5/10/17
DISCLOSURES
A THOROUGHLY MODERN
APPROACH
TO CHILDHOOD NUTRITION
IN THE 21 ST CENTURY
Consultant
Mott’s Teachable Tastes
Beef Checkoff Speaker ’s Bureau
New England Dairy & Food Council Blogger Network
Stock/Shareholder/Consultant
Once Upon a Farm, LLC
Creator
The Kids Healthy Weight Project (an online nutrition and feeding course for
parents)
Eat Like a Champion (online course for young athletes)
Food Parenting PRO (professional course)
NEW JERSEY AAP ANNUAL CONFERENCE &
EXHIBITION
MAY 24, 2017
SOMERSET, NEW JERSEY
JILL CASTLE, MS, RDN
Expert Contributor
US News & World Report
USA Swimming
Bundoo.com
© 2017 Jill Castle, MS, RDN
© 2017 Jill Castle, MS, RDN
© 2017 Jill Castle, MS, RDN
¡1 in 3 kids are overweight or obese
¡Eating disorders on the rise, especially in boys
and children under 12 years
¡ADHD, autism and food allergies increasing
¡Picky eating lasts longer (> 6 years); ARFID
¡More body image concerns
¡More food marketing to kids
FEAR
© 2017 Jill Castle, MS, RDN
TODAY
¡Feeding Kids is Harder than Ever!
© 2017 Jill Castle, MS, RDN
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5/10/17
CHANGE THE PERSPECTIVE
Short Term: The Trees
¡ Which kind of yogurt is
best?
¡ Getting kids to eat
healthy today
¡ Parents are frustrated &
don’t understand their
children
¡ Children eat less well &
don’t regulate food
intake
Long Term: The Forest
¡ What’s my strategy &
system?
¡ Teaching kids to eat
healthy for a life time
¡ Parents are
knowledgeable, patient
and prepared for
challenges
¡ Children eat better,
regulate food intake,
and enjoy eating
© 2017 Jill Castle, MS, RDN
FEEDING THE WHOLE CHILD
¡WHAT
Food & Nutrients at each stage
¡HOW
Authoritative Feeding, Positive Food
Parenting Practices
¡WHY
EAT RIGHT VS. FEED RIGHT
Healthy
Diet
Healthy
Child
What: Food &
Nutrients
Healthy
Child
Why:
Development
How: Feeding
© 2017 Jill Castle, MS, RDN
WHAT: FOOD & NUTRIENTS
Developmental Stage, Temperament
© 2017 Jill Castle, MS, RDN
BALANCED & NUTRITIOUS
© 2017 Jill Castle, MS, RDN
FOOD: THE 90:10 RULE
Food Variety
¡ Food Groups
§ within & among
¡ Rotate
Nutrient Rich
¡ Calcium, vitamin D,
potassium, fiber
Snacks
¡ At least 1 snack per day
¡ Fill in the nutrient gaps
© 2017 Jill Castle, MS, RDN
© 2017 Jill Castle, MS, RDN
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NUTRIENTS AS INSIGHT
INFANT
TODDLER/PRESCHOOLER
total fat
iron
zinc
vitamin D
DHA
calcium
vitamin D
Vitamin E
potassium
iron
CHILDREN
TEENS
fiber
potassium
iron
calcium
vitamin D
calcium
vitamin D
magnesium
vitamin E
iron
LEARNING TO LIKE FOOD
Variety
Food
Acceptance
Repeated
Exposure
© 2017 Jill Castle, MS, RDN
© 2017 Jill Castle, MS, RDN
PARENT-CHILD
RELATIONSHIP
HOW TO FEED
Trust Model of Feeding
¡ Parent believes child can self-regulate food intake
¡ Parent believes child can recognize own hunger & satiety
¡ Child trusts parent provides pleasant, structured
meals/snacks
¡ Low Trust à More Controlling
¡ High Trust à Relaxed, diplomatic, positive feeding
© 2017 Jill Castle, MS, RDN
© 2017 Jill Castle, MS, RDN
¡Authoritarian (Controlling)
¡Permissive (Indulgent)
¡Neglectful (Uninvolved)
¡Authoritative (Love with Limits/Monitoring)
¡We use all four; one is predominant; they reflect
our own upbringing
© 2017 Jill Castle, MS, RDN
Authoritarian
Permissive
ü
ü
ü
ü
ü Increased intake of high fat foods and
sweets
ü High BMI (preschoolers)
ü Predictive of OW in Mexican
American children
ü Low whole grain intake in < 5 years
ü Low nutrient-density food intake
Poor food regulation
Out of touch with hunger/fullness
Correlation with overweight/obesity
Reduced fruit/veggie intake
Neglectful
Authoritative
ü Food focused
ü Twice as likely to have weight
problems (both over- and underweight)
ü Emotional insecurity
ü Mistrust
ü Low intake of nutrient rich foods
ü
ü
ü
ü
Leaner body composition
Eat more fruits, veggies, dairy
More active
Protective against emotional eating
© 2017 Jill Castle, MS, RDN
FEEDING STYLE OUTCOMES
OVERVIEW OF FEEDING STYLES
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Authoritarian
Permissive
Food
Restriction
Catering
Structure
Pressure to
Eat
Constant
Feeding
Boundaries
Negative Practice
Characteristics
Potential Outcome
Pressuring
Nagging to eat more;
pressure to try or take bites;
reminding child to eat
Disinterest in food; early
satiety; poor weight gain;
worse picky eating; OR weight
gain; overeating; ignoring
fullness
Rewarding
Use of sweets/desserts to get
child to eat; manipulating
with rewards for eating
performance
Values reward food over
healthy food; eats to please;
poor self-regulation; relies on
external factors
Restricting
Limiting access to certain
foods, portions
Overly focused on restricted
food, overeats when available
Catering
Allowing child to make most
food choices
Limited diet; nutrient
inadequacies; child in charge;
less likely to try new foods
Constant feeding
Grazing; always hungry; lack
of structure
Constant eating; overeating;
unable to ID true hunger; may
not expand food repertoire
Authoritative
Food
Rewards
Choice
© 2017 Jill Castle, MS, RDN
© 2017 Jill Castle, MS, RDN
NEGATIVE PRACTICES DON’T
WORK
FEEDING THAT WORKS
¡ 85% of parents try to get children to eat more at
mealtime using praise, rewarding and prompting
(Appetite, 2007)
¡ 50-60% of parents ask their MS and HS students to
clean their plates; 40% asked them to eat more even
when they stated they were full (Pediatrics, 2013)
¡ Project EAT (Eating in Teens and Young Adults):
Young adults who use hunger & fullness to guide
eating àhealthier weights, less likely to have
disordered eating (Appetite, 2013)
© 2017 Jill Castle, MS, RDN
SATTER’S DIVISION OF
RESPONSIBILITY
Routine with Meals
Systematic Snacks
Location
Timing
Boundaries & Monitoring
Food availability; accessibility
Parent modeling
Parent monitoring
Parent in charge of kitchen
Reasonable Choice
Education & Autonomy
Child is involved, but not in control
Allowed to refuse food; pressure-free
praise
Mealtime is food learning time
© 2017 Jill Castle, MS, RDN
ELEMENTS TO EFFECTIVE
FEEDING
Structure
© 2017 Jill Castle, MS, RDN
Parent determines:
Location
Meal or Snack content
Timing
Child determines:
Whether or not they are
eating
How much they will eat
When “jobs” are crossed,
problems arise with
feeding and eating
EllynSatter.com
© 2017 Jill Castle, MS, RDN
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AUTHORITATIVE FEEDING
Boundaries
Reasonable Choice
Regular timing of meals
and snacks
Food availability and
accessibility
Child involvement
¡ Anticipatory Guidance makes a difference in diet
quality, food preferences, & eating behavior (NOURISH
Study)
¡ Early feeding education helps promote and sustain
responsive feeding, self-regulation and may deter obesity
development
Limited / guided choice
Usual location
Unstructured food
Monitoring
Guidance for outside
eating
¡ Responsive Feeding
Reasoning / education
¡ Promotes self-regulation and shared parent-child
responsibility for feedingà reduced incidence of childhood
obesity
¡ Non-responsive feeding is associated with wt/ht Z-
Encouragement
Modeling
Autonomy
scores, BMI z-score, overweight/obesity and adiposity
Positive Food Parenting
¡ Breastfeeding may shape feeding practices through
increased responsiveness to feeding cues.
© 2017 Jill Castle, MS, RDN
Structure
FEEDING EDUCATION WORKS
DiSantis et al. Int J Behav Nutr Phys Act. 2013; Paul et al. BMC Pediatr 2014; ; Daniels et al. Pediatrics 2015; Int J Obes 2012; Pediatrics 2013;
BMC Public Health 2009; Magarey et al. Obesity, 2016
© 2017 Jill Castle, MS, RDN
THE WHY OF FEEDING
WHAT TO EXPECT & GOALS
Baby (6 months - 2 years)
Toddler/Preschooler (2 to 5 years)
Honeymoon phase of feeding; high
growth; eats everything
Variety of tastes, textures and flavors
Nutrient-rich diet
Picky eating peak; growth slows
Bad habits can start
Don't cater or force to eat
Use Satter’s DOR
School Age (6 - 12 years)
Teenager (13-18 years)
Food choices reflect desire to be like
friends
Get cooking; manage outside
influences without being a “food cop”
Walk the talk
Wants to be different/risk taking
Shows up with food choices
Plan meals and let teens loose in the
kitchen
Keep tabs, guide & support
© 2017 Jill Castle, MS, RDN
© 2017 Jill Castle, MS, RDN
PUTTING IT ALL TOGETHER
MODERN NUTRITION: INFANT
Infant Facts
What Key nutrients iron, zinc, total fat,
DHA and vitamin D
Critical nutrition period (2 years)
Learning to eat
How
Why
© 2017 Jill Castle, MS, RDN
Acceptance for food is high
Food learning is active
Responsive feeding; add structure
Fastest stage of growth!
Brain developing -- needs more fat,
DHA, iron and zinc
Not mentally aware yet
Parent-Child Bonding
Goals of feeding
*Ensure key nutrients met
*Adequate fat for growth
*Advance texture appropriately
*Variety, variety, variety
*Bring to the table,
encourage self feeding
*Connection and attachment -positive feeding relationship
*Honor hunger and satiety
© 2017 Jill Castle, MS, RDN
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MODERN NUTRITION:
TODDLER/PRESCHOOLER 2 -5 YEARS
Toddler/
Facts
Preschooler
What
Key nutrients: iron, calcium, vitamin
E, potassium & vitamin D
Stable nutrition
How
Why
Feeding Goals
*Ensure key nutrients met
*Serve appropriate portions (smaller)
move to family-style meals
*Follow Division of Responsibility
Food neophobia peaks 2-6 years of
*Allow self (messy) feeding but teach
age
Drops some accepted foods/skeptical manners
*Find ways to fit in treats
of new
*Decrease dependence on sippy cups
Erratic eating is normal
*Mix new food with SAFE foods
Slowed period of growth
Brain still developing but at slower
rate
More mentally aware, wants control
© 2017 Jill Castle, MS, RDN
and is verbal!
Why
Second fastest growth stage
Think more abstractly
Risk taking
Moves from wanting to belong to
wanting to be different
School Facts
Age
What Key nutrients: vit D, calcium,
potassium, iron and fiber
Calcium needs increase: 9-13 year
(1300 mg)
How
Palate expands; food neophobia
decreases
Family meal; role modeling
important; boundaries
Why
Stable growth
Appetite increases with puberty
Learns basic nutrition concepts
Skill-oriented
“Comparitis”
Feeding Goals
*Ensure key nutrients met
*Serve appropriate portions; family-style
meals
*Set boundaries/limits
*Manage outside influences, scale back at
home when needed
*Discuss values about body image and
health (Child-led)
*Teach cooking skills
*Keep family meals, save food for kids
coming home late from activities
© 2017 Jill Castle, MS, RDN
MODERN CHILDHOOD NUTRITION
MODERN NUTRITION: TEENAGER
Teenager Facts
What
Key nutrients: vit D, magnesium,
calcium, potassium and iron
Nutrition may deteriorate during this
period
How
Open to new foods; hungrier than ever
Help manage hunger
Family meal; role modeling important
MODERN NUTRITION: SCHOOL AGE
Feeding Goals
*Help teen take responsibility for
meeting nutritional needs
*Guide teen’s choices outside the home
(eating out)
*Up the nutrition education and steer
away from dieting
*Stock healthy and satisfying food
*Plan meals for teen to make including
periodic dinners
*Help with shopping and meal planning
*Find time to eat together
What
How
Why
© 2017 Jill Castle, MS, RDN
© 2017 Jill Castle, MS, RDN
TARGET THE WHOLE CHILD
THANK YOU!
¡ Modern Approach: Comprehensive Food Parenting
§ Combine WHAT and HOW and WHY
§ Get feeding approach & food right
§ Anticipate and manage developmental changes
§ Discourage negative food parenting
§ Elevate and empower parents to normalize eating
© 2017 Jill Castle, MS, RDN
¡ Singularly addressing HOW to feed isn’t enough
§ Neglects present day food environment which parents need
to know how to manage
© 2017 Jill Castle, MS, RDN
Contact: Jill Castle, MS, RDN
www.JillCastle.com
[email protected]
¡ Focusing only on WHAT to feed under-serves
§ Fails to get to the root of many nutrition issues in the child
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