Megan Muscia, D.O.

I often have moms tell me their kid is picky or they can’t get them to eat their vegetables. Getting kids to eat healthy is really hard these days.  Picky eaters become the center of the meal.  We start pleading with our children – “just one more carrot,” “are you sure you don’t want more?,” “you can’t have this until you eat your vegetables.”

Most kids start becoming “picky” when they are toddlers.  This is the developmental age where they want to become independent, and one thing they have control over is what they put in their mouth! Also, it is important to know that it takes time for children to develop and acquire tastes for foods.  Research has shown that it can take 10 to 15 offerings of a food before a child will acquire a taste for a new food.  How many people continue to offer foods that many times after their child has refused it?  Thus, it is important to keep offering a wide variety of foods even if your child didn’t eat much of it the first few times you gave it to them.  Can you remember a food you didn’t like as a child but now you do?  I do.  I hated mustard, tomatoes, and quiche, all things I love to eat now.  How did it happen that I now love them?  I kept trying them.  Most foods if you try them enough you start to like them.  Parents, this is the name of the game, keep giving a wide variety of foods to your kids.  Eventually they will become familiar with new foods and even start to like them.

Here are a few other tips and tricks to avoiding mealtime wars:

• You provide, they decide: Respect that your child knows when he or she is hungry.  If they only eat a little for dinner that day and they say they are done, that is ok.  Respect their ability and NEED to understand their own satiety cues.
• Routine, routine, routine: Try to eat the same time every day.  Children especially toddlers and young kids need routine and they depend on it.
• Don’t let your child graze: Almost everywhere I go I see kids with sippy cups and snacks in their hands.  If you are going to provide a cup to your child between meals only offer water.  Filling up on milk, juice or snack foods between meals can make children less hungry for food served at mealtime.
• Continue to offer a wide variety of foods: Its important to talk with your child about the color and texture of food and show them that we enjoy eating these foods too.
• Make it fun: If your child doesn’t try a food or like it the first time, offer it in a new way the next time. Incorporate it into a soup or mash it, or cut it into fun shapes (use cookie cutters). Serve it with a food that your child likes or is familiar with such as mac & cheese, or add veggies to pizza or pasta. Make smoothies with vegetables and fruit.
• Include your child in the meal planning and cooking: Ask your child which foods they want to eat at the grocery store, have them pick a meal when planning your weekly meals.  Offer age appropriate tasks for helping in the kitchen with cooking.  They can mix or set the table.  Our daughter loves to pretend she’s cooking while we cook, so we give her a bowl and spoon and let her pretend to mix stuff.
• Lead by example: We can’t expect our children to eat healthy if we don’t do it ourselves!
• Don’t buy foods you don’t want them to eat: If you don’t want them to eat goldfish or cookies or chips don’t buy them. Out of sight out of mind will work for kids!
• Make the dinner table technology free time: It’s important to sit down and have dinner as a family if possible, but at minimum no cell phones, tablets, TVs.  Distractions can make it easy for children not to complete the task at hand.
• Food is for nourishment, not a reward or punishment:Don’t withhold dessert if your child doesn’t finish their meal or as a form of discipline. Consider only offering dessert 1 to 2 times a week and other days don’t eat dessert.
• Offer veggies/fruits first: Children are most hungry when they first sit down to eat, take advantage of that and offer these foods first.
• Don’t be a short order cook: Making a meal specifically for your child will only encourage the picky eater behavior.  Try to incorporate something you know your child likes into each meal. It is important your child stay at the table even if they are done eating.

For more information and references about picky eaters, please refer to these sites. If you are concerned that your child’s picky behavior is affecting their growth, please speak to your child’s doctor.

http://www.mayoclinic.org/healthy-lifestyle/childrens-health/in-depth/childrens-health/art-20044948

https://www.healthychildren.org/English/ages-stages/toddler/nutrition/Pages/Picky-Eaters.aspx

http://www.zerotothree.org/child-development/health-nutrition/how-to-handle-picky-eaters.html?referrer=https://www.google.com/

Nicole Keller, D.O.

Medicine is an ever changing topic. We are constantly learning new things that make us change our old recommendations. I’m sure to parents with multiple kids, it may seem frustrating to have been told one thing with your first child and then given a new piece of advice with the next. We promise we’re not trying to be wishy-washy, rather, we want to make sure we give you the best and most updated recommendations at all times! Sometimes doctors even need to update each other to make sure we are staying on top of new developments as well.

Regarding this, I read a great article in the Chicago Tribune back in early January (1/9/2015 to be exact) written by Danielle Braff detailing some of the newer pediatric recommendations out there. The article really did a good job of dispersing needed updates on important topics. So for this blog, I’d like to detail some of these recommendations for you if you haven’t already heard them at your child’s most recent doctor’s visit.

1. Children need to be in a rear-facing car seat until 2 years of age.

The old recommendation and Illinois law state that kids should be rear facing until they are one year old, but, we have found keeping kids rear facing as long as possible is the safest thing to do. Make sure that your child is within the limits for their car seat’s height and weight restrictions in addition to following this prolonged rear-facing rule.

2. There are little to no food restrictions when starting your baby on foods at 6 months of age.

There are two new recommendations here: the first is to start solid foods at six months of age instead of at four months like you might have previously heard. This decreases the risk of multiple infections and makes sure your baby is developmentally ready to swallow thicker foods as well. Secondly, you don’t have to start with just cereal anymore – fruits, veggies, even meats are OK as long as they are pureed and given one ingredient at a time. In addition, there is no need to wait to offer allergenic foods (like peanut butter, eggs, strawberries, etc) – as long as the food isn’t a choking hazard, feel free to offer it! Please make sure to offer one ingredient at a time and wait two to three days before introducing a new ingredient. That way, in case there is a reaction to a food, we know what it is from. Lastly, still no honey should be offered until one year of age.

3. As soon as your child has teeth, you can brush them twice a day with fluoride toothpaste.

We used to say that young children shouldn’t have fluoride in their toothpaste for risk of overdosing on the fluoride since they don’t know how to spit. The thing is, you would have to consume A LOT of fluoride for that to happen. Infants three years and younger  should have a grain of rice size amount of toothpaste. Children older than three can have a pea-sized amount. Speaking of dental hygiene, pregnant women can and should continue to get dental work during their pregnancy – it is safe and highly recommended to keep your oral cavity clean and free of germs that may travel to the rest of the body.

4. You can use tap water to mix formula and to offer your child to drink.

We used to say that bottled water or nursery water was the better water to use for babies. Now, though, the recommendation is that tap water is safe to use – and better because of the fluoride found in it. The only exception to this rule may be if you are on well water. Then you should have your water tested to make sure it has safe amounts of minerals for your child to consume. If you aren’t sure, you can always boil your tap water and wait for it to cool before using it for your child. Remember, free water shouldn’t be given to babies until they are six months old unless your pediatrician suggests it.

5. Picky eaters may always be picky, so make sure you start them right with a healthy variety of foods in infancy.

New research has told us that many children don’t outgrow their picky eating habits that they develop in the toddler years. For this reason, it is especially important to start your children eating a healthy variety of foods. When kids don’t have these healthy fruits, vegetables, meats and starches as babies or young infants, it is less likely they’ll like them as older kids. It can take kids multiple attempts to like a food – so keep trying! Sometimes it can take 12 to 20 times of tasting a food before we know for sure they don’t like it. Wait a couple weeks, and then go for it again!

I hope this has helped clear up some of the new recommendations in the childhood years. As always, make sure to talk to your pediatrician if you aren’t sure if something is right for you, your child or your family.  Cheers!

One quick thing before I get into this week’s post: In my last post, I mentioned when I wanted to be a doctor, but I never said why.  I was born with a “hole in my heart”; mine is a VSD. My “hole” was so big it would never close on its own. So, a month before I turned 11, I had open heart surgery to fix it. My surgeon did such an awesome job, it’s like the hole never existed. He is still practicing. Hopefully none of your children will need his services, but if so, he is the best!  Ok, on to this week’s post:

Why Choose a Pediatrician?

Pediatricians are doctors concerned with the physical, emotional, and social health of children from birth to young adulthood. Pediatricians provide health services ranging from preventive health care/checkups to the diagnosis and treatment of acute and chronic diseases. A pediatrician will: Do physical exams. Give your child recommended immunizations. Make sure your child is meeting developmental milestones in growth, behavior, and skills. Diagnose and treat your child’s illnesses, infections, injuries, and other health problems. Give you information about your child’s health, safety, nutrition, and fitness needs. Answer your questions about your child’s growth and development. Refer to and collaborate with specialists should your child need care beyond the pediatrician’s expertise.

Pediatricians understand the many factors that affect the growth and development of children. They understand that children are not simply small adults. Children change rapidly, so pediatricians take into account their stage of physical and mental development. They often present different symptoms from adults. They may need different prescriptions or treatments than adults. Pediatricians are specially trained to recognize the importance of these differences, especially with young children and newborns.

Because the welfare of children and adolescents is heavily dependent on the home and family, the pediatrician supports efforts to create a nurturing environment. Such support includes education about healthful living and guidance for both patients and parents. Pediatricians participate in the community to prevent or solve problems in child and adolescent healthcare, and they serve as advocates for children and adolescents.

Why Do You Need a Pediatrician?

Family physicians can also provide routine care for children. Choosing between a family doctor and a pediatrician can be a personal preference. Here are some reasons to consider choosing a pediatrician:

• Pediatricians have specialized training in the physical, emotional, and behavioral needs of children.
• Pediatricians only see children, so they often have a broader experience recognizing and treating childhood illnesses.
• If your child was born early or has a health condition that needs close monitoring, a pediatrician may offer more specialized care.

Pediatricians are therefore primarily concerned with the health, welfare, and development of children and adolescents from birth to age 21; they are uniquely qualified to provide care for children because of their specialized training and concern for their well-being. Pediatricians have graduated from medical school and completed a three-year residency program in pediatrics.

References:

www.abp.org

www.healthychildren.org

www.webmd.com