Healthy Food/Healthy Family?

Anyone who has attempted to define healthy food knows how difficult a task it is. It's obviously better to choose vegetables over potato chips or grilled chicken over a Big Mac. But what about organic vs. conventional? How much meat is the right amount? What about fish, eggs, chicken? Is pasta a healthy choice?

Even after considering the endless questions, the prospect of planning a healthy diet (not to be confused with a weight-loss diet) is much more challenging when faced with the obstacles of daily life. Convenience outweighs healthfulness at every corner. It takes a surprising amount of attention and diligence to sustain a healthy meal plan.

Then, applying the healthy diet to a child or family vastly increases the level of complexity and the number of variables.  As I discussed in the previous post, add in the child apt to reject food on a regular basis, and healthy food choice becomes, at best, secondary.

The underlying truth is that a healthy food plan is more a philosophy than anything else, and it has to be simple, convenient and easy if it's going to work every day. The best way to start is with a definition followed by a dose of practicality.

As the new FDA food plate suggests, a healthy diet starts with variety. Humans are omnivores which implies certain basic facts about our biological needs. There are many essential nutrients we must ingest since our bodies cannot synthesize them. We need certain building blocks such as the components of protein (amino acids) and fats (fatty acids) to maintain body function. We also need minerals and vitamins in small but finite quantities. In order to satisfy these requirements, a diet needs to be nutritious and varied. Filling your body with less valuable sources of energy such as candy, fast food or snacks neglects our basic biological needs.

Practically, this means that a healthy diet is one that fits our needs both in terms of calories and the building blocks of good health. It is too easy to get caught up in the maelstrom of assessing every morsel of food we eat. The daily chore of weighing the pros and cons of each item of food quickly becomes onerous. Either this approach becomes an obsession or is discarded. Instead, the healthy diet can't hinge on every food choice every day but comprises the entirety of what we eat over weeks and months.

These suggestions stray from the central theme of any popular diet advice: avoid a certain food group combined with calorie restriction. The goal of this type of diet is short-term weight loss. The goal of a healthy meal plan is a balanced, sane approach to food.

Similarly, parents encounter completely impractical ideas such as only organic food or wildly adventurous meals few kids will even tolerate on their plate. Any parent is aware of how impossible these suggestions are, but that doesn't stop the idealistic ones from trying. Even the most ambitious and best intentioned will falter regularly when faced with a hungry, demanding child and an evening schedule gone awry. The end result is a parent making the best choices in the moment but wracked with guilt.

The often ignored but essential piece of a family’s diet is the parent's sanity. The satisfaction of a day of organic, healthy, well-balanced meals is usually commensurate with a day of endless battles about food. But a day with more realistic food choices is generally a copacetic one. This is a perfect moment to use the wise adage, "pick your battles."

The most important concept to remember is that there is no perfect meal plan. Children will eat pizza, chicken fingers and fish sticks for dinner. They will eat chips and french fries and dessert. It isn't ideal to eat these foods constantly, but it's equally problematic to ban them from the family diet. Even if buying organic food is important, no child can possibly eat only organic food in this world. Each food decision is not critical. It is the overall meal plan that adds up to a healthy diet.

And parents have to remember that our own food choices reflect the world we live in, whether we like it or not. This means supermarkets selling products of large food companies, agribusiness and false marketing of food with dubious nutritional value to children. Not only do kids need a healthy diet, but they need to learn how to live in our current world of food.

Armed with the general concepts of variety and practicality, a parent faced with the daily chore of feeding children can keep in mind the bigger picture. A balanced approach to food choice in this cultural climate will both keep children healthy and teach them what they need to know.

The next post will discuss perhaps the question I'm asked most frequently: what do you think about dessert?

The Timeless Struggle with Picky Eaters

Most parents would, ideally, say that one goal of raising a family is to know your child in the deepest and most profound of ways. It seems both cliche in an age of obsessive parenting and patently obvious that there is no other choice.

Yet many parents would also accede that, for years, nuance and complexity of the child are summarily ignored. Instead, the database about said child grows from endless comparison with other children. So a parent accumulates information in binary form: good sleeper/bad sleeper, obedient/oppositional, engaging/shy. That paradigm extends to food: good eater/picky eater.

As the data grows, any curious adult wonders what it all means. It's easy to accept and revel in the positive checkmark, but what about the less desirable chits? Should a parent accept these as a child's traits, work hard to eradicate impending faults, or assume personal responsibility for faulty parenting? 

The recent trend in the psychological literature takes parents off the hook. The increasing weight on the nature component of the nature/nurture debate means adults aren't responsible for everything anymore. What a relief? Perhaps, except that this shift doesn't seem to apply to food.

Parents do have to teach kids how to eat and the role of food in our lives, but kids aren't a blank slate when it comes to eating either. Even though nature plays a role here too, that's not yet common knowledge. We still live in a world where a picky eater is undoubtedly the parent's fault. It's a lot easier to attribute delayed milestones like walking or talking to a pre-programmed developmental clock than to avoid self-reproach for a child only willing to eat cheerios, plain pasta and white bread.

In addition, there is nothing to dissuade lucky parents from taking full ownership over a child's accomplishments. And there is little more discouraging that the parent endlessly bragging about a child's accomplishments.

It's one thing if this is a nine month old who walks or the three year old reader. The the "each in his own time" theory can assuage the creeping worry.

But what about the three year old who eats sushi? Parents of picky eaters are going to have a much harder time absolving themselves of responsibility. Maybe the child needed exposure to whole grains earlier? Maybe the parent was too lenient about giving the same dinner every night, for a year? Precocious eating is practically a new developmental milestone, and picky eating a harbinger of that dreaded codeword: delay.

But, as I wrote in the last post, refusing food is a child's prerogative. It's how kids express themselves and fight to get heard. Obedience and a varied palate in a child says a lot about personality, preference and the adult-child relationship, but is certainly no sign of brilliance. One way to repackage the information is that all children are picky about something, and food, for many reasons, is an obvious and powerful option.

There are a few ways to approach picky eating. First, resist the daily fight! Nothing will entrench parent and child more than the expected duel at each meal. The child has the ultimate power to allow the food in or not. Any parent will be extremely frustrated by the regular food refusal and has to work hard to avoid forcing food or regular punishment. While repeating the mantra "no child will starve," the parent can place the plate in front of the child and just observe what happens. Yes, easier said than done but still the most effective strategy.

Some children may lose interest when denied the satisfaction of adult anger and just abandon the picky eater track. One possible result, though, of a more passive approach is a child pegged for many years as a picky eater. Considering that even limited diets in the Western world are more than sufficient to have a healthy child, family peace and normal development are much more likely if the child is allowed to assume that identity. Given some freedom to assert independence and exert choice on a regular basis gives many children peace of mind and allows family life to run more smoothly. Even these children gradually incorporate more food into their diet.

The most difficult picky eater emails I receive from families concern a child above age ten who eats perhaps three or four foods. The underlying fear is that these behaviors are the start of an eating disorder. There is no clear correlation between picky eating and eating disorders such as anorexia and bulimia. Any early warning of an eating disorder always comes with other psychological and emotional signs of distress that drive the eating behaviors.

The very rare case of a chronic, adult picky eater appears to stem from a physiological cause. Some variant of taste and preference leads these children to only be able to tolerate very limited foods. Although those foods may expand some into adulthood, a few of these children may maintain a fairly limited diet into adulthood.

For a child at risk, it's important for a pediatrician to be sure the child is healthy and rule out any underlying medical cause. Judicious use of vitamin and dietary supplements in addition to the limited but sufficient diet can keep the child healthy in the long run. Rather than creating a family crisis, parents are better off working within the limitations. As long as parents continue to gently offer new options and provide adequate food at mealtime, the child will be healthy, the ultimate goal.

As mentioned, the next post will address the tricky subject of healthy foods.

The Daily Feeding Ritual: Meal Time between Parent and Child

I started this blog almost two years ago after receiving a series of emails from worried parents and grandparents about difficulties feeding their children. Those emails continue to trickle into my inbox, and I respond with some clinical advice and recommendations. The common theme of these entreaties remains consistent: how can you distinguish between the typical family power struggle and a nascent medical issue.

Even for an experienced clinician, these two things can be very hard to differentiate. Despite the fact that children are born completely dependent, the innate drive to assert independence starts, albeit unconsciously, in infancy. Refusing food may be the most effective way for a child to have an impact on the hovering adults. So the most common fear I hear about from parents is also completely normal childhood behavior.

Some changes in the modern world have exacerbated this dynamic. The family unit has become more and more isolated, and one result is that very few adults ever feed a child. It doesn't take a village to raise a child anymore, just a few tired grown-ups. With fewer adults bearing this load, the intensity of the parent-child bond has escalated accordingly.

The daily feeding ritual is the moment when the child gets an adult's undivided attention. This time consequently becomes a microcosm of the parent-child relationship as a whole, an opportunity for the child to try out a host of feelings and behaviors and see what happens.  It's easy to see how this time can quickly escalate into a pitched battle between a recalcitrant child and frustrated adult.

The parent is charged with the responsibility to feed this child. Balancing the confusing and often contradictory information about nutrition and healthfulness with the task of getting food into a child's tummy is no easy feat. What is easily ignored is that the child's individual participation in the food ritual is a form of communication. The parent's inherent fear is unfounded: the child won't starve. Unless there is a clear and very rare medical cause, children are programmed to eat enough to survive. But that doesn't mean the child will eat when the parent wants them to.

Instead, the daily routine offers a child the chance to "talk" to the parent. When the parent really listens, the child's physical and emotional reactions can say much more than the child's ability with words. Even a verbally precocious child won't be able to translate abstract emotions into conversation for many years.

A parent needs to try to listen to what the child is trying to say and respond in kind. That doesn't mean pseudo-psychological babble, but it does mean, for instance, that a tired, cranky child might have trouble sitting through dinner that night and might need a new strategy not to melt down. To the adult, the goal of meal time is to feed the child. To the child, this is time to talk, learn, vent and play.

There is nothing easy about this process, and the rewards happen not over days but over months and years. However, the message sent from not listening to that child is loud and clear: no one is really paying attention.

For a focused, harried parent, the goal of feeding is just to complete the task and perhaps to educate about healthful foods and eating. Whether the obedient child complies or the oppositional one rails against the meals and rules, that child is learning many things through meal time, only one being what foods to eat and what constitutes a meal. The adult reaction to varied behaviors, moods, pickiness and food choices also represents how that child learns to see herself. These experiments aren't just games. They allow a child to figure out who she really is in this world. Parents' actions and reactions end up saying just as much, if not more than, their words.

There are many ways to react to the child who refuses dinner night after night or swallows the meal in three massive gulps or plays with food or turns the meal into a sibling fight. Over time, the family reactions become an expected social paradigm the child knows all too well. Food and meals begin to correlate not only with certain emotions and experiences but also with a reflection of that child's burgeoning identity. From this vantage point, it is artificial to separate food and healthfulness from family dynamics and emotion. The daily ritual of meal time melds quickly with the complicated task of managing the relationship with your child. Remembering this perspective can take away the urgency of of each meal and put the routine of meal time into the context of raising a child.

The fruits of this labor end with really knowing your child. Understanding that feeding a child is a process of communication can be an enormous relief for many parents, but it still begs the following question: how do you still teach your kids about food? We live in a world of complicated food choices, the pressure for thinness and the specter of disordered eating and eating disorders. Any parent would be remiss to ignore these warnings and assume that the norm for a child is an uncomplicated relationship with food. But if the child at meal time isn't really focused on food, when does a parent teach these critical lessons?

I'm going answer these questions by addressing the most common concerns parents express. And I'll take these one at a time over the next several posts: picky eaters, healthy foods, dessert and thin and fat talk.