Q: My mother-in-law watches my son a few days during the week. I leave food for him but she often returns it saying he didn’t like it and feeds him something else, much less nutritious. What should I do?

A: There are two different scenarios: the occasional fun time with grandma or where grandparents watch kids more frequently and take over as caregivers. In the second scenario, it’s important to establish consistency with feeding.

First off, instead of making comments here and there you’ll want to make time to talk to her. That means sitting down and really getting your point across.

I would start off by telling your mother-in-law what a great job she’s doing and how much you appreciate her help. You can tell her how important it is for you and your husband to raise your son to eat well and that you’ve been reading up on the subject.

Give her the why behind your requests. Explain the importance of structure at mealtimes — eating meals and snacks at the table. You can also tell her that it’s important to offer a variety of food even when kids don’t eat it because the exposure helps with acceptance.

Maybe as a compromise you could ask her to plan lunch as long as she gives your son the snacks you provide. Or it can be the other way around (you provide the lunch and she the snacks). You might even assign a snack time where your son will be served something sweet like ice cream or cookies. Let her know you don’t want to deprive your child, you just want to offer nutrition-poor foods less often and nutritious items more frequently.

You can always send her resources on the subject of feeding. I found this informative Q&A on feeding from the University of Idaho. There are many articles on this site that can be helpful as well.

It’s not easy to talk to other caregivers about feeding but it’s really important. Good luck!

Expert Profile: Nancy Clark is a registered dietitian (RD), board certified specialist in sports dietetics (CSSD) and author of several books including Nancy Clark’s Sports Nutrition Guidebook
and Food Guide for Soccer: Tips & Recipes from the Pros. She is an internationally known sports nutritionist who offers personalized, one-on-one nutrition counseling to casual exercisers and competitive athletes in the Boston-area.

Q: Do young children really need to drink sport’s drinks with lunch, sport games, and at birthday parties? I realize that replacement of electrolytes and sodium is important however the level of activity of young kids doesn’t appear to warrant the use of these drinks.

A: As a sports nutritionist, I often get questioned about sports drinks for young children. My response: Most kids really do not need sports drinks, especially in their lunch boxes! A sports drink is little more than sugar water with a dash of salt. They are a nutrient-poor alternative milk or orange juice.

Sports drinks can be appropriate for certain occasions, for example when young kids are exercising in very hot weather. For example, I let my young son have a sports drink when he was baking in the summer heat on the baseball field. I wanted him to drink a lot of fluid, and I knew he’d drink more Gatorade then plain water. But other than that, I encourage parents to fuel their young athletes with more watermelon, orange slices, grapes and watery fruits … foods that contribute to overall health. If the weather is hot, the kids might enjoy some salted pretzels, crackers or baked chips. The sodium (a part of salt) helps retain water and slow the rate of becoming dehydrated.

Real foods contain far more electrolytes (more commonly known as sodium and potassium) than most engineered foods. In general, the American diet has more than enough sodium and young kids are unlikely to become sodium depleted.

I’m concerned that marketing “electrolytes” somehow seems to be “politically correct” at a time when most health professionals encourage us to reduce our sodium intake … No wonder so many people are confused!

Q: After trying for 6 months, my 2-year old daughter refuses to drink milk or eat yogurt.  I’m worried that she’s missing out on nutrients by not drinking milk.  Can you please let me know what the impact of her not drinking milk is and provide some suggestions as to what I should be providing her via vitamins and/or food to make up for any deficiencies? 

A: The most important nutrients in milk are calcium and vitamin D.  Milk also has potassium, phosphorus, vitamin A and B vitamins but those are not difficult to find in other foods.  At age 2 your daughter only needs 500mg of calcium daily.  Because 1.5 oz of cheese contains 300mg, 2 ounces of cheese would almost get her there.  See this list for nondairy sources of calcium.

You can also try fortified orange juice and smoothies with yogurt/milk.  But because your daughter is only a toddler, I would continue to offer her milk with meals and with her cereal.  When she gets older her calcium needs will go up and dairy is a great way to help her meet her needs.

Even kids who drink milk may not get enough vitamin D so talk to her pediatrician about supplementing with vitamin D ( 400IU).  I like the Carlson D drops because you can just put it in food or drink and it has no taste.

I plan to talk more about the calcium needs of kids and adults in my upcoming “Nutrients Even Healthy Kids Miss” series.

The information on this site is for educational purposes only and does not take the place of medical advice. Please verify with your healthcare provider.

Q: My 6 yr old daughter is not overweight, and is actually tall and quite thin. She LOVES to eat, all the time. She thinks about food and talks about food very often. My real concern is that she always eats 100% of what is given, and if allowed to have more (I usually don’t offer), she seems to honestly have no limits. She especially loves sweets. I’m concerned about how emotionally attached she seems to food, and mostly, that she does not seem to have an ability to notice fullness. Can you help me?

A: I follow the advice given by internationally recognized feeding expert, Ellyn Satter, RD, LCSW. She has some great books available such as Child of Mine: Feeding with Love and Good Sense and Your Child’s Weight: Helping Without Harming. Her division of responsibility (DOR) of feeding is supported by the American Academy of Pediatrics and American Dietetic Association.

If you are not already familiar with it, DOR basically says that parents decide the “what,” “when,” and “where” of feeding and children decide the “how much” and “whether” of eating. The idea is that children know how much food to eat when provided with a variety in structured settings (regular meals and snacks at the table). While most parents complain that their young children do not eat enough, in some cases, a child might need much more food at mealtime.

When children want more and don’t get it, they can become obsessed with food and eat more when they get a chance (especially when parents aren’t around). And sweets are even more attractive because they are rich in calories.

I recommend that you provide meals for your daughter and when she’s done ask her if she wants more. Continue to feed her until she says she’s full. At first she’ll probably eat much more because she can, but after a while she will get the idea that she can have enough food and will eat as much as she needs (which still might be a lot for her metabolism).

The same thing goes with sweets. Offer them once or twice a week (at the table) and let her have as much as she wants. Assure her that she can have more another time.

Research shows that restricting intake and limiting access to sweet foods increases children’s preferences for such foods. What happens is something called “scarcity” where children feel food is scarce and want more. My dad was like this because he grew up poor and didn’t have regular access to food (he ate all of our leftovers). I don’t believe you are overly restricting her, just not allowing her to have more if she wants. But if she has a really high metabolism (being tall and thin) and is still hungry after eating what you serve, this could create scarcity for her.

Children also need a little more fat than adults so it’s okay to have butter with bread and regular cheese. Protein foods (eggs, chicken, fish, meat) are more satiating so you’ll want to make sure you are maximizing these items at mealtime. For example, cold cereal and fruit probably wouldn’t be enough sustenance for her in the morning.

You also can help her realize when she’s full by asking her, when she says she wants more, if her tummy is full. If you see her turning to food to deal with problems, encourage her to use non-food ways to solve them.

Response: I just wanted to tell you, your words really hit me–in a good way. I started that very day asking my daughter if she would like more after she finished her plate. It’s been 3 days, and I have offered more at every meal, and she has said yes each time. I have given more fruit or vegetable, and she eats all of it and then says she’s full now. I really feel a lot better, giving her the responsibility back to make the choice. And I can see in her face a change–she feels like I am trusting her to make a decision. This is really big for our relationship, and I already feel so much better not having food be such a weighty issue between us at this age.

Got a nutrition or feeding question?  Ask Maryann

This information on this site is for educational purposes only and does not take the place of medical advice. Please verify with your healthcare provider.

Q: I have two boys who eat great but they have completely different bodies types (one small for his age and the other more hefty.) The younger, more hefty boy has a sweet tooth and I have concerns about his weight. Do I continue to feed them the same way?

A: Yes. Continue to feed your boys the same way. To explain why this is my answer, let’s consider what would happen if you fed them differently.

If you started singling out your heavier child, he might get the idea you don’t approve of his body size (even though that’s not your intention) and this could negatively affect his self esteem. Additionally, seeing his brother eat different foods – and allowed to have seconds – could make him preoccupied with foods and eat more when he gets the chance. Research shows that restricting food intake in the overweight child is counterproductive.

Another problem with giving your thinner child more leeway when it comes to eating is that he won’t learn the healthy habits he’ll need as he gets older. Healthy feeding strategies help all children grow into weights that are right for them. Some kids will be bigger and others will be smaller and many will be somewhere in between. What you want to avoid is the unnecessary weight gain that comes from overeating and a lack of activity.

Some relevant posts on feeding strategies include, Why Children Thrive on Planned Meals and Snacks, 5 Times You Never Want to Feed Your Kids and the Book Review, Your Child’s Weight: Helping Without Harming.

In addition to feeding you’ll also want to provide your boys with plenty of opportunities for physical activity. Limiting screen time to 2 hours or less per day and only allow sugar-sweetened beverages (fruit drinks, soda etc.) on special occasions.

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The information on this site is for educational purposes only and does not take the place of medical advice. Please verify with your healthcare provider.

Last week, a mom asked me if her baby would miss key nutrients if she fed her a vegetarian diet. This week, the Los Angeles Times had a big spread on raising vegetarian kids. I felt like someone was trying to tell me something.

So a post was born.

According to the American Dietetic Association, 3 percent of children 8 to 18 years old are vegetarians. And if you’re a parent interested in feeding your family a vegetarian diet, you’ll want to get up-to-speed on what you need to do.

So I’ve listed the most common myths, followed by truths, about what it really takes to raise vegetarian kids.

1) All Vegetarians are the same.
The term “vegetarian” is thrown around a lot in our society. But there are the different types of vegetarians which makes a big difference when it comes to nutritional aspects of the diet:
-Lacto-ovo vegetarian: Drinks milk products and eggs but excludes meat, fish and poultry (some of these vegetarians will eat fish as well).

-Lacto vegetarian: Drinks milk but excludes meat, fish, poultry and eggs.

-Vegan: excludes all animal products including dairy.

2) Young children can’t meet their nutritional needs on a vegetarian diet.
Over the summer the American Dietetic Association released a new position paper on vegetarianism and concluded that when planned appropriately, such diets can meet the needs of both children and adults. In fact, vegetarians (including children) have diets higher in fruits, vegetables and fiber and lower in saturated fat and cholesterol.

3) As long as my child is eating enough fruits and veggies they are meeting their nutrition needs.
Even though fruits and vegetables are filled with nutrients, a child can eat plenty of them and still fall short on key nutrients. Here are nutrients of concern for vegetarians of all ages:
-Iron: Iron in plant foods is not absorbed as well as it is from meats. This is an easy fix though. Serving vitamin C-rich foods with plant sources of iron (or iron-fortified products) increases their absorption.

-Zinc:Due to its phytic acid content, the zinc in plant foods is not as “bio-available” as it is in meats. Some studies show vegetarians have marginal intakes of zinc while others find their intake adequate. Vegetarian children and adults need to maximize zinc in their daily meals by including soy, beans, grains, nuts, and cheese.

-Vitamin B12: Lacto-ovo vegetarians usually don’t have trouble getting enough B12 from dairy products. But because vegans avoid animal products, they need a reliable source of B12 coming from fortified foods or supplements.

Calcium:Lacto-ovo vegetarians aren’t as likely to have trouble meeting calcium needs as vegans. Vegans can make up for this by consuming low-oxalate greens like bock choy, broccoli, collards and kale. Calcium set tofu, fortified soy milk and rice milk are other good choices for vegans.

-Omega-3 fatty acids:Children need DHA/EPA essential fatty acids for brain and eye development and sources include fish, eggs and algae. And studies show the other type of omega-3 fatty acid (ALA) found in plant foods (like flaxseed) only converts a small amount to DHA/EPA.

Parents need to decide for themselves if they are willing to supplement with fish oils or use products made with aglae or microalgae. Our next expert interview will shed light on this.

4) Children won’t get enough protein: Vegetarians don’t have trouble meeting protein needs. It’s the deficiency of the nutrients found in animal protein sources (B12, iron and zinc) that can become a problem if diets aren’t well balanced.

Vegetarians used to be told to include complementary proteins at meals (like beans and rice) in order to obtain all the essential amino acids. As long as they eat a variety of protein sources this is no longer necessary. This post on Little Stomaks, a site dedicated to toddler nutrition, provides good information on protein sources for vegetarian toddlers.

5) Vegetarian children are more likely to develop eating disorders: There have been news reports declaring that adolescent girls with eating disorders are more likely to be vegetarians. But this isn’t a causal relationship. Instead, girls hide behind vegetarianism to explain why they can’t eat what’s being served.

Raising vegetarian kids is definitely doable and can lay the foundation for life-long healthy habits. Being part of a group like the Vegetarian Resource Group can provide families with the support they need.

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Another great resource is the ask the dietitian section of VegFamily.com

References:

Position of the American Dietetic Association: Vegetarian Diets. J Am Diet Assoc. 2009;109:1266-1282.

Q: My child has been refusing to eat dinner and then begs for something else to eat 15 minutes later. What should I do?

A: Dinner can be a tough meal for children because there tends to be more grown-up food on the table. I follow the advice from Ellyn Satter’s books and consider the whole family when planning dinner instead of focusing on my picky eater. I try to prepare at least 2 meals per week that are my daughter’s favorites and do the same for my husband and me. On the nights the dinner entree is a new item or something she doesn’t typically eat, I make sure to serve at least 2 other items that she likes such as bread and fruit.

If your son goes to bed awhile after dinner consider adding a bedtime snack. That way, when he asks for food between meals you can tell him his bedtime snack is coming in a couple of hours. If you stay consistent, your son will catch on and will stop asking for food right after dinner. Eventually, he’ll start eating a wider variety of food because he knows you’re not just going to feed him his favorites.

The hardest part is accepting that some nights your little one won’t eat a balanced meal. But I believe the above strategy pays off in the long run. My daughter is finally starting to eat more of the dinners I serve after months of refusing. And by refusing I mean taking the food off her plate yelling, no, no, no! Of course, I follow the Division of Responsibility: I decide the what, when and where of feeding and she decides the whether and how much of eating.

Got a nutrition question? Send it through!

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Q: A friend told me not to give my daughter fish because of the risk of mercury poisoning. Is it okay for young children to eat fish?

A: It’s too bad that methyl mercury has made families wary of serving fish. Fish is not only an excellent source of protein and low in fat, it’s the best source of omega-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) essential for brain development.

The FDA recommends high risk groups including young children, pregnant women, women capable of becoming pregnant and nursing moms limit low-mercury sources of fish to no more than 12 ounces per week. This amount is still much more fish than most Americans eat. The advice for children is the same except to provide smaller-than-adult portion sizes. Pregnant women and young children should also avoid raw fish (sushi).

Low mercury sources of fish include salmon, trout, shrimp, tilapia, pollock and light canned tuna. Limit canned albacore tuna to no more than 6 ounces per week. Avoid big fish that is higher in mercury including shark, swordfish, king mackerel, and tilefish. Kidsafeseafood.com is a great resource when it comes to fish choices and recipes for children.

When eating fish caught by family or friends always check local advisories for safety. If you can’t find any information, limit intake to 6 ounces and make that the only fish you eat all week.

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Resources:

http://www.epa.gov/waterscience/fish/advice/

Center for Research

This information on this site is for educational purposes only and does not take the place of medical advice. Please verify with your healthcare provider.

For more on what to feed your kids see our Nutrition for Children section

I’ve received many relevant nutrition questions from moms since starting Raise Healthy Eaters. So I thought I’d share these questions in the form of regular “Ask the Dietitian” blog posts. If you have a burning nutrition question go ahead and ask away. I will try my best get back to you within 2-3 days – and I just might post about it.

Q: Can parents actually CREATE an allergy by giving baby 2 new foods at a time, or not waiting long enough between introducing two new foods?

A: Giving two foods at once won’t create a food allergy; it will only make it difficult to tell which food made your baby allergic if he or she does have a reaction (vomiting, diarrhea, breathing problems or a rash). The standard wait time after introducing a new food is 2-3 days. Experts don’t know exactly what causes food allergies except that they tend to run in families.

There’s a lack of evidence that any type of feeding regimen makes food allergies more or less likely to happen. According to the newest report from the AAP, there’s little evidence that waiting to introduce highly allergenic foods like egg whites, milk, wheat, soy, peanuts, tree nuts, fish and shellfish and citrus is helpful. In fact, some new studies suggest that introducing these foods earlier may be beneficial but the research is still preliminary.

In my infant feeding guide, I do suggest waiting to introduce highly allergenic foods and spreading them out over time. This way if your child experiences a reaction he or she will be a little older and better able to communicate with you. If you have a family history of food allergies, it’s a good idea to find a pediatrician who has experience in this area.

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References/Resources:
AAP Policy Statement: Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children (Jan 2008).

This information on this site is for educational purposes only and does not take the place of medical advice. Please verify with your healthcare provider.