Tweens Archives - Page 18 of 34 - Two Peds in a Pod®

Escape from Candy Land

We welcome back health coach Mary McDonald (the mom who overhauled her kids’ sports snack stand), to provide advice on how to survive what Dr. Shifrin referred to last week as Candy Season.
—Drs. Lai and Kardos

If your home is like mine, you have an extraordinary amount of Halloween candy lurking in the most unusual locations: inside an old roasting pan, under a pile of shoes in your daughter’s closet, or tucked in an end table drawer in your living room. It’s an incredibly hard time of the year to eat healthy and to help your children make good food choices when sweets are so abundant from October to January. It is disturbing to think about the bad eating habits that start at the holidays and can lead to an addiction to sugar throughout the rest of the year. In order to combat the inevitable onslaught of sugary treats, here are a few strategies to consider:

Invite the “Switch Fairy” or “Switch Witch” to your home. If you’re tired of telling your children, “Step away from the candy!” then make sure it isn’t easy to access. Your kids will love you if you tell them the Switch Fairy will visit your home tonight to replace the candy with a toy, clothing, or their favorite item. Keeping sweets out of sight will make it easier to replace the candy with a healthier option, such as fruit salad or a yogurt parfait.
So, what can the Switch Fairy do with the extra sweets? Contact your local dentist or do an online search for candy donation sites. Many local organizations will buy back Halloween candy. This becomes a perfect way to subsidize the present that the Switch Fairy purchases.
Drink Water. Staying hydrated is a great way to curb cravings. When you crave sweets, there’s a good chance that you’re actually dehydrated and your brain is craving water. When your kids are tired, instead of reaching for a-little-something-sweet as a pick-me-up, try giving them a drink of water. You may be surprised that their cravings are reduced. Are you looking to make water more enticing? Try purchasing a swirly straw and designate the straw for water only.
Don’t drink soda. Soda is nothing but liquid sugar and void of any nutrition. Each 12-oz. can of Coke contains approximately 10 teaspoons of sugar. An easy way to reduce your sweets during the holiday season is to select water as your drink of choice. If your child must have a soda, suggest splitting the can with your child or with a friend. Pour a few ounces into each cup and throw away the rest. It’s okay.
Increase your carbs! Yes, you heard me correctly. For years, carbs were given a bad rap. Low carb diets promoted the idea that all carbs are created the same. In fact, they are not. Natural carbohydrates (the ones found in fruits and vegetables such as sweet potatoes, carrots, bananas, and oranges) can help reduce your cravings for sweets. Try reaching for one of these options before you go for a cookie. For an added bonus, wash this snack down with a big glass of water. You will be really surprised at how quickly you cure your sugar craving. Make fruit or veggies more exciting by using toothpicks to pick up the food. See how many green peas you can fit on a toothpick. Make it fun – who doesn’t like a pea eating competition?
Chew Gum. According to research from the University of Rhode Island, people who chewed gum consumed 68 fewer calories at lunch and did not compensate by eating more later in the day. Chewing gum also helped the study participants satisfy their cravings and resist fattening treats. And there’s more: Gum chewers actually burned about 5% more calories than non-gum chewers.
Just say no. Social pressure to join in and eat what others are eating can be overwhelming. Most people are very receptive when you say, “No thanks, I’m full.” Tell your children that it’s okay to “Just Say No”, whether you’re talking about food or other temptations.
Cook from scratch. Cooking, especially with your children, is a wonderful way to control the ingredients that are in the food that you eat. There are many wonderful natural substitutions to cane sugar (stevia, agave syrup, maple syrup, dates, raisins, etc.) that provide an equal amount of sweetness to your food. Become a scientist and experiment with alternative sweeteners. Click here for recipe ideas.
Understand your labels. Did you know that every 4 grams of sugar = 1 teaspoon of sugar? Understanding the basics of a nutrition label is critical to understanding what you are eating.

So, as you and your family weave your way through the sweetest months of the year, think of inviting the Switch Fairy to your house for a home cooked meal full of natural carbs and a big cup of water.

Mary McDonald
©2013 Two Peds in a Pod®

Mary McDonald holds a Masters of Education from Arcadia University and completed her health coach certification from Institute of Integrative Nutrition. She is a high school teacher, a mom of four daughters, and an advocate for healthy food choices. For more information on her health coaching services, please contact her at nutrition101withmary@gmail.com or visit her website at nutrition101withmary.com.

Beyond Halloween

We enjoyed meeting Pediatric media expert Dr. Don Shifrin, whose interviews have appeared in numerous publications including Good Housekeeping, the Wall Street Journal, and Time blogs. Today he writes about the “fifth season” of the year.
—Drs. Kardos and Lai

Pleading with children not to eat too much candy on Halloween borders on sacrilege. So when a USA Today headline blares, “Scary amount of candy will be consumed on Halloween,” it strikes us as proclaiming the obvious. Or does it? A candy industry analyst states that almost four percent of the yearly total for candy consumption in the US occurs on All Hallows Eve. And that “frightens doctors.”

“Why?” you might ask.

The article then goes on to give parents several parent-tested hints regarding ways to minimize candy gluttony during and after October 31.

But friends, here’s what scares me as a Pediatrician: thanks to the demonic coalition between the candy industry, advertising media, and retailers, Halloween is just the appetizer to a 6-plus month buffet of sugar laden offerings.

The main course closely follows with Thanksgiving and Christmas. Followed closely by the twin desserts of Valentine’s Day and Easter. We can get our M&Ms in all seasonal colors from scary to pastels to match each holiday. That’s over 6 months of intensive and impressive candy packaging, marketing, and buying by our nation’s most vulnerable and vocal customers- our children. I picture the wolf saying to Little Red Riding Hood, “The better to sell you, my dear.”

So parents, good luck trying to avoid the candy aisles from October through April. Here’s my perspective on the real scary part of Halloween. It signals the beginning of a newly created season, lasting from fall through spring: America’s Candy Season.

And the scariest part? It’s not just McDonald’s anymore. Groceries, drug stores, warehouse clubs, and convenience stores now join the list of places YOU can get supersized.

Don Shifrin, MD

©2013 Two Peds in a Pod®

Dr. Shifrin is a Clinical Professor of Pediatrics at the University of Washington School of Medicine in Seattle, and has practiced at Pediatrics Associates, Inc, PS. in Bellevue, Washington, for 35 years. He is past Chair of the American Academy of Pediatrics Committee on Communications—a committee which recognizes and evaluates the physical, mental, and social impact of positive and negative messages communicated to children from the media.

An injured limb: Should I stay or should I go now?

The classic punk rock song lyric “Should I stay or should I go now?” will run through your head many times during parenthood as you wonder when your kid should go to the doctor’s office. Today we turn to pediatric orthopedic surgeon and author Dr. Gleeson Rebello for advice on whether an injured limb needs immediate medical attention – Drs. Lai and Kardos.

You drive home after a tiring day at work and think about all you will do with your family in the next few hours before calling it a day. A visit to the local emergency department or your child’s doctor is definitely not on that list.

Upon arriving home, you find out your six-year-old daughter just fell from the swing in the backyard and complains of a painful elbow.

Do you hug, kiss, comfort her, stop to pour yourself a glass of wine and take it easy on the patio? Or, do you take her to a doctor?

Take her to a doctor as soon as possible if:

• She has a deformed arm

• She cannot move her arm

• She has an open injury with bone visible or with uncontrollable bleeding

• She is screaming with pain that does not seem to get better with rest, comfort and ice packs

• She cannot move the joint (shoulder, elbow, wrist and finger joints) without significant pain

DON’T GIVE HER ANYTHING TO EAT OR DRINK while you assess what is going on…. just in case she needs to undergo surgery once she gets to the hospital.

If she is in some pain with moving the elbow, immobilize her in a home-made sling using a towel and some safety pins. Apply an icepack and give her an anti-inflammatory/pain relief medication like ibuprofen (brand names Motrin, Advil).

Think strongly about going to the doctor if she shows signs of persistent discomfort and you wonder if you will be staying up with her the whole night.

If she appears comfortable, give her a light meal and elevate the elbow on a couple of pillows. Arrange her hand above the elbow, and the elbow above her heart in order for gravity to reduce the swelling.

Call your child’s doctor to set up an appointment if she is still in pain in the morning or has not improved overnight.

Hopefully you will never need to use the knowledge gained from this article!

Gleeson Rebello, MD

Dr. Gleeson Rebello serves as a pediatric orthopedic surgeon at MassGeneral Hospital for Children, and is on the faculty of Harvard Medical School. His new children’s book coauthored with Jamie Harisiades, DareBone’s Big Break , helps children navigate the potentially frightening experience of fixing a broken elbow. Dr. Rebello is dedicated to making everyday medical practice accessible to children in a fun and sophisticated manner through books and media. Applaud his efforts and like his Facebook page at https://www.facebook.com/Darebone

Another picture puzzle-hint: stymied by the question?

“When the moon hits your eye like a big pizza pie…”

Actually, that’s not amore, but that’s a stye on this child’s upper eyelid.

A stye (medical term = hordeolum) pops up seemingly overnight, although sometimes the child feels some tenderness at the eyelashes a day or two before it appears. Styes are tiny infections of eyelid glands that are self-limited and easily treated with warm wet compresses. We instruct patients to apply a clean, warm, wet cloth to the stye for 5-10 minutes four times per day.

Styes tend to improve after a few days but can take up to two weeks to completely resolve.

Persistent styes may actually be chalazions. Chalazions, the result of a dysfunctional eyelid gland, are firm and are not tender. They tend to “point” toward the inside of the eyelid rather than outward.

Insect bites may also masquerade as styes. However, insect bites are itchy rather than painful.

Reasons to call your child’s doctor:

-the entire eyelid is red, painful, and swollen

-pain is felt inside the eye itself

-child is sensitive to light

-child has vision changes

-the inside white part of your child’s eye becomes red

-stye lasts more than two weeks despite treatment with warm compresses

Julie Kardos, MD and Naline Lai, MD
©2013 Two Peds in a Pod®
With special thanks to Dean Martin

Got milk? myths about milk

milk does not cause congestion We’ve heard some interesting things about cow’s milk over the years. I am going to share with you four myths about milk that I continue to hear from my patients’ parents. Spoiler: reading myth #4 can save you lots of money.

Myth #1: Don’t give milk to a child with a fever, the milk will curdle (or some other variant).

Truth: As long as your child is not vomiting, milk is a perfectly acceptable fluid to give your febrile child. In fact it is superior to plain water if your child is refusing to eat, which is very typical of a child with a fever. Fevers take away appetites. So if your child stops eating while she is sick, at least she can drink some nutrition. Milk has energy and nutrition, which help fight infection (germs). Take milk, add a banana and a little honey (if your child is older than one year), and maybe some peanut butter for added protein, pour it into a blender, and make a nourishing milk shake for your febrile child. Children with fevers need extra hydration anyway. Even febrile infants need formula or breast milk, NOT plain water. The milk will not curdle or upset them in any way. If, on the other hand, your child is vomiting, then stick to clear fluids until her stomach settles.

Myth #2: Don’t give children milk when they have a cold because the milk will give them more mucus.

Truth: There is NOTHING mucus-inducing about milk. Milk will not make your child’s nose run thicker or make his chest more congested. Let your runny-nosed child have his milk! Yet my own mother cringes when I give my children milk when they have colds. Never mind my medical degree; my mom is simply passing on the wisdom of HER mother which is that you should not give your child milk with a cold. Then again, my grandmother also believed that your body only digests vitamin C in the morning which is why you have to drink your orange juice at breakfast time. But that’s a myth I’ll tackle in the future.

Myth #3: You can’t over- dose a child on milk.

Truth: Actually, while milk is healthy and provides necessary calcium and vitamin D, too much milk CAN be a bad thing. To get enough calcium from milk, your child’s body needs somewhere between 16 to 24 ounces of milk per day. Of course, if your child eats cheese, yogurt, and other calcium-containing foods, she does not need this much milk. New recommendations for healthy Vitamin D requirements have been increased recently to 400 IU (international units) daily which translates into 32 ounces of milk daily. BUT we pediatricians know from experience that over 24 ounces of milk daily leads to iron-deficiency anemia: calcium competes with iron absorption. You’re better off giving an over-the-counter vitamin such as Tri-Vi-Sol or letting older children chew a multivitamin that contains 400 IU of vitamin D. In addition to iron-deficiency anemia, drinking all that extra milk is bad for teeth (all milk contains sugar) and can also lead to obesity from excessive calories or can in fact lead to poor weight gain in children who are picky eaters to begin with: the milk fills them up too much for them to have any appetite left for food.

Myth #4: Organic milk is healthier than non-organic milk.

Truth: If you compare organic milk to non-organic milk, the nutrients on the label of the milk carton are the SAME. “But what about the growth hormones in milk,” you may wonder. First of all, cows may be supplemented with growth hormone, but their milk is not. In addition, let me explain about growth hormone. Some children are actually born without growth hormone, and other kids develop growth hormone deficiency because of kidney failure, or cancer treatment, or other medical problems. These children need supplemental growth hormone. Unfortunately for these kids, the only way that we have to give growth hormone to these kids is by injection (a shot) every day. Do you know why? Growth hormone gets DIGESTED in the stomach and is not active if a child eats/drinks it. SO, even if non-organic milk contained growth hormone (which it doesn’t) then your child would have no effects of it anyway because their guts would break it down before it could act on their bodies. WHEW! So unless you just like the taste better, you do NOT have to spend twice as much money on organic milk. Just buy regular milk. Put that extra money away in your college funds.

In summary, you can safely continue serving your children milk in sickness and in health, in moderation, at a lower cost than organic, every day. Now, all this talk about milk really puts me in the mood to bake cookies…

Julie Kardos, MD with Naline Lai, MD
©2013 Two Peds in a Pod®

Update: Please read this article , by the American Academy of Pediatrics in 2012, for a comprehensive, unbiased review of the data comparing health benefits of conventional vs organic milk and other foods–Drs. Kardos and Lai, October 6, 2013.

Revised from the original post from 10/5/2009

Flu vaccine 2013-2014: what’s new?

flu Pediatricians associate Back to School with “Time to get your flu vaccine.” At least this pediatrician mom does. As I try to figure out when I can get my own three children over to my office to get their flu vaccines, we want to give you a flu vaccine update.

This year, the squirt-in-the-nose flu vaccine protects against FOUR flu strains of flu, not three as in past years. Most of the injectable form of the flu vaccine this year still protects against three flu strains as in years past but some injectable flu vaccines also offer protection against a fourth strain as well (this is called QUADravalent, as opposed to the traditional TRIvalent form).

Because of supply issues, not all offices will be stocked with the newer quadravalent form of the injectable vaccine. The American Academy of Pediatrics (AAP) and the Centers for Disease Control (CDC) recommend that your children receive which ever kind of flu vaccine is available in your pediatrician’s office. We imagine that if the new quadravalent vaccine prevents more flu complications than the traditional trivalent vaccine this year, then next year manufacturers will make more of the quadravalent form.

It is not too soon to get your flu vaccines. Immunize now to help keep flu out of your homes this year. Your child’s immunity will last the entire season. As in past years, all children aged 6 months and older should receive flu vaccine. If this is the first time your child ever receives the flu vaccine and if she is under age nine years, she will need two doses spaced at least one month apart this season to receive maximum protection.

As a refresher, please see our post on how to tell the difference between the flu and the common cold, and also our flu and flu vaccine myth buster post.

You may recognize the illustration from last year. Even though school just started, the holidays and flu season are right around the corner. Today we bring the drawing back again as a symbolic gesture. After all, the flu keeps coming back too.

Julie Kardos, MD and Naline Lai, MD
©2013 Two Peds in a Pod®

Arsenic in your food: an update

arsenic in rice Good News.

Last year we responded to your concerns about arsenic in food, particularly rice, and shared with you the FDA’s recommendation at that time.

We are relieved that after considerable research which included analyzing over 1300 samples of rice products, the FDA scientists determined that “… the levels of inorganic arsenic found in the samples are too low to cause immediate health damage.” Please see this link for the details of the investigation and recommendations.

Bottom line: continue to offer a well-balanced diet to your children and vary the types of grains that you serve to your families.

Julie Kardos, MD and Naline Lai, MD
©2013 Two Peds in a Pod®

Bring on the basics: for kids who don’t like team sports

Some kids simply don’t like team sports. Today, childhood obesity specialist Dr. Patricia Cantrell and Youth Fitness Expert Anna Renderer, share a piece from their fitness site on activities which encourage kids to move without signing them up on a roster. Enjoy—and join in!
Drs. Lai and Kardos

hopscotch Running around the yard or playing kickball with friends is the essence of what it means to be a kid. They are gaining aerobic fitness, strength, social skills and much more just by PLAYING!

Getting kids on the right path towards a long healthy lifestyle all starts with basic fundamental movement skills (FMS) that are learned by participating in basically any activity that teaches body awareness, balance and coordination such as catching, kicking, jumping, balancing, throwing, etc. The easiest way to help kids improve these skills is to simply PLAY. A game of tag, Simon says, kickball, or 4-square is a great way to gain basic FMS.

What about the kids that don’t naturally feel motivated or confident to participate in school yard games or after school sports? It’s important to build their confidence and skills with similar movements that are simple and fun that can be done at home or with a friend after school.

Check out these great beginner moves/games to develop aerobic fitness, strength, balance and coordination.

Pick 4-5 of these moves per day (starting with 1-2 is a great way to begin).

Set small goals by trying to complete 1 set of each move and then progressing to the full recommendations.

FUNdamental Exercises!

1. Skipping: Perform in place or moving. In place skip for 30 seconds and then rest for 30 seconds. Try and repeat this 5-10 times (sets). Skipping improves coordination, rhythm, and strength.

2. Single Legged Hops: Perform in place or moving. In place hop for 15 seconds on each leg and then rest for 30 seconds. Try and repeat this 5-10 times. It’s also fun to use a line and hop down the line and back for 30 seconds to add variety of movement. Try hopping backwards for an added challenge!

3. Jumping Jacks: Perform in place for 10 reps and then rest for 30 seconds. Add 5 reps to your number (15,20, 25, 30) and rest for 30 seconds in between each set. Try to reach 30 reps in a row for your last set.

4. Hop Scotch: Use chalk to draw the ladder and number each step of the ladder 1-10. Every time they complete the ladder they get 1 point and their goal is 10! If performing in place: Hop Scotch for 30 seconds and then rest for 30 seconds. Try and repeat this 5-10 times.

5. Card Catch: Use a deck of playing cards for this. Throw up one card at a time and see if they can catch it before it hits the ground. This is a great way to interact with kids and encourage them one on one. It’s also fun to play with multiple kids who can cheer each other on. If playing with more than 1 kid, give them each 5 tries and have them alternate turns. Go through the entire deck as many times as desired!

6. Tennis Ball Bounce Pass: Perform with a partner or against a wall. With a partner, bounce the tennis ball between you and your partner so they can catch it. Alternate bounce passes back and forth. To progress, try and catch it with one hand versus two. To set an added challenge, set up goals about 10 feet wide and try to score with a bounce pass through your partners goal.

7. Jump Rope: Perform in place or moving. Jump rope for 30 seconds and then rest for 30 seconds. Add an extra 10 seconds to your next set (40, 50, 60) and rest for 30 seconds only between each set. Try and get to 60 seconds on your last set.

Remember that the more you move, you more you improve! Now GET READY, GET SET & GET FIT!

Anna Renderer, MS

Anna Renderer holds Bachelor and Master degrees in Clinical Exercise Physiology, is a certified Youth Fitness Specialist with the International Youth and Conditioning Association (IYCA), and is a certified Personal Trainer with the American Council on Exercise (ACE).

Dr. Pat Cantrell, mother of two young boys has practiced pediatrics at Southern California Permanente Medical Group for over 15 years. She has a special interest in pediatric obesity and is the President of KFIT Health, LLC (www.kidfitnessandhealth.com) which creates fitness and nutrition DVDs and products for children.

KFIT Health, LLC

Acne: an unwelcome bump on the road to adulthood

acne treatments Why does that big pimple always appear the first week of school, the night before prom, picture day, her sweet sixteenth birthday party, or any other important event in your teen’s life?

A rite of passage, acne is caused by a combination of genetics and bad luck. The perception of acne as a problem depends on the eye of the beholder. When I see a teenaged patient in my office for acne, the first question I ask is, “Who is more concerned about the acne? The parent or the patient?” Some kids have very mild acne, yet those kids perceive their pimples are the size of golf balls. Other kids are oblivious, and the parents are more upset than the teen. When you’re a teenager, everything to you seems bigger than it actually is.

Even if your teen starts to break out with what she perceives are huge blemishes but are really the size of pin pricks, do take her seriously. For anyone dealing with acne, to them one spot can seem like many.

Many effective, safe products can diminish mild acne and thus greatly help self-esteem in a self-conscious teen. Also, make sure to probe to see if a negative perception of her appearance extends to an overall poor body image. Sometimes distress over minimal acne can be an early sign of body image disorders such as anorexia nervosa or bulimia.

The categories of acne medicines are:

-Topical antibiotics such as benzoyl peroxide or clindamycin, applied directly to skin- works to kill the bacteria that lead to acne

-Topical medications called retenoids such as tretinoin (Retin A) and adapalene (Differin) stop acne formation mainly by penetrating into the deep layers of the skin to loosen acne causing pores

-Topical creams which combine both a retenoid and an antibiotic also exist such as the adapalene and benzoyl peroxide product called Epiduo.

-Oral antibiotics, such as minocin, clindamycin, or erythromycin also kill the bacteria that lead to acne formation

-Accutane, an oral medical reserved for severe, scarring acne. Can cause significant birth defects and so girls who take it must also take birth control pills and have periodic pregnancy tests. Chemical imbalances may occur, so blood work is required for both sexes.

-Hormonal therapy (birth control pills)- works best for females who break out near their periods, smooths out the hormonal fluctuations which fire up acne.

I always remind my patients that most treatments take six weeks to work. For kids who experience dry skin from the topical medications, use noncomedogenic (non acne forming) moisturizer liberally. Pediatricians usually schedule follow up visits for acne at 4-6 week intervals. If your teen has mild acne but truly doesn’t want to bother with treatment, just encourage washing with a mild cleanser (for example Dove or Cetaphil soap) once or twice a day. No scrubbing, and stay away from alcohol containing astringents. You don’t want him irritating already irritated skin. Also ask him not to use the same smelly germy cloth after every wash. Instead dry off with a clean washcloth or soft paper towel . Applaud his self-confidence and lack of obsession with a skin condition which almost always improves with time.

Myth buster: eating chocolate does not cause acne. The chocoholic in me is greatly relieved by this knowledge.

Truth: arranging hair to hide the face tends to make acne worse. Avoid oily hair gels and sprays. In addition, touching and picking at the skin also causes irritation in an already irritated area.

Finally, what to do on prom night? Cosmetics work wonders, and parental reassurance, even if your teen waves it aside, can take care of the rest.

Feeding picky eaters

“You just don’t appreciate a picky eater until you have one. ”
—Overheard at Dr. Lai’s dinner table.

Picky eaters come in two major varieties. One kind is the child who eats the same foods every day and will not vary her diet; for example, cereal, milk, and a banana for breakfast, peanut butter and jelly with milk or juice for lunch, and chicken, rice, and peas for dinner. This diet is nutritionally complete (has fruit, vegetable, protein, dairy, carbohydrate) but is quite “boring” to the parent.

The other kind of picky eater is the child who either leaves out entire food groups, most commonly vegetables or meat, or leaves out meals, such as always eats breakfast but never eats dinner.

My own children range from the One Who Tries Anything to the One Who Refuses Everything (these are my twins!). My oldest child lived on cheerios and peanut butter and jelly for about two years and now eats crab legs and bulgur wheat and other various foods. My point: I know where you’re coming from, I feel your frustration, and I will give you advice that works as well as optimism and a new way of thinking about feeding your children.

Fortunately, from a medical point of view, toddler/child nutrition needs to be complete as you look over several days, not just one meal. For example, if every 3 days your child has eaten some fruit, some vegetables, some protein, some dairy, and some complex carbohydrates, then nutritional needs are met and your child will thrive!

Twelve ways to outwit, outplay, and outlast picky eaters

1) Never let them know you care about what they eat. If you struggle with your child about eating, she will not eat and you will continue to feel bad about her not eating. Talk about the day, not about the food on the table. You want your child to eat for the simple reason that she feels hungry, not to please you or anyone else, and not because she feels glad or mad or sad or because of what you the parent will feel if she eats or doesn’t eat. Along these lines, NEVER cook a “special meal” for your toddler. I can guarantee that when she knows how desperately you want her to eat your cooking, she will refuse it.

2) Let them help cook. Even young children can wash vegetables and fruit, arrange food on platters, and mix, pour, and sprinkle ingredients. Older kids can read recipes out loud for you and measure ingredients. Kids are more apt to taste what they help create.

3) Let them dip their food into salad dressing, apple sauce, ketchup etc., which can make their food more appealing or interesting to eat.

4) Let them pick their own food. Whether you grow your own foods, visit a farm or just let your kids help you in the supermarket, kids often get a kick out of tasting what they pick.

5) Hide more nutritious food in the foods they already like (without them knowing). For example, carefully mix vegetables into meatballs or meatloaf or into macaroni and cheese. Let me know if you want my recipe for zucchini chocolate chip muffins or Magic Soup.

6) Offer them foods that you don’t like—THEY might like it. Here’s an example: a few years ago, my children were decorating Easter eggs with Dr. Lai’s children. My kids asked if they could eat their decorated hard boiled eggs. Now, hard boiled eggs are one of the few foods that I do NOT like. I don’t like their smell, their texture, and I really don’t like the way they taste. Yet, all three of my kids, including my pickiest, loved those hard boiled eggs dipped in a little bit of salt. Go figure. Now I have an inexpensive, easy, healthy protein source to offer even though I can’t stand the way my kitchen smells when I cook them… but hey, if my kids actually will EAT them…

7) Continue to offer foods even if they are refused. Don’t force feed; just have them on the table. It could take 20 -30 exposures before your kids might try them so don’t despair. It took eight years of exposure to brocoli until two of my three kids decided they loved it.

8) Hunger is the best sauce. Do not offer junk food as snacks. Pretzels, crackers, cookies, candy, and chips have NO nutritional value yet fill up small bellies quickly. Do not waste precious stomach space with junk because your insightful child will HOLD OUT for the junk and refuse good nutrition if they know they can fill up on snacks later. Along these lines, never bribe food for food. Chances are, if you bribe eating vegetables with dessert, all the focus will be on the dessert and a tantrum will follow. You and your child will have belly aches from stress, not full bellies.

9) It is okay to repeat similar meals day after day as long as they are nutritious. We might like variety as grownups but most toddlers and young kids prefer sameness and predictability.

10) Turn off the TV. Trust me and trust numerous scientific behavioral studies on this, while it sometimes works in the short term, it never works in the long term. In addition, watching TV during meals is antisocial and promotes obesity.

11) Do not become a “short order” chef. If you do, your child will take advantage of you and likely will not end up eating anyway. When your child says, I don’t want this dinner/lunch/breakfast, I want something else,” you say “The meal is on the table.”
One variation of this that works in some families is to have one back-up meal that is the same every day and for every meal and must be completely non-cook and nutritious, for example, a very low sugar cereal and milk, peanut butter and jelly sandwich, or yogurt with nuts or fruit mixed in it, etc, that you agree to serve if your child does not want to eat what the rest of the family is eating.

12) You can give your child a pediatric multivitamin. This tactic is not “giving up,” nor is it cheating, and it can give the Parent as Provider of Nutrients peace of mind. You can either give a multivitamin every day or just on the days that you are convinced that your child has eaten nothing.

If all else fails, your consolation is that your child will likely become a parent of a picky eater too, and she will ask you how to cope. You’ll be able to tell her what worked for you when she was a picky eater.

Julie Kardos, MD with Naline Lai, MD
©2013 Two Peds in a Pod®
Originally posted on July 24, 2009, with modifications