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by Your Child Nutrition Expert Jill Castle

8 Things I Wish Pediatricians Wouldn’t Say about Nutrition

December 10, 2013 | In: Child Nutrition

I have been fortunate in my seventeen plus years as a mother to four relatively healthy kids–minus food allergies, a bout or two with iron deficiency, and broken bones– to engage with many pediatricians who have been terrific.

As a dietitian, though, I have heard from clients and friends about nutrition comments that don’t make sense in today’s world. Maybe it’s because pediatricians get little education in medical school on the topic of nutrition.  Yet, we also know that pediatricians are the frontline for childhood nutrition advice. While I would love to see pediatricians get more nutrition education in medical school, I am glad there is a wonderful resource in Fearless Feeding: How to Raise Healthy Eaters from High Chair to High School (shameless plug) for them. Hint, hint: this is a GREAT holiday gift for your doctor!

Here’s what I would love to stop hearing, and what can be done instead:

On picky eating:

“Let them go hungry. No child has ever starved themselves.”

Maybe, but there are some kids out there who will not eat. They will go to bed hungry, or days without eating. These kids often have a more significant form of picky eating, which needs professional help and investigation. With the higher rates of premature birth, more and more children are having difficulties with eating. A pat answer like the one above only further frustrates the parent, may endanger the child, and doesn’t help kids get the services they may need.

“It’s normal, you just have to wait it out.”

Yes, picky eating is normal, up to the preschool years. By the time kids enter elementary school, picky eating should be on its way out, and signs of food variety, adventurousness and pleasure with eating should be apparent. Sure, all kids have the right to dislike certain foods, but they shouldn’t be avoiding groups of foods, like vegetables, at this point. School-age picky eating is a sign that there may be more to the story such as sensory integration disorder, learned behavior, a medical condition or a combination of these.

On overweight children:

“Don’t worry, she’ll grow out of it.”

Today, most children classified as overweight or obese (a BMI over 85%ile and 95%ile, respectively) aren’t growing out of it. Why? Because our food supply is too delicious, too calorie-dense, and too available. And, as a nation, we are too sedentary. It’s simply too hard to be at a healthy weight without awareness and some changes in lifestyle habits. “She’ll grow out of this,” implies families don’t have to do anything–just maintain the status quo.

“Just give them more fruit and vegetables.”

Yes, give them more! But this isn’t the only solution. Sit for family meals as often as possible, dine out less, serve dairy (or non-dairy alternatives) with meals and water in between, scale back the Fun Foods like soda and candy, and move more. Please don’t imply there’s only one action to take. It’s OK to focus on one thing at a time, but let families know this is the beginning, and there will be more to come. Then, refer them out to a nutrition professional who can see them regularly and follow them routinely.

On eating disorders:

“She’s fine—her weight is normal.”

A teen (or child) doesn’t have to be rail thin to have an eating disorder. In fact, it’s not uncommon for individuals with eating disorders to be normal weight or overweight, and underweight is just a portion of the population suffering from eating disorders. Pediatricians really need to have their eyes wide open, because as early as six years of age girls start to express concerns about their body weight and shape. Forty to sixty percent of elementary school girls aged six to twelve are worried about becoming too fat, a concern that sticks around throughout their lifetime. These concerns are some of the most well-known precursors to the development of an eating disorder.


“This is just a stage.”

Many parents will come to the doctor with fears their child has an eating disorder. I can almost guarantee that these parents have sat with these fears for some time—trying to figure it out on their own. Parent’s concerns shouldn’t be taken lightly. Brushing off disordered eating or a potential eating disorder only allows the disorder to take root and gain momentum. Families need help and pediatricians are the link to that help. If it is in fact, just a stage, parents will be thankfully relieved to know so for sure.

“Make sure he eats.”

Yes, pediatricians say this, and so do Dads. As if you could possibly force a child or teen with an eating disorder to eat! I guess you could, but then he would find ways to lie to you, feel badly (maybe), and become more deeply entrenched in his disorder. If eating were the solution, then it would be an easy fix. With an average recovery rate of seven years, it’s clear that assuring a child eats isn’t ‘the only fix’ for an eating disorder.

On Underweight:

You need to fatten her up!”

Easier said than done, Doc. Many times, as you know, there are other ‘things’ going on with the underweight child, such as food allergies, picky eating, or medical conditions making it uncomfortable for the child to eat. Then, there may also be interactions between the parent and child that are unproductive—such as pressuring the child to eat more, or punishing him for not eating the right foods, or enough of them. My suggestion? Send that family to a nutritionist who can spend time getting to know the ins and outs of the family dynamic and work with the foods the child is willing to eat, building from there.

What have you heard that has made little sense, or has left you feeling frustrated?


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2 Responses to 8 Things I Wish Pediatricians Wouldn’t Say about Nutrition

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Jennifer Gardner, M.D.

December 10th, 2013 at 11:26 am

As a pediatrician that has founded an online child wellness and weight management company, I agree that some pediatricians offer advice that is not constructive or outdated.

But far more doctors that are on the front lines of picky eating, eating phobias, under or overweight, and eating disorders are making an impact on the health of their patients and families. Let’s not forget this!

Jennifer A. Gardner, MD, FAAP, Founder, Healthy Kids Company
http://www.healthykidscompany.com
http://www.facebook.com/healthykidscompany.com
https://twitter.com/HealthyKidsCo

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Jill

December 10th, 2013 at 11:47 am

Hi Jennifer–

Thank you for your comments–I agree that there are many who do great work, like yourself (thank you for that, BTW!). Yet, many docs are faced with these everyday parent concerns and either don’t have the time, the interest, or the knowledge to do it justice. We need more holistic pediatricians like yourself, who can see the big picture of nutrition as it relates to overall health and lifestyle. Would love to see the AAP take a bigger stand on the training for medical students/interns. I have had the fortune of working with two big training hospitals in my career, and they did a good job of training, but this was with a hospital-based angle…we need frontline docs to get up to speed on this topic. I’ll check out your website–thanks for commenting.

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