NJ AAP-Modern Approach to Childhood Nutritionnjaap.org/wp-content/uploads/2016/06/NJ-AAP-Modern... · 2017. 5. 17. · 5/10/17 1 A THOROUGHLY MODERN APPROACH TO CHILDHOOD NUTRITION

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A THOROUGHLY MODERN APPROACH

TO CHILDHOOD NUTRITION IN THE 21ST CENTURY

NEW JERSEY AAP ANNUAL CONFERENCE & EXHIBITION

MAY 24, 2017SOMERSET, NEW JERSEY

JILL CASTLE, MS, RDN

ConsultantMott’s Teachable Tastes

Beef Checkoff Speaker ’s BureauNew England Dairy & Food Council Blogger NetworkStock/Shareholder/Consultant

Once Upon a Farm, LLCCreator

The Kids Healthy Weight Project (an online nutrition and feeding course for parents)Eat Like a Champion (online course for young athletes)Food Parenting PRO (professional course)

Expert ContributorUS News & World ReportUSA SwimmingBundoo.com

© 2017 Jill Castle, MS, RDN

DISCLOSURES

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TODAY

¡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); ARFID¡More body image concerns ¡More food marketing to kids

¡Feeding Kids is Harder than Ever!

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FEAR

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Short Term: The Trees

¡ Which kind of yogurt is best?

¡ Getting kids to eat healthy today

¡ Parents are frustrated & don’t understand their children

¡ Children eat less well & don’t regulate food intake

Long Term: The Forest

¡ What’s my strategy & system?

¡ Teaching kids to eat healthy for a life time

¡ Parents are knowledgeable, patient and prepared for challenges

¡ Children eat better, regulate food intake, and enjoy eating


CHANGE THE PERSPECTIVE EAT RIGHT VS. FEED RIGHT

Healthy Diet

HealthyChild

Healthy Child

What: Food & Nutrients

How: FeedingWhy:

Development


Food & Nutrients at each stage

Authoritative Feeding, Positive Food Parenting Practices

Developmental Stage, Temperament


FEEDING THE WHOLE CHILD

¡WHAT

¡HOW

¡WHY


WHAT: FOOD & NUTRIENTS

Food Variety¡Food Groups

§ within & among

¡RotateNutrient Rich¡Calcium, vitamin D,

potassium, fiberSnacks¡At least 1 snack per day¡Fill in the nutrient gaps


BALANCED & NUTRITIOUS


FOOD: THE 90:10 RULE

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INFANT

total fatironzincvitamin DDHA

TODDLER/PRESCHOOLER

calciumvitamin DVitamin Epotassiumiron

CHILDREN

fiberpotassiumironcalciumvitamin D

TEENS

calciumvitamin Dmagnesiumvitamin Eiron


NUTRIENTS AS INSIGHT

Variety

RepeatedExposure

Food Acceptance


LEARNING TO LIKE FOOD


HOW TO FEED PARENT-CHILD RELATIONSHIP

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, positive feeding


OVERVIEW OF FEEDING STYLES

¡Authoritarian (Controlling)¡Permissive (Indulgent)¡Neglectful (Uninvolved)¡Authoritative (Love with Limits/Monitoring)

¡We use all four; one is predominant; they reflect our own upbringing


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FEEDING STYLE OUTCOMES

Authoritarianü Poor food regulationü Out of touch with hunger/fullnessü Correlation with overweight/obesityü Reduced fruit/veggie intake

Permissiveü Increased intake of high fat foods and

sweetsü High BMI (preschoolers)ü Predictive of OW in Mexican

American childrenü Low whole grain intake in < 5 yearsü Low nutrient-density food intake

Neglectfulü Food focusedü Twice as likely to have weight

problems (both over- and under-weight)

ü Emotional insecurityü Mistrustü Low intake of nutrient rich foods

Authoritativeü Leaner body compositionü Eat more fruits, veggies, dairyü More activeü Protective against emotional eating

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Authoritarian

Food Restriction

Pressure to Eat

Food Rewards

Permissive

Catering

Constant Feeding

Authoritative

Structure

Boundaries

Choice


Negative Practice Characteristics Potential Outcome

Pressuring Nagging to eat more; pressure to try or take bites; reminding child to eat

Disinterest in food; early satiety; poor weight gain; worse picky eating; OR weight gain; overeating; ignoring fullness

Rewarding Use of sweets/desserts to get child to eat; manipulating with rewards for eatingperformance

Values reward food over healthy food; eats to please; poor self-regulation; relies on external factors

Restricting Limiting access to certain foods, portions

Overly focused on restricted food, overeats when available

Catering Allowing child to make most food choices

Limited diet; nutrient inadequacies; child in charge; less likely to try new foods

Constant feeding Grazing; always hungry; lack of structure

Constant eating; overeating; unable to ID true hunger; maynot expand food repertoire

NEGATIVE PRACTICES DON’T WORK

¡ 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)


FEEDING THAT WORKS


ELEMENTS TO EFFECTIVE FEEDING

Structure Routine with MealsSystematic SnacksLocationTiming

Boundaries & Monitoring Food availability; accessibility Parent modelingParent monitoringParent in charge of kitchen

Reasonable ChoiceEducation & Autonomy

Child is involved, but not in control Allowed to refuse food; pressure-free praiseMealtime is food learning time

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Parent determines:LocationMeal or Snack contentTiming

Child determines:Whether or not they are

eatingHow much they will eat

When “jobs” are crossed, problems arise with feeding and eating


SATTER’S DIVISION OF RESPONSIBILITY

EllynSatter.com

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Structure Boundaries Reasonable ChoiceRegular timing of meals and snacks

Usual location

Monitoring

Modeling

Food availability and accessibility

Unstructured food

Guidance for outside eating

Child involvement

Limited / guided choice

Reasoning / education

Encouragement

Autonomy


AUTHORITATIVE FEEDING

Positive Food Parenting

FEEDING EDUCATION WORKS

¡ Anticipatory Guidance makes a difference in diet quality, food preferences, & eating behavior (NOURISH Study)

¡ Early feeding education helps promote and sustain responsive feeding, self-regulation and may deter obesity development

¡ Responsive Feeding¡ Promotes self-regulation and shared parent-child

responsibility for feedingà reduced incidence of childhood obesity

¡ Non-responsive feeding is associated with wt/ht Z-scores, BMI z-score, overweight/obesity and adiposity

¡ Breastfeeding may shape feeding practices through increased responsiveness to feeding cues.

DiSantis et al. Int J Behav Nutr Phys Act. 2013; Paul et al. BMC Pediatr 2014; ; Daniels et al. Pediatrics 2015; Int J Obes 2012; Pediatrics 2013;BMC Public Health 2009; Magarey et al. Obesity, 2016

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THE WHY OF FEEDING


WHAT TO EXPECT & GOALS

Baby (6 months - 2 years)

Honeymoon phase of feeding; high growth; eats everythingVariety of tastes, textures and flavorsNutrient-rich diet

Toddler/Preschooler (2 to 5 years)

Picky eating peak; growth slowsBad habits can startDon't cater or force to eat Use Satter’s DOR

School Age (6 - 12 years)

Food choices reflect desire to be like friends Get cooking; manage outside influences without being a “food cop”Walk the talk

Teenager (13-18 years)

Wants to be different/risk taking Shows up with food choicesPlan meals and let teens loose in the kitchenKeep tabs, guide & support


PUTTING IT ALL TOGETHER


MODERN NUTRITION: INFANT

Infant Facts Goals of feedingWhat Key nutrients iron, zinc, total fat,

DHA and vitamin DCritical nutrition period (2 years)Learning to eat

*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

How Acceptance for food is highFood learning is activeResponsive feeding; add structure

Why Fastest stage of growth!Brain developing -- needs more fat, DHA, iron and zincNot mentally aware yetParent-Child Bonding

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MODERN NUTRITION: TODDLER/PRESCHOOLER 2 -5 YEARS

Toddler/Preschooler

Facts Feeding Goals

What Key nutrients: iron, calcium, vitamin E, potassium & vitamin DStable nutrition

*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 new food with SAFE foods

How Food neophobia peaks 2-6 years ofageDrops some accepted foods/skeptical of new Erratic eating is normal

Why Slowed period of growthBrain still developing but at slower rateMore mentally aware, wants control and is verbal!


MODERN NUTRITION: SCHOOL AGE

School Age

Facts Feeding Goals

What Key nutrients: vit D, calcium, potassium, iron and fiberCalcium needs increase: 9-13 year (1300 mg)

*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

How Palate expands; food neophobia decreasesFamily meal; role modeling important; boundaries

Why Stable growth Appetite increases with puberty Learns basic nutrition conceptsSkill-oriented“Comparitis”


MODERN NUTRITION: TEENAGER

Teenager Facts Feeding GoalsWhat Key nutrients: vit D, magnesium,

calcium, potassium and ironNutrition may deteriorate during this period

*Help teen take responsibility for meeting nutritional needs *Guide teen’s choices outside the home (eating out)*Up the nutrition education and steer away from dieting*Stock healthy and satisfying food*Plan meals for teen to make including periodic dinners*Help with shopping and meal planning*Find time to eat together

How Open to new foods; hungrier than everHelp manage hungerFamily meal; role modeling important

Why Second fastest growth stageThink more abstractly Risk takingMoves from wanting to belong to wanting to be different


MODERN CHILDHOOD NUTRITION

What

WhyHow

TARGET THE WHOLE CHILD

¡ 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: Comprehensive Food Parenting§ Combine WHAT and HOW and WHY§ Get feeding approach & food right§ Anticipate and manage developmental changes§ Discourage negative food parenting§ Elevate and empower parents to normalize eating

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THANK YOU!

Contact: Jill Castle, MS, [email protected]

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Documents

NJ AAP-Modern Approach to Childhood Nutritionnjaap.org/wp-content/uploads/2016/06/NJ-AAP-Modern... · 2017. 5. 17. · 5/10/17 1 A THOROUGHLY MODERN APPROACH TO CHILDHOOD NUTRITION