Dec. 19, 2023
25 | The ABCs of Feeding Picky Kids: Your Guide to Raising Good Eaters
Are mealtime battles with your picky eater driving your parents up the wall? I've got you! On today's episode, Colleen teams up with Kristen Smaldone to share the ABCs of winning over the littlest critics at your dinner table. Kristen, a pediatric Registered Dietitian, brings her kid-approved ABC method to the table, crafting a trifecta of appealing, balanced, and convenient meals that will have even the fussiest of eaters asking for seconds. Say goodbye to mealtime battles, as we give you the lowdown on protein-packed breakfasts and the secret to a varied plate that keeps everyone happy.
What you'll learn:
- Why early feeding experiences and the environment at the dinner table plays a role in getting kids to be good eaters
- Learn how to spot a pediatric feeding disorder by asking specific questions from the Feeding Matters questionnaire. This tool helps you differentiate between phases of normal picky eating and signs that may indicate it's time for a referral to a feeding specialist.
In Colleen's nutrition notes segment, she stresses the powerful influence parents have when it comes to their children's eating habits. Children are the best imitators that we have, so let's give them something great. to imitate. From modeling positive behavior to setting firm yet loving boundaries, we explore how to create a mealtime atmosphere that encourages curiosity and a love for healthy food. Join us, and let's journey together towards nurturing a lifelong healthy relationship with food for our kids.
Resources:
Feeding Matters Feeding Questionnaire
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Disclaimer: This podcast is a collection of ideas, strategies, and opinions of the author(s). Its goal is to provide useful information on each of the topics shared within. It is not intended to provide medical, health, or professional consultation or to diagnosis-specific weight or feeding challenges. The author(s) advises the reader to always consult with appropriate health, medical, and professional consultants for support for individual children and family situations. The author(s) do not take responsibility for the personal or other risks, loss, or liability incurred as a direct or indirect consequence of the application or use of information provided. All opinions stated in this podcast are my own and do not reflect the opinions of my employer.
00:00 - Improving Children's Nutrition
11:04 - Understanding Picky Eating and Assessing Concerns
18:09 - Strategies for Dealing With Picky Eaters
25:31 - Parenting and Setting Boundaries With Meals
33:00 - Parental Role in Children's Eating Habits
WEBVTT
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If you eat all your broccoli, you can have dessert.
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Just try it.
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Your sister likes it.
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If you don't finish your plate, I'm taking away your Legos.
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Do you hear the frustration, the desperation, the hopelessness in these phrases?
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These are all common things.
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I hear parents tell their picky eaters and I don't blame them.
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Feeding kids is hard and parents desperately want to feed their kids well and make sure they're adequately nourished.
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But is there a better way to get kids to eat than bribing, pressuring or punishing them?
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My name is Colleen.
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I'm a pediatric PA and registered dietitian, and this is the Exam Room Nutrition Podcast.
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For each week, I'm giving you answers to common nutrition questions to help you be a more confident, compassionate clinician.
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On today's episode, we're here to bring the flavor, fun and, most importantly, the food back into the family table.
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You'll learn a new framework you can easily use to teach your families how to build a healthy meal for their kid.
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You'll learn a quick way to calculate a child's protein needs and some easy ways to include protein at every meal.
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You'll learn how to spot a pediatric feeding disorder and specific questions you must be asking each parent.
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We discussed the importance of setting up meal and snack schedules and helping your parents maintain appropriate boundaries around food.
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Our guest today believes all kids can be good eaters and enjoys working with families to tackle their child's nutrition concerns.
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I am so excited to introduce you to Kristin Smaldone.
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She's a registered dietitian who is a board-certified specialist in pediatric nutrition.
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She has been a clinical dietitian for nine years, working both inpatient and outpatient at Yale New Haven Hospital.
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She's the owner of Kristin Smolden Nutrition, a pediatric nutrition practice in Connecticut.
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Outside her clinical role, she is also a mom to two young boys, who keep her very active.
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You can find her on Instagram at pediatricdieticianmom Kristin.
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I'm so excited to have you here.
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This is my favorite topic.
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Welcome to the show.
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Hi Colleen, Thank you so much for having me, Kristin I probably deal with the topic of picky eating multiple times a day during my clinic day and I really love your method that you have on your Instagram page and that I'm sure you use with your patients on helping to take the guesswork out of what to serve.
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So I'd love to start by having you just explain what that method is.
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Sure.
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So the method's called the ABC method and really this is just a guide for parents when they're thinking about what should we be serving our kids for meals and snacks.
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It's kind of like the framework, so it's called the ABC method and A chance for appealing, b balanced and C convenient.
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So obviously we're busy parents and we need things quick and fast and easy and this is to help uncomplicate the child's plate.
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I love that.
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Abc makes it easy enough.
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So dig a little bit deeper into what that might look like, practically Like, let's say, for a breakfast plate.
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How would we put the ABC method or the framework into play for a?
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breakfast.
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So when we think about how we want to set up the plate, we want to make sure that again, we're making this appealing.
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So we want it to be interesting for the kid.
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It has to be kind of enticing, not overly fancy, but it has to look somewhat appetizing for them to want to consume it.
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And then we want to focus on making sure that it's balanced.
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So we have to have protein-rich food, some healthy fat in there, some sort of energy source or carbohydrate, and then some sort of fiber fruit or vegetable.
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And these are all really important components for a child's nutrition.
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So in terms of complex carbohydrates, kids, that's, their primary source of energy is carbohydrates and that's what fuels their brain.
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So we need those things.
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But we also know that that can give us a blood sugar kind of roller coaster.
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So balancing it out with more protein-rich foods as well as fiber-rich foods and healthy fat can kind of stabilize that roller coaster ride to make it more of an even playing field for them.
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And then obviously, fruits and vegetables are fiber.
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Antioxidants gives us their micronutrient needs, so that's a great addition.
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So when you think of balance, those are the things that we want to think about.
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I tell my parents.
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We want to have a protein-rich food and that can also include some healthy fat, an energy-rich food and then a color food, which is our fruits and our vegetables.
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So you can serve both or one of each, it's completely up to you.
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So for a breakfast example, we can have eggs.
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That's our protein-rich food.
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You can cook it in a little bit of butter.
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That would add some healthy fat and then we serve whole grain toast on the side.
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You can put a little bit of peanut butter on it if your child's not allergic, or you could do sunflower seed butter, sprinkle on a little bit of hemp seeds and then you could put some raspberries on the side.
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So we have our protein, which comes from our eggs, our peanut butter If we sprinkle some hemp seeds on it.
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That's some more protein Fibers coming from our whole grain toast, as well as our fruit from the raspberries.
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So that's how you would balance it off and really the only thing you're really cooking is some toast and scrambled eggs and the whole family can eat that.
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So that's a really quick and easy thing that you can suggest to your patients in the clinic when they say I just don't know what to feed my kid, or they only eat one or two things.
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That ABC method ensures that you are hitting all of those food groups to make sure it's a really well-balanced plate.
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So I love that.
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I want to stay with breakfast, because this is usually the trickiest meal to get that protein, especially even for adults.
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If you don't like eggs, it's kind of what else are the options?
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And for some kids they don't like eggs yet.
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So can you give us some other suggestions that we as clinicians might provide for our parents for kind of that breakfast option for protein?
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Sure.
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So another option obviously dairy is a pretty easy source of protein if your child can tolerate dairy and if that's something that you want to include in your child's diet.
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So whole milk, 7 grams of protein in it.
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Even you could do Greek yogurt or just regular yogurt that adds some added protein.
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While most kids love cereal, you can pick cereal as an option but tends to be a little bit lower in protein.
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So if you pair it with yogurt or make kind of like a yogurt parfait with the yogurt, the cereal and some added fruit, and that is a much more balanced meal than just saying you know a bowl of cereal, so that's an option.
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Or you can even do a bowl of cereal with the milk, because that's seven grams of protein and we know that kids' protein needs are a lot lower than we traditionally think they are.
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We just kind of want to include it in every meal to kind of help balance things out.
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And I actually do hear that a lot from my parents.
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They're very concerned that their child isn't eating enough protein, because I think that's a lie that we hear on social media for us as adults that you need a high protein, high protein.
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You know 200 grams of protein and you're looking at like a 120 pound woman and it's just ridiculous.
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So they translate that into feeding their child too.
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And it's true.
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Kids really do need much less protein.
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Would you say about seven to 10 grams at each meal would be adequate for your typical toddler, two to five aged kiddo.
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Yeah, I think that would be definitely more on the higher end too, because if you take your child's weight and divide it by two, that's how many grams of protein they need per day, and then you can kind of divvy that up amongst their meals and snacks.
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You know, I think that that's like the minimum protein needs.
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You know, kids can tolerate a little bit more.
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We don't want to go onto the extreme of having too much protein, but certainly, you know, having a little bit more at each meal.
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We do know that it helps stabilize the blood sugar and balance out the meal and that can really help with tantrums and meltdowns and just behavioral aspects of things.
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So protein is important in that keeps them fuller for longer.
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So protein is the most satiating macronutrient.
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So we definitely want to make sure we're incorporating it, but not solely by itself, you know.
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That's why kind of having all those components being offered at a meal is really important.
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Yep, thank you so much for clarifying the protein, because you gave us a really easy kind of quick math to do too.
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To reassure our parents hey, this is the total grams that they need.
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Your child is doing fine with protein, don't worry, and the ABC method is a really great way to introduce foods and expose children to foods, whether they eat them or not.
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So that leads us really nicely into the next topic I wanted to discuss with you.
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That also comes up a lot for me in clinic and it even catches me off guard sometimes because I'll be doing a sick visit and we're talking about the child's rash and as the parent gets up to leave they're like, oh hey, by the way, he just doesn't eat anything.
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And you know that's such a really big broad statement that you kind of have to pause for a second and think like, okay, where do I go with this?
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And truly, it can be answered in a three minute.
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You know discussion, but help us unpack that child who the parent claims doesn't eat anything.
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Where do we start?
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What can we suggest?
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How do we navigate this topic?
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Yeah.
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So this is like a loaded question and I totally hear you from a provider standpoint.
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So you know you have both roles, as a PA and as the registered dietitian.
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You know, often in my the clinics that I do work in, there are times where the doctor will go into the visit.
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They'll come back and say, hey, can you see this patient?
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And I go see the patient and we get two different nutrition histories.
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But it's you know very specific about what kind of questions you need to ask and really you know us as the nutrition professionals are really taking the time and we have the time to really kind of delve deep into their nutrition background.
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So that can really take a long time to really kind of unpack what's truly going on here, because maybe they are eating a lot of things.
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So you know, I always like to ask my parents like a full diet recall.
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So we first go to like what is your typical intake?
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What did they eat for breakfast, lunch, dinner, snacks, and then we kind of break it down more into, okay, food groups what are their protein foods, what are their carbohydrates foods, what kind of fruits do they like, vegetables, and then what are they drinking throughout the day.
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So really kind of unpacking each nutrient in itself.
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Hey, we'll get back to the episode in just a moment, but I wanted to give you a gift for hanging out with me today.
00:10:17.479 --> 00:10:23.975
I want to give you access to a free guide that gives you a step-by-step strategy to navigate a talkative patient.
00:10:23.975 --> 00:10:31.453
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00:10:31.453 --> 00:10:33.897
I've been there, trust me.
00:10:33.897 --> 00:10:41.956
I created a simple framework called STEER that will allow the patient to feel heard, but also keep you on time.
00:10:41.956 --> 00:10:48.273
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00:10:48.273 --> 00:10:59.086
In this free PDF, you'll learn this simple acronym to guide your conversations, and I've included useful phrases you can use that will completely transform the way you talk to your patients.
00:10:59.086 --> 00:11:02.197
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00:11:02.197 --> 00:11:04.014
So check it out in the show notes below.
00:11:04.590 --> 00:11:11.289
And now let's get back to the episode and then, depending on the age, we can ask the child, okay, if they don't like certain foods.
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Their parents are like, oh, they don't eat any vegetables.
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You're like, okay, well, why don't you like vegetables?
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Is it like that color, that taste, that texture, you know?
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Do you like some raw versus cooked?
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Tell me a little bit more about why you don't like these.
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And most of the time they're like why just don't like them?
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There is, you know, disgusting.
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So really trying to like, understand why they don't like certain foods, is important.
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And then you want to dive into the eating environment.
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You know that's huge.
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Who are they eating with?
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Where are they eating?
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Are they sitting in a certain type of chair?
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What's the mood around the meal?
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Is it stressful, is it calm?
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How are the parents feeling in that moment?
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Because there could be a lot of emotions around the meal time and if we see a lot of negative emotions that can, you know, impact the child at meal time, then you want to know about what tactics are happening at the meal.
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Is the parent so stressed out that they want their child to eat something that you know they're kind of coercing them, suggesting they take a bite.
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If you do eat this, then you can have this.
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Or, oh, your brother eats this, look at them eating this type of food.
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Or you know you can't have dessert if you don't eat this.
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Oh, you used to like this.
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But you know, all those things are different types of pressure and that can definitely impact meal time and this can be extremely stressful for the child and obviously it's very stressful for the parent when you prepare a meal and then you sit it down and your kid doesn't eat it.
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So you know, I totally get that as well as like just from a parent, like you have all these expectations and then they're kind of crushed immediately when you get the child to sit down.
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You want to kind of look, look back a little bit too.
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Depending on, like their age.
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You know they're more like school age or younger, you know I'll even bring it back down to okay, so what were they fed when they were a baby?
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Where they breastfed, formula fed, did they nurse?
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Where they bottle said?
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And then look at, okay, when did you introduce solids?
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How did that go?
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Was there any difficulty with textures?
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Then, looking at if things went well initially, you know, when did you started to see a decline?
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At what age was that?
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Was there anything significant at that time that you know made kind of these changes happen?
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Obviously there's normal ranges of picky eating, you know.
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Typically it's like two to six.
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There is a wide range of kind of quote-unquote picky eating, you know.
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Some it's less than some it's definitely more extreme.
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But I think it's important not to just kind of write it off with oh, everybody's picky during that that time frame.
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I think you know there's a lot to it.
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We know that one in 37 kids are diagnosed with a pediatric feeding disorder.
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So it is really important to kind of rule out Is there a medical concern going on?
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Is this a chewing, swallowing kind of functional Issue going on?
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Is this more of like a sensory based issue with like textures and how food feels and like a skill like can they actually chew food and all of those things?
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And then also, you know, psychologically kind of ruling out, is there something else kind of going on here in terms of of that?
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And that requires a multi disciplinary kind of approach?
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But you know it is important to rule out all these kind of other factors and talk about them.
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If a child is kind of really prolonged in terms of struggling with their eating and you feel like it just keeps getting worse.
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I want to linger here because it's just such a huge topic and it can be really overwhelming to try to deal with this in clinic.
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If you don't have, you know, the luxury of having a brilliant pediatric dietitian like yourself in the office with you to just kind of pass them along to you and you do your magic, and I love that.
00:15:02.527 --> 00:15:04.279
You said it's really important not to write it off.
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You know, I didn't even know that one in 37 kids have a feeding disorder.
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That's fascinating and quite eye-opening.
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So it's really important to not just disregard when a parent says, hey, they're really picky and I'm really concerned.
00:15:17.520 --> 00:15:36.570
So, kristen, what could be maybe like the best two or three questions a clinician can ask During a well check because this is something that we should be screening for, at least to kind of give us those red flags of like okay, hey, let's pause and Discuss this more, or absolutely refer to a dietitian because I think there's something going on.
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Because what often happens is, you know, you say, hey, is your child eating?
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Okay, yep, okay, moving on, and I feel as though that that's not a great question and, like you said, asking the right question gives you the right answers or at least kind of directs you to possibly some red flags.
00:15:51.998 --> 00:15:57.214
So what could those questions be that clinicians can ask to the parents to pull out?
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Maybe some concerns about what the child is eating?
00:15:59.981 --> 00:16:06.179
So some of the questions that you can quickly, kind of easily ask as a provider, and these come from feeding matters.
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It's their innovative infant and child feeding questionnaire.
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So it's six questions that you can ask as a provider and if there's two or more red flags there, that would require you to refer out to a dietitian or have them get a feeding evaluation or, you know, consider further work up to identify if there's something else going on here.
00:16:26.972 --> 00:16:32.493
So the six questions are does your child let you know when he or she is hungry, yes or no?
00:16:32.493 --> 00:16:35.690
Do you think your child eats enough, yes or no?
00:16:35.690 --> 00:16:39.645
How many minutes does it usually take your child to eat?
00:16:39.645 --> 00:16:44.394
Less than five minutes, five to ten minutes or greater than thirty minutes?
00:16:44.394 --> 00:16:49.792
Do you have to do anything special to help your child eat, yes or no?
00:16:49.792 --> 00:16:54.484
Does your child let you know if he or she is full, yes or no?
00:16:54.484 --> 00:16:59.500
And then, based on the questions above, do you have concerns about your child's feeding, yes or no?
00:16:59.942 --> 00:17:12.180
So I include that in all of my nutrition assessment form, so I kind of run through those and then, based on that, you know, that kind of gives me a little bit more insight in terms of, like the parents perspective in terms of what's going on.
00:17:12.180 --> 00:17:29.160
Obviously, length of meal time, you know if there's just kind of sitting down super quick and then kind of getting up you know that is kind of common behavior, especially for the younger ones who just are busy bees but also something to kind of consider in terms of environment how they feel if it's taking a really long time.
00:17:29.160 --> 00:17:42.671
Is this a functional issue in terms of difficulty with whatever is being offered, or is this, you know, that's really on planet pleasant experience, or are they having some sort of Medical concern that's making them eat really long?
00:17:42.671 --> 00:17:50.733
So I love that questionnaire from feeding matters to quickly scan through Patients to see you know if there's something that we need to talk about more.
00:17:51.317 --> 00:17:51.960
Thank you so much.
00:17:51.960 --> 00:17:58.915
So, guys, I'm gonna go ahead and link that below in the Description so you can take a look at that and use it for your future use.
00:17:58.915 --> 00:18:09.093
If you haven't already, I would love if you could like and subscribe to this podcast, even share it with any of your clinicians, just so other people can find this show and to get these practical tips as well.
00:18:09.093 --> 00:18:13.173
So now, okay, we've kind of figured out some red flags.
00:18:13.173 --> 00:18:28.594
Let's just say we have a patient who is Kind of your typical eater, right, we're not really concerned about any kind of motor dysfunction or medical cause of why they don't eat anything, and we're thinking it might just be that they're a picky eater.
00:18:29.121 --> 00:18:40.240
What are some useful things the clinician can do right then and there in the clinic To help the parent because this is so overwhelming for them, and help the child to be a better eater?
00:18:40.240 --> 00:18:42.251
I get this all the time.
00:18:42.251 --> 00:18:53.875
I and this is the situation that happens almost like clockwork is it's like a two year old, two and a half year old they don't eat anything that I give them, or they maybe only eat a few bites.
00:18:53.875 --> 00:19:01.628
So I'll give her a bottle or I'll give her milk To to give her something because I want her to grow right.
00:19:01.628 --> 00:19:09.356
So I Personally don't think that that's a great strategy, because you're not really teaching them how to eat healthful foods and have a good relationship With food.
00:19:09.356 --> 00:19:12.626
But I would love to hear your expert advice on how do we navigate that.
00:19:12.626 --> 00:19:18.888
What can we say to the parents on maybe redirecting how they are approaching feeding their child?
00:19:19.915 --> 00:19:20.237
Sure.
00:19:20.237 --> 00:19:36.882
So for this question the provider could just focus on the basics, like bringing it back, that it's like oh, I have to try this and this to get my kid to eat this food, but really it's those foundational pieces that we have to work on before we even focus on oh, I want my kid to eat a piece of carrot.
00:19:36.882 --> 00:19:37.403
Like.
00:19:37.403 --> 00:19:41.414
You really need to get that framework in that foundation set before we even get there.
00:19:41.414 --> 00:19:43.681
So some of my common things that I talk about.
00:19:43.681 --> 00:19:45.946
Number one is meal and snack time schedule.
00:19:45.946 --> 00:19:54.742
We want to make sure that we kind of have this set schedule of when breakfast is, lunches, dinner is, and then spitting in a snack in between.
00:19:54.742 --> 00:19:59.255
Most kids require Five to six meals and snacks per day.
00:19:59.255 --> 00:20:07.701
So eating within one hour of waking up in the morning and then, you know, subsequently every two to three More on that three hour mark.
00:20:07.701 --> 00:20:17.474
This allows the child to kind of eat something, get full and then they get hungry and then they can come to the next meal more hungry.
00:20:17.474 --> 00:20:22.115
So it helps regulate appetite as well as kind of get them really ready for the meal.
00:20:22.115 --> 00:20:31.006
If they're kind of grazing throughout the day and you bring them to the table to eat, they're less likely to want to sit, less likely to want to eat.
00:20:31.006 --> 00:20:40.082
So really focusing on that structure can kind of reduce meal time battles because they're coming to the table with a little bit more Interest than than previously.
00:20:40.082 --> 00:20:41.066
So that's number one.
00:20:41.066 --> 00:20:43.255
You know, really making sure you have that schedule.
00:20:43.255 --> 00:20:49.817
It can be flexible, obviously, if you're like going out and things like that, it doesn't have to be this kind of strict Regimen.
00:20:49.817 --> 00:20:58.372
But you know, kind of having this half hour kind of wiggle room and you know, keeping it that the kids aren't able to kind of Grab anything in the refrigerator or in the pantry.
00:20:58.372 --> 00:21:09.701
You know, and that's the most challenging part because kids are persistent and they will wear you down to get that snack but really kind of holding our boundaries, knowing why we are doing this.
00:21:09.701 --> 00:21:13.414
We're not holding back food, right, we're still allowing them to eat.
00:21:13.414 --> 00:21:20.795
We're giving them five to six eating opportunities during the day, but we're providing in a way that's going to support their appetite best.
00:21:20.795 --> 00:21:27.030
So we're not restricting them, we're just being really strategic about when we're offering that, that food.
00:21:27.152 --> 00:21:34.214
And then, in terms of what we're Offering, kind of going back to that ABC method, we want to make sure that it's appealing.
00:21:34.214 --> 00:21:37.865
So one of those factors is making sure that we're offering safe foods.
00:21:37.865 --> 00:21:43.188
We want at least one or two preferred foods that we know the child will eat and like.
00:21:43.188 --> 00:21:57.881
Then on the side or on the plate, whatever they tolerate, or even on the table If having it on their plate or near their plate is hard, we have those kind of new foods in a small portion in which they can Try if they would like.
00:21:57.881 --> 00:22:08.528
But, you know, reducing that pressure and really kind of taking a step back, focusing on what meal time is all about, it's about the connection, the conversation, and it should be enjoyable.
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