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Feeding Tips - New Research

Posted December 15, 2011

The following Feeding Guidelines were presented at the Zero to Three 26th Annual Conference on Early Childhood, held in Washington DC in early December, 2011.  The presentor was Irene Chatoor, M.D., Professor and Vice-chair of Department of Psychiatry and Director of Infant Toddler Mental Health Program at Children's National Medical Center, Washington, D.C. I've chosen to focus on five of Dr. Chatoor's Feeding Guidelines I believe will be of special interest to readers.

 

• In order to help your child to feel hungry, feed your child at regular times, and space meals/snacks 3-4 hours apart. Do not allow your child to have any snacks, juice or milk between scheduled meal and snack times.  If your child gets thirsty, he/she should be offered water, even if it results in a temper tantrum. (There is no need for a snack between breakfast and lunch, even if your child wasn't hungry for breakfast.  We want to focus on bringing a hungry tummy to the lunchtime experience.  A small snack at the end of the afternoon nap provides a good 3-hour window that will still allow hunger at dinner time.)

• Serve small portions and allow your child to ask for 2nd, 3rd and fourth helpings.  This will help your child be engaged in the eating process and prevent her from being  overwhelmed by large amounts of food.  Most importantly, it will help your child learn to eat until she feels full.  We want children to learn to be in touch with feelings of hunger and satiety -- rather than make them eat until we feel satisfied she has had enough. 

• Teach your child to sit at the table until "mommy's and Daddy's tummys are full."  Children do not learn to eat until full unless they learn to sit at the table long enough to eat until fullness.  (Note: frequent readers of this blog may recognize this advice differs from mine.  I'm thinking this over to see if I agree.)

• Meals should last no longer than 20 to 30 minutes, even if your child has eaten very litle or nothing.  Your child will learn to make up for the minimal food intake at the next meal.

• Praise your child for self-feeding skills, but keep a neutral attitude about your child's food intake.  Do not praise or criticize your child for how much or how little he eats.  Your child's eating is not a performance, but should instead be regulated internally by your child's own hunger. 
  

Now, let's talk about your child and certain eating situations over the upcoming holiday.  First and formost, I suggest you make every effort to keep the spotlight OFF of your child during meal times.  It's important to send a silent message that your child's eating habits are not material for extended-family conversation.  Divert any questions or comments by changing the subject.

  Be sure your child's plate has very small amounts of the foods you already know he likes, even if you bring it from home.  This is not the time to present 4 new foods and tell her she needs to "at least try a bite."

If your child still eats in a high chair at home, lucky you! Take it along if you can. Booster seats present multiple problems of their own, in my opinon, because  the added freedom becomes an invitation to climb up and down rather than focus on "whether I am hungry or not."

And, from Dr. Chatoor's list above, Id' like to strongly emphasize that at home and away, parents make every effort to assure their child is hungry at the arranged mealtime.  This means avoiding the constant bits of food a few parents use throughout the day, to control whining, etc. 

Last word: Since it's Christmas,  know that - in a pinch - you an cheat on every rule, if you need to.  You can even say that your child ate before you left home, and serve her just pumpkin pie for dinner!

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Baby Refuses Solid Food

Posted September 6, 2011

First of all, it is important to remember that it isn't crucial for him to eat cereal.  Granted, it is often easy for a baby to like and provides iron for breastfed babies who don't get iron after 6 months or so.  But since he is formula fed, he is getting plenty of iron.  This means he can start with whatever he seems to tolerate best. 

Another thing that is important to remember is that milk is the major growth food until he reaches one year.  The introduction to solid food is now for "practice" only, and will not determine his rate of growth at this point.

Because he is nearly 8 months, we need to focus on approaching him via what he is curious about rather than trying to fit him into specific recommendations you might have received from books, charts you've been given, etc.  So, if he watches you eating your lunch or dinner, put a small piece of what you are eating (bread, cheese, noodle, etc.)on his tray and let him decide what to do with it.  If you don't come at him with food, he maybe much more receptive. 

Let him reach for what he wants, regardless of the time of day or the particular nutrition involved..  He gets his major calories from milk, which  should be offered about 3-4 times a day.  The timing of the solid food should be more according to when he is curious about what you are eating; it doesn't need to be locked in to breakfast, lunch or dinner.

Please write back and let me know if this makes intuitive sense to you, and if you are feeling pressure from books, clinics or charts. In the meantime, I highly recommend books by Ellyn Satter. Ellyn Satter pioneered the concepts of the feeding relationship and eating competence. She is the author of the division of responsibility in feeding. 

Kitty Raymond

As far as pressure from books, charts - perhaps I have been a little guarded in what I'm willing to let my son try (although that's gone out the window the past two days).  Most books recommend not introducing dairy or food with egg in it until after the 9 month mark.  (My meatballs have dairy products and egg in them).  I've been slightly confused by this recommendation though, given that formula is cow's milk based ?????? So, yes, I guess I have felt some pressure to "follow the rules and recommendations" of the literature I've been given at public health visits and via health link.  It's true, I've had some guilt in letting my baby eat the teething biscuits which are on the forbidden list and cheese (also forbidden).  I would love to venture into yogurt, but that's a strict taboo based on the whole "probiotics are too much for babies tummy" theory.  What's a mom to do?! 

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The Picky Eater - A New Perspective

Posted May 2, 2011

It is rare these days to hear of a toddler who eats really, really well.  I wonder if this is due to a generational change in the eating behavior of kids from about 1 to 4 years or if it a product of higher parental expectations.  The "Clean Plate Club" many parents remember from their own childhood seems to be seen as a negative - to be avoided - by today's parents but maybe it has simply taken on a new face. 

Higher parental expectations?  It is interesting to note that charts and "guidelines" posted and promoted at health clinics actually recommend a certain number of tablespoons of various kinds of food to be offered in a certain order to every child over 6 months.  The amounts increase according to age, of course, and the recommendations can easily give a parent the impression that 3 solid meals a day are required at an early age and that the challenges of vegetables, fruit and meat are just around the corner.

It is possible, but I would like to hear from you so I can be sure, that parents are left with the impression early on that their baby's birth weight, post-natal weight gain and toddler eating habits are urgent concerns causing some parents who fear they may be judged, to try to get their child to eat more than the child's appetite actually dictates. 

The research behind starting solid food and feeding toddlers and preschoolers stresses that parents should be relaxed and respectful of their child's tastes and appetite from day to day.  Young children become very aware of colors, smells and texture of food and they also can detect if there is parental pressure to eat.  They learn this when someone hovers over them, watching, coaxing or playing games to get them to eat more.  The pressure usually results in the child dreading mealtimes and actually eating less in the long run.

There are some resources available to you if you feel stress over how much your child eats.  I suggest the Ellen Satter book How to Get Your Child To Eat But Not Too Much.  Also, I welcome Telephone Counseling appointments (45 minutes) on the subject of feeding toddlers and preschoolers.  You and I will study the list of foods your child will eat willingly and make up a meal plan that takes into account your concerns and your child's nutritional needs. I'll help you gain insight into designing an eating environment so your child will grow up with a healthy relationship with food.

Dr. T. Berry Brazelton's magic menu for daily toddler survival: 2 pints of milk, 2 ounces of protein with iron, a little fruit and 1 multi-vitamin!

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