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.

Getting your little ones to help out in the kitchen can be a fun way to help them learn about food! This week, Registered Dietitian Jodi Greebel explains how it can help you raise a healthy eater and offers a few practical tips to get your toddler help you out in a safe way.

Jodi Greebel, MS, RD BS, Biology from Duke University, MS, Nutrition and Dietetics from NYU Experience: Private nutrition counseling practice 5+ years, Co-founder DinDins toddler food, author The Little Black Apron Expertise: Pediatric Nutrition and Weight Loss for Adults Website: DinDins Food , Citrition, LLC Twitter: @DinDinsFood @JodiRD LinkedIn profile: Jodi Greebel Facebook: DinDins Contact: via contact page on DinDins Food website

Question: How do I get my toddler involved in the kitchen? And, why should I bother?

Answer:

You’re trying to put together lunch, make dinner or do something else in the kitchen and your toddler is once again climbing up your leg wanting to be picked up. How can you hold your child in one arm and do anything remotely productive in the kitchen? Getting your toddler involved in the kitchen and allowing him/her to help does wonders for your ability to get anything done while also doing wonders for what your toddler is willing to eat! It’s a win-win. The more children get involved with food, the more likely they are to eat something and/or try something new. It’s one of the best strategies for raising a child who is not a picky eater. And, it’s a lot easier to get something done when you have two free hands!

It doesn’t matter how old your child is. There is something for all different ages – just pick age appropriate tasks such as:

• Holding a rubber spatula or plastic measuring spoons
• Playing with a plastic mixing bowl and spoon
• Washing the carrots
• Spinning lettuce or other greens
• Scrubbing potatoes with a brush
• Husking corn
• Holding down the button on the blender
• Stirring ingredients in a mixing bowl while you hold the bowl
• Using a plastic knife (with adult supervision) to slice banana
• Cracking the shell on a hard-boiled egg
• Putting the lids on your plastic containers
• Counting out cherry tomatoes to put in your salad
• Mashing an avocado
• Pulling basil or sage leaves off the stem

Be creative! Give your child any task that makes them feel like they are helping out (and allows you to do what you need to get done). Many kids are just climbing up your leg because they want to see what you are doing and help out! You’ll be amazed how much more willing your toddler is to try something if he/she has helped make it.

©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.

News about childhood obesity is everywhere these days. Hardly a day goes by without a screaming headline in the media about this issue. Jamie Oliver has further popularized it by his TV show and even Mrs Obama has taken up this cause via her Let’s Move campaign. There is no doubt that we must address childhood obesity, but what about the problem of underweight and short stature? How worried should a parent be if their toddler falls under the 5th percentile in weight and height?

Recently, registered dietitian Teresa Wagner tackled a reader question in our Ask the Expert column about a toddler not gaining weight. I received a follow up email from another reader who was worried that her 8 month old child was below the 5th percentile and not eating much. The tone of her message reflected her extreme worry and frustration at not knowing what to do.

There is a reason why our media does not focus on this problem. The numbers, when taken as a whole nationwide are not that high. See below a chart based on the 2008 data CDC’s Pediatric Nutrition Surveillance System (PedNSS) on growth indicators. The PedNSS system is a public health surveillance system which monitors the nutritional status of children from low income families under Federal programs. Data comes from public health clinics where these children are seen for routine care, nutrition education and supplemental food.

Percentage of children 2-5 years old who are underweight or of short stature is between 3-5% for Whites, Blacks and Hispanics. These numbers are even smaller for American Indians and Alaskan Natives. Compared to the 20-30% obesity rates, these numbers are too low to capture the attention of mainstream media and policy makers. Besides, the media loves to show extreme images of either very fat kids or severely malnourished starving kids from the third world countries. Anything else does not make the cut for prime time!

As a parent, it is natural to worry. It becomes a personal issue and fancy nationwide statistics do not make a difference. The frustrating part is that it is not always possible to get enough credible information to make informed decisions. The result is that each day becomes a battle to force feed a child in the hope that she will put on some weight. Since children have a natural ability to regulate their food intake based on their current needs, it may seem like they are not eating enough. Anger, frustration and despair are the emotions most parents feel under these circumstances.

Here are 5 questions you can consider to assess the situation and take appropriate actions

Is there a trend in my child’s growth chart numbers?

A single data point on the growth chart, although important, should not cause concern. Take time to understand growth charts and their limitations so you can use them to evaluate the general growth pattern of your child. Another thing to keep in mind is that your child may not be in the normal range for both weight and height. For example, our twins are tall for their age group but lag behind in weight. From this perspective, I like the BMI for age chart because it takes into account both weight and height at the same time. You can use this online calculator for BMI chart or ask your doctor about it.

Is there a medical reason for slow growth?

This is where keeping a close eye on your child’s growth pattern will help you find medical issues that may be affecting her growth. There may be known birth defects or undiagnosed metabolic or digestive disorders. Severe case of reflux like GERD is also a concern. Detecting them early and working with a specialist for corrective action is very important.

Is there a specific reason for poor appetite?

Nearly all toddlers are picky eaters and it is natural for them to frequently show poor appetite. But if it persists over a long period of time, you will need to be extra vigilant so you can find the root cause. Are there food allergies? Special environmental or seasonal triggers? Does a change in menu or feeding schedule help? The important thing is to pay attention to the unique needs of your child so each feeding is most effective. Siblings around the same age, twins or multiples need different treatments based on their individual personalities. Clearly a challenge for most parents, but there is no perfect answer. Practicing the principles of attachment parenting and nutrition can help.

Does my child seem different than his siblings or other family members?

Although it is not always a good idea to compare your children, you have to take into account your family history and genetic makeup. In some ways, a consideration of these factors is probably more important than the growth charts which are based on population averages. If your family ethnicity is not one of mainstream population, it is unlikely that the growth chart standards will be accurate for your child. Evaluate your child’s height, weight and BMI through the lens of your family’s history to determine if there are differences you should be concerned about.

Are there any special circumstances in my family?

Every family goes through ups and downs – financial, emotional or health-related – often over an extended period of time. Assess if you have certain stresses in your personal life or your family situation at the moment. Even toddlers pick on them easily even if they cannot articulate it. If these problems persists over a long period, there may be slow weight gain or even a loss in weight. Recognize these problems early and seek help from family, friends or your doctor to manage them.

One last thing to remember – early childhood height and weight is often a poor predictor of adult height and weight, except in the case of overweight or obesity. You may be surprised how fast your child can grow upon reaching puberty. Keep a close eye on the growth charts, spot the problems early and take appropriate action. No need for excessive worry just because of a couple of low points on the charts!

Most importantly, focus on building healthy eating habits. Offer a variety of foods in healthy balance and moderation.

Are you concerned about an underweight child? Please share your personal story in a comment below.

©2010 Littlestomaks.com

Wall Street Journal reported last week that sales of children’s supplements in 2008 were around $1.1 billion and growing at 4-6% each year. This is the first time data is available for kids supplements, although there is little doubt that multivitamins and mineral supplements are a big business. Just look at the amount of space they occupy on the shelf at a typical supermarket!

I am sure the question has come to your mind – should you give your child a supplement?

The position of the American Dietetic Association, which I agree with completely, is that food should be the primary source of vitamins and minerals your child needs. In general, it is very unlikely that your child has a strong need for additional supplementation even if he is a picky eater or does not seem to eat enough fruits and veggies! The Wall Street Journal article cites a study of 1847 pre-schoolers in Belgium which suggested that both supplement users and those who did not take them were often meeting their nutritional needs through food alone with the exception of vitamin D.

Having said that, there are situations where you do want to discuss the subject of supplements with your pediatrician. In 5 Reasons To Consider A Multivitamin Supplement, I wrote about a few of these situations:

1. If you are exclusively breastfeeding (0-24 months)
2. If your child’s diet is primarily vegetarian (2-5  years)
3. If your child does not eat enough fruits and veggies (2-5 years)
4. If you have a picky eater (2-5 years)
5. If your child’s growth profile is slower than normal (2-5 years)

The keyword here is consider - which means you should research this option and bring it up for discussion with your pediatrician or dietitian. Some experts believe that a majority of children today need some kind of supplementation, most frequently vitamin D, probiotics and omega-3, to fully optimize their nutrient intake. That may or may not apply to your child. It is very important to look at your child’s health history and growth profile over a long period of time. Just because he has become a picky eater over the last few weeks and does not eat any fruits and veggies is not enough of a reason to jump on the supplements bandwagon!

There is another aspect to supplement use. I wrote about another study of over 10,000 children 2-17 years old which concluded that kids who really need vitamins don’t get them. The point was that children from affluent households with a fairly good health profile were the biggest consumers of supplements.

In other words, parents are giving supplements to their children just in case and that they do not think there is any risk. Clearly, supplement makers focus on this behavior with their marketing and product mix. The problem is that there can be a downside if you are not careful. Here are a few possibilities -

1. Risk of overdose, particularly vitamin A which can cause liver problems and lower bone density
2. Overdose of iron can be fatal
3. Zinc overdose causes copper deficiency which can cause anemia (low red blood cells)
4. Poorly balanced formulation with respect to your child’s needs
5. One product containing high amount of selenium caused vomiting and diarrhea
6. Unknown impurities, sugar, artificial colors

The fact remains that unlike pharmaceuticals, nutritional supplements are not rigorously regulated by the FDA. Some rules do exist and the FDA has the power to force product recalls, but it is only when there is a reported problem. As a result, a few bad products actually manage to slip through the cracks.

Bottom line: Treat vitamins and other supplements like drugs and use them only after consulting with your doctor. Choose a quality product with high purity ingredients (look for the USP seal).

Are you using a supplement with your child? Share your reasons and the type of supplement in comments below.

©2010 Littlestomaks.com

Greetings! It is Friday again, which means it is time for the usual Five for Fridays! If you are just joining, this is where I highlight some of the recent food and nutrition related stories. This is also my soapbox where I offer my rants and not-so-scientific personal opinions! Sometimes, I also highlight the work of some of my favorite nutrition bloggers. Your comments and personal opinions, especially if you disagree with me, are most welcome and highly valued!

So, here are this Friday’s five! Enjoy and let me know what is on your mind.

Fruits and vegetables do not reduce cancer risk, but that’s no reason to give up on them

It appears that eating fruits and vegetables only slightly reduces your risk of getting cancer according to a recent study analyzed by Dr Ayala in her very insightful article “Another apple-a-day may save more lives than the Toyota recall“. Does it mean that we should ignore the advice of 5 fruits and veggies a day and bypass the produce aisle in the grocery store?

Absolutely not argues Dr Ayala and I agree completely. A diet rich in fruits and veggies has many benefits for your overall health and well-being. If there is anything you should ignore, it is studies like this and the sensational headlines that inevitably follow in the mass media.

I have a real problem with such studies and I am amazed they get funded in the first place! I doubt if they offer any value to the common public, except probably to the media machine hungry for anything that can be labeled as health related.

By the way, check out the long list of authors who wrote the original paper in the Journal of the National Cancer Institute. Granted that everyone has to make a living, but come on, this is crazy! Work on better hypotheses and solve some real problems!

To lose weight, take a cold shower

This may sound totally insane, but new research is suggesting that you can train your body to burn more calories simply by getting used to a cold environment! Turns out that exposure to cold activates brown fat inside your body, which is known to produce heat (which means burning calories) in contrast to the insulating nature of the regular fat. Believe it or not, researchers are discovering that obese mice are able to burn off half of their fat within a week simply by living in a cold environment even if they eat more than 1.5 times their usual diet.

It appears that our bodies have a built-in heat producing mechanism to offer protection against cold. Babies are born with brown fat which helps them keep warm long before they learn how to shiver. Even adults have this brown fat but it is not active. Cold environment activates the brown fat, and so does a special protein discovered by researchers at Harvard. Some are now thinking about developing a drug to encourage production of brown fat to solve our obesity problem!

Don’t get too excited though! Keep in mind, that a healthy weight is a result of achieving and maintaining the right energy balance your body needs. Energy in minus energy out equals weight gain (or loss) – it is that simple. You don’t have to torture yourself by taking a cold shower every day, or wait for a fancy anti-obesity drug!

Don’t fall for the low fat label, you may actually eat more calories

Would you believe that putting a low fat label on snacks causes people, especially those who are overweight,  to underestimate the calories and actually eat more? There is a devilish effect from this health halo, writes registered dietitian Janet Helms on her blog Nutrition Unplugged this week.

I found this research quite fascinating, although, not really surprising. This is the result of clever marketing messages on the package, which are designed to lower the resistance and enhance the urge to eat. This is no different from advertising for other products which often targets the hidden desires and aspirations of consumers. Brand associations are powerful, and once they stick, consumer choice is nearly automatic. Why is it that you always pick the same brand of toothpaste, shampoo and laundry detergent even though other options, including cheaper store brands, are available on the same shelf? It is the job of the marketer to make the product irresistible by serving consumer needs at many different levels. And some of them are very good at what they do!

The problem, I think, is not with the marketing slogans on food products. Although this notion is quite popular among today’s experts who propose imposing limits on food marketing, even to the extent of imposing a twinkie tax! The problem is in a total lack of awareness and self-empowerment on the part of the common consumer.

How can you fight the influence of such powerful marketing? Not by banning these products, but by making smart choices. Consider a mix of an offensive-defensive strategy by building your family’s personal brand. That will be your anchor which can offer some strength against the currents of powerful brand marketing. Also check out Janet’s insightful suggestions on how to enjoy real foods and practice mindful eating.

Many ways to enjoy vegetables, give it a try

More people are trying to include veggies in their diet and that is great news! Even better, there are so many ways to enjoy vegetables whether you like them raw, medium or well done according to the Fooducate blog, which offers helpful tips for making smart choices in the supermarket. There are many useful tips in this particular article, but this one resonated with me the most:

If you are thinking about incorporating more vegetables into meals, worry less about the healthiest preparation method, and figure out the tastiest and most convenient use case for you.

I think this is great advice. A large variety of vegetables are available in a typical supermarket today, whether in the fresh produce section or in the frozen foods aisle. Plus there is no shortage of recipes – you can check out our own simple recipes section for ideas! So go ahead, give it a try and share your vegetable story!

Calling all recovering picky eaters

My blogger friend Jenna of KidAppeal is on a mission! Inspired by Jamie Oliver’s Food Revolution, she wants to register 1000 recovering picky eaters in a month and help them develop a taste for a wide range of wholesome food. Interesting idea; so I am supporting her by spreading the word out. Now, you might be considered a recovering picky eater if:

• there are foods you don’t eat simply because you don’t like them even though they are good for your health; and
• you want to shrink the list of objectionable foods because you want to eat better and set a good example

If this is you, check out her blog and sign up! You got nothing to lose except a few bad habits!

Enjoy and let me know what is on your mind.

Photo Source: robbie jim on Flickr

©2010 Littlestomaks.com

This is a guest post by Jan Gambino, author of Reflux 101 and an expert in infant/toddler acid reflux, feeding disorders, special needs and parents education. She writes at RefluxMom.

Picky eating is common and often occurs during the toddler years. After the intense growth and the seemingly easy going attitude about eating and drinking during the first year, the average toddler will often have a slower rate of growth and become more opinionated about what she eats and when.

Picky Eating May Include

• Eating a limited variety of foods.
• Avoiding one or more food groups such as: dairy, vegetables or fruits.
• Craving Carbohydrates such as crackers, bread, pasta.
• Requesting a particular type of food (for example: a child who will only eat French Fries from the local fast food restaurant or Brand X frozen chicken nuggets from the food store).
• Showing displeasure or having a tantrum when a new food is presented.
• Crying or refusing to eat when the favored foods are not available.

For more information about this normal stage, read my previous post about coping with picky eating.

Beyond Picky

A few children have significant difficulty eating a variety of foods and these worrisome symptoms needs to be discussed with the doctor. If your child has many or all of the symptoms of picky eating plus any of the concerns listed below, it is time to schedule an appointment with the doctor.

Worrisome symptoms that need to be discussed with the doctor

• Slow weight gain.
• Weight loss.
• Extremely limited diet that may lack key nutrients.
• Tantrums, fussiness or crying at meals or when food is presented.
• Fearful about eating or when food is presented.
• Choking, coughing or gagging when food is presented or when eating.
• Immature feeding skills (for example: eating pureed food only beyond infancy).

A toddler may be picky or beyond picky like my daughter due to a medical condition such as gastroesophageal reflux disease (GERD). A food allergy, food intolerance or a digestive condition such as GERD, Celiac Disease, Lactose Intolerance or another condition may cause eating and digestion to feel uncomfortable or painful. A child may try to “fix” this problem by avoiding foods or food groups or even limiting intake. Other causes of extremely picky eating include: sensory issues (textures, temperatures and flavors cause discomfort) or an oral motor problem such as a swallowing disorder, aspiration or poor muscle tone. In addition, a learned pattern of eating or adapting to digestive discomfort may lead to behavioral issues. Sometimes a behavioral reaction to eating (turning away, crying) may occur due to an undiagnosed medical condition. It is always best to work with your child’s doctor to look at medical and behavioral causes of picky eating and developing a treatment plan together.

©2010 Littlestomaks.com

There is something ironic about freezing cold weather in Florida! I know, I should not be complaining because rest of the country seems to be under a really bitter cold, but I can’t help myself. It is not supposed to be that cold here. I would not mind it so much if it got cold enough to get some snow and everything shut down for a day or so. That way, we could go out and play in the snow with kids. That would be fun, but this bitter cold with the sun shining on us at the same time is simply miserable!

Anyway, enough of complaining about the cold. I hope you all had a wonderful Holiday season. I am just now getting in the groove with blogging again in the new year after a short break. Therefore, for this week’s 5 for Fridays, I am going to pick my personal favorite nutrition stories of 2009 I wrote about in this weekly column. So, here they are; let me know what you think about them.

Even Top Chefs Have Picky Kids (published Feb 20, 2009)

I have not seen the otherwise popular show “Top Chef”, but I really liked this interview with Chef Tom Colicchio in the New York Times. Despite his celebrity status, he appears to be quite modest and down-to-earth. Like most parents, he too struggles with his teenage son’s eating habits. I liked his ideas about wholesome food made from fresh ingredients and setting an example by eating healthy food at home. According to him, the choice of food is not between unhealthy and healthy, it is between good and bad! Although he acknowledges that people are busy, it is not really that hard and time consuming to make a healthy recipe (if you know what you are doing of course!). He proves that by giving an example of a 20-minute pasta dish with a yummy clams sauce.

Which vitamin is better – tablet or liquid? (published Mar 27, 2009)

There is an interesting debate going on in one of the LinkedIn groups on Nutrition. Does a tablet form of vitamin work better inside the body or the liquid form? Absorption of vitamins and minerals from a multivitamin supplement is not very well understood. In the absence of scientific data, all kinds of claims are made about liquid vitamins that they are better and they are absorbed quickly. In response to these claims, those who believe in tablets and capsules tend to make their own counter claims. It is all very confusing to everybody.

In response to my poll on multivitamins, most of those who used these supplements for their toddlers preferred the gummies or tablet variety. Very few favored the liquid form. Could be that liquid form of vitamins is not very common and tends to be more expensive.

I have been thinking about this topic lately and I intend to do some research before writing a post. In the meantime, feel free to share your opinion.

The sweet nothingness of artificial sweeteners (published May 29, 2009)

There are so many different types of artificial sweeteners available these days. And now there is all this buzz about Stevia, the real “natural” no-calorie sweetener. How do you decide which one of the white, blue, yellow and pink packets to go for as you try to grab your morning coffee? They are zero calories all right, but should you worry about possible adverse health effects, including the possibility of cancer, from some of these chemicals? And what about the fact that consuming zero calories sugary beverages does nothing to control your appetite and you might actually end up eating more even as you try to cut down on calories? Check out this very detailed article on artificial sweeteners which basically says that most artificial sweeteners are safe in moderate amounts. So go for the one that tastes the best to you. Overall, you will be better off going for just water instead of the sweet beverage and following a nutrient-rich diet including fruits and vegetables. Zero means zero after all!

30 states have 30% or higher childhood obesity rates (published Jul 3, 3009)

Scary statistics, and nothing to be proud of in my opinion. This data comes from a new report called F as in Fat – How Obesity Policies are Failing in America 2009 published by the Trust for America’s Health (TFAH) and Robert Wood Johnson Foundation (RWJF). Mississippi got the top honor for its 44% childhood obesity rate – that is nearly 1 in 2 children 10-17 years old is either overweight or obese. 8 of the 10 states with highest rates of childhood obesity are in the South. Another study of children 2-5 years old in low income families shows that nearly 15% of these children are obese compared to about 12% nationwide. It is not that we don’t know the reason for this trend – children eat junk food, they spend too much time watching TV or in front of a computer, they don’t exercise, and schools are not up to standard when it comes to providing healthy meals. Still, nothing is being done about it, and seems like we have no control over the expanding waistlines of our children. Clearly, childhood obesity is a problem we need to confront with all our creativity and resources since it has terrible implications for the long term health of our nation.

Watch out, eating hamburgers can paralyze you (published Oct 9, 2009)

I was shocked beyond belief to read the unfortunate story of 22 years old Stephanie Smith, who got really sick after eating a hamburger contaminated with E. coli. She was so sick that doctors had to put her in a coma for nine weeks, after which she could no longer walk because she was paralyzed from the waist down. A very heavy price to pay for a cheap hamburger all of us assume safe for eating without much thought.

Turns out there are serious gaps in the food inspection system which is supposed to test packaged meat for E. coli contamination. Ground beef is produced by processors from beef trimmings and other parts which they buy from many different suppliers. Not all of these incoming supplies are tested for contamination before grinding. The result is that contaminated cow parts can sometime enter the ground beef supply undetected. Does not happen very frequently, but it does happen often enough to make the news. 8000 people have become sick from 16 E. coli outbreaks in the last 3 years.

No matter how many regulations and inspections are put in place, there is no way to be 100% safe because of the way meat is processed in modern plants. My advice – cut down on beef in the first place – it has been shown to increase the risk of various types of cancer. And if you do want to enjoy a burger, make sure you follow the safe handling procedures and cook it thoroughly so that the inside of the hamburger reaches 165 °F.

Photo source: dylinindustries on Flickr via everystockphoto
©2010 Littlestomaks.com

Greetings! Hope you all are enjoying the beautiful days of Fall. I simply love this time of the year. We are getting ready for Trick-or-treat and pumpkin painting, and the twins are excited! They are already dreaming of collecting candy – it is going to be an uphill battle trying to keep them from eating too much. I won’t spoil the fun by telling you their costumes this year yet, but will surely post a photo after Halloween.

Here are the 5 nutrition related news that caught my eye this week. Enjoy and drop me a comment to share your thoughts.

A new index to help you select affordable nutritious foods

A new food rating system called the Affordable Nutrition Index (ANI) was introduced this week at the American Dietetic Association’s Food and Nutrition Expo in Denver. The idea is to provide a score that takes into account the cost of a certain food item in addition to its nutrition value. A food item with a high score means that it is high in 9 nutrients (protein, fiber, vitamin A, C, E, calcium, iron, potassium and magnesium), low in 3 nutrients (saturated fat, added sugar and sodium) and costs less on a per serving basis. Sweet potato, broccoli, green pepper, orange and banana scored high on the index (over 100) while packaged convenience foods scored lower than 100.

This index has been developed by Dr Adam Drewnowski, Director of the Center for Public Health Nutrition at University of Washington in Seattle. He used the Nutrient Rich Food Index (NFR9.3) which he previously developed and a price per serving information from food prices database, Seattle area supermarkets and industry sources. This research was sponsored by the Campbell Soup Company. Not surprisingly perhaps, many of the condensed soups from Campbell ended up with a high score around 100 compared to many fresh or cooked vegetables and even fresh fruits.

I am intrigued by this idea since we all want to select foods that have high nutritional value at an affordable cost. However, I don’t think that this is the only way to make that choice. I was disappointed to see that vitamin D was not included in the 9 nutrients to promote in the NFR9.3. Plus cost per serving is probably not the right measure of what a customer pays when buying a product. Also, you can manage cost by buying seasonal fruits and vegetables from local sources. Still, I think it is a good idea and I plan to write more about it in future.

Coke’s response to the debate on obesity is lame

Coca-Cola, the icon of sugary drinks is under attack! CEO Muhtar Kent wrote an Op-Ed piece in the Wall Street Journal on October 7th defending his company against proposals of soda tax. Coke Didn’t Make America Fat is what he believes; and quite arrogantly he points the finger to his own customers saying they lead a sedentary lifestyle! Well, Coke did make America fat according to my blogger colleague Dr. Ayala who wrote an excellent piece this week in response to Mr. Kent’s lame arguments.

So far, Coke’s response to the current debate on the role of sugary drinks in our obesity problem is rather lame in my opinion. They have announced that they will add calorie information on the front of Coke cans. They have given a large amount of money to the American Academy of Family Physicians (AAFP) to develop consumer education content as part of their Consumer Alliance Program. They are also a part of the Healthy Weight Commitment Foundation (HWCF), a group of 40 organizations seemingly engaged in a collaborative effort to address obesity. And now in their latest move, Coke has announced that they will introduce a 90-calorie mini soda can so that people can limit their intake of sugary cola.

While I am no fan of the twinkie tax, I do not believe that these actions by one of America’s top brands are of the high caliber needed to solve one of America’s most challenging health problems. Coke needs to do more than just pay lip service and make lame arguments defending their products in public. They need to take a more grass-roots approach – building playgrounds in schools, sponsoring healthy lifestyle events, developing after-school programs, integrating nutrition and physical education, sponsor healthy nutritious school lunches just to name a few examples. They need to measure the effectiveness of these programs in reducing obesity and make the data public.

Coke’ 3Q financial results show that they generated $6.3 billion in cash from operations year-to-date in 2009. They spent $241 million buying back their own shares. A little more of that cash spent on real programs to solve our obesity problem will not make a dent in their profits! What do you have to say about that Mr Kent?

FDA puts the hammer down on front-of-box labeling

The Smart Choice program it seems was the last straw according to Marion Nestle who writes a blog called Food Politics! In a letter to the food industry, the FDA is openly questioning the arbitrary nutrition standards used by companies to develop these labels which end up showing their own products as healthy. FDA wants to develop a set of independent criteria which these labels will need to meet before companies can use them on their products. FDA also wants to understand how these front of the box labels affect consumer choice.

I say, it’s about time. The Nutritional Facts panel, usually at the back or the side of the box, is too complicated for most consumers to read and understand. Consumers are looking for something simple that allows them to quickly make a decision.

We are lagging behind other countries in this area. A traffic light based food labeling system developed by the industry based on government guidelines in UK seems to be working very well. Why can’t we do the same here?

Here is a good background information on different types of front of box labeling systems. What is your opinion? Have you come across a labeling system you really like?

Toddler diets a cause for concern according to the 2008 FITS data

Latest data from the 2008 Nestle Feeding Infants and Toddlers Study (FITS) confirms the sorry state of a typical toddler diet in America. Most toddlers and preschoolers are not eating fruits and vegetables. They are consuming too much saturated fat and sodium. French fries are the most popular vegetable!

Good news is that the diets of infants and older babies are much better compared to the 2002 data. Mothers are breastfeeding their children longer and consumption of sugary drinks is decreasing. There is a risk of iron deficiency in some children.

Looks like parents and caregivers are following the feeding guidelines for infants. So why do things go south during the toddler years? Is it because of picky behavior? Or is it because toddlers eat what their parents eat? Or a combination of the two?

Not much progress has been made in the diet of toddlers since 2002. We need to make a deliberate effort to improve this situation.  Having dinner together, being a role model and encouraging fruits and vegetables is critical to solving the problem of childhood obesity. And in case you are struggling, here are some tips for picky eating.

Let us bring the school nutrition standards to the 21^st century

Can you believe that it was 1995 when the standards for the National School Lunch Program (NSLP) and School Breakfast Program (SBP) were last revised? Yet the NSLP served lunch to over 30 million children and SBP served breakfast to over 10 million children in 2008! If we are serious about fighting the battle of childhood obesity, we need to revise these standards and bring them to the 21st century!

Well, the good news is that the Institute of Medicine (IOM) has now issued its recommendations in a report titled School Meals: Building Blocks for Healthy Children, which the US Department is going to consider as they revise these standards. Recommended meal requirements encourage more fruits & vegetables, whole grains, min and max levels of calories and limit saturated fats  and sodium.

This is good news! I hope they will begin to implement these recommendations by the time our twins start going to school. I think progress may be slow due to cost and bureaucracy, but at least it’s a good start.

Enjoy and do let me know you think. I would love to have you share your best tips in comments below.

Photo source -cambodia4kidsorg on Flickr via everystockphoto

©2009 Littlestomaks.com

This is the National School Lunch Week. Improving the quality of school nutrition is one of the ways to address the problem of childhood obesity. It is encouraging to see that the USDA has established the HealthierUS School Challenge to recognize schools that promote good nutrition and physical activity. This week, Secretary Tom Vilsack is recognizing schools who have achieved the “Gold” status in this program. My question is: how come more schools are not participating in this program? The Secretary should address the barriers to his program’s adoption and measure performance in a transparent way. Only then he can hope to achieve the scale needed to truly address childhood obesity.

Here are the 5 nutrition related news that caught my eye this week. Enjoy and drop me a comment to share your thoughts.

Honey! I shrunk the food ingredient list

In a positive trend, Registered Dietitian Janet Helm (@JanetHelm) points out that packaged food producers are scrambling to simplify and shrink the list of ingredients on their products. Michael Pollan should feel happy – after all, he is the one who has been telling people not to buy foods that contain more than 5 ingredients or difficult to pronounce ingredients! Actually, I agree with him and welcome this trend. Even though all these ingredients including additives, colorants and preservatives are considered to be safe, it just doesn’t make sense to me when I pick up a product which has over 20 ingredients. Why process the food so much?

Some of the new products – Haagen-Dazs five ice cream for example – now claim to be made just like the way you would make at home with only a handful of ingredients. Hmmm…I wonder if they cost more than the regular products! That would be a brilliant marketing idea – make more money with less!

Rice eaters have healthier diets – really?

A new study based on national food consumption surveys finds that rice eaters in general tend to have healthier diets because they eat more grains, more vegetables and dietary fiber, less added fat, less saturated fat and less added sugar. Rice is cheap and provides a rich source of carbohydrates.

I was intrigued by this news, not because we eat a lot of rice in hour household, but because the correlation implied that people should switch to rice! But then upon a closer look at the story I found that this research was sponsored by the USA Rice Federation. There is nothing wrong in urging people to eat more rice, but then the study should also point to the risks of eating too much rice. White rice is a refined grain and even when enriched with added vitamins and minerals, it is nutritionally inferior to brown rice. It also has a high glycemic index which will make your blood sugar rise rapidly. On the other hand, brown rice comes with an expiration date, may be more expensive, takes longer to cook and you may not like its chewy texture.

Just because someone eats rice, does not mean their diet is healthy on its own.

Home remedies for the common cold not backed by science

No doubt, eating warm chicken soup when you are down with the cold and flu is very comforting. But is there any scientific evidence that home remedies like the chicken soup, drinking plenty of fluids, vitamin C, zinc, echinacea, honey and garlic can treat or prevent your sickness? In an extremely well-researched article, Dr Ayala (@DrAyala) concludes that there is no solid scientific evidence on food, nutrients and relief from the common cold. Her advice – you can try these home remedies for comfort, and they don’t hurt except that you need to be careful about supplements.

I do take vitamin C every day, but I am under no illusion that it is the magic bullet for preventing cold and flu. The best way to prevent cold and flu is to avoid contact with sick people and frequently wash your hands. Vitamin C is an immunity booster, not an immunity builder. Proper nutrition, healthy lifestyle, good hygiene are the building blocks for good health. Not an isolated supplement!

New York City bans bake sales in schools

Would banning bake sales from schools solve the childhood obesity problem? New York City regulators seem to think so! They seem to be on a roll because in their zeal to impose a wellness policy, they are going after everything they can find which can be labeled as nutritionally evil for the health of our children. This is nutritionism at its best without regard to the cultural norms.

You might be wondering why it bothers me so much! After all, I don’t live in New York City and my children are too young to go to school.

What I find troublesome is that regulators and policy makers feel that simply by making new rules and demonstrating their power, they can change unhealthy behaviors. It is only the stick, never the carrot! In this case, everybody is rightly upset that they will lose a very traditional way of raising funds for school activities. But are the regulators providing any alternative? A few exceptions to the new rules are provided, but they are practically useless in terms of fundraising.

They should try to focus on encouraging children to make the right choices about their eating habits in the long run. Not simply ban stuff without providing alternatives.

Parents magazine offers tips for turning your baby into a veggie lover

Dr Greene, the author of Feeding Baby Green, has a nice article in the November issue of the Parents magazine. He advises to build on your child’s curiosity about colorful things by introducing him to colorful fruits and veggies. Start early, keep trying,  and introduce variety right from the very beginning. A lot of parents are concerned about allergies, so they do not introduce new foods quickly. He disagrees with this approach and offers scientific data which suggests that babies learn to love new flavors best when they are introduced to new foods in rapid succession. He gives you a nice list of 21 plant families you should sample with your child before he reaches the age of 1.

It may work, or it may not work – and of course, all bets are off in the toddler years! That is when they get picky and nothing seems to work anymore. Here are a few articles we have published to help you with fruits and veggies:

Ask the Expert – Developing a Taste for Fruits and Veggies
Help! My Kids Don’t Eat Enough Fruits and Veggies
Ask the Expert – Getting Complete Nutrition on a Vegetarian Diet
Help Your Child with Autism Have Fun with Food

Enjoy and do let me know you think. I would love to have you share your best tips in comments below.

Photo source -tomhe on Flickr via everystockphoto
©2009 Littlestomaks.com

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.

This week, Family Physician and Registered Dietitian Dr. Shelley Meyer explains the recommended levels of vitamin D and A for a toddler.

Question: What is a safe level of vitamins D and A to give a 31 month child that weighs about 40 pounds?

Answer:

Vitamins A and D are fat-soluble vitamins, quite essential to children’s diets.  Vitamin D has been a particularly hot topic in the news lately, due to recent findings that a lot of Americans are deficient, including toddlers and children.  Vitamin D is needed for healthy bones, and a deficiency can cause soft, weakened bones known as rickets, and even lead to osteoporosis.  The recommended daily intake of Vitamin D for infants, toddlers and children has recently been increased from 200 IU to 400 IU.  Sunshine is needed to make Vitamin D into its active form, and little ones tend to be covered in sunscreen to protect their delicate skin, therefore explaining how potential deficiencies can occur.  However, only 10-15 minutes per day is needed to activate this essential vitamin.

It is important to remember that food sources are always better absorbed by the body than supplements.   However, if your child is a picky eater and does not drink Vitamin D fortified milk or eat foods rich in Vitamin D, such as fish and egg yolks, then it can be difficult to meet the daily requirements.  In this case, a simple daily dose of a multivitamin or a 400 IU Vitamin D supplement will suffice.

Vitamin A is generally found in abundance, as long as your child or toddler will eat fruits and vegetables.  Vitamin A is essential for healthy eyes, skin, teeth and bones.  Good sources of Vitamin A are eggs, milk, dairy, carrots, sweet potatoes, cantaloupe and dark green vegetables .   Vitamin A can be toxic in excessive amounts so it is important not to exceed the amount found in a multivitamin, generally 2500 retinol equivalent.

©2009 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.

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.

This week, published author and Reflux expert Jan Gambino offers some tips for getting your picky eater to eat regular foods.

Question: I am at my wit’s end with my picky eater! Can you give some advice on how to get her to eat regular food?

Answer:

Your baby used to eagerly anticipate every scoop of pureed peas and creamed spinach. If you didn’t scoop the food fast enough, she would yelp and complain. After the jars were empty, she was content to drink an entire bottle. Now your toddler turns away when you present anything green and healthy and shrieks with anger if you dare put a new food on her plate. A “meal” consists of a few bites of chicken nuggets and a sip or two of milk from a cup before she leaps up to chase the dog or rearrange her toys. So what happened?

Along the way, your baby has turned into an independent, opinionated little person called a toddler! She has learned to control her world in such grand ways-from crawling to walking and then climbing, offering new ways to challenge herself. Communication has taught her the power of words with “no” being the one that really tickles her! She is finding that she has the ability to make decisions and communicate her wants and needs.

She is beginning to get longer and leaner too. The rapid growth of the first year is slowing down and her body is changing. So are her eating habits. It makes sense that she will use her new skills to explore new ways of eating.

Toddlers are often labeled as picky eaters. A picky eater is a child who eats only a few foods from a few food groups. For instance, a child may eat 5 foods over and over again. Typically a picky eater will crave carbohydrates and omit fruits and vegetables. I call this the “White Diet” or “Prison Diet”. During the toddler years, my daughter was on the White Diet and would only eat chicken nuggets, mashed potatoes, crackers and dry cereal. I was worried that she was missing vital vitamins and nutrients from her limited eating. The pediatrician assured me that this was very common and somehow, most children continue to grow and thrive despite such a limited diet.

Top Tips for Coping with a Picky Eater:

1. Leave your emotions at the Kitchen Door: Remember, picky eating is normal and she will most likely emerge from this stage and expand her diet. Try not to show your anger or disappointment about her picky eating. Do not negotiate, offer bribes or withhold dessert. This just fuels the fire.
2. Routines: Try to eat at least one meal per day as a family. Little ones model our behavior whether we want them to or not. Maybe if she sees you eating fruits and vegetables over and over again, she will eventually decide to try some.
3. Kitchen Helper: An older toddler can “help” you in the kitchen. My daughter loved ripping the lettuce and making a salad each night. We told her how delicious the salad was and she beamed with pride. It was a full year before she decided to take a nibble of her handiwork!
4. Vitamins and Minerals: A picky eater may benefit from a multivitamin with minerals. Check with your doctor.
5. Nutrition Drinks: Some picky eaters may benefit from a nutrition drink made for children ages 1-12 years. It can be served as a substitute for a meal, added to a shake or smoothie or used in cooking instead of milk (i.e.: pudding pancakes).
6. Hide the Oreos: I kept my emergency chocolate supply on a high shelf. The “snack drawer” was full of healthy snacks within her reach: crackers, pretzels, raisins, nuts. That way, she was not tempted by unhealthy food choices.
7. Little Stomachs/Little Meals: Make sure you are offering small portions to your toddler. In the morning, she ate breakfast followed by her “fruit snack”. My picky eater ate half her lunch at noon and then in the afternoon, her “snack” consisted of the other half of her lunch. After dinner, if she was still hungry, it was time for her “yogurt snack”.
8. Play with your food: Make sure mealtime is enjoyable and playful. Bring out the special silverware and plates (with your child’s favorite character on it of course); invite a friend to join you. Eat in a new place: on a big rock, on the top of the jungle gym or in a kid friendly restaurant.

Remember, your picky eater will be a teenager before you know it and will surely eat you out of house and home! Good luck and happy eating!

©2009 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.

This post is a guest post by Kayris, a mom to two in Maryland. She writes about raising kids in the big city at The Great Walls of Baltimore. A proud AP mom, she especially uses the principles of Attachment Parenting in the kitchen.

Attachment Parenting is a style of parenting that focuses on creating strong and healthy emotional bonds between child and parent. AP parents believe that using love and respect to guide parenting decisions–from nutrition to discipline to how you teach your child to sleep–forges a strong and secure bond that lasts beyond childhood into adulthood. For more on the eight principles of Attachment Parenting, please visit Attachment Parenting International.

Among the many milestones a baby will reach in his first year, beginning the transition from breast milk or formula to solid food is one of the most fun. What parent doesn’t have a video of a young child sucking in spaghetti one noodle at a time, or a photo of a child wearing (rather than eating) the first birthday cake?

In the wake of the recent childhood obesity epidemic, it’s my opinion that introducing solids to your baby is one of the most important milestones as well. Starting in babyhood, you can stress the importance of respecting your body by practicing good nutrition, and by modeling healthy eating habits, you give your child tools to make healthy food choices as an older child and adult.

Think about all the people in your life and there is bound to be at least one, facing diabetes or another medical crisis, struggling to change a lifetime of bad food habits. It might seem difficult to imagine your baby as an adult, but the attitude you impart to your child NOW will last a lifetime.

As a mom to two, I’ve spent plenty of time wondering if my babies were eating enough, often enough, or a wide enough variety of foods. By making good nutrition and a healthy lifestyle a priority for our family, I now have two children that I consider to be good eaters. Each has their challenges, but here are some of the points that have worked for our AP family.

• Introduce Solids When Your Baby Is Ready–Most doctors will say this happens between four and six months, but let your child lead the way. Don’t let others pressure you into starting solids before your child is ready. My son, now 5 years old, let us know he was ready at 4 months when he would reach for food on our plates. My daughter, now 2, was closer to six months.. She showed no interest before then and it wasn’t until her sleep patterns changed that she was ready.
• Go Slow, And Keep Food Allergies In Mind–If your family has a history of food allergies, ask your pediatrician for specific instructions on when and how to introduce solids. Otherwise, try one new food at a time and wait several days in between new foods so you can be sure there isn’t a problem.
• Make Breast Or Bottle Number One–For the first year, breast milk or formula should supply most of your baby’s calories. Solids are extra. If you are breastfeeding, keep an eye on your supply, as introducing solids can decrease your supply. Read more about maintaining and increasing your supply at Kellymom.com. Personally, I always ended each solid feeding meal with my two children with a short five minute pumping session to keep my milk supply up.
• Never Force A Child To Eat–A baby that is not hungry won’t eat. Try to avoid forcing food on your child, and let his or her natural ability to gauge hunger and satiety develop. This is key to raising an older child that knows when to stop eating! If your baby isn’t interested, put away the food and try again later.
• Have Reasonable Expectations–Some children are better eaters than others. Food preferences are also partially genetic, so don’t be surprised if your baby strongly dislikes something. While some kids need to be offered a food ten times or more before they will accept it, some foods may never be accepted! Think about your own food preferences and you’ll likely find some strong favorites and some strong un-favorites. Neither of my children will eat carrots in any form, no matter how I prepare them; I’ve had to conclude that, for now, it’s a food they don’t like. In addition, pickiness is a natural stage that many children go through. Likes and dislikes will change over the years. Don’t be surprised if your baby happily accepts every food you give him, only to refuse to eat them as a strong willed toddler.
• Respect Your Child’s Individuality–This is especially important if your baby is your second child. Don’t expect or pressure your baby to do things like their older sibling did, or like the child next door. Each child develops at their own pace and in their own way. That goes for eating habits as well.
• Eat As A Family–Get your child used to sitting down with the family to eat at an early age. A study at Columbia University showed that teens who eat dinner with their families six to seven times a week are almost 50 percent more likely to remain substance-free than teens who eat dinner with their families twice a week or less. Teens who eat dinner often with their families are more likely to have better grades, lower stress levels and healthier diets. Family dinners three or more nights per week reduce a child’s likelihood to engage in risky behavior. Start your baby eating with the family now, so it’s an ingrained habit when they are older. In addition, eating as a family is a great way to bond with your children.
• Model Healthy Habits–Long before your baby becomes aware of advertising and is susceptible to tricky marketing aimed at kids, the person with the most influence is YOU. Make sure when your baby sees you eat, it’s wholesome and healthy food. If your diet could use some improvement, this is a great time to do it.

Finally, always remember the AP principle to feed with love and respect.  The healthiest food in the world doesn’t mean as much if the bond between parent and child isn’t there.

Find more information on Attachment Parenting and toddler nutrition here.

Photo source: marekf on Flickr
©2009 Littlestomaks.com

I got interested in reviewing this book by Jan Gambino when I connected with her on LinkedIn and she mentioned that some of the picky eating habits of toddlers may be due to gastroesophageal reflux (GER) or gastroesophageal reflux disease (GERD). This peeked my interest because in most cases we assume that picky eating is a behavioral problem. In some cases, the underlying reason may be physiological leading to a behavioral issue. Parents of infants and toddlers with GERD are probably already sensitized to that, but for a lot of other parents this may not be so obvious.

GER is defined as the backwashing of food from the stomach into the esophagus (food pipe) and throat during or after a meal. GERD, on the other hand, is considered to be symptoms or complications of gastroesophageal reflux. Clinical signs of GERD in children include vomiting, poor weight gain, dysphagia (difficulty swallowing), abdominal pain, esophagitis and respiratory disorders.

Overview

Jan has written this book out of a personal struggle with her youngest daughter’s severe asthma and reflux problem, which took a lot of time to diagnose, treat and control. She even calls herself a Reflux Mom! The wisdom of her personal experience and what she learned working with other parents can be clearly seen in this book. What I really liked about this book was the Question-Answer format in a lot of sections which directly addressed common concerns. It is full of practical tips and relevant comments from parents, yet it manages to cover a lot of ground on advanced medical topics and medications for GERD. Amazingly, Jan has been able to pack a lot of details in just over 250 pages!

10 things I learned from this book I did not know before

One way for me to evaluate a book is to step back and think about new actionable knowledge I gain by reading it. Luckily we did not face any major problems with reflux when our twins were still infants. There were a couple of incidents of forceful vomiting when we were introducing solids, but then we backed off, took it slow and avoided problem foods. In that way, this book gave me a lot of new information which I did not know before from personal experience. Here are 10 nuggets I gleaned from my reading:

1. Reflux (GER) is common in infants and babies and usually disappears in early toddler years. But GERD is a chronic condition which needs treatment.
2. There are several million children with GERD in the US.
3. Reflux can cause ear infections in babies.
4. Reflux can be triggered by food allergy.
5. Reflux is very common in children with autism.
6. Reflux during infancy can lead to picky eating in toddlers.
7. There is something called a silent reflux when food and acid from the stomach enters the esophagus but doesn’t come out as vomit. It can cause a lot of pain, irritation or discomfort to the child.
8. Some babies and children with reflux can even get overweight.
9. Colic and reflux can occur together but they are not the same.
10. Breast milk minimizes reflux since it is easy to digest.

What I wish this book had more of

Although this book is very well organized and there is a lot of useful information, it could use a few pictures or visuals to make its contents more appealing and not so dry. It is more of a personal preference as I am a very visual person. I like to see charts, graphs and tables to quickly understand the data. I also like pictures or photos to make it even more personal.

Recommendation

Here are a few reasons you may want to consider getting this book:

1. You would like to know more about reflux so you can be prepared to handle your baby’s needs and are not surprised by normal episodes of reflux.
2. You feel exhausted by excessive fussiness at feeding times, sleep issues and slower than expected weight gain and suspect that you need to see a doctor about these problems.
3. Your child has been diagnosed with GERD and you feel completely at a loss about how to care for him.
4. You feel isolated, constantly challenged, emotionally drained and feel you are not able to cope with the needs of your child with GERD.
5. You would like to learn more about tests, medications, surgery options and resources about GERD.

Overall, I give it a big thumbs up!

Visit RefluxMom.com for more information on GER, GERD and how to purchase this book.

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.

This week, Family Physician Dr. Michelle May offers a few tips on helping your toddler develop a taste for fruits and veggies.

Question:My 2-year-old dislikes fruits and vegetables, but I want her to get these important nutrients—and learn to like them. How can I help her develop a taste for them?

Answer:

Congratulations for recognizing the importance of a healthy diet. Only 2% of all children eat the recommended number of servings from all of the food groups. It is common for children to have strong food preferences so it can be a challenge – just don’t make it a battle. Here are ten practical tips:

1. Relax- having a positive, low-key attitude about eating makes meal time more pleasant and therefore feeding more successful.
2. Follow the leader – make family meals a high priority and be a great role model by serving and eating a variety of fruits and veggies.
3. Don’t be a short order cook – fix one balanced meal for everyone in the family. Remember, it is your responsibility to decide what you will offer but it is up to them whether they will eat it.
4. Make it fun – when my kids were small, we played Guess the Color. They closed their eyes and tried to guess the color of the food I put in their mouth. They were having too much fun to realize that the most colorful foods happen to be vegetables.
5. Serve the vegetables first – they are more likely to eat them when they are hungry.
6. Don’t bribe or reward children for eating certain foods -they quickly realize that those foods must be yucky if you have to bribe them to eat them. They also learn to hold out until the reward is offered.
7. Involve your child in shopping for, preparing and serving food – they are more likely to eat it because they participated in the process. At two, my son’s job was to tear up the lettuce and drop it in the bowl. The first time he helped, we made the mistake of telling him to tear it into “bite-sized pieces.” You guessed it…he bit off pieces of the lettuce and spit them into the bowl!
8. Be creative – add carrots to spaghetti sauce, spinach to meat loaf, tomatoes to toasted cheese and bananas to peanut butter sandwiches. Keep fresh fruit and cut up vegetables handy for snack time and offer fruit-based desserts.
9. Easy on the juice and “fruit drinks” – they don’t pack much of a nutritional punch and may just add unnecessary sugar to your child’s diet.
10. Don’t give up!It can take up to ten exposures to a particular food before a child will accept it. Maybe she doesn’t like steamed broccoli and cauliflower but will have fun dipping fresh Trees and Clouds into a little ranch dressing.

©2009 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.

This is a guest post by Dr. Kathleen Cuneo. She is the founder of Dinner Together, LLC, which provides education, consultation, and coaching to families with concerns about their children’s eating behaviors. Over the last 2 decades, Dr. Cuneo has helped parents and children of all ages including those with special needs. Follow her on Twitter @dinnertogether.

When I am asked by parents about what they can do to raise healthy eaters, my recommendations focus on the “how” of eating rather than the “what.”  Feeding children takes place in a relationship, most often a parent-child relationship.  Feeding is parenting.  It can be confusing and overwhelming at times, but it is so important.  What you do as a parent and how you approach your feeding relationship with your child can help set the stage for them to develop a healthy relationship with food and maintain a healthy weight, as well as to maintain a healthy relationship with you.

Mastering the “how” of feeding your children involves a number of factors, but one of the most important is getting in the habit of eating together with your children.  Research has shown family meals to be associated with better nutrition and academic success in children.  Frequent family meals have also been associated with lower risk for obesity, disordered eating, and substance abuse in children and adolescents.

Despite its importance, many parents struggle with getting the family together for meals regularly.  The reasons are numerous and varied.  Work schedules, children’s after school activities, and parents’ discomfort with eating and/or cooking are all potential obstacles to family meals.  Another potential obstacle, especially for families with younger children, is the child’s mealtime behavior.  Some children are picky eaters who can make mealtimes unpleasant, especially if their pickiness gets enacted by whining, complaining, or throwing food.  Some kids can’t sit still at the table and make it challenging for the rest of the family to enjoy a sit-down meal together.  Other children can disrupt the family meal with boisterous, overly-active, or other uncooperative behaviors.

I formed Dinner Together, LLC in any effort to help families find solutions to some of the obstacles they face in having successful family meals.  My experiences as a psychologist and as a parent to three children help me to help other parents.  Families with toddlers can face special challenges with feeding because this is both an exciting and frustrating time of learning and growth.  As your toddler is learning motor skills and trying to find their independence, you may find yourself feeding a very different child than the baby who sat patiently with an open and eager mouth waiting for you to spoon feed her.  Parents need to adjust their feeding expectations for this “new” little person developing before them.  A toddler will not likely be able to sit still and focus on eating (or anything else for that matter!) for more than ten minutes.  A toddler will likely reject many foods.  They may like something one day and reject it the next.  This is all normal and to be expected.

So what is a parent to do?  In a nutshell, my best advice is captured in three tips.

• First, have patience.  Raising a successful eater takes time.  There will be ups and downs along the way, but stick with it, don’t give up, and have faith.  Try not to get too discouraged with your toddler’s rejecting ways and don’t stop offering all those healthy foods you want him to eat.

• Second, relax about the nutritional content of individual meals.  Your child’s health is not determined by the nutritional value of a single meal.  Look at patterns in food intake over a period of time – more like a week’s work of meals

• Finally, understand the division of responsibility in feeding.   Familiarize yourself with Ellyn Satter’s classic work, stating that parents are responsible for the what, when, and where of feeding, while children are responsible for whether and how much.

For more information and ongoing tips, recipes, and strategies for cooking and feeding, sign up for my free e-newsletter at www.dinnertogether.com and follow my blog at www.dinnertogether.blogspot.com.  Currently, I am running a gift card giveaway and recipe contest which expires July 12, 2009.  Read more about it at my blog.

Photo Source – www.dinnertogether.com
©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