In this post on Nutrition, Dr. Laura Jana has a tip to address the common phrase, “I don’t like that.” If you’ve enjoyed Dr. Jana’s Q&A this month log on to her Web site, drlaurajana.com, where you can order a signed copy of her book,  “Food Fights: Winning the Nutritional Challenges of Parenthood Armed with Insight, Humor and a Bottle of Ketchup.”

You can read Parts One and Two of this series by clicking here.

Dr. Z: How do you address the phrase “I don’t like that?”

Dr. J: I like to remind parents that it is important to acknowledge that children are entitled to have true likes and dislikes just as parents do. That said, the phrase "I don't like that" is often uttered before a child gives a new food a chance, which is why I'm a big fan of the "no thank you bite." Did you know that it can take 10-15 exposures to a new food before a child learns to like it? I recommend allowing a resistant child to simply take a “no-thank you bite” of the scorned food. Children often respond well to this approach because it gives them some needed control.  Also, taking one bite is much more manageable than staring down a heaping helping. I have found that this is a workable way to accomplish the goal of exposing children to new foods and flavors without forcing the issue.

Dr. Z: For school age children, what tips do you have for providing a satisfying lunch that children want to eat?

Dr. J: This is a tough one.  Peer pressure and temptation can be quite challenging as early as elementary school. If a child is going to eat a school prepared lunch, I strongly recommend that parents take a close look at the menu. In light of this country's childhood obesity epidemic, school lunch programs are only just now beginning to be appropriately scrutinized. While some schools have made significant changes for the better, others have not. Parents need to visit with school personnel to discuss how important healthy meals are to them.  At home parents can prepare healthy foods such as sandwiches made with whole grain breads, low-fat cheeses, baked chips, pasta salads with light Italian dressing, hard boiled eggs, and any of a host of fruits and vegetables .  Low-cal salad dressing and hummus make great dips.

Dr. Z: Should children be forced to finish all the food on their plate before they are allowed to leave the table?

Dr. J: I call this approach the "clean plate club," and the definitive answer is NO.  It goes against several of the overarching food-related strategies for parenting success I emphasize in my book, Food Fights.  Workable strategies include acknowledging a child's likes and dislikes and keeping mealtime fun and fight-free.  It’s important to keep food for food's sake by ensuring that children learn to eat and drink only when they are hungry or thirsty. In fact, attempts to get children to eat everything on their plates can result in the following:

a) an increased dislike of the scorned food
b) the risk of teaching them to overeat
c) stressful mealtimes that leave parents with plenty of fights over food on their hands

Instead, I heartily recommend that parents simply opt for the "no thank you bite" approach and include their children in the meal planning, purchasing, cooking, and serving meals. Involving children in the process makes it that much more likely they'll be receptive to eating and trying what they are served. It's okay if children choose not to eat much of their dinner...just so long as they aren’t allowed to eat a big dessert an hour later!

This week, I’m continuing my interview with Dr. Laura Jana who has answers to some common food-related questions from parents. Let’s dig in!

You can read Part One of this series by clicking here.

Dr. Z: Here’s a question I often hear: Should children take multivitamin supplements?

Dr. J: This is a very commonly asked question, and a couple of important and often necessary vitamins and supplements are worth mentioning.

• Iron: Iron deficiency is the most common nutritional deficiency in children. All babies start off with a store of iron that they get from their mothers during pregnancy, but some end up becoming deficient towards the end of their first year. Pediatricians routinely screen for iron deficiency and, if needed, recommend iron supplements.
• Vitamin D: Vitamin D plays an important role in calcium absorption and building strong bones. Unfortunately, recent studies suggest that a majority of children simply don't get enough in their daily diets. Infants who are drinking at least 27 ounces a day of formula get all the Vitamin D they need from their formula, but breastfed babies need supplemental vitamin D starting within the first few days of life. It is recommended now that any toddler or older child who isn't drinking 32 ounces of vitamin D fortified milk should also be given a vitamin D supplement. In other words – most children need a supplement!

It is also worth noting that any child who was raised eating a vegetarian diet warrants special dietary consideration to ensure they get enough of certain nutrients commonly deficient in a vegetarian diet. Parents will want to be sure to discuss vegetarian dietary needs with their pediatrician.

With the exception of vitamin D supplementation or supplements for an iron deficiency, most children don't really need multi-vitamin supplements. Even for the pickiest eaters, it doesn't take more than a very few "picks" from each of the basic food groups for children to meet their recommended amounts. Many essential vitamins and minerals can be stored in the body, and how much children need in their diet is usually quite a bit less than parents think.

Dr. Z: What type of milk do you recommend parents serve? Whole, two-percent, one-percent, or reduced-fat? And why?

Dr. J: The American Academy of Pediatrics has changed their recommendations in recent years regarding what type of milk children should drink based on nutritional research that suggests that most children do not need the increased fat found in whole and 2% milk. This type of fat is not the "healthy" type of fat, while the nutrients found in skim milk are no less than those in whole or 2%. For these reasons, as well as a growing commitment towards obesity prevention starting in early childhood, it is now recommended that most 1-2 year-olds be given 2% milk and then transitioned to skim milk at the age of 2. I also recommend parents drink skim milk as well as an example.

Dr. Z: What types of snacks do you recommend parents serve on-the-go?

Dr. J: With only a little advance preparation, fruits and vegetables can easily fit the bill and many can even be bought already prepared in the grocery store. Sliced carrots, orange slices, chilled grapes and pieces of red bell pepper are all great options. If parents are going to grab chips, I strongly suggest baked, not fried. If their children want juice, they need to make it 100% juice, and even then dilute that with water (or, even better - just bring water!). I will point out, however, that all too often, as parents, we unconsciously teach our children to "need" snacks when they’re on the go. While this may be true for very young children (toddlers), kids unfortunately learn to associate a trip in the car, a walk to the park, or even waiting in the exam room for a doctor's appointment with the "need" for food and drink when in reality, they aren't actually hungry or thirsty.

Dr. Z: At what age do you recommend introducing solid foods? Are there any specific foods that should be introduced before others?

Dr. J: Introducing solid foods should typically begin between the ages of 4-6 months (with many experts erring towards 6 months, especially for breastfed babies). As for which specific foods to begin with, these recommendations have recently changed. Although baby cereal (most commonly rice cereal) has long been the recommended first food of choice for babies, nutrition experts now suggest that it is not, necessary or even nutritionally beneficial to do so. While parents may still want to start out with very pureed (Stage 1) baby foods and introduce one at a time, it is now thought to be nutritionally acceptable and beneficial to start with fruits and vegetables. And no, it's not thought to make much difference which comes first. Even pureed meats which provide added iron to a baby's diet and are a good source of protein can be started along with the baby cereals as a nutritious first food.

Dr. Z: What are the symptoms should parents watch for in children who may have undiagnosed allergies to soy, peanuts, lactose, or other common food allergies?

Dr. J: Food allergies are increasingly prevalent in children today. Some of the characteristic symptoms of food intolerances and/or allergies include anything from rashes, including hives, contact rashes, or the worsening of eczema to intestinal symptoms such as an upset stomach, nausea, spitting up, or vomiting, or blood in the stool. More severe allergic reactions can include difficulty breathing and/or swallowing, wheezing, and swelling--especially of the eyes, lips, tongue, face, and/or throat.   All of these symptoms are suggestive of a true allergic reaction and need immediate medical attention and treatment.

Now that the sugar-filled holidays are over, I thought it would be a good time to focus on healthy eating habits. Childhood obesity is an increasingly critical issue in our country and parents are on the frontlines wanting to know what’s best for their children’s health. We are lucky at Primrose to count Dr. Laura Jana as one of our franchise owners. She is a trusted pediatrician and co-author of the book “Food Fights: Winning the Nutritional Challenges of Parenthood Armed with Insight, Humor and a Bottle of Ketchup.” I’ve compiled questions that I frequently hear from parents and asked Dr. Jana to share some insights with us. This week, we’ll start with a focus on fruits and veggies. Next week, we’ll turn to other common questions like children’s vitamins and 2% milk.  I think you’ll find her expert advice to be down to earth and very helpful so be sure to check back in for more tips!

Dr. Z:  Are there foods that are commonly missing from children’s diets?

Dr. J: Although missing foods can vary from child to child, on the whole I'd have to say vegetables are the most notably lacking, followed by fruits. However, I’ve seen picky eaters whose diets were significantly lacking in other important food groups, like protein. In some cases, children will often refuse to drink milk, which makes it more important to pay attention to how to include other dairy and calcium enriched foods in their diet.


Dr. Z: How many fruits and vegetables should children really eat on a daily basis? How do you recommend increasing their intake?

Dr. J: It’s much less stressful for everyone if parents take a long range view of their children’s diet.  Instead of focusing on how many fruits and vegetables a child should eat each and every day, parents will find it helpful to take a look at their child's weekly intake. This takes the pressure off of them if a child has a particularly picky day every now and then. They’ll still want to offer their child a variety each day, but they won't need to lose sleep if their attempts aren't always met with success.

If you think about it, fruits and vegetables can be very appealing.  They come in lots of colors, flavors, and textures and many are, in fact, sweet. Simply making fruits and vegetables readily available on a daily basis can go a long way towards increasing intake. Parents can make it as easy to grab some carrot sticks, a banana or a handful of grapes (cut in pieces for younger children for safety's sake) as it is to grab junk food. I also recommend keeping less junk food on hand so fruits and vegetables don't have to compete with the likes of cookies, candy, and other unhealthy but tempting treats.

I am a big fan of letting kids take part in the process by helping grow vegetables in a garden, pick new and colorful fruits and vegetables out at the grocery store, and even read books about them (Eating the Alphabet and How are You Peeling: Foods with Moods).