Parents Corner

What Parents Need to Know About Children’s Nutrition Now

by William V. Tamborlane, MD professor of Pediatrics
Yale University School of Medicine

Bottom Line, Personal -- November 1, 1998

Modern living creates special challenges for busy parents who are concerned about their children’s food choices and eating habits.

Bottom Line/Personal asked pediatrician Williams V. Tamborlane, M.D., about the big nutrition issues parents face today.

What can parents do to get children to eat a good breakfast when they say they’re not hungry in the morning? Some children aren’t hungry when they first wake up. Their appetites surface around midmorning.

Don’t insist that children eat breakfast before they leave the house. It’s a losing battle. Instead, pack snacks for them to eat in the car or on the bus on their way to school or at around 9 am or 120am.

A low-fat granola bar and a juice box is an excellent morning snack. So is cheese with crackers and a piece of fruit.

Should parents of picky eaters let their kids eat what they want and hope they’ll get the nutrition they need? There’s no need to micro-manage your child’s eating. All children have an internal food regulator that tells them what and when to eat. Much of our appetite is actually genetically programmed and operates on a subconscious level.

I wouldn’t worry if a child’s appetite seems small or if he/she insists on eating the same foods over and over again. Such good fads will change or disappear over time.

Even though there may be day-to-day variations in food intake, almost all kids, left to their own devices, will satisfy their nutritional needs over the course of a few days to a week. Research also indicates that children’s day-to-day variations in appetite probably relate to their calorie expenditures the cay before. If they were very active yesterday, they’re likely to be ravenous today.

My best advice: Stock our kitchen with a variety of nutritious food....provide balanced meals...and let your children eat as they desire. Forcing them to eat foods they don’t like only makes them more resistant.

What can I do when children object to eating vegetables? Substitute fruit, or try giving them more selections from the grain, cereal, rice and pasta group. This will provide some of the minerals, trace nutrients and fiber they are missing by not eating vegetables.

I still suggest, however, that you offer children vegetables at most meals-especially in combination with foods they like. You could also offer raw instead of cooked vegetables with or without sauces. Or simply the one favorite vegetables they will eat over and over again.

Example: My teenage son only eats salad, so we make sure to have that with dinner every night.

How many sweets a day should I allow my child? Don’t exclude cookies or candy from a child’s diet. But-don’t use them as a reward for good behavior. Those rules only make these "forbidden" foods more attractive.

The goal is to make sweets a small but acceptable part of a total diet. I think a few cookies a day to satisfy the sweet tooth is fine. Also encourage your children to get more physical activity. Have them get out and play...ride bikes...jumps rope...hike...or play team sports.

An active lifestyle helps children manage their weight and increases the chance that they’ll be hungry come dinnertime.

You, too, should get into the habit of exercise if you don’t already work out. You have a wonderful opportunity to help your youngsters learn good eating and exercise habits by setting a good example.

Do children need a daily multivitamin supplement? For children who eat varied and balanced diets, vitamin supplements are not necessary. However, if children are finicky eaters or they won’t eat breakfast, it won’t do them any harm to give them a multivitamin/mineral supplement.

Any of the leading brands of children’s vitamins is fine, but be sure the supplement you choose contains iron and calcium. These are two minerals in which children’s diets may be deficient.

Give the supplement at breakfast or dinner. Good helps the body to better absorb vitamins and minerals.

Feeding your baby

The transition from an all liquid diet to solid foods should take place gradually. Pediatricians now feel that babies do not need solid foods until the child is about 4 to 6 months of age. Since each child develops at his own rate, when to add solid foods depends upon the child's:

1. Maturity

2. Appetite

3. Digestion

Begin introducing solids when your child is ready. You will begin noticing that the child:

1. shows an interest in table food. He will probably begin reaching for food that is on the table.

2. Increases his demand to be fed, which continues for several days in spite of more frequent feedings.

Begin introducing solid foods when you and your doctor feel that your child is ready.

Begin gradually.

a. The child must learn to take food from a cold, hard spoon rather than sucking.

b. The form of the food changes from liquid to semi-liquid to solid.

c. The food varies in texture, taste and smell.

d. The child must eventually learn to chew food.

Give your baby a spoon to hold onto while you are feeding him and hold him on your lap.

Introduce one new food at a time.

a. Start with l/ teaspoon. Use a very small spoon to feed your baby. -

b. Give the same food for 4-5 days (no other new food is to be given). If the child develops an allergy you will know which food is causing the problem.

Begin by giving solid foods between feedings.

a. A hungry baby is in no mood to try something new.

b. At first, solid foods are taken in such small amounts that they do not contribute many nutrients to the total diet. As the child grows older solids become more important until the solid foods provide the majority of nutrients.

c. Introduce a new food when you and your baby are relaxed and you are not in a hurry.

d. Your baby may not like every new food at first, but try it again in a few weeks.

e. Be pleasant and positive.

f. Do not encourage your baby to eat more than he will readily accept.

Stop feeding when the baby snows the first indication that he is satisfied.

a. Never coax, push or force food. Never bribe (especially using dessert as a reward).

b. Some indications that he has eaten enough - his mouth may close or his head may turn away. The child knows when he is full.

c. If you push food, the child realizes that his refusal is an effective weapon.

d. There is more danger of overfeeding than under-feeding.

Children less than 1 year of age should not be given:

1. Egg white (allergies)

2. Gas forming vegetables -broccoli, brussel sprouts, cabbage, cauliflower, turnips

3. Nuts or peanuts (hard to digest)

4. Corn or popcorn (hard to digest)

5. Dry cereal (child may choke)

6. Condiments such as mustard, catsup, salt and pepper. When the child begins demanding them he will usually settle for a lot of fanfare and a small amount of condiment.

7. Nonfat or lowfat milk (may harm child's kidneys)

Children less than 2 years of age should not be given:

1. Onions (gas producing)

2. Chocolate (may cause diarrhea) .3. Salty, spicy, greasy or fatty foods and foods high in sugar Soft drinks.

All ages sucking

It is important to realize that sucking is more than just a way to get sustenance. Babies have a need to suck for the sake of sucking. The mouth is an important sense organ through which the baby gets a great deal of information about the world. Many adults have oral needs not too different from the baby's. Smoking, gum-chewing, gnawing on erasers or wads of paper, and perhaps overeating, all serve to allay oral cravings which may be a carryover from an infancy in which our sucking and chewing urges went unsatisfied.

If the baby is given all the sucking opportunities he needs, he will give up day time thumb and pacifier sucking - except in moments of stress - by about age two, and by two and a half he can be talked out of taking his pacifier to bed. Sucking is a need, not a virtue, ana as a need it shouldn't last forever.

Weaning

Except for mothers living in poverty or in "seriously unsanitary conditions, breast-feeding will ordinarily have served its psychological and nutritional functions by the time the baby is six months old. Those who are still nursing will notice that most babies begin to teeth at this age, and once he has teeth he bites because that is what he senses his teeth are for. This may be a time to wean the baby on to a bottle. It is conceivable that the six or seven month old could be weaned directly to taking milk from a cup, especially the kind fitted with a spout, but babies at this age find it hard to manage milk in doses larger than what they get by sucking the nipple. Baby still needs to suck so he will need a replacement for that if he successfully weans to a cup.

Solid foods

Most pediatricians nowadays recommend that solids be tried out from an early age -three or four months - not so much because the baby needs them as to get him used to taking food in this novel form. It is a good idea not to begin a feeding with solids since a very hungry baby will be in no mood for experiments.

Once he has gotten used to eating solids, and you have learned about his preferences, you can begin trying new foods. Babies like to try tidbits from the adults' plates, and once they are able to pick things up, they enjoy gnawing on a cracker or apple slice which they can hold themselves. Even earlier, they like to grab a fistful of mush and cram it into the mouth with the palm of the hand.

Many babies take pleasure in exploring the physical properties of foods. They like to pour and dabble and smear, using food for finger painting. Dr. Joseph Church recommends a degree of permissiveness and patience. This is one more component of the baby's learning about the world he lives in and his capacities for control and manipulation. When the baby has finished playing with his food, he may want his hands and fingers wiped clean. This is not an expression of some primordial guilt; rather, his sense of touch is impaired by all the goop!

The baby will not be able to feed himself with a spoon independently until he is well over a year old, but long before that he wants to try. His efforts along this line will reduce the efficiency of the feeding process, but efficiency is less important than good communication, and the development of competence. A relaxed parent will find that he can share management of the spoon with the baby and still get him fed, regardless of spilling.

At a slightly later age, baby can be given his own spoon to hold. In the beginning, he will use it mainly to dip in and out of the dish, at times raising it.' to his mouth to suck or lick off whatever food may be clinging to it. Over the months, he will become more expert and can take over more of the job. Bear in mind that when he is eating true solids, like peas or bits of meat, he will ordinarily use his fingers.

Feeding problems

Although not very common, we still hears about children who "just won't eat." This description is not really accurate, since children with "feeding problems" survive and grow, which starving children do not. It cannot be denied though, that a certain number of children eat very little or restrict their diet to a very few foodstuffs. There are probably some physical disabilities to account for some feeding problems, but the overwhelming majority seem to exemplify the working of the self-fulfilling prophecy. It is precisely those mothers - and it usually seems to be the mothers - who are afraid of feeding problems or who are grimly determined to avoid them, who have children with feeding problems. For such mothers, mealtimes are charged with anxiety; the anxiety shows up in the way they feed the child, and the child responds by losing his appetite. The more the mother urges, cajoles, or tries to force the child into eating, the more disagreeable the idea of eating becomes to him. Maintaining a friendly, non-pressuring atmosphere usually works fairly well. If the baby simply shows little interest in eating, remove the food and put him down. Wait until the next regular mealtime before offering him food again. He will usually be hungry by then.

If your child is falling off the growth chart, it is time to seek professional assistance. A registered dietician and or an occupational therapist is the most likely person to assist with these feeding issues.

The eating of non-foods (PICA)

Most babies at some point tend to be "a!l mouth" and test and taste everything this way. Some babies eat things which do nor qualify as food, some of which are harmless and some which may be dangerous. Since babies cannot tell which foods are harmless and which are poison, a close watch must be kept. Distracting the baby or simply removing him from the sand, grass or whatever it is he keeps eating will often help solve the problem. It is rare that a baby will eat so much of a non food item that he becomes sick. If this "stage" is not being outgrown, it is time for professional assistance. Again, an occupational therapist will be most competent to assist in this situation.

Ways to make meals more enjoyable

1. Include a variety of colors, textures, and temperatures in each meal.

2. Include some foods the baby can feed himself, if able to.

3. Do not pressure the child into eating foods he isn't interested in - instead, give him a choice of two new foods, so he can select the one to try. Forcing new foods usually results in resentment and feeding problems.

4. Serve the food in small portions - its easier to add a little extra than to try to get a baby to eat everything on his plate.

5. Keep mealtimes pleasant - avoid getting upset over messes or spilled mess. Instead, if the child is old enough, let him cooperate in wiping up a spill or explain to him calmly what happened while you clean it up.

6. Cut food into bite size pieces for easy eating. Babies tend to prefer to feed themselves, and by cutting the food up ahead, they can often feed themselves without any problem.

7. If he insists on no food, set him down with no fuss and wait until the next meal time. Also avoid snacks just before meals.

Bon Appetite!

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