Starting Solids

Many parents are excited yet apprehensive about starting solids with their infants. So many questions… so many fears. Many food introduction guidelines have changed in recent years. What you did with your older kids might not be following current recommendations.

Back in time

I first published a version of this in 2011, and I still hear so much confusion.  It was actually Dr. Phil Boucher’s blog Why Is Introducing Baby Foods So Complicated?? that made me recall my blog and look to see when I wrote it.

Sadly, despite the time lapse of over 5 years, the American Academy of Pediatrics continues to have what I feel is a confusing message. On one line they say a baby may be ready at 4 months, then they say about 6 months. No wonder parents are still confused!

Starting solids
https://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/Switching-To-Solid-Foods.aspx

Parenting is hard

Yes, there are things about parenting that are hard. Watching kids hurt. Letting kids make mistakes without coming to their rescue and knowing when it’s time to step in. Sleepless nights with crying infants and sick children.

But there are times that parents make it harder than it needs to be. Not only with feeding, but I think parental anxieties bring us to over think too much. (Yes, I’ve been guilty of this over the years too.)

The stay at home moms are made to feel guilty that they aren’t showing their kids an independent female role model. But the working moms have the guilt of missing milestones and other events.

We have the Mommy Wars about breastfeeding and formula. If you don’t breastfeed, you’re made to feel guilty. Unless you breastfeed too long, then you’re made to feel guilty. If you use formula… never mind. This isn’t really about the Mommy Wars.

We need to stop inventing things to be guilty about. Stop trying to perfect parenting and just enjoy the moments. (And for those moments you can’t enjoy yet, like the poop all over the wall… wait for it to become a funny story to embarrass the older version of your toddler.)

Feeding “Rules”

Old Rules for starting solids

The older “rules” for starting solids were so confusing… different sources will vary on these rules.

  • Don’t feed before 6 months
  • Don’t give nuts, eggs, and other “allergy” foods until ___ (2/3/5 years, varying by expert)
  • Don’t start more than one food every 3-5 days
  • Start with rice and other whole grain cereals, then add vegetables, then meat. Save fruit for last.

Variations of this were plenty, depending on the provider’s preferences.

No wonder there is so much confusion!!!!

New Rules for starting solids

New rules are much easier.  I like easier.

  • Start healthy new foods between 4 and 6 months, when your baby shows interest and is able to sit with minimal support and hold the head up.
  • Don’t give honey until 1 year of age.
  • Don’t give any textures your baby will choke on.

Done.

That’s it. Nothing fancy.

Any foods in any order.

Nothing too salted. Try nutritious foods, not junk.

Common sense (and your baby’s response) will hopefully guide types of foods.

Don't make starting solids with your baby too difficult. When they're ready give healthy foods and follow a few rules.

What about food allergies?

Research does not support the thought that starting foods earlier lead to allergies.

In fact, there is research to support that starting foods, specifically peanuts, earlier might prevent food allergies. A full 180 degree change!

Pregnant women and breastfeeding mothers no longer have to avoid nuts or other allergy foods in most cases.

If there is a close family member with a food allergy, it might still be beneficial to wait to introduce that food. There may be a risk to the person with the allergy if Baby shares saliva laden with the allergen, and Baby might be higher risk of having a reaction. Of course, early introduction might help to prevent your baby from developing an allergy, so it is complicated. Talk with your pediatrician and possibly an allergist if a close family relative is allergic to foods.

I admit that I was initially nervous about telling parents it was okay to give nut products in infancy. Not just the allergy aspect, but also choking risks. Nuts are hard and round– two no-nos. Peanut butter is thick and sticky– another choking risk. I have a blog devoted to introducing peanuts safely.

Any of the more allergy prone foods should first be offered in small amounts at home. These foods include nuts, egg, and fish. Do this only if there is no one in your house who is allergic to that food. Have diphenhydramine allergy syrup around just in case, but remember most kids are NOT allergic, and starting younger seems to prevent allergy.

What about saving the fruit for last so they don’t get a sweet tooth?

Babies who have had breast milk have had sweet all along! Breast milk is very sweet, yet babies who are graduating to foods often love the new flavors and textures with foods.

Formula babies haven’t had the sweet milk, but they can still develop a healthy appreciation of flavors with addition of new foods.

I tend to find that most babies prefer bland foods initially. Vegetables, meats, and whole grains are pretty bland. Babies are not used to strong flavors, so they don’t like fruits or fruit juices. (I don’t recommend juice.)

Saving fruit for last simply doesn’t seem to make a difference for long-term flavor preferences.

Fruits should be added after or along with other foods to give a balance of nutrition.

The more colors on our plates, the healthier the meal probably is!

I thought they couldn’t have cow’s milk until after a year…

Cow’s milk is not a meal in itself (like breast milk or formula). It’s missing many vitamins and minerals, so babies need to continue breast milk or formula until at least a year. If they change to regular milk (whole, 2%, skim, organic or regular) they are at risk of nutritional deficiencies.

Milk products, such as cheese and yogurt can be given to babies as part of an otherwise well-rounded diet as long as they don’t show any allergy risks to milk. If they have allergies to milk products, talk to your pediatrician.

Regardless of dairy intake, it is recommended for infants under 6 months to have 400 IU Vitamin D/day and those over 6 months to take 600 IU Vitamin D/day as a supplement.

I thought they should have cereal first…

Rice cereal has been the first food for generations, probably because grandma said so.

There has never been any research supporting giving it first. With white rice and other “white” carbohydrates under attack now, it is no wonder the “rice first” rule is being debated. Despite being fortified with vitamins and iron, it is relatively nutrient poor, so choosing a meat or vegetable as first foods will offer more nutrition.

Shouldn’t we wait on meat?

Waiting on meat due to protein load was once recommended, but no longer felt to be needed.

Pureed meats (preferably from your refrigerator… baby food meats are not very palatable) are a great source of nutrition for baby!

Some experts recommend meat as the first food due to its high nutritional value and low allergy risk.

How do we recognize symptoms of allergy?

I know so many parents who worry about allergies that they hesitate to start foods.

First, most kids are not allergic.

Second, introducing foods earlier helps prevent allergies, so when parents wait due to fear, they are increasing risk.

Allergy symptoms can vary and often are not specific
  • dry skin (eczema)
  • runny nose
  • hives
  • swelling of lips
  • difficulty breathing
  • vomiting
  • diarrhea
  • blood in the stool

If your child has one of these reactions we can test to see what the offender was. While testing is possible, it is not always recommended.

For possible food reactions that are mild, such as eczema or runny nose, schedule an appointment to discuss this with your doctor.

Significant reactions of anaphylaxis, such as lip swelling, extensive hives, or difficulty breathing are rare, but deserve immediate evaluation and treatment.

When’s the best time for starting solids?

This question has many variations… Will foods help baby sleep through the night? If we start foods before 6 months will it cause obesity or diabetes? Does starting wheat lead to gluten sensitivity?

It’s also one of the most difficult to answer because the American Academy of Pediatrics isn’t clear in their recommendation (as shown above). The American Academy of Allergy and Immunology is a bit more clear, but is not where pediatricians look for guidance primarily.

Your baby may be ready for starting solids if he/she:
  • is at least 4 months of age (in term babies, later in premature babies)
  • has the ability to sit with minimal support and hold their head up
  • shows interest in food by reaching for it and opening mouth as food approaches

You can wait until 6 months to start foods, but some studies show poor weight gain and nutritional balance as well as resistance to foods if started after 6 months.

Starting foods before 4 months is associated with obesity and diabetes. In formula fed babies the risk of obesity increases by 6 times at 3 years of age if foods are started before 4 months of age. That risk is not seen in exclusively breast-fed infants or those who begin foods after 4 months of age.

It is still an old wives’ tale that starting solids will help baby sleep through the night. Babies tend to sleep longer stretches at this age, so it is no wonder that this myth perpetuates. Start foods because you see signs that baby is ready, not because you want longer sleep patterns!

How do I know how much to feed my baby?

Babies will let you know when they are full by turning away, pursing their lips, spitting out food, or throwing foods.

As they eat more food, they will need less breast milk or formula.  In general a baby who is gaining weight normally will self regulate volumes.

What’s better: baby foods bought at the store or home-made foods?

This is a common question, but I think it’s the wrong question. Homemade and store-bought foods can be either nutritious or not nutritious. It’s more important that it’s a healthy food. In general healthy foods are fruits, vegetables, legumes, nuts, eggs, meats, and whole grains.

Marketing and ease of preparation has made pre-prepared foods for us all common place. It does not mean they are any better. They cost more than home-made foods and often contain unhealthy additions, such as sugar.

I didn’t make baby foods when my kids were babies because I thought it would be too hard. As my kids got older, they started limiting vegetable  intake despite loving them when they were younger. I began to puree foods to put into recipes. It really isn’t hard.

Take whatever you’re cooking for your family and put the items in a food processor or blender before adding a lot of salt and spices. Add a little water, breast milk or formula to get it to a texture baby can eat. Voila! Home made food. There are of course many baby food cookbooks and online recipes. You can freeze meal-sized portions so you can make multiple meals at one sitting.

There is help for parents who want to safely prepare baby food at home on How to Make Your Own Baby Food from What to Expect.

Baby led weaning

Common questions about finger foods include:

  • My baby only wants table foods. Is that okay?
  • Don’t they need pureed foods first?
  • He doesn’t have many teeth! How can he eat foods?
What is baby led weaning?

Baby led weaning is a process of starting solids that allows babies to start finger foods and self feed.

There are many benefits to finger feeding. Babies use and develop fine motor skills while finger feeding. They can learn what the foods look like as they associate flavors and textures of various foods. You can also name the foods, so they learn vocabulary as they eat.

Baby needs to be willing and able

Pureed foods are what most babies start with due to the easy texture, but some babies want to feed themselves. If they are able to get the food in their mouth, move it to the back safely with their tongue, and swallow without choking, they are ready to feed table foods… at least with some textures. Beware of chewy or hard foods as well as round foods ~ these all increase the risk of choking.

You don’t need to wait for teeth!

Most babies will be able to eat table foods between 6 and 12 months. They tend to not have molars until after 12 months, so they grind with their gums and use all their saliva to help break down food. They need foods broken into small enough pieces until they can bite off a safe bite themselves.

Minimize choking risks

Don’t put the whole meal on their tray at once… they will shove it all in and choke! Put a few bites down at a time and let them swallow before putting more down. Rotate food groups to give them a balance, or feed the least favorite first when they are most hungry, saving the best for last!

This is a great time for parents, sitters, and other caregivers to take a refresher course on CPR in case baby does choke. Infants and young children are more likely to choke on foods and small objects, so it is always good to be prepared!

Don’t overdo spices, sugar, and salt

Avoid giving the exact same foods as the rest of the family. Babies should have limited salt and spices. More on honey below…

Read labels to see how much sugar is in packaged foods. Don’t add extra sugar, honey, or agave to their foods. They don’t need things sweetened!

Let them enjoy the real flavors of foods.

Want more information?

For more on baby led weaning, check out Sarah Remmer, RD’s blog, Baby-Led Weaning: 5 Things You Need to Know Before You Start

How much juice should my baby drink?

I think babies don’t need juice at all. They can practice drinking from a cup with water.

Juice adds little nutritional value and a lot of sugar, even if there’s no added sugar. Eating fruit and drinking water is preferable.

See New Juice Guidelines for the current AAP juice recommendations.

What about organic? 

This is a fantastic question, but you’ll have to wait for the next post to see the answer. I have asked a fellow pediatrician, Dr. Nicole Keller, to help with this common question. Stay tuned.

Be sure to sign up to receive new blog posts by email so you don’t miss the next post. This is easy to do under the “SUBSCRIBE TO BLOG VIA EMAIL” header. I promise to not overload your inbox or sell your information.

 

Distracted Eating

We all do it sometimes. We grab a snack and plop down on the couch to watch a movie. Before we know it the whole thing is gone. We only meant to eat some of it, but downed it in one sitting. That is distracted eating at it’s finest. It exemplifies the problem of eating without intention. Not eating because of hunger. Not even eating healthy foods usually. Just eating because it’s there.

What happened to sitting around the table and eating as a family without the tv or cell phones?

What is distracted eating?

I see many kids who always have distracted eating. Parents often worry that they’re not eating enough, but they’re typically getting too many unhealthy foods.

Distracted eating is eating when your mind is elsewhere. It’s the opposite of intentional eating, where we enjoy our meal and make smart choices about what and how much we eat.

It occurs when kids are distracted by a television or video game while eating. When any of us eat in front of the screen, we don’t focus on what goes into our mouth.

Or when parents allow kids to carry food around the house all day and take a bite here and there.

It can happen when any of us eat because it’s there and we aren’t listening to our body’s hunger cues.

Dream feeding

The youngest distracted eaters might fit into another category all together, but they certainly aren’t intentionally eating. These are the babies who parents “dream feed” – basically feed them while they’re sleeping.

This can be because parents think they don’t eat as much as they should when they’re awake. Or maybe parents want to get one more feed in before they go to bed so baby will let them sleep.

I know many parents rely on it, but I will never recommend it for many reasons.

  • It can disrupt their normal sleep cycles if you feed during periods of deep sleep.
  • Dream feeds also feed a baby who might not be hungry or need to eat. It’s hard to know when to stop.
  • After the first 4-6 months most babies don’t need to eat at night, but they are trained to eat at that time.
  • Once they get teeth it can increase the risk of cavities if they eat without brushing teeth before returning to sleep.
  • There are also risks of choking, though if they’re being held, it won’t go unrecognized. A parent can use CPR techniques to help them.

Constant snacking

As kids move into the toddler years, they often become picky with foods and eat small volumes. This is normal.

Parents need to offer healthy foods and feed small frequent meals. Think of snacks as mini meals so you will offer healthy foods – and no, goldfish crackers are not healthy foods. Young children tend to eat about six small meals a day. Each meal offer either a fruit or a vegetable and a protein to help ensure your child gets enough of these food groups daily.

Unfortunately, some parents solve the “problem” of kids not eating a lot at meal times by allowing them to carry around food all hours of the day. This might be cereal, crackers, milk, or whatever the favorite food of the week is.

This allows the child to snack all day, which means they’re never hungry, so they don’t eat at meal times. Parents will think it’s better than eating nothing, and even think that since it’s cereal or milk it’s healthy.

But it’s not.

Risks of constant snacking

  • Snack foods are usually highly processed and have little nutrition.
  • Constantly nibbling doesn’t allow the body to learn hunger cues.
  • Nibbling throughout the day doesn’t allow saliva to clean teeth between feedings, which increases the risk of cavities.
  • If kids drink excessive milk they are at risk of severe malnutrition. Parents argue that milk is healthy, but they are thinking of mother’s milk or formula for infants. Cow’s milk has protein, calcium, and other nutrients, but it is not a complete meal substitute. I have seen children need blood transfusions due to severe iron deficiency anemia from excessive milk intake. Blood transfusions. It can be that bad. Yes, your child might like milk. And he might refuse to eat at meal time. But if you keep giving milk he will never get hungry enough to eat the food offered.

Feed while watching tv

Other parents realize that kids will eat more if they feed the child, especially if the child is watching tv. This is wrong on many levels.

  • Once kids are able to feed themselves, it is a great skill to use. They work on fine motor skills when self feeding.
  • When offered healthy options, kids will eat when hungry and stop when full. When parents do the feeding, they keep pushing foods until the plate is empty. Many parents have an unrealistic expectation of how much food a child should eat and overfeed the child.
  • If a child is watching tv while eating, the focus is on the screen, not the food. Again, the child then doesn’t listen to hunger and satiety cues.

Self feeding is an important skill.

I see several kids each year who will be going to full day school for the first time and parents worry that they won’t be able to eat lunch because they never self feed. Many of these kids are overweight because they’ve been overfed for years yet the parents often think the child doesn’t eat enough.

Beyond the first birthday, most toddlers should be able to self feed. Many infants can do so even earlier. They don’t need a lot of teeth to eat small pieces of foods. Of course hard, round, chewy foods should be avoided for all young children, but most foods can be safely given to young kids at the table.

Don’t wait until your child is school aged to realize they’re behind on this important skill!

Family Meals

Eating together as a family is one of the best things you can do to raise healthy and independent children. As long as you use the time wisely.

If families eat while watching television or playing on smart phones or tablets, no one is connecting during the meal. No one is really enjoying the food or the conversation.

There are many studies that show the more often families eat together the less likely kids will develop obesity, get depressed, do drugs, smoke, and consider suicide.

Kids who eat with their families are more likely to eat healthy foods, do well in school, delay having sex, and have stronger family ties.

Help stop the habit of mindless eating.

Encourage eating at the table as a family as much as possible.

Offer healthy food choices and let everyone decide how much of each thing to eat.

If you worry that your child isn’t eating adequately, talk to your pediatrician.

We all do it sometimes. We grab a snack and plop down on the couch to watch a movie. Before we know it the whole thing is gone. We only meant to eat some of it, but downed it in one sitting. That is distracted eating at it's finest. It exemplifies the problem of eating without intention. Not because of hunger. Not even healthy foods typically. Just eating because it's there.

Resources:

MyPlate offers portion sizes for children, tips on healthy foods, activities for kids to learn about nutrition, and more.

If you’re a Pinterest fan, check out my Nutritional Sites and Getting Kids to Eat Vegetables and Other Healthy Stuff

Nutrition.gov has several resources for healthy eating.

Stanford Introduction to Food and Health looks very interesting. I haven’t taken the free online course yet, but another pediatrician friend highly recommends it.

Alternative Treatments for ADHD

I’ve covered why you should get your child evaluated for learning and behavior issues, who does the evaluations, and what the evaluation process involves in my previous posts. I’ve also covered specific diets and supplements. Today I want to talk about alternative treatments for ADHD. If parents aren’t ready to use medicines yet or if they want to supplement medications with additional treatments, there are many alternatives.

Natural treatments, psychological and occupational therapies, and complementary alternative therapy for the treatment of ADHD are available. Some of these are more effective than others.

Alternative Treatments

Nutritionalternative treatments for ADHD

Nutrition is very important for learning and behavior in all kids, not just those with a diagnosis of some sort. My next blog will be dedicated to more on components of nutrition and elimination diets, then the following blog will cover vitamins and supplements.

Behavioral Therapy

Behavioral therapy can be very effective to help manage the symptoms of ADHD. It is beneficial even for children who are medicated to help them learn to control behaviors over time.

Parent skills training provides parents with tools and techniques for managing their child’s behavior. Behavior therapy rewards appropriate behavior and discourages destructive behavior. This training has been shown to improve ADHD symptoms among children, but studies show it does not change academic performance when used alone.

Parent training teaches parents to interact differently with children to encourage desirable behavior. This is done by reinforcing good behavior and having set consequences for bad behavior.

There are several kinds of parent training that have been shown to be effective. These include Parent-Child Interaction Therapy (PCIT), Parent Management Training (PMT), Positive Parenting Program (Triple P).

Cognitive Behavioral Therapy (CBT) is a way to change thinking from negative to positive and focuses on finding solutions to current problems. It has been proven to be effective in the treatment of ADHD and other common issues, such as anxiety. CBT can help children learn techniques to control behaviors, screen thoughts before speaking, organize things, and more.

Initial treatment for ADHD in children under 5 years of age is behavioral therapy. Studies show that the best benefits for ADHD are a combination of medication and behavioral therapy for those over 5 years of age.

 

social skills group

Many kids with ADHD struggle socially. They tend to lag behind peers by a few years developmentally. Their impulsivity and inattention leads to poor behavior and trouble making good friends. They may also have trouble managing their emotions.

Joining a professionally run social skills group can help kids learn and practice important skills for interacting with others. Some school counselors can do this during school hours and many therapists offer groups outside of school.

School resources

Schools have various abilities in helping kids with unique needs. They can offer special seating (or standing desks), extra time for tests, fidget items, and other accommodations. To learn more about school resources, Understood.org has much needed information about what is available and what you can do to legally get accommodations with IEPs or 504Plans.

Exercise

Getting kids outside and moving has many benefits for all kids – including those with ADHD.

First, they are off all screens, which have been shown to increase aggressiveness and impulsivity.

Second, they are getting exercise. Studies show that when kids play outside their focus, attention, and behavior improve.

Exercise helps to elevate the same neurotransmitters that are increased with stimulant medications, which helps with executive functioning skills (sequencing, working memory, prioritizing, inhibiting, and sustaining attention).

Any exercise helps, but studies show the best are martial arts, ballet, ice skating, gymnastics, yoga, rock climbing, mountain biking, skateboarding, and whitewater paddling (I know not all of these are practical on a regular basis, but most are). These activities require sustaining attention, balance, timing, fine motor adjustments, sequencing, evaluating consequences, error correction, and inhibition.

Sleep

Sleep problems are common in many children, especially those with ADHD. Fixing the sleep cycle can have extreme benefits in learning and behavior.

Sometimes it’s as easy as getting a routine for sleep to ensure the proper number of hours for a child, but often they suffer from insomnia, nightmares, sleep apnea, restless leg, or other medical conditions that impair sleep time and/or quality.

Symptoms of chronic sleep deprivation in kids are hyperactivity, poor focus, and irritability. There are many kids who can have all of their ADHD symptoms relieved when they simply get better sleep. I see this in many teens who suddenly “develop ADHD”- only it’s really not ADHD at all. They are running on 4-5 hours of sleep a night. If your child has sleep troubles not improved with these Sleep Tips, talk to your child’s doctor.

Occupational Therapy and Sensory Training

There are many kids with ADHD who benefit from using techniques that occupational therapists use with sensory processing disorder (SPD). In some kids, SPD might be the real diagnosis causing symptoms of ADHD, but in others they may co-exist.

Treating SPD is usually fun for the kids, and there is no harm in doing their techniques even if a child doesn’t have the disorder.

Schools have started integrating these ideas into their classrooms as needed, such as having kids sit on stability balls or using tactile objects at their desks.

Therapy for SPD involves playing in ways that use sensory input (such as with sand or play doh, rolling down a hill, manipulating tactile objects, and more).

For a great list of ideas visit Sensory Integration Activities, but working with an occupational therapist is recommended.

Biofeedback and Neurofeedback

Biofeedback and neurofeedback are often not covered by insurance due to inconclusive evidence that they work. Children and adults with ADHD often have abnormal patterns of brain electrical activity on electroencephalographic (EEG) testing. EEG biofeedback is aimed at normalizing EEG activity by correcting the brain’s state of relative under-arousal and optimizing cognitive and behavioral functioning.

Neurofeedback trains kids to become more aware of their physiological responses and improve their executive functioning. Each neurofeedback session lasts 30-60 min and children usually need 10-20 sessions. Patients wear a cap that measures their brain activities, and it helps them train their brain to maintain focus during video games specific to this purpose.

The significance of most findings on neurofeedback and EEG biofeedback is limited by study design flaws that include small study sizes, heterogeneous populations, absence of a control group, inconsistent outcome measures, self-selection bias, and limited or no long-term follow-up. While this doesn’t mean they don’t work, I would like to see more studies showing their benefit. You might invest a lot of time and money only to find out it doesn’t work.

Working memory training

Working memory training has been shown in studies to help with symptoms of ADHD, though there are some conflicting studies out there.

Cogmed is the company that has studies showing benefit. It’s a computer program that kids play like a video game, but it reportedly trains their brain to remember things. Cogmed is intensive: 1 hour a day, 5 days a week for 5 weeks, but can be done at home. It can be expensive and is often not covered by insurance. About 70-80% of children show improvement immediately after the training, and of those who improved, 80% maintained the benefit over a 6 – 12 month window. Cogmed is designed to be used with medication, such as stimulants.

Herbs and other supplements

There are some studies supporting nutritional supplements or herbal medicines for ADHD, but many reported treatments have not been found effective. I will cover these in a separate blog.

ADHD Coaching

Just like anyone who needs help improving a skill, working with a coach with experience helping others in that area can be a big help.

Working with an ADHD coach can help many with certain aspects of their life. ADHD coaches can help with organization, motivate a person with ADHD to finish tasks, or help them learn techniques that makes them more effective at life skills.

Coaches do not do psychotherapy or counseling. This can be beneficial for people who are against therapy but need help to improve their skills.

It does not work if the parent makes the child go. The child must be motivated to make changes in his or her life and be willing to work on things, then coaching can be great.

Tips on finding an ADHD coach can be found on PsychCentral.

Mindfulness

I recommend mindfulness for many issues, especially anxiety (which often co-exists with ADHD). Mindfulness is thought to help with ADHD as well. It is a process of being focused on the present moment and is more fully explained on Understood.org’s Mindfulness page.

There are many free apps that can help kids (and adults) learn mindfulness.

No evidence exists for these treatments

There are many alternative treatments out there that do not have scientific proof that they help. Many parents try these treatment programs in hope that their child’s symptoms will go away.

In general, if it sounds too good to be true, it probably is.

Don’t be fooled into thinking “alternative” or “natural” treatments are without risk. There are always risks, including the lost time not being on a proven therapy, leading to a child falling further behind academically and suffering emotionally from symptoms related to ADHD.

“Train the brain” games 

There are claims that games designed to train the brain can improve memory, attention and other skills, but there is no research that supports this claim. Kids may get good at playing the game and seem to learn, but studies have found no improvements that generalize to their daily life or learning. For more, see what experts say about “train the brain games” for kids with ADHD.

Brain Balance has a center in our city, and I’ve seen more than a few parents who waste time and money on their program. I don’t know of any that noted significant and continued benefit. Although their website might look like there’s impressive evidence to use it, there really isn’t. Please see Science Based Medicine: Brain Balance for more information.

Caffeine

Caffeine is a stimulant but since it is available from grocery stores instead of pharmacies some parents feel more comfortable using it instead of a medication.

If you’re using it as a drug, it is a drug.

Whether it comes in a beverage or a pill, it is a chemical with properties that act like other drugs in our bodies.

Unfortunately studies don’t really support its use. It’s difficult to dose since it comes in so many forms, and most people develop a tolerance for it, requiring more and more, which can increase side effects.

For details, see Science Based Medicine: Caffeine for ADHD.

chiropractic medicine, Vision therapy, and Applied kinesiology

I have not been able to find any valid scientific studies for chiropractic medicine, vision training, and applied kinesiology for the treatment of ADHD.

Insurance usually does not cover these and they can be quite expensive. I do not recommend them.

Essential oils and aromatherapy

Essential oils are all the rage now. It seems they can cure everything if you do a quick online search. The problem is that research hasn’t shown that to be true. Dr. Chad Hayes does a good job of discussing what they are and why they aren’t recommended.

Remember…

There is no alternative medicine. There is only medicine that works and medicine that doesn’t work. ~ Richard Dawkins

If it stays alternative, that must say something. Once an alternative treatment is shown to work, it becomes a preferred treatment, no longer an alternative…

Things to consider when choosing treatment plans:

  • First, be sure your child is properly assessed to make the best diagnosis on which to base the treatment plan.
  • Natural isn’t necessarily safe. Evaluate all the risks and benefits known before making a decision. Even exercise (which is always recommended) comes with risks, such as injury and at times sleep problems due to scheduled activity times.
  • Talk with your doctor about any treatments you are doing with your child. Don’t forget to mention vitamins, supplements, herbs, brain training, therapies, etc.
  • Choosing one treatment doesn’t mean you are married to it. If response doesn’t prove to be beneficial, re-think your approach.
  • There is no cure for ADHD known at this time. If someone claims that they can cure your child, don’t buy into it.
  • Learn your costs. Does insurance cover it? Insurance companies often prefer certain treatments due to their cost and other factors. They also do not cover many treatments. Sometimes this is again due to cost, but other times it is because there is no evidence to show the treatment is effective. (Hint: This is a good clue to look at other treatments!)
  • Is the treatment something your child can do and is your family willing to put in the time? CBT is proven to help, but it doesn’t work if the child and parents don’t work on the techniques at home. Neurofeedback and Cogmed take many hours of treatment over weeks of time and are not guaranteed to work in all children.  Medications must be titrated to find the most effective dose that limits side effects. This requires frequent follow up with your doctor until the best dose is found.

Sources:

The ADDitude Guide to Alternative ADHD Treatment

WebMD: Attention Deficit and Hyperactivity Disorder: Alternative Treatments 

American Psychological Association: Easing ADHD Without Meds
Psych Central: Neurofeedback Therapy an Effective, Non-Drug Treatment for ADHD

Psychiatric Times: Integrative Management of ADHD: What the Evidence Suggests

Attention Deficit Hyperactivity Disorder: Diagnosis and Treatment in Children and Adolescents

Looking for more?

Many parents benefit from support groups to learn from others who have gone through or are currently going through similar situations, fears, failures, and successes. Find one in your area that might help you go through the process with others who share your concerns. If you know of a support group that deserves mention, please share!

ADHD

CHADD is the nationwide support group that offers a lot online and has many local chapters, such as ADHDKC. I am a volunteer board member of ADHDKC and have been impressed with the impact they have made in our community in the short time they have existed (established in 2012). I encourage parents to attend their free informational meetings. The speakers have all been fantastic and there are many more great topics coming up!

Anxiety

Many parents are surprised to learn how much anxiety can affect behavior and learning. To look for local support groups, check out the tool on Psychology Today.

Autism

The Autism Society has an extensive list of resources.

Dyslexia 

Dyslexia Help is designed to help dyslexics, parents, and professionals find the resources they need, from scholarly articles and reviewed books to online forums and support groups.

Learning Disabilities 

Learning Disabilities Association of America offers support groups as well as information to help understand learning disabilities, negotiating the special education process, and helping your child and yourself.

Tourette’s Syndrome and Tic Disorders 

Tourette’s Syndrome Association is a great resource for people with tic disorders.

General Support Group List 

For a list of many support groups in Kansas: Support Groups in Kansas .

School information

Choosing schools for kids with ADHD and learning differences isn’t always possible, but look to the linked articles on ways to decide what might work best for your child. When choosing colleges, look specifically for programs they offer for students who learn differently and plan ahead to get your teen ready for this challenge.

Midwest ADHD Conference – April 2018

Check out the Midwest ADHD Conference coming to the KC area in April, 2018. I’m involved in the planning stages and it will be a FANTASTIC conference for parents, adults with ADHD, and educators/teachers.

Midwest ADHD Conference
The Midwest ADHD Conference will be held in April 2018, in Overland Park, Kansas.

 

Special Diets for ADHD

Most of us have heard of the claims of cures for all sorts of ills, including behavioral problems (especially ADHD and autism) with simple dietary changes (with and without supplements). This post covers some diets for ADHD that have been recommended as treatments. Supplements will be covered tomorrow.

Why talk about diets for ADHD?

ADHD elimination diet, vitaminsFears of side effects from long-term medication or a history of medication failures cause families to look for alternative treatment options for child behavior issues. Diet modification and restriction is intriguing for parents since it fits into the ideal of a healthy lifestyle without added medicines and their potential side effects. However, there is a lot of controversy as to whether these restrictions help except in a small subset of children who have true allergy to the substance.

In general if a simple solution through diet was found, everyone would be doing it.

That just isn’t happening.

I do think that we all benefit from eating real foods — the ones that look like they did when they were grown, not processed and packaged. Fruits, vegetables, protein sources, whole grains, and complex carbohydrates should be the basis for everyone’s diet. It’s just good nutrition. But the direct effect of special diets on learning, behavior, and conditions such as ADHD is limited.

Natural does not equal safe.

When my kids were young and picky eaters I never would have considered stimulating their appetite with organically grown marijuana. While it is all natural (even organic!) and it might increase their appetites, it would have risks, right? In this case I don’t think the risks would outweigh the benefits. But so often parents think that if it’s natural, it’s healthier than something made by man.

Drugs have been tested. They have risks too, but those risks are a known. Some natural therapies have not been as thoroughly tested and they are not regulated, so the label might not correctly identify the contents. For this reason, I think that healthy foods are a great option for everyone, but I hesitate to recommend a lot of supplements, especially by brand.

Elimination diets

Over the years there have been many foods or additives that have been blamed for causing learning and behavioral problems. Some of the proposed problematic foods:

  • food dyes
  • refined sugars
  • gluten
  • salicylate and additives
  • dairy products
  • wheat
  • corn
  • yeast
  • soy
  • citrus
  • eggs
  • chocolate
  • nuts

I’m sure the list goes on, but I’ve got to move on. I’ll discuss some of the specific elimination diets and what evidence about each says.

Food additives

Food additives have been blamed for learning and behavior problems for many years. In 1975, Dr. Ben Feingold hypothesized that food additives (artificial flavors and colors, and naturally occurring salicylates) were associated with learning disabilities and hyperactive behavior in some children.

Since then many case reports of similar claims have continued to surface, but those do not have the same weight as a double-blinded control study. Most studies done in a scientific manner have failed to show a benefit.

It never hurts to eliminate artificial dyes and additives in your child’s diet. If it helps, continue to avoid them. But if no change is noted, don’t continue to rely on dye avoidance as a treatment plan.

GAPS Diet

Another elimination diet is the GAPS (Gut and Psychology Syndrome) diet, designed by Dr. Natasha Campbell-McBride.

She asserts that a wide variety of health problems  (autism, ADHD, schizophrenia, depression, and more) are from an imbalance of gut microbes. Not only has it not been proven to work, I worry that it restricts healthy foods, such as fruits, and kids will develop other problems on this diet.

I cannot go into details in this space, but for more information visit Science Based Medicine: GAPS diet.

Gluten

Gluten is in the news to be the base of many problems. It seems to be recommended to go gluten free for just about any ailment you can think of.

There are a subset of people who are really sensitive to gluten, and they benefit greatly from a gluten free diet.

But the large majority of people gain no direct benefit from this expensive and restrictive diet. One indirect benefit of the diet previously was that it was nearly impossible to eat pre-packaged and processed foods, which leaves real fruits, vegetables, and other high quality foods. As more people are going gluten free there are more pre-package products made gluten free. I wonder if the benefits people have noticed previously will wane when they eat these foods.

Talk with your doctor before deciding if going gluten free will work for your child.

Sugar

Sugar is often blamed on hyperactivity. By all means, no child needs extra sugar, so cut out what you can.

Well controlled studies did not find a behavioral difference in kids after refined sugars.

Interestingly, parents still perceived a change (despite researchers finding none) in at least one study by Wolraich, Wilson, and White. 1995.

Food allergies

Food allergies are now commonly thought to be related to behavior and learning problems.

In some children with true allergies, foods can affect behavior. However, most children do not have food allergies and avoiding foods does not alter behavior. It can be challenging to determine if there is a food allergy since some of the tests offered are not reliable.

Elimination Diets Final Thoughts

In a small subset of kids food avoidance helps, but in the large majority studies do not support avoidance of foods.

If you think your child benefits from avoiding one or two foods, it probably isn’t a big deal to restrict those foods.

But if you suspect your child is allergic to everything under the sun, you will need to work with your doctor and possibly an allergist and a nutritionist to determine exactly what your child must avoid and how they can get all the nutrients they need to grow and develop normally.

Next up: Supplements for ADHD

Stay tuned for a summary of supplements on ADHD – what’s been proven to work and what hasn’t!

Weight is Weighing on My Mind

Too much sugar is causing an epidemic of obesity in our kids. Even the ones who aren’t overweight are often less healthy due to food choices. Excess sugar consumption over time is linked to many health issues such as high cholesterol, diabetes, metabolic syndrome, and it can trigger earlier puberty – leading to overall shorter adult height. Not to mention the psychological and social implications of bullying, depression, eating disorders, and more.

Back in the day…

Why is weight so much more of a problem now than it was years ago?

As a child I did not have a perfect diet, yet I was not overweight (and neither were my classmates) because we spent most waking moments outside if we weren’t in school.

My mother packed a dessert in every lunch box. We ate red meat most days. My mother usually put white bread and butter on the table at dinner. I drank 2% milk and ate ice cream every night.

But we walked to school– without a parent by the time I was in 1st grade. (gasp!)

There were only a couple tv channels, and Saturday morning was the only time we could watch tv.

We were able to ride bikes, go to a wooded area, play on a nearby playground, dig in the dirt, you name it – we found something to make it fun!

Update: I just read a fantastic blog from Dr. Alison Escalante that shows beautifully how she and her siblings were able to explore and learn as kids. Take a look at The Summer of No TV: Why Boredom Breeds Creativity Part 1.

Why is weight so much more of a problem now than it was years ago?
unhealthy foods
Childhood obesity is a growing problem. Kids need to eat healthy and move daily.

I think it’s a combination of what they’re eating and what they’re doing.

Today’s kids are shut up in the house after school watching one of many tv channels or playing video games.

Even those who are shuttled to activities get overall less exercise because it is structured differently than free play. They ride in the car to practice or class, then sit and wait for things to start. They might sit or stand while others are getting instruction.

Simply put: They eat a lot of processed and junk food and they don’t get to do active things at their own pace with their own creativity for as long as they want.

Shouldn’t we worry about them getting hurt?

I know parents are worried that their kids will get hurt or abducted if they play outside with friends, especially if they go out of sight from a parent. But I think in some ways we’re killing our kids slowly by allowing unhealthy habits to kick in.

The reality is that most kids won’t get hurt if they’re playing. Yes, some will. But if they play video games all day, they won’t get injured. They are likely to have long term problems though.

I’m seeing adult problems in young kids, such as Type 2 diabetes, high cholesterol, non-alcoholic fatty liver disease, hip/knee problems, and more. The poor kids who are overweight have the potential to suffer long term consequences.

What to do???

On one hand kids need to learn to make healthy choices to maintain a healthy body weight for height, but on the other hand you don’t want to focus so much on weight that they develop eating disorders. I think this is possible if we focus on the word “healthy” – not “weight”.

Starting at school age I ask kids at well visits if they think they are too heavy, too skinny, too short, or too tall. If they have a concern, I follow up with something along the line of, “How would you change that?” I’m often surprised by the answers, but I can use this very important information to guide how I approach their weight, height, and BMI. We talk about where they are on the graph, and healthy ways to either stay in a good place or how to get to a better BMI.

I focus on 3 things we all need to be healthy (not healthy weight, but healthy):

  1. Healthy eating (eat a plant and protein each meal and snack)
  2. Exercise (with proper safety equipment but that’s another topic!)
  3. Sleep (again, another topic entirely!)
Food is a part of our daily needs, but much more than that.

It’s a huge part of our lifestyle.

We have special meals for celebrations but on a day to day basis it tends to be more repetitive.

We all get into ruts of what our kids will eat, so that is what we prepare. The typical kid likes pizza, nuggets, fries, PB&J, burgers, mac and cheese, and a few other select meals.

If we’re lucky our kids like one or two vegetables and some fruits. We might even be able to sneak a whole grain bread in the mix.

If our family is busy we eat on the run– often prepared foods that are low in nutrition, high in fat and added sugars, and things our kids think taste good (ie things we won’t hear whining about).

We want our kids to be happy and we don’t want to hear they are hungry 30 minutes after the meal is over because they didn’t like what was served and chose not to eat, so we tend to cave in and give them what they want.

We as parents need to learn to stop trying to make our kids happy for the moment, but healthy for a lifetime.

There’s often a discrepancy between the child’s BMI (body mass index) and the parent’s perception of healthy.

The perception of calorie needs and actual calorie needs can be very mismatched. I have seen a number of parents who worry that their toddler or child won’t eat, so they encourage unhealthy eating unintentionally in a variety of ways:

  • turn on the tv and feed the child while the child is distracted
  • reward eating with dessert
  • refuse to let the child leave the table until the plate is empty
  • allow excessive milk “since at least it’s healthy”
  • allow snacking throughout the day
  • legitimize that a “healthy” snack of goldfish is better than cookies
Any of these are problematic on several levels.  Kids don’t learn to respond to their own hunger cues if they are forced to eat.  
If offered a choice between a favorite low-nutrition/high fat food and a healthy meal that includes a vegetable, lean protein, whole grain, and low fat milk, which do you think any self-respecting kid would choose?
If they’re only offered the healthy meal or no food at all, most kids will eventually eat because they’re hungry.
No kid will starve to death after 1-2 days of not eating.  
They can, however, over time slowly kill themselves with unhealthy habits.  

So what does your child need to eat?

Think of the calories used in your child’s life and how many they really need.  Calorie needs are based on age, weight, activity level, growing patterns, and more.
It’s too hard to count calories for most of us though.
If kids fill up on healthy options, they won’t be hungry for the junk.
Offer a plant and a protein for each meal and snack. Plants are fruits and vegetables. Proteins are in meats, nuts, eggs and dairy.
Don’t think that your child needs to eat outside of regular meal and snack times.
One of my personal pet peeves is the practice of giving treats during and after athletic games. It’s not uncommon for kids to get a treat at half time and after every game. Most teams have a schedule of which parent will bring treats for after the game.
Do parents realize how damaging this can be?  
  • A 50 pound child playing 15 minutes of basketball burns 39 calories.  Think about how many minutes your child actually plays in a game. Most do not play a full hour, which would burn 158 calories in that 50 pound child.
  • A 50 pound child burns 23 calories playing 15 minutes of t-ball, softball, or baseball.  They burn 90 calories in an hour.
  • A non-competitive 50 pound soccer player burns 34 calories in 15 min/135 per hour. A competitive player burns 51 calories in 15 min/ 203 in an hour.
  • Find your own child’s calories burned (must be at least 50 pounds) at CalorieLab.
Now consider those famous treats at games.
Many teams have a half time snack AND an after game treat.  Calories found on brand company websites or NutritionData:
  • Typical flavored drinks or juice range 50-90 calories per 6 ounce serving.
  • Potato chips (1 ounce) 158 calories (A common bag size is 2 oz… which is 316 calories and has 1/3 of the child’s DAILY recommended fat intake!)
  • Fruit roll up (28g) 104 calories
  • 1 medium chocolate chip cookie: 48 calories
  • Orange slices (1 cup): 85 calories
  • Grapes (1 cup): 62 calories
  • Apple slices (1 cup): 65 calories

So…Let’s say the kids get orange slices (a lot of calories but also good vitamin C, low in fat, and high in fiber) at half time, then a fruit drink and cookie after the game. That totals about 200 calories.

The typical 50 pound soccer player burned 135 calories in a one hour game. They took in more calories than they used.

They did get some nutrition out of the orange, but they also ate the cookie and fruit drink.

The cookie has fewer calories than other options but no nutritional value and a lot of added sugars.

The kids end up taking in many more calories than they consumed during play.

Water

What’s wrong with WATER? That’s what we should give kids to drink at games.

They should eat real food after the game if only they’re hungry.  Snacks are likely to decrease appetite for the next meal, so if they’re hungry give a mini-meal, not a sugar-filled, empty calorie treat every game.

There are many resources on the web to learn about healthy foods for both kids and parents. Rethink the way you look at how your family eats.

Simple suggestions:

      • Offer a fruit and vegetable with a protein at every meal and snack. Fill the plate with various colors! (As I tell the kids: eat a plant and a protein every time you eat ~ meals and snacks!)
      • Picky kids? Hide the vegetable in sauces, offer dips of yogurt or cheese, let kids eat in fun new ways – like with a toothpick. Don’t forget to lead by example and eat your veggies!
      • Buy whole grains.
      • Choose lean proteins.
      • Don’t skip meals.
      • Make time for sleep.
      • Get at least 60 minutes of exercise a day!
      • Eat together as a family as often as possible.
      • Turn off the tv during meals. Don’t use distracted eating!
      • Encourage the “taste a bite without a fight” rule for kids over 3 years. But don’t force more than one bite.
      • Don’t buy foods and drinks with a lot of empty calories. Save them for special treats. If they aren’t in the home, they can’t be eaten!
      • Drink water instead of juice, flavored drinks, or sodas.
      • Limit portions on the plate to fist sized. Keep the serving platters off the table.
      • Eat small healthy snacks between meals. Think of fruit, vegetable slices, cheese, and nuts for snacks. I tell kids all the time: eat a plant and a protein every time you eat – both meals and snacks. Think of snacks as mini-meals!

 

 

Lead by Example

We’ve all heard the saying: kids will do what they’re shown, not as they’re told. Lead by example.

It’s so true. Think about all the times your kids are watching you. They are learning from you.

What can you do to help them have healthy habits?
  • Eat your vegetables.
  • Get daily exercise.
  • Wear your seatbelt.
  • Stop at stop signs.
  • Don’t use your phone while driving.
  • Wear a life vest near a lake or river.
  • Maintain your composure during times of stress.
  • No phones at the dinner table.
  • Don’t tell lies- even little ones.
  • Get enough sleep.
  • Be kind to others.
  • Call home- your parents and siblings would love to hear from you.
  • Don’t permit violence in your presence.
  • Give your time and talents to others.
  • Take care of your things.
  • Limit screen time.
  • Brush your teeth at least twice a day and floss daily.
  • Wear a helmet when on a bike.
  • Don’t mow the lawn without proper shoes.
  • Make time for family.
  • Lead by example every day!

 

helmets, exercise
Exercising together safely as a family sets great lifelong habits!

New Juice Guidelines!

Juice that comes from fruit is not the same thing as eating fruit. It’s missing the fiber and even the feeling of fullness that comes from eating foods rather than drinking. Too many kids drink excessive juice, which fills them with empty calories and can contribute to obesity and tooth decay. The American Academy of Pediatrics has updated their juice guidelines to help families limit juice intake to more appropriate amounts.

How much juice should kids have?

  • Juice is not recommended at all under 1 year of age in the new guidelines.
  • Toddlers from 1-3 years can have up to 4 ounces of 100% juice a day.
  • Children ages 4-6 years can have 4-6 ounces (half to three-quarters of a cup).
  • Children ages 7-18 years can have up to 8 ounces (1 cup) of 100% fruit juice as part of the recommended 2 to 2 ½ cups of fruit servings per day.

General tips and tricks:

100% juice

Offer only 100% juice if you’re giving juice at all. Fruit flavored drinks are not the same thing as juice.

Water

Water is always healthy!

If your kids want it flavored, cut up fruit and put it in the water.

There are many recipes online to get ideas, but kids don’t need anything fancy – just put cut up pieces of their favorite fruit with water in a glass container. Put the container in the refrigerator for 2-4 hours and then pour the infused water into their cup without the fruit (which could pose a choking risk). The infused water will stay fresh in the refrigerator for up to 2 days.

Water bottles

Some kids like to start the day with a frozen water bottle. Simply put a 1/2 to 3/4 full water bottle in the freezer overnight – don’t fill it too much because ice expands! Add a bit of water in the morning to help it start melting so it’s drinkable when they want a sip. Adjust the amount of water to freeze as needed depending on how insulated your water bottle is.

water it down

If your kids demand more than the recommended amount of juice for their age per day, water it down. By mixing water (or sparkling water for a bit of zip) with juice, you decrease the amount of sugar in every serving. You can give 1/2 the recommended daily maximum amount of juice with water twice and still stay within the daily limit.

Never let kids drink juice out of a bottle

Kids tend to drink more volume when it’s in a bottle. Infants who take bottles are too young for juice anyway. As they get into the toddler years, transition onto cups.

Bedtime!

Never put kids to bed with juice. They should brush teeth before bed and be allowed only water until morning.

Pasteurization

Offer only pasteurized juice. Unpasteurized juice can cause severe illness.

Real fruit

Give kids real fruits and/or vegetables with every meal and snack.

Make smoothies!

Putting fruits and vegetables in a blender to make a smoothie is a great way to give the full fruit or vegetable instead of juice.

Consider adding plain yogurt**, chia, flax, oats, nuts, and other healthy additions to increase the nutritional components of the smoothie! **Flavored yogurts often have added sugars. Look for just milk and cultures in your yogurt.

Juice box: not recommended!

Most juice boxes have more than a day’s supply of juice. Don’t use juice boxes. Offer juice in cups so you can limit to the age appropriate amount.

What about organic?

Organic juice is not healthier than other juice. Many parents presume it has less sugar or more nutrients, but it doesn’t.

Vegetable juice

Vegetable juices may have less sugar and fewer calories than in the fruit juice, but are often mixed with fruit juices so you must read ingredients. They also lack the fiber of the actual vegetable, so eating the vegetable (or pureeing veggies into a smoothie) is healthier.

Read labels

Beware of labels that look like juice but aren’t 100% juice.

The label might say “juice cocktail,” “juice-flavored beverage” or “juice drink.”

Most of these have only small amounts of real juice. Their main ingredients are usually water, small amounts of juice, and some type of sweetener, such as high-fructose corn syrup.

Nutritionally, these drinks are similar to most soft drinks: rich in sugar and calories, but low in nutrients. Avoid them.

Sports drinks?

Sports drinks are not healthy substitutes for water.

They are sugar-sweetened beverages that contain sodium and other electrolytes. Unless one is doing high intensity exercise for over an hour (such as running a marathon, not playing in a baseball tournament), water and a regular healthy diet provide all the calories and electrolytes we need.

water (again)

Water’s the best drink for our bodies.

Buy fun reusable water bottles and challenge your kids to empty them throughout the day.

The old rule of “8 cups a day” is outdated, but we should get enough water (from the water content in foods + drinks) to keep our urine pale.

We need more water when it’s hot, when we exercise, when we’re sick and when the air’s really dry.

Once we feel thirsty we’re already mildly dehydrated, so drink water to prevent dehydration.

juice guidelines
The AAP’s 2017 Juice Guidelines

 

Nutrition for the Picky Eater

I am frequently asked about how to get kids to eat, especially about how to ensure healthy nutrition for the picky eater.

A few quick “rules” to healthy eating

Don’t offer junk

Don’t make it easily available at home… most kids can’t drive to the store!

Hungry kids will eat what’s offered

Let them get hungry between meals. No grazing.

Use snacks

Not every food group will be eaten at every meal, so use the day to space foods to incorporate a range of nutrition over time.

Think of snacks as mini-meals.

Keep meal time fun

Turn off the tv and have a family conversation about something other than the food.

Plant + Protein

Offer a “plant and protein” every meal and snack to get kids to the 5 a day of fruits and veggies and to give a protein for “staying power”.

This also fills kids up with the good things so they aren’t hungry for junk.

Try it

Enforce “Taste a bite without a fight” after 3 years of age.

Kids should at least taste a bite before they decide if they like it or not.

Forcing more than the bite might cause more problems, so start with just a bite.

Hide it

It’s okay to be tricky and fun: add pureed vegetables to things, use yogurt or hummus dips, put food on a stick, arrange food into fun shapes, be creative.

Limit juice

Juice is not a food. It is mostly sugar – even if it’s 100% fruit juice.

Offer the fruit instead. It comes with more benefits than the juice alone!

Videos

This is my first attempt at adding video to my blog.

I apologize for the tilted view… it looked straight on my camera! YouTube limits the length to 10 minutes, and I ended up at 11 minutes, so it is broken into two shorter segments.

Part 1:

Part 2:
Resources mentioned at the end:

My Pinterest page has several boards with recipes and nutritional information, in addition to other kid-friendly ideas! (Warning: if you don’t use Pinterest, it can be addictive. Tons of great project ideas and recipes, educational sites, and other time wasters…)

Kids Eat Right: The Academy of Nutrition and Dietetics’ page on scientifically based health and nutrition information you can trust to help your child grow healthy.