“Ugh! I never thought I would have a picky eater. Day after day, meal after meal, so many opportunities to totally FAIL as a parent!” Parenting a picky eater can be frustrating and stressful, causing any parent to succumb to the chicken nugget and french fry rut with these words: “At least I know he’ll eat it and there’s some comfort in that.” But once a family has fallen into that rut, that hole, that cavern…that deep, dark pit…well, you get the idea. It’s hard to climb out.

This week’s blog series focuses on the topic of picky eating in children. I will share strategies to help your kids become more adventurous eaters at breakfast, lunch, dinner and even in the school cafeteria. Whether you just want to know how to keep your little gourmet on the right path to adventurous, healthy eating or you are trying to find your way back to eating a veggie or two, this week’s ideas are for you.

Let’s start with 2 strategies you can begin using right away:

1. Nix the Label: Picky Eater. Although my career is focused on solving picky eating, I want you to know I never use that term in front of a child. Kids will always live up to the labels we assign to them, so best not to give them the picky eater brand. Instead, find what your child CAN do. If the best he can do is carefully spoon a Brussel sprout and put it on his plate, then declare him “The best Brussel sprout balancer in the west!” Start there. Learning to be an adventurous eater is a step by step process. The first step to learning any new skill is celebrating the smallest accomplishment and then, build from that. Tasting a Brussel sprout may still be weeks away, but today, he’s feeling darn good about his interaction with that veggie.

 

2. Sit! The first thing I do when I visit a home is make sure your child is positioned correctly in their high chair, booster or appropriate seating at the table. Nine times out of ten, kids are positioned incorrectly. One mother told me just last week: “I had no idea what a difference buying the correct booster seat would make for my daughter”. Once a child can sit up on their own, make sure their hips are at a 90 degree angle and they have a foot rest for stability. Toddlers and younger kids need additional stability around their hips to keep their trunk still while they practice learning to eat finger foods, use utensils and even learn to chew more advance foods. A rolled up towel behind their back to provide lumbar support and stabilize the sides of the pelvis is an easy solution.

Do you have a picky eater? How much stress does it create for you? A little? A lot? Tell us about it – we appreciate your input!

Tomorrow’s post: Strategies for kids who don’t like to eat breakfast. The stress of having a picky eater begins early for many families. As one father told me, “Every morning I wake and mutter to myself, ‘Let the Hunger Games begin.’”

Last Thanksgiving I announced a bold campaign, spearheaded by an amazing band of volunteers, to upgrade babies’ first foods to real foods – and babies’ first grains to whole grains – and to do this in 2011.

It’s November, and we still have a ways to go, but we also have an exciting reason to celebrate!

Over 10,000 physicians, mostly pediatricians, took part in a July/August 2011 survey by Medscape.com that demonstrated an historic shift in their feeding recommendations this year. The first question in the survey was “What do you recommend for baby’s first food (check all that apply)?” The options were white rice cereal, whole grain cereal, a vegetable, a fruit, egg yolk, meat, or other. Of those who answered as of August 31, the number one choice was white rice cereal – garnering nearly twice as many votes as the next most common.

But after reading an article about WhiteOut Now, our public service campaign the survey results were strikingly different.

Responding to,” What will you recommend for baby’s first food (check all that apply)” only 3% even included white rice cereal among their recommended choices. Physicians were also asked, “Do you think white rice cereal is the best choice for baby’s first food?” About 3% of those who responded had “No opinion” and an overwhelming 93% responded, “No.”

As of now over 12,000 physicians have taken part in the survey, and the change continues to spread. To me this major reversal suggests that the old white rice cereal recommendations were based on well-meaning habit rather than on science or even on careful consideration. When asked to reconsider, an overwhelming majority of physicians were quickly able to see advantages of abandoning the old recommendation.

Evidence is mounting that changing early feeding habits is critical to reversing the childhood obesity epidemic. This stunning survey suggests that first feedings are poised to change. A reason to be thankful indeed!

Dr. Greene’s Answer:

For breastfed babies, the nutrition in the breast milk changes throughout the nursing experience. Breastmilk is quite different when the baby is 6 days old, 6 months old, and 18 months old. These changes happen gradually over time. Formulas come in a few different stages to try to address children’s changing nutritional needs as they grow.

Toddler formulas have many of the same vitamins and minerals found in infant formulas. The main difference between toddler and infant formulas is that toddler formulas contain a greater amount of calcium and phosphorus. They are designed to match the higher calcium and phosphorus levels children need as they grow, similar to the levels found in whole milk.

One benefit of formulas over whole milk is that many of them contain DHA, an important omega-3 fatty acid (that you would find in breastmilk). One way or another, getting DHA in the diet seems especially important in the first two years. If you think your child needs formula after the first year, switching to a toddler formula at that time is one way to accomplish this while providing her with the extra calcium and phosphorus she needs..

Toddlers don’t necessarily need formula, even if they don’t nurse. Children who are eating a balanced variety of healthy solids after the first birthday should be able to get the extra vitamins and minerals found in formula from their diets, perhaps with the added safety net of a multivitamin. If there is concern that your child is not eating an adequate amount of solids, formula will provide most of her nutritional needs while she is experimenting with solid food.

It is important not to force your child into eating more solids. For most kids, it’s okay for them to eat as much or as little as they want, chosen from healthy options. It will vary day by day. To encourage solids, offer them at least three times a day, preferably before a bottle.

For most kids, it’s best not to coax them to eat with moving the spoon like an airplane or with music or sound effects. They have an internal mechanism that tells them how much to eat that you want to keep intact. If you suspect it is not intact or there are serious food allergies complicating the picture, then it is usually best to work with a feeding specialist to learn how to encourage feeding while still keeping the child’s motivation strong.

She may be fine with 16 ounces of formula a day now. Or she may want 24 ounces. If she consistently takes more or less than that, run it by your pediatrician to be sure she is getting a good amount for her specific situation. At the one-year physical, you’ll get to see on the charts just how she is growing. And one way or the other, your darling baby is on the doorstep of toddling into a whole new stage of life. Bon appétit!

Introduction to iron deficiency:

A baby is born with about 0.5 grams of iron in the body. A healthy adolescent’s body has 5.0 grams. This 900 percent increase in iron comes from the iron in the food your child eats or the vitamins she takes. Throughout childhood, a steady supply of iron enables your child to make healthy red blood cells, which will provide the oxygen needed for life, health, and growth.

What is iron deficiency?

The most common reason for a child to be anemic is an inadequate supply of iron. Iron is a mineral that your body needs in order to make red blood cells. Children who lack enough iron will make small, pale, ineffective red blood cells.

Who gets iron deficiency?

Children get iron deficiency anemia if they don’t eat enough iron-containing food, if they lose too much iron (through bleeding), or if their need for new red blood cells is increased (as in periods of rapid growth). Thus, iron deficiency anemia is most common in infants and in adolescents (especially adolescent girls).
Drinking too much milk can lead to iron deficiency. It irritates the intestines, and leads to iron loss. It can also make it more difficult for the body to use iron.
Most cases of severe iron deficiency in young children are in those who drink too much milk.
Food allergies can also lead to iron deficiency through iron loss in the stool.
Children with iron deficiency are more likely to have lead toxicity than their peers.

What are the symptoms of iron deficiency?

In most children, the anemia never gets severe enough to cause noticeable symptoms, but it can still slow cognitive development. Iron deficiency (even mild enough not to cause anemia) is associated with a decrease in attention span, alertness, and learning ability. Iron-deficient children are also more likely to eat dirt, paint chips, ice, and other mineral-containing items.
Irritability and fatigue are common in mild to moderate iron deficiency anemia. The white part of the eyes can take on a bluish tint. The child may appear pale.
Prolonged or severe anemia can cause marked irritability, decreased appetite, slowed growth, a swollen tongue, and flattened, spoon-shaped, or brittle nails. There may be irritated sores at the corners of the mouth. In very severe cases, children can even go into heart failure.

Is iron deficiency contagious?

No

How long does iron deficiency last?

Iron deficiency lasts until the body’s iron stores are replenished from the new iron taken in. With proper treatment, this usually takes one to three months.
Sometimes ongoing iron losses (as from too much milk) need to be corrected to solve the iron deficiency.

How is iron deficiency diagnosed?

Most children get a blood test between 6 and 18 months of age to look for anemia. The blood test is important because it can identify anemia before there are any symptoms.
Anemia on the screening blood test is not necessarily caused by iron deficiency, but mild anemia in an otherwise well child is most likely caused by iron deficiency.
If the anemia does not respond as expected to treatment, other tests should be done to confirm that the problem is iron deficiency. Lead poisoning and thalassemia, for instance, can also produce anemia with small red blood cells.

How is iron deficiency treated?

The dietary changes listed below (under prevention) are the foundation of treating iron deficiency. If there is significant anemia, or if the diet isn’t working, iron drops may be necessary to replenish your child’s iron stores.
When these drops are given with juice, they are often better tolerated and better absorbed. If they are given straight, they may darken the teeth. Iron drops can turn the stools dark and cause constipation, no matter how they are given.
The drops are usually given for about a month before a repeat blood test is performed to see if the anemia is resolving. If it is, the drops are given for another few months. If it is not, further investigation is needed into the many other possible causes of anemia.

How can iron deficiency be prevented?

Improving your child’s diet is the most important way to prevent and to treat iron deficiency. Many foods are good sources of iron:

• Good — Tuna, oatmeal, apricots, raisins, spinach, kale, greens, prunes
• Better — Eggs, meat, fish, chicken, turkey, soybeans, dried beans, peanut butter, peas, lentils, molasses
• Best — Breast milk (the iron is very easily used by the child), formula with iron, infant cereals, other iron-fortified cereals, liver, prune juice

The intestines of children who are being breast-fed are two to three times more efficient at absorbing iron from every source. Taking vitamin C, or eating foods high in vitamin C (such as orange juice) at the same time as foods high in iron, also helps the body absorb and use the iron. The iron in iron-fortified foods is poorly absorbed, but usually contains enough extra iron to compensate for this.
Cooking in iron pans can help by adding iron to the food. Taking an over-the-counter multi-vitaminwith iron can help provide a safety net for picky eaters.
Drinking too much cow’s milk makes anemia worse. Most toddlers get sufficient calories and calcium from 16-24 ounces of milk daily. No child needs more than 32 ounces of cow’s milk a day.

Related A-to-Z Information:

Anemia (Low hemoglobin), Breath Holding, Food Allergies, Lead Poisoning, Sickle Cell Anemia

Dr. Greene’s Answer:

Holding a newborn in your arms is incomparable magic, but a wonderful new stage of smiling, laughing, and interaction comes later, signaled by the introduction of solid foods.

Looking at a baby’s development is far more important than looking at a calendar to decide when is the right time to start feeding solids. It was once popular to do this according to a rigid timeline of set serving sizes at certain intervals, but we now know that each baby develops uniquely.

Your baby may know it is time before you do! The most obvious sign is a baby that still seems hungry after getting enough milk (8-10 breast feedings or 32 ounces of formula in a day). Your darling may lean forward eagerly or act fussy when you are eating.

Babies that are ready for solids can lift and support their own heads. They usually weigh at least 13 pounds and have often doubled their birth weights. They display curiosity about the world around them, following objects with their eyes and smiling at what they see.

Newborns are built for liquid nutrition. They instinctively push their tongues against anything inserted into their mouths. To succeed with solids, babies will need to overcome the strong tongue-thrust reflex they are born with.

For most babies this readiness happens between 4 and 6 months old. Not coincidently, this is the same period when most babies have increased caloric needs and are starting to deplete the iron they are born with. Iron-fortified infant cereals can help supply these needs.

But again, don’t look at the calendar: watch for the developmental cues listed above.

For the first several days, more food is likely to end up on the face than in the mouth. Pictures and videos taken during these historic days will be treasures for a lifetime.

If your baby gets upset at solids, or doesn’t seem interested at all, go back to nursing or bottle-feeding exclusively for a week or two, and then try again. There’s certainly no rush before at least 6 months old.

I do recommend at least trying solids by the time babies are rolling easily and sitting independently, even if they haven’t yet seemed interested. This will give them a good opportunity to learn the process of eating and swallowing while their brains are primed for it.

When the first spoonful is accepted and swallowed, at whatever age, you and your baby enter a new era in your relationship, a rich time of deepening new interactions.

You are becoming friends.