Wellness 13 days ago by Liz Adams

Wellness Expert Q&A: Advice from a Pediatric Dietitian

I think it’s safe to say that when it comes to our kids’ nutrition, we are all trying our best. Some days our toddlers will gobble up all of their vegetables, other days it’s all about the frozen pizza. I don’t think any mom is alone in feeling like this, but it always helps to hear from an expert. That’s why we are so, so excited to be introducing all of you to Liz King, MS, RD, LDN. Liz is currently a pediatric dietitian at a children’s hospital, and she has an incredible amount of experience working with families and kids of all ages and varying health needs. Liz is a big advocate of intuitive eating, feeling good and enjoying ALL types of food while balancing it all out. She also just had a baby girl!

We’ll let Liz take it from here:

Q: What vitamins (if any) should my toddler be taking? 

A: If your toddler has variety and balance in their diet, there is usually no need for a vitamin. We absorb all nutrients best from foods! There are a few exceptions to this. If your toddler is still breastfeeding and/or does not have a dairy source, you can continue to supplement with vitamin D. If your family is following a strict plant-based diet, you may need to supplement vitamin B12. If your toddler is extremely picky, ie only eats “white” foods, a complete multivitamin might be a good idea! You can ask your pediatrician but an over the counter complete multivitamin (ie with iron and calcium) will usually suffice.

Q: Dealing with some picky eaters over here! How can I get my child to diversify their diet?

A: My best recommendation is repeated exposure to the same foods. Consistency is key. If they are used to seeing a vegetable on their plate every single night, this will become their norm. For example, if your child refuses any vegetables, start by putting one green bean on their plate. Don’t mention that it’s there, just allow them to tolerate a green vegetable on their plate. Starting with one or two bites on their plates allows them to get used to this without you having to worry about food waste. Eventually, they may take a bite! Praise them for trying something new while ignoring it altogether if they refuse. 

Q: Should I be worried that my 16-month old despises all veggies, but loves all fruit? 

A: This can be VERY normal for that age and you are not alone! Use their preference for fruits to your advantage. That’s so great they enjoy fruit! Continue to offer fruits as you would. Try to offer a new vegetable with something they already love as they may be more likely to try something for the first time with something they are familiar with. See question #2 about repeated exposure and staying consistent! 

Q: How often should we be giving our kids treats? I want to establish healthy eating habits but don’t want to deprive them.

A: Treats, desserts, “junk” food, fast food, etc can all fit into our lifestyle. Try to avoid labeling foods as “treats” or “special” — this is hard, we all do it. It is totally appropriate to have no treats some weeks, while other weeks (think holidays, summertime, birthday parties) there are treats every day. When at home, put it on their plate with the rest of the meal. They might eat it first, they might not, but they learn that it can become a part of their diet in an appropriate way. Without labeling, the desire for something they “can’t” have goes away. Kids are very intuitive, you would be surprised! As adults, we should feel the same way — no guilt surrounding foods is much easier when we don’t label as “good” or “bad”. 

A: Help! How do I get my toddler to eat vegetables?

A: See questions 2 and 3! Consistency is so important. It might take three weeks of consistently having green beans on their plates before they take a bite. This is considered progress! Another strategy is offering the same type of fruit or vegetable in multiple ways. For example: applesauce in a cup, sliced apples on their plate, chopped apples warm with cinnamon. Another example: carrots dipped in ranch dressing one day and cooked carrots (in a different shape) the next day. 

Q: My 8-year old has a high BMI for her age. We do our best to eat healthily but I’m worried that this will be a lifelong issue for her. What should I be doing? 

A: You are doing a great job! Do everything you can not to focus on her weight — no numbers! Offer all types of foods, but focus on what will fill her up — fruits, vegetables, and whole grains have fiber and healthy fats fill you up more than “diet” foods. Don’t restrict portions or “treats,” especially if other members of your family do not have a high BMI. Give your daughter the tools to choose a balanced diet and the confidence to feel good about food. It is possible to have a high BMI for age and still be healthy! If needed, keep the tempting foods out of the house — out of sight, out of mind. It should be a family approach to healthy eating and you are doing great!

Q: I feel like my kid is constantly sick. Is this related to diet at all?

A: Food can most definitely be related to our immune system, but it is not the only thing. Offer foods that are high in antioxidants: fruits (especially berries), leafy greens, beans — this makes me think of the perfect opportunity to make smoothies. 

Q: Is juice really that bad for kiddos? 

Without using the label “good” vs. “bad”, the reason I’d recommend avoiding juice is because whole fruits have beneficial fiber and other nutrients that you would lose in a juice. Young kids also have tiny tummies that we should fill with whole foods instead of a sugary fluid. Eat your fruits, don’t drink them! (Again, all foods have a place in diet — I would totally allow a juice at a birthday party, for example)

Q: How much meat should I be giving my kids? 

A: Consider portions: start with the amount that would fill up your child’s palm. A few tablespoons of meat provide plenty of protein for most kids. 

Q: Should pre-K to elementary school kids be drinking milk for growth and bone health? 

The Vitamin D and Calcium in milk are what contributes to growth and bone health, so yes, I would recommend milk OR an alternative like cheese or yogurt. You can aim for three servings of dairy per day (1 serving = 4-8 ounces of milk or yogurt, 1 ounce of cheese). If your family or child avoids milk/dairy (or has an allergy), then work in alternative sources of calcium such as leafy greens, beans, tofu. You can also look for foods that are fortified with calcium. This might be an instance where you would supplement with vitamin D. 

Q: Should I limit the quantity that my toddler wants to eat? She often asks for seconds/thirds and I’m worried she isn’t listening to her hunger cues.

A: Start with a balanced plate: a healthy fat, foods with fiber (fruits/vegetables), a grain, a protein. If your toddler asks for more, it’s usually okay! Does she want second helpings of everything? Is she bored or truly hungry? Maybe offer seconds of the fruit/vegetable first, if she is truly hungry she’ll take it! If not, maybe just bored! This can apply to all ages. 

Q: My son is 2 and refuses to eat meat, eggs, and beans. What are some other good sources of protein? 

A: Plant sources of protein include beans, lentils, quinoa, nuts/seeds (though is still considered a choking hazard if whole at 2 years old), nut butters, soy protein (tofu). Other sources of protein include cheese and milk. 

Q: Do you have any tips for dealing with food anxiety? Our toddler has severe allergies and now won’t try any new food.

A: I touched on this above about trying to expand a child’s diet. Stay calm at meals and snacks to help their anxiety too, but if you’re truly worried, you can ask your pediatrician if some type of behavioral therapy might help! 

Q: What should we be serving for after-school snacks? 

A: You could offer a healthy fat and a filling fiber: carrot sticks and hummus, whole-grain crackers and avocado slices or guacamole, apple and peanut butter, raisins and a few pieces of chocolate, cottage cheese or yogurt with peach slices are all examples that come to mind! 

Q: How many calories should a toddler consume on a daily basis?

A: Just like there are a wide range of healthy weights (ie the growth chart) for any given child who is the same age, the same goes for the amount of calories. Focus on portions and the variety of foods they are being offered. A toddler should be offered three meals per day plus a few snacks (morning and afternoon, at least). 

Q: How important is it, really, to eat organic?

This is often a very personal family choice. If this is important to you, maybe start with the “dirty dozen” to get your feet wet. Personally, I buy organic and hormone-free dairy and meat (when able!). I don’t stress about it if not, though. If organic pasta and grains are on sale, I buy those, too! I think about it this way: the benefit of eating lots of (non-organic) fruits and veggies probably outweight the risks of eating only a few organic fruits and veggies every once in awhile. 

Q: Should my toddler be taking a probiotic?

A: Probiotics and their claims, just like supplements, are not regulated by the FDA (like food is). This is also a personal preference, but there are definitely children who may benefit from probiotics (ie may help with diarrhea from antibiotics; may help with children who are prone to constipation; etc.)

Q: Can a vegan or plant-based diet be healthy for kids?

A: Absolutely! It takes some planning for sure, but plant-based can absolutely meet the nutritional needs of children (and adults). I might recommend seeing a dietitian to talk about details, but certain supplements may be needed to fill any nutrition gaps when going 100% plant-based (for example: Vitamin B12 only comes from animal sources, for the most part;  taking note to offer enough sources of iron)

Q: What’s the best way to start introducing solid foods to infants?

A: There are so many different approaches to take to this! This question may be specific to “Baby Led Weaning” which takes the approach of skipping purees or spoon feeds and starting with solids. There is no nutritional need to skip purees and if so, solids can be introduced after that — this is a great way to offer a variety of textures to infants. Soft, dissolvable solids are great to start with. If your baby likes pureed banana, try offering mashed banana (new texture exposure), and after that, try letting them hold a piece of whole banana. No matter what approach you take, let them play with their food and get messy! 

Q: What should we be doing to establish healthy eating habits in our kids (and avoid creating issues later on)?

A: Offer a wide variety of foods often. Let them try new foods but avoid negativity if they don’t love it the first time. Don’t forget that treats can fit into a healthy lifestyle and avoid labeling foods as “good” or “bad”. Involve your kids in grocery shopping, meal preparation, food choices. Most of all, be amazing role models for your kids. If they hear dad say he “hates brussels sprouts!”, what do you think they are going to say? If you are taking care of your own health, kids take note of this (and not just when it comes to eating!). This makes me think of Liz, she talks a lot about this when it comes to her commitment to exercise and fitness. 

Finally, please know that I am sensitive to the current events happening. I am fortunate to be on maternity leave right now; I continue to receive an income and I don’t have to worry about childcare. I’m using this time to hunker down at home with my six-week-old and know that not everyone can do the same. I am thinking about my coworkers and patients who are all very worried. I urge everyone to practice social distancing! Take this time to bake brownies with your kids! Have them help you make dinner to pass some time. Take a picnic to the backyard. Give yourself grace if the kids are eating frozen chicken nuggets for the third time this week. Don’t worry if they haven’t had a fruit or a vegetable in days. We are all doing our best, especially in these times! 

I’d like to thank Liz for allowing me to share a little bit on her page. I admire her passion for health, fitness, and wellness for her and her family. I have enjoyed following along this month (which is also, coincidentally, National Nutrition Month!) and can’t wait to see what else we get to learn.

Thank you, Liz! I found this post simultaneously inspiring and reassuring, and I hope you all did, too! Leave any other questions you have in the comments and we’ll try to get them answered for you!

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  1. From a fellow pediatric dietitian and long time follower, this post is 🙌🏼🙌🏼🙌🏼. Good work Liz and Liz!!!

  2. A big thanks to both of you for putting this post together. Dr. Liz, this was such positive and straightforward information. I am a wellness lover and a mom to a 4 year old, 2.5 year old and 8 month old. This eased some anxious thoughts of mine and also gave some new ideas.
    My kids are similar, some days they will eat allll the veggies and some days they just want noodles for breakfast, lunch and dinner. One trick I tried was to serve dinner “family style” at least a few times a week. We eat pretty plant-based and so I always have a variety of veggies as the main focus of dinner. I noticed that if my kids were able to pick what they wanted on their plate they typically tried a bigger assortment of veggies or grains and also felt very grown-up.
    Thank you both again for your positive attitudes!

  3. Hi! I have a 7 year old who has always been small and skated the FTT diagnosis her whole life, but finally was given to her this last spring for lack of weight gain. We’ve done a whole work up with GI and found nothing, and really he had no other ideas or plan. Met with a nutritionist once but it fell though and she really wasn’t that helpful. Any other ideas or thoughts? Second gi opinion? New nutritionist?? She is not a picky eater, but has a low appetite/volume.

  4. Thank you so so much for all of this! Very helpful and appreciated. What do you recommend for trying to get more calories in a 6 year old who needs a bit more for weight gain? Food examples, extra snack times recommended, etc— any guidance would be helpful. Thanks!