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Feeding Picky Eaters
Ruth Carey, RD, CSSD, LD
June 24th, 2008
Nebraska School Food Service Association
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Objectives
• Identify problems/situations within families that lead to development of picky eaters.
• Effectively counsel families who have difficulty with children’s food choices and eating behaviors.
• Learn to strategize with children and parents to solve mealtime struggles and grocery store choices for picky eaters.
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Children’s Nutrition
• ADA Position Paper: Dietary Guidance for a Healthy Children ages 2 to 11 Years, 2004, JADA
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Prevalence of Overweight
• Overweight has more than doubled among 2-5 yo since 1970’s
• Overweight has more than tripled among 6-11 yo since 1970’s
• Overweight is now more prevalent than under weight or growth retardation
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Children’s Nutrition
• Energy intake has increased over the last quarter century
• Overall decline in milk, vegetables, soups, grains, and eggs
• Increase in intake of fruits, fruit juices, sweetened beverages, poultry and cheese
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Children’s Nutrition
• Increased restaurant food consumption– 1997 - half food expenditures were spent
outside the home, one third on fast foods
• larger portion sizes, super sizing
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Shifts in beverage consumption
– 1945 Americans drank 4 times more milk than soda
– 1997 Americans drank 2.5 times more soda than milk
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Shifts in meal patterns
• Breakfast consumption is down among children and adolescents from 1965 to 1991.
• Snacking has increased significantly in the U.S.
• 50 % of children ages 6-18 report 5 eating occasions or more daily
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Impact of school meals
• Children in School Lunch programs have higher intake of vegetables, milk, and meat
• Children in School Breakfast program have higher intakes of many vitamin and minerals
• School foods many times look like fast foods,i.e.: burgers, fries, pizza, nuggets
• Competitive foods in high schools and middle schools offer FMNV
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Family Trends
• Fewer families eat meals together
• More families with both parents working outside home
• Increased child care by providers other than parents
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Family influence
• availability and accessibility of foods
• meal structure
• adult food modeling
• food socialization practices
• food related parenting style
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Situations that may encourage a picky eater
• Parents may not realize that there is a natural tendency for children to reject a new food: taste or texture issues
• Parents give in to children’s demands– fear child won’t eat– don’t want to deal with bad behavior– each child has different likes or dislikes
• Child has special needs
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It may take up to 15 tries for a child to accept a new food
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Division of Responsibility
• Ellyn Satter, MS, RD, LSW
• www.EllynSatter.com
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Division of Responsibility
• Parent provides nutritious meals and snacks
• Parent provides regular meal and snack time
• Child decides how much to eat
• Child decides whether to eat
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Common parenting mistakes
• Giving up on offering healthful foods after one refusal
• Giving in to child’s demands for food choices
• Letting a child eat while watching TV
• Letting a child eat alone
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Parenting mistakes
• Giving child different meal from adult meal
• Making personal food aversions known to child
• Restricting amount or certain foods
• Dieting/restriction of own diet
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Counseling children
• Cognitive development (Spear)• Early childhood: concrete operational
thought– black and white, straight forward messages– family based, multi-component education best
• Adolescence :formal operational thought– ability to think hypothetically and abstractly– Family and school based education effective
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Early Adolescence
• respect for adult authority
• simple instructions
• encouragement of family involvement and direction
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Middle Adolescence
• recurrent challenges to family or parental authority
• reliance on peers for standards of appearance and behavior
• simplified problem-solving techniques
• role playing
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Late Adolescence
• greater reliance on internalized values
• fewer challenges to adult authority
• less reliance on peers for standards
• increased capacity to solve life problems
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Counseling Parents or Caregiver
• Set a good example– healthful foods, table manners, family meals
• Model variety, moderation and balance
• Involve child in meal planning, and shopping when age appropriate
• Encourage help with meal preparation (age appropriate)
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Parents and/or caregiver
• Allow child to express hunger and fullness and encourage listening to internal cues
• Allow child sufficient time to finish meal without distraction from T. V. etc.
• Avoid using dessert as reward or punishment
• Remove child from table for disruptive behaviors
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Tips for increasing vegetables, dairy, variety and moderation
• Sneak vegetables into favorite food– mac and cheese
• Allow children to put favorite sauces on foods, let them dip
• Involve children in growing, picking and age appropriate preparation of meals
• Don’t provide soft drinks or sugared beverages
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Tips (cont.)
• Provide a variety of vegetables and fruits often
• Use Food Guide Pyramid for meal planning
• Don’t bribe, reward or punish for eating/not eating foods
• Don’t label foods as “good or bad” or child as good or bad based on food choices
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Case Study
• Daniel
• 14 yo
• 64” 87.8 lbs
• BMI 6th percentile for age
• medication : concerta
• track and Tai Kwan Do competitor
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Diet Recall
• Breakfast: Multigrain Cherrios, nonfat milk,– recently added instant breakfast
• Lunch: white roll and milk (school)
• Snack: cereal, milk, ice cream
• Dinner: white bread and jelly sandwich or French bread ham and cheese, milk
• Dessert: milkshake
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Other findings
• MI scale of 7 on motivation to change
• Has never eaten family meals at dinner
• Does not eat fruit or vegetables
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Assessment
• underweight for height
• inadequate protein and calories for growth, sport
• diet low in fiber
• diet low in fruits and vegetables
• diet lacks variety
• extremely picky eater going back to toddler days
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Recommendations
• 2500 calorie exchange plan
• planned 3 sample days menus
• increase fruits and vegetables
• eat dinner with family some nights per week
• eat more protein
• add whole grains
• take multivitamin with iron
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Goals
• to eat dinner with family 3 nights per week
• to include protein in most meals
• to try eating fruits and vegetables
• to journal food intake
• return in one month
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Case Study II
• Kathy
• 11 yo girl
• 5’6” 180lbs.
• >95 %ile stature for age > 95%ile wt for age
• BMI 29 >95th %ile
• no medications or other health concerns
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Diet Recall
• Breakfast: sugared cereal, NF milk, banana– or white bagel with cream cheese
• Lunch: School lunch with chocolate milk, or lemonade– or turkey sandwich with mustard, 100 cal pack
of cookies or crackers
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Diet recall (cont);
• Snack: Crackers, chips, or granola bar, milk
• Dinner: Grilled chicken, broccoli or – Out: Applebee’s Orange Chicken and Rice,
lemonade
• Dessert: Lite ice cream
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Other findings:
• Mom “ Kathy can eat large portions”
• Constipation a problem
• No allergies
• Rarely drinks water
• Activity is PE at school only 2 days week
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Assessment
• diet low in fruits and vegetables
• sugared cereals and beverages contribute empty calories
• breakfast is low in fiber and protein
• breakfast and lunch inadequate calories
• low in fluids/ water
• not enough regular activity
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Recommendations
• Planned sample menu for 3 days, using Food Guide Pyramid
• Include protein at breakfast– egg or peanut butter with whole wheat toast– whole wheat English muffin with fat free cream
cheese
• Switch to high fiber cereal – Oatmeal, Bran flakes
• Drink water with all meals and snacks
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Recommendations (cont)
• Drink plain milk and water at lunch
• Include fruit and vegetable at lunch in place of “100 calorie packs”
• Pack lunch 3 days per week, and buy 2 days
• Have yogurt and fruit, or cheese stick and vegetables and dip for after school snack
• Control portions at dinner (measure for a while to learn portion control)
• Increase activity to one hour per day
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Recommendations (cont)
• Concrete, black and white
• First visit, set goal to work on breakfast recommendations
• Second visit, set goal to work on lunch recommendations
• Third visit, set goal to work on snack recommendations
• Keep simple food journal for 3 days each week
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Results
• At one month weight is holding steady, no loss or gain
• Kathy is reading labels, sugar and fiber
• Mother realizes that this is a slow process of change
• Kathy has signed up for softball and is trying to be more active
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Case Study III
• Sally
• 12 yo girl
• 5’4” 110 lbs.
• 90%ile for stature for age 75% ile wt for age
• BMI 19 54% ile
• vegetarian , lacto- ovo x 2 years
• allergic to legumes
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Other
• plays competitive basketball and soccer 2 X per week
• goes to athletic club with father for pick up games and run mile
• has not started menses• Dr. concerned with recent weight loss• Mother complains Sally wants to be
vegetarian but is picky eater
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Diet Recall
• Breakfast: granola with yogurt (recent change to whole milk yogurt)
• Lunch: Bagel and fruit, sometimes a cheese stick
• Snack: granola or Odwalla bar
• Dinner: Pasta with parmesan cheese, bread, broccoli
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Diet Recall (cont)
• Sally wants to eat all meals downstairs in front of T.V.
• Sally states “it’s so lame to eat with your parents, none of my friends eat with their parents”
• Great deal of tension between mother and daughter
• Mother also a vegetarian, has always watched her diet
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Assessment
• Diet is low in protein
• Diet is low in fruits and vegetables and variety
• Diet is low in calories for all activity
• Diet is low in calcium
• Lack of family meals
• Sally is in Middle adolescent phase
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Recommendations
• 2400 calorie vegetarian exchange diet
• increase low fat dairy to 4 servings daily
• increase fruits and vegetables to 9 servings daily
• increase protein to 6 servings daily
• Sally plans 2 dinners for family per week
• Sally eats with parents with no T. V.
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Recommendations
• Two goals per visit
• Concrete, specific food choices, ideas for increasing variety
• Keep food journal
• Take a multivitamin with iron
• Sally direct help from mother
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Results: 3 follow up visits:• Sally has increased her protein at all meals
– edemame, sushi, dried beans and more cheese
• Sally still needs to drink more milk or eat more yogurt
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Results (cont.)
• Sally has increased her fruit intake, eating more variety of vegetables
• Sally is eating tree nuts for snacks
• Increase in weight 1-2 lbs per week.
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Case Study IV
• Adam
• 15 yo male
• 72” 237 lbs
• >95 %ile for weight 90% ile for height
• BMI: 32 >95%ile
• Dx: pre-diabetic, ADD
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Medications
• Concerta
• Respiradal
• Selexa
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Diet Recall
• Breakfast: lg bowl cereal and skim milk• Lunch: White Bagel with cream cheese and
water• After school snack: Sandwich, Lean Pocket,
Goldfish, nuts, 2 diet sodas• Dinner: Meat, chicken or fish, potatoes• Snack: Cereal with milk or dessert of
cookies and ice cream
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Assessment:
• lacking in fruits and vegetables
• lacking in protein and calories at breakfast and lunch
• too large after school snack
• lacking in calcium, does not like milk
• no exercise
• medications affect appetite
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Recommendations
• 2500 calories, exchange type pattern
• Weight loss
• 3 sample menus created
• Increase size of breakfast
• Add protein to breakfast and lunch
• Add fruit to breakfast
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Recommendations (cont.)
• Increase intake of vegetables at dinner
• Walk 4 days per week, increasing to daily activity
• Set 2 goals per visit
• Parents both involved to help and monitor
• Help directed by Adam
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Results : 6 weeks
• Weight loss of 7 lbs.
• Walking 4 days per week for 30-40 minutes
• Discontinued anti -depressant
• Oatmeal x 2 packets with protein powder most days of week
• Eating fruit at pm snack
• Eating vegetable with dinner
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Conclusion
• Parents and care givers provide variety of healthy food choices
• Parents and care givers provide regular meal and snack times
• Children decide whether to eat and how much
• Involve children in growing, preparing and serving
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Thank You!