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

Screen time: Do you have a love - hate relationship with it?

Screen time. Parents often have a love - hate relationship with it. We've all heard the warnings that it is bad for our kids, but we've experienced the benefits of it keeping our kids occupied while we get things done. And some programs and games have an educational component -- do we group those in the same category as purely entertaining ones?

Most parents by now have heard the recommendations that kids under 2 years should have no screen time. At all. And older kids should have no more than 10 hours / week total.

Most parents are also fully aware that their kids exceed those guidelines. Some by a little. Others by a  lot. There are all kinds of reasons parents have for allowing this. Some are good reasons, others are not.

To be honest, there is still a lot we don't know about screen time. Research continues. When I was a child, television and movies were just passive watching. Thankfully there wasn't much offered, and with a limited number of channels, we usually stuck to watching tv only on Saturday mornings. Other times we played outside. Shows were not as action packed and overstimulating as those of today. Compare Mr. Rogers to pretty much any show designed for kids today with quick scene changes, music in the background and motion everywhere. Now there are interactive games, many of which are educational, or at least they seem to be teaching letters, counting, or other skills. There's even Wii and Kinect that use whole body movements to get kids off the couch. One can get a good workout with some of the games, but Wii bowling is nothing compared to real bowling.

So how do you count educational and active game time? Should it be included in that 10 hours/ week, or should you allow extra time for it? Are e-readers a form of screen? They often allow interaction like a computer and many can show videos and offer games.

Short answer about counting total screen time: We don't know.  Experts can give thoughtful opinions, but really at this point it's all educated guesses.

Some studies show that kids learn better when things are presented on a computer or video format. Maybe it keeps their attention better than a paper workbook. I love the ability to hold my finger on a word in an electronic e-reader and have the pronunciation and definition pop up. How many times as a young reader did I simply skip over words I didn't know? My daughter likes to increase the font size so only a sentence or two are on the screen. She feels like she reads faster because she "turns the page" more often. Does this build her confidence reading? Does it actually slow her down? I don't know. But she's happier to read and it seems to work for her. (This does drive me nuts if I pick up the Kindle after she's changed the settings... but I can change it back to my preferences easily.) Are kids losing the ability to find things in alphabetical order, such as using an encyclopedia to look something up, since they just hit "search" and find the answers? Does it matter?

Parents must really pay attention to what kids are watching and playing as well as how much time they are spending on a screen. For every minute they are on a screen they aren't interacting with people to work on social skills, they aren't outside playing games and getting exercise. If the games they are playing help develop thinking skills, strategy, math, reading, and more, then some screen time every day can benefit. If the content has violence or other age inappropriate material, it can be very detrimental. If they are online playing against other people, dangers multiply. While I can see kids who hate to read actually not notice how much they must read to play a game on a computer or tablet, are there better ways to get them pumped into reading a book?

There's a time and place for everything. The dinner table and bedroom are never a good place for online/screen time. Watch and play with your kids. They will love the time with you and you can better supervise what they're exposure is and modify it as needed.

More information:
Media Resolutions Every Family Should Make in 2014 has some tips to help monitor and limit screen time.
For information on internet safety, check out YourSphere for Parents.
American Academy of Pediatrics Media page.

Sleep tricks

I preach about sleep to kids all the time, both at the office and at home. It is one of my three most important things for overall health along with eating nutritious foods and exercise. Most of us don't get enough sleep. Here are some tricks to get in a few extra minutes each day... they all add up!

photo source: Shutterstock

Most of these tips are appropriate not only for kids and teens, but also for their parents!

Know how much sleep is typical for every age group. A great infographic of this is found at the Sleep Foundation. Warning: It shows generalizations. For example: when tweens and teens go through a growth spurt many need 10-11 hours of sleep per night, which is more than the graph shows. Just remember that individuals are just that: individual.

Think of sleep as a currency. We can go into sleep debt when we don't get enough. If it's just a little loss of sleep, it is easy to catch up and pay back the debt. The further into debt you go, the harder it is to get out of debt. Don't let the bank come after you in terms of health problems!

• Listen to your body. If you're tired, you need more sleep. The longer you stay up, the harder it will be to fall asleep. It is ironic, but sleep deprivation leads to insomnia. If you suffer, try to get extra zzz's on a weekend to fill the deficit. But don't allow yourself to sleep so late that you can't go to bed on time that night. (Note: many kids get hyper when they're tired, so don't be fooled if they have lots of energy in the evening. If they don't wake easily in the morning, they are tired!)
• Routines. Go to bed and get up at the same times every night. If you stay up later on a weekend, be sure it isn't more than 2 hours past your ideal bedtime.
• If you have a hard time getting up, try to get natural sunlight as soon as possible in the morning. It helps set your circadian rhythm. If you can't get natural sunlight, turn on lights in your home.
• Conversely, start turning down lights a few hours before bedtime. Avoid screens (tv, computers, smart phones). Lights keep you from feeling tired. Don't let them keep you up!
• Journal before bed if thoughts keep you awake. People who spend bedtime thinking about everything can't sleep. Jot a few things down to give yourself permission to not think anymore. Sounds weird, but this "worry list" works for many people!
• Be active during the day. Lounging around makes you feel more tired during the day, but it is then harder to fall to sleep at night. Experts recommend avoiding exercise for a few hours before bedtime, but I know that is really hard for kids in sports. I don't have a great fix for that, unfortunately.
• Set the alarm for the last possible minute. Kids and their parents who hit snooze several times miss out on all that sleep that they are in a half awake zone. If you really don't need to get up until the 3rd snooze time, set the alarm for that time. You will be more well rested so it will be easier to get up immediately. Train your body (or your kids) to get up at that time. After several days of an extra few minutes of sleep, you'll notice the difference!
• Learn meditation or biofeedback. Some insurance plans might pay for this. There are apps available for smartphones and tablets, just do a search. Here's one review of apps to release tension. I have used the StressEraser, but it can be pricey. Searching Amazon or eBay will have less expensive options, allow you to browse several brands, and read customer reviews.
• Set the mood in the room: darken the room, get the temperature "just right", and find the number of blankets that helps you sleep. Setting up a fan or other white noise maker helps many people sleep. For more tips on setting up the perfect room for sleeping, see Bedroom.
• Keep kids out of the parent bed so everyone gets the best sleep. Snoring, different bedtime, and other body movements makes it hard to sleep together. No one sleeps well, which makes everyone grumpy the next day. 
• Reading at bedtime can be a great relaxing thing, but if you have a page turner, be careful to not get caught up in the book for hours. I find that stopping at a lull mid-chapter is better than waiting until the end of a chapter. A good author leaves you hanging at the end of a chapter and begging for more! Set a time limit and stop reading when time's up! That's what bookmarks are for.
• Avoid caffeine, especially hidden sources. I have occasionally gotten ice cream with coffee for a family bedtime treat, only to find out upon tasting it that it had coffee. Caffeine is often added to drinks, so read labels. But be careful! It might not say caffeine directly. Some are labeled as "guarana" -- a plant with caffeine. Pretty much anything that is labeled as an energy drink (or food) is a likely culprit.  Even decaf coffee has a small amount. Chocolate naturally has caffeine... the darker the chocolate the higher the caffeine content. Some pain relievers and other medicines have caffeine. Especially for those not accustomed to caffeine, it will disrupt sleep even if taken several hours before bedtime.
• Take a warm bath. This can help relax you for a good night's rest.
• Ask a family member to give you a massage or back rub. Again, a great way to relax!
• Warm milk or herbal teas might help some sleep.