Ask The Expert is a weekly column on Littlestomaks.com. The idea is to have a reader-submitted question answered by a nutrition expert or a pediatrician. Feel free to submit your question in the comments section below.

Nearly all parents of toddlers struggle to feed their little ones. But when it comes to feeding twins, it may be the ultimate extreme sport!  This week, Registered Dietitian Aaron Flores, who is also a dad of twins, shares his experience and a couple of successful strategies of feeding kids.

Aaron Flores, RD Bachelors in Family and Consumer Sciences and RD Experience – 4 years experience as a clinical RD specializing in weight management Expertise — General Nutrition, Weight Loss, Nutrition news, Sustainable eating Website: Balance-Variety-Moderation Blog: Balance-Variety-Moderation Blog Twitter: @Afjamp Contact: via email Aaron@bvmrd.com

Question: How can I get my twins to eat well and develop healthy habits?

Answer:

You would think that a dietitian would have an easy time when it comes to feeding their own children right? After all, we do consider ourselves the nutrition experts.  I find it is quite the contrary.  Knowledge does not always equal 100% success when it comes to feeding your kids.  Along with being a dietitian, I am also the proud father of not-quite 3-year-old twins, Reuben and Shira.  Being a father of twins and a registered dietitian, I think I’ve gained some unique perspective on feeding children.

Before being father, I remember sitting in school earning my bachelor’s degree, and learning about Ellyn Satter.  I found out she was a dietitian who had very interesting insights into feeding children.  I knew she wrote many books on the subject I never was motivated to read them until I found out my wife was pregnant.  Until you have children of your own, you never really know what kind of parent you will be or how you will handle any given situation.  You think you will handle it one way but until that actual moment is there, you never really know. Feeding my children was a perfect example of this.

What I loved about Satter’s theory is that focuses on responsibilities.  She believes that a parent’s job is to provide healthy, balanced meals to their children.  Then it is the child’s responsibility to eat the meal.  A parent is not a short order cook and should not run to the kitchen to make a whole new meal just because he/she doesn’t like what is being served.  Sounds simple?  In theory it is but until you experience the five-minute tantrum that your son is having because he doesn’t want pasta with vegetables, you don’t know how hard that is.

Having twins adds another complexity to all of this.  Some think that twins (no matter if they are identical or fraternal) should be similar since they have the same birthday, are raised together and share most of their experiences.  Wrong!  Twins are really just siblings who share a birthday and can be as different as night and day, especially when it comes to food.  My kids eat the same meals as each other but how they react during a meal is totally different.  One is more likely to get upset and the other is more likely to lose attention quickly and eat only one or two bites of food before asking to leave the table.  We learned that there were differences very early on.  Our daughter was colicky for the first four months of her life.  We tried everything to relieve the symptoms.  There was one point when she had different bottles, nipples and formula than our son.  It was our first lesson that what applied to one would not necessarily apply to the other.

If you want some insight into chaos theory, come over for dinner one night.  It is a bit of a circus but despite all of this, my wife and I have two kids that are actually very good eaters.

So how did we do it? They key is that with most things behavioral, there is no quick fix.  It takes time and consistency but pays off in the end.  Here’s what’s worked for us and maybe it can work for you too.

1. Everyone sits down at the dining room table with the TV off for dinner. (Unless there is a big football game on!)  This gives us structure at night and allows us to connect with each other
2. Have regular snack times.  If one child doesn’t eat at dinner for any reason (mood or not hungry) my wife and I know that they won’t starve.  They will have a balanced and nutritious snack in a couple hours that will satisfy them
3. As your children get older, involve them in the meals.  I made falafels at home for the first time last month and the kids helped by adding the ingredients in the food processor.  Since they were apart of the process they were more interested in trying this new food.
4. Grow some vegetables with your kids.  They will love watching the plants grow and be excited to see how a cucumber started from a seed to the long green vegetable that is now on their plate.
5. As they get older, give them a choice between two things for dinner.  Every night I ask, “Ok, do you want this or that for dinner tonight,” and that’s it.  I don’t give them more choices and I try not to get into a negotiation.

©2010 Littlestomaks.com. All Rights Reserved

Disclaimer – Information provided in Ask The Expert column on Littlestomaks.com is intended to give you general guidance on a question related to toddler nutrition. It is not meant to be treated as medical advice. You are welcome to contact this expert for a detailed consultation on your specific situation to determine what actions, if any, you should take regarding nutrition and health of your toddlers. We do not recommend you to take any action based solely on the information presented in this column. Experts have agreed to provide their professional opinion on toddler nutrition related questions on a voluntary basis and no compensation is offered to them by Littlestomaks.com.

I have a guest post today on challenges of feeding our two little monkeys as we try to apply Ellyn Satter’s division of responsibility.

Simply put, division of responsibility means parents are responsible for what, when and where and the child is responsible for how much and whether.

Check it out at Dr. Kathleen Cuneo’s Dinner Together blog. Feel free to share your challenges and tips in trying to feed your little one!

Photo: Littlestomaks.com All rights reserved
©2009 Littlestomaks.com

Getting your toddler to sit down at the dinner table and eat with you as a family is a task of monumental proportions for most parents, us included! It is something we all want, yet we struggle each day; only to pick up the pieces of our valiant efforts and move on to the next! We even stop going out to restaurants because we hate the looks we get from others – some sympathetic, some politely unapproving while some others rudely hostile! We wish for the toddler years to magically fly by hoping that one day our energetic monkey will simply learn to sit quietly in his seat and finish his meal like a grown-up, well-behaved child.

In her guest post The Power of Family Meals – Tips for Feeding Toddlers, Dr. Kathleen Cuneo offered some tips for making mealtimes a pleasant experience unlike the daily battles most toddler parents are used to. We have been trying some of these ideas, sometimes with success. But there is nothing predictable about our 3-year olds when it comes to mealtime behavior. Recently, however we stumbled upon a trick that seems to have worked a few times. I want to share it with you in this post.

A couple of days back, we took our twins to the community pool, and on our way back stopped by to pick up some pizza we had ordered earlier. As soon as we came home, we got the twins in their high chairs on the dinner table and immediately offered them a slice of their favorite cheese pizza. We got our own plates out and started with our own veggie pizza. A few minutes passed by, and still no one jumped out of their chair! So far so good, I thought – give them a few more minutes then we will see!

Suddenly, without any plan or serious thinking, I started a “question” game with the twins:

And my favorite food is?

PIZZA, shouted out my daughter.

I looked at my son, and asked “And what is your favorite food?”

He stopped, looked at me for a moment, his mouth full of the bite of pizza he had just taken. Holding the half-eaten slice in his hand, he shouted COOKIES! – well no surprises there!!

This is fun, let us keep playing I told myself.

And …. your favorite animal is? I paused as I looked at my daughter.

SHEEP, she answered, obviously remembering her recent favorite stuffed animal.

TRAIN, reflected my son – in his mind, a train was an animal! But hey there is no point debating on this topic with an imaginative 3-year old, right?

And my favorite animal ….I paused….is FISH!

They both looked at me and laughed. By this time, one full slice of pizza had disappeared.

And …… what is your favorite drink?

MILK (daughter), and a few seconds later, Hmmmm….ICE CREAM! (son). (we give him homemade OJ ice cream cup)

And my favorite drink…another pause…is WATER!

By this time, both of them were fully engaged in this game as the whole family enjoyed pizza. Almost 15 minutes had passed and everyone was still in their chairs. Their plates had a second slice of pizza now.

We kept on – the questions and answers kept going in a pattern, first my daughter, then my son, then me and then their mom, who by now seemed to be thoroughly enjoying this spectacle with befuddled amusement.

And …. who is your favorite person?

MOM! cried my daughter. I was so disappointed, but then the sight of mom’s beaming face was a memorable moment!

Eventually, we all finished the pizza. Mom and I even enjoyed a glass of wine!

Looking back, having fun is probably the most important trick of all. Play is the secret ingredient for success at mealtime!

What is your favorite tip for fun at mealtime?

In case you are wondering, the photo of our twins in this post was taken at a Thai restaurant when we went out to celeberate our 10th anniversary this year. It is not often that we find them having so much fun, but when they do, it is nice to have a camera handy!

Enjoy!

©2009 Littlestomaks.com

This is a guest post by Maryann Tomovich Jacobsen. She is the creator of www.RaiseHealthyEaters.com as well as mom of two, registered dietitian and freelance writer. After becoming pregnant in 2006, Maryann began to research pregnancy, child and family nutrition. She shares her research-based resources and insights on her blog.You can follow her on Twitter at @mtjacobsen.

When I first introduced my daughter to solid foods, she ate most of what I put in front of her – green, orange and otherwise.  Being a dietitian, I was ecstatic to have a good eater.  But other moms warned me to expect a new, pickier version of my daughter as she entered toddlerhood.  “Enjoy it while it lasts” they told me.

At about 18 months my daughter did become skeptical of certain foods.  She no longer stuffed broccoli in her mouth and wouldn’t pick off my dinner plate at restaurants.  But because I knew how to handle her with effective feeding strategies, she has stayed a pretty good eater.

I have learned that “how” you feed you toddler is as important as “what” you put on the table.  Here are feeding strategies that can make feeding your child a monumental task – or a sure delight.

1. Encouraging them to eat more than they want – It’s tough for parents to watch their child take a few bites of their meal and then declare that they are done.  As a result, many parents will encourage their little ones to eat more or even offer rewards for finishing part or all of their meal.

   Why this backfires? Children are born with the ability to self-regulate food intake by eating when they are hungry and stopping when full.  When parents insist that children eat more, they are teaching them to ignore what their bodies are telling them.  Children can grow into adults who ignore their satiety cues, eating more than their bodies need and gaining weight.

   A better strategy: Ask them if they are sure they are done eating and then excuse them.  Basically, allow them to decide how much to eat.  Ellen Satter, RD, author of Secrets to Feeding a Healthy Family, encourages parents to employ what she calls “The the division of responsibility” – parents decide the “what” and “when” of feeding and children decide “how much” to eat.

2. Feeding only their favorite foods – When kids are extremely picky, sometimes parents will provide them only with foods they like.  They figure “why waste food if they aren’t going to eat it”

   Why this backfires? In Secrets Satter talks about how it takes repeated (neutral) exposure for children to learn to like a variety of foods.  If you don’t give a child the opportunity to learn, they will grow up with a short list of foods they can eat.

   A better strategy: Follow the division of responsibility and decide what’s on the menu at mealtime.  Provide meals that are a mix of foods you know your child will eat and other foods that make up a balanced meal.  For example, if you know your child will eat grilled cheese, serve it with fruit and some milk.  Trying a new dinner?  Make sure there are two items at the table that your child is likely to eat.

3. Being pushy with healthy foods – When I talk to parents they tell me they never force veggies on their children.  But when I observe them I find subtle coercion going on.  One mom might say, “Mmmm….veggies are so good and good for you” and another might say “you usually like broccoli, how come you didn’t touch it tonight?”

   Why this backfires? Studies show that kids pressured to eat consume less food than those not pressured.  And if kids eat only to please their parents, they probably won’t eat the same foods when their parents aren’t around.

   A better strategy: My daughter never ate asparagus when I prepared it as a side dish for dinner.  I kept serving it and putting it on her plate and she’d take it off saying, “no, no, no!”  One time I left it off her plate by placing it in a big serving dish.  For the first time ever, she grabbed two pieces and ate them.  I sat their silent smiling on the inside.

   All you can do to help your children eat a variety of foods is to repeatedly expose them to it without saying a word. When your children are old enough, let them serve themselves.

4. Restricting access to empty-calorie foods – Sometimes parents completely restrict foods that offer little to no nutritional value. Or when they do offer something like sweets, they make sure they have to complete a task in order to get it (clean room, eat veggies, finish homework etc.).

   Why this backfires? Consider a 1999 Study published in Appetite.  Girls with the highest level of snack food restriction at home ate the most snack foods when they were freely offered after a meal.  Restricting palatable foods, or making them a reward for mundane tasks, makes such items even more attractive and can lead kids to overeat such foods when given the chance.

   A better strategy: Show your children how to eat empty-calorie foods in moderation by providing them 1-3 times a week as part of a balanced diet.  For example, have cookies and milk for a snack or chips with a sandwich. And use other non-food items to reward good behavior.>

5. Limiting how much they eat – While toddlers are known for erratic eating, a select few eat very well.  In fact, parents of these children often worry about weight problems and may attempt to control how much their child eats at mealtime.

   Why this backfires? My dad grew up very poor where food was scarce.  After he and my mom married and had 5 kids, he made sure to finish our plates whether or not he was hungry (at least my parents didn’t make us finish them!).  But he dealt with a weight problem his whole life.If you limit how much your children eat at mealtime, they begin to see food as scarce which can lead to obsessive food thoughts.  This is why diets don’t work – purposely limiting food intake makes people want to eat more.

   A better strategy: It comes back to the division of responsibility and letting your child decide how much to eat.  Your job is to provide balanced, nutritious meals with empty calorie (fun) food in moderation and to make physical activity a normal part of their life.

To sum up
It’s not always easy trusting children to know how much food they need.  But try to remember that your goal is bigger than just having a toddler that eats well – it’s having a toddler that grows up to be a healthy, happy and confident eater.  The right feeding strategies may not guarantee this, but it sure can increase the likelihood that your child will never have to diet, fight chronic disease or waste one minute feeling guilty for enjoying the pleasure of food. And that makes it all worth it.

References

Fisher JO. Restricting access to palatable foods affects children’s behavioral response, food selection and intake.  Am J Clin Nutr. 1999;69(6): 1264-72.

Birch SR, Daniels MW, Gilman AH, Lichtenstein KT, Steinberger J, Stettler N, Van Horn L. Dietary recommendations for children and adolescents: A Guide for Practitioners. Pediatrics. 2006:117:544-59.

Fisher JO.  Effects of age on children’s intake of large and self-selected portions. Obesity. 2007;15(2):403-12.

Secrets to Feeding A Healthy Family: How To Eat, How To Raise Good Eaters, How To Cook by Ellen Satter, RD

This is a guest post by Melissa who has two children on the autism spectrum. She blogs about life with special needs children on Mutterings Of A Mindless Mommy. Follow her on Twitter @MommyMellie.

Most parents have gone through that picky toddler stage with their child.  However, some kids seem to take the concept to a new level.  Others may still be dealing with a “picky toddler” when their child is seven or eight.  To parents who are dealing with one of these two issues, I say, “Welcome to my world.”

I have two children on the autism spectrum and extreme pickiness, oral defensiveness, decreased oral motor muscle tone and other similar issues have led to some unique (and at times frustrating) food challenges in our household.  When my oldest was two and three years old, well-meaning friends and family would tell me “oh, he’ll eat when he’s hungry.”  What they didn’t know is that no, he wouldn’t eat when he was hungry.  If the food being offered to him was not on his list of approved foods, it wouldn’t even be touched.

At two, my son had three or four foods that he would eat.  That is typical of two year-olds.  At three, he still had three or four foods that he would eat.  At four, he only ate two different foods with any regularity.  Finally, at age five, the list of foods began to expand.  Now he is seven and still only eats a handful of foods on a regular basis.  He won’t eat some food because of its color and other food because of its consistency.  If a food requires much in the way of chewing, he will forego it even if he likes the flavor.  His mouth muscles are weak and so the task of chewing food is tiresome for him.

However, looking back to how he was at four, we are happy with the variety of food that he eats now.  In case you find yourself in a similar situation, I wanted to share with you a few of the techniques that I used over the years to get him to try new foods and eventually move these new foods into the acceptable list.

Smoothies

I am sure that most parents of picky toddlers have tried the smoothie trick at least once.  You can pack many nutrients into one delicious-tasting smoothie.  It isn’t just the fruit or yogurt, but the extras that you can put in there that will make a difference with a super-skinny super-picky eater.

While making a smoothie, you can easily add in flax seeds, protein powder, etc.  We did all of those from time-to-time but the one item that I found the most tolerated, and most helpful, was coconut oil.  Coconut oil contains beneficial fat and protein – two things that were often missing in my son’s diet.  Coconut does have a distinct flavor but it blends in well with a fruit smoothie.

Food Van Goghs

Many children release their inner Van Goghs with a carrot stick and some finger paint.  While a picky toddler might not eat a raw carrot, the picky toddler with autism may not touch it or even allow it within ten feet of him.  Getting this child to actually touch the raw carrot is the first step in getting him to try a little bite.

You can do this at home – simply purchase a veggie tray and some finger paint.  Spread out several pieces of paper and show your child that the vegetables are there for something different.  Pick up a carrot and draw a smiley face.  Use a piece of broccoli to create a pattern.  Encourage your child to join in but never force him.  The purpose of this activity is to grow your child’s tolerance of the vegetable.  In the end, you may find that your child finds a favorite vegetable.  My son likes broccoli now.

Dip Baby Dip
Dips are a wonderful way to introduce new foods into any child’s diet, whether the child is on the autism spectrum or not.  In order for this to be successful, you need to let go of the traditional concept of dip.  Anything is dip.  That cup of organic baby yogurt, that’s dip.  Pulpy orange juice?  Yes, that can be dip too.  If your child is interested in dipping one item into something else, then let her experiment.

In our house, many new foods were discovered this way.  My daughter is now five and still dips her grape tomatoes into yogurt.  It sounds yucky to me but she’s eating fresh tomatoes.

Follow Your Child’s Cues

In my opinion, this is the most important part of overcoming extreme pickiness.  You absolutely need to follow your child’s cues.  Never force her to eat something, never make food an issue of reward and punishment and don’t make dessert contingent on dinner.  If dessert is part of the meal, then everyone should be allowed to eat dessert.

Many times parents have a hard time letting go of the traditional thought that a child who doesn’t eat dinner simply shouldn’t be allowed to eat dessert.  One way to get around this is to make sure that what you are serving for dessert is healthy and nutritious.  If dessert is delicious, homemade zucchini bread then you will know that your child is getting nutritional benefit from the dessert.

The ideas listed here are only a handful of ideas that myself and other parents of children with autism have tried over the years.  A child that has an aversion to smooth textures or cold food is not going to like a smoothie, no matter what you put into it.  You have to experiment to determine what works with your child and what doesn’t.  The key to this process is to have fun and let your child decide the direction your food experiments take.  Good luck!