Wednesday, December 04, 2013

toddler eating + ellyn satter

at annabel's 18 month checkup, our pediatrician looked at me somewhat sternly.  she was still on the curve for weight, but riiiiight at the top.  and at 65% for length [somehow], this apparently put our MD on guard a little bit.

and for a while after this visit, i have to admit that i was too.  for the record, i think that annabel is the cutest, most beautiful child i have ever seen [not that i'm biased or anything :) ].  i love her squeeze-ability, her sturdiness.  and i know her diet is quite healthy!  she isn't terribly picky [though getting pickier . . . ] and drinks zero juice, loves water, and eats the same things that josh and i eat [no mac 'n' cheese habit!].  but after our ped commented, i did start to get a little worried.  i think that this is because i happen to work in a field where i see frighteningly overweight children quite often.  10 year olds pushing 200 lbs who are debilitated by their size.  6 year olds who outweigh me [or they did in my non-pregnant state].  depressed teens who are physically and emotionally paralyzed by an extra 150+ lbs.  i'm not saying that this is true for every overweight 17 year old -- perhaps some are well-adjusted and healthy, and they just don't get referred to an endocrinologist.  but many that i have seen make me incredibly sad.  treatment often feels incredibly FUTILE, too.

and after that visit, i thought -- is our ped implying that MY adorable toddler is headed in that direction?  is it even remotely possible or likely?

it turns out that:

a) it isn't likely [this relatively well-regarded calculator gives her about a 4/1000 -- 0.4% -- chance of ending up with a true obesity issue during childhood]

b) it will be better for everyone -- EVERYONE -- if i just follow normal toddler eating recommendations, without worrying about it.

i learned this from reading child of mine, by renowned pediatric RD ellyn satter.  her book made so much sense to me and i felt so much better after reading it.  the guidelines are laid out for EVERY child - those on both sides of the spectrum, and also right down the middle.

the main guise of the book:
parents are in charge of deciding what, when, and where children will eat.

children [from infants to teens] are in charge of whether and how much.  satter believes [and i do, too] that with a variety of healthy food provided, kids [and even adults, but that can be tougher] will self-regulate and find their natural set-point.  some kids will be smaller, and others bigger.  and both are ok!  but most likely, they won't self-regulate to an unhealthy point.

some of her more specific recommendations included:

-- offering 3 meals and 2 snacks [where 'snack' does not have to mean unhealthy - often can be just as nutritious as traditional 'meal' offerings] daily, in a predictable fashion

-- meals and snacks should be eaten at the table, not while playing

-- keeping mealtimes casual and never pressuring a child to EAT MORE / EAT THIS / STOP EATING / etc.

-- always provide at least one item on the plate that the child likes -- even if it's bread, rice, a fruit, whatever -- but do NOT cook/cater to the child or do any short-order cooking.  [i have always been against the idea of 'kid food' and continue to be, so i loved this one.]

-- have family meals whenever possible.  i wish we did this more - it's the one area where i am failing a bit.  we always have breakfast together, and of course lunch and most dinners on weekends.  but weekday dinners are tough.

-- sometimes allow for treats, to avoid them becoming 'forbidden fruit'.  we don't give annabel dessert-type foods regularly, but maybe one treat-type food [a cupcake, cookie, whatever] something like weekly.  [it's worth it alone just to hear her pronunciation of 'cupcake' = 'tup-tate.'  omggg.]

i really just loved her overall tone, and for me the absolute best part was that i realized exactly what were my responsibilities [see above] and what i truly should not worry about.  in the absence of a syndrome or endocrine disorder [which i can say quite confidently that annabel does not have :) ], children will learn to self-regulate.  in the end, all i can hope for is that she has a healthy and happy relationship with food to stay with her forever.



#1: just for the record, i was quite a chubby baby/toddler, too.  i was also TALLLLL - my 18 month stats put me at 95% height!!  josh as a child was super short and super scrawny [sorry babe, you were!  but you were still cute], and grew like 4" after graduating from high school.  so parents - don't assume that your kids will look the same as adults as they do as toddlers.

#2: one issue i did have with the book was that satter does not really address the potentially bad habits that are out there today -- candy/junk in classrooms on a daily basis [not just as treats], juice as default beverage, etc.  for the records, i DO think there are things that can interfere with self-regulation and they are not always easy to avoid.  but that tends to be more of an issue for older children.

#3: i am now trying to bring these recommendations to my practice when appropriate, and have recommended satter's books to a few parents.  i'll have to let you know if i get any feedback.


and on another note:
YOGA.  a knows tree [shown below], warrior [sort of - she forgets the arms] and down dog.  omg, i love this age.