Helpful Rules For Parents Of Picky Feeders

        Picky feeding can develop anytime in childhood. Here are some basic rules for dealing with picky feeders:

#1. Eat Together.  With both parents working, having family meals can be hard, but mealtime should be a time for the family to sit down together with TVs and smart phones off. Fewer distractions can mean quieter, calmer and better meals for everyone. Younger children eat better when they see their parents eating the same thing that they are eating. Sitting a child in a high chair and trying to have him eat while other people in the house are doing other things is rarely successful.

#2. No fights at the table.  No one’s appetite is helped by being upset. Forget “clean-plate “and “one-more-bite” arguments. Don’t coax, plead or try to force (It’s impossible for one human being to force another to eat and your child will be happy to prove that to you!).  Mealtime is the time for families to enjoy each other and to talk about anything other than food and meals.

#3. Presentation is important.   For both adults and kids, how a meal looks (and, for toddlers, how it feels) can help or hurt the appetite. We all like fresh-looking food and bright colors, but remember that, for a toddler, the peas being arranged in a smiley face might help, too. Play with your food and make mealtime fun.

#4. Make a meal and serve it to everyone – avoid substitutions. Approach each meal with a positive attitude. Even though your toddler refused noodles yesterday, he might like them today. Continue to make and serve what you like, but you can experiment – if he didn’t like noodles with tomato sauce, he might like them with cheese. If you are going to discuss menu planning with your older child (every teenager wants to be a vegetarian at some time), have that discussion between meals. Once a meal is made and served, don’t be quick to offer substitutions like bread, hot dogs or extra glasses of milk or juice. If a child eats nothing but potatoes at a given meal, it is not a problem. But saying, “If you don’t like what I made, you can always have a hot dog” is a fast-track way to teach your child to be a picky feeder. If a child turned down everything you served, allowing him to have a dessert is just one more form of substitution.

#5. Picky Feeders aren’t hungry.  Children in third-world countries aren’t picky – they’re hungry. They eat whatever comes their way. Experts talk about children eating 5 small meals a day, but there are meals and there are snacks. Sometimes the snacks can sabotage the meals. Drinking milk or juice between meals is the #1 appetite-killer, especially with toddlers sucking on a bottle. Allow only water between meals and give fresh fruit for snacks. Fruit snacks are not fruit. Neither is juice. And allow your child to actually get hungry before the meal. Don’t give anything but water for 1 hour before any meal. If a child refuses to eat a meal, that means somewhere he got too much to eat between this meal and the last one. Don’t make the same mistake twice. If he turns down a meal totally, he can only have all the water he wants until the next meal. By then, the peas might look a lot better to him.

Nutritional Supplements For Autism

     In the April issue of Contemporary Pediatrics, there is an article written by Mary Beth Nierngarten (a native of my city, Saint Paul) called “Managing autism symptoms through nutrition”. The article points out that a high percentage of parents of autistic children use alternative medical supplements or nutritional manipulations such as modified diets.

     The diagnosis of autism is devastating to parents. What makes it especially difficult is the fact that physicians don’t have a “reason” or “cause” for autism and we also don’t have a “cure”. That results in desperation in the parents and leaves them susceptible to people who will offer “cures” that have no basis in fact.

    Ms. Niergarten’s article lists many of the alternative medicine supplements that parents use in the diets of their autistic children: Vitamin B6 - Magnesium, Vitamin C, Omega-3-fatty acids, cod liver oil and probiotics. It also mentions gluten-free diets, casein-free diets, high-fat/ low carbohydrate diets, and special carbohydrate diets (monosaccharides).  The article uses soft terminology like: “evidence to date does not confirm the rationale” and “evidence insufficient to support efficacy”. The reality is that none of these things have any real scientific evidence that shows that they are actually beneficial and some of the supplements are dangerous if given in high doses.

     There are also many “tests” offered online for “nutritional evaluation”, “allergy evaluation” and evaluation for nutritional deficiencies. As with the people selling supplements, the people who promote these tests are only taking advantage of the parents’ feelings of helplessness. A similar phony market exists for parents of children with Down’s syndrome.

     None of us has unlimited funds. The money spent on these unproven treatments could be better spent on the speech therapy, physical therapy, occupational therapy, special education and psychologic help that has been be proven to help autistic children.

Apology

Dear Readers, I failed to publish this Friday because my granddaughter is hospitalized and I haven't had time to write. A new article will be coming next Friday right on schedule.    Dr. John

Fainting

     Fainting is not lightheadedness or dizziness. It is a sudden, brief loss of consciousness in which the child “passes out” for a short time and then “comes to” and is all right. About one in every six children experience fainting sometime before adulthood. Most fainting in children is called vasovagal syncope (syncope means “fainting”) and is caused by a temporary slowing of the heart rate that causes less blood to flow to the brain and causes the child to faint. Along with having a slow heart rate, the child’s skin is pale, clammy and cold. The child rapidly regains consciousness and has no other problems after he wakes up. A fainting episode is harmless, although the child might sustain an injury from falling when he faints. Fainting commonly occurs when the child rapidly stands up from a sitting or lying position, is under stress or is in warm or crowded conditions (it often happens at church).

    However, there are other causes of fainting that are dangerous and parents should know how to tell the difference. The most dangerous form of fainting is caused by an abnormality of the heart. A study of 106 children who were seen for fainting found that 17 of them had heart trouble as a cause of their fainting. One of the most common heart problems is called hypertrophic cardiomyopathy. This is an inherited tendency for a chamber of the heart to gradually enlarge as the child gets older until it can no longer pump enough blood. This condition is the reason for most of the reports of an adolescent suddenly falling dead while playing a sport. These children often have no symptoms of their problem other than having fainting episodes while exercising. Any child who has a family history of sudden cardiac death during exercise needs to be closely examined before being allowed to exercise and any child who has a fainting episode during exercise needs a full heart evaluation including an electrocardiogram (EKG).

     Fainting can be a sign of other heart problems, too. These can be problems with an abnormal heart rhythm, infection of the heart, abnormal anatomy of the heart or abnormal blood vessels in the heart. Most of these can also be found with a good family history, a good physical exam and, possibly an EKG. This is not the kind of examination that can be done in an “assembly-line” fashion in a gym full of young athletes. If there is any family history of heart problems, a history of someone in the family who died suddenly at a young age or if a child has ever had fainting during exercise, that child needs at least a full evaluation by their physician and probably a cardiology referral.