Food for Thought: Eating Consistently

Follow our series on the who, what, where, when, and how of feeding our children of all ages!

Our Readers Ask:

My 16-month-old son used to be a very laid-back and cooperative eater. He ate enough and was always happy to try any new food item we gave him. Lately, though, he has become uncharacteristically fussy. This has happened right on the heels of my getting promoted at work, which means I am working many more hours than before. I've been able to have my nanny bring him to my office at my lunch hour most days; without this arrangement, I would go without seeing him for twelve plus hours every day, since I arrive home so late and usually miss dinner. On the weekends my husband and I are much more relaxed and we spend all of our time with our son, but we still have difficulty getting him to eat the way he used to. All he seems to want now is milk, plain noodles, or Goldfish crackers. How can we get him to eat again? 

Regardless of how you nursed or bottle-fed your baby, during that time you probably got a good sense of how critical a schedule is to developing good feeding behaviors, and this continues to be true especially throughout his toddlerhood. The unfortunate downside to the change in your work schedule is that it has probably  Simply put, a major part of developing healthy eating habits is maintaining as much consistency as possible with regards to when and where he eats. Even on the weekends, try as much as you can to mirror the same schedule you have on weekdays. Scheduling meals so that they are predictable will help your son learn to regulate his appetite, as well as anticipate and delay gratification. You can reinforce his eating schedule by providing foods typically associated with breakfast, lunch, snack, and dinner for these meals, respectively. He will have a stronger grasp of how his day is ordered and what is coming next if he knows that certain foods appear mainly at certain times of the day. This kind of consistency will also make it easier and more comfortable for him to enjoy a wide range of foods, identifying her favorite things to eat but also being open to trying new tastes and textures.

Besides maintaining a schedule of when your child eats, it is also important to be consistent for the most part about where you feed your child. Your little girl will be free to focus more on the social aspect of eating if she doesn't also have to struggle with a change of eating environment. By now you have probably noticed how difficult it is to feed a child in a place that is strange to them, like a restaurant or a relative's home, no matter how comfortable you are. To a point, when the child is not thoroughly aware of her surroundings, she will eat as long as you are there to feed her. Somewhere around 15-18 months, a child begins to notice differences between you and other people, and herself and you. It will be more difficult for the next year and a half to feed her anywhere besides her own little highchair.

 Watch Your Baby Play

Our Readers Ask:

I have a two year old boy who gets into the bathtub with his toys and completely shuts me out! He runs his cars and boats up and down the edge of the tub, humming to himself or talking to the toys, and pays no attention to me, even though I'm sitting right there on the floor next to him. If I try to join in the play, he acts like I am an evil witch intruding on him! He pushes my hand away and just turns further around. I feel left out, and honestly, sometimes my feelings are hurt. He does this when we play on the floor, too, but it isn’t so obvious, because I'm not usually sitting so close to him as I am at bath time. But, despite all this, if I move away for an instant, he gets really cranky. Should I be upset? Should I insist he include me? 

Your question comes up with nearly every parent of a toddler, believe it or not. In fact, we have termed this behavior “watched play,” because it is so universal. Until recently, it wasn’t really labeled, and parents like yourself became distressed and resentful, or worse, would retaliate by leaving to attend to other things when their toddler became absorbed in playing in his own world.

There are two kinds of play: the kind you are used to, called "reciprocal play," in which you and your child take turns participating in activity or game together, like feeding each other in the toy kitchen, building a block tower, or playing back and forth with cars. Meanwhile, the kind of play that is upsetting you, “watched play,” is a state of play wherein a child is absorbed in creating a play world in his own imagination, but still needs you to be there next to him to help him regulate his feelings. 

Although it's not readily apparent, your child is using you as an anchor for the feelings he is expressing in his play. Having you near to him while he plays in this way is very important, especially if the feelings in question are negative ones—this may look like competition between cars, or aggressive impulses that he imagines the cars to have, or fears of retaliation between the imaginary figures or vehicles. 

At this age, children are forming their ability to manage their feelings, and play is a way of regulating them in which they can practice self-control through controlling their cars or baby dolls. Because of their cognitive immaturity, children between 2 and 3 years old can’t really understand when they will be punished for their bad thoughts, as may happen during the proverbial “terrible twos,” and when they won’t. (Parents are often equally confused!) Play helps them work this out, a process that begins to take hold from ages 3-5.

If you experience this, by no means abandon your child to use the phone or the computer! He really does need you to sit there, quietly, competently monitoring those feelings you can’t see, as difficult as it may be to do so. There will be plenty of reciprocal play at other times. 

And, by the way, a young child who feels safe playing “alone” due to the silent presence of his parent nearby becomes the older child who will be able to do his homework "alone” with you near to him in a similar fashion. At that point, he’ll probably feel safe enough to let you read a magazine!

-- Dr. S and Dr. G

Communicating With Your Newborn

Our Readers Ask:

I recently had my first child, and for some reason it’s been difficult to find the right time and the right place to talk to her. She doesn't really make eye contact with me when she's feeding, and I'm afraid of overexciting her so that she won't fall asleep.  How important is it to talk to your newborn, and how do you do it? 

This question is asked frequently by many of the new mothers we see, and we can’t stress enough the importance of parents talking to their babies right from the beginning. In fact, we now know that your baby has been listening to you for quite some time from inside the womb!

Many new parents wonder when they can find the time and opportunity to make eye contact with their infants and talk to them directly. Besides the fact that most new parents' time is spent in the often overwhelming cycles of feeding, burping, bathing, and putting the baby to sleep, it can sometimes seem that their babies aren't really receptive to interaction. While some babies are born with a noticeably fixed gaze (which can look as though they are seeing you perfectly well, although this is not possible), many babies don't seem to seek eye contact with their parents at all during the first weeks or longer. Your baby sounds like she is one of those perfectly normal babies who seem to be more prone to looking around while she is at the bottle or breast. Some babies actually can't see their mothers' faces very well during nursing, due to the size and shape of the breast. Once, we had a new mother client who was certain that her baby didn't love her because her child would only stare at the chandelier while nursing, or at some random object, and never made eye contact at all! To top it off, fussy babies--who are also completely normal--are difficult to engage.

We find that a good time for “conversation” is during diapering, since the diapering table provides just the right distance both for making eye contact and for capturing your baby’s attention. By talking to her as you change her, she will follow your voice and will try to focus on your face, gradually developing the ability to mirror your expression. Even as a newborn, she is sensitive to your tone of voice, and although she does not know what you are saying, she will be bonding with you through this contact.

A newborn baby doesn't yet have the ability to see your facial features, but she can perceive the tone of your voice. Babies respond best to a somewhat high-pitched but gentle tone of voice, and you can say just about anything you like. Cooing and repeating sounds in a rhythmic lilt, smiling, and nodding your head up and down as you talk to her are all typical approaches. Because diapering occurs many times a day, it provides you with the consistent opportunity for a joyful experience. Learning your special sounds, repetition in your singing, and the motions of your head all help her develop a sense of pattern which is an essential part of a baby's development. Soon you will find her babbling back to you, trying to mimic you. You will know when she has begun to fully recognize you as a whole when she begins to respond gleefully to you by waving her arms or even trying to grab your face! 

Your baby will be best able to develop the same sense of recognition of her daddy's voice (and that of other important people in her life) if he is regularly incorporated into her routines. You may notice that other women who talk to her in a similar tone and speech pattern to the one you use will bring to her face the same smile of recognition, in contrast to a "strange" or gruff voice that she hasn't heard before. Sometimes, grandmothers who have "forgotten" how to talk to babies will feel dismayed or rejected when their new granddaughters don't immediately smile with joy on first meeting them!

Another time you can make eye contact is while changing your baby’s clothes, such as on the changing table, on the bed, or while she is sitting or lying on your lap. Any time you find that there is a few feet between the two of you, take advantage of it by "chatting" about what you are doing and where the two of you are going.

We also encourage mothers to begin to make little "conversations" with their babies by asking them questions and then allowing a pause, even if the baby cannot answer. This teaches the baby the rhythm of conversations and, again, builds a sense of reciprocity that will help your baby develop the internal rhythms that help her regulate herself as she grows.

During activities in which you cannot make eye contact (such as while burping, riding in a carrier, etc.), you can still make the most of the time with your baby by talking to her and describing whatever you are doing. Your baby will be comforted by your voice, and no matter whether you are talking to her as to a companion, singing to her as she is being soothed, or something else entirely, she will begin to understand how interested you are in her.

Rest assured you do not need to talk to your baby the entire time that she is  awake. Striking the right balance for you and your baby is important. 

The difficulties in talking to an infant who cannot understand or respond to you can cause some mothers to become unwittingly prone to ignoring interaction with their babies a bit too much. It's tempting to linger on the phone while feeding the baby; after all, she doesn't seem to mind! But time you spend with your baby should be special, and if possible, try to give her as much undivided attention as you can.

--Dr. S and Dr. G

A Baby's Ability to Self-Soothe

Our Readers Ask:

I currently have a 2 month old baby. Although I am a stay at home mother, I tend to the house and also pay the bills, which is time consuming. I love my baby and obviously do not want to leave him alone, or upset him while I am working. For this reason, I am wondering when and how does a baby develop the capacity to soothe himself? Is there anything I can do to help the process? Thanks!

This is a great question because there is a common misconception that young infants should be encouraged to self-soothe. While the ability to self soothe starts in infancy, over the course of the first few months of life, a baby must first develop a sense of his mother taking care of him, from which he will create an internal model of soothing and care taking. Babies develop the ability to amuse themselves for brief periods of time around 2-4 months, at which time Mother is often surprised to come into her baby’s nursery and find him awake, looking around his crib, and maybe even babbling to himself or making cooing sounds. Later on, from about 4-6 months, this process can also include a developing interest in his feet and hands, reaching for things in and around his crib, and turning himself over. Eventually, a baby’s ability to explore his environment, and entertain himself without his mother in view, is wonderful and rewarding evidence that he has experienced his mothering as “good enough,” and now, he doesn't need his mother to be there immediately at all times.

However, although the ability to self-soothe may be emerging during the first 6 months, you should neither depend on this, nor try to foster it. Babies as young as yours will not benefit from being left, even temporarily, to “figure it out.” They will become better self-soothers by reliably being soothed by you in this early period. Steadily, over time, as your baby begins to identify himself as a person, separate from you (6 months and beyond), he integrates his experience of being cared for into an ability to do the same thing for himself.

I appreciate how difficult this can be, but try to bring him wherever you go, in his bassinet or on some blankets, or perhaps you could carry him in a sling or pack as you work. Also, talking to him while you work is a great way to connect with your infant. Babies love to hear the sound of Mother's voice, which they recognize more quickly than they recognize Mother's face. And, check on him frequently during his "awake" time, smiling and cooing to him--it will pay off in the end!

--Dr. S and Dr. G

Tantrums and a Toddler's Sense of Time

Our Readers Ask:

My son is approaching the period often associated with great difficulty. I know toddlerhood is widely described as a time of rapid growth.  I am trying to understand my child’s temper tantrums and frustration—I understand why he may have a tantrum when I leave him, but why does he tantrum when we are out together?

One of the major reasons a toddler begins to tantrum is exactly what you pointed to- he becomes acutely aware of leave-takings, both yours, and his! He has no control over when you leave or come home, nor does he have control over when he goes out or comes back, or whether you will be there or not. For example, you could be at the park together, having a “good time.” From his point of view, he has some sense that as long as you are in the park together, he has you to himself. But when he gets home, you will suddenly become busy with chores, get on the phone, or reunite with his siblings. He may feel torn: he is happy right now in the park with you, but he also misses home, and he can’t know how long you will be out, how much time will elapse before he gets home, nor how long you will stay with him when he gets home. What to do? Throw a fit!

Why? A two-year-old thinks of time in two categories: “now” and “not now.” He does not yet have a concept of “two more minutes,” “yesterday,” or “in 2 weeks.” Even if he knows these words, he will often use them incorrectly: “yesterday” was actually earlier today! He derives no comfort from Mommy telling him, “Don’t worry, I’m only going out for half an hour,” or even “I’ll be home to give you a bath.”

In addition, the tantrums come about because toddlers (18 month olds – 2 1/2 year olds) are notoriously bad at regulating themselves. They feel emotions strongly and have little ability to control them. In addition to lacking the cognitive skill to tell time, they also lack something we call “object constancy.” This term refers to the ability on the part of a child to hold in mind where Mommy is, as well as where “home” is. A 15 month old will be content to be in a strange environment, as long as all of his people and things are the same; his “home” has come with him. A 2 year old both “knows” he is out of the “home,” and can miss his home, but without being able to say so. However, a 3 year old can say, and understand what he means, when he says, “I want to go home.”

At almost exactly 3 years to the minute, a toddler undergoes a salient cognitive change based on the progressive advances in myelinization of the fibers in the cognitive centers of his brain, advances that give him the ability to understand “the bigger picture” in every respect. He suddenly can understand “time” and days of the week, and sequences, like “I’ll read to you in 15 minutes, as soon as I’m done feeding the baby,” make sense to him. What’s more, he has increasingly developed the ability to control his emotions, and has learned to express himself more clearly. All of these developmental changes give him more control over himself, and the opportunity to make more sense of separations. 

-- Dr. S & Dr. G

Junk Food, Junk Food, Everywhere

Our Readers Ask:

I have two children, a 10-year-old and a 6-year-old. In our home we eat very nutritiously, and I always try to have enough healthy snacks that the kids can grab when they want. The problem isn't in our home, though- I feel like every time we are away from home, they are needlessly bombarded with junk food. As a reward for taking a difficult practice test at school, the students were all given ice cream sandwiches. It seems like every other day it is someone's birthday at school or at one of their extracurricular activities, which means there are inevitably cupcakes and candy and soda. My 6-year-old went on a playdate with a new friend and got completely ramped up because her friend's mother let them drink extremely sugary juice all afternoon. I can't help but feel as though all of these situations are undercutting my attempts to feed them healthfully. I don't want to be "that mother" who won't let her children socialize because of junk food, but I have to be honest, I find it kind of disgusting! What can I do?

Food for Thought: Modeling Healthy Eating Patterns

Follow our series on the who, what, where, when, and how of feeding our children of all ages!

Our Readers Ask:

My daughter is nine months old, and soon she will be ready to eat exclusively solid foods. I am feeling extremely anxious about this transition, and about her subsequent eating patterns. I struggled with an eating disorder for many years, and while I'm working on my own issues, I'm terrified of unwittingly imposing food and body anxieties onto my daughter. It seems like there are so many extreme perspectives on how children should eat and so much judgment from other parents. Even reading some of the online parenting forums on food are sometimes enough to trigger my old negative thoughts. How can I make sure she is getting the nutrition she needs without making her (and myself) anxious about food?

 First of all, kudos to you for making an effort to untangle your own anxiety from your daughter's needs. So much of the judgment that you so acutely experience stems from the fact that not many adults make this same effort, and ultimately project their own health concerns onto their children. Unless they have witnessed adults expressing anxiety about fat, sugar, and gluten, or whether their thighs are too big or their belly is too round, children do not naturally express the same fears. So one of the most important things you can do to help your daughter eat healthfully and enjoy food is to maintain this separation between you and her. If you're having negative feelings about your body, don't verbalize them in front of her. Try not to talk about food and eating in terms of vice and virtue; eating and loving vegetables doesn't make you "good," nor does eating a lot of cookies at a party make you "bad." And if you do notice yourself starting to slip back into some of your old thoughts or behaviors, have patience and compassion for yourself, so that you can be patient and compassionate with your daughter, and allow her to cultivate these same qualities. 

You will help yourself and your daughter best by demonstrating that balance and variety are healthier than extremes. From the moment you put your little girl in her highchair, it's a good idea to also have an overview that you intend to make it easy and comfortable for her to enjoy a wide range of foods, identifying her favorite things to eat but also being open to trying new tastes and textures. It is even more important when serving her to offer small amounts at a time. This way if she wants more, she can ask for it and learn what fullness means to her- "to her" being the operative term here. As long as she is eating something, it is her prerogative to decide how much or how little of it she wants to eat. This is true of all food groups, including and especially desserts. Prohibiting desserts or using them as a bargaining tool ("I'll get you ice cream if you behave at the store") gives desserts power, and causes children to fixate on them. If you allow your daughter to enjoy desserts in small amounts after her lunches and dinners, she will learn that it is totally possible, and even normal and healthy, to enjoy a treat without losing control. Keep in mind that "dessert," like any other food group, should vary- it can mean anything from fruit, ice cream, cookies and cake. (The French even enjoy fruit and cheese as a dessert!) 

This is a valuable lesson to learn while she is young. You must trust your daughter's awareness of her appetite and her ability to regulate it. Don't comment on how much she eats, and if other family members or friends say anything to that effect, shoot them down by firmly saying something like, "She knows when she's had enough," and then changing the subject. If she can sense that other people (especially you) are having anxiety about her eating, she in turn will develop anxiety about eating.

Let us reiterate that children are much more likely to develop eating disorders in homes where there is a culture of deprivation and food as punishment or reward, and where food is endowed with loaded social and emotional value.  

-- Dr. S & Dr. G