My child won’t eat!

I hear from worried parents often that their kids won’t eat. There are many reasons for this. Usually as long as a child is hydrated, gaining weight appropriately, and getting a variety of nutrients, I’m not worried.

Some reasons kids don’t eat:

They’re really getting enough food, parents just have unrealistic expectations.

This is very common.

Portion sizes are smaller than many parents think. They vary with age and size of a child as well as his activity level. If your child is growing well and has plenty of energy throughout the day, why should he eat more?

Kids tend to eat small meals frequently and even on holidays they don’t overeat like the adults tend to do.

When offering snacks, think of them as mini meals to help balance out the nutrients of the day. Don’t let them snack all day long though or they’ll never really be hungry.

Schedule meals and snacks and allow water in between.

We have an obesity epidemic in this country, so if you’re comparing your child to another child, chances are that your thin child is healthy and normal, but the other one is one of the 30% who is overweight.

Or maybe not.

It doesn’t matter. Just be sure your child is getting a proper variety of nutrients. Parents can choose what foods are offered, but kids should determine how much to eat.

Talk to his doctor about growth at regularly scheduled well visits (more often if you’re concerned) to be sure it’s appropriate.

They’re sick and it’s temporary.

When kids are sick they lose their appetites.

This is normal.

It usually returns with a vengeance when they’re feeling better. They need to drink to stay hydrated and can eat what they feel up to it, but don’t force it. See their doctor if you’re worried.

It’s a new food and they just aren’t sure yet. 

I encourage that kids over 3 years old take one bite of a food.

Kids often hear me say, “taste a bite without a fight.” The bite needs to be enough that they taste it. If they like it, they can keep eating. If they don’t want more, resist trying to convince them to eat more.

Allowing them to take ownership of the decision of what to eat empowers them. Kids like power, right. Give it to them while modeling healthy eating behaviors yourself. They learn from what you do, not what you say — and not from what they’re forced to do.

When preparing a new dish, include familiar foods they like to balance out the meal so they can enjoy at least something on the plate.

They’re picky eaters.

Aren’t they all?

Most kids go through phases where they love a food, then they suddenly dislike it. They might dislike a certain texture or a whole food group. While there are kids with real problems eating, most picky eaters can be encouraged to eat a healthy variety of foods as described above.

Some children really suffer from being overly restrictive. Children with autism, sensory problems, food allergies, and other issues are not included in this “typical” picky eater category.

A great series of blogs on picky eaters (typical and more concerning) is found on Raise Healthy Eaters.

They’re more interested in something else. 

Make meals an event in itself.

Sit together and talk. Turn off the television. Put away your phone.

Have everyone focus on the meal, which includes the food and the conversation. Try to keep the conversation pleasant and not about the food. Take the pressure off eating!

They’ve filled up already.

If kids have access to snacks all day, they won’t be hungry for meals.

Make sure they have set meal and snack times, but no foods between. They’ll come to the table hungry if they haven’t snacked all day.

Some kids drink too much milk, juice, or other calorie-filled drinks. While it might seem that milk or juice are healthy, the reality is that they do not have a variety of nutrients that our kids need. Milk at least has protein, but it’s missing iron and other key nutrients. Juice is mostly sugar and really should be avoided. Don’t let your kids fill up on drinks.

When they’re hungry, they’re more likely to eat what’s offered.

A medicine makes them not hungry.

Some kids take medicines that decrease their appetite.

If your child is on one of these, their physician will need to follow their growth carefully, but it doesn’t automatically mean they shouldn’t take the medicine. Most kids can get the calories they need for healthy growth despite these medicines.

In summary…

In general, parents should choose what foods kids are offered so that there’s a balance of nutrients, but kids determine how much they eat.

If they’re hungry, they’ll eat. If they’re not hungry, they shouldn’t eat. Learning to eat when not hungry is something that causes many of us to struggle with weight. Most kids are able to limit intake to needs. Don’t force them to change that great quality!

If you’re worried about your child’s appetite, talk to your pediatrician. The physician will need to see your child to check the growth pattern and to examine him or her for signs of illness. Labs are usually not needed, but can be done if there are concerns for some medical conditions. Medicines are rarely used to stimulate the appetite.

For more, see my related blogs:

If your child doesn't eat as much as you think he should, check out this list of possible reasons.
If your child doesn’t eat as much as you think he should, check out this list of possible reasons.

Food Strike! What can I do when my child won’t eat anything anymore?

“What can I do to help little Sally eat? She used to eat everything, but now she hardly eats anything at all.” I call this a food strike, and it’s very common. But kids are smart, they won’t let themselves starve. The way you handle it as a parent can either encourage unhealthy eating or healthy eating.

Eat it or wear it.

This question always reminds me of the Judy Blume book, Tales of a Fourth Grade Nothing, one of my favorite books growing up.

The younger brother in the book, Fudge, refuses to eat. After many failed trials of bribing and forcing food, his father finally loses patience and says “eat it or wear it.”

Needless to say, Fudge ends up with the bowl of cereal on his head and goes around for days saying “eat it or wear it!”

I would not advise this approach.

When is a food strike a real concern?

Most of the time picky eating is a normal phase. Sometimes it’s simply that toddlers and young children don’t need as many calories because they’re not growing as fast as during infancy. Or it could be that they’re filling up with empty calories due to inappropriate snacking.

Of course there are some instances that are cause for concern.

Red Flags include:
  • Recurrent or persistent illness
  • Frequent vomiting or diarrhea
  • Food allergies
  • Very limited food types over an extended period of time
  • Problems swallowing or choking
  • Falling off growth curve
  • Sensory issues (trouble with textures, tastes, smells, and more)
  • Anxiety about eating or around foods
  • Body image problems

There is a great series of posts covering picky eating on a dietitian’s blog. Some articles are authored by a nutrition therapist. I will include some of my favorites below, but you can find them all on the site.

If you notice one or more of the red flags above, be sure to talk with your child’s pediatrician.

Encouraging healthy eating

If hungry, kids will eat. Don’t let them fill up on things that aren’t giving a nutritious balance. Even just milk all day can be harmful because it lacks many vitamins and minerals. A little milk with other foods is better!

Healthy food choices

Offer veggies, fruits, cheese, nuts, etc at scheduled snack times. Think of snacks as mini-meals. If kids are offered healthy foods at meals and snacks, they will eat them when they’re hungry.

Limit pre-packaged foods

Many prepackaged foods are preferred over fruits, vegetables, dairy products, nuts, and other healthier options.

If kids have a choice between cucumbers and hummus or a bag of chips, what do you think they’ll pick?

Healthy drinks

Limit drinks other than water and milk.

Drinks fill kids up and don’t offer balanced nutrition.

Limit milk to no more than 24 ounces per 24 hours.

Too much is overwhelming

Put only a small amount of each food on the plate. It might be overwhelming to have a full plate.

Different personality types can even respond differently to different plate sizes. See Children’s Personalities & Bowl Bias: Extravert and Introvert Children Are Not Equally Influenced by Plate Size!

Turn off the tv and put down the screens

Have a dinner conversation with the family. This not only sets up healthy eating habits, but also healthy family dynamics. Teens who eat with their families are less likely to have risky behaviors!

Set a good example!

Talk about how much you are enjoying the healthy foods at the table. (Not how healthy they are, but rather how good they taste.)

Keep foods separate on the plate

Kids might eat a food if it’s not touching another but refuse it if it’s contaminated.

Scheduled eating

Set a time for meals and stick to it. If your child doesn’t eat, clear the table.

When they complain of being hungry, don’t be condescending. Simply say, “I know how you feel. I’m hungry too when I don’t eat. Dinner is coming up soon. I’m sure you’ll be ready!” Don’t offer filler foods. Keep the discussion calm and without blame or judgement.

Kids are smart, they’ll pick up on the fact that they need to eat at meal time or be hungry.  They won’t starve to death!

Hide healthy foods

Puree a can of beets into spaghetti sauce. It makes a cool color without changing the flavor much at all.

Blend carrots, spinach, kale, or cauliflower into smoothies. I’ve even used frozen peas when there was nothing else. Strawberries, bananas, kiwi, and other fruits are much more flavorful than many veggies and kids tend to like their tastes. If your kids balk at the color, try to match the fruit and vegetable colors to hide the vegetable.

Puree onions, carrots, zucchini, spinach, and other vegetables in recipes rather than chopping them… kids won’t pick them out!

With all of these hidden foods, chances are they won’t even know they’re there.

Try foods in different forms

Frozen peas are crunchy– maybe they don’t like the squishy texture of cooked peas.

Raw broccoli is much different in taste and texture than cooked broccoli.

Many kids love cheese over vegetables or foods dunked in ketchup or yogurt.

It’s fun to eat with fingers for a change. Let them get messy!

Try cutting things into pieces and serve with toothpicks. Everything’s more fun on a stick!

Cut sandwiches with a large cookie cutter for fun shapes.

Use small cookie cutters for bite sized sandwiches or fruit pieces.

Take a look at Pinterest to find ideas on how to make foods fun if you really have a lot of time on your hands.

Rewards?

Try not to use food as a reward. This can set up unhealthy eating habits.

Don’t reward for eating. Most kids will get the intrinsic reward of satiety. They don’t need stickers or dessert for eating a meal.

Praise small steps

If kids try a new food (whether they like it or not) praise the fact that they tried!

Set realistic expectations 

Don’t expect kids to eat as much as infants/toddlers or teens/adults. Calorie needs go down when not in growth spurts. Just make the nutrition needs balance.

Don’t worry as much about volume as variety of healthy foods! Parents can decide what kids eat, but kids should decide how much to eat.

Most kids don’t need supplemental meals in a can (Pediasure and other brands) ~ they are getting the nutrition and calories they need, there is just an imbalance of perception of what they need.

I always prefer a healthy, active, thin child over a child who is overweight and not active (and often undernourished due to poor quality foods).

Will they get enough vitamins?

Vitamin supplement use and need is debated. It’s very difficult to study vitamin supplements. Baseline diet variations could make a big difference as to whether or not the supplement is needed. The time that needs to be studied is very long, because many health issues develop over many years. This means we need to wait a long time to see results and there’s a bigger potential that study participants are lost to follow up.

Vitamin D is one vitamin that I believe should be supplemented by all. Very few foods have vitamin D. Milk and a few other foods have been supplemented, but that alone will not give sufficient levels. Sunlight is a great way to raise vitamin D levels. But sunlight availability is unreliable and amounts needed vary based on skin type and quality of the light. Not to mention that sunlight can damage our skin.

In general I think it’s a good idea to give a multivitamin with iron if kids aren’t eating well. I prefer for them to get nutrients from foods, but if they refuse, then there’s no need for them to become deficient in nutrients. Iron deficiency actually causes anorexia, which increases the problem by not eating well!

If your family uses vitamins, be sure to lock them up as if they’re medications so kids don’t accidentally ingest too much.

Last thoughts

Most kids grow well during their picky eating and food strike phases. Just be patient and aware of any red flags that need to be evaluated.

If you are concerned, schedule an appointment to discuss foods, growth, nutrition, and concerns. Bring a typical food log of foods and drinks (with approximate volumes) for at least one week. Your physician can either identify a concern and develop a plan of action or reassure you that your child is normal!

Food strike! What do you do when your child stops eating?Resources:

How much food should I eat? (KidsHealth.org)

Choose My Plate 

How to Handle Picky Eaters (Zero to Three)

Picking Produce: Organic or Conventional- Does it matter?

Social media is great for making connections. I’ve followed Dr. Nicole Keller, a pediatrician who is passionate about sharing information about farming and food production. After several “conversations” I asked if she’d be willing to write a post for this blog to explain organic versus conventionally grown foods and she agreed. I learn a lot from her and others who share the science behind the foods. I hope you do too! ~ DrS

Raising kids is hard. There are so many decisions all the time. One of those daily choices comes in the form of what to feed your kids – and that happens 3 times every day (if not more)! Food choices are very personal decisions and with all the information (and misinformation) out there about food, picking the right options seems impossible.

As a pediatrician, I have a vested interest in kids’ health. But when I’m not a pediatrician, I’m also a farmer’s wife. My connections to agriculture and medicine have helped me navigate the food labels craze and I would like to help you do the same. I’m writing here to help you feel good about what you feed your kids based on sound evidence – no matter what the labels may say.

Organic versus conventionally grown foods. Does it matter?
Is organic food really healthier?

What type of produce should you buy?

Eating plenty of fresh produce is an important part of our diets – fruits and veggies should make up a large portion of our diets if we want to stay healthy.

The short answer to what type of produce you should buy is whatever you can afford and what looks good to you and your family – no matter how they were grown.

Lists like the Environmental Working Group’s “Dirty dozen” take data and skew results to unnecessarily and wrongly  scare consumers away from healthy produce options. There is no need to avoid any produce even if it makes one of these highly publicized lists.

For example, organic produce can only use certain growing methods and certain chemicals to be approved as organic (yes, organic can use pesticides – read on to learn more!).  Even so, a food can still qualify as organic if it has less than 5% of the EPA’s tolerance level for that pesticide (ie. if the tolerance level is 100, a level of 5 can be acceptable). In 2016, the EWG’s #1 dirtiest conventional produce (strawberries) met this 5% rule in 76% of samples where residues were detected. So 3/4 of the samples they claimed as “dirty” actually met measures to be considered organic.

The point here is that skipping produce because you fear its safety is much more harmful than eating even the “dirtiest” of these produce options on a regular basis.

Even so, it is hard to not to go to the store and look at the options and wonder if something that has a healthier looking label or a higher price tag is better.

So, do higher cost, fancy labeling or buzz words (i.e. “all-natural”, “organic”, etc) equate to more nutrition or safety? Read on to find out.

“What is organic? What is non-organic or conventional?”

Organic and conventional (non-organic) foods tell you how a product was grown.

Each type of farming has to meet standards for safety of their own.

Both organic and conventional farmers can use chemicals to help control pests. Pests come in the form of bugs, weeds, disease, or other things that negatively affect a crop.

Organic has their own list of approved pesticides as does conventional farming. Traditionally, conventional farming is allowed to use synthetic (lab created) chemicals where most organic pesticides are classified as natural (naturally occurring).

“Aren’t natural pesticides healthier because they already occur naturally?”

Not necessarily.  This “appeal to nature” or the “naturalistic fallacy” assumes if something is natural it is good. If it is unnatural it is bad. This is a common misconception.

Many natural things in our world can be dangerous: belladonna, poison mushrooms, cyanide, etc. These naturally occurring substances can cause great harm (or death) even though they have not been made in a lab.

What makes the difference is the dose.

With any chemical, natural or synthetic, dose makes the poison. Water can be deadly in the right amounts, yet it is necessary for life as well.

Additionally, pesticides created in a lab may be more fine-tuned – they can be made potent for the appropriate purpose but safe in other aspects.

We don’t get to dictate that with naturally occurring chemicals.

Less pesticide in organics

“Organic products have less pesticide though, right? And less pesticide residue must be better, right?”

Again, not necessarily.

In truth, 99% of the pesticides we consume in our diet are made by plants themselves! This means we consume a HUGE amount of naturally occurring pesticides made by plants on a regular basis.

Additionally, these naturally occurring compounds show similar (and sometimes worse) potential for toxicity when consumed.

Testing for all pesticides wouldn’t be helpful as plants make them as part of their typical life cycle and they can’t be avoided no matter how the plant was grown.

In regards to pesticide residue testing done by the USDA, traditionally, organic produce has shown to have less pesticide residue compared to conventional. The catch here is that those results only account for what the food was actually tested for.

At this time, many organic pesticides aren’t tested for the same way synthetic ones are tested for because they are assumed to be safe.

So does this mean synthetic occurring chemicals are assumed to be unsafe then because they are not natural? No, but, because of their synthetic creation they are held more accountable when testing is done. This increased accountability makes sure the synthetic pesticides created are being applied safely and leaving safe levels (if any) of residue.

Why use synthetic pesticides at all?

“If plants produce their own pest control naturally why can’t we just rely on that and not use synthetic pesticides at all?”

Sometimes the plant’s natural defenses just aren’t enough to combat certain pests.

When you have millions of people to feed around the world that is a big gamble to take.

One of the ways to help achieve a better guarantee of good crop yields is use of synthetic pesticides that were created to deal with specific crop-destroying pests.

How do we know the chemicals are safe?
How do we know the chemicals are safe?

This is where many consumers get nervous – “how do we know the chemicals we are creating won’t harm us somehow?”

Well, remember above we talked about being able to fine-tune chemicals by creating them in the lab?

This refinement is done with the help of expert scientists testing how the synthetic chemical works on the plant, breaks down, and what happens when ingested (by humans and even by other species like insects and pets).

Fine-tuning of chemicals in the lab allows us to adjust a couple things: effectiveness, dose needed, and side effects.

By being able to refine all these aspects, the result is a very effective chemical that can be used in small quantities while also having low toxicity.

For example, when glyphosate is sprayed on a crop, it is effective at very low doses – a volume of less than 2 pop cans diluted in water are applied on an area the size of a football field. The chemical also breaks down very quickly into non-harmful components (it is less toxic than baking soda!) leaving no harm to the crop, the soil, and no harm when ingested.

In contrast, an organic (naturally occurring) pesticide many times needs several exposures to achieve effects because it is not as “finely-tuned” as the synthetic version. Additionally, they may have more side effects that are out of our control.

Think of it like a sharpened razor versus a dull knife. Both may eventually cut, but with the sharp razor you can achieve your goal with one swipe and have clean edges where the dull knife needs several strokes and may also leave you with tattered edges.

Reducing chemicals

“I still don’t like that conventional produce has more pesticide residues. I want to reduce my chemical intake, period.”

The question to really ask yourself here is, “What do those residues mean in regards to my health?” Especially since you now know you’ll be ingesting residues whether you eat organic or non-organic foods.

For example, there are more carcinogens in a cup of coffee than in a year’s worth of produce consumption. So what makes the chemicals in coffee acceptable but the chemicals in produce so scary?

“Why am I afraid of these chemicals in particular?”

After all, everything in our world is a chemical – water is dihydrogen monoxide. Add an extra oxygen to that formula and it becomes dihydrogen dimonoxide which is commonly known as hydrogen peroxide.

Small change in the above mentioned chemicals means big changes if you tried to drink a glass of each! Both sound scary when using their chemical names too, but, when used appropriately, both can be used safely no matter how scary their scientific formulations sound.

We need not fear chemicals outright.

We should of course be careful of what we put in or on our bodies. The residues found on all types of produce are tested for annually by the USDA. These levels have been repeatedly shown to be well below that would cause harm in short or in long term exposures in your diet.

Dose makes the poison

The presence of small chemical residues below margins of safety mean consumption is safe.

Think of it like taking Tylenol for a headache. If you take the appropriate dose, you can help your pain but not cause harm.

You may find Tylenol residues in your blood or urine but the presence of those residues don’t mean your dose was harmful. Your body breaks down the medication and leaves no residual harm in the body.

Again, dose makes the poison and the “dose” of pesticide residues we may ingest in our diets have consistently been shown to be well below levels that will cause any harm.

All produce should be washed before eating (no matter how it was grown) to remove dirt, bacteria and other contaminants. But in regards to chemical ingestion, our food supply has been repeatedly shown to be safe no matter the option you choose to buy at the store.

Care of land and animals

Taking care of our earth is important.
What about the earth?

Some consumers may believe that organic farmers respect their land and animals more than conventional farmers – they buy organic to ensure products were raised responsibly and respectfully.

The truth is, farmers of all types want the best for their land, their crops and their animals. Not only is it their livelihood, it is also what is feeding their own families!

Badly cared for land produces poor crops.

Unhealthy or unhappy animals do not produce good meat, eggs or milk.

Additionally, the large majority of farms (over 95%!) are family owned and family run – these are real people with real investments in their products and their work.

Organic and conventional farmers alike want what’s best for their farms and the products they raise.

Hormones in cattle
Hormones in cattle from bestfoodfacts.org

Health and safety

“But organic raised meat, eggs and milk have been shown to be healthier and safer, right?”

In regards to hormones, antibiotics and nutrient content, organic and conventionally raised animal products are equal.

The labels you see regarding hormone and antibiotic use in animals are fairly pointless.

These labels help sell a product.  The consumer assumes the non-labeled product is somehow lesser.

Truth is, it is illegal to use hormones in chickens and pork. Hormone use in beef is rarely done nowadays and even when given there are no residues of this added hormone in the products we eat.

Naturally occurring hormones will always be in certain foods – meats are one of them – but not because a farmer added hormones while the animal was being raised.

To put this into perspective, there’s thousands more hormones in a serving of nuts (over 45,000 nanograms) as compared to a hormone implanted steer (3 nanograms) – both being in ranges that are safe to consume regardless.

Antibiotics are allowed to be used in conventional farming but not in organic. Even so, when an antibiotic is used, it is used with the animal’s best interest in mind (to treat an illness) and only when needed (when confirmed illness is present that the medication can treat).

Antibiotics are expensive and using them needlessly would be of no benefit. Beyond this, once an animal is given an antibiotic, they must go through a withdrawal period and tested prior to using that animal again.

Additionally, many farmers feel it is unethical to not allow an animal to get a medication when it is sick. So if we’re talking about responsible treatment of animals, this is a big point to consider. Ultimately, appropriate use of antibiotics only when needed in humans and animals is important goal for doctors and farmers alike.

In the end, ignore the labels about antibiotics and hormones in animal products. They are all safe and healthy and all must pass the same standards to be able to be sold in stores.

“What about the environment – is one type of farming better for mother earth?”

Great question.

Turns out both types of farming have their merits and both have their pitfalls.

You see, farming in itself isn’t natural, but, it is necessary to feed our population. If we didn’t work the land, it would just go back to what it was prior (grasses and weeds).

But, since we have to work the land, it is important for all farmers to take care of their land.

And guess what, farmers do care for their land – it is in their best interest to do so! If they didn’t take good care of their land, they wouldn’t get good crops.

At this time, with typical methods of farming, there isn’t one clear winner in regards to the environment.

In conventional farming,  modern technology has made farming so much easier and better for the earth. The use of refined synthetic chemicals (remember this allows us to use less chemical with less side effects) along with GMO crops (see below for more on this) allow conventional farmers to have more yield for less – this is great for responsible use of resources and guaranteeing enough product to feed the masses. Also, since conventional farming uses no-till farming more, there is less soil loss and run-off (organic typically needs mechanical weed control requiring tillage).

Organic farming on the other hand does tend to take more land to achieve the same yields as conventional farming. It therefore use more resources as well – these facts put organic farming at a disadvantage in regards to environmental impact.

Both types of farming can use crop rotation and integrated pest management to be conscious of the environment.

“I’ve heard GMOs are bad. I should avoid them, right?”

This is a myth that is SO important to debunk.

GMO Lettuce? www.foodinsight.org
GMO Lettuce? www.foodinsight.org

GMOs (genetically modified organisms) are products grown that were altered in the lab in some way.

This process is done with the help of expert scientists and takes time to perfect and test before it is brought to the public.

What it has allowed is for is helping crops to resist disease on their own, use of less pesticides, and making crops more hearty to survive harsh growing conditions.

GMOs are an amazing advancement in food technology and have already saved certain foods from existence – look up the rainbow papaya if you’re curious.

Currently, certain foods are facing extinction secondary to disease – such as banana wilt in bananas – but, if we can find a way to alter the plant’s genetics in the lab to resist this disease, we may continue to save these crops – and our food supply.

Additionally, in countries around the world many conditions could be prevented or halted with certain nutrients that may be hard to come by.

By adding nutrients to foods with genetic engineering, we can prevent disease. An example of this is added vitamin A in golden rice to prevent blindness.

So, in reality, GMOs are something to be celebrated, not feared. So please ignore the scary headlines and pesky “made with non-GMO ingredients” labels – GMOs are safe and should be supported.

“Which is more nutritious: organic or non-organic (conventional) food?”

This is pretty easy to answer actually: they are equal!

There are no nutritional or health benefits to either type of food. Research has shown this.

Some foods that are genetically modified can have added nutrients into them but if you don’t count these, conventional and organic foods are equally healthy. An example of this GM type of crop would be golden rice that has added vitamin A to help prevent blindness from nutritional deficiency.

Why is organic more expensive?

“So you’re telling me that the organic label is no healthier, can still use chemicals, doesn’t mean something was raised more responsibly and isn’t better for the Earth – then why the higher price tag?”

Organic farming traditionally requires more land and resources – this costs more.

Additionally, the organic label is what people perceive as better so they can charge a higher premium for those products.

In the end, in regards to nutrition, safety, the environment and respectful farming, the label doesn’t mean anything other than how it was grown.

The bottom line:

The next time you’re at the store wondering whether it’s worth the extra 30% cost (or more) to pay for organic products, you can feel better knowing what the label means.

Make sure to keep your family healthy with multiple types of foods in moderation with a diet rich in fruits and vegetables that you can afford and that look good to you.

Skip the label worry and buy what is fresh and tasty!

Wash all your produce prior to consumption.

If you still are concerned, talk to your farmers about their products or ask your grocer who they buy from.

You’ll likely find a family farm behind the choices at your grocery store who wants what is best for their family and yours too.

Happy eating!

Learn more about GMO and organic versus conventionally grown foods:

General buying considerations

Safety of Pesticide Use and Regulations

Hormones

Environment

GMOs

Health

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. (It’s here!)

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.

Learn to be mindful with eating in 6 Ways to Practice Mindful Eating.

Supplements for ADHD: Do Vitamins, Herbs, and Fatty Acids Work?

Parents often ask if they can treat their child’s ADHD without prescription medication. There are many alternative treatments in addition to prescription medications – some of which are more effective than others.  I will cover ADHD treatment with supplements today.

Supplements for ADHD – general

If you’re giving your kids supplements for any reason, be sure to tell their physician and pharmacist to avoid any known complications or interactions with other treatments.

Supplement use in general is gaining popularity. All you have to do is visit a pharmacy or specialty store and you will see various products marketed to treat ADHD.

There are some studies that show people with ADHD have low levels of certain vitamins and minerals. More studies are being done to determine if supplementing helps symptoms. There is growing evidence for vitamin supplementation, but there are no standard recommendations yet.

Should you use high dose vitamins?

Clinical trials using various combinations of high dose vitamins such as vitamin C, pantothenic acid, and pyridoxine show no effect on ADHD.

I don’t recommend high dose vitamin supplements unless a specific deficiency is identified. I don’t routinely screen for deficiencies at this time because there are no standard recommendations for this. We still have a long way to go before we know enough to make recommendations.

For children without a known vitamin deficiency, a standard pediatric multivitamin can be used, but effectiveness is not proven. I have no problems with anyone taking a multivitamin daily. However, I cannot recommend any specific brand since none of them are regulated by the FDA and there are many reports that show the label often misrepresents levels of what is really in the bottle. There have been instances of higher or lower than listed amounts of ingredients as well as unlisted ingredients in supplements.

My advice is to buy a brand that allows independent lab testing of their products if you choose to buy any vitamin or supplement.

Vitamins & minerals

The following is adapted from the University of Maryland Medical Center with the help of ADDitude Magazine and Natural Medicines Comprehensive Database.

Magnesium

Symptoms of magnesium deficiency include irritability, decreased attention span, and mental confusion.

Some experts believe that children with ADHD may be showing the effects of mild magnesium deficiency. In one preliminary study of 75 magnesium-deficient children with ADHD, those who received magnesium supplements showed an improvement in behavior compared to those who did not receive the supplements.

Too much magnesium can be dangerous and magnesium can interfere with certain medications, including antibiotics and blood pressure medications.

Talk to your doctor before supplementing with magnesium.

Vitamin B6

Adequate levels of vitamin B6 are needed for the body to make and use brain chemicals called neurotransmitters. These include serotonin, dopamine, and norepinephrine, the chemicals affected in children with ADHD.

One preliminary study found that B6 pyridoxine was slightly more effective than Ritalin in improving behavior among hyperactive children – but other studies failed to show a benefit. The study that did show benefit used a high dose of B6, which could cause nerve damage, so more studies need to be done to confirm that it helps.

If B6 is found to help, we need to learn how to monitor levels and dose the vitamin before this can be used safely.

Because high doses can be dangerous, do not give your child B6 without your doctor’s supervision.

Vitamin C

Vitamin C can help modulate the dopamine levels in the brain. Dopamine is a neurotransmitter that helps control the reward and pleasure centers in the brain.

Vitamin C can affect the way your body absorbs medications (especially stimulants for ADHD) so it is suggested to avoid vitamin C supplements and citrus fruits that are high in vitamin C within the hour of taking medicines.

Preliminary evidence suggests that a low dose of vitamin C in combination with flaxseed oil twice per day might improve some measures of attention, impulsivity, restlessness, and self-control in some children with ADHD. More evidence is needed before this combination can be recommended.

Vitamin D

Vitamin D is the one vitamin that is recommended to take as a supplement by many experts.

As we have gotten smarter about sun exposure, our vitamin D levels have decreased. Vitamin D deficiency has been linked to many problems, including ADHD.

Zinc

Zinc regulates the activity of brain chemicals, fatty acids, and melatonin. All of these are related to behavior.

Several studies show that zinc may help improve behavior.

Higher doses of zinc can be dangerous, so talk to your doctor before giving zinc to a child or taking it yourself.

Iron

Iron deficiencies commonly occur in children due to inadequate dietary sources since kids are so picky. Other causes include blood loss or excessive milk intake.

Iron is needed for the synthesis of dopamine, norepinephrine, and serotonin- all neurotransmitters in the brain.

Low iron has been linked to learning and behavior problems.

Too much iron can be dangerous, so talk with your doctor if you want to start high dose supplements. (Regular multivitamins with iron should not cause overdose if used according to package directions.)

If you’re using high doses of iron, it is important to follow labs to be sure the iron dose is not too high.

Essential fatty acids

Fatty acids, such as those found in fish, fish oil, flax seed (omega-3 fatty acids) and evening primrose oil (omega-6 fatty acids) are “good fats” that play a key role in normal brain function.

In a large review, Omega-3/6 supplementation made no difference in ADHD symptoms, but there are other benefits to this supplement and it carries little risk.

If you want to try fish oil to see if it reduces ADHD symptoms, talk to your doctor about the best dose. Some experts recommend that young school aged kids take 1,000-1,500 mg a day, and kids over 8 years get 2,000-2,500 mg daily.

For ADHD symptom control it is often recommended to get twice the amount of EPA to DHA.

L-carnitine

L-carnitine is formed from an amino acid and helps cells in the body produce energy.

One study found that 54% of a group of boys with ADHD showed improvement in behavior when taking L-carnitine. More research is needed to confirm any benefit.

Because L-carnitine has not been studied for safety in children, talk to your doctor before giving a child L-carnitine.

L-carnitine may make symptoms of hypothyroid worse and may increase the risk of seizures in people who have had seizures before. It can also interact with some medications. L-carnitine should not be given until you talk to your child’s doctor.

 

Proteins

Proteins are great for maintaining a healthy blood sugar and for keeping the brain focused.

They are best eaten as foods: lean meats, eggs, dairy, nuts and seeds, legumes, and fish are high protein foods. Most people in our country eat more protein than is needed.

If your child does not eat these foods in good quantity, there are supplements available. Talk with your doctor to see if they are appropriate for your child. Many of the supplements are high in sugar and other additives. Some have too much protein for children to safely eat on a regular basis.

Herbs

There are some studies supporting nutritional supplements or herbal medicines for ADHD, but many reported treatments have not been found effective.

Pinus marinus (French maritime pine bark), and a Chinese herbal formula (Ningdong) showed some support.

Current data suggest that Ginkgo biloba (ginkgo) and Hypercium perforatum (St. John’s wort) are ineffective in treating ADHD.

Summary

In general I think we all should eat a healthy diet that is made up primarily of fruits, vegetables, lean proteins, and complex carbohydrates.

If children are on a restricted diet due to allergy or sensitivities to foods or additives (or extreme pickiness), discuss their diet with your doctor. Consider working with a nutritionist to be sure your child is getting all the nutrition needed for proper growth.

If supplements are being considered, they should be discussed with your doctor. Talking about risks and benefits can help decide which are right for your child.


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.


Share Quest for Health

 

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!

 

 

Which Supplements Help Prevent and Treat Infections?

I don’t know anyone who wants to get sick, so most of us try our best to avoid illnesses. We do this by washing our hands and encouraging our kids to cover their coughs. Avoiding sick people as much as possible can help. We should routinely get enough sleep (most Americans fail in this regard) and eat more fruits and vegetables (again, most of us fail to get the minimum recommended amounts of plants in our diets). Can supplements help prevent and treat infections?

What will boost our immune system?

I’m often asked if vitamin C, zinc, or essential oils will help various ailments or boost our immune system.

I know that many people try natural products that are promoted to boost or support the immune system. They’re hopeful that stimulating immune system activity will help the body fight off a virus.

But research doesn’t show that our immune system works that way.

A virus can cause illness even in healthy people.

If you want to read an in-depth summary of how our immune system works, the Skeptical Raptor has done a nice job discussing the complexities and why it’s not as easy as eating healthy and taking supplements.

Not to mention the fact that we don’t necessarily want an overactive immune system, which is associated with allergies and autoimmune diseases.

Lacking regulation

One thing we need to remember first and foremost in the discussion of supplements is that this is an under-regulated industry.

The FDA is not authorized to review dietary supplement products for safety and effectiveness before they are marketed. For this reason I hesitate to recommend supplements at all.

Even though I do recommend Vitamin D supplements because studies support the need for additional Vitamin D in most people, I cannot endorse one particular product.

Over the years many supplements, homeopathic products and herbs have been reported to have significant variances in amounts of product and unnamed contaminants, including lead and other hazards.

Summaries of supplement and other “natural treatment” effectiveness:

Probiotics

Probiotics may actually help prevent the number of infections.

There are many, many types of probiotics, so further studies are needed on how to choose the best strain.

Zinc

Zinc has been shown to help prevent upper respiratory tract infections in children and teens and to decrease the duration of the common cold symptoms.

It is best given as a lozenge to help with absorption. Intranasal zinc has been linked to a permanent loss of smell and should not be used.

High doses can cause significant side effects, so talk to your doctor and pharmacist before supplementing.

Nasal rinses

Nasal saline rinses show benefit in treating symptoms of upper respiratory tract infections.

Learn how to do these correctly before trying it.

I often recommend Nasopure products as an unpaid endorsement. They’re a local company with a very helpful website. Use their library to learn how to properly use nasal rinses in kids as young as 2 years of age.

Honey

Honey may reduce the frequency of cough and improve the quality of sleep for children with the common cold.

Honey should never be used in children younger than 1 year of age because of the risk of botulism.

Echinacea

Echinacea has consistently been shown to be ineffective in many studies.

I know that many people have heard of its benefits, so if you aren’t convinced that you shouldn’t waste money on it, see the NCCIH’s Echinacea page.

Garlic

Garlic shows overall low evidence of benefit.

Vitamin C

Vitamin C can shorten the duration of illness mildly with daily supplementation.

Herbal Medicines

Chinese herbal medicines do not have high quality studies so effectiveness is unknown.

Geranium extract (Pelargonium sidoides) has insufficient evidence of benefit for cold and cough symptoms.

Turmeric‘s supposed anti-inflammatory properties have not been shown to be effective by research.

Essential oils

Essential oils have the potential for beneficial effects – but they also have the potential for adverse reactions.

Although they are touted as a cure for many ailments, published studies regarding the uses of aromatherapy have generally focused on its psychological effects on stress and anxiety or its use as a topical treatment for skin conditions.

Both Young Living and dōTERRA have received warning letters from the FDA about improper marketing and unsubstantiated claims for uses of their oils.

While many people think essential oils are safe, they can lead to significant problems.

Some people suffer from allergic reactions to oils.

They can increase sensitivity to the sun when applied topically.

Tea tree oil and lavender have estrogen-like effects and caution should be used with these.

Some of these substances can even lead to seizures, liver damage, and death if used improperly. Ingestion of the oils is a growing concern – as more households have them, more children are ingesting them.

For more:

Alice Callahan’s “Immune-Boosting” Supplements Won’t Protect You from Back-to-School Germs is a great review of many of the supplements touted to prevent or treat illnesses. Her background in nutrition provides a solid base for reviewing claims that many of us don’t understand completely.

Cautious use

Generally supplements are not recommended, but if you choose to use them, use them cautiously.

Read ingredients, but no guarantees

Supplements contain a wide variety of ingredients – including vitamins, minerals, amino acids, and herbs. Remember that these are unregulated, so what is on the package isn’t necessarily true.

Research has confirmed health benefits of some dietary supplements but not others. The woo can be strong in this area, so be cautious where you get your information.

Supplements have been known to include unlisted ingredients and to have inconsistent levels of product. When they are recalled, there is no mechanism in place to identify and notify people who have purchased affected products.

Learn from reliable sources

Find a reliable source to evaluate effectiveness and risks.

Some reports have shown that people who take supplements have higher risks of cancer, liver damage, birth defects, bleeding, and other health problems.

When looking for information, use noncommercial sites (National Institutes of HealthFood and Drug AdministrationUS Department of AgricultureNational Center for Complementary Health) rather than depending on information from sellers.

Natural does not mean safe

I’ve always said that I wouldn’t give my picky eater marijuana to stimulate his appetite and encourage him to eat. Not even if it was organic. That usually gets the point across. You need to know the risks of a product, even if it’s natural.

Talk to your doctor & pharmacist

If supplements will be taken, talk to your doctor and pharmacist about drug interactions.

Sometimes it’s difficult to know the risks because not all ingredients are included on the label and not all ingredients have been well studied, especially in combination with other supplements and medications.

Pregnancy

Most dietary supplements have not been tested in pregnant women, nursing mothers, or children.

Remember just because something’s natural doesn’t mean it’s safe. Arsenic is natural but I wouldn’t advise taking it in high doses.

If something sounds too good to be true, it probably is

There are no miracle cures.

Avoid being manipulated by advertising.

It’s easy to fall prey because we all want to feel better quickly and parents want their kids to be healthy.

But if it claims to be 100% effective or to have no side effects, it’s probably false advertising.

Personal accounts of something working are as likely to be based on bias or coincidence as to be from real benefit.

Rely on large clinical studies that have been reproduced by other researchers.

For more:

Dr. Chad Hayes has a very long, but wonderful post on how many of the integrative medicines are not simply not beneficial but potentially dangerous – Citations Needed: The curious “science” of integrative medicineMy experience at “Get Your Life Back NOW!”

A bit on antibiotics

This post isn’t about antibiotics, but they don’t work against viral illnesses any better than supplements.
They don’t prevent the development of ear infections or pneumonia, so even if your child seems to always develop these complications, your doctor should not prescribe them preventatively.
Don’t use antibiotics for routine upper respiratory infections, stomach bugs, and other viral illnesses.

Do you know what really boosts your immune system?

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