20 Healthy Eating Tips for 2020

image: Valeria Boltneva, Pexels

1. Eat breakfast. Start your morning with a healthy breakfast that includes lean protein, whole grains, fruits and vegetables. Try making a breakfast burrito with scrambled eggs, low-fat cheese, salsa and a whole wheat tortilla or a parfait with low-fat plain yogurt, fruit and whole grain cereal.

2. Make half your plate fruits and vegetables. Fruits and veggies add color, flavor and texture, plus vitamins, minerals and dietary fiber to your plate. Make 2 cups of fruit and 2 ½ cups of vegetables your daily goal. Experiment with different types, including fresh, frozen and canned.

3. Watch portion sizes. Get out the measuring cups and see how close your portions are to the recommended serving size. Use half your plate for fruits and vegetables and the other half for grains and lean protein foods. To complete the meal, add a serving of fat-free or low-fat milk or yogurt.

4. Be active. Regular physical activity has many health benefits. Start by doing what exercise you can. Children and teens should get 60 or more minutes of physical activity per day, and adults at least two hours and 30 minutes per week. You don’t have to hit the gym—take a walk after dinner or play a game of catch or basketball.

5. Get to know food labels. Reading the Nutrition Facts panel can help you shop and eat or drink smarter.

6. Fix healthy snacks. Healthy snacks can sustain your energy levels between meals, especially when they include a combination of foods. Choose from two or more of the MyPlate food groups: grains, fruits, vegetables, dairy, and protein. Try raw veggies with low-fat cottage cheese, or a tablespoon of peanut butter with an apple or banana.

7. Consult an RDN. Whether you want to lose weight, lower your health-risks or manage a chronic disease, consult the experts. Registered dietitian nutritionists can help you by providing sound, easy-to-follow personalized nutrition advice.

8. Follow food safety guidelines. Reduce your chances of getting sick with proper food safety. This includes regular hand washing, separating raw foods from ready-to-eat foods, cooking foods to the appropriate internal temperature, and refrigerating food promptly. Learn more about home food safety at homefoodsafety.org.

9. Drink more water. Quench your thirst with water instead of drinks with added sugars. Stay hydrated and drink plenty of water, especially if you are active, an older adult or live or work in hot conditions.

10. Get cooking. Preparing foods at home can be healthy, rewarding and cost-effective. Master some kitchen basics, like dicing onions or cooking dried beans.

11. Dine out without ditching goals. You can eat out and stick to your healthy eating plan! The key is to plan ahead, ask questions and choose foods carefully. Compare nutrition information (if available) and look for healthier options that are grilled, baked, broiled or steamed.

12. Enact family mealtime. Plan to eat as a family at least a few times each week. Set a regular mealtime. Turn off the TV, phones and other electronic devices to encourage mealtime talk. Get kids involved in meal planning and cooking and use this time to teach them about good nutrition.

13. Banish brown bag boredom. Whether it’s for work or school, prevent brown bag boredom with easy-to-make, healthy lunch ideas. Try a whole-wheat pita pocket with veggies and hummus or a low sodium vegetable soup with whole grain crackers or a salad of mixed greens with low-fat dressing and a hard-boiled egg.

14. Reduce added sugars. Foods and drinks with added sugars can contribute empty calories and little or no nutrition. Review the new and improved Nutrition Facts labels or ingredients list to identify sources of added sugars.

15. Eat seafood twice a week. Seafood—fish and shellfish—contains a range of nutrients including healthy omega-3 fats. Salmon, trout, oysters and sardines are higher in omega-3s and lower in mercury.

16. Explore new foods and flavors. Add more nutrition and eating pleasure by expanding your range of food choices. When shopping, make a point of selecting a fruit, vegetable or whole grain that’s new to you or your family.

17. Experiment with plant-based meals. Expand variety in your menus with budget-friendly meatless meals. Many recipes that use meat and poultry can be made without. Eating a variety of plant foods can help. Vegetables, beans, and lentils are all great substitutes. Try including one meatless meal per week to start.

18. Make an effort to reduce food waste. Check out what foods you have on hand before stocking up at the grocery store. Plan meals based on leftovers and only buy what you will use or freeze within a couple of days. Managing these food resources at home can help save nutrients and money.

19. Slow down at mealtime. Instead of eating on the run, try sitting down and focusing on the food you’re about to eat. Dedicating time to enjoy the taste and textures of foods can have a positive effect on your food intake.

20. Supplement with caution. Choose foods first for your nutrition needs. A dietary supplement may be necessary when nutrient requirements can’t be met or there is a confirmed deficiency. If you’re considering a vitamin, mineral or herbal supplement, be sure to discuss safe and appropriate options with an RDN or another healthcare provider before taking.

Provided by Mary Ligotti-Hitch, R.D., a registered dietitian with the Beaumont Health Center’s Weight Control Center. Authored by Academy of Nutrition and Dietetics staff registered dietitian nutritionists.

Vegetarian, Keto and More! Your Teen and Dieting

image credit: Oleg Magni, Pexels

Teenagers who choose to diet fall into two categories: health conscious and weight conscious. Each has their own challenges for parents and kids, but recognizing the underlying motivation is important.

Health-conscious teens

Health-conscious teenagers tend to be near normal weight to begin with or may even be on the thin side. They are often athletic and high academic performers. Teenagers who are motivated to eat healthy while still in middle or high school often have high expectations for their own performance in every aspect of life and see changing their diet as another way to be in control of their body and health.

When done well, in a balanced and flexible way, these teenagers are choosing to change their eating habits for the better. Most aren’t primarily motivated to lose weight but rather are interested in becoming healthier.

Most health-conscious teens are opting for a vegetarian or plant-based diet. Healthy vegetarian diets are great when done well. Eating a plant-based diet is fantastic for all of us! Protein is in abundance in grains, veggies, and non-meat sources, so dairy is optional for vegetarians. Parents worry too much about the protein issue for vegetarian teens. I’ve yet to meet a grain-eating vegetarian who is protein deficient. The challenge for teenager vegetarians is to actually eat veggies! Most are just meat avoiders and replace meat with carbs. In order to do a vegetarian diet well, eating mostly veggies and fruits is a must. A multivitamin with iron is also a great idea as is a Vitamin D supplement (at least here in the cloudy Midwest).

Parents can support teenagers interested in a plant-based or vegetarian diet by sending them YouTube videos or getting them short books that are designed for teenagers. Content that is designed to show how easy it is and great the benefits of this way of eating are best. Avoid content that shows the hurdles. Encouragement is the way to go! Send just one or two, as too many will seem overbearing to your teenager who may want to do this on their own.

Health-conscious teenagers sometimes go a little off the deep end though. And because of their tendency to be high achievers, they can get caught up in the specifics of the program. Eating only certain foods, having no flexibility when few options exist, and going without food rather than bend.

If a health-conscious teen has a dual desire to lose weight, the rigidity can get even more extreme, especially if the teen has a compulsive personality. Food restriction and avoidance can result in a sense of control and power that fuels more of the same, especially if weight loss ensues. Behaviors like these are a slippery slope on the path to an eating disorder.

It’s tempting to “remind” teenagers to eat or to ask about protein sources or meal plans when your independent eater is preparing her own meals. Instead, try hard to ask what advice or help they need to succeed. Have your teenager give you a grocery list, prep food together, avoid giving opinions, and instead give praise. Reminders and advice will drive your teenager away and will not get them to eat differently.

Weight-conscious teens

Weight-conscious teens tend to consider other diets when they are in the mood to change their appearance. Like most adults, they wax and wane in their motivation to stick to a diet/eating plan. Most overweight kids have at least one parent who is overweight and it helps for the whole family to adjust their eating habits when an overweight teenager is ready to change their eating habits.

Some diets (e.g., keto, paleo, Mediterranean, vegetarian) focus solely on what a teen is eating. However, options like the Beaumont Healthy Kids Programs and Weight Watchers focus on teaching behaviors to promote and improve lifelong health.

So what is the best option for an overweight teen? To be frank, any of these will result in weight loss and are healthy enough for a teen to follow. Being able to stick to the plan is the biggest challenge. Let your teen choose the one that they think is the best fit for long term success. For example, keto and paleo may be difficult for teenagers to maintain due to the lack of carbs given the carb-laden foods they will be in constant contact with, but if that is the diet your teenager feels is the best fit then let him go for it.

One of the biggest challenges for parents is to support their teenager without managing the diet. Teens who express an interest in changing their eating habits need your help to grocery shop, learn to prepare foods, and to cheer them on when things are going well. Ask them what you can do to support them and then listen to what they say. Teenagers are not looking for advice, reminders or coaching. The more you do that, the more resentment and attitude you’ll get from your teen.

Until a teenager is self-motivated, your efforts to help will only breed resentment. Instead, prepare healthy foods at home and don’t mention eating habits with your teenager. They know what healthy eating looks like and know full well what they are doing isn’t healthy. Your reminders won’t change their behaviors, and if they are overweight, will only make them feel worse about themselves. Even if you are trying to approach the subject from a health perspective, teenagers who are overweight interpret this as another message about how fat they are and feel worse about who they are. When your teenager is finally ready, don’t go overboard, remember they are just like the rest of us — interested in dieting a week or two and then fall off the wagon. Stay patient, loving and let your teenager lead the way.

Parents who are concerned about their teens’ diet choices, behaviors around eating (like restrictive eating), or who recognize that a doctor would be a good person to discuss diet and eating choices, should make an appointment with their pediatrician. We are a great resource for parents and for teenagers who are changing their eating habits—hopefully for the better!

– Dr. Molly O’Shea, a board-certified Beaumont pediatrician, offers traditional medicine in non-traditional ways including newborn home visits and emailing parents directly. She has practiced pediatrics for nearly 30 years and was the “Ask the Pediatrician” columnist for the Detroit News for many years. A journal editor for the American Academy of Pediatrics, she also organized the AAP’s national continuing education programming for pediatricians. Dr. Molly loves cooking, traveling and spending time with her family.

The Hidden Dangers of Teen Dating

My 17-year-old son started dating this year, a lovely young woman who has been a friend since seventh grade. They are both nearly adults in age, but still adolescents in many ways. As parents we discuss everything from sexting to STDs to pregnancy with our son, and I know her mom does the same. We have planted books that contain answers to questions he may be embarrassed to ask. But it honestly never occurred to us to talk to him about domestic violence. He does not witness violence in his home, but he certainly sees plenty of it in the media, from games to YouTube to movies.

Domestic violence – specifically teen dating violence – is not a topic we should ignore simply because it is not part of our experience. Just because a child does not experience violence at home doesn’t mean they are not susceptible to violence – as victims or abusers. Here are some important facts from the Centers for Disease Control:

  • 1 in 11 female teens experienced physical dating violence in the last year
  • 1 in 15 male teens experienced physical dating violence in the last year
  • 1 in 9 female teens experienced sexual dating violence in the last year
  • 1 in 36 male teens experienced sexual dating violence in the last year
  • 26% of women and 15% of men who have experienced domestic violence had their first experience before the age of 18
  • LGBTQIA teens are more likely to experience dating violence than their heterosexual peers
image credit: CDC

Many parents are unaware of these statistics and may also be unaware of how teen dating violence is defined. There are four types:

  • Physical violence – when one partner harms another by hitting, kicking or otherwise physically assaulting them
  • Sexual violence – forcing or attempting to force a partner into performing a sexual act; includes sexual touching but also includes unsolicited non-physical sexual activity such as sexting
  • Psychological aggression – using verbal or non-verbal communication to exert control and/or inflict harm on another person mentally or emotionally
  • Stalking – unwanted attention and contact that is systematically repeated in order to cause fear and attempt to control the behavior and activity of the other person

Some of these behaviors, such as sexting, can start at a very early age. Children commonly get their first smart phone at age 10 and a discussion about sexting needs to happen before their personal phone is placed in their hands. Both boys and girls need to understand what kind of pictures are OK and which are not OK. They also need to understand that unsolicited sexual overtures cause the recipient to experience the same kind of distress and anxiety as if they had been physically sexually harassed.

There are a number of behaviors to look out for if you are concerned your child is experiencing or perpetrating dating violence (from the National Domestic Violence Hotline website):

  • Your child’s partner is extremely jealous or possessive to the point where your child stops spending time with other friends and family. When asked how they feel about this, your child might say something like: She thinks my friends don’t like her, so she doesn’t like spending time around them. Or, she thinks they’re a bad influence on me, and she’s just trying to help.
  • You notice unexplained marks or bruises.
  • You notice that your son or daughter is depressed or anxious.
  • Your child stops participating in extracurricular activities or other interests.
  • Your child begins to dress differently; for example, wearing loose clothing because their partner doesn’t like for them to show off their body or attract the attention of someone else.
  • Your child worries if they can’t text/call their partner back right away because their partner might get upset.
  • Your child expresses fear about how their partner will react in a given situation.

It’s important to stay tuned in to your teen as they make their way in the dating world. Teens who experience abuse or violence in their adolescent relationships are at much higher risk in college and adulthood. Teen victims may experience depression or anxiety; may use drugs to escape; may pass along the violence they experience in anti-social behaviors like lying, shoplifting, bullying, or physically abusing others (younger siblings can become a target); or may experience suicidal ideation or even attempt suicide.

Open a communication channel about healthy relationships with your children starting at a young age. Encourage them to think critically about the health of their friendships as those behaviors form the basis for their intimate relationships. Most of all, be that non-judgmental listening ear so they know that you will love and support them in all aspects of their lives.

For more information and resources, visit the CDC’s Dating Matters website.

– Kathy Henry is the adoptive mom to two amazing young men; a writer and business marketing consultant; and an active volunteer in her public school, Unitarian Universalist church, and community.

My Journey with Breast Cancer

image credit: Jacob Sippel, U.S. Navy

It was a late November afternoon in 2013 when I went to Beaumont Imaging Center for my mammogram. I was good about showing up for my yearly visit since breast cancer runs in my family; my mom and my two aunts all had breast cancer. I was directed to a second mammogram and a core biopsy. A few days later when I was called in to see my doctor, I knew why so I stopped to pick up my husband.

We met with the doctor and she confirmed my suspicion. I had breast cancer. I sat and listened while she recommended a breast cancer surgeon while thinking, “Breast cancer is treatable. It’s not a death sentence,” while also wondering what my future would look like. My husband on the other hand was devasted.

Next I met with the breast surgeon who could not have been more thorough. I went into the visit thinking I’d just get a little lumpectomy, not too bad. But my bubble was burst when she informed me there were two spots and not close together. That shot my plan!

Now what choices did I have? I could have a double mastectomy or a single. Great. All of a sudden, this cancer thing became real. I made my decision for a single mastectomy and reconstruction. Would I need radiation or chemo? That would be determined by my oncologist and the results of the lymph node biopsies taken during surgery.

Just a few weeks earlier I was a healthy woman with one doctor who only went for a yearly check-up. Now I was a cancer patient with a cancer surgeon, an oncologist and a plastic surgeon!

Surgery was scheduled for January 17, 2014. That meant there was a long time of waiting and thinking between my diagnosis in early December and the surgery date. I did a lot of research, some of which was pretty scary! I met with my plastic surgeon and learned all about the reconstruction phase. It was as if everyone was talking about someone else not me.

The day before surgery I looked in the mirror one last time to see the body that was all mine. Never again would I be whole. I cried for the first time.

Surgery was in the morning and with my family beside me, I walked to get my breast and cancer removed. Knowing that so much depended on my lymphoid biopsies (and whether they showed any cancer cells), it was all I could think about before surgery. It was also the first thing I asked in the recovery room. I was lucky; my cancer had not spread!

The following days were difficult emotionally as well as physically. No one told me that my arm would feel so heavy and sore from the removal of the lymph nodes. I also didn’t want to see my new body. But within days the bandage was off and I had to eventually look at the seam across my chest.

My first visit to the plastic surgeon after surgery gave me the go-ahead to return to work. What would I do about my lopsided breast? I became very self-conscious about how I looked and wore a scarf for many months to disguise my uneven chest. I didn’t even own a scarf before this!

With the visit to the oncologist, I was told I would not need radiation or chemo! I was fortunate and extremely grateful that I did not have to do the treatments some of my friends went through!

A year after surgery with reconstruction completed, I finally walked away from my bi-weekly visits to the plastic surgeon. I finally felt this ordeal was over! But it never really is — every time I look in the mirror, I’m reminded of a part of me that was taken away by this awful disease.

And five years later, I’m reminded that, “Breast cancer is not a death sentence. It is treatable!”

– Joy Smick is a Parenting Program volunteer.

What Zit All About? Acne 101

image: Kjerstin Michaela Haraldsen, Pixabay

Blackheads, whiteheads, pimples, and oily skin are the hallmarks of acne. Most of us had our fair share of acne over the years and we heard a lot of advice about how to manage it. From basic advice of washing twice a day with soap to using expensive skin care products you can get delivered to your door every month to prescription medicines, acne remedies abound.

The reason there are so many strategies out there is that acne is embarrassing for teenagers and adults alike. Often the thought of going to the doctor to talk about skin issues (or even bringing up the topic with parents) is too difficult for most teenagers. Parents need to take the lead and ask teenagers if they are interested in doing something about their acne. Some teens are interested in working on their skin while others aren’t.

Before discussing the skin care regimes that work, it makes sense to understand the different components of acne.

  • Blackheads and whiteheads: These are pores that are blocked with debris (i.e., dead skin, oils, bacteria) but don’t have much inflammation (swelling or redness). What makes them black or white is whether the pore is still open (blackhead) or closed at the top (whitehead).
  • Pimples: These are blackheads or whiteheads that have gotten inflamed. Usually they are still close to the skin’s surface so the inflammation (i.e., swelling, redness and pus accumulation) come to a head quickly and resolves. Sometimes pimples will scar but if they are left alone and there are few of them scarring is less common.
  • Cystic acne: These are pimples deep under the skin as well as large inflamed pimples near the surface. What differentiates cystic acne from regular pimples is size of the swelling and depth of the inflammation. Because some of these acne lesions are so deep, they don’t come to a head and those that do are so large that they may leave scars.

Once parents have broached the subject with their tween or teen, what strategies work?

For mild acne that is made up of mostly blackheads and whiteheads and only a few pimples here and there, washing twice a day with a mild soap and using benzoyl peroxide 10% (available in a variety of over-the-counter preparations) once a day makes sense.

Once pimples are the main attraction, benzoyl peroxide probably won’t cut it. Talking to your pediatrician is the best first step. When pimples are the main issue, retinoids in the form of a cream used once-a-day (along with skin hygiene) is the best approach. Retinoids take about eight weeks to work and your teenager’s skin will actually look a little worse before it starts to look better. Once the improvement starts though, it’s a big improvement!

Because retinoids can be harsh on the skin, some doctors start with topical benzoyl peroxide and antibiotic combo creams or gels. These are not as effective but may be enough for mild acne.

Cystic acne is different. Because of its scarring nature and because many of the pimples are so deep, topical management doesn’t work well. Heading the dermatologist makes sense. Accutane is the best management strategy for cystic acne. Even with all of its challenges (including monthly lab tests, appointments, and side effects), this pill is by far the most effective approach. It is taken for nine months or so and then many people need a second course a year or two later for another three to six months. All in all it’s easier than years-long skin regimes and far more effective.

The biggest challenge though in any acne treatment plan is compliance. Many teenagers get frustrated or bored with the skin regime of washing twice a day and applying product. Because so few solutions are foolproof and all require continuous participation to gain continued results, teenagers are at risk for falling off the skin regime bandwagon when results aren’t as good as they had hoped, or when their skin is looking better for a week or so. Either way their lack of commitment is the Achilles’ heel of any approach parents and doctors put forth. That’s why opening the conversation with your teens and getting a real sense of how interested they are in addressing their skin health is key to moving forward.

Many families ask about commercially available skin regimes that they see engaging advertising for. Many of these products do work and if they teen is coming to you engaged by the sales pitch, he or she may be more committed to the regime which is really the “magic” that ensures the success of the product.

As a final comment, let’s cover some common myths and truths about what makes acne worse.

  • Myth: Never use moisturizer on your face.
    • Moisturizing acne-prone skin can get tricky. You want to be sure to choose an oil-free moisturizer. Many products now will even say “non-comedogenic” on the label, which is good sign it’s acne friendly.
  • Myth: Chocolate (or milk, or fatty foods) makes acne worse.
    • Eating a healthy diet and drinking plenty of water is great for your body and your skin. Eating certain foods though won’t make your acne worse. All kinds of old wives’ tales surround food and acne, but research shows that what you eat makes no real difference in how your acne progresses.
  • Truth: Hair products, like gels and hair oils, increase acne.
    • Any oils, gels or even your hair’s own natural oils (if on your forehead all the time) can worsen your acne. If your forehead is your main problem area, keep your hair off your face and keep hair care products far away!

– Dr. Molly O’Shea, a board-certified Beaumont pediatrician, offers traditional medicine in non-traditional ways including newborn home visits and emailing parents directly. She has practiced pediatrics for nearly 30 years and was the “Ask the Pediatrician” columnist for the Detroit News for many years. A journal editor for the American Academy of Pediatrics, she also organized the AAP’s national continuing education programming for pediatricians. Dr. Molly loves cooking, traveling and spending time with her family.

The Calm Before the Storm: Parenting My Anxious Child

image: Tobias Wahlqvist, Pixabay.

The call always and only comes on Monday mornings. The school counselor assures me it’s never an emergency. There’s just a teary boy on the other end missing his mom. And he’s worried. Worried that something is going to happen to me when he’s at school.

And occasionally, the worry storm starts brewing Sunday nights as the end of the weekend starts to draw near. And he can’t articulate why he’s crying, but he knows he feels worried about being at school the next day and that something might happen to me.

His worry is not founded on any truth. Nothing has ever happened to me while he’s been at school. But that’s beside the point. Any parent of an anxious child knows too well that the rational brain is not in charge of the worrying one, and that all the reassurance in the world just isn’t enough to calm it down.

And so, the therapist had to become the client. And with courage and a lot of patience, I built a small toolkit of strategies that I know he responds to because lately, I’m not getting any Monday calls. And Sunday evening storms aren’t passing over our house for the time being.

  • My mantra: You have to push through it to get out of it.

The hardest part of the Monday calls are balancing his need for reassurance that I’m OK with my desire to get him back into his day. But the key for me is always to get him back into his day because the more he practices pushing through the uncomfortable feelings, the more confident he becomes in his abilities to self-manage when he feels anxious.

  • His mantra: You got this!

Self-talk is a powerful way for him to recruit his inner resources.

  • A “coping” card

On an index card, we made a list of all the things he can think about when he starts to worry about me. This process helps him counter that worry thought with more comforting and productive thoughts like, “Nothing has ever happened to mom when I’ve been at school so she’ll probably be fine,” or “I can’t wait to see her when I get off the bus.” He keeps this card tucked away in his backpack so he can look at it when he’s at school.

  • Model confidence.

I try to counter his worry voice with a calm and confident response. I don’t want to feed his anxiety with mine. In this way, I am sending him the message that I believe he can handle this (even when I am dying inside!).

Parenting an anxious child can be really hard. But if we can remind ourselves of the influence we have in this space before the storm hits, it will help us feel empowered in a situation that often feels so out of our control.

– Andree Palmgren, LPC, is a therapist with a private practice in Westport, CT and is a parent to 4 kids ages 16, 14, 11 and 7.

Stumbling blocks that can increase childhood obesity

image: David Goehring, Flickr. CC license.

September is National Childhood Obesity Awareness Month. No parent starts off feeding their kids with the hope of creating an unhealthy or overweight child. Every parent wants to be the very best parent in all ways and along the way we realize how hard it is to be perfect at everything. Sometimes maintaining healthy eating habits for just ourselves is tough, so keeping them going for our kids can seem like a lot of work! With a little effort though, parents can avoid some of the stumbling blocks that create unhealthy eaters and reduce the risk of obesity.

Parents of infants spend a lot of time thinking about, choosing, and preparing food for their new solid-food eater. Most babies gobble up virtually everything they are offered and parents feel great about what they are doing. Then something happens though along the way.

By the time children are 3 years old, many are “picky eaters” and parents report that their children will “only eat” carbs with a smattering of fruit and dairy. Unsurprisingly, parents lose their confidence (and their will) to lead the charge of healthy eating; by the time children are in grade school (or even sooner), snacks for soccer are convenience foods like single-serve chips or cookies, a Lunchable and sugar-laden Go-Gurt® comprise lunch, and desserts are nightly as a treat for eating a single broccoli spear.

This may be a bit of an exaggeration, but only a bit.

After almost 30 years as a pediatrician, I’ve seen some common stumbling blocks along the way. If parents can avoid tripping over these, kids have a better chance of remaining healthy eaters and avoiding obesity.

Stumbling block #1: Parents reinforce picky eating

This toddler slide from “eager” eater to a “picky” one may be the critical point in the process for child and parent that, if weathered successfully, can set the stage for obesity prevention. If a parent can make it through the toddler “picky” stage and continue to offer healthy foods all along (without falling prey to the culture pressure of junk food), healthy eating patterns can be sustained. Here’s how picky eating happens:

Since baby’s growth slows dramatically after he or she turns one, appetite will decrease sometime between 12 and 24 months. Sometimes that decrease is dramatic and whole meals are skipped because your sweet pea will consume all the calories needed by the time dinner comes along. Because their appetites slow, children can afford to get “choosy” and just eat what they prefer. It’s not that they don’t like the other foods, it’s more that they aren’t as hungry so they don’t need to eat everything just to satisfy their need to grow. Parents worry when they see their little one not eating much and resort to all sorts of strategies: feeding their children, offering preferred foods when dinner isn’t eaten, offering smoothies with veggies because a child isn’t eating them otherwise, offering pouches of purees, continuing bottles longer to make sure their baby gets something before bed, offering food throughout the day (not just at meals), turning on the TV or screen to distract their child to eat. You get the idea. All of these strategies will ultimately send the message to the child that they shouldn’t be listening to their own body’s messages of “full” or “hungry.” The other message a child receives is that if you won’t eat what is in front of you, you will be given fatty, concentrated sweet, or carb laden food as an alternative (read: pureed foods, mac and cheese, chicken nuggets, snack crackers, sweetened yogurt, etc.). These messages sent so early and often create habits that can be hard to change.

What to do: When your toddler’s low-eating phase presents itself, relax! Keep offering whole fruits and veggies, lean proteins, carbs and dairy in healthy proportions. Eliminate between meal snacking if your child isn’t coming to the meal hungry, since snacks typically aren’t “meal worthy” foods. Only offer milk and water to drink—and only with meals and snacks (as opposed to having a cup available all the time). By limiting access to fluids, you won’t dehydrate your child and you won’t allow your child to fill up on fluids sending a “full” message to his brain when it’s mealtime.

Don’t worry if he doesn’t eat a single veggie or fruit. If you keep offering them when he gets hungry, he will. Don’t resort to pouches or purees which are really just concentrated veggie and fruit sugars and don’t provide much mouth experience with the food. Give a multivitamin instead during this time.

If you are concerned about skipping snacks, only offer whole veggies and fruits for snacks during this low-eating phase. If your child is truly hungry she will eat them. If she’s not hungry enough, she’ll pass on them and will come to the meal readier to eat.

I promise your child will still sleep through the night even if he doesn’t eat dinner. If he gets hungry later (before bed), offer part of the dinner again rather than a preferred food.

Stumbling block #2: Snack time is all the time

I don’t know when it began, but it seems that our culture has decided that kids need snacks all the time. Three-year-old soccer practice for 30 minutes assigns a snack parent now. Kids are getting food with every activity whether they really ‘need’ to eat or not. Children go to preschool for three hours in the morning and have a snack part way through. Parents give kids food to quiet them down in the car (or perhaps worse: a screen to watch).

Kids don’t really need to eat all the time. They do need to eat breakfast, lunch and dinner of course. Many kids will need a snack if the time between those meals is greater than five hours and especially if meals are lacking protein. In reality, most kids need an afternoon snack added to the three meals and that’s about it. If they are having a snack with an event, they don’t need an additional one too. We have gone a little snack crazy in our society and some kids are now expecting to eat all the time.

What to do: Set routines in your house for meals and snacks. Send healthy snacks (e.g., fruits, veggies, 1 ounce of cheese about the size of one die) with your child rather than have a bag of chips. Avoid sugar-laden snacks like fruit rolls-ups (even the all-fruit ones are still all fruit sugar and real fruit is much better), Go-Gurt, and chips even though they are convenient.

Talk to other parents. You aren’t alone in wanting to limit sugar or snacks and even in offering healthy snacks. Figure out if you even need to have a “snack parent” at soccer, for example. Of course, some kids will need a snack due to their metabolisms or family schedules but their parents can provide it. No need for the whole group to get in the habit every time.

Stumbling block #3: Eating out/Carrying In

This is a tough one, especially as kids get older and schedules get hectic. The data is clear that the more that families eat homemade food, the less obese their children are. Sitting down as a family for dinner is not going to be possible during the super crazy days of multiple kids in sports/dance/music, but that doesn’t mean that you can’t eat healthy food on the go.

What to do: Meal plan as a family. Kids as young as 8 years old can help with plan and prep. Take time on the weekend to get a plan for the week. Even if you are all eating sandwiches, fruit and bringing milk in a Thermos, this is dramatically healthier than anything else you will eat out on the go. When you take the time to plan together, meal prep and even pack dinners for the week on the weekend, and the busy week will go much more smoothly. You will also help your kids see the importance of healthy eating and budgeting.

Final comments

Notice I didn’t mention anything about exercise. Although being physically active is super important for heart health and kids who are sedentary are more likely to be obese, weight management is almost completely about what you eat. Sedentary kids eat dramatically more than active kids. Sedentary kids also eat much less healthy food which accounts for the vast majority of the weight difference. Please be active but understand the key to healthy weight is healthy eating.

Lastly, no parent is perfect. No parent can do it all. Do your best, offer fruits and veggies all the time, eat homemade food as much as you can, and don’t turn food into a reward and you just might create a healthy eater.

– Dr. Molly O’Shea, a board-certified Beaumont pediatrician, offers traditional medicine in non-traditional ways including newborn home visits and emailing parents directly. She has practiced pediatrics for nearly 30 years and was the “Ask the Pediatrician” columnist for the Detroit News for many years. A journal editor for the American Academy of Pediatrics, she also organized the AAP’s national continuing education programming for pediatricians. Dr. Molly loves cooking, traveling and spending time with her family.