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

Multiple studies suggest that walking even 20 minutes daily can decrease your risk of mortality and improve your quality of life. Read how a busy working mom finds the time to exercise, and read her perspective on the many benefits of regular exercise. Come on moms out there! You can do it! If not for yourself, then for the long term health of your family.

New year. New you!

From Alison Groom:

Being a working mom of three small kiddos is a hard job for anyone, but finding the time to be healthy and active while being a working mom of three kiddos can be a tough job in itself. For me, finding the time to do something active can be hard and I am certainly not perfect at making it a daily priority, but I do my best to do it as much as possible throughout the week.

What I have recently noticed is that my kids watch and mimic every single thing I do. The way my 3 year old talks to her baby dolls is often a reflection of how I speak to her. The same goes for what I eat and how I live my life. Statistics say that if a parent smokes cigarettes, the children in the home will likely smoke as an adult too.

This is also the same for being active. If my children learn the fundamentals of being healthy and staying active as kids, they will likely continue that throughout the adolescent years and into their adult lives. My 7 year old has started wanting to exercise with me and will often ask to run on the treadmill when we are playing in the driveway. I keep our treadmill in the garage because it keeps me from having an excuse not to run.

I am a wimp when it is cold and I do not run when it is raining, so if it is in the garage, I have zero excuses for why I cannot run on a cold or rainy day. We often go for "family walks" after dinner too. We look like a circus sometimes with my 3 year old wanting in and then out of the stroller, the two giant dogs getting tangled leashes or tripping up my 6 year old, but it is family time. It is a time that we talk about our day, we teach our kids about nature and try to find interesting new things to discover. It is also a great time to talk about being healthy and about the benefits of walking and exercising for our growing bodies. It is exercise that allows us uninterrupted time with our precious kids, which is a win win if you ask me. J

Exercising does not have to take an hour to do. I work from home, so when I put my kids down for a nap, I hustle out to the garage to run on my treadmill. It may only be a 10 minute run, or a 20 minute fast paced walk.

Sometimes, I only have time to do a couple sets of pushup and sit ups, but that is better than nothing! A walk around the block can quickly turn into two laps around the block, and then to a mile and so on. Making a conscious effort to walk faster while grocery shopping can be a simple step toward elevating your heart rate and getting your metabolism up for the day. The hardest part about working out for me, is putting on my shoes. Once they are on, I am ready to go.

Make a decision for yourself and for those precious children who ARE watching your every move to be healthy. Take twenty minutes out of your day for you to have a moment for yourself. Exercising is also a GREAT way to release your tensions and anxieties of your day. I often take a moment to run or workout just to clear my head and have a moment to do ME for a minute. That can be so hard for people to do, but it is so beneficial. I promise, if you take twenty minutes to yourself each day, you WILL be a better mother, a better wife, and a better you. Look into different methods of exercise. Reach out to friends, neighbors, or family to see if anyone is also wanting to exercise but needs someone to hold them accountable. Having a partner to walk with around the neighborhood or do a workout video with when the kids go to bed is great! It gives you some time to interact with another adult, vent about your day, and also to be held accountable to doing your workout each day. Start with baby steps and find the right workout or activity for you. If you find pleasure in what you choose, you will likely stick with it.

When author Dan Buettner and fellow staff members looked at areas of the world where people lived longer - they circled it with a blue sharpie on the map - that is how those areas became known as The Blue Zones. Some of the areas with longevity that Dan studied were Sardinia, Italy, Okinawa, Japan, and Loma Linda, California. He learned that the people in these communities didn't choose longevity. Longevity happened to them. Environment is the key to a healthy life, not necessarily personal will power. 

Cook Childrens is a proud sponsor of the Blue Zones Project and Fort Worth is the only city in the south participating. I recently attended the Fort Worth kickoff event for the Blue Zones Project. Dan discussed the common threads that he found in the communities he studied.

Here are some of his suggestions for longevity and a life free from chronic illness:

1. Stay active.

2. Wake up with purpose each day.

3. Find down time daily.

4. Eat mindfully. Eat more fruits and vegetables.

5. Belong. Make time for family, friends, and fellowship.

As a pediatrician, parents come to me with questions about how to care for their children. They depend on my advice to help them raise healthy kids, safe from the burdens of chronic diseases like obesity, hypertension, diabetes and heart disease. Providing a medical home truly is a partnership. It is up to all of us: the parents, the doctors, and the kids. We are a team.

In the upcoming weeks, I will give you tips on how to create a Blue Zone in your home. We can do this together.

For more information about blue zones, see www.bluezones.com and check out the vitality compass.

Ensure school-age children know when to wash - before eating and after playing on a playground at recess, using the restroom, and coming into contact wiht friends and classmates. Teach kids that it's important not to chew their fingernails or touch their faces.

"Hand-to-mouth transmission is a major way children are infected by viruses," said Vanessa Charette, M.D., a Cook Children's pediatrician in Fort Worth. "Keeping hands out of the mouth is a difficult behavior for certain children to master, but it's important that they do."

Little hands can pick up a lot of germs. At any given time, you have close to 150 different bacteria living on your hands, and 80 percent of illnesses are spread by direct human contact. For kids, stomach bugs, strep throat and other bacterial illnesses can spread quickly, particularly in environments such as schools and day cares.

"I also tell young children to keep their hands below their neck. They don't rub their eyes, such their fingers or pick their nose," said Kim Mangham, M.D. a Cook Children's pediatrician in Keller. "Kids can have all the germs in the world living on their hands, but they don't put their hands in their mouth, nose or eyes, they won't get sick."

Having trouble convincing your children to get with the hand hygiene program? Let them know that fighting the spread of germs can be pretty cool. A recent study published in the American Journal of Infection Control concluded that fist bumping transmits far few bacteria than handshaking.

It is so interesting to note that maternal food preferences (what moms eat, why we eat, and how much we eat) strongly influences the eating behavior of our children. Like so many areas of parenting, our kids will do what we do way more readily than they will do what we say.

As we approach the Thanksgiving holiday, it is a great time to give thanks for our own health and for the health or our children. It is a great time to reflect on the self-care we model for our own children. Studies suggest that toddlers may need to taste a food 10-15 times before they decide it is something they want to eat. Maybe, just maybe, as grown-ups we should try some new foods as well.

Here are some healthy Thanksgiving ideas from Theresa Nash, director of Food and Nutrition Services at Cook Children’s:

1. A sweet potato casserole can be prepared in a healthy manner, and because of their sweetness may be enjoyed by children.

2. Disguising a vegetable in a mixture of children's other well accepted food is a way to get them to later choose them prepared in other ways: ex: broccoli and rice or yellow squash casserole.

3. Try something more unique and unexpected like Brussel sprouts.

As for me, I will work on giving lima beans another 8-10 chances …

After she gave us her tips. Theresa gave us a fun Brussel sprouts’ recipe. She said this is one she loves and she’s still making for her “grown” kids today:

Roasted Brussels Sprouts-Kids “and Parents” will Enjoy

• 1 pound fresh brussels sprouts
• 3 Tbsp olive oil
• 3 Tbsp honey
• 1 tsp garlic powder
• Salt & Pepper to taste: optional
• 1/4 cup dried cranberries or golden raisins
• 1/4 cup grated Parmesan cheese

1. Preheat oven to 450 degree F.
2. Cut the ends of the brussels sprouts and cut each in half.
3. Whisk olive oil, honey, garlic, (salt and black pepper) in a bowl. Toss in Brussels sprouts and stir to coat.
4. Spread on a baking sheet and sprinkle with dried fruit and Parmesan cheese.

Bake for 15-20 minutes until golden brown. Enjoy!

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.