Feeding Picky Eaters Ruth Carey, RD, CSSD, LD June 24th, 2008 Nebraska School Food Service...

Feeding Picky Eaters

Ruth Carey, RD, CSSD, LD

June 24th, 2008

Nebraska School Food Service Association

Objectives

• Identify problems/situations within families that lead to development of picky eaters.

• Effectively counsel families who have difficulty with children’s food choices and eating behaviors.

• Learn to strategize with children and parents to solve mealtime struggles and grocery store choices for picky eaters.

Children’s Nutrition

• ADA Position Paper: Dietary Guidance for a Healthy Children ages 2 to 11 Years, 2004, JADA

Prevalence of Overweight

• Overweight has more than doubled among 2-5 yo since 1970’s

• Overweight has more than tripled among 6-11 yo since 1970’s

• Overweight is now more prevalent than under weight or growth retardation

Children’s Nutrition

• Energy intake has increased over the last quarter century

• Overall decline in milk, vegetables, soups, grains, and eggs

• Increase in intake of fruits, fruit juices, sweetened beverages, poultry and cheese

Children’s Nutrition

• Increased restaurant food consumption– 1997 - half food expenditures were spent

outside the home, one third on fast foods

• larger portion sizes, super sizing

Shifts in beverage consumption

– 1945 Americans drank 4 times more milk than soda

– 1997 Americans drank 2.5 times more soda than milk

Shifts in meal patterns

• Breakfast consumption is down among children and adolescents from 1965 to 1991.

• Snacking has increased significantly in the U.S.

• 50 % of children ages 6-18 report 5 eating occasions or more daily

Impact of school meals

• Children in School Lunch programs have higher intake of vegetables, milk, and meat

• Children in School Breakfast program have higher intakes of many vitamin and minerals

• School foods many times look like fast foods,i.e.: burgers, fries, pizza, nuggets

• Competitive foods in high schools and middle schools offer FMNV

Family Trends

• Fewer families eat meals together

• More families with both parents working outside home

• Increased child care by providers other than parents

Family influence

• availability and accessibility of foods

• meal structure

• adult food modeling

• food socialization practices

• food related parenting style

Situations that may encourage a picky eater

• Parents may not realize that there is a natural tendency for children to reject a new food: taste or texture issues

• Parents give in to children’s demands– fear child won’t eat– don’t want to deal with bad behavior– each child has different likes or dislikes

• Child has special needs

It may take up to 15 tries for a child to accept a new food

Division of Responsibility

• Ellyn Satter, MS, RD, LSW

• www.EllynSatter.com

Division of Responsibility

• Parent provides nutritious meals and snacks

• Parent provides regular meal and snack time

• Child decides how much to eat

• Child decides whether to eat

Common parenting mistakes

• Giving up on offering healthful foods after one refusal

• Giving in to child’s demands for food choices

• Letting a child eat while watching TV

• Letting a child eat alone

Parenting mistakes

• Giving child different meal from adult meal

• Making personal food aversions known to child

• Restricting amount or certain foods

• Dieting/restriction of own diet

Counseling children

• Cognitive development (Spear)• Early childhood: concrete operational

thought– black and white, straight forward messages– family based, multi-component education best

• Adolescence :formal operational thought– ability to think hypothetically and abstractly– Family and school based education effective

Early Adolescence

• respect for adult authority

• simple instructions

• encouragement of family involvement and direction

Middle Adolescence

• recurrent challenges to family or parental authority

• reliance on peers for standards of appearance and behavior

• simplified problem-solving techniques

• role playing

Late Adolescence

• greater reliance on internalized values

• fewer challenges to adult authority

• less reliance on peers for standards

• increased capacity to solve life problems

Counseling Parents or Caregiver

• Set a good example– healthful foods, table manners, family meals

• Model variety, moderation and balance

• Involve child in meal planning, and shopping when age appropriate

• Encourage help with meal preparation (age appropriate)

Parents and/or caregiver

• Allow child to express hunger and fullness and encourage listening to internal cues

• Allow child sufficient time to finish meal without distraction from T. V. etc.

• Avoid using dessert as reward or punishment

• Remove child from table for disruptive behaviors

Tips for increasing vegetables, dairy, variety and moderation

• Sneak vegetables into favorite food– mac and cheese

• Allow children to put favorite sauces on foods, let them dip

• Involve children in growing, picking and age appropriate preparation of meals

• Don’t provide soft drinks or sugared beverages

Tips (cont.)

• Provide a variety of vegetables and fruits often

• Use Food Guide Pyramid for meal planning

• Don’t bribe, reward or punish for eating/not eating foods

• Don’t label foods as “good or bad” or child as good or bad based on food choices

Case Study

• Daniel

• 14 yo

• 64” 87.8 lbs

• BMI 6th percentile for age

• medication : concerta

• track and Tai Kwan Do competitor

Diet Recall

• Breakfast: Multigrain Cherrios, nonfat milk,– recently added instant breakfast

• Lunch: white roll and milk (school)

• Snack: cereal, milk, ice cream

• Dinner: white bread and jelly sandwich or French bread ham and cheese, milk

• Dessert: milkshake

Other findings

• MI scale of 7 on motivation to change

• Has never eaten family meals at dinner

• Does not eat fruit or vegetables

Assessment

• underweight for height

• inadequate protein and calories for growth, sport

• diet low in fiber

• diet low in fruits and vegetables

• diet lacks variety

• extremely picky eater going back to toddler days

Recommendations

• 2500 calorie exchange plan

• planned 3 sample days menus

• increase fruits and vegetables

• eat dinner with family some nights per week

• eat more protein

• add whole grains

• take multivitamin with iron

Goals

• to eat dinner with family 3 nights per week

• to include protein in most meals

• to try eating fruits and vegetables

• to journal food intake

• return in one month

Case Study II

• Kathy

• 11 yo girl

• 5’6” 180lbs.

• >95 %ile stature for age > 95%ile wt for age

• BMI 29 >95th %ile

• no medications or other health concerns

Diet Recall

• Breakfast: sugared cereal, NF milk, banana– or white bagel with cream cheese

• Lunch: School lunch with chocolate milk, or lemonade– or turkey sandwich with mustard, 100 cal pack

of cookies or crackers

Diet recall (cont);

• Snack: Crackers, chips, or granola bar, milk

• Dinner: Grilled chicken, broccoli or – Out: Applebee’s Orange Chicken and Rice,

lemonade

• Dessert: Lite ice cream

Other findings:

• Mom “ Kathy can eat large portions”

• Constipation a problem

• No allergies

• Rarely drinks water

• Activity is PE at school only 2 days week

Assessment

• diet low in fruits and vegetables

• sugared cereals and beverages contribute empty calories

• breakfast is low in fiber and protein

• breakfast and lunch inadequate calories

• low in fluids/ water

• not enough regular activity

Recommendations

• Planned sample menu for 3 days, using Food Guide Pyramid

• Include protein at breakfast– egg or peanut butter with whole wheat toast– whole wheat English muffin with fat free cream

cheese

• Switch to high fiber cereal – Oatmeal, Bran flakes

• Drink water with all meals and snacks

Recommendations (cont)

• Drink plain milk and water at lunch

• Include fruit and vegetable at lunch in place of “100 calorie packs”

• Pack lunch 3 days per week, and buy 2 days

• Have yogurt and fruit, or cheese stick and vegetables and dip for after school snack

• Control portions at dinner (measure for a while to learn portion control)

• Increase activity to one hour per day

Recommendations (cont)

• Concrete, black and white

• First visit, set goal to work on breakfast recommendations

• Second visit, set goal to work on lunch recommendations

• Third visit, set goal to work on snack recommendations

• Keep simple food journal for 3 days each week

Results

• At one month weight is holding steady, no loss or gain

• Kathy is reading labels, sugar and fiber

• Mother realizes that this is a slow process of change

• Kathy has signed up for softball and is trying to be more active

Case Study III

• Sally

• 12 yo girl

• 5’4” 110 lbs.

• 90%ile for stature for age 75% ile wt for age

• BMI 19 54% ile

• vegetarian , lacto- ovo x 2 years

• allergic to legumes

Other

• plays competitive basketball and soccer 2 X per week

• goes to athletic club with father for pick up games and run mile

• has not started menses• Dr. concerned with recent weight loss• Mother complains Sally wants to be

vegetarian but is picky eater

Diet Recall

• Breakfast: granola with yogurt (recent change to whole milk yogurt)

• Lunch: Bagel and fruit, sometimes a cheese stick

• Snack: granola or Odwalla bar

• Dinner: Pasta with parmesan cheese, bread, broccoli

Diet Recall (cont)

• Sally wants to eat all meals downstairs in front of T.V.

• Sally states “it’s so lame to eat with your parents, none of my friends eat with their parents”

• Great deal of tension between mother and daughter

• Mother also a vegetarian, has always watched her diet

Assessment

• Diet is low in protein

• Diet is low in fruits and vegetables and variety

• Diet is low in calories for all activity

• Diet is low in calcium

• Lack of family meals

• Sally is in Middle adolescent phase

Recommendations

• 2400 calorie vegetarian exchange diet

• increase low fat dairy to 4 servings daily

• increase fruits and vegetables to 9 servings daily

• increase protein to 6 servings daily

• Sally plans 2 dinners for family per week

• Sally eats with parents with no T. V.

Recommendations

• Two goals per visit

• Concrete, specific food choices, ideas for increasing variety

• Keep food journal

• Take a multivitamin with iron

• Sally direct help from mother

Results: 3 follow up visits:• Sally has increased her protein at all meals

– edemame, sushi, dried beans and more cheese

• Sally still needs to drink more milk or eat more yogurt

Results (cont.)

• Sally has increased her fruit intake, eating more variety of vegetables

• Sally is eating tree nuts for snacks

• Increase in weight 1-2 lbs per week.

Case Study IV

• Adam

• 15 yo male

• 72” 237 lbs

• >95 %ile for weight 90% ile for height

• BMI: 32 >95%ile

• Dx: pre-diabetic, ADD

Medications

• Concerta

• Respiradal

• Selexa

Diet Recall

• Breakfast: lg bowl cereal and skim milk• Lunch: White Bagel with cream cheese and

water• After school snack: Sandwich, Lean Pocket,

Goldfish, nuts, 2 diet sodas• Dinner: Meat, chicken or fish, potatoes• Snack: Cereal with milk or dessert of

cookies and ice cream

Assessment:

• lacking in fruits and vegetables

• lacking in protein and calories at breakfast and lunch

• too large after school snack

• lacking in calcium, does not like milk

• no exercise

• medications affect appetite

Recommendations

• 2500 calories, exchange type pattern

• Weight loss

• 3 sample menus created

• Increase size of breakfast

• Add protein to breakfast and lunch

• Add fruit to breakfast

Recommendations (cont.)

• Increase intake of vegetables at dinner

• Walk 4 days per week, increasing to daily activity

• Set 2 goals per visit

• Parents both involved to help and monitor

• Help directed by Adam

Results : 6 weeks

• Weight loss of 7 lbs.

• Walking 4 days per week for 30-40 minutes

• Discontinued anti -depressant

• Oatmeal x 2 packets with protein powder most days of week

• Eating fruit at pm snack

• Eating vegetable with dinner

Conclusion

• Parents and care givers provide variety of healthy food choices

• Parents and care givers provide regular meal and snack times

• Children decide whether to eat and how much

• Involve children in growing, preparing and serving

Thank You!