All About Eating – PediaCast 067
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Topics
- Hungry All the Time
- Good Eater, Slow Growth
- Skimpy Eater, Slow Growth
- Picky Eater
Transcription
Announcer: This is PediaCast.
& [Music]
Announcer: Welcome to PediaCast, a pediatric podcast for parents, the listener edition. And now direct from Bird House Studios, here's your host Dr. Mike.
0:00:25
Dr. Mike Patrick: Hello everyone and welcome to PediaCast, its episode 67, the listener edition for Tuesday, October 23rd, 2007. Hungry and not so hungry kids. Also welcome to those of you who are watching live at stickam.com, that's S T I C K A M dot com. And if you go there and I had mentioned couple of nights ago, actually I think Friday and then again yesterday then I'm going to try to do this every night sometime between 7pm and 8pm. My son who was down here when I was recording part of it, after I was done he said dad they don't necessarily know what time zone you're in. I forget that the show has a global reach so I am in the Eastern Time zone, eastern daylight time we're still on but we should be switching to Eastern Standard Time here soon.
0:01:22
But even if you are here between 7 and 8 eastern time, you still wouldn't miss me cause I'm looking at the clock now and it's 10pm eastern time so sorry about that. So all I can say is check in from time to time.& I'll figure out a way here soon to put a note up on the site with a link to let you know if we're actually recording like hey we are recording now, what the link to get you to stickam. But if you do want to participate in that you have to be a member of stickam. It doesn't cost anything.
0:01:55
Sign up for membership and then you want to add PediaCast as a friend. I think you request it and then we have to say its okay. But you don't have to be a friend of PediaCast to listen or view the show but you do have to be a member of stickam. So make sure you go to STICK like stick, AM like the old am radio, STICK AM dot com and check us out there. I do want to mention that we are definitely thinking about all of you in Southern California who's dealing, who are dealing with wild fires right now. As most of you or some of you know we did take a family vacation to Southern California couple of weeks ago, spent time in San Diego and then Orange County. And so a lot of these places that we're hearing about in the news, we were just there and I know the folks are just so friendly and just hard to go out and hopefully everyone's okay.
0:02:52
I do have one funny story for you. I tried to include these as much I can without getting into you know, who exactly it was because of the patient confidentiality. When kids say funny things I can't help it to share those. I had a kid in the office when I was talking to the mom, actually his brothers and one of the older brother was there and he needed a hepatitis A vaccine. So I was telling the mom you know he's going to need his hepatitis A shot today and a few seconds later his little brother interrupted and said mom what's a hot potato shot?
0:03:30
So no, not a hot potato shot it was a hepatitis A shot. So anyway it gave me a chuckle in the midst of a very busy day in the office so I appreciated that. Alright this is our listener edition and we actually have a theme of the show. And again it's hungry and not so hungry kids. We have one listener whose child is hungry all the time. Another one is a good eater but has slow growth. Third is a skimpy eater and also has slow growth. And then finally we'll wrap things up with a picky eater so I'm sure lots and lots will view out there can identify with eating issues in children.
0:04:07
Don't forget if there's a topic you would like to discuss or you have a question, a comment line on the interview, if you're really good friends with the presidential candidate and you'd like to get them on the show all you have to do is go to PediaCast.org. Some of them I don't want. Okay we won't go there.
0:04:26
Just go to PediaCast.org and click on the contact link. You can also email me at PediaCast@gmail.com. If you go that route make sure you let me know where you're from or you can call the voice line at 3474045437. And again if you use the voice line also please let us know where you are. Don't forget the information presented in PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals.
0:04:55
If you have a concern about your child's health call your doctor and arrange a face to face interview and hands on physical examination. Also your use of this audio program is subject to the PediaCast terms of use agreement which you can find at PediaCast.org. And with that in mind we'll be back to answer your questions right after this short break.
[Music]
0:05:44
Okay listener number 1 is Adina and this comes from Boston Massachusetts. And speaking of Boston, I have to say congratulations to the red socks. Your team definitely deserved to win that series. So I'm going to be rooting for you in the World Series. You know I'm a closet red socks fan I guess I should say. And for all of you who lived in Colorado or in the Rockies you know I still love you. I'm just going to root for the red socks.
0:06:12
Alright, and Adina says hi Dr. Mike I have a question for you about my 8-year old son. He's a very active boy and spends a lot of time doing sports, running around outside, etcetera, etcetera. My issue with him is that he is constantly hungry. Once he has cereal for breakfast, he wants more breakfast. When he comes home from school he wants a snack, then another snack, then another snack. The kid is starving. I tried to give him healthy snacks as much as possible. He loves fruit but sometimes I just ran out of ideas.
0:06:44
My question is, is this normal for an 8-year old boy? And what do i do about it? Do I just refuse to give him food after a while? Thanks so much. Love the show. Well thanks for your question Adina. You know and most of you who have listened for a long time probably get this idea. I'm really, personally end result oriented. So you got to look, I mean you can say kids eat all the time and they're active but what's the bottom line? You know I want to know about the child's growth? What's the family pattern and of course the child's activity level I think is important here.
0:07:20
So you know if you have a kid who's eating all the time but their growth looks great, you know their BMI looks good, they're proportionate for height versus weight, they're kind of following the family pattern, and they're pretty active, you know then it's hard to make an argument if they're eating too much.
Now I do think that small healthy snacks are probably going to be the best way to go especially if they are eating many snacks. I mean you don't want many large snacks or else, you know eventually their growth is not going to look good. But as long as you're balancing their calories in and their calories out even with frequent snacks, as long as they're growing okay, they're healthy, they're active; it's probably not really a big issue.
0:08:00
You definitely want to avoid lots of snacks that are combined with low activity and as you say Adina, you do want those snacks to be healthy snacks as much as possible. Also you want to know if your child is really hungry or are they just bored you know a lot of kids they don't know what to do. Hey I'm hungry, can I have something to eat? And sometimes just a little redirection and get them involved in an activity to take their mind off of it is enough.
0:08:23
But if they're really, truly hungry, they probably are not going to work very well. Also to try to get them to go a little bit longer. Remember complex carbohydrates are going to keep their blood sugar high or longer. So things like breads and cheeses, crackers, you know those kinds of things with more complex carbohydrates are going to be helpful. Fruit is great and it's healthy and if you're just doing you know a snack here or there they're probably good.
0:08:49
But remember they are simple sugars and they're not going to last as long as snacks with complex carbohydrates so just something to think about. But if you know, a combination of fruits and carbs you know were probably the way to go. You can of course overdo snacks. You can. And this is somewhere arbitrary depends on the kid. But teaching moderation is important too. But it is tough in an active kid whose growing well because if they're truly hungry and you're not letting them eat you know they start to obsess over food and then that can cause eating issues down the road too.
0:09:25
So I mean I think in general a reasonable schedule you know they have in 3 meals a day, a snack sometime between each of the meals, and before bedtime. But again each kid is going to be a little bit different and you have to look at their growth and motivation. If you have a kid who's not very active and you know kind of they're sedentary and they're overweight you know those are not the kids you want to encourage them to be having snacks.
0:09:51
There are medical conditions that can increase appetite and most of these are going to be associated with obesity along with that increased appetite. There are certain brain tumors that can do that, adrenal gland tumors, genetic syndromes. There are medications like oral steroids, usually not the inhaled steroids that we used to treat chronic asthma. Those usually are not a problem but there's a medicine like oral steroids and there's some psychiatric drugs that are used to that can also cause increased appetite with weight gain.
0:10:21
And a type one diabetes you can see kids with increased appetite with that. They're usually associated with drinking a lot and peeing a lot and weight loss despite the fact that they're eating more. So my point here is just if you have a kid whose hungry all the time you do want to talk to your doctor cause there could be a medical condition that's causing that. But in the overwhelming majority of cases there's not going to be a problem. You simply have a healthy kid who's active, growing and recharging themselves, and just teaching them about moderation, healthy choices are really the important things here.
0:10:56
Okay our second listener question comes from Carrie and Carrie is in Flint Michigan. And Carrie says Dr. Mike my son was a 3-pound preemie who will be 2 years old next month. My dilemma is this; we took him to the doctor recently for a pretty bad cough. And the doc said he had lost 2 pounds since his last appointment 2 months ago. We've had a relatively, continuous problem with him not gaining weight though he is abnormal height. He currently weighs 22 pounds. He eats like a little piglet and he's a happy, very active, talkative and otherwise healthy toddler.
0:11:32
I don't want to force food on him all day long as we already give him 3 healthy meals plus 2 snacks plus 1-2 bottles of pedia sure every day. My question is do you have any advice on how I can help him gain weight or what is your opinion on whether or not to even make him gain weight? I don't want to start up a bad eating habit such a young age such as eating as much food as he can, eating all the time, etcetera. If he's metabolism slows down as he gets older, he would likely run into some completely different health issues.
0:12:02
Any advice or ideas you can give would be greatly appreciated. On behalf of your listeners thank you for spending what little free time you probably have. You don't know. You don't know the half of it. Spending what little free time, you probably have to do this podcast for us parents. You're really appreciated and we'll be listening. Well thanks Carrie.
0:12:22
This is an example of how the rules really have to change when you have special circumstances and why each child has to be looked at as an individual. It's also why seeing your doctors much more important than relying on information you read online or in a book. A couple pound weight losses actually are significant in a 20-pound kid. If you think about it it's actually a 10% loss of their body weight. So I mean if you had a 2-pound loss in a kid that was 60-pound that's a whole different story. But when you're talking about couple of pounds and a 20-pound child, it is a significant amount of weight.
0:12:59
So in this situation like your doctor you know I think you need to find a way to maximize calories and to make sure there's nothing else going on that might interfere with your child's growth. Now keep in mind even if nothing is wrong your doctor is using growth as an indicator of good health. And as a doctor when we see weight going in a different direction then what we would expect it to be going, our job is to ask why.
0:13:26
And so even if nothing really is wrong, just having that reassurance that they're gaining weight appropriately helps us not to lose sleep over your child that night. Like should we've worked that kid up? You know next time I got to remember if you know we're going to do this, or we're going to do that, making notes in the chart. So I think in a kid like this, by increasing their calories and then seeing that growth sort of resumes the way we want it to, we breathe easier.
0:13:54
If on the other hand the trend isn't easily reversed then we have to start searching for problems. Now medical problems that can cause weight loss and there's lots of them. Thyroid issues, cystic fibrosis, there's metabolic disorders, other genetic syndromes and you know it's a mistake to blame the slow growth just on being a preemie because there's you know usually premature babies grow pretty quickly once they are out of the womb.
0:14:21
Now and you know get passed that initial, couple months of life, I wouldn't worry so much about the effect of increasing calories on later eating habits. I mean right now you have a job to do and it's approved that he can grow and doesn't need an extensive medical work up to find out why he's not. So in this case I think the benefit of increasing calories probably outweighs the risk of eating and weight issues later in life. See, medicine is a constant battle between looking at risks and benefits.
0:14:53
Okay so if we've established that you have to kick start growth little bit here how do you do it? How do you increase calories in a kid who's this age? So I mean here you have, here you have a child who is about 2 years old and you want to try to get them to increase their calories, how do you do it?
0:15:15
Well most pediatric GI departments have nutritionists who can help with this. And there are ways to increase calories without increasing the total amount of food eaten. So there's ways to sort of pack in the calories that go even beyond what you're doing. There are ways that I suggest people do this in my office but I'm not going to talk about them here. Because it just comes a little too close to providing specific advice for a specific child which I really don't want to do and different doctors have different feelings on this. You know in terms of, do you increase the calories with fat? Do you do it with protein, with carbs? I mean how do you go about it?
0:15:55
So I think in this case your best bet would be, just keep doing what you're doing. See your doctor again in a month for a weight recheck. And if the growth isn't happening then your doctor will likely do either some sort of many works up like looking a thyroid or cystic fibrosis, those sorts of things. There, you know easy enough to rule out. And if things you know continue to not go in the right direction then my next step would be to refer you to a pediatric gastro-intestinal doctor and especially the nutritionist, they're dietician that specializes in toddlers who can help you out and give you some ideas on how to increase calories.
0:16:34
So that's where I am with that one. Next we have Krista in New Jersey. And Krista says hi Dr. Mike I recommend your podcast to every parent I meet. And they all come back thanking me for cluing them in to such a great resource. Oh that's nice. I just got back from my pedia, and it's appreciated too. I just got back from my pediatrician and I'm a bit of a mess. My son is almost 9 months old and only weighs 18 pounds 5 ounces. Boy, but Carrie you know probably thinking 9 months and 18 pounds, that's a huge kid. What are you talking about?
0:17:12
See it's all in our perspective. I'm sorry. Krista goes on to say although that puts him into 20 to 25th percentile, my doctor's very concern because he's weight gain hasn't been what he wants to see. I thought it could be because he is super active and crawling since he was 6 months. He's currently cruising and about to walk any day. He was always on the move. But my doctor says that does not factor in. How can this be?
0:17:39
He eats solids 3 times a day, a good mix of cereal, yogurt, veggies, fruit and meat. He's exclusively nursing except for bottles of pumped milk 3 days a week while I am at work. Obviously I can't measure how much he takes in a day. He is a very happy baby meeting all of his milestones, weeks sometimes months early. He has chunky arms and legs and his height, though in the 20th percentile, is fine with our doctor. His father and I are both small people.
0:18:07
Despite all of his eat; see she's learning here, you guys are learning, you got to look at family history. Despite all of his eating he has only gained 3 and a half pounds in the past 5 months. Any thought on how to help him put on weight? We feed him often and don't stop until he decides he's full. I nurse on demand and while I am at work about 12 hours he eats 2 and a half jars of food and 15-20 ounces of milk. He has never fussy, well except when we stop him from roping up magazines or trying to call up the furniture.
0:18:37
Also is it true that the activity level of a baby doesn't factor in when tracking a baby's weight? Thanks in advance for your help. Well thanks for your question Krista. You know it's interesting. I see slowdowns like this at around 9 months that 9 month well check-up all the time. And you really, you have to realize that a lot of kids don't have smooth linear growth. I mean for a lot of kids and I would say that the kids that I would see in my office, I'm going to, it's just going to be rough estimate. But I'm guessing somewhere between a coder to a third of the kids that I see.
0:19:13
Their growth chart looked more like a set of staircases especially when they look at they're weight. Then it does a smooth line. So you basically have a kid who is a stair stepper you know they slow their growth considerably and then they'll have a growth spurt. And then they slow and then a growth spurt. And then a slow and then a growth spurt. So on the growth chart, if you're tracking this frequently, it looks their weight in particular looks like a set of stairs.
0:19:39
And you see this less often on the length, their height chart. So normal height gain with slow growth or slow weight gain in a round 9 months. It's not a terrible cause for concern. Also you have to realize that the most rapid growth is between births and somewhere between 6 and 9 months of age. So if you look at a growth chart and you look at the slope of the curve and if you remember the slope is how steep it is. You remember from you know high school geometry class.
0:20:13
The slope is much steeper between birth and 6 months. And then it starts to level out a little bit. I mean the slope becomes less steep right around 6-9 months of age and then on up until they're 2 when we switched to a different growth chart. So normally kids have a slow down around this age. Now if you have a kid who has an exaggerated slow down, at that age, and they're a stair stepper on their growth, then you know they can lose percentiles temporarily compared to other kids between a read around 9 months of age. And so this is something that we see quite a bit.
0:20:56
Now also the absolute percentiles don't really bother me. You know if you're not looking into drop and you say well their height's 20th percentile and their weight is 25th percentile that's normal. And some of you this is obvious and others it maybe what is this percentile thing? So I'm going to explain it like I explained it to people who look at me like what are you talking about.
0:21:17
What the percentile means is that if you took at random in the population, 100 kids who were all the same age and the same sex. So let's say you have a 9-month old if you just went out on the street and you took at random 100 9 month olds and you line them up with number 1 being the shortest or the lightest depending on if you're looking at length or weight. And number 100 is going to be the longest or the most, the one that weighs the most, and then the percentile is just where your child would fit in at that random line up of kids of the same sex and age.
0:21:54
So when you say 20 to 25th percentile that means that every time you do a random sampling of 100 kids, 20 to 25 of them are going to be shorter than you or weigh less than your child does. So you know 50th percentile is just average if all the world were average then you know everybody would be the exact same height and weight which you know be pretty boring world.
0:22:17
So keep that in mind. I think you know sometimes oh we say 25th percentile but that's not worrisome. 25th percentile was fine and you make the excellent observation that your family tends to be smaller people. So we would expect 20 to 25th percentile.
0:22:33
So if I saw a kid like this in my office I don't personally it doesn't sound like I'll be all that concerned. I don't think I would change anything. I'd probably say let's just take a look at what he's weight and length looked like at 12-months and we'll go from there. And actually I bet that's what really your doctor said too. I mean he raised the issue, showed you the chart and it doesn't sound like you really did anything, he just said well I'm a little concerned and let's watch it and we'll see how it'll look next time. And if that's how it went down I'm good with that.
0:23:03
Alright listener number 4, our final one here, this comes from DJ in Tucson Arizona. DJ says dear Dr. Mike, love the show and thanks so much for what you do. My 6-year olds food groups are slowly disappearing. Although we offer lots of healthy food choices for meals, he will only eat peanut butter, pizza, spaghetti, chicken nuggets and one or two other things and probably depending on the day.
0:23:28
He is below the 5th percentile in height and weight. We are torn as to whether we should just say fish are the choice for dinner tonight and let him choose not to eat or whether we should just make sure that he is getting enough protein, carbs and vitamins, and let him eat what he's comfortable with. Thanks for your thoughts.
0:23:46
This is the most difficult question of this set. I mean this is a tough one DJ. First let me make a difference between a differentiation, that's the word I'm looking for, between skimpy eaters and picky eaters. Now skimpy eaters you know of course are the ones that don't eat much you know eat a little bit of everything but not much of it. And a lot of times skimpy eaters tend to be small for age and like years you know 5th percentile or even less.
0:24:17
The question becomes are they small because they are skimpy eater or are they eating skimpy because they're programmed to be small? I mean one of the ways that our bodies get to the size that we sort of genetically programmed to be, one of the ways is through appetite. So if you have a kid who is a skimpy eater and they're small, grandmas oftentimes will say oh that kid needs to eat more. Look at how little he is. But you know is he little because he's not eating nor is he not eating much because he supposed to be little? And again you really have to look at the family pattern to get an idea about that.
0:24:56
Now I realized we're not talking about skimpy eaters. We're talking about picky eaters. But I feel strongly about that and I wanted to insert that in there. So let's talk about picky eaters. Now do you give in to pickiness or do you fight it? This is one of those things they do not teach you in medical school. I mean no one sits down in a lecture and says this is how you deal with picky children or kids who are picky eaters.
0:25:23
Okay this is where experiences a parent comes in handy. And as it turns out our kids are picky eaters. And I wonder sometimes if we had done things a little bit differently when they were younger whether that would be true still today. You know when they were younger if we had made them eat you know more variety of things, would they like those things now. We did give in to their pickiness a lot. And they are 13 and 10 to the stay and they you know, my son won't eat tomatoes, which is fine. I don't like more tomatoes either. Neither of them will eat mushrooms. They don't eat. There's a lot of& foods that I ate when I was a kid and I think the reason why I ate it when I was a kid is because my parents would basically I mean this is what was for dinner and if you didn't want it then you didn't eat.
0:26:10
There was no making special meal and the same thing was true with my wife and that I think 2 part of your parenting skills come from your past experiences as a kid. So I think we've, as parents have been more likely to go ahead and give in to their pickiness maybe because we weren't giving in for us. And now that they're older and they don't like a lot of the things I liked at their age. You know do I have some regrets and think I could have maybe done that better.
0:26:38
Yeah maybe a little but I'm not sure the outcome. It would have been much different. So I know I'm not really giving in answer here. I think that I'm going to take the easy road here and say I'm not sure there is a right road. I mean you want to encourage a diversity of foods so that hopefully they'll grow up to be you know to like a variety of things and to get a good balanced diet, get all the food groups in. But you also want to pick your battles and so I think the final answer here is going to depend on the child's temperament and the parents' value system.
0:27:13
Now I know it sounds a little bit lofty but let me explain what I'm talking about. You can have families with a busy mom who does not have time to make 2 meals every night. And for other moms their passion is to provide for their kids, whatever that takes, and if they don't make something their kids going to like in addition maybe to what mom and dad are going to eat cause you know you can only eat you know chicken nuggets so many nights of the week as in adult.
0:27:38
But if you don't do that then the guilt is going to overtake you and you just, you're going to feel terrible about it. So you know I mean I think for some families the right thing to do is to say look this is what's for dinner. I mean there's, we've got things to do tonight. You know for me to be a good mom and maybe do whatever its is, whether it be a job, whether it be family game time later on. I mean there are priorities in life and you can't say that for one family this is you know or you can't say for all families this is the way you do it.
0:28:11
I mean there's going to be families where the right thing to do is look this is for dinner and the kids adjust. You know because that's life for them. That's their reality and it's not necessarily child abuse to do that. Now I mean if you've given you kids anchovies and caviar every night not so many choices okay then maybe that's a bit abusive. But you know for the most part we're not talking about that kind of situation.
0:28:33
So you know I think in the end it just really depends on your value system, how you grew up, you know what kind of time factors you have, what things make you feel guilty or don' make you feel guilty, and have to take each individual family you know in the context of what's going on in the family. Now there is this 5th percentile factor that complicate things DJ in your situation. I mean you have a kid who's small to begin with. It's not that they're skimpy eater but they're a picky eater. And I mean you do want to provide nutrients and calories, and is that better than constant refusal to eat but yet you want them to learn to eat a variety of different foods.
0:29:15
So who said parenting is easy? In this case again I'm not sure there's a right answer or wrong answer but I think this is how we dealt with picky eaters. It's a middle of the road approach. It's not perfect. It may not be the right approach for everyone but what we've generally done is when we have meals we generally do make alternative, either alternative versions of what we're eating or something completely different.
0:29:43
I shouldn't say we. My wife gets all the credit for this. So Karen often will make things a little different for the kids depending on their taste. But we do try to make them at least taste everything. You know like a no thank you helping because at some point they may decide that they do like whatever is this that they refuse all the time. I mean if you don't make them at least try it now and then they may not find that out.
0:30:07
My kids, you know they used to not like corn. Well actually I shouldn't say that Katie has always really liked corn. And Nick is growing on them but you know if he had his say he just say you know he'd never touched corn again. But we kept making him try it, okay try a bite. You got to eat a bite of your corn and eventually you know it's like you know what mom and dad corn is not really so bad after all. Now there's going to be some foods that you know you never get to that point. But I think you know you want him to get the calories. You want him to be good eaters and you know you can have a heart for you know some kids are going to like what you are eating and some aren't. And you know if there's some food that you really like as an adult and your kids can't stand it, do you never get to have that food? So I mean compromise and alternatives I think are fine but you know you do want to keep making them try things. No thank you helping or you know try a bite of this because at some point they may give in. What you don't want is refusal to eat and then demands for unhealthy snacks later on that you definitely want to avoid that.
0:31:11
But again there's no right or wrong approach with this and you really have to tailor it to your own family, to your child's temperament, to your family's value systems as it turns out. So I hope this has been helpful. You know I wish I could say oh yeah that's easy. You know here's the cook book approach. This is what you do but unfortunately parenting is not like that.
0:31:33
Alright we are going to take a quick break and we'll be back to wrap up the show right after this.
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0:32:10
Alright thanks to all of you for tuning in and listening to PediaCast day after day, really appreciate it. Also thanks goes to Vlad over vladstudio.com for contributing the art work to our site. Just a reminder, Karen, my lovely wife does a parenting and just general interest blog over at pediascribe.com. So if you want to know more about my family life, you would definitely fry find out more than you wanted to know. Maybe more than I wanted you to know at pediascribe.com. So be sure to check that out.
0:32:42
ITunes reviews are helpful. So if you haven't done that yet please do. Also this is important, if you don't take anything that I ask seriously please take this seriously. We don't have a big advertising budget here at PediaCast and you know it's difficult for people to stumble upon something like this. So if you've come across PediaCast& and you find it helpful please tell other people about it. Tell your pediatrician. Tell your family practice doctor about the show, where they can find it. We do have posters at the website at PediaCast.org you can download. At least give them the website and tell them to check it out and see what they think.
0:33:28
That would really be appreciated. Alright later this week we have more listener questions. I'm going to try to get a research show in this week. We haven't done that in a while. So I'm going to do my best. Also more news and we do have an interview coming up later in the week with a pediatric pulmonologist regarding vocal cord dysfunction and it's confusion with asthma. So that's coming up. And until tomorrow this is Dr. Mike saying stay safe, stay healthy and stay involved with your kids. So on everybody.
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