Picky eating with kiddos is such a complex beast, there's so much that goes into it. Sensory issues, medical issues, you name it. Two weeks ago, we talked about picky eating from an Occupational Therapy standpoint. This week I wanted to bring y'all another perspective from a different field.
This week's interview is with pediatric registered dietitian (and good friend) Laura Andersen. Laura is a military wife, which has opened up multiple opportunities for her to work in many different settings. She's worked with WIC, in her private practice, and in hospital settings. Not only that but she graduated Magna Cum Laude! She's a soon to be mama of twins herself, and offers some great info for other mamas!
So let's get started!
‣ For those who don’t know, what is a pediatric dietitian?
A pediatric dietitian is a credentialed nutrition professional that specializes in the nutritional health and wellbeing of children (newborns to 21 years of age) in all nutrition related capacities including children who have special needs.
‣ What made you want to be a dietitian?
As a child, I had a multitude of nutrition related issues and, fortunately, a registered dietitian was heavily involved in my treatment. She inspired me and motivated me to be the healthiest I could be both physically and mentally, which in turn, inspired my career path.
‣ Do you ever come across kiddos who have feeding problems?
A large part of my job is counseling kids and families with children who have feeding difficulties. This could range from kids with physical or mental impairments that inhibit or prevent necessary feeding skills to kids who have aversions or phobias related to food/eating.
‣ What are some reasons why kiddos have feeding problems?
Like briefly mentioned above, there are a multitude of cofactors that can be related to feeding problems. Mental and physical impairments are one source. This includes conditions such as: tongue tied, cleft palate, esophageal stricture, pyloric stenosis, dysphagia, Autism, Down’s syndrome, Cerebral Palsy, Multiple Sclerosis, etc. Traumatic events (either physical or mental) could also be related to feeding issues. This might include: phagophobia due to an event such as choking or eating disorders related to mental health issues and/or that are triggered by a traumatic event(s). I will leave you with this, human beings are complex and children are no exception. It is not uncommon that there is more than one cause of any one feeding issue. It is important for a multidisciplinary team of professionals (including a registered dietitian) to be involved in a child’s treatment if a feeding problem is identified.
‣ What concerns should parents have with kiddos who have a limited diet?
It is not uncommon when a child has a limited diet. To some degree, it is fairly normal for kids to be selective eaters; so, it’s no surprise when I hear a parent say their child is a picky eater. However, kids need a well balanced diet. If they are so selective that they are consuming only a few types of food on a regular basis, chances are they are not getting the appropriate macro or micro nutrients that are required by their bodies for accelerated growth. Even if they take a daily vitamin, the capacity at which the human body is able to absorb nutrients from a vitamin, is more often than not far inferior to food.
‣ What are some ways to make sure our kiddos get the proper nutrients when they have such limited diets?
This is one of the most common struggles among the families I counsel. If you are struggling to get your child to consume a variety of foods there are several options out there for you to try. Be sure to check with your pediatrician or a registered dietitian prior to implementing any vitamins or supplements to be sure it is medically safe and appropriate for your child.
One thing to consider is an appropriate children’s multivitamin. Now, like I said, this will not solve all of your problems, but it will certainly help get some of the micro nutrients into their daily diet. If appropriate, you can supplement with oral nutrition supplements, such as PediaSure. If you prefer, you can also fortify smoothies, milkshakes, soups, dressings with higher calorie, high protein foods such as peanut butter, wheat germ, whole/dry milk, etc. Some parents have good luck with disguising foods that their kids are not typically agreeable to by adding it to foods they do like such as smoothies or pasta dishes.
‣ When should a parent/caregiver seek the help of a pediatric dietitian or professional?
Parents know their children’s baseline health and eating habits the best. So, I urge parents to seek the help of a registered dietitian if they notice anything related to feeding that is concerning to them. Some signs may include but are not limited to, if your child is failing to gain in either height or weight, begins to lose weight, becomes lethargic, has any aversions to foods of like texture or taste, is persistently vomiting, diarrhea or constipation, or you notice any chewing or swallowing difficulties.
‣ What are some red flags for parents/caregivers to watch out for for malnutrition?
Malnutrition is a scary word but is a real concern for children with feeding issues. The first thing I look for in identifying malnutrition is if the child is growing according to their growth curve. If a child begins to lose weight or fails to gain weight or height as expected, then malnutrition (to some degree) is likely the culprit. So, if you notice that your little one’s clothes are fitting more loosely, their clothes sizes are not changing with increasing age, their weight and/or height is the same over multiple doctor’s visits, then it would be a good idea to bring up your concerns with your pediatrician and seek the help of a registered dietitian.
‣ What are some of the biggest myths out there about nutrition and kiddos?
“It’s a phase, they will grow out of it.”-- In some instances, your child may just be going through a phase and grow out of their picky behaviors, but that’s not all kids! Sometimes, as a parent, you really have to try hard to advocate for your kids nutritional health. If your child’s physical or cognitive growth is being affected by their nutrition, or lack there of, then it may NOT be just a phase.
“My kid’s will never eat that, they don’t like it.”-- Research has shown that it takes anywhere from 12-20 times before a child will even try a particular food. Give it a chance. Keep trying. And most of all, eat those foods yourself! The power of a role model is the greatest power you have as a parent.
‣ What are your top 5 tips for picky eaters and problem feeders?
- Don’t give up. Keep trying to introduce and offer a variety of foods!
- Don’t make food a negative experience. The last thing we want to do with a picky eater or problem feeder is to create negativity around food/feeding time. Be patient and create a positive, non-threatening feeding environment.
- Make eating fun! If they are the appropriate age, get the kids involved. Let them help you pick out the foods your family is going to try one week and then let them help prepare those foods. Shift some of the power to them and let them make some of the decisions.
- Make sure you maintain control of the situation. It is important that you make eating a positive fun experience, however, it is also important that you remember that you are the adult. You are responsible for your child’s health, which includes what they put into their bodies. Allow them some autonomy but maintain control over their choices. For example, create a “snack box” filled with healthy snacks of your choosing and when snack time comes, let them choose a snack from their snack box.
- Seek help if you need it. Parent’s do indeed know their kids better than any professional, but don’t be afraid to seek help when it’s needed. That is what we are here for!
‣ Is there anything that you think is important for parents/caregivers to know about nutrition and kiddos?
Nutrition is important for everyone, but is especially important for vulnerable populations such as children. Kids bodies are constantly changing and growing, which requires a specific amount of nutrients. If these needs aren’t met, the child’s physical and/or cognitive development can be jeopardized. So, it is important not to underestimate the power and importance of nutrition.
‣ What are your thoughts about pediatricians and nutrition?
Family pediatricians are often the first and only contact many parents have with a medical provider specialized in pediatrics and they can be an excellent resource for information. That being said, pediatricians often have a limited amount of time with their patients due to their patient load; remember your child is not their only patient. In addition to that, there are specialized practices for a reason, and although pediatricians are usually on top of their game, they are human and can’t know it all. Don’t be afraid to ask your pediatrician questions and ask them for a referral to other specialists. If you think it’s important, it probably is!
‣ Is there any evidence that certain diets such as gluten free, dye free, etc help kiddos with Autism and sensory processing disorder?
There is no solid evidence that any specialty diet can or should be used as a treatment for children with Autism or sensory processing disorders. There have been studies that report autistic children having an increased occurrence of gut sensitivities; however, if your child does not have issues with certain types of foods or does not have a medical need to be on a specific diet, restricting food is not necessary. In regards to dye free diets, there is some research that suggests dyes may increase hyperactivity in children, however there is not enough research regarding artificial dyes effect on children with autism spectrum disorders. One study published in 2012 by Hyman, Stewart ( DOI 10.1542/peds.2012-0900L) found no correlation between artificial food dye consumption and repetitive behaviors or externalizing behaviors; however, she did find a correlation between yellow food dye consumption and sleep disturbances. Long story short, more research needs to be done!
Well there you have it! A HUGE thank you to my girl Laura for taking time out of her busy life to chat with me! I love to bring y'all the expert advice, but I also want to give you my own trips and tricks that I've found help for my kiddos with their picky eating so bare with me theres more...
- 8theplate: This is MAGIC. A friend of mine who's son has Autism introduced this to me waaaaay back when we were first having issues with the twins and feeding. I brought it up to their OT and they ended up buying one and using it in therapy and it made a WORLD of a difference. They were trying new foods that I never thought they would. I highly highly recommend this to all the mamas with picky eaters!
- Get Creative: this can be really hard if your kiddo(s) are EXTREMELY particular with their food. Some kids are so particular that they only eat certain brands...the twins can be like that with certain things (like mac n cheese) but I've found that if I present it as something else they're more likely to try it. There are also fun plates like this one that you can buy on Amazon to try!
- Get Silly: I probably look like an idiot when trying to get the boys to eat. My voice gets high and squeaky, I jump around and make it fun. As silly as it sounds it does get them to try things more often. I also let them make a mess. This was SO hard for me at first. I'm a recovering perfectionist and neat freak so at first the thought of letting my kids color on the placemat with their food was horrifying. But, just as Rachel and Jessica mention, MESSY PLAY ALL DAY. The more exposure they have the better! Plus, Bentley specifically will try WAY more foods when he gets to dip them in any sort of sauce, so it's a win-win.
- Don't Stress: This was probably the hardest lesson for me to learn. Heck I'm still learning it. As a mama, it's hard to ignore those feelings of panic when your kiddo just won't eat. We all want our kids to grow healthy and strong and the only way to do that is to eat a nutritionally balanced diet. With that said, you can only do so much. I'm going to repeat that...YOU CAN'T DO IT ALL MAMA. Give yourself some grace and keep trying!
So there you have it! If you've made it this far I really appreciate you taking the time to read this! I hope this helped give y'all some good information. If you're struggling with a picky eater, what are some of your tips and tricks? I'd love to hear them!
