Thursday April 25, 2024 
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My grandmother used to tell us before eating her Sunday dinner of homemade spaghetti and meatballs that food was love. I have followed in her footsteps. I lovingly make food for my boys because my grandmother’s voice rings in my ears as I swiftly move around my kitchen. Pasta. Cake. Cookies. In my quest to learn more about healthy eating I reached out to Debra Brown-Grossman, a registered dietitian/nutritionist (RDN) and certified diabetes educator (CDE). She offered her expertise and guidance on nutrition while offering her perspective on how food has evolved over the years. Knowledge is power.
Debra has been a medical nutrition and weight management therapist for over 38 years. Also an expert in Pediatric and Adolescent Nutrition, Debra has developed and directed numerous weight management programs for both adults and children. She has authored a book chapter on pediatric obesity and has worked as a nutrition specialist for major medical centers, including St. Luke’s Roosevelt, Mount Sinai and Maimonides Medical Centers in New York and the Joslin Diabetes Center in New Jersey. Her current areas of focus are moving to more plant-based Mediterranean style diets and using a non-diet/mindful eating approach for pediatric and adult weight concerns.
How has nutrition in children changed in the years you’ve been in practice and what is contributing to these changes?
DEBRA: Our children are becoming more obese and are developing more eating disorders. Higher rates of eating disorders are now being seen in younger children, boys and in minority groups. There is evidence that eating disorders such as Anorexia and Bulimia are increasingly seen in children who were previously obese in reaction to previous dieting behaviors and focus on weight or food in the family.
As far as food choices and preferences, we use data from the NHANES (National Health and Nutrition Examination Survey)which is a large dietary survey carried out by the Department of Agriculture every 2 to 4 years. The good news from these surveys is that after decades of increases, mean energy intake measured in calories has significantly decreased from 2003-2004 to data from 2009-2010.
My personal observation is that children and their parents are demanding healthier foods both in restaurants and in schools. This is more than likely due to social media and the internet where parents are seeking and obtaining nutrition information. A recent Harvard study showed that US sugary beverage consumption is declining while there has been an increasing percentage of water drinkers among both children and adults. Still on any given day, 61% of children reported drinking surgery beverages which is down from 80% in 2003-2004. The biggest nutritional risks US children have are not getting enough calcium or Vitamin D if they are not drinking milk or another fortified diary beverage. Toddlers and adolescent girls sometimes have difficulty getting enough iron in the diet especially if the intake of red meats or other animal proteins is limited.
Will a child outgrow being a picky eater and how do parents know when to seek professional intervention?
DEBRA: Most children do outgrow picky eating. The rule of thumb is for parents to decide the “What, Where and How” children eat and to allow the child to decide the “How Much or If.” This advice comes from Ellen Satter’s Division of Responsibility of Feeding and her books are great references for parents. Parents should seek professional help if by the age of 7 or 8 the child is showing signs of malnutrition such as losing height and weight gains on their growth chart or refusing to go to social events due to fear or embarrassment of trying new foods. There is a new diagnostic category called ARFID (Avoidant Restrictive Food Intake Disorder) which is being used for preadolescents and adolescents of all ages who have problems with eating that are not related to body image distortions. The average age of diagnosis of ARFID is 11 or 12 while the age for diagnosing Anorexia Nervosa is 14-15. Parents should intervene earlier than this if possible because the longer a child is severely picky, the harder it will be for him or her to try new foods.
How much food is really enough for children at different ages and what are some tips for ensuring that young children develop good eating habits?
DEBRA: Young children and toddlers nutritional needs are small compared to adults. Generally, by the age of 2 years , the guidelines are: no more than 2 cups of low-fat milk per day; 2-3 ounces of protein foods such as meats, poultry, eggs and cheese and 1/4th to 1/3rd cup vegetables or fruits 2-3 times per day as well as 1/3 cup serving of starch with each meal. Kids at this age need at least 5 to 6 scheduled meals or snacks per day. As many meals as possible should be seated at a table with at least one meal per day eaten as a family. Also, cut up fruit can substitute for vegetables so there is no need to put pressure on kids about having to eat vegetables! Continual requests for empty calorie snack foods such as chips, candy, cookies, etc., should be countered by allowing some occasionally, but also offering a couple of other healthier snack choices. Children enjoy choosing their own foods and will choose healthier ones if they know they cannot have the others.
Some other tips for developing positive eating attitudes and behaviors are: Be a good role model and sit down and eat with your kids! Serve yourself a normal balanced meal and eat it joyfully without mentioning anything negative about your child’s food refusals. Do not use dessert as a reward; serve it at the meal or later on at the scheduled snack time. Create some rules at the table eating, including manners and a time limit for remaining at the table politely.
As much as possible be a strong gatekeeper of your home: keep unhealthy snacks and drinks off your shopping list allowing them in small portions when out of the house. Encourage children to try new foods when out at a restaurant. Food preferences are developed early in life so stand firm on offering variety. You may need to serve a new food several times for a young child to accept it. Never force a child to eat; suggest that they take a few bites. With older children ask them to try just one bite for you! Encourage trying new foods when out to eat; offer small tastes of things you have ordered and see what happens! The less attention you pay to food refusals the better!
Food is not love! Find other ways to say “I love you”. When food is given as a show of affection children often respond by using food to cope with stress or other emotions. Offer hugs, praise and attention instead of food treats. KEEP IT POSITIVE!!!
To learn more about Debra or to schedule a visit with her please visit her website: http://www.debradietworks.com or contact her directly via e-mail at debradietworks@nullgmail.com.
Emily Marcason-Tolmie, a Saratoga native, is a writer, researcher, wife and mother. Emily and her husband, Ryan, are the parents to two wonderful little boys, ages 4 and 1.