Monday, November 1, 2010
Friday, October 29, 2010
A reader called me out on some lazy writing (excerpted with permission from a private email) on the Pediasure post... This is long, but if you are struggling with feeding, picky eaters or low weight concerns, read on...
"Hi, I just recently started following your blog. It was miraculous to me. My daughter (5) is an extremely limited eater. The amount of stress and despair this was causing in our household cannot be underestimated. Feeding your child is primal, it is a fundamental responsibility of parents to provide food, and when your child won't eat, it is devastating.
The "division of responsibility" and taking the pressure off was a godsend to us. I borrowed Ellyn's book from the library, and we are working at removing the pressure, tweaking our mealtimes etc. and we are seeing progress. (Little bits, her commenting on food smelling good, her moving to eating grilled cheese sandwiches that have a little bit of mozzerella mixed with the other cheese etc.)
We take full responsibility for how our daughter ended up such a poor eater. She was a tiny baby (not premature, just small), she didn't breastfeed well, and didn't move to solid food well. She was and probably always will be skeptical of new food. So we made the classic mistakes, we were so concerned about the amount she was eating, that we "coned" down her food to only serve foods she ate a lot of, which, of course, are now the only foods she eats. We were so freaked out about variety that we tried again and again to get her to try foods, laying on the pressure, lots of fighting. Exhausting and stressful for everybody.
The information that I could find or that was available in magazines, and books that I read (unfortunately, I didn't stumble upon Ellyn's book) was completely unhelpful. Hide veggies in her meatballs (she won't eat meatballs, and it is hard to hide veggies in plain noodles with butter on them.) Just "make them eat" --- that one just gets me every time ...
Parents today are really pressured. 'Make sure your child is getting enough of all the nutrients.' (One book I read said that children (aged 4-8) should eat 8 to 10 servings of vegetables a day, a serving size being 1/2 cup - my child doesn't eat that much food in a day, let alone of vegetables!)
So today, when I read your post, I have to say that I was hurt. I was hurt that you described parents who use Pediasure as lazy, as wanting to take "the easy way". I don't use Pediasure, I've considered it but they only sell it in big expensive packs, and I wasn't sure she would like it. Plus, I wasn't sure that I wanted to have her drinking some sweet concoction, I want her to eat, and be healthy and enjoy food.
But those parents who do ... they aren't lazy, they are desperate and they are worried, and they love their children as much as you love yours. They want their child to be healthy, and they feel the weight of the pressure. *(I totally agree)
I'm sure some of them are making feeding mistakes, but I'm sure that lots of them do meal plan and have regular meals and snacks, and have children that are "underweight" or "problem eaters" and they talked to a doctor or nutritionist or a grandmother or a neighbor who suggested they try Pediasure. So all these people, myself included, love their children and are trying to do what "experts" tell them is "best" and end up more screwed up.
Couldn't Pediasure (or like products) be used by parents to help them take the pressure off? If they were feeling more confident that nutritional needs were being met somewhat, would that help them take the pressure off at mealtimes? My daughter enjoys vegetable muffins (healthy, low-fat, high-fiber, muffins. I make them with pumpkin or carrot or zucchini, she enjoys them and takes them in her lunch to school.) This helps me, and my husband, not panic when at dinner she decides not to have a carrot stick or only nibbles the flowerets off one piece of broccoli, I know she is getting some vegetable nutrients in her day.
Anyway, I just wanted to say my piece. Thank you for your blog, it is really helping us. Progess is slow, and of course we messed her up so much that it is probably going to be a really slow go to getting her on track. But I used to look ahead and know, in my bones know, that she was going to be anorexic some day, that the amount of power struggles around food was going to be our doom, and not know what to do. And now, I am starting to feel hope, hope that someday she will eat normally, have some likes and dislikes, eat too much one day, and too little another, and most off all not stress about it.
P.S. I was a picky child (though really just a mostly normal child who liked a fair amount of things, as long as they were plain). My husband was an extremely picky child (only ate grilled cheese and chicken noodle soup for about 10 years). Now we both eat a huge variety of foods, lots of different vegetables, grains, fruits and meat. My husband's favourite food is sushi! I don't care for it though ... I don't like the taste of seaweed, and I still don't care for fish even after all these years."
Thank you for your thoughtful email.
I am so sorry that you felt hurt by my comment. I am sorry for all the worry you have gone through around feeding. I am sorry that the system failed you and did not provide help (and likely heightened your anxieties) all along the way– when your daughter was born small, had trouble with breast-feeding, trouble with solids etc. I see so many times when you could have been helped perhaps...
Back to my post. I write my posts quickly and not often with the most thorough thinking! I am angry and upset precisely because desperate parents are tossed a bottle of Pediasure, with no help, no direction on how to really address or solve the underlying problem. As my friend said, "We felt like we were circling a black hole. Things were getting so bad and we just needed someone to pull us out of it." We shouldn't just be throwing bottles of Pediasure down that hole!
Another reader illustrated my concerns:
"Pediasure was recommended to me from a physician when I tried to discuss my child's picky eating issues. We used it at meal times. It filled him up. He didn't want or need to eat any other foods at dinner. Almost two years later, I have banned it from my house and am now struggling with an even older and pickier eater thanks to that ill advice. Wish I had learned about D of R long ago. We're almost 3 months in to D of R and he's yet to try something new, but my 5 year old has and that gives me hope..."
This is precisely what I am upset about. The family goes in for help. The untrained expert "helps" the best she knows how and problems continue and worsen...
I do what I do because I know parents are desperate, are trying hard, are consumed with worry, are scared beyond belief. I did not mean to call parents lazy who use Pediasure.
Parents are desperate and will do what they can to help their children.
I do think that the medical professionals are ignorant and pressed for time in that they recommend Pediasure without a thorough understanding of the situation. They have no knowledge about how to even ask about the feeding atmosphere. It's simply not on their radar (I generalize based on my own experiences, experiences with teaching those in the profession and my client and reader experiences...)
These parents are not lazy at all. In fact they are consumed with worry and expend huge amounts of energy, often in a counterproductive way to help kids with eating. It doesn't have to be so hard!
My anger, disappointment and accusations are almost 100% directed at the health professionals and the advertisers for Pediasure.
I hope that clarifies things...
I do think there can be a role for Pediasure but with extreme caution. If children will drink it without pressure, if it helps parents relax and back off pressure, if there is a real concern about nutrients (you would be amazed how many really picky eaters are actually meeting nutritional requirements when there is a full 7 day intake analysis) and if it is given within a framework of addressing feeding in the best way possible, meaning sit-down snacks and meals and no grazing, DOR etc. It's simply not fair for desperate parents to be given half-measures that may actually make matters worse.
Please let me know if I didn't get to your concerns, and thank you for writing. I am so glad that you are seeing progress with your daughter. Your words help me keep doing what I do.
I hope my laziness with my blog today won't put you off from reading my blog!
Hang in there, and great news that you and your husband have expanded your tastes! Your daughter is lucky to have two such loving and considerate parents.
readers, what do you think?
Thursday, October 28, 2010
I'm a little more than dismayed at the ads recently for Pediasure. It plays on the worst fears of parents. "Be 110% sure!" (My goodness, Timmy didn't eat the food pyramid yesterday. That could effect his brain development! I need to do something! Or Becky is at the 3rd percentile, and the doctor is threatening me with a 'failure to thrive' diagnosis! Help!)
On TV, a pyramid of wholesome foods float in the air. Slowly, foods disappear from the pyramid as little Ashley refuses to eat more and more foods. Phew! Thank goodness there is Pediasure which magically floats in and fills the holes!
Did you watch the ad? Please do, then answer these questions:
How do you feel about your kids eating? Anxious? Worried?
Do you want to "feed your child's potential?"
What if your child IS missing some nutrient. It can't hurt can it?
What emotion are they attacking? Guilt? Are they reassuring or fear-mongering?
What if my child's development is being effected!
OK, and why is it that in all the ads (I watched them) the kids don't eat any real food, but all LOVE the taste of Pediasure...
How could you NOT "feed your kids potential."
The quick fix. The prescription (literally) for picky or small kids. Many physicians who don't have the time or training to address feeding problems, will recommend Pediasure. WIC (supplemental food assistance for women, infants, children) participants need a prescription.
At a recent WIC workshop, a nutritionist mentioned that there are "great recipes" using Pediasure. When asked if she had ever tried any, she said, 'no.' I wouldn't either. The dietitians bemoaned that fact that the docs all rush to Pediasure and don't address feeding at all.
Yummo! Cooking with Pediasure! (Sarcasm in case you missed it.)
Here is an example of a recipe...
Banana-Chip Muffins (not endorsed by FFD...)
1 14-oz package Pillsbury® Banana Quick Bread & Muffin Mix
1 8-fl-oz bottle Vanilla or Banana PediaSure
1/2 cup vegetable oil
2 large eggs
1/2 cup miniature chocolate chips
Are the recipes balanced, or a way to sell more products owned by the umbrella company...
My friend, who's child fell of the growth curve after a GI illness was instructed to offer food all day long with Pediasure being the central food. She literally chased her toddler around with a sippy-cup full of Pediasure for weeks. It didn't help and intake continued to suffer. A feeding clinic work-up later, and they were basically sent home with a list of recommendations from Ellyn Satter's work: structure, no grazing, sit-down meals and snacks, no pressure, Division of Responsibility...
Because in fact it is less work- for the physician and for the parent (less effective I might add) to reach for the quick fix, the "pill" in bottle form to fix the problem rather than to delve into feeding. Less work to have a sippy-cup of Pediasure than it is to shop for, plan and prepare 3 sit-down meals and 2-3 sit-down snacks. It is less work to hand the child a bottle than to sit with them and eat.
What could my friend have done (she didn't ask, so I didn't offer...) First, grazing, or drinking supplements all day in small quantities doesn't work. Kids don't develop a proper appetite and studies show that they will eat less well and grow less well.
(Note, this is general info, and is not intended to replace an evaluation or work-up. In other words I don't want to recommend stopping Pediasure in case you, gentle Reader have a child who really needs it.)
So, if you are using Pediasure, start by bringing it into sit-down meals and snacks every 2-3 hours for smaller children and every 3-4 for older. Offer balanced foods with those meals and snacks. Sit and eat with your child as much as possible. Don't let them graze in between. Allow them the opportunity to get hungry. Not too hungry, but come to the table with some hunger. Stop pressuring or bribing. In other words, follow the Division of Responsibility in feeding.
OK, that's it. My mini-rant on Pediasure, a whirlwind bit of advice.
Folks, what have your experiences been with Pediasure?
Tuesday, October 26, 2010
Monday, October 25, 2010
Sometime this week this blog site will disappear (I think!) I am consolidating to one site with website and blog all at one address, www.familyfeedingdynamics.com.
I hope you are enjoying the blog and will follow to the new location. I'm not sure how your SRS readers etc will work. If you FAN Family Feeding Dynamics on Facebook, you will get updates automatically. Please let me know if you have any trouble, and I apologize for any inconvenience. The old content should be there though there may be some formatting issues, but the comments will be new and improved, and I hope will make things easier for readers and clients alike.
I am working with someone on this and we are on a deadline with the domain so it will be a little sloppy at first, but hey, I have to keep the family dinners going! Thanks for hanging in there with me!
Tuesday, October 12, 2010
Note: I will be out of town from the 13th-23rd, so expect another posting towards the end of the month!
So, M has seen hummus with meals at least 100 times in the last 3 years. I love it (local Hollyland hummus is the bomb) and it is often there for lunch with other options. Out of the blue, she asked for hummus yesterday morning for breakfast. It was in the fridge right in front of her (I was making French toast from left-over bread.) I was curious so I said, "sure!" (Those of you paying close attention note that I was letting her do the job of deciding 'what' to eat, I hope you'll go with it for now....) :)
She pulled out the hummus, I peeled a carrot for her and she nibbled on that while we chatted and I tended to the French Toast.
"This is good hummus. It's just like Freddie's!"
Well, bowl me over and Thank You Freddie!
You know the line about kids needing to "try" foods 10 times before they decide they like it? Well, they may need dozens and dozens, and sometimes 100 exposures before they decided to even try it! I think they had hummus for snack at school, and Freddie occasionally had it at lunch time.
So, don't despair, don't pressure. I know how tempting it is to ask kids to try it, or to eat something they are reluctant to eat. I firmly believe that almost all kids, when exposed over time to a food in a neutral and pleasant setting will learn to like it.
Like my client who called after six months saying her son tried cauliflower and sushi all in one week, or the child who declared he might try a chicken nugget next time... It takes time, lots of it for some kids. Having a positive attitude about eating and food is critical.
Your 5 year old doesn't have to eat or love everything (nor does your two or eleven year old.) I wasn't even exposed to most 'exotic' cuisine until college and beyond. Trust that if you love eating a variety of foods and you provide your children with that opportunity, with time, they will learn to like those foods.
What if I had MADE her try it, or pressured her? Might she have taken a few bites to please me? Might she have refused and had the 45 minute stand-off? Would she have been as positive about it so soon?
What was it like to be pressured to try new foods for you as a kid... I know I didn't even TRY my mom's red cabbage until I was in my mid-twenties. They always wanted me to try it, but it was my line in the sand....
Are there foods you were encouraged or forced to eat that took you a long time to be open to? ( I still haven't even tried my dad's home-made green tomato chutney...)
Oh, and this was the 3rd time we had French Toast, and M at 2 smallish slices, while she only nibbled the first few times...
Monday, October 11, 2010
M loves rice, white rice mind you. (I know, it's a current favorite punching bag nutritionally-speaking.) I like both white and brown, prefer white with stir-fry and brown with a bolder, more tomato or squash-based meal.
Friday, October 8, 2010
Thursday, October 7, 2010
I always struggle to come up with the wording for workshops, particularly for parents.
Wednesday, October 6, 2010
I'm enjoying a quick breakfast, and the cereal choices are fruit loops or All-Bran... Couldn't there be something in between? Seemed kind of emblematic of our food atmosphere, one of extremes. One where most folks don't cook, but Iron Chef gets hundreds of thousands (millions?) of viewers, one where nutrition classes pit KFC against Quinoa...
Monday, October 4, 2010
Friday, October 1, 2010
This is a scenario I see or hear about over and over. A mom standing in the kitchen with a 1-2 year old child asking over an over, "What do you want for breakfast?" (or lunch, or snack...)
"Do you want noodles?" pause....
"Do you want eggs?" pause....
"Do you want a cereal bar?" pause...
"How about a Go-gurt?" pause...
And it goes on until there is a positive, or at least not a negative response.
So, let's say Susie asks for noodles with butter. Mom makes it. Susie looks at it and says "Yuck." (Maybe she's been munching on crackers while she's waiting for the noodles because she's crying that she can't wait, and she's so cute and she's small and hungry!)
So, she has rejected what she 'ordered.'
Do you get mad? Try to reason? "Well, this is what you asked for! You liked it the other day, don't be so picky..."
Susie throws it on the floor and asks for a granola bar. Now you're late for music class, you grab a juice box and a granola bar that she nibbles on in the car, and she whines off and on for all of music class that she's "HUNGRY!" and she nibbles on some more granola bar and maybe some raisins on the way home, and then it's almost dinner time.
"What do you want for dinner?"...
Small children shouldn't meal plan. They can't. Heck, I can't some days! Remember, as the parent of the young child- and I include young school-aged kids in this group- it is YOUR job to meal-plan. It is your job to think of balanced options that you can offer, and your job to enforce the structure that will help her learn to like new foods and tune-in and eat the right amounts.
So, how does this feel...
"Jimmy, it's time for breakfast in five minutes, please get ready to put your blocks away."
Meanwhile you think about what you like to eat, what might have some fat, protein and carbohydrate.
"Jimmy, come to the table now please. You see we have toast and you can choose butter, jam or peanut butter. I also made a plate of scrambled eggs and there's some melon. Would you like milk or water? Oh, you chose toast and jam. Can I help you spread it? Here is a spreader so you can try..."
Meanwhile if you can, sit down yourself and enjoy some eggs or toast with your tea or coffee.
Jimmy doesn't have to worry or chose. It's not his job. He just gets to show up and eat from what you made. He gets to tune-in and eat until he is full (which might be two bites, or a cup of melon and two pieces of toast.) Then he gets to wait 2-3 hours until snack time.
My table? I enjoy eggs and think they're a great and easy food to balance nutrition and give kids energy, but M isn't a fan. If I ask if she wants an egg, she says, "no." But, if I cook an extra (medium-boiled and she doesn't eat the yolk mind you) she always asks for it when it hits the table and usually asks for another, but I don't boil 2 extra because it's just too wasteful and I don't want to eat 3 eggs! I also often make a scrambled egg and put it in the middle of the table so I can eat some, and she occasionally helps herself to some with little or no yolk. A pan-scrambled egg takes less time than microwaved oatmeal...
Me: "OK, you don't have to eat it, there are other choices."
Most often the food she was just complaining about was then eaten happily without comment a few moments later.
Does this sound like meal-time at your house? Do your kiddos ask for and reject foods, or eat what they say they don't want?
Wednesday, September 29, 2010
"I am personally sooo sick of hearing about "just try it" and "two bite" rules. Especially the accompanying insistance that their application will turn my son from a neophobic eater into an adventuresome eater. I can only assume that this technique works for some kids because it sure is popular.
We only had to try it a few times to realize that it didn't work for our son. The instant that he is told he has to try something he immediately assigns it to the "I don't like it" category. And foods are seldom removed from this category once they are placed in them... Also, to actually get him to try something he doesn't want to requires an EXTREME amount of pressure, so extreme that I know it has to be wrong."
Monday, September 27, 2010
This article in the NYT originally, and then in our local paper answers 'why' Americans aren't eating more veggies– but doesn't realize it. It's not for lack of trying, for lack of public health campaigns or effort or money spent on getting out the word. It's not that there aren't enough posters in our schools showing cool kids eating veggies, or exhorting kids to eat more veggies, or smiley faces 'eating the rainbow...'
Sunday, September 26, 2010
Friday, September 24, 2010
With school and work ramping up these days (a nice problem to have, but I have to admit to being a little overwhelmed as most parents may be these days...) I've had to let a few things slide to keep up the really important stuff-like family meals...
Wednesday, September 22, 2010
Usually when we have a sitter, I make mac-n-cheese. Last night we also had grapes and carrots and dip. I sat with and ate it too. I love that white Annie's mac-n-cheese...
Monday, September 20, 2010
Thursday, September 16, 2010
And, time to finish packing for Denver. I'll check in again next week. I'll be able to review and publish comments and tap out brief replies perhaps!
Wednesday, September 15, 2010
Tuesday, September 14, 2010
Please check out an interview I did with Psych Central coming out in three parts this week.
Monday, September 13, 2010
I saw the book Ellyn is referring to recently. It is a gorgeous book, lovely drawings, a well-intended sentiment, but ultimately not helpful, and crosses into pressure. Read on for Ellyn's astute retelling of this story. (Reprinted with permission, and a little gratitude that I don't need to write a full post on a day when our water AND gas are being shut-off for construction. I am at the coffee shop hoping they don't blow up my house before a 9:30 appointment.)
September 2010 • Family Meals Focus #49 Review, The Two Bite Club
It is gratifying when nutrition professionals take the big step to writing educational materials from the point of view of feeding dynamics. However, there is such a big contradiction between the feeding dynamics model and the conventional approach, it isn’t surprising when errors creep in. Even seasoned professionals trip themselves up with messages that cross the lines of the division of responsibility in feeding. With that in mind, let’s take a friendly but realistic look at a recent and free (and therefore widely distributed) publication of USDA’s Food and Nutrition Service: The Two Bite Club.
Older brother Will is the protagonist of the piece. “My teacher said that if we eat two bites from each food group we can be members of the Two Bite Club!” Will’s teacher is to be forgiven for this - most teachers don’t know about the division of responsibility in feeding. Teachers interested in nutrition can sometimes be a bit zealous - and controlling - about it.
Little sister Anna can smell pressure a mile away. “OK, but I might not like it,” she replies cautiously. Mother says, “Anna, I know you can be a big girl and try two little bites of each food, then you will be in the Two Bite Club!” Sure enough, Anna’s caution is well-founded. There are not just one but two cleverly disguised pieces of pressure in one sentence: 1) If you force yourself to eat you will be a big girl and 2) It is only two little bites. Anna is only a preschooler, and she isn’t able to deconstruct that sentence. However, like most children, she knows what she knows - she is being railroaded! So far, the Two Bite Club is faithful to the reality of feeding children.
First, they play a little game. They find a food that fits in the grain group of MyPyramid for Preschoolers. Well, all right, that’s kind of like a treasure hunt. Anna likes treasure hunts. Will finds some whole-wheat crackers. “Let’s try these!” he says. “Oh, no,” says Anna, “I don’t think I’ll like them.” Anna can smell pressure, even when it is coming from Will! Anna might be one of those slow-to-warm-up types, but more likely she is just a typically canny preschooler. Here is where our book takes leave of reality. “But she [Anna] tried two little bites. ‘I like them!’” she exclaimed.
Oh, come on. How realistic is that? Every child I have seen coerced this way makes a sour face and says “Eew! I don’t like it!” The research says the same. When you coerce children to eat, they like foods less well, not better. Even when you don’t coerce them, it takes a lot of exposures - 5 or 10 or 47 - for a child to learn to like a new food. The slow-to-warm-up types take longer. Anna might be a slow-to-warm-up type, or she might just be made to appear that way by the hard sell for this strange club.
So on they go. Like the bread group, the perfectly acceptable treasure hunt for vegetables contains a zinger: Anna has to take two bites of broccoli. So what if they are only little tiny microscopic bites? What if Anna only has to lick it? Do you know how gross it is to be strong-armed into making close contact with something - strange? Here is a more likely scenario: Anna took a bite of broccoli. “Eew! I don’t like it!” she gagged, spitting it on the floor. (We could have her spitting on her plate or in her napkin but Anna, Will, and Mother are all standing up for the Club meeting.)
Then they hunt for fruit. By now, you would expect Anna to slope off to watch Dora the Explorer rather than play this game, but our story has her coming back for more. This time, Anna gets to choose, and she finds a yellow apple in the fruit bowl. The optimistic folks who hope that letting Anna pick the food will get her to eat it are heartened. Ever vigilant, Anna recognizes the pressure. “I don’t think I like yellow apples; I only like red apples,” she says.
So let’s give Anna a break and write a new ending to our story. “You don’t have to eat it if you don’t want to,” says mother, learning from her mistakes. “Yes,” says Will. “Let’s forget about the bites. I don’t have to belong to any dumb club in order to enjoy my food.”
So Mother got Will and Anna’s lunch ready. She put on the whole grain crackers and broccoli and stirred some Ranch Dressing mix into the yogurt to make dip. She put on some cheese and some milk and they all agreed those foods were from the milk group. She peeled the apple and cut it up. Anna could see that on the inside a yellow apple was just the same as a red one. Mother let Anna and Will pick and choose what to eat from what was on the table. Anna ate a whole apple and some cheese and drank some milk and dipped a cracker in the dip and ate a little corner of it. She ignored the broccoli - she’d had enough of that for one day.
And they all ate happily ever after.Copyright © 2010 by Ellyn Satter. Published at www.EllynSatter.com.
Saturday, September 11, 2010
Friday, September 10, 2010
M this morning, "Can I have that sweet cereal again? I want sugar for breakfast! Sugar! I want something sweet!"
Thursday, September 9, 2010
- I waste food because I can afford to. (The photo above is at the end of our meal.)
- I can stop eating because I know I will have enough, good-tasting variety of foods before I get truly hungry again. (Reliable meals and snacks.)
- I can try new foods and introduce my daughter to new foods because I know I will have other things to eat, and because I have enough resources to try something that might not get eaten.
- I can stop because I can eat any of those foods when I want to. (I don't need to eat 2 biscuits because if I want to order them again sometime, I can-without guilt.)
- I leave food because I have never been truly hungry (childhood food insecurity and hunger often has long-lasting effects, with adults who experienced it more likely to feel anxious or panicky with food, and more likely to binge when foods are available-a smart survival strategy at the time...)
- I leave food because I have learned to eat in a way that is tuned-in to my internal cues of hunger, appetite and satiety.
- I am lucky...
Poverty, how much we eat, what kinds of foods we eat, are more complex than most (especially in the public health world) would have us believe. Food is at it's heart survival, and making it simply into a moral issue without a deeper understanding of the complexities–the physiology and psychology of hunger (monetary or self-inflicted)– is dangerous and short-sighted.
Wednesday, September 8, 2010
My daughter had sugar-snap beans, a pickle, a little container of ketchup and 3 Swedish Fish...
Tuesday, September 7, 2010
Thursday, September 2, 2010
We were on the road, and tired of McDonald's and Subway. (Road-trips were the only time I was allowed to eat fast food and I relished it as a kid. I am a little more lenient, but we don't often do fast food at home, so looking forward to a Happy Meal is a nice way to help with hours and hours in the car...)
Wednesday, September 1, 2010
I have twins and my daughter was tiny from birth. She has never been on the charts and at 6 months weighed only 12 pounds, which triggered a number of GI specialist appointments, the coordination of a dietician, etc. I was nursing her but had to begin supplementing with high-calorie formula in an attempt to increase weight gain. No physical issues were ever found, and she continued to grow steadily, just...slowly. The GI doctor at one point warned me that if she didn't gain more weight, her cognitive functioning could be harmed.
Of course I was terrified and this sparked a terrible pattern for us, in which I constantly tried to cajole/encourage/trick/force my daughter into eating more, and she, naturally, pushed back from day 1. It saddens me to look back on this and think that we were going through this power struggle even when she was a baby. It continued on and on, because at each appointment, she was still "not on the charts". Our doctor suggested some helpful, healthy things to increase the caloric density of her foods, but also some unhealthy things (such as feeding her Carnation Instant Breakfast, which she would never touch anyway). I had to monitor the number of calories my daughter consumed every day. On a good calorie day, I was thrilled, on a low calorie day, I was frightened, miserable, and often cried.
My daughter was 16 lbs at a year and 21.5 lbs at 2 years. This intense emphasis on her weight set up a terrible relationship to food and feeding. Shortly after she turned 2, my mother located all of my baby records from birth up to 2 years. And it turns out that at every single appointment, I had actually weighed slightly less than my daughter at the same age! My husband and I are both small, slim, people. The difference is that back then, in the 70s, my doctor didn't consider it a problem, and wrote notes such as "she's doing well" or "she's fine" to my mother.
At that point I realized my daughter is playing out her genetics and her well-meaning pediatrician's focus on her smallness had helped us set up a bad dynamic in which our mealtimes were disasters and my daughter wouldn't eat out of a need for control. Shortly after she turned 2 I swallowed hard, began following the Child of Mine advice, and backed way, way off. I no longer try to convince/bargain/trick her into eating. I provide healthy meals at specific times, and I allow her to eat what she wants. I don't comment on it, and I don't bribe with dessert. At first it was REALLY hard because of our historical weight issues, but I soon found that she actually eats much, much better now! She tries many more things, and her weight hasn't suffered. Now mealtime is no longer a terrible battle, and instead we can enjoy ourselves. Given how small she is it's still hard for me to grit my teeth and say nothing if she decides not to eat much at a given meal, but I try to take a whole day, or whole week approach and realize that she actually does eat a good variety of foods."
I'm fat. Not heavy, not 'overweight' - I'm fat. I weigh 275 pounds at 5'4". My husband is also fat. He's 280 at 5'10".
The weight talk started at my son's six week appointment. I keep hearing moms talk about their doctors worried that their kid is not gaining enough. Ours discussed with us if we had concerns about him gaining _too much._ I said "No, not really. I mean, his gain is normal, right?" and the doctor replied "Low end of normal, actually, but I see that both you and the baby's father are... uh... " "Fat? Yes, we are fat. Are you suggesting a preemptive diet for my six week old?" "No, I just thought you might be concerned." Oy. I mean, really. I let the doctor know that I was not interested in feeding schedules, limiting baby's intake so early or "supplementing" with water. (And let me say, calling my husband "the baby's father" repeatedly instead of my husband, while he sits there is kind of insulting. I've heard this doctor tell other women "Your husband... " but somehow, mine is "the baby's father." Maybe he can't believe a fat woman is married?)
The doctor suggested switching him to whole cow's milk at 9 months - I said that WHO didn't recommend that and I wasn't interested. He again brought up that my husband and I are fat. I asked if he would recommend that a thin mom and dad switch their higher-weight baby to whole milk at 9 months. He said no, breast was best until 2/formula until 1. I said again, that I wasn't interested in going against WHO recommendations and general practice just because we're fat. He then asked if I would be willing to limit intake. I asked if he would suggest that for a higher-weight baby of thin parents. He said no. I said, again, no.
What's sad is that I have interviewed several pediatricians, all of whom want to put him on feeding schedules, limited intake, switch to cow's milk, switch to water for all but two bottles a day - I've gotten some crazy suggestions. When I ask about higher-weight babies with thin parents, they tell me that they wouldn't recommend any of this to them because "the babies will just thin out someday." My common refrain in the doctor's office these days is "What would you recommend to thin parents?"
For what it's worth, my son is 97th percentile for height, 95th percentile for head size and 90th percentile for weight. Part of my hesitation (okay, more like deep unwillingness) to do feeding schedules and limited intake is that my parents did it with me. My father tells everyone he encounters with a baby about how I cried and cried. They followed the schedule the pediatrician gave them - so many ounces every so many hours. My mother pumped so they could measure the milk and later switched to formula. They took me to countless doctors, some diagnosed me with various conditions. I was "diagnosed" with a pyloric valve issue and they wanted to do surgery. There was a grandmother in the doctor's office that my parents were at to discuss this and she told my father "There's nothing wrong with that baby except HUNGER. You need to feed that baby." My father says he explained to her the feeding schedules, the pumping and measuring, the formula. She told him to "Knock that nonsense off, keep making bottles until the baby isn't hungry anymore." My father - fed up, tired and at the end of his rope went home and did exactly that. He said that it was the first night I slept at all for more than 30 minutes - he kept checking to see if I was alive. After that? No feeding schedules. I am the oldest of three children and the only overweight adult. The other two have no issues with food, exercise (as in, I require a lot of it to maintain and even more to lose) or weight. Ancedata, perhaps, but enough for me to say no to feeding schedules and metered intake.
Center for Eating Disorders did a nice little piece on why our current obsession with weight, extending now to the VERY young is problematic.
Here is an excerpt from the article:
Consider moving away from a hyper-focus on weight, body type, BMI or any other calculator of weight. Like most efforts involved in parenting, it’s not an easy task to accomplish particularly when it seems like every newspaper article, concerned relative, or public service campaign is telling you to do the opposite. Do your best to focus instead on your child’s overall health (remembering that weight does not = health). Honor and accept your child’s natural body size and shape. Create positive goals around eating that involve paying attention to your baby’s or child’s internal hunger and fullness cues instead of relying on external messages about how much is “too much”.
*The photo is me around 1 year. "Obese" by today's standards and bottle-fed!!! E-gads!