5 Reasons to Cook for the Family!

Most parents would agree that good nutrition for their kids is a priority, but it is difficult to put that priority into action on a daily basis. Parents today family cookingare busier than ever. The Bureau of Labor Statistics reported that as of 2011, both parents are working in 58.5% of married-couple families (1). This is compared to 51% in 1998 and 33% in 1976 (2). Also, the labor force participation rate (the percent of the population working or looking for work) for all mothers with children under age 18 was 70.6% in 2011 (1). More time at work for parents means less time at home to make meals for the family. And of course it takes additional time to plan meals, find recipes, and grocery shop for the food.

As a dietitian, it is my job to educate families on the importance of nutrition and how to achieve good nutrition status, especially for growing children and those who have special healthcare needs. But I am also able to personally help those busy parents and families by offering in-home cooking sessions, meal planning, and grocery store visits. In this way, better nutrition status as well as nutrition education can be accomplished.

Here are 5 reasons why cooking from home is so important:

  1. It is almost always healthier. Cooking from home, especially when using whole food ingredients, most often means fewer calories, fat, sodium, preservatives, and other additives than eating out or eating packaged convenience foods. Alternatively, excessive calories, fat, and sodium are implicated in cardiovascular disease, hypertension, overweight and obesity, cancer, and many other chronic medical conditions.
  2. It is often cheaper. When you crunch the numbers, it can be much more affordable to buy ingredients to make meals from home (which may also provide leftovers for future meals) than it is to buy those same meals out at a restaurant. In other words, you could feed your whole family spaghetti with meat sauce, salad, and breadsticks for less than what that meal would cost to serve one family member at a restaurant.
  3. Home-cooked food instills good eating habits. When you are planning family meals, you are making an effort to include a variety of healthy foods. When you take time to make the meal and share the meal with the family, you have the opportunity to be a role model for healthy eating. You can also have positive discussions about eating well and what is nutritious about the meal.
  4. Cooking at home provides a platform for establishing and sharing family traditions. Food and cooking are a big part of cultural traditions. That is, if your family continues to cook and share meals that your relatives and ancestors did. If we stop making and sharing these recipes, then we lose that aspect of our family’s culture that makes us who we are. Instead we may end up aligned with the “culture” of major food corporations and their marketing efforts.
  5. Research shows that eating as a family has numerous positive effects on children. In fact, studies have demonstrated that teenagers who regularly eat dinner with their families are healthier, happier, do better in school and engage in fewer risky behaviors than teenagers who don’t regularly eat family dinners (3, 4). Again, the family dinner is a great platform for communicating with your kids. It is a chance to really hear about what is going with them and show them that you are engaged in their lives.

To make an appointment with a registered dietitian at North Shore Pediatric Therapy who can help YOUR family, call 877-486-4140 to schedule an appointment. Our registered dietitians offer grocery store shopping and/or education sessions, meal planning services to meet your families’ nutrition needs, and in-home cooking services. We are happy to help make your life easier and your family healthier.

Schedule A Nutrition       Assessment

1. http://www.bls.gov/news.release/famee.nr0.htm
2. Tamar Lewin, “Now a Majority: Families With 2 Parents Who Work,” New York Times, October 24, 2000.
3. Eisenberg, M.E., Olson, R.E., Neumark-Sztainer, D., Story, M., & Bearinger, L.H. (2004). Correlations between family meals and psychosocial well-being among adolescents. Archives of Pediatrics and Adolescent Medicine, 158, 792-796.
4. Lyttle, J., & Baugh, E. (2008). The importance of family dinners. Gainesville, FL: Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida. FY 1054, http://edis.ifas.ufl.edu/fy1054.


Ideas for Kid-Friendly Vegetarian Dinners

People choose to have a vegetarian diet for a variety of reasons. There are some nutrition advantages to being a vegetarian, especially when it is done vegi childcorrectly. In other words, when eating as a vegetarian, it is still important to eat quality foods. If abstaining from meat implies consuming more processed carbohydrates and cheese, this is not exactly a healthy trade-off. Fruits and vegetables should be emphasized, of course, but a variety of quality protein sources and healthy fats should be included in a vegetarian diet as well. See my previous blog on protein sources for kids for a list of alternatives to meat.

I believe it is great to include one or two vegetarian meals a week. It introduces variety to your family so that dinners do not always involve a rotation of meat, starch and vegetables. It can also save money to feed your family a vegetarian meal; for example, if you use dried or canned legumes as the main course. Finally, vegetarian dinners tend to be lower in fat and higher in fiber, which are the ingredients to a heart-healthy diet.

Here are three easy recipes for vegetarian dinners that are also kid-friendly:

White Bean and Quinoa Panini-Wraps

1 small onion, chopped
1-2 tablespoons olive oil
1-2 can white beans, drained and rinsed (estimate 1 can for about 4 servings)
2 cups cooked quinoa
1-2 handfuls of baby spinach leaves
½ tablespoon cumin
1 cup shredded mozzarella cheese
½ cup plain yogurt
6 whole wheat tortillas

Heat olive oil in a medium or large pan over medium heat. Saute onions until soft. Add beans, quinoa, spinach and cumin. Continue stirring over medium heat for a few minutes until all ingredients are heated thoroughly and spinach is wilted. Remove from heat and stir in yogurt and cheese. Heat another skillet or griddle over medium heat. Scoop ½ cup of the bean mixture and place into the center of the tortilla. Fold tortilla sides inward. Place wraps on the skillet or griddle, seam side down. Press flat and let toast 3-5 minutes on each side.
Makes 6 servings.

Since this recipe incorporates protein, whole grains and vegetables, the only side you need to add is fruit!

Peanut Butter-Drizzled… Tofu Stir Fry

1 block of organic, extra firm tofu, cubed
1-2 tablespoons olive oil
2 cups of your favorite vegetables, chopped. (Let the kids pick! Or go with colorful bell peppers)
1 cup chopped dark leafy greens (kale, spinach, chard, etc.)

1/4 cup peanut butter or almond butter
2 teaspoons maple syrup
2 tablespoons soy sauce
1 teaspoon grated ginger
1/3 cup water

Saute tofu in olive oil over medium heat until tofu starts to brown (approx 10 minutes). While this is cooking, mix all of the ingredients for the sauce in a small saucepan over low heat. Stir with a whisk frequently until it is smooth and heated thoroughly. In the tofu pan, add vegetables and greens; continue stirring frequently. Let the tofu and vegetables saute until the vegetables are softened and the greens are wilted. Pour sauce over the tofu-vegetable mixture and mix well. Serve with noodles or brown rice and fruit.
Makes approx 4 servings.

Scrambled Egg Burritos

6 eggs
1 tablespoon butter
6 soft corn tortillas
1-2 cups shredded cheddar cheese
Condiments- chopped avocado, cilantro, and salsa or any your family chooses.

Melt butter in pan and cook eggs, scrambled-style. Warm the tortillas so that they are softened prior to assembling the burritos. Place each condiment, including the cheese, in small bowls on the table. Let the kids assemble their own burritos and pick which condiments they would like. Serve with a side of seasoned black beans (can of beans that has been drained, rinsed and heated in a small pot with salt, pepper, cumin and pinch of red pepper) and a side of fruit.

Try creating and serving these recipes once a week with your family. Help them enjoy a new meal by showing your own enthusiasm for it and asking them to help prepare it. Remember to use words to name the meal that they are already familiar with, such as Panini, peanut butter and burrito. This may help them feel more comfortable with the meal rather than saying quinoa and spinach, tofu and vegetables or eggs and beans. Enjoy!


Swallowing Disorders vs. Feeding Disorders in Children

Swallowing Disorder and Dysphagia are terms that are used often to specifically describe difficulty eating as a result of physiological or anatomical baby eatingissues. These issues result in the inefficiency or inability of a child to safely ingest an age-appropriate diet that meets all nutritional needs. For example, an infant who is unable to coordinate the actions of sucking, swallowing and breathing to nurse may aspirate during meals (when liquid or food enters the windpipe, and may eventually reach the lungs). This could be due to physiological dis-coordination and anatomical weakness. We all have experienced a “Dysphagia moment” before due to this type of dis-coordination which results in “down the wrong pipe” discomfort and, usually, a coughing fit. However, this example is just that- one example of the multitude of ways a child’s swallowing pattern may be negatively altered and result in Dysphagia. It is not always obvious (i.e., silent aspiration will not result in a coughing fit) and has many causes and signs.

What Is A Feeding Disorder?

A feeding disorder is a more broad term that is used to describe the difficulty a child may have accepting a varied and age-appropriate diet. A feeding disorder may best describe a child who shows strict texture and food preferences. A feeding disorder may also describe a child who shows signs of aversion to being fed or feeding themselves. Feeding disorders in children can sometimes develop due to a child’s history of Dysphagia and the uncomfortable eating situations they have experienced. This history will likely impacted their flexibility and acceptance in trying new foods.

How To Identify Swallowing And Feeding Disorders?

A very broad and simplified way to differentiate between these types of feeding difficulties is to consider where the breakdown lies. A child who experiences difficulty getting food from a plate to their mouth for manipulation exhibits a feeding disorder, whereas a child who experiences difficulty getting food safely from their mouth into their digestive system exhibits Dysphagia.

Feeding and swallowing difficulties must be identified and treated as soon as possible for the greatest success of a child. If you have any concerns with your child’s abilities or behavior during meal times, seek out the advice of your pediatrician. An evaluation with a Speech-Language Pathologist, Nutritionist or Occupational Therapist may be warranted to ensure the development of age-appropriate feeding skills and the acceptance of a varied diet.


Snacks for Kids: How Much, When, and What to Give Them

Snacks are an important part of a growing child’s diet. It is important to set boundaries around snacking in the household, as eating too many caloriesfrom snacks can lead to excessive weight gain. Also, “grazing” on small snack foods all day can decrease appetite at mealtimes. Beloware the general “snacking guidelines” by age.

Snack Suggestions for ages 1-2:

Snacks should be offered twice a day, between meals. At this age, they still need somewhat frequent feedings, as eating every few hours supports their growth and energy needs. Make sure that snack times have defined starting and ending times (about 15 minutes), so that the child isn’t grazing all morning or afternoon.

boy and girl with snack

Smart Snack Choices:

  • fresh fruit
  • dried fruit (once they are able to chew it well)
  • pretzels
  • whole grain or rice crackers
  • rice cakes
  • dry whole grain cereal
  • string cheese
  • only offer water to drink between meals

Portion sizes: ½ piece fruit, ¼ cup dried fruit, 1/3 cup pretzels, crackers or cereal, 1 rice cake, 1 piece of string cheese.

Snack Suggestions for ages 2-4:

Growth rates slow quite a bit during these years, compared to the rate of rapid growth in infancy. Hopefully, up to this point, your child has been offered meals and snacks at regular, scheduled times daily. He or she should have a good sense of when mealtimes are coming and what behaviors are expected at meals. At this age, your child may not need snacks between every meal to support growth. This is the age of picky eating, so be sure your kids have a good appetite for meals by not giving them unnecessary snacks.

Smart Snack Choices:

  • fruit or vegetables
  • granola bars
  • yogurt
  • string cheese
  • rice cakes
  • whole grain crackers
  • only offer water to drink between meals

Portion sizes: 1 piece of fruit, 6 mini carrot sticks, 1 granola bar, 4 oz yogurt, 1 string cheese, 6-10 crackers, 1 rice cake.

Snack Suggestions for ages 4-8:

Growth occurs at a somewhat slower rate during these years. However, kids at this age should be very active. Often, kids will say they are hungry after coming home from school. Do not allow them to come home, get a bag of chips, and sit in front of the TV munching. Instead, offer a small snack, a glass of water, and tell them to go play until it’s time for homework or dinner.

Smart Snack Choices:

  • fruit or vegetables
  • granola bars
  • yogurt
  • string cheese
  • rice cakes
  • whole grain crackers
  • only offer water to drink between meals

Portion sizes: Pick one or two of the choices listed above, based on how hungry your child is and how soon the next meal will be.

Snack Suggestions for ages Pre-puberty and Puberty:

Children start puberty at different ages, and this is another time of rapid growth. Kids in or entering puberty often feel hungry all the time, especially if they are very active. Be sure to have quality snacks available to them. Refrain from stocking the house with junk food, because that is exactly what they will go for first.

Smart Snack Choices:

  • peanut butter spread on whole grain bread or fruit
  • trail mix with nuts and dried fruit
  • cheese and whole grain crackers
  • rice cakes or veggies and hummus
  • smoothie with 1 cup yogurt + ½ cup frozen berries + ½ banana + handful baby spinach leaves
  • granola bars
  • hard-boiled eggs

Portion sizes: ½ sandwich, 1 piece of fruit with 1-2 tablespoons peanut butter, ½ cup trail mix, 1 piece of cheese and 6-10 crackers, 1 rice cake with 2 tablespoons hummus, smoothie per recipe above, 1 granola bar such as a Clif Bar or Larabar, 1 hard boiled egg with ½ piece of whole grain toast.

Children at any age who are overweight or obese should choose fresh fruits and vegetables as their snacks. Children who are underweight should always be offered snacks between meals, and the snacks should include a combination of carbohydrates, fat and protein. If you need more guidance on this issue or on meal planning for your family, make an appointment to see a registered dietitian at North Shore Pediatric Therapy.


Is Gluten Bad For You?

Recently a colleague asked me: “is gluten bad for you”? I know this question is stemming from the popularity of gluten-free diets. My guess is that many people do not know what exactly gluten is and when a gluten-free diet is actually appropriate. So to answer the question, no, gluten is not bad for you inherently, although it does make some people sick.

Gluten is a protein fraction found in wheat. Yes, gluten is actually a protein. Gluten itself is not a carb. Gluten is found in a carb, and wheat is a major staple carb source in most Americans’ diets multiple times per day. This is why sometimes people lose weight when they go gluten-free, because they are cutting out lots of starchy calories.

How Gluten May Make People Sick:

As I said, gluten can make some people sick. Gluten is the protein culprit that causes the devastating autoimmune response in the gut for people with Celiac disease. Our gut is lined with tiny villi that look like millions of fingers, and these villi contain important enzymes for digestion and also absorb all of the vital nutrients from food that our body needs to function. When someone with Celiac eats gluten via wheat, the gluten causes an immune reaction where the villi are destroyed. On a biopsy under a microscope, the villi will actually look flat and blunted.

gluten diet

Photo from www.marquettenutrition.com

This causes significant symptoms, which vary by person, but can include nutritional deficiencies such as iron deficiency anemia, weight loss, growth stunting, diarrhea, abdominal pain, and vomiting. Celiac disease is also genetic. Some people live with Celiac disease and the accompanying symptoms for years before getting diagnosed. There is more awareness now of Celiac disease, so more people are getting diagnosed. The gold standard of diagnosing Celiac is with a biopsy of intestinal villi by a gastroenterologist. The treatment is life-long strict avoidance of all gluten, and education is provided by a registered dietitian.

What is a Wheat Allergy:

Wheat allergy is one of the top 8 most common food allergies diagnosed in children. A wheat allergy is different than Celiac in that it is not a genetic, auto-immune mediated response, but rather an immune response where IgE antibodies react to wheat proteins as foreign antigens, and mount a response that produces symptoms. These can include eczema, diarrhea, abdominal pain, vomiting, and more. A registered dietitian can help families navigate the difficult wheat-free diet in this case as well.

Finally, many people try a gluten-free diet because they suspect gluten or wheat intolerance. With a gluten intolerance, the immune system is not involved as with allergies or Celiac. But nevertheless, people find that consuming wheat products makes them sick in one way or another. When they stop eating wheat for a couple weeks, they notice many positive changes in their health and the way they feel. For some people this can mean fewer headaches, or less stomach aches, or more energy, or rashes that disappear, and so on.

To reinforce the point, gluten is not bad for you or your kids to eat, unless one of the above scenarios applies. Wheat should be eaten in moderation however, and I recommend rotating different types of grains into your family’s diet for well-rounded nutrition and to prevent over-exposure to one particular food. Some different grains to experiment with include quinoa, amaranth, rice, buckwheat, and millet.


Arsenic found in over 200 rice products tested, including infant rice cereal!

Recently, Consumer Reports released their findings of arsenic in rice and rice-containing foods that are commonly eaten, including infant rice cereal, Arsenic in Ricerice cakes, white rice, brown rice, organic rice, rice pasta, and more. When I heard about this on the news, I thought about three sectors of the population I work with who would be affected based on their dietary intake of rice: infants who eat rice cereal as a staple in their diet; kids on gluten-free diets who eat rice products as an alternative grain; and ethnic groups who traditionally eat rice daily.

What did the study find?

Click here to see Consumer Reports‘ results table with all the foods tested, including brands, and the level of arsenic found per serving. There are two types of arsenic: inorganic arsenic which is known to cause cancer, and organic arsenic which is also considered toxic. Both types were found in all of the rice products in the study.  The question is what level of arsenic in foods is safe? There are no federal standards set at this point for acceptable levels of arsenic in foods; however, there are arsenic regulations for drinking water.  New Jersey has the most conservative allowed amount of arsenic in water which is 5 ppb. In the table of results, Consumer Reports used 5 ppb as a standard of comparison, and found that many rice foods had levels >5 ppb of inorganic arsenic per serving and many foods having total arsenic levels in the hundreds ppb. Brown rice was found to have more arsenic than white rice, which is because white rice has had the outer layers stripped in processing, thus stripping some of the absorbed arsenic.

What does this mean for your family?

It is important to consider how much rice you or your child is eating. If it’s daily, you should consider decreasing that intake to weekly instead, until the FDA responds with regulations for arsenic in foods. In the case of infant rice cereal, switch to baby oatmeal cereal or make your own infant cereal by grinding whole, dry quinoa, millet or amaranth in a coffee grinder, then cook with water per the directions. Once cooled, stir in breastmilk or formula to desired consistency. Talk to your pediatrician or registered dietitian about more sources of iron in your child’s diet if taking out iron-fortified rice cereal is a concern. On another note, although brown rice was found to have higher arsenic levels than white rice, brown rice is better nutritionally than white rice because it has more fiber, naturally occurring vitamins and minerals, and small amounts of healthy fats.

How does this affect children?

As I mentioned, inorganic arsenic is a known carcinogen. Children and especially infants have immature organs and detoxification processes compared to adults, so exposure to toxins like arsenic can be more harmful for the very young. At any age, eating a variety of grains is healthy and based on the study results, decreasing rice intake and replacing with other grains would be advisable.

Here is a list of different types of grains that could substitute for rice:

  • quinoa
  • amaranth
  • millet
  • oatmeal
  • buckwheat
  • corn or grits

This study demonstrates the need for regulations on allowable levels of these kinds of toxins in our food supply. This would need to include regulations on arsenic and other potentially harmful toxins in pesticides, fertilizers, as well as drugs and feed given to animals. To find out more about what is being done and how you can get involved, go to ConsumersUnion.org/arsenic. We all need to have a better awareness of what is in the foods we eat and feed to our kids, even beyond the major nutrients and ingredients. For nutrition counseling to evaluate and improve your family’s diet, contact North Shore Pediatric Therapy for an appointment with one of our registered dietitians.

What is GERD and how does it affect babies’ eating habits?

Gastroesophageal reflux disease, or GERD, is a fairly common condition in infants. To be clear, almost all babies will have typical infant reflux, or Acid Reflux Baby“spitting up” to some degree, because their gastroesophageal sphincter muscles are still developing. More severe infant reflux will be painful, causing fussiness and sometimes interfering with successful feeding and weight gain.

Signs that an infant has more serious reflux issues are:

  • Frequent spit ups, with crying and fussiness before, during and after spitting up
  • Back arching during feeds
  • Eyes watering during feeds
  • Face turning red, along with grimacing and signs of pain during and after feeds and/or spit-up episodes
  • Frequent hiccups
  • Fussiness when lying down that improves when upright
  • Baby refusing breast or bottle feeds
  • Infant not meeting weight gain or growth goals at pediatrician visits

Most of the above symptoms are a direct response to the burning pain the baby feels when acidic stomach contents are refluxing up into the esophagus. In severe cases of reflux, the infant begins to develop a strong negative association of pain with breast or bottle-feeding. The infant will begin to refuse feeds in order to avoid this pain. This response becomes a learned habit, and over time, results in lower intake, slower weight gain, and dehydration in extreme cases. A baby who is refusing feeds can cause alarm for parents, who then might try forcing feeds in desperation, which can be distressing to the infant and cause further negative association with feeding. Parents should be aware of these signs of GERD and contact the pediatrician right away.

Diagnosis and Treatment of GERD:

Reflux is more common in premature infants since their gastrointestinal tracts are immature compared to term infants. It can also be a symptom of food allergies, in which case the infant may be allergic to the milk proteins in formula, or proteins from foods passing through mother’s breastmilk. In any case, a pediatrician can discern symptoms and diagnose GERD. Treatment protocols for infant GERD usually include a medication, such as ranitidine (also known as Zantac) or lansoprazole (also known as Prevacid). In some cases, the infant needs a special formula or mom may need to eliminate food allergens from her diet. A registered dietitian can help moms navigate special diet needs related to GERD, as well as ensure proper growth and transition to solids if these areas have been affected. Also, the pediatrician can educate parents on “reflux precautions”, which include feeding the baby at a more upright angle, not lying baby flat on their back after feeds, burping baby well, etc.

Sometimes the painful association of GERD creates long-term feeding issues with infants and kids. In these cases, children will continue to have “oral aversion” to eating. Signs of oral aversion stemming from reflux include difficulty transitioning to solids, very picky eating, refusal to put objects in their mouths in general, etc. If your child has signs of feeding difficulties, or if his or her growth has been impacted by GERD, contact North Shore Pediatric Therapy. A multi-disciplinary team including registered dietitians and speech therapists can work with your child to ensure adequate nutrition, growth, and development related to feeding skills.


What is Failure to Thrive and What Can Be Done About It? | Pediatric Therapy Tv

In today’s Webisode, a Registered Dietitian discusses Failure to Thrive and how you can help.

In this video you will learn:

  • The causes of Failure to Thrive
  • Steps and measures to take when your child shows signs of Failure to Thrive
  • How a dietitian and a doctor can help when your child has Failure to Thrive

Video Transcription:

Announcer: From Chicago’s leading experts in pediatrics to a worldwide
audience, this is Pediatric Therapy TV where we provide experience and
innovation to maximize your child’s potential. Now your host, here’s Robyn.

Robyn: Hello, and welcome to Pediatric Therapy TV. I’m your host, Robyn
Ackerman. I’m standing here today with a registered dietician, Stephanie
Wells. Stephanie, can you tell us what failure to thrive is and what can be
done about it?

Stephanie: Sure. Failure to thrive is diagnosed in children that are less
than two years old when their weight for length is less than the fifth
percentile on the growth chart and for kids that are over two years old, if
their BMI is less than the fifth percentile on the growth chart.

So in terms of what can be done, first a doctor and a registered dietician
can assess if there are any medical factors that are causing the failure to
thrive and then address those medical issues if that’s necessary. Second,
then a dietician can meet with the parent and the child and put together a
high calorie, high protein diet that includes three meals and two to three
snacks per day. Third, often these children need to be on some sort of a
high calorie, high protein formula or oral supplement beverage which the
dietician can recommend and get a prescription for, if needed. And then
from there, the dietician and doctor will closely monitor the child’s
weight and growth to make sure that they’re moving in the right direction
and meeting the goals that the dietician has made for the child.

Robyn: All right. Thank you, Stephanie, for that explanation and thank you
to our viewers. And remember, keep on blossoming.

Announcer: This has been Pediatric Therapy TV, where we bring peace of mind
to your family with the best in educational programming. To subscribe to
our broadcast, read our blogs, or learn more, visit our website at
learnmore.me. That’s learnmore.me.

Problem Feeders: When Picky Eating is a More Serious Problem

Following my last post about picky eaters, parents should know that there is a more severe level of picky eating, which has been termed problem feeding. In the medical community, it is often diagnosed as “feeding difficulties”.

Problem feeders have the following behaviors:

  • Young infants who refuse bottle or breast, or drink a small Mother feeds a babyamount then refuse. This results in a decreased overall volume consumed, and eventually weight loss and dehydration.
  • Toddlers and children who eat less than 20 foods.
  • Kids who “lose” foods that they once ate, and do not resume eating them even after a few weeks break. Eventually they may be down to 5-10 foods.
  • Kids who refuse certain textures altogether.
  • Kids who scream, cry, and panic over touching, smelling, or tasting a new food.
  • Kids who are unwilling to try almost any new food even after 10+ exposures.

Why do some kids become problem feeders?

There is an underlying reason why they have a strong negative association with eating, to the point where they will starve themselves before consuming foods outside of their repertoire. There is often a medical diagnosis that contributes to the development of a problem feeder, such as:

In these cases, the child forms “oral aversion” associated with the pain and discomfort they feel/felt as a result of eating or swallowing. This association is made very strongly in the young developing brain, and in the case of problem feeders, overrides hunger. Oral aversion becomes a protective mechanism, which is why they panic over eating new foods. Problem feeders can be underweight or overweight as a result of their rigid food choices, depending on what type and how much food they eat.

The big difference between picky eaters and problem feeders:

Eventually, a picky eater will come around to eat some type of food they are presented with outside of their usual repertoire, if they are hungry enough. A problem feeder will not respond to hunger cues to meet their needs with the food options presented to them if it is outside of their “accepted” foods. Problem feeders will go on a food “strike”, even if it results in dehydration and malnutrition.

Problem feeders need assessment and feeding therapy, which can be effectively achieved with a multidisciplinary team, such as at North Shore Pediatric Therapy. NSPT has occupational therapists, speech therapists, and dietitians to work through sensory, oral-motor, and nutritional deficits as well as mealtime behaviors. We also have social workers for additional support and behavior guidance.  If you are concerned that your child is a problem feeder or a picky eater, contact our facility for an evaluation.

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Help! My child is a picky eater!

The picky eater phenomenon is not uncommon, and can be quite challenging and stressful for parents.

Picky eaters have the following characteristics/behaviors

  • Eat a limited number of foods (20-30).
  • Avoid classes of foods such as red meat or green vegetables.
  • May reject foods they previously accepted, but will re-accept these foods after a two-week break.
  • Will try some new foods after being exposed to the food several different times.
  • Will touch and play with new foods, although they may not eat it at first.
  • Picky eaters usually eat enough to support growth within normal ranges.  (1, 2)

How To Encourage Your Picky Eater, To Eat More:

To alleviate some stress, first examine if your expectations for your child’s eating is realistic. Kids are naturally wary of new things (think “stranger danger”), including new foods. Picky EaterTheir first reaction to something they have never seen, smelled, touched or tasted before is to not trust it. Do not be discouraged if your child doesn’t love hummus, spinach, and salmon right away. It takes an average of 8-15 exposures to a new food before the child will actually eat it (2). Also, toddlers and teens particularly want to exert their sense of control and opinion, including what they will (and won’t) eat. In other words, sometimes a strong-willed child will refuse to eat what you want them to just because it gives them control over that aspect of their environment.

Typically developing young children will eat according to their innate hunger and satiety cues. That is, they will eat what they need when they are hungry and not when they are satisfied. Imagine how you might feel if you were full from dinner, and someone comes at you with a spoonful of food telling you to take another bite. Imagine you are really full, and the thought of taking another bite makes you sick. Now this person starts yelling at you and threatening to punish you. How would you feel? It can be difficult to let go and trust your child’s appetite. Your job as the parent is to provide healthy meal choices, regular mealtimes and snacks, and a positive eating environment without toys or TV.

Finally, using bribes like “one more bite and you can have dessert”, and punishments such as “you can’t play outside if you don’t finish your plate” are not effective in the long run. Doing these things negates children’s natural ability to eat what they need. It also creates a negative, untrustworthy dynamic between the child and the caregiver at the table. Picky eaters will continue to thrive and meet their nutrition needs when provided an optimal mealtime environment. A dietitian at North Shore Pediatric Therapy can counsel families to help picky eaters.

However, there is a difference between a picky eater and a problem feeder. Problem feeders have more rigid food preferences, a dwindling number of accepted foods, and will refuse food (and drinks) that are not part of their repertoire to the point of malnutrition. These children require more intensive evaluation and therapy, and benefit from multidisciplinary treatment available at North Shore Pediatric Therapy. I will further discuss problem feeders in my blog next week.

  • Carruth BR, Skinner J, Houck K, Moran III J, Coletta F, Ott D. The phenomenon of “picky eater”: a behavioral marker in eating patterns of toddlers. J Am Coll Nutr 17:180-186, 1998.
  • Carruth BR, Ziegler PJ, Gordon A, Barr SI. Prevalence of picky eaters among infants and toddlers and their caregivers’ decisions about offering a new food. J Am Diet Assoc. 2004 Jan;104(1Suppl1):s57-64.