Peace at the Table: The Whys and Hows of Nurturance

American Academy of Pediatrics Guide to Your Child's Nutrition: Making Peace at the Table and Building Healthy Eating Habits for Life
by The American Academy of Pediatrics, William H. Dietz, M.D., Ph.D., Loraine Stern, M.D.

One of our favorite cartoons is "Baby Blues," by Rick Kirkman and Jerry Scott. A young couple have two children, a preschooler and an infant. In one strip, the preschooler climbs up on a stool next to her mother and asks, "What are you cooking?"

"Chicken and rice," her mother answers.

The child screws up her face, throws herself on the floor, and writhes, yelling, "Bleah! Yuk! Gaak!"

In the last box, she lies quietly on the floor and asks, "What's that taste like?"

What we hope this book will do, among other things, is help you to be calm and effectual when faced with situations such as this.

Meals: Time to Relax and Enjoy

"Nurture" means "to care for" and "to feed." As we nurture our children, we often allow food to become an indicator of how well we are doing our job. As a result, food turns into a measure of how much our children love us and obey us, rather than a source of energy and nutrients. Food becomes emotionally charged, and mealtimes are a source of anxiety and tension rather than opportunities to relax, interact, and enjoy one another.

What we offer children and what they eat have a great deal to do with their health and growth. But whether they actually eat what we serve depends on more than what we choose to lay before them. Their own tastes and preferences, their moods, and-most important-what they learn from people around them in subtle and not-so-subtle ways determine what and how much they eat.

The title of this book includes "peace at the table." Peace is best maintained by wise administrators who know when to intervene and when to hold back, not by a police state. If you turn into "food police," our experience is that you may provoke conflict and make the situation worse. Remember your respective roles: As parents, you are responsible for offering a healthful variety of foods. Your children are responsible for deciding what and how much they want to eat from what they are offered.

Offer Wholesome Choices, Then Stand Aside

Children will not become ill or suffer permanently if they refuse a meal or two, but parents sometimes act as though youngsters might shrivel up and die. Parents' fears and concessions have produced toddlers who will eat only white foods such as milk, macaroni, white bread, and potatoes, or children who take no food other than milk, or parents who collapse in tears at every mealtime while their toddler rules the family from her booster seat. All of these situations eventually resolve; all of them can be prevented. With infants and young children, your job is to offer wholesome food choices and then step back.

Lois, the mother of a patient, told Dr. Loraine Stern the following story: Lois's sister and brother-in-law took off for a long weekend, leaving Kristin, their 8-year-old daughter, with Lois. When they dropped Kristin off, they also left a long list of what she would and wouldn't eat. Lois accepted the list and wished her sister and brother-in-law a good time.

That evening at dinnertime, Kristin asked, "What are we having?"

When Lois told her, she screwed up her face and said, "I don't like that."

"Gee, I'm sorry," Lois said. "You don't have to eat it if you don't want to."

Kristin left the main course on her plate, although she picked a little at the side dishes while she pouted. Lois paid no attention and took Kristin's plate away when everyone was through. Kristin probably went to bed a little hungry. However, the next morning, because she was hungry, she relished what was served for breakfast. She made no more complaints and ate well the entire weekend. Of course, we're sure she went back to her pickiness with her parents when they returned.

After Kelly, a colleague of Dr. William Dietz, found herself making a separate main course for her 4-year-old every time she cooked something he didn't like, she promised herself this would not happen with her next child. So when 3-year-old Colleen turned up her nose at the fish the rest of the family was eating, Kelly said, "You don't have to eat it. I'll just put it in the refrigerator and you can have it later if you want."

When bedtime arrived, Colleen said, "I think I'd better eat that fish or I'll get hungry."

This tactic really works.

Emotions Complicate Nutrition

Parents of young children worry mostly about whether their children are eating enough of the right foods. Among older children and adolescents, however, the most important issues are usually obesity and eating disorders, such as anorexia and bulimia. Early experiences, interactions within the family around foods, the influence of peers, the media, and lifestyles that reduce the time children spend eating with the family all probably contribute to these diseases. In addition, a teenager who is preoccupied with weight and body image may both literally and symbolically slam the door when worried parents try to discuss issues of food and weight. Every pediatrician has the experience of seeing unexpected tears on a teenager's cheeks when the subject of weight arises during a checkup. In these families, everyone is upset: parents, because everything they do seems to make matters worse; adolescents, because they want their parents' help, but only on their own terms.

This situation is not very different from food issues with younger children. The nutrients in food are only part of the problem. Emotional, behavioral, and psychological issues are equally important.

Nutrition: A Long-Range Issue

In this book, we emphasize healthful food choices and the Food Guide Pyramid, but we do not emphasize rigid fat- and calorie-counting. Nutrition is a long-range issue, and one day or one week does not make or break good health. Rather, we want you to develop a perspective on how to feed your children a wholesome diet and maintain a healthful lifestyle, how to allow for individual styles and preferences, and how to make shared mealtimes enjoyable as well as stress and guilt-free.

This book reflects not only the writers' and editors' experience and opinion, but also information reviewed by many experts. Although we have included personal anecdotes from our practices, this book represents the consensus of the 53,000 pediatricians of North and South America who are members of the American Academy of Pediatrics. Members include pediatricians, pediatric medical subspecialists, and pediatric surgical specialists.

The Guide to Your Child's Nutrition is designed to be useful at various points in your children's lives and to help solve particular problems that may arise. Because we know it may not be read straight through, some sections may be repetitious. This is deliberate. We want to make sure that a parent consulting us from time to time will not miss important points that are covered in other parts of the book.

Peace, and bon appetit!

William H. Dietz, M.D., Ph.D., F.A.A.P.
Loraine Stern, M.D., F.A.A.R
Editors

Excerpted from American Academy of Pediatrics Guide to Your Child's Nutrition by William H. Dietz, M.D., Ph.D., F.A.A.P, and Loraine Stern, M.D., F.A.A.P, Editors Copyright © 1999 by William H. Dietz, M.D., Ph.D., F.A.A.P, and Loraine Stern, M.D., F.A.A.P, Editors. Excerpted by permission of Villard, a division of Random House, Inc. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

About the Author

The American Academy of Pediatrics is an organization of 57,000 primary care pediatricians, pediatric medical subspecialists, and pediatric specialists dedicated to the health, safety, and well-being of infants, children, adolescents, and young adults. AAP books with Bantam include Caring for Your Baby and Young Child Birth to Five, Caring for Your School-Age Child Ages 5 to 12, Caring for Your Teenager, Guide to Toilet Training, and New Mother's Guide to Breastfeeding.

William H. Dietz, M.D., Ph.D., F.A.A.P., is director of the Division of Nutrition and Physical Activity at the Centers for Disease Control and Prevention in Atlanta.

Loraine Stern, M.D., F.A.A.P., is associate clinical professor in the Department of Pediatrics at the UCLA School of Medicine and is a regular contributor to Woman's Day.