• Family Nutrition Q and A

    by Rebecca Unger MD
    on Jun 17th, 2016


Welcome to our Share the Health blog! The Neighborhood Parent Network (NPNparents.org) implemented an Ask the Expert Discussion Forum about several family friendly topics. I participated as the expert in the discussion forum about nutrition. The NPN members submitted questions about nutrition and I answered the questions which were posted on the NPN website. It was an informative way to share information. Luckily I had help from my colleague, Linda Somers, a dietician from the Lurie Children’s Hospital. Linda and I have been working together and counseling overweight and obese patients for more than 25 years in the Lurie Wellness and Weight Management Clinic. Here are some of the questions and answers from the Neighborhood Parent Network discussion forum.  This first post covers questions and answers about picky eaters. Stay tuned for our next post which covers topics to help you make healthy food choices for your family.

When I was a kid, if I didn’t want to eat my dinner, I would go to bed hungry. Of course, I don’t want to be a short order cook (for my 3 year old) but I also don’t want him waking up in the middle of the night complaining that he’s hungry. I’d love some guidance on how to handle pick eating particularly at dinner time.

This is one of my favorite questions! It is important for families to eat meals together, whenever possible. There is a lot of communication and learning that goes on during family meals. That being said, it can be tricky to keep a toddler from turning up his nose at what is served for dinner.  It is important to NOT be a short order cook. As a general rule, a parent or caregiver should provide a healthy meal, and the child should decide what to eat. If you know that your child might not like what you are making for dinner, you can include in the initial offering of what is put on the table a side dish that you know your child will eat.

Even when your children are very young, it is helpful to promote an enjoyable atmosphere during mealtime. Parents and caregivers should role model good eating and communication habits as much as possible. Kim John Payne and Lisa M. Ross even suggest lighting a candle during family meals in the book Simplicity Parenting.

The good news is that children change their ways when they are repeatedly presented with foods that initially are undesirable. With a cheerleading section and good role modeling to encourage your child to eat broccoli, she will eventually learn to like her broccoli. Studies have shown that if you offer the same undesired food 14 times, a child will eventually learn to like it.  The moral of this tale is that you should not give up!

As for your concern about going to bed hungry, if your child exhibits undesirable behavior at the dinner table, such as refusing to eat his meal, you should calmly tell him that his meal is over and get him down from the family dinner table. Meanwhile, it is helpful for him to observe how much fun the rest of the family is having at the dinner table from which he was just removed. You should explain to him briefly and calmly why he is not allowed at the table. Before bed, you can offer your child a “before bed snack”, which can be hearty enough to make sure he is not going to bed hungry. An example of a bedtime snack in this situation is yogurt with fruit. Your child does not have to know that his bedtime snack was more substantial because he did not eat his dinner. That is one of our parental secrets!

In their school lunch my kids will only eat ham sandwiches on sub buns. We alternate whole wheat buns (my choice) with white bread buns (their choice) every week. How bad is this lunch? How hard do I have to fight to get them to mix it up a little bit, or at least stick to whole wheat buns? They usually eat their vegetables at dinner, so at least there’s that….

Three regular meals/day contributes to a healthy eating pattern. Packing a school lunch is a parental labor of love. I like the idea of “picking your battles”. Much of where you end up with your choices depends on your child’s eating habits during the nonschool parts of the day, weight to height proportion and activity level. Assuming your child has healthy eating patterns at home and a healthy weight to height proportion, I think that offering whole grains is optimal but alternating with white bread buns is reasonable if that is what it takes to get your child to eat lunch. Reaching that compromise is much better than fighting for the whole-ly whole wheat.

Ideally children should eat at least five fruits and vegetables/day. It is a good idea to offer fruits and/or vegetables with every meal and snack, which would include a school lunch. Whether your child eats the fruit in her lunch bag or trades it away is out of your control!

My child (3 years) gags when she eats yogurt and will drink milk only when forced to.  I am trying to find creative ways to get calcium down her (although she does love cheese!) as she has this aversion to creamy things.  Thanks in advance for your suggestions!

Children are commonly deficient in calcium and vitamin D intake. The calcium recommendations for children are: 700 mg for 1-3 year olds, 1000 mg for 4-8 year olds and 1300 mg for 9-18 year olds. The vitamin D recommendations are 400 IU for infants and at least 600 IU for children over 1 year of age. The calcium and vitamin D intake in childhood affects bone health later on in life so it is important to be creative about calcium and vitamin D intake.

An 8 ounce glass of milk contains 300 mg of calcium and about 100 IU of vitamin D. Keep in mind that children two years and older should drink a low fat milk (either skim or 1 %). Calcium can be found in other foods such as cheese, yogurt, leafy green vegetables, fish, chickpeas, nuts and even blackstrap molasses.  Vitamin D is harder to find in other foods although it may be in some yogurt and yogurt drinks. It is a good idea to check labels for products that have the nutrients you are looking for. Although juice is not recommended, a small amount of calcium and vitamin D fortified orange juice can contribute to meeting calcium and vitamin D needs. A multivitamin, calcium/vitamin D supplement or a plain vitamin D supplement can also help meet your child’s needs.

There are other milk free foods that are calcium and vitamin D fortified such as rice, hemp, almond, coconut and soy milk. If your child has a dairy allergy it is a good idea to talk to your health care provider and your allergist to discuss these dairy free options. A helpful website for food allergies is Food Allergy Research and Education (FARE.org).

Creative ways to encourage calcium and vitamin D intake:

Resource: American Academy of Pediatrics, Committee on Nutrition, 2014

Another picky-eating question! If my kids don’t eat what I’ve cooked for dinner I sometimes let them leave the table even though they have hardly eaten anything – and they don’t get anything else to eat before bed. Is there is a different strategy that you recommend? When they’ve gone to bed basically skipping dinner, should I make up their calories and nutrition at breakfast the next morning? My kids are very petit – 6 and 8 year old boys who each weigh about 43 pounds. Thanks!

Question on a 3yr old picky eater: She won’t eat vegetables. Tried every possible ways (mashed etc) with no success. I keep presenting it over and over without forcing and with the ultimate hope that one day she will eat it? Any suggestions? Thanks!

It sounds like your daughter read the book on how to be a three year old. It is very common for children to develop picky eating habits at that age. My suggestion is to keep trying! If your child has a normal weight to height proportion then you can use this at your motto:

PARENTS/CAREGIVERS PROVIDE, CHILDREN DECIDE

If you continue to offer healthy choices, including the undesired vegetables, with good role modeling during family meals, eventually your child will change her taste and texture preferences. Meanwhile, you can give her a children’s multivitamin to make up for her decreased vegetable intake. It might also be helpful to include your daughter in meal preparation. Sometimes that can help break down the vegetable strike. Inviting others to your dinner table can also help provide role models of all ages to encourage your child to try new foods.

Author Rebecca Unger MD

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