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Katja Rowell, M.D. Headshot

You Can't Always Count on 'Experts' to Help You Raise a Competent Eater

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We are facing a childhood feeding crisis, not an "obesity" crisis. In one study, half the parents of grade schoolers prepared separate meals for their children, blaming picky eating. In the general population, up to 20 percent of children are felt to suffer from a feeding disorder, and there are indications of increased weight dysregulation at both extremes. Parents are struggling with feeding and weight worries, and whom do they turn to first? Their child's health care provider.

It may surprise you to learn that your friendly and knowledgeable primary care doctor likely has no idea how to help your child learn to grow up to be a competent eater. I am outing my colleagues because it matters, and because I was one of them.

The sum of my nutrition and feeding education, at a top 10 medical school, was one lecture from a dietitian who recommended switching to fat-free cheese and mayo and low-sodium soups. (I suspect from this joyless menu that she didn't like food much, or know how to cook.) I learned to concentrate formula for the "feeders and growers" in the Neonatal ICU, and in residency I had one breastfeeding lecture. There was no mention of how to help parents with feeding -- nothing about introducing solids, the basics in anticipatory guidance, or the fact that pressure with feeding almost always backfires, whether trying to get a child to eat less or more.

Poor advice coming from respected and trusted authority figures is especially harmful. It is not malice, but simply ignorance that explains why doctors have been the source of some of the most harmful advice to my clients, including: "Your child can go three weeks without eating and be fine," "Just make him eat," and, "Don't you dare give her more than 1,000 calories a day!"

As a childhood feeding specialist, I've seen parents' concerns brushed off, with a child subsisting on Pediasure while having panic attacks around unfamiliar foods. I've heard from parents of infants with simple feeding blips, such as no longer wanting to be spoon-fed, referred to intensive feeding clinics (with a six-week wait). In the meantime, a brief phone call with some basic advice like, "Don't force it, give him the spoon, let him feed himself safely-prepared finger foods," solved the issue for at least half of the families.

I've seen the result when a 4-month-old breast-fed infant is put on a diet because the pediatrician misinterpreted growth (among other things). The mother was told to cut out all nighttime feeds and make her "obese" infant wait 30 minutes to feed after signaling hunger. Picture Mom sobbing in one room, baby screaming in the other, and the start of years of feeding struggles with a child who from then on became anxious and "insatiable" at feedings and meals (all whole, from-scratch foods, by the way).

And it's not just primary care doctors. The gastroenterologist may scold you for allowing your "failure to thrive" selective son his plain spinach, the first food he has ever enjoyed, and tell you to "douse it in Ranch dressing." The dietitian at the university-based pediatric weight loss clinic may tell you that Crystal Lite is a "preferred" beverage for your "obese" toddler, and to cut out fruit juice and candy -- when she's never had any. Your feeding therapist may force-feed your toddler.

I had to learn about feeding dynamics, the research on feeding styles, responsive feeding, and eating competence as a parent, and I am grateful that I did. Seeing the transformation in my own home, as well as the growing literature on the health and wellness benefits of eating well, guided by internal cues of hunger and fullness, convinced me that helping children grow up to be competent eaters is preventive medicine.

Increasingly, I feel the need to reach out to the professionals parents turn to. When I get in front of health care providers and therapists who are new to this information, most express surprise, telling me how the research makes sense, and wondering why they've never heard of it before (and how they can't wait to go home and try it on their own picky eaters).

It doesn't make sense that I had three lectures on pheochromocytoma (.05-.2 percent incidence) in medical school, but nothing on feeding and supporting self-regulation, which I muddled through as a family doctor on a daily basis. Training for health care professionals has to change to reflect the needs of patients and families, and the sooner the better.

For information on the nation's first countywide feeding education collaborative in Santa Clara County, visit: Childhood Feeding Collaborative.