Fearless Feeding: TODAY TODAY 4/9/16 NUTRITION & FEEDING A MODERN APPROACH TO CHILDHOOD NUTRITION IN THE 21 ST CENTURY

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1 Fearless Feeding: NUTRITION & FEEDING A MODERN APPROACH TO CHILDHOOD NUTRITION IN THE 21 ST CENTURY MICHIGAN ACADEMY OF NUTRITION AND DIETETICS APRIL 22, 2016 JILL CASTLE, MS, RDN TODAY TODAY 95% of parents believe healthy eating is important 82% believe they are successful at feeding kids healthfully 80% believe they have no control over picky eating 75% give in 30% of moms give themselves a C when it comes to knowing the right mix of nutrition for their baby 85% of 2-3 yr toddlers consume sweets and sweet drinks each day 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) More body image concerns More nutrient-poor foods available More food marketing to kids 1

2 FEAR CHANGE THE PERSPECTIVE Short Term Which kind of yogurt is best? Getting kids to eat healthy today Parents frustrated & don t understand their children Children eat less well & don t regulate food intake Long Term What s my strategy & system? Teaching kids to eat healthy for a life time Parents knowledgeable, patient and prepared for challenges Children eat better, regulate food intake, and enjoy eating THE WHOLE CHILD APPROACH WHAT: FOOD & NUTRIENTS WHAT Food & Nutrients at each stage HOW Authoritative Feeding, Positive Feeding Practices WHY Developmental Stage, Temperament 2

3 FOOD BALANCE THE 90:10 RULE Food Variety Food Groups -variety within Don t get into a rut Meals/Snacks 3 meals At least 1 snack per day Flexibility MEAL PLANS TOP 5 NUTRIENTS Food Groups/Portions Dairy Lean meats Fruit Vegetables Grains Fats Fun Foods **Portions change w/ age Nutrients Calcium Vitamin D Iron Zinc Potassium Fiber And more! INFANT total fat iron zinc vitamin D DHA CHILDREN fiber potassium iron calcium vitamin D TODDLER/PRESCHOOLER calcium vitamin D vitamin E potassium iron TEENS calcium vitamin D magnesium vitamin E iron 3

4 HOW TO FEED PARENT-CHILD RELATIONSHIP Trust-based Feeding or 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,? Low structure/ boundaries AUTHORITARIAN FEEDING STYLE (CONTROLLING) Low sensitivity to hunger, fullness, food preferences Demanding Do as I say, not as I do approach clean your plate High structure, clear rules Poor Food Regulation Out of touch with hunger/fullness Correlation with overweight/ obesity Reduced fruit/veggie intake EMERGING RESEARCH Controlled Feeding Predict eating behaviors at 12 months Low awareness of feeding style Restrictive feeding in twin samples Restriction toward heavier & poorly regulated twin Pressuring toward lighter twin Mothers vary feeding style among twins Rhees et al, Pediatrics 2006; Patrick et al, Appetite, 2005; Clark et al, J Pub Health 2007 Tripicchio et al. Pediatrics 2014; Bergmeier et al. J Nutr

5 PERMISSIVE FEEDING STYLE (INDULGENT) Highly responsive Low demands yes parent Child takes the lead on food choice Little structure Increased intake of high fat foods & sweets High BMI (preschoolers) Predicts overweight in Mexican American children EMERGING RESEARCH Using food to soothe infant/ toddler distress Infant weight gain Associated with low nutrient density food intake Children under 5 years Low whole grain intake Intention? Promotion vs. Prevention approach to feeding Promotion (healthy eating) Prevention (unhealthy eating) Hughes et al, J Dev Behav Pediatr, 2008; Olvera et al, J Pediatr Psychol, 2009; Olvera et al. J Ped Psych, 2010 Hennessey et al. JAND, 2012; Stifter et al. Appetite 2015; Tovar et al. Appetite 2015; Melbye et al. BioMed Res Intl, 2015 NEGLECTFUL FEEDING STYLE (UNINVOLVED) Low responsiveness Low demands Lack of rhythm with food/ eating Unreliable meals Food focus Twice as likely to have weight problems Emotional insecurity Mistrust Low intake of nutrient rich foods EMERGING RESEARCH Depression in low income families Assoc. w/ parenting and feeding styles Moms at risk for DEP, ANX, Stress: High risk for neglectful feeding style UNICEF framework focused on emotional climate of family to prevent obesity Parental stress Feeding styles Depression Mom s own eating Hoerr et al. Int J Beh Nutr Phys Act 2009 Hughes et al. Appetite, 2015; Hurley et al. J Nutr. 2008; El-Behadli et al. Br J Nutr

6 AUTHORITATIVE FEEDING STYLE (LOVE WITH LIMITS) Highly responsive High demands Structured feeding; boundaries with eating Reasonable choice Responds to hunger, fullness, food preferences Leaner Eat more fruits, veggies, dairy More active Protect against emotional eating Patrick et al, Appetite 2005; Topham et al, Appetite 2011 DIVISION OF RESPONSIBILITY Parent determines: Location Meal or Snack content Timing Child determines: Whether or not they are eating How much they will eat When jobs are crossed, problems arise with feeding and eating EllynSatter.com EFFECTIVE AUTHORITATIVE FEEDING PARENT PRACTICES Structure Boundaries Reasonable Choice Routine with Meals Systematic Snacks Location Timing Ratio of healthy: unhealthy foods Parent in charge of food purchases Parent in charge of food decisions Parent in charge of kitchen Child has a say in whether or not he eats Able to choose between 2-3 food options Allowed to have input in food selection 6

7 55% of parents of 3 year olds use rewards to get them to eat healthier Disregards internal hunger regulation Reward food takes priority Food preferences change: devalue healthy food & favor less healthy food Gets kids to eat today, but may not get them to LIKE food tomorrow Role for non-food rewards: can get kids to taste new food REWARDING Authoritarian Feeding Style Greater intake of & preference for limited food Eating in Absence of Hunger Poor self-regulation Increased risk for overweight Value restricted food RESTRICTING Authoritarian Feeding Style Faith et al, Obes Res, 2004; Webber et al. J Am Diet Assoc Cooke et al. Appetite, 2011 Birch et al. Am J Clin Nutr 2003; Savage et al. J Law Med Ethics 2007; Webber et al. J Am Nutr Diet 2010 PROMPTING/PRESSURE CONTROLLING Lower ability to regulate intake Decreased intake of fruit/ veggies Increased satiety responsiveness Slow & fussy eating Overeating Authoritarian Feeding Style Unclear influence During infancy, control over what and how much is eaten produces lower BMI at age 2 Older child: May promote uncontrolled eating, EAH, overeating and weight gain Long term: negative effects on quality of diet by reducing preference for healthier foods Authoritarian Feeding Style Fisher et al, AJCN, 2002; Webber et al. Acad Nutr & Diet Farrow et al, Pediatrics, 2008; Scaglioni et al. Brit J Nutr 2008; Birch. Annu Rev Nutr,

8 NEGATIVE STYLES DON T WORK! THE WHY OF FEEDING 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) Child Development Temperament Baby (6 months - 2 years) WHAT TO EXPECT Honeymoon phase of feeding; high growth; eats everything Variety of tastes, textures and flavors School Age (6-12 years) Food choices reflect desire to be like friends Get cooking; manage outside influences without being a food cop 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 WHAT YOU DON T KNOW CAN HURT Problem Parents get frustrated with their child or blame themselves; lack of understanding Attempt to change what isn t change-able; Kids get the message they are bad eaters Not prepared for challenges Solution Understand how child development relates to eating Appreciate many transitions are normal & work with it; kids feel good about eating Prepared for challenges at each stage 8

9 PUTTING IT ALL TOGETHER MODERN NUTRITION: INFANT Infant Facts What Key nutrients iron, zinc, total fat, DHA and vitamin D Critical nutrition period (2 years) Learning to eat How Acceptance for food is high Food learning is active Responsive feeding; add structure Why Fastest stage of growth! Brain developing -- needs more fat, DHA, iron 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 MODERN NUTRITION: TODDLER/ PRESCHOOLER 2-5 YEARS MODERN NUTRITION: SCHOOL AGE Toddler/ Preschooler What How Why Facts Key nutrients: iron, calcium, vitamin E, potassium & vitamin D Stable nutrition Drops some accepted foods/ skeptical of new Erratic eating is normal Food neophobia peaks 2-6 years of age Slowed period of growth Brain still developing but at slower rate More mentally aware, wants control and is verbal! Feeding Goals *Ensure key nutrients met *Serve appropriate portions (smaller) move to family-style meals *Follow Division of Responsibility *Allow self (messy) feeding but teach manners *Find ways to fit in treats *Decrease dependence on sippy cups *Mix the new with the old School Facts Age What Key nutrients: vit D, calcium, potassium, iron and fiber Calcium needs increase: 9-13 year (1300mg) How Palate expands; food neophobia decreases Family meal; role modeling important; boundaries Why Stable growth; appetite increases at puberty (girls 10-11/boys years) 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 9

10 MODERN NUTRITION: TEENAGER MODERN NUTRITION Teenager Facts Feeding Goals What Key nutrients: vit D, magnesium, calcium, potassium and iron *Help teen take responsibility for meeting nutritional needs Nutrition may deteriorate during this *Guide teen s choices outside the home (eating out) period *Up the nutrition education and steer How Open to new foods; hungrier than ever Help manage hunger Family meal; role modeling important away from dieting *Stock healthy and satisfying food *Plan meals for teen to make including periodic dinners Why Second fastest growth stage *Help with shopping and meal planning Think more abstractly *Find time to eat together Risk taking Moves from wanting to belong to wanting to be different How What Why TARGET THE WHOLE CHILD TAKE-AWAY Focusing only on WHAT to feed under-serves Fails to get to the root of many nutrition issues in the child Singularly addressing HOW to feed isn t enough Neglects present day food environment which parents need to know how to manage Modern Approach Combine WHAT and HOW and WHY Get feeding approach & food right Anticipate and manage developmental changes Elevate parent role to normalize eating, raise a healthy human for a lifetime Eating healthy food doesn t guarantee a healthy child. Perfect nutrition doesn t exist. Don t feed the myth. Nutrition is personal. Get personal. Food and nutrition is only a slice of the childhood nutrition pie. Trust and connection need more time at the table. Bring this to your clients. Parents shape eating attitudes and behaviors. Negative feeding styles and practices are barriers. Child development is predictable. Know and understand it. How will you modernize your practice? How will you do your part to solve modern-day childhood nutrition problems? 10

11 THANK YOU! Contact: Blog Books Website Specializing In Pediatric Nutrition 11