How to Please Fussy Eaters

Young children need a variety of foods to get the energy they need to grow up healthy. Read on for information from the American Academy of Pediatrics (AAP) on creative ways to serve up breakfast and lunch and tips for picky eaters.
If you have specific questions about your child's nutrition, talk with your child's doctor or a registered dietitian.

Off to a good start...breakfast

Breakfast gives children energy to carry through an active morning. Children who skip breakfast may not concentrate well at school or may lack energy to play. They also tend to eat unhealthy foods as snacks.
Cereal with low-fat milk is a favorite, but sweetened cereal can have a lot of added sugar. Check the Nutrition Facts label before buying. Although the percent daily values on food labels are based on calorie levels for adults, they can still be used to select more nutrient-rich cereals (and other foods). Choose cereals with less than 10 grams of sugar and at least 2 grams of fiber per serving. If your child prefers a sweet taste, jazz up unsweetened cereal with sliced peaches or bananas, strawberries, or blueberries.

For children who don't like traditional breakfast foods like cereal or toast, try one of the following recipes:

• Breakfast shake: Combine milk, fruit, and ice in a blender. (See "Milk—whole or reduced fat?")
• Frozen banana: Dip a banana in yogurt, then roll it in crushed cereal. Freeze.
• Leftovers: Serve whole wheat spaghetti or chicken hot or cold.
• Peanut butter snack: Spread peanut butter on whole wheat crackers, a tortilla, apple slices, or jicama slices. (See "Safety check.")

Milk—whole or reduced fat?

The following are guidelines about what type of milk to give your child.

Age	Type of Milk
Younger than 12 months	Breast milk is best; iron-fortified formula should be used if breast milk is not available.
12 to 24 months	Wholemilk. Your child's doctor may recommend reduced-fat (2%) or low-fat (1%) milk if your child is obese or overweight, or if there is a family history of high cholesterol or heart disease. Check with your child's doctor or a registered dietitian before switching from whole to reduced-fat milk. Note: Breastfeeding can continue after 12 months of age as long as is desired by mom and baby.
Older than 24 months	Low-fat (1%) or nonfat (skim) milk

Lunches worth munchin'

Children who help make their own lunches are more likely to eat them.

Following are ideas to make lunches fun!

• Use cookie cutters to cut sandwiches into fun, interesting shapes.
• Decorate lunch bags with colorful stickers.
• Put a new twist on a sandwich favorite. Top peanut butter with raisins, bananas, or apple slices.
• For color and crunch, use a variety of veggies as sandwich toppers: cucumber slices, grated carrots, or zucchini.

Picky eaters

Even the most nutritious meal won't do any good if a child won't eat it. Some children are picky eaters. Others eat only certain foods—or refuse food—as a way to assert themselves.

Try these ideas to make your family meals pleasant:

• If your child refuses one food from a food group, try another from the same food group.
• Try deep-yellow or orange vegetables instead of green vegetables.
• Try chicken, turkey, fish, or pork instead of lean beef.
• Try low-fat flavored milk, cheese, or yogurt instead of low-fat milk.
• Boost the nutritional value of prepared dishes with extra ingredients. Add nonfat dry milk to cream soups, milk shakes, and puddings. Mix grated zucchini and carrots into quick breads, muffins, meat loaf, lasagna, and soups.
• Serve a food your child enjoys along with a food that he or she has refused to eat in the past.
• Try serving a food again if it was refused before. It may take many tries before a child likes it.
• Invite children to help with food preparation. It can make eating food more fun.
• Add eye appeal. Cut foods into interesting shapes. Create a smiling face on top of a casserole with cheese, vegetables, or fruit strips.
• Set a good example by eating well yourself. Ideally, eat at least one meal together as a family every day or try for 3 to 4 times per week.

Note: The amount of food and number of servings children need daily from each food group depends on their age and how active they are. Some parents worry because young children seem to eat small amounts of food, especially when compared with adult portions. Don't worry about how little a child eats. A child who is growing well is getting enough to eat. If you are concerned, talk with your child's doctor.

Safety check

Food safety

Remember 2 important rules to prevent food-borne illness:

• Everyone should wash their hands well before and after meals.
• Keep hot foods hot and cold foods cold. When there's no refrigerator to store a bag lunch, following are ways to keep food safe:
• Tuck an ice or freezer pack into the lunch bag. Or use an insulated container to keep hot foods hot.
• Add a box of frozen 100% fruit juice (unsweetened). Note: The AAP recommends that juice be limited to 4 to 6 ounces per day for children 1 to 6 years of age, and 8 to 12 ounces per day for children 7 to 18 years of age.
• Freeze the sandwich bread and filling— or other freezable foods—the night before.

Hungry in a Hurry: Food for Fast Times

When it comes to food, families want convenience. It's no surprise that fast-food restaurants are so popular. However, many fast foods have a lot of fat, calories, and salt. Children and adults can eat these foods every once in a while if other food choices are sensible.

Following are tips on how to make healthier fast-food choices:

At fast-food restaurants

• Share. Split an order of fries with other family members.
• Choose a food from each food group. Most fast-food places offer a variety of lower-fat choices, including the salad bar (low-fat dressing), plain baked potatoes (top with veggies or salsa), chili, low-fat milk, low-fat frozen yogurt, English muffins, or grilled (non-fried) chicken sandwiches.
• Substitute. Order 100% fruit juice (unsweetened) or low-fat milk instead of soft drinks. If dessert is included with a meal, ask if fruit is available instead of a dessert.
• Balance high-fat choices with low-fat choices. Order a small hamburger and the salad bar. Kids often like many foods available on a salad bar like fresh fruit, carrot sticks, and broccoli florets.

At the supermarket

• Plan ahead. It takes less than a minute to fix a sandwich with reduced-fat meat and cheese if you have the ingredients. Check the Nutrition Facts label on packaged meats because many deli meats, like salami and bologna, are high in fat.
• Shop for healthier meals. For grab-and go meals, try ready-made deli sandwiches (made with reduced-fat deli meats) or roasted chicken served with fresh fruits and vegetables from the salad bar.
• Shop for healthier snacks. Whole wheat pretzels, baked tortilla chips, and baked potato chips are low-fat alternatives, but watch salt content.

How to Get Your Child to Eat More Fruits and Veggies

​ We all know that eating fruits and vegetables is important. But how do you get kids to eat more of these foods? The following tips might help.

What You Can Do

• Use fruits and vegetables as snacks.
• Serve salads more often. Teach your child what an appropriate amount of salad dressing is and how it can be ordered on the side at restaurants.
• Try out child-friendly vegetarian recipes for spaghetti, lasagna, chili, or other foods using vegetables instead of meat.
• Include one green leafy or yellow vegetable for vitamin A such as spinach, broccoli, winter squash, greens, or carrots.
• Include one vitamin C–rich fruit, vegetable, or juice, such as citrus juices, orange, grapefruit, strawberries, melon, tomato, and broccoli.
• Include a fruit or vegetable as part of every meal or snack. For example, you could put fruit on cereal, add a piece of fruit or small salad to your child’s lunch, use vegetables and dip for an after-school snack, or add a vegetable or two you want to try to the family’s dinner.
• Be a role model—eat more fruits and vegetables yourself.

How Much is Enough?

Be sure your child is getting the recommended amount of fruits and vegetables each day.

What You Can Do

• Visit MyPlate to find out how much of each food group your child should be getting.
• When shopping for food, start in the area of the store where they keep fresh fruits and vegetables. Stock up. That way you know you always have some on hand to serve your child.
• Avoid buying high-calorie foods such as chips, cookies, and candy bars. Your child may not ask for these treats if they are not in sight.
• Limit or eliminate how much fruit juice you give your child and make sure it is 100% juice, not juice “drinks.”
• Eat as a family whenever possible. Research shows that kids eat more vegetables and fruits and less fried foods and sugary drinks when they eat with the entire family.

Remember

By choosing health-promoting foods, you can establish good nutritional habits in your child that will last for the rest of his or her life.

Good Nutrition for Athletes

Good nutrition—it’s not just for breakfast anymore. It’s for growth of a young body, preventing diseases, maintaining healthy functioning tissues of the body all the way to your cells, and fueling the body involved in exercise activity. Daily proper nutrition helps sustain and support exercise demands on a regular basis. If your child participates in competitions or sporting events, there are some more basics to cover.

Pre-event Nutrition

Remember that the days leading up to an event or practice are important to keep fuel and energy stores full with good sources of complex carbohydrates. Fats are slow and difficult to digest, so they should be avoided for the few hours before an event. Choose good sources of nutrition that the body can use quickly without the danger of a sugar crash. A donut with a candy bar chaser is not the way to go—but don’t think I haven’t seen it. Maintaining excellent hydration is also key to prevent going into an event already dry.

During-event Nutrition

Fluids such as water and sports drinks are important to maintain energy and hydration. If the event lasts for hours with breaks between competition, light carbohydrate snacks such as fruit, natural yogurts, or concentrated gels can be used along with water and sports drinks. Highly caffeinated drinks or high-sugar soft drinks are not recommended because these pull fluids away from tissues that need them.

Post-event Nutrition

This is a very important aspect to recovery that many kids overlook. The amount of energy spent needs to be replaced to allow the body to be ready for the next training  session or exercise bout. Your child’s muscles are like wide receivers just waiting to restore what they have used up. The ability to soak up muscle carbohydrate like a sponge is best during the first 30 to 60 minutes after exercise, and the process seems to work better with a little protein. This restoration process has important implications. If your child uses up more stored energy than she replaces, you can see that the storage unit will slowly get emptier over time. Inability to completely and properly replenish carbohydrate stores can lead to a progressive decline in performance, exercise staleness, overtraining, depression, and immune system malfunction.

Nutritional sources are not only important for carbohydrate replacement, but also for antioxidants that are critical for providing the clearing machinery necessary to get rid of free radicals and other chemical by-products of exercise and keep the immune system andother cells healthy.

Rehydration must also occur to make up for sweat losses and heat exposure. Remember that having a poor thirst drive is a developmental problem with youngsters. They also base their intake on taste. These characteristics show the importance of having mandatory drink breaks and also determining the best way for your child to want to have adequate fluid intake. Water is usually great, but kids often will not like it because it has no taste. It will suffice for short events, but if there are longer situations, your child may need something different to keep her adequately hydrated. Some of the electrolyte sports drinks taste better to them, which helps them drink more, and those drinks also help keep the thirst drive stimulated because of the electrolyte effects.

The basic 4 components of performance are genetics, equipment, training and technique, and nutrition. Because genetics cannot be controlled and equipment can be equalized, it boils down to training and nutrition, which are intimately connected. Your youngster may train for hours, but without the right nutrition, training cannot be supported optimally. Kids have the added need to provide calories for both growth and exercise energy. Good nutrition is not limited by age and developmental boundaries, so proper nutritional practices can and should be started from birth.

Back to the Basics

Every day I hear more about the worsening nutritional world that surrounds our youth, and every day I see, read, and hear more about the importance of fruits, vegetables, and grains for disease prevention and long-term health. So, Mom was always right. Back to the basics again. The government even thinks they are so important for disease prevention that it has raised the recommended daily servings and supports a new food pyramid. It’s easy to recommend, but not always so easy to do. These basics apply to everyone. If youth are to grow and exercise properly, it’s necessary for them to eat properly—but they don’t. Kids and adults can be pretty picky and not only have trouble getting the daily recommended servings, but getting the variety they need to provide the most nutritionally intense value of food.

Gluten-Free/Casein-Free Diets

History

Back in the 1960s, a physician named F. Curtis Dohan speculated that people who had celiac disease were more likely to have schizophrenia. Celiac disease is an autoimmune disorder in which the body cannot tolerate gluten, a protein found naturally in wheat, as well as rye, barley, and sometimes oats that are processed in the same place as these other grains. Later studies have not established that reducing the amount of wheat in the diet of people with schizophrenia significantly reduces their symptoms. Dohan’s writings marked the beginning of the proposed link between diet and psychiatric and neurologic illnesses.

Link Between Gluten and Casein and Autism

The suggested link between gluten and casein and autism emerged in the 1970s. The theory—which remains unproven—was that children who have ASDs are unable to break down the dietary proteins in gluten and casein, causing the formation of opioid-like peptides (amino acids that are similar to proteins). Children with autism are also believed to have “leaky gut syndrome.” Because of this syndrome, these peptides are then able to escape from the digestive tract, cross the intestinal membranes, enter the bloodstream, and go up to the brain, causing the neurobehavioral symptoms that we know as ASDs. By eliminating foods that contain gluten and casein from a child’s diet (known as the gluten-free/casein-free [GFCF] diet), it was believed that you could diminish the symptoms of autism.

Some parents say that the GFCF diet has lessened their child’s symptoms. Research, however, has found little support for the GFCF diet and “leaky gut” theory. Several studies of the GFCF diet in children with ASDs have shown that removing gluten and casein from a child’s diet did not improve social skills or communication, nor did it help with sleep duration and activity levels. Even so, it’s possible that some children with ASDs who have significant gastrointestinal problems may reap some benefits from the GFCF diet, especially if they, coincidentally, also have celiac disease (gluten-sensitivity autoimmune disorder).

Still, many parents try removing gluten and casein from their child’s diet. In fact, the GFCF diet is the most popular CAM intervention among children who have ASDs. It’s generally considered safe, and some parents report that the diet has actually made a difference in their child’s behavior. But it’s hard to know if these behavioral changes are directly related to the GFCF diet or if they are the result of another intervention that the child may be undergoing at the same time.

It’s possible, too, that some children are lactose intolerant, meaning they can’t tolerate the sugar in milk, which may cause gastrointestinal distress leading to irritability. Others may actually have celiac disease, which can also cause behavioral disturbances. By removing lactose and gluten in children who have these conditions, you may also notice behavioral improvements.

Should You Try It With Your Child?

While the available science does not support the GFCF diet, it is understandable that some parents will want to try this intervention. After all, it’s something that you can control and do on your own, and it is thought to be relatively safe. Before you do anything, though, talk with your child’s pediatrician first. You may also want to speak with a nutritionist because the GFCF diet may place your child at risk for some nutritional deficiencies.

For example, eliminating all milk products from your child’s diet removes a critical source of calcium and vitamin D, key nutrients essential for strong bones. New evidence suggests that vitamin D may also play a role in the immune system and preventing infections, cancer, and diabetes. In addition, your child may require additional sources of protein because dairy products are often a major source of protein in a child’s diet. Of note, however, is that these needed minerals are not always included in the now-popular “gummy” type vitamins.

Taking gluten out of your child’s diet can pose challenges too. Removing grains like wheat, barley, rye, and oats from your child’s diet eliminates important nutrients such as the B vitamins, iron, and fiber. Children who do the GFCF diet may benefit from vitamin and mineral supplements to make up for the nutrients missing from their daily diet.

Doing the diet can be difficult too. Gluten isn’t always easy to detect, and reading labels can be challenging. While some sources like bread, pasta, and cereal may be obvious, others such as deli meats, salad dressings, and broths may be less so. And if your child is already a picky eater, it may be a challenge to convince him to adopt this new way of eating. Food preparation may be more time-consuming for children on a GFCF diet, and the cost of the diet can be higher than a traditional diet for children.

While the GFCF diet is certainly among the most popular eating plans used in children with ASDs, you may also hear about diets that restrict certain foods or nutrients. Before putting your child on any type of diet, talk with your child’s pediatrician first. You’ll need to make sure your child is receiving all the nutrients important for his growth and development.

Alternative Sources of Key Nutrients For Children on Gluten-Free/Casein-Free Diets

If you decide to put your child on the gluten-free/casein-free diet, it’s important to pay attention to certain nutrients such as vitamin D, calcium, iron, protein, and fiber, which may be lacking in this eating plan. The following chart offers other options for getting these important nutrients:

Nutrient Needs	Alternative Sources
Vitamin D	Fortified rice, soy, and almond milk; cod liver oil; tofu, eggs; short-term exposure to sunlight; supplements
Calcium	Fortified rice, soy, and almond milk; fortified orange juice; beans, broccoli, spinach, kale, tofu, tempeh; supplements
Iron	Red meats, pork, chicken (mainly in dark meat), shellfish, egg yolks, spinach, soybean nuts, prunes, raisins; supplements
Protein	Eggs, nuts and seeds, lean meats, beans, peanut butter
Fiber	Legumes, fruits, vegetables, nuts, seeds; supplements

Food Substitutions

Substitutions For Foods Your Child Will Not Eat 

Fruit	Vegetables, raw or cooked; if your child won’t eat fresh fruits, try dried fruits such as apricots, pears, raisins, cherries, mango, pineapple, and bananas, and gradually introduce fresh fruits; make pureed sauces for yogurt with fresh or frozen fruit and gradually introduce chunks of whole fruit; serve applesauce instead of whole fruit. If your child refuses citrus fruits, offer alternative sources of vitamin C (eg, strawberries, cantaloupe, vitamin C-enriched juices, broccoli and other cruciferous vegetables, watermelon, potatoes); try mixing fruits such as blueberries, chopped apples, and bananas in muffin, quick bread, and waffle batters.
Meat	Fish, poultry, eggs, tofu, legumes (dried beans, chickpeas, and peas) and grains, and peanut butter; use chopped vegetable mixtures instead of ground meat or poultry to make pasta sauces, taco fillings; breads, crackers, and pasta made with iron-fortified flour.
Milk	Cheeses, yogurts, and other dairy foods made with cow’s, goat’s, or sheep’s milk; soy- and rice-based substitutes for milk and cheese (ask your pediatrician whether your child should be taking supplements of vitamins B12 and D); canned fish with bones (salmon, sardines, herring) for calcium and vitamin D; good vegetable sources of calcium such as broccoli; safe exposure to sunlight for vitamin D.
Vegetables	If your child refuses green leafy vegetables, try dark-yellow and orange vegetables (carrots, squash, sweet potatoes) for vitamin A and folic acid, fruits and fruit juices for vitamin C, as well as folic acid; a child who turns down cooked vegetables may enjoy raw vegetable sticks and salads; offer low-sodium vegetable juice instead of fruit juice; children who balk at plain vegetables may enjoy Asian-style stir-fried vegetables; make pasta and taco sauces with finely chopped vegetables instead of, or in addition to, meat.
Whole-grain breads	High-fiber white bread; whole wheat and rye crackers; whole wheat pasta.