Distracted eating

We all do it sometimes. We grab a snack and plop down on the couch to watch a movie. Before we know it the whole thing is gone. We only meant to eat some of it, but downed it in one sitting.

That is distracted eating at it's finest. It exemplifies the problem of eating without intention. Not because of hunger. Not even healthy foods typically. Just eating because it's there.

What happened to sitting around the table and eating as a family without the tv or cell phones?

Photo source: Wikimedia

I see many kids who always have distracted eating.

The youngest might fit into another category all together, but they certainly aren't intentionally eating. These are the babies who parents "dream feed" - basically feed them while they're sleeping. This can be because they don't eat as parents think they should when they're awake or because parents want to get one more feed in before they go to bed so baby will let them sleep. I know many parents rely on it, but I will never recommend it for many reasons. It can disrupt their normal sleep cycles if you feed during periods of deep sleep.  Dream feeds also feed a baby who might not be hungry or need to eat, and it is hard to know when to stop. After the first few months most babies don't need to eat at night, but they are trained to eat at that time. Once they get teeth it can increase the risk of cavities if they eat without brushing teeth before returning to sleep. There are also risks of choking. And again, I firmly believe that we all need to eat when hungry and not just because there's food offered.

As kids move into the toddler years, they often become picky with foods and eat small volumes. This is normal. Parents need to offer healthy foods and feed small frequent meals. Think of snacks as mini meals so you will offer healthy foods - and no, goldfish crackers are not healthy foods. Young children tend to eat about six small meals a day. Each meal offer either a fruit or a vegetable and a protein to help insure your child gets enough of these food groups daily.

Unfortunately, some parents solve the "problem" of kids not eating a lot at meal times by allowing them to carry around food all hours of the day. This might be cereal, crackers, milk, or whatever the favorite food of the week is. This allows the child to snack all day, which means they are never hungry, so they don't eat at meal times. Parents will think it's better than eating nothing, and even think that since it's cereal or milk it's healthy. But it's not. These foods are usually highly processed and have little nutrition. Constantly nibbling doesn't allow the body to learn hunger cues. It also doesn't allow saliva to clean teeth between feedings, which increases the risk of cavities. If kids drink excessive milk they are at risk of severe malnutrition. Parents argue that milk is healthy, but they are thinking of mother's milk or formula for infants. Cow's milk has protein, calcium, and other nutrients, but it is not a complete meal substitute. I have seen children need blood transfusions due to severe iron deficiency anemia from excessive milk intake. Blood transfusions. It can be that bad. Yes, your child might like milk. And he might refuse to eat at meal time. But if you keep giving milk he will never get hungry enough to eat the food offered.

Other parents realize that kids will eat more if they feed the child, especially if the child is watching tv. This is wrong on many levels.

• Once kids are able to feed themselves, it is a great skill to use. They work on fine motor skills when self feeding. 
• Kids need to learn to pick (from healthy choices hopefully) which food they will eat next and to stop when full. When parents do the feeding, they keep pushing foods until the plate is empty. Many parents have an unrealistic appreciation of how much food a child should eat. 
• If a child is watching tv while eating, the focus is on the screen, not the food. Again, the child then doesn't listen to hunger and satiety cues.

I see several kids each year who will be going to full day school (kindergarten or 1st grade depending on the child) and parents worry that they won't be able to eat lunch because they never self feed. Many of these kids are overweight because they've been overfed for years but the parents often think the child doesn't eat enough.

If families eat while watching television or playing on smart phones or tablets, no one is connecting during the meal. No one is really enjoying the food or the conversation. There are many studies that show the more often families eat together (really together, not sitting at a table connected to a screen) the less likely kids will develop obesity, get depressed, do drugs, smoke, and consider suicide. Kids who eat with their families are more likely to eat healthy foods, do well in school, delay having sex, and have stronger family ties.

Help stop the habit of mindless eating. Encourage eating at the table as a family as much as possible. Offer healthy food choices and let everyone decide how much of each thing to eat. If you worry that your child isn't eating adequately, talk to your pediatrician.

For more, see my related blogs:

• Nutrition for the Picky Eater
• Taste a Bite Without a Fight
• Food Strike!
• Kid's Weight Is Weighing On My Mind
• Excessive Milk Can Cause Anemia? How?
• My Child Won't Eat... What Should I Do?

Resources:

MyPlate offers portion sizes for children, tips on healthy foods, activities for kids to learn about nutrition, and more.

If you're a Pinterest fan, check out my Nutritional Sites and Getting Kids to Eat Vegetables and Other Healthy Stuff

My child won't eat... what should I do?

I hear from worried parents often that their kids won't eat. There are many reasons for this. Usually as long as a child is hydrated, gaining weight appropriately, and getting a variety of nutrients, I am not worried.

Some reasons kids don't eat:

• They're really getting enough food, parents just have unrealistic expectations. This is very common. Portion sizes are smaller than many parents think. They vary with age and size of a child as well as his activity level. If your child is growing well and has plenty of energy throughout the day, why should he eat more? Kids tend to eat small meals frequently and even on holidays they don't overeat like the adults tend to do. When offering snacks, think of them as mini meals to help balance out the nutrients of the day. Don't let them snack all day long though or they'll never really be hungry. Schedule meals and snacks and allow water in between. We have an obesity epidemic in this country, so if you're comparing your child to another child, chances are that your thin child is healthy and normal, but the other one is one of the 30% who is overweight. Or maybe not. It doesn't matter. Just be sure your child is getting a proper variety of nutrients, he should determine how much to eat. Talk to his doctor about his growth at regularly scheduled well visits (more often if you're concerned) to be sure it's appropriate.
• They're sick and it's temporary. When kids are sick they lose their appetites. This is normal. It usually returns with a vengeance when they're feeling better. They need to drink to stay hydrated and can eat what they feel up to it, but don't force it. See their doctor if you're worried.
• It's a new food and they just aren't sure yet. I encourage that kids over 3 years old take one bite of a food. Kids often hear me say, "taste a bite without a fight." The bite needs to be enough that they taste it. If they like it they can keep eating. If they don't want more, resist trying to convince them to eat more. Allowing them to take ownership of the decision of what to eat empowers them. Kids like power, right. Give it to them while modeling healthy eating behaviors yourself. They learn from what you do, not what you say -- and not from what they're forced to do. When preparing a new dish, include familiar foods they like to balance out the meal so they can enjoy at least something on the plate.
• They're picky eaters. Aren't they all? Most kids go through phases where they love a food then they suddenly dislike it. They might dislike a certain texture or a whole food group. While there are kids with real problems eating, most picky eaters can be encouraged to eat a healthy variety of foods as described above. Some children really suffer from being overly restrictive. Children with autism, sensory problems, food allergies, and other issues are not included in this "typical" picky eater category. A great series of blogs on picky eaters (typical and more concerning) is found on Raise Healthy Eaters. 
• They're more interested in something else. Make meals an event in itself. Sit together and talk. Turn off the television. Put away your phone. Have everyone focus on the meal, which includes the food and the conversation. Try to keep the conversation pleasant and not about the food. Take the pressure off eating!

In general, parents should choose what foods kids are offered so that there's a balance of nutrients, but kids determine how much they eat. If they're hungry, they'll eat. If they're not hungry, they shouldn't eat. Learning to eat when not hungry is something that causes many of us to struggle with weight. Most kids are able to limit intake to needs. Don't force them to change that great quality!

For more, see my other blogs on the subject:

• Nutrition for the Picky Eater
• Taste a Bite Without a Fight
• Food Strike!
• Kid's Weight Is Weighing On My Mind

Is an apple a good bedtime treat?

Photo source: Shutterstock

As parents we try to get as many fruits and vegetables in our kids as they will take, so when Junior asks for a bedtime snack, it is tempting to allow a piece of fruit. Sounds healthy, right?  Surely better than ice cream...

An apple is healthy and can be a great part of a healthy snack, but kids (and adults) shouldn't have a high carbohydrate snack before bed without some protein and / or fat.

Why?

When we eat, our body senses the increase in blood sugar and sends out insulin to store the sugar in cells for future energy. An apple (or other fruit) is high in carbohydrates (sugar) and low in fat and protein. Sugars and can be quickly stored, lowering the blood sugar pretty fast unless there is fat or protein to stabilize it.

Fats and proteins are more complex to digest.  They must first be converted into smaller molecules before insulin can store the food for energy.  This allows a more gradual fall of the blood sugar.

Why is this important at bedtime?

We always have some sugar in our blood, ideally 70-100 mg/dl, but rising after eating and falling when fasting (not eating).  Normal sugar levels give our cells energy for all they need to do. We go for many hours without eating again when we sleep all night. If the insulin level is still high after storing all the easy to store carbohydrates but there aren't more molecules from the breakdown of protein or fat around to start storing, the insulin lowers the normal blood sugar to unsafe levels.  This is especially dangerous at night because one early sign that the blood sugar is too low is tiredness, which is unnoticed when asleep.

Diabetics should be especially aware of this response because their body does not regulate insulin normally, and they can suffer from severe low sugar if too much insulin is given without the proper balance of nutrients.

It would be extremely uncommon for a person with normal sugar management to have serious consequences of low blood sugar (such as coma or seizures) from this apple before bed, but without a good sugar level, the body will not get the most benefits of sleep: restoration of the body and growth in children.

So what's my recommendation for that bedtime snack? Go ahead and give that apple-- with a glass of milk, yogurt, peanut butter, cheese, or other food with protein.

And ice cream isn't all that bad as far as a snack that won't lower blood sugar too much... it just has less nutritional value.  So as a fun treat when kids are eating enough fruits and veggies the rest of the day and have gotten exercise and not an overabundance of empty calories, it's okay to have an ice cream once in awhile.  After all, it's made from milk, so not all bad!

Which reminds me of this great Bill Cosby clip: Chocolate Cake  (Who says we can't have a little fun when talking nutrition?)

Taste a Bite Without a Fight

Photo source: Shutterstock

Here's another blog inspired by a facebook question:

Megan Brower Lynberg My 2.5 year old son is super picky and I swear he looks at certain foods and decides not to eat them. I know most parents have the try it rule, or just one bite, but we can't even get him to do that most times. Any suggestions on how to implement that? Or should we just let it go and know that for the most part he gets a balanced diet and hopefully he'll branch out as he gets older?

Picky eating is synonymous with most toddlers and school aged kids. I smile inwardly when parents boast that their one year old will eat anything, unlike "other kids" who are picky, as if the other parents did something wrong.

It is between 15 months and 3 years that kids who used to eat anything go through phases of pickiness. I say phases, because sometimes it is a favorite food one week, only to be "yuck" the next week.  I knew this when my kids were young, so I took pictures of my toddlers devouring things like broccoli, so I could show them later that they did, in fact, love it.  (It didn't help.)

Overall the two biggest food groups kids dislike, vegetables and meats, are two of the most nutritious, so parents fret about how to get the nutrition in.  My general advice: parents decide what foods are offered, kids decide how much they eat.

My kids learned "Taste a bite without a fight" at daycare. Why silly rhymes work, I don't know, but sometimes they do.  I usually advise to enforce a bite after 3 years.  Before this age, they might just be too young to fight the battle yet. They simply don't know how to follow rules until about 3. I have heard of parents turning on the tv so the child mindlessly eats what the parent puts in his mouth. Don't do that! It sets up so many bad eating habits!!!

Until the taste a bite rule can be enforced (and even after that) I like to use hidden foods as nutrients. We are having pumpkin french toast this morning-- pumpkin puree added to the eggs/milk. This is not much vegetable, but more than they would get from a bowl of cereal or standard french toast. If this is done with many meals, it all adds up. Find foods your child likes, then "tweak" to fit in needed nutrients.

Vegetables and fruits can easily be pureed and put into sauces, casseroles, smoothies, and ground meats (meatballs, burgers, meatloaf).  Put a can of beets into the blender with your spaghetti sauce for a funky colored sauce. If your kids don't like sauce on noodles, try making pizza with a zucchini/carrot/beet jazzed up sauce. Some people just finely shred or chop. I find that puree works better because they don't see it and pick it out! There are many recipes for this online and in cookbooks for parents.  Check out my Pinterest Meal Ideas page for starters. (Not all ideas are healthy on this page... some are things I just want to try!)

Putting a cheese sauce over vegetables or offering a dunking sauce (yogurt, catsup, ranch dressing) makes it more acceptable to many kids. 

Add fruits and vegetables to breads or noodles. Most kids love the bread group. Banana bread, pumpkin bread, zucchini bread, spinach noodles, and more are all ways to add a little fruit or vegetable into something they will eat. Yes, they will get more sugar this way, but ...

Try a soup or stew. This is a great time of year to throw things in the crock pot in the morning and come home to the smell of dinner already ready!  

If it's meat he doesn't like (most don't at this age) use other forms of protein and iron (eggs, nuts, legumes, etc). Dairy helps with the protein, but has no iron, so don't only use cheese - a common food they love! You can also try meat hidden in casseroles or in fun forms, but remember there are entire countries of people who don't eat meat. Just make sure your kids are getting the nutrition they need.

Play with the food: make the food fun to eat by arranging into shapes. Use a cookie cutter for fun shapes. Arrange food into a face on the plate. There are many ideas of this online! 

Let kids help prepare the meals in an age/ability safe way, starting with washing vegetables, or arranging them on a plate. Start a garden next season so kids can see the food grow! 

A tip from my mother-in-law: kids will eat anything on a stick or fun appetizer sized! Make roll ups with a tortilla, cream cheese, lunch meats, spinach, or whatever sandwich fillings you use and cut into circles. Put a toothpick in small pieces of fruit or jazzed up meatballs (or load up fruit or vegetables on a skewer for a fun kabob).  

Read books that involve foods. I have put some ideas on my Pinterest Books page. Two of my favorites: "I Will Never Not Ever Eat a Tomato" by Lauren Child and "Green Eggs and Ham" by Dr Seuss. Use the books to stimulate ideas-- like making green eggs!

Above all, try to keep meal time pleasant. It should be a time the family gathers to talk, laugh, and enjoy one another. If the focus is a fight about eating, it is not serving one of the big benefits of eating together.  Work the nutrition in, but keep the meal itself fun!

Post suggestions of what has worked for your family. I always love to hear new tricks!  And if your child is really restricted in foods, talk with your doctor.  Sometimes it's more than just picky!

Food Strike!

A recent facebook question: Any articles out there about what to do when your child goes on an eating strike? My son, who's five (soon), has these occasionally, and he's already thin as a rail to begin with :)

My answer became much too long, as this is a very common concern and there are so many aspects, so it turned into this blog.

This question (very common) always reminds me of the Judy Blume book, Tales of a Fourth Grade Nothing.  (One of my favorite books growing up.)  The younger brother in the book, Fudge, refuses to eat.  After many failed trials of forcing food, and bribing, his Dad finally loses patience and says "eat it or wear it."  Needless to say, Fudge ends up with the bowl of cereal on his head and goes around for days saying "eat it or wear it!"

Food Strike!  This is a common concern of parents.  But kids are smart, they won't let themselves starve.

Of course there are some instances that are cause for concern.  Red Flags include kids who are sick, recurrently vomit or ruminate, seem dehydrated, have problems with food allergies, are very limited in foods over an extended time, experience swallowing problems or choking, or who are not following their growth curve.  Red flags are another topic entirely!  Work with your physician in these cases.

If hungry, he will eat.  Just don't let him fill up on things that aren't giving a nutritious balance. Even just milk all day can be harmful because it lacks many vitamins and minerals, so a little milk with other foods is better!

• Offer veggies, fruits, cheese, nuts, etc at scheduled snack times. 
• Limit pre-packaged foods and snacks.
• Limit drinks other than water and low calorie milks.  These fill kids up and don't offer balanced nutrition.
• Put only a small amount on his plate... it might be overwhelming to have a full plate.
• Turn off the tv.  Have a dinner conversation with the family.  This not only sets up healthy eating habits, but also healthy family dynamics. Teens who eat with their families are less likely to have risky behaviors!
• Set a good example!  Talk about how much you are enjoying the healthy foods at the table. (Not how healthy they are, but rather how good they taste.)
• Keep foods separate on the plate... they might eat one food if not touching another.
• Set a time for meals and stick to it.  If your child doesn't eat, still clear the table.  When they complain of being hungry, don't be condescending.  Simply say, "I know how you feel.  I'm hungry too when I don't eat.  Dinner is coming up soon. I'm sure you'll be ready!"  Don't offer filler foods. Don't yell.  Don't over-discuss.  Kids are smart, they'll pick up on the fact that they need to eat at meal time or be hungry.  (They won't starve to death!)
• Hide healthy foods in casseroles, sauces, etc.  I love my blender... the food processor was too much for me to clean, but my blender works just as well!  Many vegetables have little flavor, which makes it easy to "hide" them in things.

• I put a can of beets in with the spaghetti sauce --makes a cool color without changing the flavor.    

• I put carrots, spinach, or cabbage in my smoothies without changing the flavor.  Strawberries, bananas, kiwi, and other fruits are much more flavorful than many veggies and kids tend to like their tastes.  I just try to match color to hide the vegetable. 

•  Puree onions, carrots, zucchini, spinach, and other vegetables in recipes rather than chopping them... kids won't pick them out!  Chances are they won't even know they're there.

• Try foods in different forms: 

• frozen peas are crunchy-- maybe they don't like the squishy texture of cooked peas
• raw broccoli is much different in taste and texture than cooked broccoli
• many kids love cheese over vegetables or foods dunked in catsup or yogurt
• it is fun to eat with fingers for a change... let them get messy!
• try cutting things into pieces and serve with toothpicks
• make a kabob of fruit and cheese pieces... it's always more fun to eat off a stick! 
• cut sandwiches with a large cookie cutter for fun shapes
• use small cookie cutters for bite sized sandwiches or fruit pieces 

• Try not to use food as a reward. This can set up unhealthy eating habits.
• Don't reward for eating.  Most kids will get the intrinsic reward of satiety.  They don't need stickers or dessert for eating a meal.
• Praise small steps.  If kids try a new food (whether they like it or not) praise the fact that they tried!

Set your expectations realistically.  Don't expect kids to eat as much as infants/toddlers or teens/adults.  Calorie needs go down when not in growth spurts.  Just make the nutrition needs balance.  Don't worry as much about volume as variety of healthy foods!  Most kids don't need supplemental meals in a can (Pediasure and other brands) ~ they are getting the nutrition and calories they need, there is just an imbalance of perception of what they need.  I always prefer a healthy, active, thin child over a child who is overweight and not active (and often undernourished due to poor quality foods).

Vitamin supplement use and need is debated (except Vitamin D, which is recommended for all).  In general, I think it is a good idea to give a multivitamin with iron if kids aren't eating well.  Iron deficiency actually causes anorexia-- increasing the problem!   Just be sure to lock up vitamins as if they are medications, so kids don't accidentally ingest too much. 

Most kids grow well during their picky eating and food strike phases!  Just be patient and aware of any red flags that need to be evaluated.  If you are concerned, schedule an appointment to discuss foods, growth, nutrition, and concerns.  Bring a typical food log of foods and drinks (with approximate volumes) for at least one week.  We can either identify a concern and develop a plan of action, or reassure you that your child is normal!