Pediasure-the answer to all your feeding worries!

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...)

Ingredients

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...

I don't deny that there are some children who really do need nutritional support or even exclusive or supplemental tube feeds (those with certain rare medical or physical conditions,) but that is not who Pediasure is marketing to. They are marketing to the average parent who worries about nutrition, who struggles with feeding and likely a picky child. I would also guess there is an army of attractive sales reps making the rounds with free lunches to pediatricians offices too...

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?

small kids don't know what they want to eat until it's in their mouth

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...

Kids often ask for foods and then don't want them, or say they don't want or like something, and eat it a few minutes later (if we can keep out of the fight!) M did this all the time too. "I don't like steak!"
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?

moms speak out, "two-bite rule" and listening to your gut

Thank you to those who filled out the survey. I can only assume from those who chose not to that I am doing everything perfectly! (Just kidding, but why not go with the self-affirming assumption?)

Many wanted to hear from other moms who are in the "trenches."

Here is a great comment from a reader about the two-bite rule (or the on-bite-rule or the 'no thank-you bite'...)

"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."

The pressure moms feel to get their kids to eat "right" is also extreme. Many, knowing that it feels wrong, slog through joyless meals, miserably doing as they are told to get the pyramid into their kids every day. My favorite quote? "Dinner feels like 45 minutes of hostage negotiations." The reader is right, it does 'work' for some kids, the easy-going, adventurous kind perhaps. It even works for one sibling, but not the other. Trust when you feel that something isn't working. If you dread feeding and meals, something is wrong.

Or the mom with the son who is rapidly gaining weight who was scolded by the doctor, "You're the parent here! Step up and don't bring that crap into the house!" Well, now her son is being shunned by friends because he cleans out their pantries of all the forbidden foods when he hangs out at their homes. She KNOWS it feels wrong, and it's not working, but the doctor told her to do it, and hey, she's a bad mom if she doesn't, right?

What feels wrong to you?

New survey: America still isn't eating "enough" vegetables. But why?

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...'

About 1 in 4 Americans gets veggies three or more times a day. About 1 in 10 teens get the recommended amount. As someone working with families (and according to nationwide surveys) I know that it is not for lack of knowledge. Parents want their kids to eat well and have good nutrition, but they don't know HOW to support it (and many struggle financially to do so. But I will put the issue of food insecurity aside for a moment.) What American doesn't know what they "should" be eating? What parent doesn't lament the battles over broccoli?

One expert realizes, "There is nothing you can say to get Americans to eat more veggies." -duh

(I would add, there is very little we can say to get our children to eat more veggies...)

The author and experts assert Americans would eat more veggies if they were cheaper and tasted better. A nurse admits she won't eat veggies because they make her "gag." (I'd love to know if she was forced to try veggies or clean her plate as a child...) They don't explicitly get to it, but the following quotes hint at part of the solution. Read these and guess what is missing...

"The moment you have something fresh, you have to schedule your life around it."

"An apple you can just grab, but what am I going to do, put a piece of kale in my purse?"

What jumps out? What is missing?

Sitting down to meals and structure...

As I have gone through my training (my reading, now being lucky enough to be a part Ellyn Satter's clinical faculty with access to their incredible breadth and years of experience, seeing my own meals and family's eating, working with clients...) I have come to believe that without structure, without the habit of saying, "I am going to sit down now and make myself/may family something to eat" (or sit down to take-out or a frozen meal) that improving variety and successfully adding things like veggies is almost impossible.

The parents I meet and talk to want their children to be healthy and to eat well. They try really hard to get them to eat veggies. They bribe, they hide, they sneak, they beg, they threaten, they reward with stickers or treats-and for the most part, it's making their kids like veggies less, not more. Remember that how to feed is the key to the what. That notion of the Division of Responsibility, which is the basis for the feeding relationship all but requires meals and structure.

The structure has to come first. The meals have to come first. They don't have to be fancy, or "fresh" (canned and frozen are just fine) but you can't have a meal in your purse or strapped into a car-seat. (You can eat that way, but it's not a meal where you can tune-in to hungry and full, tune in to appetite, explore new foods, flavors and eventually improve variety.)

If you're grabbing Goldfish on the go (and who hasn't for the kiddos or even ourselves) it's easy to wander around contented for the moment with Goldfish. But, sit down, pay attention to the food, and the question, "What might taste good to me with these goldfish, or to little Timmy?" might come up. The answer might be, a cut up apple, or some microwaved frozen squash with butter, salt and brown sugar, or a sliced tomato...

What do you think?

sweet-obsessed kids: a 'how-to'

I like this post about what makes a child obsessed with sweets...

threat level orange!!! parents are in a constant state of anxiety around feeding

Back from Denver after a great conference. I met some very dedicated folks working to help kids with eating and weight.

On the way to the airport, I passed the same sign that has been up for the last 9 years.

THREAT LEVEL ORANGE!!!

Several more reminders in the airports that the 'powers that be' have determined our threat level is orange. In case you forgot. In case you go more than an hour without being reminded of 9/11 in an airport, or in case you relax a little. Would any of us do anything differently if the threat level was green? I suppose I would pay attention to a red, since I don't think there has been one for years...

Since 9/11 we have constant reminders that we're not safe, with warnings of enemies real and imagined. I remember how often I had to turn off the radio for months after the terrible attacks as the pundits spun out elaborate scenarios of planes full of anthrax dusting our coasts and how easy it would be to destroy us all. I know how much that spoiled my days. How we are reminded for weeks that some terrorist is going to be arraigned next week, he's going to be arraigned tomorrow, today, last week. Hourly reminders....

It reminds me of that state we have gotten to with kids and food. How many people can just enjoy being with their kids and feeding them-one of the purest, most elemental expressions of loving and caring? Instead, with the relentless drumbeat today of hype-the continuous "threat level orange" around feeding, the experience is spoiled for most parents and for most children, and it is interfering with our natural capabilities with eating.

Some recent emails, conversations and news stories illustrate a few fears.

Parents worry about:

getting all the fruits and vegetables in

calcium for bones

pesticides and ADHD

mercury in fish

allergies

not enough protein

too much protein

too much fat

too much sugar

food dyes

hormones in milk

raw milk

salmonella in eggs

salmonella in chicken

e.coli in meat

e.coli in spinach

me kid is too big

my kid is too small

high fructose corn syrup

when to start your child on a diet

how to avoid encouraging disordered eating

how to instill positive body image

how to get kids "60 minutes of uninterrupted physical activity" every day

when to find time to cook

how to afford organics

how to afford enough food. period.

BPA in cans and water bottles

...

Does this list sound familiar? What are your worries? What would it be like not to hear or read about obesity or protein or BPA in the news every day?

My first 'tag-line' was "take anxiety and conflict off the menu..." Sure, occasionally there is cause for concern, but most often our worries only spoil our experiences, color how we feed, invite pressure and fear into the feeding relationship and no one benefits.

I'd love to declare a "level green" month for feeding, with a moratorium on the stories designed to generate fear and anxiety. I know before I found the feeding dynamics model, that I was scared by the news stories and it changed how I fed. How about you?

interview on PsychCentral: feeding kids and our cultural "ab-norm" with food

Please check out an interview I did with Psych Central coming out in three parts this week.

Today's topics:

Where did we go wrong

more about the feeding model I work with and how I found it

what are the keys to raising kids who are competent eaters

We have our water back, but it's brownish and supposedly full of lead. I'm starting to pack and do final preps for a conference in Colorado Thursday and Friday, so again I am grateful for the lazy post! Moms who work outside-the-home (or home business,) how do you juggle it all! How long do you ever feel you have the 'balance' between work and family down? (I sure don't right now!)

wasting food, hunger, and finding that "stopping place"

Here we are at Cracker Barrel, which was across from our hotel on our recent drive (2 days in the car!) to see family. I skipped the Kids Menu, and M ordered rice, chicken, corn and milk. I had roasted chicken, beans, stuffing and corn. We ate maybe 25% of what was on the table. I ordered her a main meal because all the kids stuff was the typical fried, limited fare that M doesn't love anyway. She had biscuits for the first time. She liked the corn bread too. We had a pleasant meal, but here is what we left. (I suppose we could have shared entrees had I realized how much food there would be...)

It got me thinking again about poverty, food insecurity (or restrained or unreliable feeding) and how it effects what we eat and how much we eat.

• 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...

If I weren't so lucky, I would have ordered food for M that I KNEW she would eat. If I didn't know when the next meal was coming, I would order reliably filling foods with lots of calories for the least amount of money. If I hadn't eaten all day because I was "saving points" for dinner, or didn't have any cash, or felt guilty about how I blew my diet yesterday... (you see where this is going.)

(BTW, M doesn't really have to "think" about any of this, or know it on any rational level. In spite of my inclinations as a chatty extrovert, I don't explain or rationalize any of this to her. I do my jobs with providing reliable, good-tasting foods every 3-4 hours. She just shows up and listens to her body... She stops eating when her body tells her to.)

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.

How do your childhood experiences of hunger (in any form) effect your eating today?

first day of school lunch?

My daughter had sugar-snap beans, a pickle, a little container of ketchup and 3 Swedish Fish...

I felt so bad for her, she forgot that I packed her a thermos with warm left-over mashed potatoes and steak! (At summer camp, they didn't refrigerate her lunch bag so I put the hot on one half and the cold in another. I reminded her yesterday morning that her thermos was in her backpack, she even watched me cut up the steak, but she forgot.)

Poor thing realized what had happened on the way home and LOST IT. She wanted to eat it when we got home, but I already sort of cross my fingers about temperature and food saftety having the food in a thermos until noon so I said 'no.'

I thought it was interesting that none of the adults noticed that she was eating cold beans with ketchup. They must see some interesting lunches. Maybe they have finally taken my advice and decided to leave her alone with her food :)

Today, she gets her favorite, turkey curry and rice. I'll pack some beet salad and maybe some grapes. Hope she finds it all this time!

What did your child eat on the first day of school? International readers, I'd love to hear from you!

sugary cereal first-hand

So we generally try to stay with cereals with less than 6 grams of sugar per serving. Sweet foods are easy to like, and tend to replace other foods and worsen variety, and thereby nutritional quality. Meaning, kids will often eat only sweet things if given the chance. (It's why desserts and sweets are treated differently with the Division of Responsibility.)

I watched this first-hand with our first box of Frosted Flakes. I took M with me shopping, something I try not to do, and she asked for frosted flakes. I had already said "no" to ding-dongs and a few other things (I much prefer Ghirardelli brownies anyway, which M also likes...) and I wanted to see what happened, so we bought a box.

We had the cereal on offer the next few mornings, and literally ALL M ate was dry frosted flakes. Nothing else. Not enough variety, not enough fat or protein to sustain her and our mornings were more difficult. I didn't explain that she needed to eat other things, but after 3 mornings of this, we said, she "could have toast, eggs or Kix or Oat Squares today." She chose the toast and some Oat Squares and milk and was fine. I expected a big battle for the FF's but didn't have it.

It was an interesting experiment. We might offer it on occasion, when she's home and I know I can offer a balanced snack or lunch, but it definitely confirmed the sweets-kill-variety if not managed appropriately.

What have you noticed with sugary foods?

purple beans: kids are naturally excited about foods

M's summer camp had a lovely little garden. I was bemused when a note came home one day with, "she even tried green beans!" (They are a favorite.)

We don't need to make smiley faces out of foods, or over-sell foods with crazy names or try to get kids to try new foods with bribes, reward stickers or praise.

Case in point? Purple beans.

After camp one day, M and I harvested in the garden. I got to try two new foods (for me too) with my daughter. That was pretty cool! We picked the above deep purple beans and snacked on them right off the vine, and brought about a dozen home. We also tried "golden raspberries" which I insisted were simply unripe, but M assured me was how they were supposed to be and were actually glorious, champagne-colored raspberries...

So we brought some beans and berries home to share with Dad but ran into the gaggle of neighborhood kids across the street. M skipped over to show them the veggies she picked and then doled out beans to share. Of the 7 kids there, all but one (who has food allergies which can contribute to an understandable caution about food) eagerly tried and ate the beans. No bribing, no rewarding, no faces, no lectures about vegetables. "Cool! A purple bean!"

"That's awesome!" We ran out before D got a chance to taste them.

It just reminded me again that the HOW of food and introducing it is so important. It was positive, no pressure, fun and a reminder that kids are naturally curious about new foods and we largely screw it up as parents and caregivers when we try to control the process.

Also, research shows that kids are more likely to try foods that they grow or have a hand in, but it is not a guarantee :)

Have you tried new foods with your kids?

Addendum: THANK YOU for the comments. I knew all of these children VERY well, one mom was there, I know the specific allergies of the child in question. I was with my child and asked permission from the mom (the neighbors all tend to be pretty free with sharing foods with my M as well) But, you are RIGHT. Always check with a parent before offering food to any child (preferably ever) but especially if you don't know the child's allergy history. M often wants to share things with kids I don't know at school/parks etc, and I always either ask, or tell the kids kindly that I can't share food unless the parents OKs it. Kids are pretty savy and used to this these days, I find.

"You're so brave!": how praise feels like pressure...

I blogged recently about how M tried snails, and just about everything else on the trip (she didn't like them much, and a few things got spit into a napkin, but she enjoyed herself at the table...)

Well, at camp, the counselor came up to me and RAVED about how "BRAVE!" M was to have tried snails. How they were all "so impressed!"

Stop it! I wanted to yell... "Of course she tried snails, and nutella and lots of other delicious things!" I replied, smiling...

What does it do to a child's natural curiosity, her natural drive and ability to try and learn new foods when adults praise?

Will she be as likely to try snails or a new food again, or did that praise feel like pressure? Did that word "brave" imply that there was something unusual about trying snails, or something scary about snails or new foods?

What do you think?

nutrition "education," calorie counting for the preschool age

I was enjoying the local farmer's market this weekend and sitting next to my daughter who was coloring at a lovely little shaded area with beanbag toss (based on the food pyramid-ugh) when I read this piece of cow-dung. I was only happy that my little M doesn't know how to read yet.

The bottom part if you can't read it says: (exclamations are theirs, not mine)

Circle the healthiest choice (fewest calories)!

Ring the cowbell!

1/2 cup diced fruit salad (60 calories)

1/2 cup diced fruit salad with 2 Tbspn orange juice (88 calories)

1/2 cup diced fruit salad with 2 Tbspns light yogurt (96 calories)

Oh, where to begin!!

Nutrition education for children has the potential to do great harm. I wonder why adding yogurt is not "healthy" or the assertion that the definition of "healthy" is low calorie. Low-calorie and low-fat diets fail nutritionally for small children (and fail for adults too.) I won't elaborate on why this is garbage "nutrition" info which is more harmful than helpful. (Think of a table of first grade comparing calorie and fat counts in the name of health-it's happening people.)

I spoke with the nice folks who worked for this farm/education group and explained that I was a family doctor and feeding specialist and that their info was wrong and dangerous. I also said I would not stick around for the cooking demo (fruit salsa, could be great, but don't want M hearing about "healthy" eating from these folks...) The lady explained that they had a dietitian come up with the materials and that they "struggled" with them.

Brother. Stop. Don't wade in where you are not qualified, don't promote more craziness around food. Why not just color in the picture and talk about all the delicious foods at the market, talk about how gorgeous the colors are. Do your demo, be positive, be happy, let us taste the amazing fruits of our farmer's labors, just leave "health," calories, fat out of it. It managed to do what so much nutrition and health info does these days, take such potential and passion and energy- and poison it with misinformation and misguided food moralism.

(BTW, I couldn't help saying, "More cowbell!" ala SNL. I thought I was pretty clever...)

Keep your eyes out for garbage nutrition messages aimed at kids. Share them here! I think you'll be surprised what you find when you open your eyes...

SUGAR: trust your body, not your brain, oh and fat women can self-regulate too...

Here is an interesting article about sugar, weight and internal regulation. This apparently replicated findings on a similar study done on 'normal' weight women.

Basically they took 'overweight' women (25-30 BMI) and fed two groups with a sweet beverage. One group had artificial sweetener and the other had a sugar sweetened drink. Neither group knew what they were drinking.

The coolest part? The women who drank more calories from the sugar sweetened beverage consumed less throughout the day. When their minds were taken out of the equation, their bodies regulated and compensated by consuming fewer calories. Those 'fat' women were able to self-regulate. They could trust their bodies.

(Different studies show that when women THINK they are eating low-fat yogurt for example, but it is high in fat, they actually eat MORE throughout the day. The so-called "halo" effect means people tend to eat more if foods are labeled low-fat or even organic.) The body does a better job than the brain. (Internal vs. cognitive control of intake.)

A few quotes from the article:

"The results show that overweight women do not suffer adverse effects, such as weight gain or mood fluctuation, if they do not know whether or not they are drinking a sugary or artificially sweetened drink. Instead women took in fewer calories elsewhere in the diet, to balance the calories in the drinks."

"Widespread publicity about the supposed harmful effects of sugar may make such effects more likely, as believing sugar to be harmful may encourage negative emotions after eating sugary food and lead to the abstinence violation effect."

Have you experienced the "abstinence violation" effect? In other words, the binge after the diet? The being 'bad' after the being 'good?' The "I've been starving all day and now I'm, stressed and can't hold myself back anymore?"

The good news is we can trust our bodies. We just have to learn how to get our heads and all the crazy around food out of the equation...

picky eating, size concerns: "don't worry about it" means different things to different people

A mom called me to talk about her teen who has been eating -almost exclusively- microwaved lean pockets for 7 years. At every doctor's visit she was told not to worry about it, that it was fairly nutritious, and he would likely grow out of it. A young pediatrician recently wrote in (A., I read your comment but couldn't find it when I needed to post! Sorry) to say when parents come to her with picky eating complaints, she too tells them not to worry. I probably gave similar advice ('mac-n-cheese is fine! Just add a multivitamin!) when I was a new doc.

I look back now at how naive I was, how misinformed, and how unhelpful ultimately to so many parents. You see, I grew up with structure, family meals, enough money for a wide variety of foods that were largely presented in a pleasant atmosphere free of pressure. (I think part of me assumed that was happening in most homes.) I had no training in feeding other than how to concentrate formula and calculate calorie needs for the "feeders and growers" in the neonatal ward, and I didn't have my own kids. (OK, a few lectures on breast-feeding and perhaps a review of a handout about starting solids, always the what, never the HOW to feed...)

In short I had no idea how many families struggle with feeding, how many moms truly agonize over intake or a child's size. I had no idea how many of the moms I was seeing had themselves struggled with eating and were terrified of feeding their child. I didn't know how normal it was for most families to feed children one meal (often the same meal of macaroni and cheese and nuggets) and feed themselves later, and how much energy went into trying to get the kids to eat more or different foods. I didn't know that most of these picky kids were "good eaters" early on but systematically coned down to an accepted menu of brown and beige foods because parents didn't know how to handle normal feeding stages, or fed out of worry over nutrition or size (see last few paragraphs of that post.)

I didn't know that most feeding advice (if parents got any) was counterproductive. I didn't know that most folks today (kids included) seem to graze most of the day. I had no idea how much pain and conflict was inflicted in the name of weight and nutrition. (The moms who call crying because a child is refusing to eat and is losing weight, or another child is showing markedly disordered behaviors at age 7...)

OK, back from "tangent land."

point 1) your doctor might not have a clue. There, I said it. I didn't have a clue.

point 2) your doctor may be giving you bad advice. Again, I did...

point 3) health care providers, be careful about saying, "Don't worry about it" in terms of picky eating or odd eating behaviors.

More on "don't worry"

for health care providers and parents, just to make it extra confusing :)

First you need to ask more questions about feeding. A normal weight or growth curve should not give false confidence that feeding is going well. As a parent, if you see a health care provider and you're worried, and you are not getting your concerns addressed, ask yourself some more questions, get help... (Or if you get advice that sounds off like, "Just serve beef and green beans for 3 days, he'll learn to like it..." don't give up!)

Docs, ask: (moms, ask yourselves...)

How is feeding going?

How do you/I feel about feeding?

Are you/we eating meals as a family?

Do you/I struggle with eating?

Do you/I continue to offer a variety of foods?

Are you/we getting into battles around food?

Are you/we worried about your/our child's size?

Are you/we familiar with or following the Division of Responsibility?

Because, "don't worry about it" might be just the right advice for a family that is otherwise doing well with feeding. Support and optimize good feeding practices.

But –and here is the sad part– a family that is really struggling who is told, "don't worry about it," as is often the case, is a missed opportunity. It is much easier to turn around a feeding issue when a child is 5, vs 15... "Don't worry about it" to some means, keep serving mac-n-cheese and nuggets every night so you don't have to fight about is as much. Keep bribing and pressuring, keep worrying. And maybe 5, or 20 years go by (seriously) where the child only eats 5 foods, or maybe the dieting starts or the disordered eating...

Ask the feeding questions, optimize best feeding, educate yourself (Child of Mine should be required reading in all med schools as far as I'm concerned...) or at least have some titles or handouts you can refer parents to. Don't worry, but do have family meals, do offer variety, don't feed with pressure, do eat foods you enjoy, and follow up.

Moms, have you been told, "don't worry about it?" Did you still worry? What wacky advice have you gotten about your feeding concerns? From whom? Family? Docs?

breakfast theater, or act II of "tiny, crazy, irrational people"

scene: breakfast
offerings: brioche, cereal, English muffin, yogurt, BANANA

me: Hey, M, would you like to cut the banana for us this morning? (offering her the chance to be involved in meal prep, all together now... Kids who are involved in meal prep are more likely-not gauranteed-to eat the foods they help with.)
M: no, gross, I don't want any banana
Me: You don't have to have any, please don't say 'gross,' but I want to cut it up for everyone to have some if they want. (I cut the banana.)

30 seconds later...
M: what's that yummy smell? Oh, it's the banana. May I have a piece of banana, please?
Me: Of course, help yourself. I like how you asked.
M: (happily eats banana chunk, after about 10 seconds, makes a face...) You know why I don't eat lots of bananas? They give me canker sores.
Me: Oh, really? Hmm.

remember, kids are tiny, irrational and unpredictable people around food. That is why we have to be predictable and neutral...

adult picky eaters

There was an interesting article in the WSJ this morning about adult picky eaters.

Please check it out! Picky eating is one of the most common issues I help families with. As you see here, some kids don't outgrow their picky eating. If you are concerned, read a book, get some help. (Child of Mine, or Secrets to Feeding a Healthy Family, both by Ellyn Satter.)

Are you an adult who only eats a handful of foods? Will you share with us, and maybe how you were fed as a child?

It was interesting that the adults in this article describe their picky eating habits starting in childhood. One of the moms in the article is so scared her daughter will pick up her poor habits that she breaks into sweats and pushes food/ sticker charts for eating more at breakfast... Can you guess where this is likely headed?

This is pretty sad on many levels. I would imagine that these adults were not fed well as children. Were they catered to, fed special food just so they ate something? Were they provided the opportunity to try new foods without pressure? Were they forced to try new foods or eat "two-bites" of everything? Were they not fed reliably at all and had to fend for themselves? I hope that the Duke study into adult picky eating will consider how these folks were fed as children. The next level that is heartbreaking is how terrified the one mom in particular was of "passing on" her feeding issues and how she has not been given the tools to begin to succeed.

Ellyn Satter wrote a short piece on helping adult picky eaters.

Tell me what you think...

But I'm not hungry!! How it feels to be pressured to eat.

Twice in the last week or so I have been pressured to eat when I didn't want to. Most of us can easily tap into the feelings we get when we are not allowed to eat, or when we are on a diet. Most adult Americans are currently ON a diet. I know that if I can't eat for whatever reason for an extended time (more then four hours) I will get anxious, irritable, grouchy and food pre-occupied. But, it is not often that adults get overt pressure to eat more...

Last week I was eating lunch with M and Hubby and I was chewing something. M leaned over and kept trying to put a chip in my mouth. "Just eat it Momma!" I would turn my head away, and when I turned my head back, there was the chip, pushed up to my lips which I kept clamped shut. (Does this sound familiar? I watched an almost-toddler go through this very thing at a restaurant last week. Dad kept pushing chopsticks with food at her mouth and she repeatedly turned away, adding a swat every now and then...) "No thank you, " I said after I had swallowed. I think she thought it was funny because she poked the chip at me one more time. I could feel myself getting angry. My body was tense, I was irritated and focusing on my frustration with her, rather than on the eating experience. "In this house we don't eat anything we don't want to. Please stop."

Then again, last week, I enjoyed a large and satisfying lunch only to have the next stop unexpectedly be a place with lots of wonderful foods– and the chef was there. The chef was so eager for me to try the foods that she verbally pressed me at least a dozen times to eat X, Y or try Z. I found myself getting really angry. In spite of several apologies that I was already uncomfortably full (I also topped the meal off with a hot coffee on a hot day) she persisted. I finally said, "I am so full that I am uncomfortable, I am sure your food is delicious but I am just not hungry. It's actually making me upset that you are pushing me to eat." Yet, she persisted... Finally I tried a few bites, and I specifically said, "I am not hungry, but I will eat this to make you happy." (The food was delicious, which I assured her.)

What surprised me in both instances was how upset, angry and physically tense I became. I resented that I was being pressured and pushed. I do this work all the time, talk to parents about how pressuring with feeding backfires, but I had usually been most able to empathize with pressure to eat less, not more food. It was fascinating!

I can only imagine if I was a toddler with the hair-trigger temper, where my main job developmentally is to assert my independence and "do it myself," how I would have reacted! (Moms and dads of toddlers can picture this as well!)

In the first scenario, I might have gotten so upset that I stopped eating before I was full. (It is hard to focus on sensations of hunger and fullness when you're upset.) In the second case, I overate to please someone else. (Might a pre-schooler do this to please a parent or favorite teacher who insists that all the "growing food" gets eaten before dessert?) In both situations, the pressure made it harder for me to tune-in to my internal cues and eat the right amount, and it spoiled the fun!

How do you feel when you are pressured to eat more or less food than you want?

teaching kids to overeat

The summer-camp brochures probably don't say, "We'll teach your kids to swim, paint, get along with others, and overeat!"

My husband told me that while I was in Denver, M asked him to pack her less food for lunch. When he asked why, she said that the camp teachers have a rule that you have to eat all of your other foods before you get your "treat," and she was getting too full but still wanted to eat her treat. (Note, her lunches usually have leftovers like stir fry and rice, and one or two sides which might be a baggie of cherry tomatoes or red pepper, or pickles, maybe some tortilla chips, or yogurt, or carrots, and about twice a week she gets a mini candy bar or fruit snacks for dessert...As with every other meal and snack, the idea is that she gets to pick and chose from what I provide and decide how much or if to eat. I can't predict her hunger so I often pack extra. Some days she eats everything I send, others barely a bite...

Hubby said he was surprised by how mad it made him. (I thought this was cute :) He was upset that they are trying to push her to eat and are interfering- of course he left it to me to deal with so I get to look forward to dropping M off with a note in her lunch bag that says, "M is allowed to pick and chose from what we pack her. If she wants to eat her dessert first and only that, that's fine. Please do not make her eat or finish parts of her meal to get her dessert. She knows how to eat. Please call me if you have any questions." I have told M to hand them the note if they try to tell her anything about eating.

I'll talk to the director and her teachers to get them to "back the $%##!!& off," in a nice way of course. You see, I too am angry that they are interfering with her ability to tune in to hunger and fullness. We work hard to feed well, and it is getting harder as she goes out into the world more, to protect her from harmful interference.

Though, I imagine most parents come in asking the staff the opposite– to make sure the kids eat their "growing food" before the "treats." I am always amazed how many parents pick their kids up from school and the first question is, "Did you eat all your lunch?" while digging out the lunch box and inspecting the contents.

There are lots of reasons why making kids finish their food or arbitrary amounts before dessert mucks things up. Here are a few

1) it teaches kids to overeat. Dessert can taste so good they will often overeat to get to dessert.

2) it teaches kids that the only good food is the treat, and all the rest is what you have to slog through to get to it.

3) it takes over the child's job with feeding, deciding how much to eat.

4) it is hard work for the provider and a waste of effort

5) it sets up a power struggle and conflict

6) children eat LESS well (less fruits and veggies) when pressured

How do your childcare/schools support or undermine your feeding practices? How do you deal with it?

update: this morning I was putting the fruit chews in her lunch and Hubby mentioned that the same baggie kept coming back last week uneaten. M even asked me then not to put so much treats in her lunch so she wouldn't get too full. Annoyed beyond measure, but happy that my little one resisted the pressure and still stopped when she was full...

"but they're baked!"

I was having lunch at Subway yesterday. It was interesting. M asked to have a smaller sandwich since the last two times we were there she couldn't finish hers (6 inch) We ordered the kids' sandwich which was perfect. She enjoyed picking her toppings on white bread, she had extra pickles, green peppers, lettuce, ham and cheese. She ate a few chips with water. We had had strawberries with whipped cream and angel food cake for a special Father's Day breakfast :)

We are going to a new church and on the way there I said (I admit to trying to sweeten the deal of going to a new church on a sunny day...) "You'll see your teacher Jenny, and then after church we can have the cookies or a cupcake and meet some new friends." She replied, "I already had cake for breakfast. I had enough sweet stuff for today I think." A statement that my four-year-old self would have found crazy! It's interesting to me to see her be able to think about what she feels like eating and be very matter of fact about it. (Though this morning we had crying about why we were not having cake again for breakfast, "No, actually Mom, this is whining, not crying...")

Another family was at Subway and it was painful to watch and listen to. Three boys- and every bite, every choice was argued, and counseled. First the argument for 9 grain bread, then trying to get some veggies on the subs, then the argument over the drink. (OK, chocolate milk) then over the chips, "You know you have to have baked chips, you can have baked Lays or Sun Chips..." Then the kids tried this one, "Mom, can we have cookies, it says they're baked and fresh! That sounds good, right?" Mom shut them down on the cookies, "I know what you're trying to do and it won't work..." Then there was threatening over eating the sub (all three were white bread with turkey,) not just the chips and chocolate milk... Ugh. I felt bad for all of them, mom especially. I always have to stifle the urge to put my card or put a bookmark for Ellyn Satter's, Child of Mine on the table. I have experienced feeding anxieties and am sure mom is not happy about how feeding feels.

It doesn't have to be so hard, and kids will eat better if we let them do their jobs with feeding, stop pressuring and do our jobs with feeding. This Subway eaves-dropping ecperience seems pretty much the norm these days. Do you remember this much attention when we were kids?

On another note, I will be off for a workshop this week, so will be checking in only sporadically. I am getting some great feeding questions via email and blog and will check in with those in the coming weeks.

Kids are smart! Baked? What have your kids figured out? I remember a little girl I was seeing for rapid weight gain when I was in the clinic setting and practicing the standard medical model, and she said to her mom, "Mom, if we get that puppy I always wanted, I would be more active..." Pretty sad and smart.