Healthy eating starts early, and prepares a child for lifetime health

Madelyn Parmentier, a children’s dietitian at Dartmouth Health, tackles a menu of food- and feeding-related issues in newborns through 20-year-olds.

Her goal?

Establish a healthy relationship with food early on, catch food phobias and nutritional deficiencies before they become entrenched, and plant the seed of good habits and choices that promote health and longevity.

The Union Leader spoke with Parmentier in a videoconference on June 5.

Children can be picky. How can parents set the stage for a healthy relationship with food?

It’s important to have “a neutral mindset around foods. Try not to prioritize or put a hierarchy on certain foods and try not to categorize foods as good and bad,” she said.

“We want to keep everything positive, focusing on mindful eating and being aware of your children’s hunger and fullness cues.” Focus on regular meal and snacktime routines and make sure kids are accustomed to eating only within those time frames, which can help establish those hunger and fullness cues.

“Involve children in cooking and family meals. Talk about those foods in positive ways” and keep food preparation a fun and positive experience. Bring kids to the grocery store and have them help with groceries at home, with food preparation.

“All that type of stuff is great. Family routines can help establish positive relationships with food, even growing your own food at home, if possible, or going to your local farmers’ market.”

“Switching things up and keeping things interesting for kids is really important. Kind of like entertaining them with the food instead of pressuring them to eat it and pressuring them to like it. Keeping everything pretty low-pressure around mealtimes, especially if it’s a new food for them, can be helpful.”

Talk about the characteristics of food and ask probing questions instead of asking them to just take another bite. Ask them to think about what it might taste like or feel like. Ask questions that “encourage them to interact with the food in a way they might feel comfortable,” she said.

What does healthy eating look like in practice?

In general, she said, opt for whole foods with natural ingredients. Try to eliminate or cut back on processed foods, prepared frozen meals and foods with added sugar or sodium, Parmentier said.

Why should kids cut way back on or avoid processed foods?

Processed foods are frequently high in sodium and added sugar, which children don’t need, she said.

Ultra-processed foods include soda, candy, all typical snack foods like cookies, crackers, chips — foods that are in packages. In general, “Those foods have a lot of additives” and have little nutritional value. “They may have parts of whole foods, but they’re so stripped of the nutrients of whole food that they don’t pose any major benefits.”

Highly processed foods include chicken nuggets, bacon, breads and buns that aren’t whole grain, sweetened and flavored yogurts, chocolate and strawberry flavored milk, coffee creamer, pastries, baked goods, ice cream and frozen desserts, chocolate, and energy and sports drinks (which may also be high in caffeine, with adult levels that aren’t safe for kids).

Fruit juices without added sugar are highly processed, she said, but they’re a source of valuable Vitamin C for children who don’t have access to fresh fruit.

Sodium is another thing to keep track of in processed food. “It’s definitely OK to have sodium and we need sodium in our diet. But if a child is eating a whole lot of processed foods, it may be too much.” As a rule of thumb, avoid foods where the milligrams of sodium are a higher number than the calorie content in a serving size: “If something is 100 calories in that serving, but there’s like 300 milligrams of sodium in that serving, that’s a bit high.”

The most important thing to avoid is added sugar, Parmentier said. That’s critical, especially for the youngest children with developing teeth.

Food labels, with percentages based on a 2,000 calorie per day adult diet, list carbohydrates, total sugars and added sugars. When it comes to added sugar, “the lower the better and closer to zero if possible.”

Four grams of added sugar equal one teaspoon of sugar. So if a product has 15 grams of sugar, “that’s a lot of teaspoons of sugar they’ve added into that food.”

Better to buy plain yogurt and add fruit or maple syrup to sweeten it lightly, or buy no-added-sugar yogurts, Parmentier said.

Milk is high in lactose, a form of sugar, but it has no added sugar.

On food labels, Parmentier said, serving percentages that are over 20% in any nutrient, vitamin or mineral are generally too high for children.

Why is it important not to talk about body weight and body shape, including your own?

“It’s really important to have positive body image. Try not to have negative self-talk in front of children.”

The danger is that the child might hear it and apply it to themselves.

“The child might, if they have the same or similar body shape (or physical feature), automatically assume that is something that’s wrong with them, something that needs to be fixed,” Parmentier said. “So we really want to focus on not doing that in front of children and at least or try not to talk about your body in a negative way in front of children.”

What are signs that children might not be getting the nutrition they need to be healthy?

“Rapid changes in growth. If there’s rapid weight loss or rapid weight gain, and it’s associated with dietary changes.

“Rapid weight loss might be associated with a significant decrease in calories, which will ultimately decrease the amount of vitamins and minerals that the child might be eating.

“Rapid weight gain might be due to overeating if nothing else, nothing medically, is going on with the child.”

Laboratory tests may detect nutrient deficiencies.

In general, physical exams and nutrition- focused exams can pick up signs of a problem.

“Iron deficiency is pretty common in children and that might be seen in pale skin, lower energy, hair thinning” and fingernails that begin to cup or curve up like spoons.

“They definitely change shape if a child is very iron deficient.”

What is ARFID and why should parents be concerned?

ARFID, or avoidant/restrictive food intake disorder, is a relatively new eating disorder diagnosis, Parmentier said.

“I think it’s very underdiagnosed, so a lot of patients go undiagnosed” and they can continue through and beyond childhood with ARFID.

“It kind of presents just like typical picky eating and can get brushed off just as picky eating. It can go undiagnosed into teenage years and even into adulthood.

“It’s very restrictive eating in childhood, being very avoidant of certain foods” because of changes with the food, certain colors, textures and the way it feels in their mouth.

Trauma such as vomiting or trouble swallowing can trigger ARFID. It’s becoming more known and diagnosed, Parmentier said, but diagnosis is only the first step.

“It does need a lot of support from a dietitian, their pediatrician, a psychologist,” with an interdisciplinary team that includes feeding therapy.