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Questionable things “experts” say about food and weight: Part 1

Posted by on Mar 14, 2011 in Blog Posts | 21 comments

I get to talk to lots and lots of parents, and often, my jaw drops with some of the advice they get from people they go to for help with feeding. It makes me beyond sad that parents who might be struggling (or maybe aren’t really) are getting out-of-date and often counter-productive feeding advice that can make matters far, far worse- not better. Here are a few from primary care physicians.

“Just give him only milk to drink. He will drink it before he gets dehydrated.”

“Don’t give your baby any table foods until twelve months.” (This was the most recent that came up in a class, and I had a hard time trying to be neutral. I usually try to not react and udermine a care-giver, but this time I couldn’t help myself. “Really? You were told that? Until 12 months? Did I understand that? No table foods until 12 months? I have to respectfully say that about every resource would disagree with that advice.” Well, I don’t think I was that respectful…

“Just serve beef and green beans for three days. She’ll eat it eventually.”

“Your baby (4 month old healthy breast-fed) is gaining weight too fast, she’s at risk for obesity. You should make her wait an hour when she starts to act hungry. Try to cut out a feeding or two a day.” (This was a breast-fed baby born a little early who was doing some catch-up growth from about 10% to about 50% and following a typical breast-fed pattern of early rapid gain.)

What’s the worst advice you’ve heard about feeding? From a health care professional or other? What was the most helpful?

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  1. Heather

    At my son’s last well-child visit (he’s 5), the doctor asked him if he eats “healthy foods.” He just looked at her blankly. She went on, “Do you eat chicken? Is it a healthy food? How about broccoli? That’s a healthy food. What about cookies? No, they’re not a healthy food.”

    I was peeved, but I couldn’t figure out how to respond on the spot.

    • katja

      I usually respond to those types of comments, (or even head them off…) with something like, “We love eating all kinds of wonderful foods. Lots of fruits and veggies and cookies and sandwiches and ice-cream…” (I just list “healthy” and “not healthy” together. Many docs probably have a kind of checklist where they have to “document” obesity prevention, or nutrition counseling. what a joke.
      Usually folks get the hint and don’t press the issue. I can imagine if I was fat, or if my doctor didn’t know I would have a fit if she mentioned weight, we would get the same kind of lecture. M is still “overweight” as she is trending slowly towards the mean. it’s sad that we have to protect our kids from their pediatricians!

      • Heather

        Yeah, I don’t know if it makes it better or worse that my son is very thin (13th percentile for weight I think). I wish I had said “It’s not Cailan’s responsibility to worry about what foods are healthy.” Maybe next time I’ll go armed with a printout from Ellyn Satter’s website.

  2. Jennifer

    Both of my kids didn’t eat until they were 7-8 months. If I tried to feed them, the food came right back out or they closed their mouths and refused. Both times the health nurses were concerned about it but especially for my son who, ironically, was the bigger of the two.

    I was told that I had to “get him to eat” or there could be problems later because there is some “special window” to get him to eat. They were not able to give me any helpful advice to get him to eat. (Surprise, surprise!) They at least agreed with me when I said that I wasn’t going to force him to eat. They just told me, you have to keep trying, keep offering food don’t give up! You have to get him to eat! You have to get him to eat! It was all about me having to do stuff to get him to eat, nothing at all to do with his readiness.

    I knew it was wrong but I couldn’t find anyone to disagree with them. Everyone was pretty adamant about not rushing starting solids until they found out that he was over 6 months old and then it was all “oh my god he needs iron” and “he can’t survive just on breastmilk!”.

    Now I feel bad that I wasn’t able to ignore them and I spend two weeks, steaming, mushing and offering food that wasn’t eaten. That doesn’t sound like very long but that’s about 21 separate instances of me repeately putting food in his mouth and him spitting it out. Put it in his mouth an he spits it out. Put it in his mouth and then he spits it out… Though, I would feel much worse about it if it weren’t for two things. One, he didn’t seem to mind too much, he seemed relatively happy to put the food in his mouth and then spit it out. Two, my mother-in-law fed him once and managed to get him to swallow a small bowl of food. Which makes me feel, in retrospect, that even though I may have been somwhat pressuring him to eat, I didn’t actually force him past want he wanted/was able to do.

    I think I’ve gotten some sloppy Ellyn Satter/DOR type advice from a health nurse too, but this post is probably long enough already…

    • katja

      So glad you all figured it out.Luckily little ones are so “plastic” (adaptable) that even some pretty rough early feeding experiences can be healed. Sounds like yours was pretty minor in the big scheme of things, but so sad that there was that needless worry and pressure! Imagine if your child was 5%? Can you guess how much more intense that pressure would have been, and your concern?
      I’d love someday to hear about the sloppy DOR advice. That’s also a peeve of mine. Professional groups that love the DOR, but still talk about portion control…

      • Jennifer

        I consider some advice I got from a health nurse about “catering” kind of sloppy DOR.

        I had read Ellyn Satter’s book “How to get Your Child to Eat” and I was trying to stop catering so much to my son but I was having a hard time figuring out how to actually do it given the fact that he didn’t eat a huge variety and he didn’t eat the types of food that I normally serve for dinner. I don’t remember if the book didn’t explain in enough detail or if I just didn’t “get it” when I read the book.

        Anyways, I was talking to the nurse and saying that I couldn’t figure out how not to catering but still have him eat. She just said to serve what I would normally serve and that he would eat. I said that I didn’t think he would eat and that I didn’t think this plan would be very effective. She assured me that he wouldn’t starve to death and would eventually come around.

        I’m pretty sure that plan would have been a disaster, I’m sure he wouldn’t actually have starved, even he will bow to extreme pressure and I’m sure he could have gotten quite creative in regards to sneaking food. I’m also sure that I would have, at that point, been dealing with some pretty severe behaviour issues and have a pretty fractured relationship with my son.

        I needed someone to actually ask what he ate and what I was serving and figure out that I wasn’t doing a very good job at providing an appropriate selection of food for him.

        I’ve got another story too! Maybe later if I’ve got time…

  3. MrsH

    I’m so thankful my kids are mostly “normal” weight these days, although I was told today that my son’s BMI “is a little high.” He’s super active, as in running around for about 2-4 hours a day and looking at him, he is not chunky at all. But apparently his BMI says otherwise. How do you feel about skim vs whole milk (or 1% or 2%?). We drink whole, for lots of reasons, and I assume that they’ll regulate… but the doctor didn’t agree with that. Thoughts?

    • Anne

      Oh man, that stupid BMI chart. My son has always been tall for his weight but one year he gained weight faster than he grew, so his BMI went from 25th% to 50th% and the nurse practitioner (my regular doc was out) was all “We should keep an eye on that to make sure it doesn’t become a pattern” *eyeroll* What.Ever.

    • baconsmom

      The BMI is a tool designed to be used to track the weight of populations. Not individuals, and absolutely never children.

      Don’t listen to anyone who takes BMI seriously. It is so deeply, deeply flawed and so inappropriate to apply to personal health that I would, if you can, find a new doctor. This one obviously isn’t up on her science – and that scares me in a doc, frankly.

    • katja

      search for my post “Don’t let your doctor label your child obese” Kids can be a range of sizes and healthy. Alas, docs are misinformed. Also, my post on skim vs whole milk. If you all enjoy drinking whole, and he drinks milk and other beverages, and water, and not a gallon a day, he most likely will regulate. there is no evidence that recommending low-fat milk makes kids skinnier, but they all do it. BMI misdiagnosis roughly 1/3 of school aged boys (at least according to the study I read from 2009 in the ADA) Look for acceleration over time, or changes in his behaviors, and don’t fret too much about a number! 🙂

  4. Sarah

    Our family dr recently referred my 5-yo to a therapist to help with some pooping and eating issues (he has been getting progressively more restrictive with what he will eat because he’s afraid of “making poop” because he gets constipated, and he has crossed from 40th to under 10th percentile in 1 year). At our first meeting, the therapist spent 3/4 of the session talking about teaching my son to recognize and interpret his body’s signals with regards to pooping. Then, despite me telling the therapist that we’ve been having some success with serving meals family-style, he told me to fix my son a plate and not let him leave the table until he cleans it. When I asked if this would be counter-productive with the “listening to your body’s signals” approach, he told me that I read too much and I need to stop letting my son “rule the roost”.

    • katja

      Wow. Just wow. contact me privately and I can give you (unsolicited) thoughts on constipation, if you’re interested 🙂
      Hang in there. Glad you are addressing things, finding a new therapist, maybe? Refer him to Child of Mine…

  5. mitzi

    When my infant son threw up every feeding a doctor told me that is was normal and that her son in his 20’s still had reflux issues, imagine her surprise when I found a Nurse practitioner who heard what I was saying and my 1 year old was diagnosed with type 1 diabetes!

    • katja

      Oh boy. That’s tough. Parents really just want to be listened to, and doctors often wish they had more time too. Problem is with feeding, many don’t even know what questions to ask. Type I DM is so rare in infants, as you know, it might have been hard to diagnose in the early stages, but it sounds like you weren’t listened to. I too have had some of my best health care from “para” professionals, like an NP.

  6. baconsmom

    Well, the pediatrician who put me on my first diet at age 5 – and then had me on a series of them, including Slim Fast when I was 11 – was pretty ridiculous.

    None of Bacon’s doctors has given me any guff about her eating habits, but I’m lucky that we only ever have done the division of responsibility and she likes trying new things and is “normal” weight. I’m sure if we had any troubles with her or if she were plumper there’d be ridiculous advice from all sides, considering her latest ped assumed Bacon came early because I had high blood pressure. Last I checked, no, I had no bp problems during my pregnancy, 38 weeks is still full-term, and also, THE DOCTOR DIDN’T HAVE MY CHART IN FRONT OF HER.

    • katja

      can you say “weight bias” perhaps?
      I’m sorry that happened to you. Not fair, not helpful, but so thankful that you have found a way to do better for your child. Isn’t that the ultimate gift?

      • baconsmom

        It is! I was so lucky to find HAES principles and intuitive eating and Ellyn Satter early on in her life. Thank heavens for one less thing to worry about!

  7. Emgee

    With apologies for those who read it last time, I have to repeat that I was upset the other night to hear the moms talking about their kids and food. One mom talked about her son being a picky eater. She is dieting and tends to only serve salad, grilled meat and veggies and her son is refusing to eat it. She said her doc is telling her to just refuse to provide any food between meals. Another mom said she should do as she does, wrap up the uneaten dinner and present it for breakfast: “Don’t worry, he’ll eat when he’s hungry enough.” Can you say “Mommy Dearest”????

  8. Anne

    When my son was four months old, I was still exclusively breastfeeding with no issues. He was growing perfectly fine but for some reason when we saw the substitute doc he said since he was nursing so much I should start him on solids – since that’s what *his* baby did. Seriously – that was his reason, never mind that my child was growing perfectly well and I wasn’t complaining about him being hungry. I try to avoid that doctor whenever I go to my otherwise awesome pediatric practice.

    The best advice I ever got was from my favorite doctor at that same office. This was around 4-5 when my son started getting picky. She asked how he was eating and I said he had stopped eating vegetables. She asked “Does he eat fruit?” and I said yes, there was not a fruit he didn’t like and she very calmly/neutrally replied “Then don’t worry, he’ll be fine.”

    • katja

      That’s what I’m saying. Most of these folks go by a “this worked for me” or something they read in the Parents mag in their waiting room. HCPs get very little to no training in childhood nutrition and feeding issues…


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