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.

What is a Bone Age?

 

Bone age is helpful in assessing a child who is shorter or taller than predicted based on parent heights or if a child has early or late pubertal changes. It’s simply an x-ray of the child’s hand and wrist. It involves minimal radiation and doesn’t hurt. The bone age can help us approximate how much longer a child will grow and the expected height, but does not tell us why a child is shorter or taller than expected or hitting puberty at an unexpected age.

bone age can help identify final heightBone age is difficult to understand, and I hope this helps parents understand with some pictures.

I completely made up these growth charts. They do not reflect any real patient or any real diagnosis. They are solely to illustrate how we estimate the bone age on the growth chart to help assess final predicted height.

The reasons behind altered growth patterns are many and might require further evaluation.

Delayed bone age

A delayed bone age means that the bones think they are younger than the child actually is.

This can mean catch up growth after peers have stopped growing.

A delayed bone age can happen for many reasons, but a common one is due to late puberty and can run in families.

A history, physical exam and possibly labs can help asses the reason for delayed bone age.

Advanced bone age

If a child has an advanced bone age it means the bones appear older than the child’s actual age.

With this we expect them to stop growing earlier than most kids.

This means that even if they are tall for their age, they could end up shorter than average.

Advance bone age is often associated with early puberty and childhood obesity.

An advanced bone age needs further evaluation to identify the cause.

Normal bone age

If the bone age equals the actual age, you can estimate the final height to be about the same percentage as the current height.

We often repeat bone ages to see if they are changing at a different rate than the child grows.

How’s a bone age determined?

Radiologists and endocrinologists use books with x-rays of standard bones of various age groups to assess which age the child’s x-ray most closely resembles.

Since there are different bones that can develop at different rates, it is possible that two doctors will assign a different bone age.

It is not an exact science, but can give a good estimate of how much longer a child may grow.

The photo above is from Amazon’s bookstore. You can see how the bones of the youngest hand on the left are very different from those in the hand on the right. The radiologist or endocrinologist finds the image that is most like the child’s x-ray and call it that bone age.

How to read a growth chart

In the boy growth charts pictured below, the top set of lines is the height (stature) for age chart. The bottom set is the weight chart.

Hopefully these looks familiar because you’ve seen a graph like this at your child’s doctor. If you haven’t, be sure to ask to see it next time you’re there.

The ages that are used to plot a height and weight at a given time are listed at the top and bottom.

The heights and weights are listed on the right and left of the respective graph. I only marked the height graphs for the purpose of this blog.

The middle line is 50%, which reflects a height of 50% (taller than half/shorter than half of boys of the same age). The other lines are also labeled for their respective height percentiles on the far right.

What is normal on a height chart?

There are many “normal” heights, usually determined by genetics.

Tall parents tend to have tall kids, short parents have short kids.

There is no “correct” height or “best” height, the percentiles simply give us a way to follow the growth over time and estimate final adult height if a child hits puberty at a typical age (early puberty stops the growth early, late puberty allows for later growth).

Figure 1: Growth delay

In Figure 1, I filled in a fictitious child’s heights with blue dots.

Reading the chart

You can see that from 3 to 5 years this boy was at the 50th percentile for height. That means he was taller than half the boys his age and shorter than half. The fact that he’s in the middle doesn’t make it “normal” it just means that if his parents are average height, he is growing as expected because it’s consistent year to year and he is of average height like his parents.

At 6 years, he dropped to the 25th percentile, and at 8 years he fell to the 10th percentile. This consistent drop in growth often triggers a physician to look for reasons of the drop.

The red arrow on the right marks the actual height at 8 years (blue) at about 47 inches (120cm).

For this fictitious child, the bone age is 7 years, and if you plot 47 inches (the actual height at the time) at 7 years (the bone age), you will see this white dot is at the 50th percentile and marked by the red arrow on the left.

I finished out the growth plots, and this kiddo actually fell more (down to the 5th percentile) before he hit a late puberty and grew into late teens/early 20s to hit a final height at the 50th percentile.

bone age correlates to growth delay
Figure 1: Growth delay

Causes of growth delay

Maybe the parents are both very short.

A delay in bone age often coincides with a late growth spurt. A late puberty often follows a family pattern called constitutional growth delay.

It could be due to a medical problem, such as a hormonal imbalance.

Sometimes there is a family history of people having late growth spurts (called “constitutional growth delay”).

Treatment (if needed) varies depending on the cause. The bone age won’t give a cause, but once a cause is identified and treated, growth often returns to a normal rate.

Figure 2: Tall kids don’t always become tall adults

In Figure 2 below, a fictitious boy is tall for his age early on.

Reading the chart

At 6 years old his height (black dot) is at the 97th percentile (he is taller than 97 out of 100 of boys his age) at about 49.5 inches (125.5cm).

His bone age at the time (red dot) is 8 years 6 months, which is at the 25th percentile for height.

A year later he is off the height chart, taller than over 97% of boys his age, but the bone age is 10 years 9 months, again at the 25th percentile.

This chart shows an early growth spurt (as he looks taller than his peers) but an early puberty and a slowed growth faster than other boys.

His final height is only at the 25th percentile, much shorter than his early heights would have predicted.

tall kids don't always grow to become tall adults
Figure 2: Early puberty

Isn’t tall good?

Many parents are super excited when their children are tall and can’t comprehend when I talk about the possibility that it might not last.

I typically discuss this if both parents are short but the child is tall, if I see signs of early puberty, or if the child is obese – especially if parents are not as tall as the child’s height predicts.

The bone age does not give a reason for the altered growth rate, but can help identify a need for further evaluation and treatment if indicated.

Yearly well visits – even when kids are healthy!

Unexpected growth problems is one very important reason to do yearly well visits at your child’s primary care office.

If you move physician offices for whatever reason, be sure to have the medical records transferred before your first visit. This allows your child’s  growth to be properly followed.

If you do a sports physical at a school clinic or an urgent care, realize that it is not a substitute for a yearly visit in your child’s medical home.

At every well visit your child should have a height and weight measured and discussed with you.

If the yearly growth accelerates too fast or slows, talk to your doctor about possible reasons.

If a bone age is done, you can use a growth chart to estimate the bone age. This allows you to see how tall the final height estimate would be. It is also the reason to do the x-ray soon after your child’s height was measured. Waiting a few months requires another visit to look at the height at the time of the x-ray.

Yearly tracking isn’t a guarantee that your child will grow to his or her potential, but can be helpful in identifying problems early.


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