bodies. I know this sounds crazy, but trust me, I have seen it. These cases especially trigger me and I have to use all of my personal resources regarding counseling skills and self-control to avoid saying something I will regret. What I want to say is “don’t you see how your failure to accept your kid for who they are is affecting their self-esteem? How can you be so shallow?” But I don’t because the reality is these are all good, loving parents who care about their kids. They are doing the best they can. Their intentions are good. The repercussions are really bad though, so I need to say something.

Not everyone accepts what I have to say. I usually try to focus on the research regarding restricting children, or even what happens when adults diet. This almost always leads to more focus on food, binge eating, eating disorders and yes, weight gain. When I ask if they notice any sneaking of food, inevitably the parent says yes. It starts when the child is restricted. So that often opens the door to the parent considering a different approach, such as focusing on health for the entire family. But it still is not easy for parents to change. They truly do want to help their kids, but it is complicated because of the parent’s relationship with food, their own body image concerns and dieting history, their beliefs about weight and healthy, their values, etc.

So what is my plea to parents? First ask yourself these questions:

  1. Do you feel that your child’s body size reflects on you as a parent?
  2. Do you feel you are a failure or did something wrong because your child does not have a thin body like their friends?
  3. Do you make comments about your body, your children’s bodies, other people’s bodies?
  4. Do you weigh your child EVER at home? Do you talk about that number?
  5. Do you allow anyone in your home to talk about another’s weight or body?
  6. Have you changed your behavior toward your child’s eating after a pediatrician visit where you were told something about weight?
  7. Do you forbid one child from eating certain foods but allow others in the home to have it? Do you limit portion sizes for just one child and not others?
  8. Do you force your child or teenager to use a treadmill, exercise bike or other forms of exercise to help them lose weight even if they do not enjoy it?

If you answered yes to any of these questions, my guess is your child or teenager is getting a few messages from you that may harm them, either now or in the future. The messages are:

  1. I am not ok the way I am.
  2. My body size is important in life. That number on the scale defines me.
  3. I should feel bad if I eat certain foods.
  4. Exercise is not fun.
  5. If I lose weight my parents will be happy.

Are these the beliefs you want your kid to carry with them on to their adult lives? Do you carry these beliefs as an adult? How has it worked for YOU?

What is the alternative? It is never too late to create a shift to a healthier relationship with food, eating and weight. You CAN help your children grow up to be the best they can be in every way including body size. You just need to accept the fact that we have absolutely no control on what are bodies want to be (that is in our genes). You can however work on your family’s lifestyle to promote health. You can work hard to accept the goal of feeling good and being healthy instead. Now that is a pretty good message to send to your kids I think. How do you do that? Here is a way to start:

  1. Throw away your scale. Vow to focus on promoting healthy behaviors and not the force of gravity on your body.
  2. Treat every single person who lives in your home the same when it comes to food.
  3. Talk about health, not weight or bodies.
  4. Defend your child. Do not allow anyone at anytime in any place to talk about your child’s body. That means siblings, dad, mom, aunts, uncles, grandma and grandpa.It also includes the doctor. Warn them ahead of time. Tell them you do not want to draw attention to weight. Assure them you are educating yourself about healthy eating and exercise (you can actually ask for a referral to a Registered Dietitian for help with healthy eating, but be sure the dietitian also knows you do not want to focus on weight, just health). Remember, your pediatrician is trained to look at numbers such as BMI and is obligated to diagnose “obesity” however they do not need to talk about it, especially in front of a child.
  5. Do not give your child a “look” when they are eating something, or taking a second helping. They will sense your judgement and it will hurt them. Remember, if you are offering healthy meals and opportunities for fun movement, your child will be fine. They need to learn to listen to their own bodies, and when the emphasis is not on restricting and controlling every morsel they eat, eventually they become less focused on food and eating. All kids are different and it depends on what they have already gone through, as well as their own genetic and psychological make-up. Your job is to set an example of a healthy lifestyle, that is how your children will know what matters. If they see you jumping on a scale every day followed by a reaction from you depending on that number, they learn that is what matters.
  6. Get help. If this is really hard for you for whatever reason, consider getting some support. If you have eating issues of your own, or if you are stuck in a diet mentality, or are afraid of getting rid of your scale don’t give up. I have worked with many women with eating disorders who fear they will somehow pass on their issues to their children. Just their awareness of their own issues really helps.

So my plea in a nutshell is, please let go of it. Let go of our culture’s focus on body size. Let go of thinking you and your entire family have to look a certain way, otherwise you are not a good parent. Instead, embrace caring about health. This does not mean eating perfectly or exercising a certain amount of time every day. It means moving in a direction that feels good and makes sense. If you could have seen that little girl’s face in the waiting room that day, you would understand. Please don’t do that to your child.



Teens and Eating Disorders: 5 Mistakes To Avoid if You Are a Parent

cropped-img_1418.jpgI will call her Jessica. She was one tough cookie, starting from the day her mom brought her in for her first visit with the dietitian. She was 16 years old and referred by her pediatrician for weight loss and a possible eating disorder. I could tell from Jessica’s demeanor and angry face that she would rather be having her toenails pulled out than be here. I met with mom first (I have learned that having both parent and teenager in together almost always turned my otherwise very pleasant counseling room into a war zone). Anyway, Jessica’s mom filled me in on the fact that her daughter did not want to come today. Mom wanted to prepare me for a very bad visit. I let her tell the story of why she was there, and just as with many parents I have seen, the feelings  transitioned from anger to sadness and eventually tears. A newly diagnosed eating disordered teenager is ….well… difficult for me to even put into words, because I just can’t imagine how painful it is to watch your son or daughter fading before your eyes. I also know it is scary  for a teenager when they are being taken over by this deadly disease. So when a parent finds out their teenage child has an issue with their eating, what they do can be critical.

With today being the very last day of February, Eating Disorder’s Awareness Month, I thought it might be helpful to share my experiences with the intent to help parents understand just a little bit about what is happening when their teenager seems to be falling into the grip of disordered eating. Let me make it clear that from my experience, every single parent I have ever met who has brought their teen to come see me for help are always caring parents who love their children and only want the best for them. But most of them don’t understand what is going on, and their reactions to their teenagers behavior are often not helpful.

So here are just 5 things I wanted to bring to the attention of any parent who may have to struggle through this with their teenager:

  1. Do not ignore weight loss.

You know how it is when you see someone everyday….sometimes small changes go unnoticed. Sometimes, when teenagers are wearing baggie clothing (which is very common in people with body image concerns) we just don’t realize a significant weight loss has occurred. And sometimes, if a teen is a bit on the larger size, she may get attention for losing weight. Parents sometimes feel happy and proud when weight is lost. They don’t want their daughter to be overweight, the importance of avoiding obesity is all over the media, why wouldn’t they be happy? The problem is (and I see this all the time, when people don’t stop to think) sometimes weight is lost in a way that is not healthy at all, and even dangerous. Sometimes kids skip meals, teenagers stop menstruating (a huge red flag) or even may suffer from dizzy spells and fainting. Parents need to investigate when a teen loses weight, not condone it, not praise it, but find out why. If someone cuts out soda, or takes up a healthy sport and is enjoying life, still eating with the family and eating normally, then there may be no issue at all (but PLEASE don’t give too much attention to the weight loss, instead support the healthy lifestyle as that is a good thing, and has nothing to do with weight). Be sure to take your teenager for regular doctor’s visits and ask to see the growth chart. Ask your doctor to explain it, and if your teen is falling off the growth chart, or not gaining weight, find out why. If your daughter stops having a period, or starts skipping periods, tell the doctor. But do not ever ignore weight loss in a teenager.

2. Do not make the dinner table a war zone.

If your teenager used to love your mashed potatoes and now does not want them, don’t make an issue out of it (at first). But if you notice they no longer want other foods they used to love, and insist on only grilled chicken and salad, don’t ignore it, however don’t start pressuring them at the table. The dinner table needs to be a happy place for everyone in the family. Plus, it will not work, and will most likely cause your teenager to avoid the dinner table altogether. Instead, seek out the help of a professional. Tell your pediatrician about the sudden food refusal and ask for some references for therapists who deal with eating disorders. Tell your teenager that you are worried about her eating and that she does not eat the way she used to. I explain it as an “assessment” so that is sounds less threatening. It is just to be sure everything is ok. Or, you can start with a dietitian to be sure your teenager is getting what she needs nutritionally. Sometimes, kids go through phases when they want to eat healthy, or experiment with vegetarianism, etc. and they just need a professional (and not their mother) to explain why it is ok to eat pizza or potatoes, or ice cream, or whatever because it all contributes nutrition. I have had many teens show a sign of relief that someone who “knows” gave them permission to eat ice cream again! They happily go back to mom’s potatoes. But if they don’t, typically the dietitian can also help along with the pediatrician in finding a therapist who has expertise in eating disorders.

3. Do not ignore your instincts.

Besides refusing foods they used to like, are you getting a feeling that something is just not right? Do you catch your teenager in telling little “fibs”that may not seem significant, but make you think something is up? For instance, your son says he is going to eat with his friends at the pizza joint after school, yet when you see his friends later that week, you hear them ask where he was….is he finagling his way out of meals? Or, has your daughter started a new routine, where for some reason, after eating she always has to run to the bathroom? Could she be vomiting after meals? Or have you caught your teen checking out their tummy in the mirror? Of course this can be totally normal, but if it is coupled with other “red-flag” behaviors such as food refusal, and your instincts are telling you something is wrong, don’t ignore it. Ask questions. Let your teenager know you have concerns and are wondering what is up.

4. Do not think your teenager is purposefully trying to drive you crazy.

One of the first things I always say to a parent whose teenager is newly diagnosed with an eating disorder is “they are not doing this on purpose”. Parents get very angry (at first) when their previously happy eat-you-out-of-house-and-home teenager no longer will even sit at the dinner table. Teenage years are not always the easiest as it is (having had 3 of these I can say from experience). The purple hair, the pierced eyebrows, the roller blades, loud music, protesting the rodeo……teenage years are a time of transition, so throwing in body image issues and disordered eating into the mix certainly has the potential to create some explosive scenarios.  But when it comes to an eating disorder, trust me, no one, not even a teenager, wishes the torturing mindset that comes with the disease upon themselves. What has helped me tremendously in understanding what those with eating disorders are going through is the concept of “ED”. ED is what I imagine as a monstrous little creature sitting on your teenager’s shoulder, muttering the most horrible and distorted demands into their heads that they just can’t ignore. “Don’t eat that! It will make you fat!” “Don’t listen to her, she wants to make you fat!” ” You need to skip dinner, you ate lunch, or you will get fat!” “You don’t deserve that, you were bad all week” And on and on and on. All day. Every meal. After every bite. So when your teenager has a fit, and gets mad at you, and yells and swears, just know it is not her or him. They are under the influence of something very powerful and not in their control. Not yet, until they get help. Which brings me to the last point….

5, Do not think you can go it alone.

It really is hard to commit yourself to doing what you need to do to get help. These days, we are all so busy. Both parents work, and there are more single parent households relying on only one income. Teenagers are involved in sports, getting their driving permits, there are proms to go to, it is endless. But, if ED gets control, none of that will matter in the long run because he can get such a grip on a person’s life that it will only get harder and harder to shake him off. Not only health,but lives are at risk.  No matter what it takes, rearranging work time, finding a therapist who has evening hours, getting into a program, the sooner you get help, the better. Check out the National Eating Disorders and Awareness site at NEDA for more information on eating disorders. Your teenager does not have power or control over what is going on with their eating or their body image. But you CAN help your teen by getting them help. Trust your instinct as a parent. If you think something is wrong, you are probably right.

You might wonder why I chose the beautiful photo at the beginning of this post. It is from a kayak trip down the Connecticut River, off the town of Essex. To me it symbolizes what I have learned an eating disorder is to many patients: it is something they turn to in order to deal with something else in their lives. It is a “life preserver” such as those thrown into a river when someone can’t swim.They need to learn to swim before they can let go. But there is so much to look forward to, like the beautiful sunset in the distance. They will get there.

Then and Now: Is Technology Affecting Your Child’s Health?

computer-danger-2-1428562Do you struggle with your child or teenager because they seem obsessed with a video game? Or maybe their cell phone seems to have become an extension of their body? Or, if your child has been identified by his pediatrician as “overweight”, have you gotten the spiel about limiting “screen time” to less than 2 hours a day? What is really going on here and does it really matter?

The purpose of this post is not only to share my experiences with families, but also share some of the research that gives us insight into this whole situation. We older folks like to reflect on “the way it was” back in the day. Although we tend to joke about it, “when I was your age….” the challenges parents face today truly are not funny. The direction we see kids going as far as health and lifestyle is scary.

First, let me get it over with. “When I was young”, make that the year 1974, when I was a senior in high school, this memory sticks with me: the typing teacher (yes, we had giant, heavy typewriters) called us into a room to show us the school’s first computer. It was the size of a refrigerator. It spit out cards with markings on them that meant nothing to me. He said “one day, you all will have one in your homes”. Not me! I thought. Who would want that giant thing in their house? Why would you need one? And here I now sit, nice and comfy on the couch, looking out over the newly fallen snow, with my convenient lap top resting on top of the cozy blanket on my lap, enabling me to write something that people as far away as Australia will (hopefully) read. My husband is in another room, on another computer checking all over the world for possible vacation destinations. My cell phone just beeped (got a message), but at least the television is off (OK, I admit, I am recording the sports station because I love all the pregame stories before the Super Bowl).

Here we go, you know this story, too: when I was young we had one TV in the living room with 3 channels. We walked 2 miles to and from school everyday. We had gym everyday. We walked to the park in the summer and stayed there all day in the pool (pond) or played baseball, hop scotch, hide and seek, rode our bikes, built forts in the woods. Our bedtime was our bedtime, and sometimes the sun was still out. If it snowed, nothing changed. We were still outside all day, building our snow forts and having snow ball fights. You get the picture. We loved it and we were happy. I imagine it was not easy for parents back then, having to be firm with us to get to bed, get us to the park for our swimming lessons before we were old enough to go ourselves. They had nothing to entertain or occupy us (except maybe coloring books and puzzles, or an Easy Bake Oven if you were lucky). Today, it is different.

Consider Tony (made up name) a teenager referred by his endocrinologist for nutrition counseling because of pre-diabetes and obesity. He came to the visit with his mother who was also large sized and had Type 2 diabetes. She was a single mom with mental health issues of her own. After talking to Tony for a very short time it was clear he was not motivated, and really was not worried about his health. For most of his life he has had a television in his bedroom as well as a computer and many video games. His favorite was the one that allows you to play with people all over the world (that was why, he said, he had to stay up until 4 am, because of the time zone differences, and that is when his “team” played). He went to his room the minute he got home after school and stayed there all night. Since his mom did not like cooking, they tended to order out a lot (pizza, Chinese) which Tony would eat in his room while doing his thing. He actually had a small fridge in his room to keep his soda cold, and that way, he did not have to walk down to the kitchen.

As I write Tony’s story, it occurs to me that his story is not unique in my world. Some of you may be thinking “that is horrible!” but the truth is, that story describes a typical teenager that I have seen over the years for the same issues. Yes, being a single parent, especially a parent with depression makes it even harder to make changes. But, this lifestyle is identical in many two-parent homes, with happy-go-lucky parents who are healthy and do not have mental health issues.

It seems to be our culture now that not only adults, but most children have a television in their bedrooms at a very young age (I have seen it even at the toddler age). I believe one of the reasons is that as a parent, it does make your life a bit easier when Johnny is occupied in his room with some movie or game so that you can get your laundry done! Also, peer pressure contributes to the scenario. I can count on one hand the number of parents I know who refused to get their child a cell phone (other than for emergencies, or when they are out so they can call home, which is different, and I don’t blame them!). It is hard to say no to a child who wants the latest video game (all his friends have it!) and it is nice I bet to have something to bribe your child with (if you do this, then I will get you that game!). Not to mention, these games and computers and phone plans are not cheap!

Besides the cost of technology, what are some of the other negative consequences? Here is what I have noticed:

  • Isolation (not much family time if your child is holed up in his room for hours). In one STUDY of over 5,000 children in 12 countries, that average time spend in sedentary behavior was 8.6 hours.
  • Poor sleep (many a teenager has admitted to me they turn their computers back on after parents have gone to bed. It is just too hard to resist). Poor sleep contributes to food cravings and abnormal weight gain.
  • Poor nutrition intake (kids are not snacking on carrots and hummus when they are playing video games, but tend to eat unhealthy foods that do not contribute to health and normal growth). See Study on food intake and physical activity
  • Lack of social skills (playing with imaginary people on an imaginary video game does not help kids learn how to talk to real live beings).
  • Addiction (some children are more prone to becoming addicted to video games, see One study on children and teens)
  • Dangerous situations (if a child has a computer and internet access in their bedrooms, and are logging on after parents go to bed, they are susceptible to trouble)
  • Physical inactivity (which leads to an unhealthy body, if we need an hour of fun physical activity daily, then spending over 8 hours a day in front of a screen does not leave much time left)

Even though it is clear to most of us that too much screen time is not healthy for our children and teens, what are you supposed to do if your child already has that TV in her bedroom, already has a cell phone they are attached to or already spends hours secluded in their bedrooms with their electronics and technology? Prevention, of course, is easier than a cure.  A recent study on Parent’s Screen Viewing Time and children’s suggests that the apple does not fall too far from the tree, and that we need to direct our efforts for helping parent’s change their ways first. Here is my advice:

  • Take a look at your own habits as a parent. How much time do YOU spend watching TV or working on a computer? Are YOU addicted to any games yourself? Focus on changing your ways and your children will follow. Remember, kids do what you do, not what you tell them to do.
  • Start early. NEVER put a television or computer in a child’s room. Tell your child, the bedroom is for sleeping. Or maybe playing with friends or reading.
  • Challenge yourself: can you remove the TV from your own bedroom? That would free you up to join your children in doing something else…hhhhmmmm.
  • Remove cell phones and computers, tablets, etc. from a child’s room an hour before bed. If you let them keep it in their rooms, even if they “swear they won’t turn it on!” don’t believe them. Don’t expect a child or teenager to be able to control this. Most of them can’t (from what I have seen).
  • Get ready for some tantrums! If you have allowed your child or teen to be attached to the tablet or phone or TV, and now you suddenly try to change it overnight, there will be fireworks. You might want to start by having a discussion about making healthy changes, and gradually decreasing the time on devices. I have seen success with setting alarms and/or parental controls. I have also seen more success when parents join in and do something fun with their children (puzzles, cooking, hikes, games, etc) as a substitute. Most young kids really love doing fun things with you. Playing a game of checkers with my siblings was always a blast! I know, I know, how are you supposed to get anything done? That could be another post in itself: How to Live With A House That Is Not Perfectly Clean and Organized so That You Can Spend More Time With Your Children Because Before You Know It, They Will Be Gone
  • Consider transitioning to some active video games that you can do with your child. Kids just love watching mom or dad stumble over their feet with Dance Dance Revolution. It is a fun way to get to use technology yet get some good physical activity in at the same time. Start by moving your electronics to one common area like a family room or living room, that way everyone can participate. Also, it will be less likely your child will be spending excessive time on the device since it will be out in the open.
  • There are exceptions of course. Many children with special needs really can’t survive without a screen or tablet. They are used for motivation, communication or just to help a child focus. This is different, but you know your child best, so go with your instincts as a parent.

I am sure there are other important points, and good reasons to change this trend. Maybe it is because of the era I grew up that it strikes me as scary. It just bothers me when I enter an elevator in the hospital where I work, and even the young doctors can’t look up to say good morning because they are glued to their phones. It is not to address some emergency, it is clearly a discomfort with communicating in person. I don’t think it is good.

As for me, my screen time is up! It is almost noon here in New England, and I plan on breaking in those new snow shoes ; ) I hope you get out and enjoy the real world too.


Continue reading “Then and Now: Is Technology Affecting Your Child’s Health?”

5 Mistakes Parents Make With Picky Eaters

eating-watermelon-1-1324695I dislike beets. I have tried them 7 times. To me they taste like dirt. The 20 bite rule is hard for me when it comes to beets (I really want to give up). For those of you who aren’t familiar with the 20 bite rule, it just means you really don’t know if you like a food until you have tried it at least 20 times. It only took me about 5 times to know I actually did like sushi (not all of it, but the one I was persistent with trying, and even though it has fried tempura shrimp on top, it still counts as sushi). The point is that we all have foods that we don’t like, don’t want to try, or even make us go “eeeewww”.

When it comes to getting children to eat, most caring, wonderful parents that I have met tend to practice the same strategies with no success. I call them “old school” strategies because they are the same old things we have always done to try to get our kids to eat. Although I have shared a few posts on feeding kids and picky eating, I recently read an article in the Hartford Current(January 3, 2016) about Kids and food, and saying the right things. It brought up some great points and made me realize this stuff is worth repeating.

Parenting is not an easy thing, and we all look back with some regrets at the way we did things. But if you want to raise a child who grows up to be an adult with a healthy relationship to food, read these 5 common mistakes parents make, along with a better way.

Mistake #1. Making a child sit at the table until he finishes the peas (or meat, or green beans, or heaven forbid, the beets). If you have done this, you know what happens. Some kids will sit for hours and make a scene. Others will stuff the peas in, gag, and sometimes vomit or spit out the food. If you were forced to eat that one food you despise, what would be your reaction? I would be pissed! Is it no surprise that your child does not behave that well when forced into this situation? The down side of this is the table becomes a terrible place to be. It would not increase the likelihood of trying that food in the future and actually, due to the terrible experience, could turn off someone for good.

Instead, feeding therapists often use a “food scientist” approach to non-preferred foods. For example, the food will be on the table, or even a small amount may be on the child’s plate, but just for “exploration”. What color is it? purple. Is it hard or soft? a little soft. What does it smell like? dirt. Can you lick it? Yes, it is a little sweet, hhhhmmmm. No pressure. Just exposure in a fun, non-threatening way. and the good thing is the table is still a fun place to be.

Mistake#2: Making a child finish his plate. Or refusing seconds to a child. Imagine it is one of those days you ate a late lunch out with friends, and then came home and your husband decided to make an early dinner. You sit down to this beautiful dinner but you really are not that hungry. He piles your plate high with mashed potatoes and gravy, a large slab of turkey, stuffing and a big salad on the side. You tell him you just aren’t that hungry, however he says you have to finish the entire plate. Not a morsel can be left. How would you feel? Again, your body is giving you an appropriate message that you are not that hungry, yet your husband is telling you not to listen to your own natural body signals. You feel you have to force that food down, you feel stuffed and not good, and again, the table is not a fun place to be. The same holds true if the opposite occurs. Imagine you missed lunch and come home famished. The same lovely meal is waiting for you, however this time your husband says “that’s enough for you”. You wanted more potatoes but he won’t give them to you. You leave the table feeling hungry and still thinking about food (and when he goes to bed, because you are an adult, you probably would just go heat some up. But for a child, this triggers sneaking food, which then leads to feelings of shame, clearly not good for a kids self-esteem).

Instead, encourage a child to “listen to your tummy”. Start with smaller portions so you don’t end up throwing away food, then give more if a child finishes. Or simply save the leftover food for a snack for later. This prevents drama, and guess what…..makes the table a more fun place to be, along with teaching the importance of honoring your hunger and fullness. Kids usually have this internal mechanism that will keep them growing normally  until we adults ruin it with forcing them to over or under eat.

Mistake #3: Allowing a child to graze or nibble all day long. When kids are picky and refuse meals, or don’t eat much at a meal, parents worry. They think their child is not getting enough nutrition and they really want them to grow. So, if the child asks for some crackers in between, mom is going to give them. Sometimes, a bowl of the snack is left on a coffee table so a toddler can go help herself. The end result is a child who is nibbling all day long on foods that don’t typically provide much nutrition, and then when dinner rolls around, the child has no appetite. Sometimes, the pressure starts, the scolding, the forcing, again, all leading to a negative experience. Imagine picking on food all day long. Are you really in the mood for a full meal when you can’t really tell if you are hungry or full?

Instead, parents should provide 6 opportunities to eat. Breakfast, a morning snack, lunch, an afternoon snack, dinner and one evening snack. If the child refuses lunch, then, without fanfare or pressure, the food is removed from the table (typical meal times are 20-30 minutes). If she comes around asking for food 30 minutes after lunch was offered, the answer needs to be NO. Water could be offered, but that is it. Yes, kids will cry, it is not fun, but they usually do much better at the next meal. Eventually kids get the message that they better eat at meal times or snack time because the kitchen is closed.

Mistake #4: Catering to a picky eater. Short order cooking. This is when you make that macaroni and cheese, or pick up those chicken nuggets because you know Johnny does not eat meatloaf. Or pasta. Or soup. Or fish. And on and on. And why would he? For his entire life he has gotten his nuggets. I have seen teenagers who are stuck on 3 foods because their parents catered to their picky eating. I sometimes joke that if I refused to eat unless it was lobster, I could probably get my husband to make me lobster every night ; ) People who care about us want us to be healthy, but catering to a child does not lead to healthy eating.

Instead, Ellyn Satter (see ellynsatterinstitute ) suggests offering a few “go to” foods that provide nutrition yet do not make you go out of your way. For example, most kids will eat your basic bread and butter, and will drink milk. If you are making meatloaf, potatoes and peas, don’t make a separate meal but have a basket of rolls or bread, a glass of milk and maybe some fruit. Let your child eat as much of these go to foods but do not give in and make that mac and cheese. Instead, have mac and cheese for a meal for everyone in the family once in awhile (we all like our favorite foods on the menu). If you do this along with the food scientist approach, it will be much more likely that your child will try something new. Again, this makes the dinner table a much more fun place to be.

Mistake #5: Forcing food, yelling, belittling, comparing or any other “not nice” behavior at the table. I have heard horror stories from parents about what they do to get their kids to eat. They literally have held down arms and stuck food in mouths (and you wonder why someone would hate sitting at the table?). Parents compare “your brother ate it, why can’t you?” They threaten “if you don’t eat, you won’t get dessert”. This of course could be it’s own mistake because holding back dessert to force a child to eat veggies just teaches them that something is wrong with veggies and sweets are the reward. This can stick with a person forever (when they grow up, have a job, and can afford to reward themselves whenever they want…..a big contributor to emotional eating).

Instead, set an example for your children regarding not only cooking and eating healthy food in a healthy manner (at the table, no TV, no electronics, etc) but also with using polite language. Don’t threaten. It is ok to remind children that it will be a few hours until snack time so be sure you had enough, listen to your tummy, etc. Involve children with menu planning, cooking, setting the table and clean up. Don’t use food for anything other than what it really is: something to enjoy and fuel us and keep us healthy so we can do fun things.

In the end, dinner times can create the most wonderful memories yet. Just keep it happy if you can. I miss those days with 3 kids chatting away around the table, then teenagers, and even the additional friends. It was a blast and even today, when I make certain foods, I think of them. Jen loved stuffed shrimp. Kara loved pesto pasta. Dan loved everything (beef stew for his friend Nick, banana pancakes for half the football team-rumor has it that I made the best of all the moms…just saying).

So start making precious memories of your own. The table is not the place for battles.

And I am going to keep trying beets. At least 13 more times.