Fussy eater - Scientific Symposia conducted by me for mothers at Chandigarh

Dr Gaurav Gupta sharing his tips on managing children who are fussy/ picky eaters at 23rd August, 2012 at Park Plaza Hotel, Sector 17 Chandigarh - Newspaper report published Daily Post

Tips for FUSSY/PICKY EATERS

FUSSY/PICKY EATERS

Managing a “fussy” eater involves a division of   responsibility

• The parent is responsible for the “what,  when, and where” of feeding
• The child is responsible for the “how much” and “whether” of eating

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Children's nutrition doesn't have to be frustrating. Consider these strategies to avoid power struggles and help the picky eater in your family eat a balanced diet.

• Respect your child's appetite — or lack of one

• If your child isn't hungry, don't force a meal or snack.
• Don't bribe or force your child to eat certain foods or clean his or her plate.
• Serve small portions to avoid overwhelming your child.
• Provide more food if it is requested.
• Provide a relaxed eating environment.

• Stick to the routine

• Serve meals and snacks at about the same times every day.
• Don’t serve the same item two days in a row and deliberately rotate through

different tastes and textures.

• Provide juice or milk with the food, and offer water between meals and snacks.
• Don’t allow your child to fill up on juice or milk throughout the day as this might decrease his or her appetite for meals.
• FOOD CURFEW: Clearly define eating and non-eating times. Don’t let your toddler eat on demand.
• A mild distraction helps for some kids – not TV, but coloring book, storytelling etc. may help a hyperactive child eat well. No mobiles or distractions for moms too!

• Be patient with new foods

• Don’t ask your child to eat new foods! Ask them to taste a pea-sized sample and describe what they’ve tasted instead. Give them the option to spit it (in a tissue) or swallow it. Let them ask for more ☺
• Young children often touch or smell new foods, and may even put tiny bits in their mouths and then take them back out again. Your child might need repeated exposure to a new food before he or she takes the first bite.
• Encourage your child by talking about a food's color, shape, aroma and texture, and not whether it tastes good. Serve new foods along with your child's favorite foods.
• Try eating new stuff yourself, your child may follow.

• Make it fun

• Allow children to put favorite sauces on foods.
• Cut foods into various shapes with cookie cutters.
• Serve a variety of brightly colored foods.
• Kids can’t eat what isn’t being served! The more frequently you expose your kids to fruits and vegetables the more normal these foods will seem.
• Let your little one add ingredients to dishes, sprinkle herbs or stir in the milk.
• Measuring out a teaspoon of liquid is good balancing practice and adding four teaspoons calls on counting skills, too.

• Recruit your child's help

• At the grocery store, ask your child to help you select fruits, vegetables and other healthy foods.
• Don't buy anything that you don't want your child to eat!
• At home, encourage your child to help you rinse veggies, or set the table.

• Set a good example

• If you eat a variety of healthy foods, your child is more likely to follow suit!

• Minimize distractions

• Turn off the television and other electronic gadgets during meals.
• Don’t let your child eat alone.

• Don't be a short-order cook

• Preparing a separate meal for your child after he or she rejects the original meal might promote picky eating.
• Encourage your child to stay at the table for the designated mealtime — even if he or she doesn't eat.
• Keep serving your child healthy choices until they become familiar and preferred.
• Redefine dessert as fruit, yogurt or other healthy choices.

• Reduce temptation

• Try not to keep junk food around the house.
• If you want to keep some snacks, try using a Snack Jar to limit intake of these around mealtime.

• Shouting makes it harder all round

• Angry discipline is wrong discipline.
• Everyone gets angry with their kids from time to time, so it's important that you know how to calm down, and that you can teach your children how to deal with their anger, if they're getting cross too.

If you're concerned that picky eating is compromising your child's growth and development, consult your child's doctor. In addition, consider recording the types and amounts of food your child eats for three days. The big picture might help ease your worries. A food log can also help your child's doctor determine any problems.

NOTE: Remember that your child's eating habits won't likely change overnight but the small steps you take each day can help promote a lifetime of healthy eating ☺

REFERENCES:

1. Coping with a Fussy Eater, http://www.supernanny.co.uk
2. Children's nutrition: 10 tips for picky eaters, http://www.mayoclinic.com
3. ITS NOT ABOUT NUTRITION, THE ART AND SCIENCE OF TEACHING KIDS TO EAT RIGHT, http://itsnotaboutnutrition.squarespace.com
4. Feeding Picky Eaters, Ruth Carey, RD, CSSD, LD, June 24th, 2008 Nebraska School Food Service Association
5. Putting the Pleasure Back into Family Meals, www.ellynsatter.com

Is there any difference in this year's Flu vaccine (2012), since it changes every year?

Flu vaccine recommendations are issued every year by WHO. There are two sets of recommendations given for Northern & Southern hemispheres separately. The recommendations are given on the basis of the prevailing flu strains that are sent to the WHO lab from around the world in the last one year.

So the answer to your question is Yes, after 3 years of being the same, this year's Northern hemisphere vaccine is different from the previous years recommendations.

There are 3 strains in the Flu vaccine, out of which the H1N1 (Swine flu strain) remains the same. The other strains. 

• The old A/Perth/16/2009 (H3N2)-like virus now gives way to the A/Victoria/361/2011 (H3N2)-likevirus.

• And the Victoria lineage B/Brisbane/60/2008-likevirus will be replaced by a Yamagata strain; theB/Wisconsin/1/2010-like virus. 

As far as India is concerned, this vaccine is likely to be available by September 2012, and you should ask your Pediatrician if it is needed for your child.

If you have any other vaccine or child related query, or any comments, please let us know,

What parents feel about doctor's using terms that may stigmatize overweight kids?

In light of the importance of provider-patient dialogue and trust in managing obesity, this interesting article reviews the need to avoid terminology that either stigmatizes or discourages overweight individuals from addressing their weight problem. In addition, the authors discuss using terms that parents and patients might find motivational and could help providers manage the growing number of overweight children.

Methods. This study surveyed adults who were part of an international pool of survey participants in 2010. The respondents included 445 parents who had a child between 2 and 18 years old. Almost 60% of the respondents were women, 71% were white and 13% black, and 44% had at least 1 overweight child. More than 50% of the respondents were either overweight or obese on the basis of their reported height and weight, from which body mass index (BMI) was calculated. Just over one fourth (26%) of respondents had been teased or discriminated against because of their own weight, and 43% of the respondents had at least 1 child who was teased or discriminated against because of his or her weight.

During the survey, the investigators presented 10 terms in random order and asked the respondents to score them on a 1- to 5- point scale with respect to the term's desirability for clinicians to use when referring to their child's weight. The 10 terms were:

• Extremely obese;
• High BMI;
• Weight problem;
• Unhealthy weight;
• Weight;
• Heavy;
• Obese;
• Overweight;
• Chubby; and
• Fat.

The respondents rated, on the same scale, the degree to which each of the terms was stigmatizing as well as the degree to which they thought each term would motivate a child to lose weight. Finally, the participants were asked to respond to a question about how they would react if their child's healthcare provider referred to their child's weight in a way that made the child feel stigmatized. Options for that question included "speaking with doctor, avoiding future appointments, encouraging the child to lose weight," and other options.

Findings. With respect to the desirability of terms, the term "weight" was considered desirable by the greatest number of respondents. Second in rank was "unhealthy weight," followed by "high BMI." Those 3 terms were ranked very closely together by the respondents. The next 2 preferred terms were "weight problem" and "overweight." Five terms were considered undesirable: heavy, chubby, obese, and extremely obese., The term "fat" was the least desirable of the 10 terms.

When the parent was asked how stigmatizing the term for the child's weight would be, the order of responses was almost identical, with "fat" being the least desirable and "high BMI" being the least stigmatizing. The least desirable terms were also felt to be the least encouraging with respect to weight loss, whereas "unhealthy weight" or "weight problem" were the words that would be most encouraging to actually lose weight. Most (68%) parents reported that they would react to the use of a stigmatizing term by encouraging the child to lose weight, and 50% reported that they would discuss more encouraging terms with the provider. However, 35% of the parents reported that they would search for a new provider, and 24% would avoid future medical appointments. The investigators concluded that the terms "weight" and "unhealthy weight" were the terms preferred by parents for providers to use when referring to a child's weight problem and that the terms "fat," "extremely obese," and "obese" were the least desirable. They were also viewed as the most stigmatizing words.

Viewpoint

I wonder how many providers felt that we were actually improving the situation when we began to use more objective terms such as "overweight" and "obese" as defined by Centers for Disease Control and Prevention's BMI percentiles? It certainly makes sense that the term "unhealthy weight" would be preferred, focusing on the goal of improving health and not stigmatizing an individual. This seems to be something that both patients and providers can get behind and support. Therefore, it might be worth making the term "unhealthy weight" part of our daily lexicon as one more weapon in the ongoing fight against childhood obesity.

Source

Abstract

Commentary: In India, most parents call an overweight child as being 'healthy'. Hence the term 'unhealthy weight' is not only less stigmatizing, but also confronts this issue head on! I would suggest that given the increasing problems related to obesity in adults (cardiac hospitals are the one of the fastest growing healthcare segment in India) it is imperative for Pediatricians to identify this problem in children, avoid stigmatizing the children/ parents, & encourage 'lifestyle changes' that focus not only on the child but the entire family to help the child lose weight.

This still remains the 'sweetest' & most effective home remedy for childhood cough !

Honey is more effective than a placebo in controlling nighttime cough in children with upper respiratory infections (URI), according to the results from a new randomized placebo-controlled, double-blind trial. The results were published online August 6 in Pediatrics.

The World Health Organization recommends honey as a nighttime treatment for coughing in young children with URIs. However, prior studies either tested only a single type of honey or were not blinded.

In the current study, children with URIs and nocturnal cough were given either 1 of 3 different honey products or a placebo 30 minutes before bedtime, based on a double-blind randomization plan. The primary outcome evaluated was a subjective change in cough frequency, based on parent surveys. Secondary outcomes measured included a change in cough severity, the effect of the cough on sleep for both the child and the parent, and the combined score on the pre- and postintervention surveys.

"The results of this study demonstrate that each of the 3 types of honey (eucalyptus, citrus, and labiatae) was more effective than the placebo for the treatment of all of the outcomes related to nocturnal cough, child sleep, and parental sleep," the authors write.

The researchers enrolled 300 children with URIs, aged 1 to 5 years, who were seen at 1 of 6 general pediatric community clinics between January 2009 and December 2009. Patients were eligible if they had a nocturnal cough attributed to the URI. Children were excluded if they had symptoms of asthma, pneumonia, laryngotracheobronchitis, sinusitis, and/or allergic rhinitis. Patients who used any cough or cold medication or honey in the previous 24 hours were also excluded.

Parents were asked to evaluate the children the day of presentation, when no medication had been given, and then again the day after a single dose of 10 g of eucalyptus honey, citrus honey, labiatae honey, or placebo (silan date extract) had been administered before bedtime. Pre- and postintervention subjective assessments were obtained using a 5-item Likert-scale questionnaire regarding the child's cough and sleep difficulty. Only those children whose parents rated severity as at least a 3 (on a 7-point scale) for at least 2 of the 3 questions related to nocturnal cough and sleep quality on the preintervention questionnaire were included.

Of the 300 patients enrolled, 270 (89.7%) completed the single-night study. The median age of these children was 29 months (range, 12 - 71 months). There was no significant age difference among the treatment groups. Symptom severity was also similar among all 4 treatment groups.

The authors acknowledge the limitations of the study, including the subjective nature of the survey and the fact that the intervention period was limited to a single dose. In addition, they note that some of the improvement measured may be attributed to the natural progression of URIs, which may improve with supportive care and time.

"Honey may be a preferable treatment of cough and sleep difficulties associated with childhood URI," they conclude.

Pediatrics. Published online August 6, 2012.

 Source

Commentary: I find it exciting to see traditional Indian home remedies (daadi maa ke nuskhe - Grandmother's recipe's) finding favor in International Scientific studies! I believe that the power of observation has a lot to do with it, and this is how the older generation managed to find many remedies that were quite effective, reliable, cheap and with limited side-effects.
Pediatricians in India are even more liberal with the use of honey, and many of us actually use it for infants too, since we do not seem to have cases of Infant botulism, as reported in the Western literature from use of honey at this age. Plus it is a well accepted remedy by parents & grandparents too, which does play some part in acceptance of treatment in younger children.

Can I eat chinese food during pregnancy ? Is there any problem in eating ajinomoto (monosodium glutamate) during pregnancy?

I had a pregnant lady asking me about having Chinese food, since she read worrying things online regarding Ajinomoto's (MSG) effect on the developing baby.
After researching online, here is what I found to be the most relevant ( & logical) information regarding eating Chinese food in pregnancy...
"If MSG doesn't bother you when you're not pregnant! Monosodium glutamate (MSG) is a natural component of many foods. It's a salt of the amino acid glutamine, and we always have some MSG in our bodies. Plus, it's commonly used to enhance the flavor of many foods, especially Asian food.

The Food and Drug Administration (FDA) has been testing MSG for years and rates it "generally recognized as safe." However, the FDA requires that all foods containing MSG include that information on the label, because some people develop an adverse reaction to it, whether pregnant or not.

In people who are sensitive to it, MSG can trigger headaches, nausea, vomiting, dizziness, and sleep disturbances. So you may want to avoid it during pregnancy, especially if you were sensitive to MSG before pregnancy.

There's no evidence that MSG is harmful to a developing baby. In fact, it would be very difficult to ingest enough MSG to cause a problem. Even a large dose — which can cause nausea and vomiting even in someone who's not sensitive to it — wouldn't pose a known risk to a developing baby."
Source
So, as with many other chemicals found routinely in our foods, moderation may be the key while consuming outside food during pregnancy.
For those who are big fan of Chinese food, it may be worthwhile cooking it at home, so that we can avoid MSG. Another option would be to ask in the restaurant for MSG free food, since many higher-end eating places do offer this option.