5/10/17 TODAY FEAR A THOROUGHLY MODERN APPROACH TO CHILDHOOD NUTRITION IN THE 21 ST CENTURY DISCLOSURES. Feeding Kids is Harder than Ever!

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1 DISCLOSURES A THOROUGHLY MODERN APPROACH TO CHILDHOOD NUTRITION IN THE 21 ST CENTURY Consultant Mott s Teachable Tastes Beef Checkoff Speaker s Bureau New England Dairy & Food Council Blogger Network Stock/Shareholder/Consultant Once Upon a Farm, LLC Creator The Kids Healthy Weight Project (an online nutrition and feeding course for parents) Eat Like a Champion (online course for young athletes) Food Parenting PRO (professional course) NEW JERSEY AAP ANNUAL CONFERENCE & EXHIBITION MAY 24, 2017 SOMERSET, NEW JERSEY JILL CASTLE, MS, RDN Expert Contributor US News & World Report USA Swimming Bundoo.com 1 in 3 kids are overweight or obese Eating disorders on the rise, especially in boys and children under 12 years ADHD, autism and food allergies increasing Picky eating lasts longer (> 6 years); ARFID More body image concerns More food marketing to kids FEAR TODAY Feeding Kids is Harder than Ever! 1

2 CHANGE THE PERSPECTIVE Short Term: The Trees Which kind of yogurt is best? Getting kids to eat healthy today Parents are frustrated & don t understand their children Children eat less well & don t regulate food intake Long Term: The Forest What s my strategy & system? Teaching kids to eat healthy for a life time Parents are knowledgeable, patient and prepared for challenges Children eat better, regulate food intake, and enjoy eating FEEDING THE WHOLE CHILD WHAT Food & Nutrients at each stage HOW Authoritative Feeding, Positive Food Parenting Practices WHY EAT RIGHT VS. FEED RIGHT Healthy Diet Healthy Child What: Food & Nutrients Healthy Child : Development : Feeding WHAT: FOOD & NUTRIENTS Developmental Stage, Temperament BALANCED & NUTRITIOUS FOOD: THE 90:10 RULE Food Variety Food Groups within & among Rotate Nutrient Rich Calcium,, potassium, fiber Snacks At least 1 snack per day Fill in the nutrient gaps 2

3 NUTRIENTS AS INSIGHT LEARNING TO LIKE FOOD INFANT TODDLER/PRESCHOOLER total fat zinc DHA CHILDREN calcium Vitamin E potassium TEENS Variety Food Acceptance fiber potassium calcium calcium magnesium vitamin E Repeated Exposure HOW TO FEED PARENT-CHILD RELATIONSHIP Trust Model of Feeding Parent believes child can self-regulate food intake Parent believes child can recognize own hunger & satiety Child trusts parent provides pleasant, structured meals/snacks Low Trust à More Controlling High Trust à Relaxed, diplomatic, positive feeding OVERVIEW OF FEEDING STYLES FEEDING STYLE OUTCOMES Authoritarian (Controlling) Permissive (Indulgent) Neglectful (Uninvolved) Authoritative (Love with Limits/Monitoring) We use all four; one is predominant; they reflect our own upbringing Authoritarian ü Poor food regulation ü Out of touch with hunger/fullness ü Correlation with overweight/obesity ü Reduced fruit/veggie intake Neglectful ü Food focused ü Twice as likely to have weight problems (both over- and underweight) ü Emotional insecurity ü Mistrust ü Low intake of nutrient rich foods Permissive ü Increased intake of high fat foods and sweets ü High BMI (preschoolers) ü Predictive of OW in Mexican American children ü Low whole grain intake in < 5 years ü Low nutrient-density food intake Authoritative ü Leaner body composition ü Eat more fruits, veggies, dairy ü More active ü Protective against emotional eating 3

4 Negative Practice Characteristics Potential Outcome Authoritarian Permissive Authoritative Pressuring Nagging to eat more; pressure to try or take bites; reminding child to eat Disinterest in food; early satiety; poor weight gain; worse picky eating; OR weight gain; overeating; ignoring fullness Food Restriction Catering Structure Rewarding Use of sweets/desserts to get child to eat; manipulating with rewards for eating performance Values reward food over healthy food; eats to please; poor self-regulation; relies on external factors Pressure to Eat Constant Feeding Boundaries Restricting Limiting access to certain foods, portions Overly focused on restricted food, overeats when available Food Rewards Choice Catering Constant feeding Allowing child to make most food choices Grazing; always hungry; lack of structure Limited diet; nutrient inadequacies; child in charge; less likely to try new foods Constant eating; overeating; unable to ID true hunger; may not expand food repertoire NEGATIVE PRACTICES DON T WORK FEEDING THAT WORKS 85% of parents try to get children to eat more at mealtime using praise, rewarding and prompting (Appetite, 2007) 50-60% of parents ask their MS and HS students to clean their plates; 40% asked them to eat more even when they stated they were full (Pediatrics, 2013) Project EAT (Eating in Teens and Young Adults): Young adults who use hunger & fullness to guide eating àhealthier weights, less likely to have disordered eating (Appetite, 2013) Structure ELEMENTS TO EFFECTIVE FEEDING Boundaries & Monitoring Reasonable Choice Education & Autonomy Routine with Meals Systematic Snacks Location Timing Food availability; accessibility Parent modeling Parent monitoring Parent in charge of kitchen Child is involved, but not in control Allowed to refuse food; pressure-free praise Mealtime is food learning time SATTER S DIVISION OF RESPONSIBILITY Parent determines: Location Meal or Snack content Timing Child determines: Whether or not they are eating much they will eat When jobs are crossed, problems arise with feeding and eating EllynSatter.com 4

5 AUTHORITATIVE FEEDING FEEDING EDUCATION WORKS Structure Boundaries Reasonable Choice Regular timing of meals and snacks Usual location Monitoring Modeling Food availability and accessibility Unstructured food Guidance for outside eating Positive Food Parenting Child involvement Limited / guided choice Reasoning / education Encouragement Autonomy Anticipatory Guidance makes a difference in diet quality, food preferences, & eating behavior (NOURISH Study) Early feeding education helps promote and sustain responsive feeding, self-regulation and may deter obesity development Responsive Feeding Promotes self-regulation and shared parent-child responsibility for feedingà reduced incidence of childhood obesity Non-responsive feeding is associated with wt/ht Z- scores, BMI z-score, overweight/obesity and adiposity Breastfeeding may shape feeding practices through increased responsiveness to feeding cues. DiSantis et al. Int J Behav Nutr Phys Act. 2013; Paul et al. BMC Pediatr 2014; ; Daniels et al. Pediatrics 2015; Int J Obes 2012; Pediatrics 2013; BMC Public Health 2009; Magarey et al. Obesity, 2016 THE WHY OF FEEDING WHAT TO EXPECT & GOALS Baby (6 months - 2 years) Honeymoon phase of feeding; high growth; eats everything Variety of tastes, textures and flavors Nutrient-rich diet School Age (6-12 years) Food choices reflect desire to be like friends Get cooking; manage outside influences without being a food cop Walk the talk Toddler/Preschooler (2 to 5 years) Picky eating peak; growth slows Bad habits can start Don't cater or force to eat Use Satter s DOR Teenager (13-18 years) Wants to be different/risk taking Shows up with food choices Plan meals and let teens loose in the kitchen Keep tabs, guide & support PUTTING IT ALL TOGETHER MODERN NUTRITION: INFANT Infant Facts What Key nutrients, zinc, total fat, DHA and Critical nutrition period (2 years) Learning to eat Acceptance for food is high Food learning is active Responsive feeding; add structure Fastest stage of growth! Brain developing -- needs more fat, DHA, and zinc Not mentally aware yet Parent-Child Bonding Goals of feeding *Ensure key nutrients met *Adequate fat for growth *Advance texture appropriately *Variety, variety, variety *Bring to the table, encourage self feeding *Connection and attachment -- positive feeding relationship *Honor hunger and satiety 5

6 MODERN NUTRITION: TODDLER/PRESCHOOLER 2-5 YEARS Toddler/ Facts Preschooler What Key nutrients:, calcium, vitamin E, potassium & Stable nutrition Feeding Goals *Ensure key nutrients met *Serve appropriate portions (smaller) move to family-style meals *Follow Division of Responsibility Food neophobia peaks 2-6 years of *Allow self (messy) feeding but teach age Drops some accepted foods/skeptical manners *Find ways to fit in treats of new *Decrease dependence on sippy cups Erratic eating is normal *Mix new food with SAFE foods Slowed period of growth Brain still developing but at slower rate More mentally aware, wants control and is verbal! Second fastest growth stage Think more abstractly Risk taking Moves from wanting to belong to wanting to be different School Facts Age What Key nutrients: vit D, calcium, potassium, and fiber Calcium needs increase: 9-13 year (1300 mg) Palate expands; food neophobia decreases Family meal; role modeling important; boundaries Stable growth Appetite increases with puberty Learns basic nutrition concepts Skill-oriented Comparitis Feeding Goals *Ensure key nutrients met *Serve appropriate portions; family-style meals *Set boundaries/limits *Manage outside influences, scale back at home when needed *Discuss values about body image and health (Child-led) *Teach cooking skills *Keep family meals, save food for kids coming home late from activities MODERN CHILDHOOD NUTRITION MODERN NUTRITION: TEENAGER Teenager Facts What Key nutrients: vit D, magnesium, calcium, potassium and Nutrition may deteriorate during this period Open to new foods; hungrier than ever Help manage hunger Family meal; role modeling important MODERN NUTRITION: SCHOOL AGE Feeding Goals *Help teen take responsibility for meeting nutritional needs *Guide teen s choices outside the home (eating out) *Up the nutrition education and steer away from dieting *Stock healthy and satisfying food *Plan meals for teen to make including periodic dinners *Help with shopping and meal planning *Find time to eat together What TARGET THE WHOLE CHILD THANK YOU! Modern Approach: Comprehensive Food Parenting Combine WHAT and HOW and WHY Get feeding approach & food right Anticipate and manage developmental changes Discourage negative food parenting Elevate and empower parents to normalize eating Singularly addressing HOW to feed isn t enough Neglects present day food envment which parents need to know how to manage Contact: Jill Castle, MS, RDN Jill@JillCastle.com Focusing only on WHAT to feed under-serves Fails to get to the root of many nutrition issues in the child 6