Help Kids Develop a Healthy Relationship with Food
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By the time parents see Christy Gardner, M.S., RD, LD/N, food is a fraught subject. Meals that should sustain, nourish, and nurture cause meltdowns and physical ailments.
“Families come to me because there’s a problem with their child’s nutrition,” says Gardner, a pediatric clinical dietitian with the University of Miami Health System. “I see patients with conditions that are followed by our pediatric gastroenterologists. Our team also manages children with obesity, failure to thrive, and other nutrition-related issues.”
Your child may not have a gastrointestinal issue, she says, but if you can’t get through dinner without a disagreement, consider looking at the behavior first.
For example, “When a child is a picky eater, there may be underlying behavioral issues. Without fixing the behavior, we can’t address nutrition.”
If meals morph into a power struggle – whether your child eats too much or too little, or their emotional or physical health suffers from eating habits – Gardner’s guidance may help.
Getting to know you
When families see Gardner for the first time (after being evaluated by a gastroenterologist to rule out underlying medical conditions), she spends time with them.
“I ask, ‘What brings you in, and how can I help?’ I ask them to walk me through a typical day, homing in with questions about when and what they eat and how they feel before and after a meal. It’s a collaborative process that helps me tailor a plan for that family.”
She looks to the “Division of Responsibility in Feeding” guidelines developed by Ellyn Satter, a dietitian, and psychotherapist who specializes in the family-based treatment of eating disorders. Satter’s guidelines teach parents of healthy (or struggling) children to help them become competent eaters from infancy through adolescence.
What we consume determines our health, especially in children whose bodies are still developing. A balanced diet of whole foods and fewer high-fat, high-sugar, highly processed products builds a better body and, some say, a better brain. One study stated that the well-being of children with ADHD and irritability benefitted greatly from micronutrient supplements – the nutrients found in a healthy, balanced diet. However, Gardner says, “There’s not enough good evidence to say that one particular food negatively or positively affects behavior.”
Though the research linking diet with mood is still inclusive, any parent whose child experiences a sugar crash after devouring cake, ice cream, and candy at a birthday party, might beg to differ. Gardner agrees that birthday treats cause a “huge glucose spike” in the body but cautions against “vilifying food”. Celebrations are part of society; an occasional treat is okay.
Strategies for parents
In coaching parents, Gardner shares tips to help them establish healthy dietary behaviors early on; other suggestions work well at any age.
“The younger the child, the more impactful changes can be. As a child ages, it’s more difficult to impart change.”
Model healthy behavior.
Consider your dietary habits and how you talk about food, eating, and your body. Kids of all ages listen and learn from their parents.
Don’t be a short-order cook.
Use Division of Responsibility concepts when dealing with selective eaters. “Everybody eats the same food. Kids shouldn’t be in charge. In other places of the world, kids’ meals don’t exist,” Gardner says. If you’re preparing soup and salad, don’t prepare a separate meal of chicken nuggets. Older kids naturally want more autonomy; include them in meal planning and preparation to make them feel involved.
It helps with behavior, Gardner says, if kids know what to expect. As much as possible, serve meals at the same time and same place each day. Instill a rhythm and routine to mealtimes.
Make the table a no-phone zone. Television, mobile phones, and other digital devices distract everyone from their plate. Encourage mindful eating at the dinner table and avoid mindless munching on the couch.
Offer repeated exposure.
Some kids won’t eat vegetables or try anything new. Providing new foods regularly familiarizes children with the food and might make them willing to take a bite.
“Broadening your family’s palate is all about repeated exposure. Don’t feel defeated if your child isn’t receptive. It takes patience.”
Expand your child’s food horizons, Gardner says, by engaging them in a conversation about what’s on their plate. “Ask, ‘What does that food feel like in your hand? What would it feel like in your mouth?'”
Make a game of trying new things.
Appeal to children’s natural curiosity and playfulness by adding fun to family meals. Your child doesn’t like green food? They might try broccoli if you encourage them to eat the “little trees.” Celery stuffed with peanut butter and a few raisins on top becomes a healthy snack called “ants on a log.”
If your child refuses to eat anything resembling fruits or vegetables, toss a handful of spinach and berries in a blender with milk or nut milk for a breakfast smoothie. Who doesn’t love a taco? Lettuce, tomato, and beans tucked into a taco is a mini salad in disguise. You can add spinach to your favorite lasagna recipe or add applesauce, shredded carrots, or zucchini to a muffin mix.
Pair with protein.
Pack balanced snacks for school.
“Many kids have a piece of fruit or a bag of chips or cookies. To make their metabolism work as efficiently as possible, balance the sugar or carbohydrate snack with protein such as yogurt, nuts, peanut butter, or cheese. Even if they don’t eat it or take just one bite, the protein is presented.”
Involve and engage.
When introducing something new or different, ask yourself, “When is the best time of day to try this?”
Children involved in food choices and preparation, Gardner says, may be more receptive. The approach varies, depending on age.
“You might ask your child, ‘What new fruit or vegetable are we going to try this week?’ Or have them help with grocery shopping, meal planning, looking up recipes, or food preparation.”
When your child is old enough to feed themselves, let them do it.
Saying, “Why can’t you be more like your sister? She’s not a picky eater!” builds resistance and shame around food. Avoid the comparison trap.
Stick to your budget.
“Food insecurity is associated with poor health. There can be shame in food-insecure families who must choose between paying the rent or buying healthy food. All health care professionals should screen for food access and insecurity and direct families in need to resources,” Gardner says.
Busy families on a budget can add nutrition to their diet with affordable canned or frozen varieties. Read more budget-friendly tips here.
If your child has a gastrointestinal condition that would benefit from seeing a physician and dietitian, call 305-243-3166.
Nancy Moreland is a regular contributor to UMiami Health News. She has written for several major health care systems and the CDC. Her writing also appears in the Chicago Tribune and U.S. News & World Report.