Exam Room Nutrition: Where Busy Clinicians Learn About Nutrition

23 | Just Take a Bite: How to Get Kids to Embrace Veggies

December 05, 2023 Colleen Sloan, PA-C, RDN Episode 22
Exam Room Nutrition: Where Busy Clinicians Learn About Nutrition
23 | Just Take a Bite: How to Get Kids to Embrace Veggies
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"My child won't eat any vegetables!" How many of your parents tell you that during a check up?! Parents feel like they're in a tug of war with their kids when it comes to veggies and they come to the pediatrician looking for answers. So today we're guiding you in the conversation about getting kids to eat their veggies. And no, it's not pressuring them to "just take a bite" and it's not bribing them with dessert. I am joined by Pediatric Registered Dietitian, Leah Hackney, to help me you navigate this universal parental challenge. 

In this episode, we unravel the mystery of getting kids to eat their veggies and share practical strategies that will not only make mealtime enjoyable but also lay the foundation for a lifetime of healthy eating habits.

Key Takeaways:

  • Understanding Developmental Stages: Learn how developmental changes around the one-year mark can impact a child's selectivity in food, especially veggies.
  • The Power of Modeling: Discover why modeling healthy eating habits in front of kids is one of the most effective ways to encourage them to embrace a variety of foods.
  • Family Meals Matter: Explore the significance of family meals and how incorporating favorite options can create a positive association with trying new foods.
  • Food Chaining: Uncover the concept of food chaining, building upon familiar foods to introduce new ones and gradually expanding their palate.
  • Avoiding Sneaky Tactics: Leah advises against sneaking veggies into meals, emphasizing the importance of honesty and involving kids in the kitchen.
  • Teeny Tiny Portions: Learn the art of introducing minuscule portions, allowing kids to interact with the food at their own pace without overwhelming them.
  • Managing Parental Stress: Leah reassures parents that children can meet their nutritional needs over multiple days, relieving the stress associated with daily veggie intake.

Join us for a fun and informative discussion that will transform your approach to pediatric nutrition. Ready to make veggies a source of joy, not frustration? Join us on this journey to raise healthier kids, one meal at a time. So let's start making veggies fun!

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Disclaimer: This podcast is a collection of ideas, strategies, and opinions of the author(s). Its goal is to provide useful information on each of the topics shared within. It is not intended to provide medical, health, or professional consultation or to diagnosis-specific weight or feeding challenges. The author(s) advises the reader to always consult with appropriate health, medical, and professional consultants for support for individual children and family situations. The author(s) do not take responsibility for the personal or other risks, loss, or liability incurred as a direct or indirect consequence of the application or use of information provided. All opinions stated in this podcast are my own and do not reflect the opinions of my employer.

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Colleen:

We all know that veggies are an essential part of a balanced diet packed with vital nutrients that support our immune system and gut health. But convincing little ones to take a bite can sometimes feel like an uphill battle. Parents have tried bribing and pressuring and begging and nothing works. Raise your hand if the parent of your patient says she just won't eat any vegetables. I hear this daily. My name is Colleen, I'm a pediatric PA and registered dietician, and this is the Exam Room Nutrition Podcast where each week, I'm giving you answers to common nutrition questions to help you be a more confident, compassionate clinician. On today's episode, we're sharing our strategies for getting kids to eat their vegetables, and it might not be what you think. Get ready for a mindset shift in how we educate our parents that will lead to lifelong healthy eaters who have a positive relationship with food and their bodies. You'll gain an understanding of childhood developmental stages and why kids become selective eaters in the first place, why family meals and modeling behaviors is vital, why sneaking foods is not always helpful and what an appropriate portion size looks like for kids learning to like new foods.

Colleen:

I am so excited to have my guests back on today. Leah Hackney is joining me and if you missed the previous episode we did, titled Do's and Don'ts of Weight Conversations with Kids. You'll definitely want to take a listen to that, as we taught you how to appropriately discuss a child's weight. Leah is a pediatric registered dietician in both the US and Canada. She works virtually with families all over the world to help families with infant feeding, picky eating and raising kids to have a healthy relationship with food. You can find her on Instagram at kidsnutritionist, and every time we have you on the show, leah, our listeners just want more because you have such helpful, practical information. So thanks so much for being here.

Colleen:

Welcome back to the show, leah Hackney. Thank you so much for having me back. Well, I know our topic today is going to be very impactful with a lot of people, because we're going to be talking about veggies and we know how important vegetables are to a healthy diet and there's just so much nutritional value to vegetables. But our kids don't tend to like them very much, and so getting them to eat them can be very tricky. So I'm so excited to learn from you and helping us get our kids to go from hating vegetables to maybe liking them. I'm going to just give you the floor to help us work with our parents when they ask us what do I do? My child's won't eat any vegetables.

Leah:

I love this question because there are so many different approaches. But as a practitioner you have that 15 minutes and really at the end of it all you can do is hope that you either planted a seed or maybe gave them one piece of advice that they can take and actually implement in their life. So what I start with is really understanding where the child is at developmentally and also educating the parents on appropriate developmental changes that actually do affect eating in kids. So we know, around the one year mark, research indicates that there is going to be an increase in selectivity. We have changes in body autonomy. We have different self-awareness levels with the child and we have the child navigating, self-feeding in a way, and their own body autonomy where no is their favorite answer, even if they ate something as a baby they loved broccoli it's really common developmentally to see food rejection and or selectivity in toddlerhood. So I find that educating parents on the fact that there are going to be some stages in life where developmentally you will encounter food rejection, but how we navigate that in the meantime determines whether it gets worse or better or something that we can kind of help in the long run. So, for example, with vegetables, younger kids really may be very sensitive to those green vegetables that we're all told Everybody needs to eat.

Leah:

For some kids, especially in this selective developmental stage, they may taste very strong, very bitter. They may be something where it's just a texture and a taste that is really hard for them to navigate and on a biological level, their brains may be actually red flagging for them. Hey, this is something that is strange, this is something that is off On a biological level. There is some research that indicates something called food neophobia and there is some debated research on this. But we do know that there is a theory where the reason why toddlers may reject certain foods is on a biological level. It's kind of an evolutionary way of the brain saying hey, don't eat. That you know. They are now more mobile, they're self-feeding and in nature certain plants taste very bitter. That may not be something that they should eat, and or their brains and their development may not be able to indicate the difference between that house plant that they shouldn't eat versus the broccoli on their plate that they shouldn't eat.

Leah:

So encountering that with parents and educating on what is developmentally appropriate is something that I would first start with and I would just let them know, I would say hey, did you know that around this year mark and potentially for the next few years, you're going to be encountering some food selectivity? Just so that they're aware. The next thing I would say after that is I would say so, don't give up and don't stop offering. So I would actually then ask them next what are your favorite vegetables? What are your favorites? How do you like to eat them? And really I would then emphasize that modeling eating the foods that we enjoy in front of kids is one of the best ways to help them have a healthy relationship with food for their life. It's one of the strongest bits of research we have. We actually know that modeling eating these foods and enjoying them not necessarily for the pursuit of thinness, but for the pursuit of enjoying them that is something that can really be a huge impact on their relationship with that food.

Leah:

The other thing that I would mention too is see, I know it's not always reasonable for a lot of families nowadays, but are they eating together as a family, not just seeing the parent eat the vegetables, but are they eating them together as a family? I find having some meals if they are closer to that four to five year mark, having some meals family style where they have multiple options on the table, always having one option. You know that they love to really help getting meals started, to help get that eating going, to help getting that that hey, oh, I'm ready to eat, there's something on the table that I like and enjoy they are going to be more likely to want to try other foods on that table. So, family style meals when you can, whatever that looks like, that looks like once a month, hey, do it. If that looks like multiple times a week, go for it. But we do find that eating together and eating those foods in front of them is really impactful. So I would just ask them about that and see is there something realistic or realistic time where you find you can sit and eat the same foods with them? Always make sure there is a favorite on the table so that they can feel comfortable with the table eating, so it doesn't feel like we brought them to the table to only eat a bowl of broccoli or whatever like that. That's not the goal.

Leah:

I also want to educate parents on being okay and understanding that it will be met with rejection. Offering multiple times will still be met with rejection. So really educating parents that it is a long-term goal, not necessarily something that is immediate. I say that too because we do know that pressure can really backfire. I find there are very few kids where you can just say, eat your broccoli, and they eat it, and there's no fuss and they just eat it. I find that's the exception. If you have one of those kids, that's amazing. I don't know how. How do you have those kids? But for the most part, most children really do value their body autonomy at meals. So I tell parents to really let go of that pressure that we've served it and they have to eat it. So really letting them see that the rest of the family eat it. They know that it's a food that the family eats. They will see it on the table, but again, we provide the food. They decide if they eat it or not. That is kind of the gold standard and pediatric feeding, the division of responsibility founded by pediatric dietitian. So be okay with food rejection, and I educate parents that it can take up to 15, maybe even 20 plus times before a child will learn to eat it or try it or lick it.

Leah:

Also, I like to tell parents that the process of them, eating a food is not linear.

Leah:

It doesn't necessarily go from.

Leah:

It goes onto their plate. They pick it up with their fork or their spoon or their hands and then they eat the food. The eating process actually begins before it's actually eating. They are thinking about the food or their experience around the food is built up before they're actually getting to the table. So consider that Were they involved in the process of picking out the food? Did they see it at the grocery store? Were they helping with washing the food? All of these little experiences actually build positive experiences with that food on touching it, smelling it, without pressure to eat it. Then that builds a foundation to where, by the time it's actually on their plate, they feel more comfortable, they feel safe eating it. They feel like, oh, this is something that I might actually want to try. We really want to kind of foster that internal motivation for that food versus that external pressure and external hey, they have to eat it, they have to eat it, they have to eat it. So really tell parents it's going to be a long run, it's not going to be immediate.

Colleen:

Hey, we'll get back to the episode in just a moment, but I wanted to give you a gift for hanging out with me today. I want to give you access to a free guide that gives you a step-by-step strategy to navigate a talkative patient. You know the one who rattles off 10 different concerns the minute you say so how can I help you today? I've been there, trust me. So I created a simple framework called STEER that will allow the patient to feel heard and keep you on time. The patient will feel respected, their concerns will be addressed and you won't be constantly running late. In this free PDF, you'll learn this simple acronym to guide your conversations, and I have included useful phrases you can use that will completely transform the way you talk to your patients. It's all free and it's my way of saying thank you, so check it out in the show notes below. Now let's get back to the episode.

Leah:

The next thing I want to address is the idea of sneaking foods in versus adding foods in. Sneaking foods can feel to some kids, especially when they're older, a little bit deceptive and it can break some of the trust and it can actually turn them off to rejecting not only that food that you tried to sneak in but the whole meal or plate and even if there are other parts of that meal that they would have eaten normally. For example, if they found out that something was sneaked into a sauce and then all of a sudden it's like well, I normally eat this, but now I won't. So I find you know your child best. If they are comfortable with foods or vegetables being added into some of their favorites, and that's awesome, that's a great way to do it. But I call that adding because it's a little bit more of like hey, this is just the recipe. The recipe calls for shredded zucchini in this or zucchini muffins. They have zucchini in them. That's exactly what it is. So really take a moment as a practitioner and to kind of just say you know, I really recommend being as honest as possible about the process or about the food and the best way to just go up to the adding process versus sneaking process is just to have them in the kitchen and just to have them help make that food. So that actually kind of negates the whole need to even sneak something in.

Leah:

The next thing that I want to mention is that adding favorite sauces, adding spices, adding butter, adding fats does not take away from the nutrition of that vegetable. There is still nutrition, there is still fiber, there's still vitamins and minerals. And do not get caught up in the cooking process. Online you will see some things like if you boil broccoli you lose all the vitamin C, but there are so many other things that broccoli can still offer, even if you have boiled it and lost a specific amount of nutrients due to the cooking methods. That is something that is entirely inevitable. When you cook something, certain nutrients will get altered. So if they do kind of ask that question, really just emphasize that I like to say adding favorite sauces, adding something that is a favorite, combining a favorite with the vegetable, does not take away the nutrition of the vegetable. If they're loving zucchini muffins and the zucchini muffins have a little bit of sugar in them that muffin may be a gateway to learning another food that has vegetables in it, or it may be enough of a positive experience for them to where they are willing to try vegetables a different way. So I always say any food is a good starting place to learning a new food.

Leah:

So don't stress about the vegetable or the whatever it is that you're working on them off eating. Don't stress about dips, sauces or anything else. As a practitioner I say go for it If they want to dip their broccoli in ketchup. That does not take away the nutrition from the broccoli. I would really just educate them on what's developmentally appropriate and then see if you can actually food chain.

Leah:

So what I mentioned at the last part of the conversation it's technically called food chaining.

Leah:

We're building upon foods your child loves and you're adding nutrition.

Leah:

You're adding things to the vegetables to improve the flavor, flavor, mask the food, make it a little bit more acceptable.

Leah:

The final tips that I would have is teeny tiny micro portions, like teeny tiny.

Leah:

And when we think teeny tiny we think okay, maybe one piece of broccoli like I'm thinking smaller, I'm thinking like the tiniest broccoli stem.

Leah:

That is like placed on their plate and it is a little bit less assuming. So teeny tiny portions with the understanding that they may only eat the favorites on the plate during this season in their nutrition, but understanding that you are still creating positive relationships and experiences with that food by modeling, eating it in front of them, by not pressuring them to eat it, and understanding that that tiny, teeny portion on their plate, one day they may interact with it, they may decide they want to try it and that teeny, tiny portion can grow with time. So letting parents know that it is not a linear process, it does take time and that I always would in the conversation with if meals are feeling stressful, if you are finding that you are having a lot of food battles, a lot of back and forth with your child, if you find are there rejecting foods and you're worried about their growth, I can refer you to a pediatric dietitian or a speech language phologist to help navigate, moving towards a goal that they're looking for.

Colleen:

Oh, what excellent pieces of advice, and I am a fan of the dips and suggesting that they can use any sauce that they want, no matter how weird and gross it sounds. To us it might not be weird and gross to the patient and I always tell them that I don't care if they're dipping their carrots in barbecue sauce. If they're eating a carrot it's a win, so I love that you mentioned that and you know I'm a pediatric PA, so I'm fun and goofy and silly all the time, and I think creating a fun environment for kids around food allows them to feel less stressed to try it and maybe just kind of play and interact with it for a while before they even try it. But it takes that pressure off of them when they feel like they can have fun playing with dips or playing with some different sauces. So thank you so much. Those were some extremely useful strategies and techniques that we can introduce to our patients and parents to help them navigate vegetable eating.

Leah:

I think what you emphasized on making things fun is also incredibly important, because that also takes the pressure off of parents. It's so easy to get caught up on your child eating a certain way and I think, as a practitioner, sometimes they need to hear that. They need to hear that your child does not have to eat a certain way or the way you see on social media, in order for them to be healthy and grow and have a healthy relationship with food.

Colleen:

It's a great point because I'm a mom and you know social media has just made everyone's lives perfect, whether it's eating or fitness or work or whatever. You just think that there's this alternate reality of like perfection and everybody's child is perfect and it's. It is very reassuring to have someone tell you it's okay. My child didn't eat any vegetables today either, so less stress is very helpful. So I love to close out the segment by asking you, as the expert, what is one thing that our clinician should never say when it comes to encouraging patients or parents to help their children eat vegetables. So we've talked about all the things we should do should say what is one thing that is extremely unhelpful and we should avoid at all costs.

Leah:

I think the one thing that I would really emphasize practitioners not to say is it shouldn't be vegetables at any cost. It shouldn't be that well, you have to get them to eat their vegetables, so just sneak it in or just add this or just, you know, tell them to eat it, because we have the research that that is not going to work for a large amount of the population. So I would really just try to emphasize that, talking about the food to parents, they know that the vegetable is something that is a goal already because they're asking about it, so they don't necessarily need to be shamed. And or the patient doesn't necessarily need to be shamed. I'm like, well, why don't you eat this? So those questions of like the why don't you eat this, or why aren't you doing it this way, or you know, those are things I would definitely avoid saying.

Colleen:

That would be probably one of the answers for that question I'm sure there's many right the things that we should say versus the things that we should not say. Sometimes one outweighs the other. I tend to encourage parents not to compare children. So I'll often have, in a visit, the parent telling the child well, come on, you know your sister eats her vegetables, no problem. Why can't you just eat your vegetables? And I feel that that is extremely unhelpful. And now you're judging and you're comparing them to a different standard and a completely different child. So when I'm educating my colleagues, I always recommend they don't even mention any other sibling or mention any other family member and asking why they aren't like them, because they're their own human being and they have their own preferences and their own struggles and things that they're working through.

Leah:

I love love, love that. And one thing that, even though this is slightly unrelated to what you just said, one thing that did come to mind in terms of educating the parents that I do find is really helpful to ease the vegetable intake worries is educating and saying that kids meet their nutrition needs over multiple days and or the week. So even us, as adults, we do not need our nutrient needs every day. Even bodybuilders or people that are tracking every single nutrient it is so variable on how you move and drink and how your body works you know the tablets and there are so many factors and that kids can grow to have a healthy relationship with food and they can grow and not have a vegetable in a day or multiple days or even a week, and that they can still meet their nutrient needs and that the goal of a vegetable can be something for the future and that again, I would probably circle back to that it doesn't need to be vegetables at any cost.

Colleen:

What a great tip to end on. Leah, you are truly the expert in this area and we are so grateful for your practical suggestions and useful tips to help our clinicians have impactful nutrition discussions and, hopefully, my listeners, you guys, glean something from this conversation and you can take some of these strategies and incorporate it into your next wall check, leah. Thanks so much for being here, until we see you next time. Thank you All right guys. Now it's time for my nutrition notes. This is where I'll leave you with a nutrition tip, an interesting quote or a fascinating case that I came across. So today I'm going to leave you with my nutrition tip and helpful way to get kids to try veggies.

Colleen:

Leah had some excellent advice and tips and I wanted to share one that I use personally with my daughter when she was younger. So I love cauliflower and I always would cook it in the oven with a little bit of olive oil and garlic. But she did not like it for years. She would not touch it, she would not taste it, she would not try it. She said it was yucky and I really wanted her to try some cauliflower because it was an easy thing for me to prepare. So one day, in all my frustration, I was preparing the cauliflower and I just cut off a floret and I just said to her here, do you want to try this? She tried a plain, cold, crunchy cauliflower floret and you'll never guess what she said this is yummy. So I wanted to leave you with this piece of advice.

Colleen:

Just because you like a food prepared a certain way doesn't mean your child would so. Explore with different techniques of cooking. If you're used to cooking in the oven, consider maybe sauteing it on the pan with some butter. If your child doesn't like it warm, maybe consider just serving it to them raw. They might like things cold and crunchy, whereas you like things warm and mushy. Additionally, think about different flavors. If you always prepare your things salty or a little garlic, maybe make it plain for them. Or maybe they might like it with a sweeter dip, like Asian sauce or barbecue sauce or even some ketchup. So I encourage you if you've got a picky eater and you're trying to get them to try some vegetables, try to prepare it in different ways. You might be surprised.

Colleen:

Well, guys, thank you so much for being here with me. I really cannot express just how grateful that I am that you're listening, that you're hanging out with me and I hope that I'm presenting really valuable information for you. So if you have any questions that you would like me to have a dietician feature on this podcast, I would love to hear from you. You can send me a message at Exam Room. Nutrition If you haven't already, please share this podcast with your colleagues. I would love for more people to gain some valuable insights that would impact the way that they practice and the way that they care for their patients. As always, let's continue to make our patients healthier, one exam room at a time. I'll see you next time.

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