But I hear from my patient families all the time that it's anything but relaxing.

The American Academy of Pediatrics recommends doctors ask parents three questions about mealtime:

1. How anxious are you about your child’s eating?

2. How would you describe what happens during mealtime?

3. What do you do when your child won’t eat?

When offered a healthy, well balanced meal with fresh fruits, vegetables, and lean proteins, kids will stop eating when they are full. Children will naturally refuse to eat when they are not hungry. We often describe these as normal appetite slumps. We can disturb children’s natural satiety cues by either forcing them to eat or by offering foods high in added sugar or salt when they won’t eat. This results in a child who will “only eat chicken nuggets.”

Parents are most successful in feeding their children more fruits and vegetables when they model healthy eating, set appropriate limits, and have a positive attitude at mealtime. “The parent determines where, when, and what the child is fed; the child determines what to eat.” ⁽¹⁾ In other words, “parents provide and kids decide”. ⁽²⁾ 

Here are some tips on eating mindfully and encouraging your kids to eat in a manner that gives them more energy and helps them avoid chronic disease. These are easy ways to change your lifestyle that don’t involve a ton of work and expensive supplements.

1.Drink more water. Kids should not drink juice or soda except on special occasions.

2.Drink milk with meals. Children from age 1-2 should be on whole milk. After the age of 2, low fat or skim milk is recommended.

3.Vitamin supplements are not needed unless your child does not drink milk. Vitamin D is essential for bone health and immune function and may play a role in prevention of chronic disease.

4.Serve 5-9 servings of fruits and vegetables daily. Encourage your children to at least take a bite of everything you serve. Remember that children will need to taste a food 10-15 times before they decide they like it. Lean protein like fish and baked chicken might be better accepted if you add ketchup as a condiment.

5.Add healthy protein likes nuts (for older children) and legumes. Peanut butter is fine for younger children and new allergy immunology guidelines suggest that early introduction of peanut may actually decrease the risk of peanut allergy.

6.Eat more meals at home. Keep staples such as eggs, whole grain pasta, pasta sauce, yogurt, carrots, frozen vegetables, chicken breasts, and fruit stocked at all times so that in a pinch you could throw together a simple meal.

7.Double your recipes and freeze 1 meal at the same time that you cook the other meal. This will save you from making a trip to a fast food restaurant when you have that go to meal in your freezer.

8.Serve only whole grain breads and pastas.

9.Avoid buying, eating, or serving processed foods (chips, cookies, cakes).

10.Avoid fried foods and fast foods.

To read more about nutrition needs of children at different ages, I highly recommend the book “Nutrition: What Every Parent Needs to Know" available on the American Academy of Pediatrics (AAP) online bookstore.

See choosemyplate.gov for more information about how your child’s plate should look at meal time.

Realize that children’s tastes will change over time. They will sometimes refuse foods they readily accepted in the past, and they will readily accept foods that they refused in the past. Involve your children in shopping and meal planning. Let them help in the kitchen! Take them to a local farmer’s market and let them choose something new for everyone to try.

Take a matter of fact and pleasant approach to meal times and ENJOY YOUR FAMILY! Create wonderful childhood memories.

References:

1. “A Practical Approach to Classifying and Managing Feeding Difficulties” Pediatrics Volume 135, number 2, February 2015

2.Nutrition: What Every Parent Needs to Know. AAP

At least not yet, but both school districts are considering adopting a policy and Dallas ISD could have one by the end of the day.

That news makes Kim Mangham, M.D., a Cook Children’s pediatrician in Keller, both relieved and happy. Dr. Mangham focuses on nutrition and activity with her patient families and she believes this is a good start for area schools to get kids moving.

As early as January 2007, A Clinical Report in the Journal of Pediatrics emphasized the benefits of free play for children, “but since that time it seems we have drifted farther and farther away from this concept,” Dr. Mangham said. “Kindergarten and even preschool curriculums are emphasizing academics over social and emotional development, and kids are presenting at younger ages with anxiety and depression due to academic pressures.”

For all children, especially those with ADHD, Dr. Mangham said it is vital that they are offered unstructured free time to allow them to process the information they have learned and to get their exercise. Only then can they return to the classroom and focus.

Children have an innate need to be outside and run and play, according to Dr. Mangham. This helps them to connect socially with their peers and allows them to settle back down in the classroom and learn again.

“I hear from so many of my parents that their children do so much better with homework if they are allowed to play outside after school,” Dr. Mangham said. “Kids are so worn out by the end of the day, they need to decompress and let their brains rest before they can focus again on school work. I tell my parents that if they want well behaved children, to let them run and play outside and to burn off all of their energy. “

Why not focus on the things that are free from side effects and cost nothing? We have so much to gain, says Dr. Mangham.

Children have so much adult-directed time – in the classroom, with sports, with extracurricular activities and with chores in the home. Adults even try to interfere with free play. Children need that free time to learn to share, play nicely, make up games, follow rules, get along and just enjoy friends.

As reported in December 2015 by KERA news and a recent segment on the Today show, schools are starting to see the benefits of recess.

Cook Children’s offers Go Noodle to 18 ISDs (including public, private and charter elementary schools in Cook Children’s six-county region) and 515 schools. The 120,619 students and 4,918 teachers have logged over 35 million aggregate minutes of physical activity.

“My 12 year old daughter started sixth grade this year,” Dr. Mangham said. “Her biggest complaint is not being able to be outside all day. Their only break is the four minute transition time between classes and lunch. “She says, ‘I miss being outside and seeing the sky and the trees.’ My 8 year old son loves climbing trees. The reflection and relaxation he gets while sitting in the top of his tree is just as important as the exercise he gets while climbing.”

About the source

Kim Mangham, M.D., is a Cook Children's pediatrician at 1601 Keller Parkway in Keller, Texas. She earned her medical degree at University of Texas Southwestern Medical School in Dallas. She completed the pediatric residency program at University of Oklahoma Health Sciences Center in Oklahoma City. Her interests include breastfeeding education as well as disease and injury prevention. Dr. Mangham is board certified in pediatrics.

The incidence of anxiety and depression in pediatrics is due in part to overscheduled children and families. Here are some suggestions on how to slow down and find some down time with your family.

1. Gardening: My children’s happiest moments have been picking tomatoes and digging out potatoes in their grandparent’s garden. In describing her experiences in the garden, their grandmother, Jean Mangham writes “I love to get outside to feel the sun, smell the dirt and hear the birds sing. My garden provides me with a place to see the miracle of life. Put a small seed into the dirt and with just a little nurturing, you produce a fruit or a flower. Gardening also provides me with a great sense of pride, and how important that is to pass along to my grandchildren.”
2. Kathleen Wayland, a music teacher, writes, “Relaxation is a learned behavior. A child’s day, even one spent at home, can be very stimulating, offering a little, unstructured quiet time. Having some quiet time with your child provides an opportunity for you to model relaxation for your child and let them know they can relax, even when it’s not naptime or bedtime. This is also a wonderful opportunity for some bonding time to deepen your connection with your child. Holding, rocking, singing and cuddling are all ways to have a quiet, bonding time that will relax both of you. Children need time to be stimulated and engaged, and they also need time to be at leisure. This down time is physically necessary for the brain to process the learning that occurs during structured activities and interaction.”
3. One of my yoga instructors once said, “If you can breathe, you can do yoga.” The practice of yoga and meditation promotes physical and mental wellness. Heidi McGall, a trained yoga instructor teaches kids relaxation: “I have kids close their eyes and imagine a balloon in a big empty blue sky. Imagine anything that is bothering them – schoolwork, family life, things that are nagging them. Imagine tying all those troubles to the balloon. Then they set the balloon free. It floats off into the blue sky out of their vision and they are left with the perfect blue cloudless sky. Then take a big inhale and exhale and open their eyes.”
4. Take your children outside. Being near trees and under a blue sky are inherently relaxing. Go for a walk, take a bike ride, plan a camping trip. Read the book, “Last Child in the Woods” by Richard Louvs. He describes why being in nature is important for children. He lists nature activities for kids and families. Have you and your kids seen the movie The Lorax? You should. It is a thoughtful look at the value of nature in the lives of our children.

And to quote another wise sage, “Life moves pretty fast. If you don't stop and look around once in a while, you could miss it.” – Ferris Bueller.

My family and I LOVE, LOVE, LOVE the state fair. We go every year and get our corn dog and our roasted corn. We see the dog show, and we watch the acrobats. The sights and sounds are the same as they were 20 plus years ago, and I hope to make the same happy memories for my own kids.

How do we enjoy the fair without compromising the healthy lifestyle that we enjoy? Here are some tips from our staff members and from the nutrition department at Cook Children’s.

1. Start your day off with a healthy well balanced meal at home. Do not show up hungry!
2. Bring waters and healthy snacks with you (nuts and dried fruit travel well). This will also help your ticketbook!
3. Allow your child to pick one treat.
4. If he or she (or you) can’t decide – pick a few treats to share – 1 or 2 bites of a fried Oreo^® is probably enough to satisfy even the worst sweet tooth.
5. Pick healthy alternatives to the fried foods: the roasted corn (a must), smoked turkey leg, fruit kabobs, and chicken kabobs.
6. The fairgrounds are huge! Walk a lot. Walk off those calories that you consume!

Special occasions like The State Fair of Texas include traditional foods to be enjoyed together. Remember that there are always healthy alternatives, and that the quality family time is the most important part of these magical moments.

I order a kid’s meal for my son at a seafood restaurant in Galveston, Texas. I tell the waiter to hold the fries. He gets a very odd look on his face and replies “But they come free with the meal." My response. “I understand that, but we don’t want them.”  

There is good evidence that meals eaten at home are healthier. One way we can improve the nutrition choices we make when we eat out is to avoid the pitfall of accepting the free choices that come with a meal and worse – encouraging our kids to finish them. 

I know I’ve had the experience of wanting only the sandwich at a restaurant, yet ordering the entire meal is actually cheaper. This comes with chips or fries and a drink that I don’t even really want, yet I end up picking a soft drink instead of a water because it is “free,” and also eating the chips that I didn’t plan to order.

I heard a news clip on the radio the other day about all inclusive restaurants and how many calories we tend to consume on these trips. I think we definitely get caught trying to get our money’s worth at all you can eat buffets. 

The excess calories consumed and the subsequent health consequences for ourselves and for our children can be quite costly in terms of our overall health. So the next time we try to find the best value in our meals while eating out – it might be in saying no to the free extras.

About the author

Kim Mangham, M.D., is a Cook Children's pediatrician at 1601 Keller Parkway in Keller, Texas. She earned her medical degree at University of Texas Southwestern Medical School in Dallas. She completed the pediatric residency program at University of Oklahoma Health Sciences Center in Oklahoma City. Her interests include breastfeeding education as well as disease and injury prevention. Dr. Mangham is board certified in pediatrics.