eNutrition
a LaFrance Consulting Services™ e-Course
Nutrition for Nursing Students, independent study

All mothers, new or experienced, need to remember that there is nothing in the job description (for Mother) that includes “short-order cook.” If Mom is going to cook, she also gets to plan the meal (as table d'hôte, or Chef's choice); and all family members are expected to eat what the Chef serves. [If Dad is the Chef, he can not be a short-order cook either].

Child

Growth and development continue for up to about 22 years, but after the initial growth to toddler, growth tends to occur in “spurts.” Although the nutritional needs will approach adult levels by the end of growth, it is not a steady decline from the high levels for newborn through toddler years. At the onset of a growth spurt, the nutritional needs will increase (but not as high as for the previous growth spurt because each growth spurt adds a smaller percent increase than the previous growth spurt), then drop back to maintenance levels (close to adulthood). As long as the child was not taught as a toddler [or later] to overeat nor to be a picky eater, he/she will intuitively adjust his/her food intake to match his/her nutritional needs for Calories (carbs and fats) and for protein. Unfortunately, the intuitive adjustment of vitamin and mineral intake requires enough maturity (emotional and cognitive) to suppress the urge to override the intuitive craving for vegetables. As a result, considerable teaching of feeding skills is still necessary. By the time the child has outgrown the toddler stage, he/she should have learned to operate eating utensils efficiently. They can now feed themselves with minimal assistance, but have little or no grasp of what they ought to eat. Given free choice of foodstuffs, they will base their choices solely on pleasure derived from tasting the foods. Meanwhile (according to my hypothesis for the mechanism that allows Humans to adjust food intake to nutritional needs intuitively) the child is accumulating the sub-conscious memory of the nutrients provided by foodstuffs [based on nutrient data collected by the hypothalamus] plus the amount of pleasure to be gained by eating the foodstuff. Once this memory is sufficiently complete, the child will have the capacity to regulate nutrient intake intuitively, although willingness to do so may not happen for several more years. Clearly, however, the child can never develop the subconscious memory of the nutrient content of spinach, broccoli,… unless they are required to eat these items.
    It becomes the responsibility of the parents not only to provide nutritious foods but also to provide educational guidance [by modelling feeding skills behaviors] toward obtaining nutritients wisely. The first thing that needs to happen is for at least the evening meal to be “family time,” because this usually can make the meal a pleasant experience [provided it does not become an opportunity for the parents to yell at the child about perceived misbehavior; the child should not be expected to exhibit socially correct behavior until they have learned what is considered to be socially correct behavior based on positive feedback from the parents]. When a meal is a pleasant experience, it can promote eating slowly [if for no other reason than to prolong the pleasant experience]. It has been suggested that persons who eat slowly tend to maintain healthy weight while fast eaters tend to gain weight. My experience (as a slow eater) tells me that slow eaters also have more time to taste their food, and will seek out foods with better taste (and frequently those that are higher in nutrient density). Fast eaters seem to spend less time observing the taste of food, and tend to select high carbohydrate food because of the lower taste sensations associated with such foods. Preschool, and to a lesser degree school-aged, children rarely purchase their own food, so they must eat whatever the parents provide. Eventually they will grow up and become grocery store customers, but need to begin learning as pre-schoolers what they should shop for when they get old enough to shop for food-like substances. Toward this goal, the parents ought to provide a variety of healthly foods, with particular attention to nutrient dense foods. The dinner plate ought to include a reasonably small serving of protein dense food, plus vegetables (vitamin dense vegetables such as dark green leafy vegetables, and carotene [red, yellow, orange] dense vegetables such as carrots, [bell] peppers, squash, … ) and fruits. The child should be permitted not to like some foods, but only after they have tried a full bite. A week or so later, the same food they did not like can be re-presented. This time when they declare that they don't like it, you would ask if they have tried it before (they usually won't remember; and if they do, tell them it is prepared differently this time, and ask them to try it). After about three tries, you have to allow them to not like the food item [but you can try again after several months]. At some point during the meal, the child will want to stop eating. Assume that this means that they are full, and let them be done [otherwise, you are teaching them how to over-eat and eventually become diagnosably obese]. Especially when you suspect that they are claiming to be “full” in order to get dessert, you should permit them to be too full to eat dinner, but not too full to eat dessert [the alternative is to teach them that the most fattening part of the meal (dessert, if the diet was designed correctly) is a REWARD for over-eating; almost guaranteeing that they can achieve diagnosable obesity before they enter High School]. On the other hand, the day will arrive when the child declines to eat dinner at all, and you suspect that they will later develop an appetite for dessert or snacks. This can best be handled by allowing them to be “full,” but do not excuse them from the table (it is family time, remember) and take their plate from the table to the refridgerator. Later, when they become hungry expecting a snack or dessert, take their dinner plate out of the fridge, forget that the microwave oven has been invented, and serve them the exact same dinner which they rejected earlier, except now it is cold and less pleasant. Again, they do not have to clean their plate; just eat some of each item on the plate. For most children, it will take very few of these events for them to catch on that they are expected to try the dinner when it is served; if you re-heat their dinner it will take longer for them to learn that you are not going to cook to their orders (since re-heating made you look very much like a short-order cook). The only snacks a pre-school child is going to eat are the snacks made available by the parents; and, until they begin talking to other children, they will think that what you do is “normal.” Snack foods can include fruits and raw vegetables. Cookies and candy are not required; the number of confirmed cases of clinical cookie deficiency in America is surprisingly small.

    The book, Deceptively Delicious by Jessica Sienfeld (HarperCollins, [Oct] 2007) suggests that you can trick children into eating vegetables by hiding them in other foods [mac & cheese; pizza; breading on chicken nuggets]. Prepare the vegetables by steaming fresh veggies, then puree them and add the puree to foods of similar color, or to desserts [cookies; brownies; cakes], for example:
      squash, sweet potatoes in macaroni & cheese
      cauliflower in mashed potatoes
The problem I see with this plan is the risk that the intuitive food - nutrition memory will be confused by this plan. The hypothalamus may determine that mac & cheese is a good source of beta-carotenes and some vitamins, and the patient will crave mac & cheese rather than a vitamin dense vegetable.

nutrition problems

Since the parents are responsible for all food choices available to the young child, any nutrition problems are the parents' problems, not the child's [but the child has to live with any deficiency or over-dose symptoms]. The most serious nutrition problem (of young children) I have seen in young adults is the failure of the parents to teach the children, at pre-school age, the critical feeding skills: selecting nutrient dense foods, and eating only until satiety is achieved. There are two “Don't do it” cautions for the proper nutrition education of children pre-K to 8th grade: avoiding artificial ingredients, and providing young children with “heart-healthy diets” designed for 30 to 50 year old adults.
    Avoid artificial ingredients to the extent that it is possible, but based on reading Nutrition labels in grocery stores I suspect that artificial ingredients can no longer be avoided in 21st Century America. Due to the controversies and claims of adverse long-term health effects of the artificial sweeteners, there are increasing numbers of recommendations to avoid these substances with children. With young children, the best way to avoid artificial sweeteners is to reduce the use of all sweeteners, so the child will not learn to expect everything to be over-sweetened. Remember until they talk to other children, they will assume that what you do is normal. My children did not learn until they had Kool-Aid™ at a friend's house that their Dad made the “worst Kool-Aid ever,” since I used less than half the recommended cup of sugar to a quart of Kool-Aid. My parents did not let their three sons add sugar to their dry cereal until we learned that other people [such as grandparents] engaged in this practice. My older brother and I still prefer foods with minimal sugar added, and neither of us made it into the upper half of “normal” weight range for our ages and heights until we were over 50 years old. We are also weird in that he is a “century” rider (has bicycled more than 100 miles in a single day more than once) and I have hiked over 3,000 miles in a single summer more than once.
    Low fat, low cholesterol diets are not appropriate for chldren of toddler and pre-K to 8th grade. Due to their rather rapid growth, they need the essential fatty acids and cholesterol in their diet. The Yuppie generation tried this experiment on their children and produced the first generation of children in the United States who failed (on average) to be taller than their parents, and were “stunted” due to inadequate growth hormone and anabloic steroid production [both hormones are based on the cholesterol molecule].
    Parental influence on the child's food choices is limited to the parents' home. At a friend's house, your child will have some choices available that are not available at your house, and if you have taught them correctly, they should want to try the new food options. At school, they will make choices than you would not approve for two separate reasons. The school menu is not nutritional sound (for example: a hot dog has long been considered to be a full meat serving and a handful of potato chips is a full serving of vegetables; and under the Reagan presidency, ketchup became [by Presidential proclamation] a vegetable for school lunch purposes). In spite of the assurances of teachers and school lunchroom personnel that it never happens, children in grade school learn to barter by trading lunch food items [at my granddaughter's school, during lunch-with-grampa, I observed a third grade boy with 3 ice creams and no meat nor vegetables]; they also trade for anything else whenever they can arrange a trade.

Adolescent

The best advice I can give anyone who has a child approaching the preteen and teen years is to “CHOOSE YOUR BATTLES.”
The adolescent is required to switch from parental enforcement of rules to setting their own rules. They WILL challenge parental authority; and must win some battles if they are to become responsible, ethical adults. Let them win the minor challenges, so you can stand firm on the critical issues. By now, your opportunity to teach them anything about feeding skills (such as nutrition choices) has passed. They will normally ignore this during the teen years. We can hope they return to healthly eating habits when they mature. But the first opportunity you have to question their nutritional choices, you should do so. They will, of course, object and argue. After a brief “discussion,” back down gracefully. They just won a battle over their right to control their own life, but only because they had to argue their case [without the argument, it doesn't count as a victory in their mind]. From now on you can monitor for signs of eating disorders [both sexes], but otherwise they are on their own. At home, you should try to keep the evening meal as “family time” but don't worry too much if the kid(s) don't always attend (as long as they can provide an acceptable excuse.
    I would suggest that the critical issues where you should retain control until they go off to college (or life) are: alcohol consumption, street drugs, promiscuous sex, and (for athletes) performance enhancing drugs and supplements.



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revised: 15 Jun 2009