How to Get Kids to Eat Their Vegetables: Time to Garden!

Posted by Dr. Lovlie

little baby gardener lost in the moment with the sun shinning in

In Anna Karenina, Leo Tolstoy wrote “Spring is the time of plans and projects.” Plans and projects keep children out of trouble!

Not to mention that one of the best ways to coax kids into eating what is good for them is to involve them in its preparation. They are far more likely to eat the lunch they prepared with their own two hands than one you slaved over. If they help you peel and cut up carrots for dinner they will try them, and brag about their contribution while chewing.

Extend this a bit and you reap the miracle of children eating their vegetables because they grew them in their very own garden. They planted the seeds, watched over them, watered them, and cared for them. They will proudly eat the fruits of their labor and proclaim their tastiness.

Children need a variety of vitamins and minerals in order to function and grow, and the best place to get those nutrients, along with carbs for energy and fiber for bowel function, is in fruits and vegetables. Some, like beans and peas, are even excellent sources of protein. Many of them can be grown in small plots or in containers on a porch.

Carrots can be grown easily from seeds bought in your local garden store, and are very high in Vitamin A. Vitamin A helps with eyesight–especially night vision–which is why your mom always told you to eat lots. Watermelon, peas, peppers, beans, and tomatoes also have bunches of Vitamin A.
Tomatoes, peppers, and beans are high in B complex vitamins. B vitamins like riboflavin, niacin, thiamine and folic acid are tiny machines that allow your body to function. They help with everything from making blood cells, to generating energy from carbohydrates, to scavenging free radicles and protecting you from cancer.
Strawberries, raspberries, and blackberries are high in Vitamin C, which is necessary for collagen synthesis and wound healing and is an effective antioxidant. Without Vitamin C, people get scurvy.

Minerals are also easily come by on the plant side of your plate.

Calcium to build strong bones can be found in beans.
Potatoes, beans, corn, and mushrooms are high in iron, which helps carry oxygen around your body.
Potassium, necessary for muscle contraction and to maintain your heart rhythm, is present in potatoes, berries, peas, beans, and peppers.
Essential minerals like magnesium, phosphorus, copper, and zinc are all available in fruits and vegetables.

I’ve never seen a child turn down a pea fresh from the pod, or a strawberry plucked from the plant. Find a plant catalogue, pour through it with your child, pay attention to what will grow in your area and how much room the plants need to grow, and choose. Consider what you have room for: will these be container plants on the porch, or can you spare a patch of yard? Do you have space for a tree, or are we looking at a mushroom kit in the closet?

Some of my favorite kid friendly plants are peas, beans, peppers, tomatoes, and the ever popular carrot. Melons, pumpkins, and cucumbers are great if you have a little more room. Berries come in all sizes, from tiny strawberry plants fit for containers with pockets down the side, to raspberry vines best grown on trellises, to fat thorny blackberry bushes. Tires can be stacked up and filled with dirt in a tower as potato plants grow, then harvested by taking off one tire at a time.

Growing a few plants allows you to spend time with your children, get some exercise, and build some vitamin D of your own from all that sunshine. Have a conversation about science and nutrition while you are digging in the dirt. Money can be earned and financial lessons taught by naming the watering and weeding of those plants “chores.” Other lessons can be taught without any conversation: responsibility for life, the fruitfulness of hard work, and pride of accomplishment. Don’t miss this opportunity for spring plans and projects!

The Gluten Free Blog

Posted by Dr. Lovlie

I recently heard some very strange theories about gluten. Reminiscent of the telephone game we played as children, whispering into each other’s ears down a line, what people hear at the end is very different from the reality spoken at the beginning. Let’s clear up some confusion.

Our ancestors survived in no small part due to the development of cultivated grasses: the seeds of grasses are high in carbohydrates for energy, protein for strong muscles, and fiber for bowel function. They contain iron, B vitamins, zinc, and magnesium. They could be dried and stored, so groups of people could stay in one place and survive the winter. Worldwide throughout history, every culture has developed some sort of grain based food as a staple, from bread to flatbread, corn tortillas to rice.

Gluten is the protein found in wheat, spelt, barley, and rye grains. It gives elasticity to bread dough so that it can rise and maintain its shape and chewiness. Gluten is pervasive in our foods: it is in breads, pastas and cereals, is added into low protein foods to improve their nutritional value, and is present in everything from ketchup to soy sauce to beer. It is even in our cosmetics, hair and skin products.

Our bodies use the amino acids that make up gluten to build our muscles and everything from our fingernails to the cartilage in our noses; to make our immune system work so it can fight off disease; to communicate within our bodies; to carry oxygen through our bloodstreams; even to make sperm able to swim so the next generation can be born. We cannot make all of these amino acids ourselves, so we have to ingest them. Whole grains are an excellent source.

Since whole grains contain so many nutrients and have such fantastic health benefits, and since avoiding gluten is both inconvenient and expensive, let’s make sure living gluten free makes sense, before we commit.

Celiac disease is the condition we worry about with gluten. It is caused by an immune reaction to the gluten protein: it acts as an allergen in genetically predisposed people, like pollen to people with hay fever. It is most common in the Saharawi in the Western Sahara and Spain. In the US, about 7 in 1000 people have it. It is programmed into the DNA of affected people, inherited from their ancestors, like having blue eyes or brown hair. The inheritance is complex, with many genes contributing, so the disease has a variety of presentations. Children most typically present between 6 months and 2 years of age with weight loss, diarrhea, muscle wasting and abdominal distention. Some less common presentations include:

Iron deficiency anemia
Poor growth
Delayed puberty, infertility
Itchy bumps on the elbows, knees, and buttocks
Mouth ulcers
Arthritis
Chronic tiredness
Behavioral problems, depression
Headaches
Weak, thin bones with frequent fractures

It is more common in people with Type 1 Diabetes, Down’s syndrome, autoimmune disease, and thyroiditis. The symptoms can be more severe when there is concurrent illness, like rotavirus or a toxin ingestion.

In the people who have Celiac, gluten triggers an inflammatory reaction which causes the little absorptive pillars in the small intestine to die off, and causes crypt hyperplasia in the walls of the gut. This affects the person’s ability to absorb nutrients, resulting in the weight loss, diarrhea, and the other symptoms listed above. It also causes the production of antigliadin antibody (AGA), tissue transglutaminase (tTG), and antiendomysium antibody (EMA), which can be tested for and are used to screen for Celiac disease. Convenient, yes?

If you think your children might have Celiac disease, get them tested. If the test is positive, he or she will need to see a specialist and have a biopsy done to confirm the diagnosis. Children who test positive for Celiac disease need to consult with a nutritionist, both to learn which foods and products contain gluten, and to learn how to maintain a healthful diet without the many things that include gluten. Short term, deficiencies of trace elements, vitamins and minerals are common with a gluten free diet (zinc, magnesium, iron and B vitamins especially); long term risks include cancers of the gut and recurrent bone fractures. Deficiencies can lead to anemia, poor immune function, poor growth, skin lesions, messed up heart and brain function, and a host of other unpleasant symptoms. Living gluten free is not something you would want to attempt without knowledge and expert guidance.

A gluten free diet is a medical necessity for people with Celiac disease. It is not a healthful way to lose weight. It is also not a good way to nourish your child. Sustenance should not be a fashion trend.

Children use food to lengthen their bones, grow their muscles, build their brains, and give them energy to run, climb, and think. We need to avoid feeding our children things like concentrated sweets, sodas, and greasy fast food; we do not need to avoid whole grain breads and cereals.

Whole grain and protein are not in any way toxic, even though a very few people are allergic and have to avoid them. Pretending to have an allergy to be “hip” is just silly, and disrespectful of the people who actually have Celiac disease.

If your children do not have Celiac, stick to a nutritious diet including whole and enriched grains. Feeding your children a gluten free diet when they don’t have Celiac disease is not only inconvenient and expensive, it also carries with it serious risk to your children’s health.

To grow, two-year-olds should have about three ounces of grain per day; by four, they should get five ounces; between nine and eighteen, they need to take in between five and eight ounces. At least half of this should be whole grain; the rest should be enriched (iron, vitamins and minerals added back in).

Don’t let fads decide for you what to feed your child; rely on common sense and nutritional science. Focus on fresh fruits and vegetables, then add whole and enriched grains and a little protein. Sit down and eat together as a family, and watch your munchkins grow and thrive.

Why Did My Kid React to That Food?

Posted by Dr. Lovlie

Little chief-cook tasting the carrot Kids can have reactions to food for many different reasons. They can be allergic, sensitive, intolerant, or have problems because the food contains poisons or has drug effects.

Food allergies are caused by a child’s immune system reacting to a food, similar to the way they can react to pollen or bug bites. Allergic reactions are usually to the protein in the food rather than the sugar or fat, and are usually immediate. The most common severe reactions are to tree nuts, peanuts, and shellfish. Less severe reactions are most common with cow’s milk, eggs, soy, wheat, and fish.

Celiac disease is in this category. People with celiac are allergic to the gluten protein in wheat and react with their immune system if they are exposed to even a tiny amount. Gluten allergy was worth a whole blog all by itself: A Gluten Free Blog.

80-90% of the time, kids will outgrow allergies to eggs, wheat, milk, and soy by 5 years of age. They outgrow peanut allergies only 20% of the time. (Do NOT experiment with this!) Fewer will outgrow allergies to tree nuts and seafood.

Symptoms of an allergic reaction include:

Skin rashes. Hives, or whelps–itchy raised patches with pale centers and red rims. Hives move around, fading in one area to reappear in another. Antihistamines like Benadryl (diphenhydramine) help the symptoms.
Breathing problems. Food reactions can make kids wheeze, make their throats feel tight, and give them sneezing fits.
Gastrointestinal symptoms like nausea, vomiting, and diarrhea.
Circulatory symptoms like paleness, lightheadedness, and loss of consciousness.
Severe reactions can involve several of these areas, and are called anaphylaxis.

Food sensitivities and intolerances are not allergies. Some children can be sensitive to the common effects of a food and react strongly. For example:

Apples, pears and bananas contain pectin and can be constipating (useful if your child has diarrhea). Some children can get stopped up if they eat too many.
Dairy products can also constipate–some kids will never poop again if they eat a lot of cheese. (This may be a slight exaggeration.)
Sugar can cause diarrhea, so children may have problems if they drink a lot of juice. (Interestingly, we have never been able to prove that sugar makes kids hyper.)
Kids can react to dyes and preservatives in foods–they will feel nauseated or tired, and we have proven that red dye can make them hyper.
Lactose intolerance is an reaction to the sugar in milk. People who are lactose intolerant are missing the enzyme (lactase) that breaks down the sugar in milk (lactose). They get bloating, gas, and diarrhea.

There are certainly plants that contain toxins (poisons) in themselves–poisonous mushrooms, apple seeds, and belladonna are examples–but most poisonings are accidental, usually from foods that have spoiled:

C. Botulinium bacteria grows in improperly canned food and in cans that have rusted through.When we used to give Karo syrup for constipation, the bacteria would grow in Karo left on a cupboard shelf and children would die, paralyzed by the neurotoxin (nerve poison) that the bacteria produced.
Staph Aureus can grow in spoiled food and produce a toxin that is usually self limited in its effect, giving kids cramping, diarrhea, and vomiting.
Clostridium perfringens produces a similar toxin, and is frequently the villain in cafeteria incidents and contaminations in soil and sewage.
Salmonella can grow in spoiled meat, eggs, and milk and give your child diarrhea, vomiting and fever.
E. coli is more likely to grow in beef, but can be found in mishandled produce. Same unpleasant symptoms.
Shigella is common in daycare outbreaks. It causes the same nausea, vomiting, diarrhea, and fever, but has the added risk of seizures from the toxin it produces.

Foods can also have drug effects. The best examples of this are drinks (coffee, tea, energy drinks) and food (chocolate) that contain caffeine. Caffeine makes kids restless, shaky, and interferes with their sleep. In large doses, as with energy drinks, it can produce a rapid heartbeat, muscle tremors and seizures. There were 20,783 emergency room visits from energy drinks in 2011; 5 people died after consuming them. The youngest was a 14 year old girl.

Foods can also be irritants. For example, babies can get rashes around their mouths or diaper rashes from acidic foods.

People do not react to a food solely because it is a GMO (genetically modified organism)–GMOs are not something you need to avoid unless you have a reaction to the particular item. GMO wheat produces the same allergens as non-GMO wheat; if you are allergic to one, you will be allergic to the other. Also the subject of an entire blog: What’s the Deal with GMOs?

In conclusion, not every food reaction is a food allergy. Avoidance or treatment of the food reaction varies with the actual cause. If a child has an anaphylactic allergic reaction to peanuts, he or she never needs to be around peanuts again. They may outgrow other allergies. If they get gassy from a lactose intolerance, they can take lactase tablets when they eat dairy. Kids who become constipated with apples or cheese need to limit the number they eat. It is always important for every child to not be fed spoiled food or energy drinks.

Knowing in what way your child reacted to a food determines what you do about it in the future. Knowledge rules.

The Kid’s Menu: Food Marketing to Children

Posted by Dr. Lovlie

Happy New Year! If you resolved to feed your munchkins a healthier diet (yay!), you need to know that purveyors of fast food are not on your side. Their success depends on your failure, and they have bigger wallets than you do.

Knowledge is power, so some facts about fast food advertising from the Rudd Center:

In 2012, 4.6 billion dollars was spent on fast food advertising. That is a hard number for me to get my brain around. 4.6 billion dollars will buy 920 million kid’s meals: 33,000 lifetimes worth of daily happy meals. Imagine the profit that must be generated to make spending that amount of money reasonable. These people are not your friends.
Fewer than 1% of kid’s meals (33 out of 5427) met USDA nutrition standards.
Only 3% of kid’s meals met the industry’s own standards.

Fast food was traditionally advertised in print, on TV and radio, and on billboards. Add on product placement and packaging (that attractive box is not at small-hand-reaching-from-cart-distance by accident). Pile on celebrity endorsements and the use of popular characters (Spongebob Squarepants Fruit Snacks anyone?)

Newer methods embrace social media, including YouTube, Twitter, and Facebook. Americans spent an estimated 121 billion minutes–a total of 230,213 years–on social media in 2012. Where better to find a potential customer?

Social media sites entice with advergames, contests, points to redeem, and free downloads; if your child subscribes to or follows a YouTube or Twitter site he or she is volunteering to be sent endless “opportunities,” with ads on the side. They recruit their users (your children) to “share” and “invite” friends to participate on the websites–free word of mouth advertising! The star of social media is Facebook, but it comes with 6 billion fast food ads–19% of the total ads on the site.

Advertisers hire brilliant marketers to design attractive logos which grab the attention of potential customers. Food stylists make their options look better than they ever do in reality. Ads hint at advantages beyond the food: “Live every day with love” with Ne-Yo at McDonalds, or have cool friends with applewood smoked “bacon teens” at Wendy’s. They suggest health benefits and a happier, more carefree life. They bait with prices that will feed your children more cheaply than the grocery store, until you switch to higher priced items at the counter.

McDonalds alone spends almost three times the dollars on advertisements than all of the fruit, vegetable, water, and milk producers combined.

Children’s advocates fight to decrease fast food advertisements aimed at children, and increase ads for nutritious foods. We fight to have most of the kid’s options healthy, not just the current average of 2%. We work to make fast food restaurants default to a healthy option (apples and milk, rather than fries and soda), and keep those healthy options affordable. We have made inroads, but the struggle is a mountain and profit motive is a mudslide.

Fast food ads have presence in your child’s life. They are unavoidable. Your children will see them and will want what they are selling.

We have absolutely no evidence that media literacy in any way defends against the effectiveness of advertisements. None. Knowing that they are trying to sell you something that is bad for you does not keep you from wanting it. You may not remember that you can “live every day with love” with Ne-Yo, but you will get a bit of a lift when you see that bright red and gold sign. We are grown ups, and we fall for the ads. We cannot expect more of our children than we do of ourselves.

In the end, it comes down to committing to do the right thing, and then acting on that commitment:

Clean out your cupboards and throw out all the junk.
Make a meal plan for the week before you shop.
Shop with a list made from that meal plan.
Shop at farmer’s markets and around the outer rim of the grocery store. Avoid the aisles unless there is something on your list that is on that aisle.
Prepare meals ahead for busy nights, so that you don’t end up in that line at the fast food restaurant.
Keep healthy snack food available to hand: fruits and veggies, whole grain crackers, cheese, popcorn… Throw out the chips and snack cakes.
Eat the food you bought, at home, with your kids, at the table and with the TV off. So much better than the fast food line with your kids bickering in the back seat!

Most importantly, be consistent.

Remember that “never” is much easier for a child to understand and deal with than “sometimes.” If you never stop at the drive through and never buy junk food, after the first two weeks your kids will rarely ask, even though they saw that yummy advertisement a dozen times and really wanted to try those fruit snacks.

If you sometimes give in, they will ask until your ears bleed. Pestering is powerful when you’re tired and stressed.

You can do this. They have 4.6 billion dollars on their side, but you have love for your children and the responsibility they handed you with that warm sweet bundle. You win.

All the Right Foods

Posted by Dr. Lovlie

One of my favorite teachers once said “Never fight a battle with a child that you cannot win.” Excellent, timeless advice.

Luckily, children are young and inexperienced. We adults are old and treacherous–we can outsmart them.

This is particularly good advice when it comes to nourishing a child. The grown ups need to win food battles, because the losing side is populated with joint pain, back pain, heart disease, stroke and death. We have to set up this battle so that we cannot lose, because otherwise our child will suffer.

There are two keys to making this work.

The first is that children do not cry for what they don’t know exists. A three year old who doesn’t know about chicken nuggets and French fries does not beg for them. If it’s not too late, start on day one and keep only healthy food in the house, in the proportions you want them to consume. Eat at home. Then let them have it. Everything in the house is good for them, so you never have any arguments over what your urchins can or cannot eat. If they munch on healthy snacks throughout the day, like whole grain crackers with cheese or pieces of fruit or veggies, it really doesn’t matter if they eat formal meals. There is no need to argue over what they need to eat before they leave the table.

If it is too late and they already have some bad habits, explain to them that you’re turning over a new leaf, eating healthier, and throwing out all the junk. Then do it, and put in earplugs. It gets better in about two weeks if you are consistent and don’t give in.

The second key is that “never” is a lot easier for a child to deal with than “sometimes.” “Never” is a shake of the head, a smile, and a change of subject. “Sometimes” is endless daily arguments over what they want today because sometimes they get it, sometimes you buy it, sometimes it’s O.K. It’s easier for the child as well: children are less stressed and develop healthier habits when they can eat when they’re hungry, eat whatever is available, and stop eating when they’re not hungry.

So what edibles do you bring into the house? Start with whole foods: things that look like they grew out of the ground or lived on it. Shop mostly around the outside of the grocery store where they keep the produce, meats, and dairy. Avoid the aisles unless there is something specific on them that you need. Don’t buy anything with ingredients that you can’t pronounce without a chemistry degree, and don’t buy sodas.

Make a meal plan for the week, taking into account what is in season, what you like to eat, and what your week is going to be like. Make meals ahead that you can reheat or reinvent later in the week when you have a crazy busy night. Throw together an extra pan of lasagna, bake a larger chicken than you need so you can make quick quesadillas, or save some leftovers for a shepherd’s pie. Plan ahead so you won’t be tempted by the drive through.

About 2/3 of everything children eat should be fruits, veggies and whole or enriched grains. This leaves only about 1/3 for proteins (meat, eggs, cheese, beans, and nuts) and starches (potatoes, bread, corn). That translates to a maximum of about 6 ounces per day of protein containing foods for a medium sized child, and 6 ounces of starch. Visually this is a portion about the size of a deck of cards, much less than the average child eats. This leaves lots of room in their stomachs for fruits, vegetables, and whole grains.

Children don’t overeat on a diet that is mostly fruits and veggies, which means you don’t have to chase them around trying to limit how much they eat so that they won’t get chubby. Feel free to let them have seconds, thirds and fourths on the broccoli and carrots, but sorry kid, that’s all the meat and potatoes we made.

Arrange the battlefield ahead of time in such a way that you have no chance of losing–you don’t even actually need to fight–so that your child will grow up healthy, nourished and strong, with good lifelong habits. Do this consistently and everyone’s lives will be less stressful. Your children will know that food is nourishment of the body, not an emotional crutch for the soul.

Below is a chart that should give you an idea of what the goals are for your child’s diet, based on their sex, age, and activity level:

Practical Parenting Blog

Practical Parenting Advice from a Pediatrician and Mom

food

How to Get Kids to Eat Their Vegetables: Time to Garden!

The Gluten Free Blog

Why Did My Kid React to That Food?

All the Right Foods