Wednesday, April 16, 2014
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POSTED: Wednesday, April 2, 2014, 5:30 AM

In my clinical practice, I specialize in treating children with selective eating disorder (aka Avoidant/Restrictive Food Intake Disorder).  In a recent post, I addressed the question of whether picky eating is harmful.  The short answer was “yes:” prolonged picky eating compromises a child’s nutrition, inhibits their ability to eat like their peers at social and school events, and generally makes mealtimes a battleground (harmful to family harmony, not to mention parental sanity).

The following are my recommendations to help your picky eater.  They are probably most appropriate for kids aged 5 to 10, the age group that I generally treat. The list assumes that you have already seen a physician to rule out any medical cause for the picky eating, such as swallowing difficulties or gastro-intestinal problems.

  1. Believe that your child is capable of eating just about any food.  That extreme distress he displays whenever there’s pressure to try a new or nonpreferred food?  It is not the result of a physical or psychological incapability. Rather, it is the result of years of avoidance. A basic rule of the brain is this: The longer something is avoided, the more distressing and impossible it seems. This goes for just about anything, from completing a big homework assignment, to starting a complicated project at work, to calling someone up and asking for a date.  It’s also true for a food.
  2. What’s needed, then, is repeated exposure to foods until your child habituates to them.  Habituation is just a fancy word for “learned safety” or “the brain gets used to it.”  Research has shown that young children need an average of 8 to 15 exposures to habituate to and accept a new food.  Unfortunately, how many times do most parents offer a food before deciding their child will never like it? Just 3-5
  3. For the picky eater, exposure means tasting and swallowing the food.  It does not, in this case, mean merely having the food on the plate, looking at it, touching it, or smelling it.
  4. You are no doubt wondering, “But how do I get my kid to swallow it?”  Answer: By making it worth his while. Plenty of research confirms that kids will eat nonpreferred foods for rewards.  In my experience, the easiest and most motivating reward is access to screen time after a meal.
  5. Establish a consistent pattern, such as requiring your child to taste and swallow a new or nonpreferred food each night at dinner. Start with very small bites and then work up to larger and larger amounts as your child gets over the initial days of distress and comes to accept that a nightly “challenge food” is just another dreary fact of daily life.  
  6. Many desperate parents have tried telling their children that they can’t leave the table until they have eaten a nonpreferred food. In my experience, this leads to a child who sits at the table for hours, whining loudly and often.  My recommendation is to require that he eats that nightly challenge food within the first 5 minutes of a meal. Go ahead and set a timer. The 5-minute rule means he gets it over with right at the start of the meal and then everybody can relax.
  7. Reward successes and mostly ignore failures. He eats the nightly challenge food = lots of praise and access to rewards/privileges. He doesn’t = “No screentime for the rest of the night, but I know you can do it tomorrow” said once, with sincerity and optimism.
  8. Don’t worry about rewarding or restricting privileges based on eating: There are no credible, converging lines of scientific evidence that doing so causes eating disorders or self-esteem problems.  Think about it: parents require their children do things they don’t want to do for their own good all the time (teeth brushing, taking a bath, getting homework done).  That’s called good parenting. Why should it be any different when it comes to insisting your child eat a varied and healthful diet?
  9. Remember, this will not happen overnight.  It will not happen over many nights. It will happen over many months – so be patient.  With enough successful exposures, your child will eventually habituate to enough foods that his diet is greatly expanded and mealtimes are a peaceful experience for everyone.

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POSTED: Thursday, March 20, 2014, 5:30 AM
Filed Under: Growing Pains | Mario Cruz | Parenting | Tips

Guest blogging today with regular contributor Mario Cruz, MD, is Nova Ashanti, MD, a pediatric resident at St. Christopher's Hospital for Children.

While you may not want to be reminded about your child’s rapidly changing body and emerging sexuality (yikes!), puberty remains a life transition that parents and teens must navigate together.

During puberty, children are especially vulnerable to depression and to participating in a number of risky behaviors. Regular conversations with your child may help them deal better with these physical and emotional changes.

POSTED: Wednesday, March 12, 2014, 5:30 AM

On a beautiful Sunday morning, I was enjoying a walk in a park, admiring the views, the gardens, the art and the variety of people, when something caught my eye and took my thoughts right back to work. A mom was strolling with her two young children and both kids had their first names written in huge letters on the back of their tie-dyed sweatshirts.

I think this is a dangerous thing to do. Twenty years ago, when law enforcement stressed stranger-danger and abduction-prevention advice to parents, a cardinal rule was to avoid personalizing children's clothes. The fear was that predators could call kids by their first names and engage them through familiarity.

While I'm the first to remind anyone who will listen that the overwhelming majority of sexual abuse against children is perpetrated by someone they know, there's absolutely no reason why we should we give any predator an advantage. Kids need to know about boundary-pushing relatives or acquaintances who prey on children and youth, and that strangers can be predators as well. Adults can turn to the Take 25 Campaign from the National Center for Missing and Exploited Children as a resource to start the conversation in their family using the materials available in English and Spanish.

Predators who would take advantage of a child’s name on her clothing often feign familiarity and indicate that the parent sent them to pick the child up. Another recommendation that bears repeating is for families to specify a code word that a child should expect to hear from any adult claiming to know the child or his family. Preparation is so important; young children -- and many adults -- are incapable of outwitting a charming sociopath.

POSTED: Tuesday, March 11, 2014, 5:30 AM

A 20-year-old college student talked to me about recent suicides on college campuses: “When a suicide happens to someone your own age, it is so sad that it doesn’t feel real. Even if you don’t know the person, you may have mutual friends on Facebook. The person may look happy on Facebook and then you are shocked to see ‘R.I.P.’  messages."

Young people everywhere are upset about suicides among their peers. As parents, we are worried when suicide touches the lives of our children. Here are some observations about suicide among young people, and some suggestions as to how parents can help reduce the risk factors and offer emotional support.

Suicide rates for 18- to 24-year-olds, both students and non-students, come from the National Violent Death Reporting System.  The 2001 data was collected from four states (CT, ME, UT, WI) and two counties (Allegheny PA, San Francisco CA) and is derived from 181 suicide victims.  Most of the suicide victims were male (88%), white (89%) and non-students (80%).  According to the data, college students actually had a lower risk of suicide than people their age who were not in school. Use of firearms (51%) or suffocation or hanging (37%) were the most common methods. Students were less likely to use firearms than non-students.

POSTED: Monday, March 10, 2014, 9:17 AM
Filed Under: Anita Kulick | Parenting

Let’s confess. Most of us are secretly in love with our mobile devices.  What started out as a convenience – being able to make phone calls anytime or using a laptop to stay connected  to work – has now invaded every part of our lives. And why not? There are so many terrific devices from which to choose. Our old flip-phones are now “smart”, our laptops have shrunken into mini tablets, and we can get the latest edition of the paper or books on our e-readers.

So what’s the problem?  In many ways, technology has made our lives easier. But, there’s a price to pay for always “being connected” and all too often that cost takes its toll on our most intimate relationships, the ones we have with our children. For instance, have you found yourself spending “just a little more time” checking email when at the playground or responding to a text from the office during a birthday party?

A study released online today in Pediatrics gives us a glimpse of this impact by the examining patterns of mobile device use by caregivers and children during meals in fast food restaurants. Researchers from Boston University Medical Center designed the study to generate sound scientific hypotheses about its effect on caregiver-child interactions for future studies. Little research has been done on this topic so far.

POSTED: Thursday, March 6, 2014, 5:30 AM
A man drinking alcohol as part of the game NekNominate. (via youtube/oakelfish)

If you look up “NekNominate” on YouTube, here’s a preview of what you’ll find: A 20-something pouring beer down a toilet who is then whisked up by friends to drink it upside down. In another video, a young man mixes up a disturbing cocktail of alcohol, milk, live bugs, and a dead mouse in a food processor before drinking it.

What is happening? Kids are being nominated by their peers to take video of themselves downing — or "necking" — strong drinks under bizarre or dangerous circumstances before challenging others to film an even more shocking video to post online within 24 hours. Refusing a nomination could lead to being teased over social media.

The game is believed to have started in Australia and has spread rapidly across the world due to Twitter and Facebook. While some of the videos can be viewed as harmless fun, the drinking game has been linked to at least five deaths of men under the age of 30, CNN reported.

POSTED: Tuesday, February 18, 2014, 5:30 AM
Filed Under: Anita Kulick | Parenting | Sex

I vividly remember the first time my son’s pediatrician asked me to leave the examining room during his annual check-up. He said that as his patients approached adolescence, it was his practice to spend a few minutes with them privately. It would allow them to ask any questions or voice concerns that they might not be willing to discuss in front of their parents.

At first, I was fuming.  I thought, “Who does this doctor think he is?” After all, my husband and I have been in charge of our son’s health from the moment of his conception. We’re his parents, the ones who know him best. We have a good relationship, we openly and often talk about difficult issues and the challenges he may be facing. We only want what’s best for him.

Once I got over my misplaced anger, I realized that the doctor also wanted what was best for our son.  That day turned out to be a learning milestone for all of us. Our son had the chance to take another step away from childhood and toward independence and manhood.  He also had the chance to share his thoughts, worries, and personal questions with someone other than his Mom and Dad, someone especially skilled at asking and answering difficult questions.

POSTED: Wednesday, January 22, 2014, 5:30 AM

Need some help figuring out how to talk to your child about underage drinking? Wondering how the conversation will play out?

Start the Talk, is a new interactive online tool that helps parents practice tough conversations about underage drinking with their kids in a videogame-like environment.

It is part of the Talk. They Hear You. campaign launched last spring from Substance Abuse and Mental Health Services Administration, which gives parents and caregivers information and tools to start talking to children — as early as 9 years old — about the dangers of alcohol. Research has shown that children start to think differently about alcohol between the ages of 9 and 13, and many children begin to think underage drinking is OK.

Between the ages of 9 and 13, children start to think differently about alcohol.  Many children begin to think underage drinking is OK. 
Between the ages of 9 and 13, children start to think differently about alcohol.  Many children begin to think underage drinking is OK. 
About this blog
The Healthy Kids blog is your window into the latest news, research and advice around children's health. Learn more about our growing list of contributors here.

If you have questions about your child's health, ask them here.

Anna Nguyen Healthy Kids blog Editor
Stephen Aronoff, M.D., M.B.A. Temple University Hospital
Christopher C. Chang, M.D., Ph.D Nemours/Alfred I. duPont Hospital for Children, Jefferson Medical Colg
Mario Cruz, M.D St. Christopher’s Hospital for Children, Drexel University College of Medicine
Katherine K. Dahlsgaard, Ph.D. Lead Psychologist - The Anxiety Behaviors Clinic, CHOP
Gary A. Emmett, M.D. Director of Hospital Pediatrics at TJU Hospital & Pediatrics Professor at Thomas Jefferson Univ.
Lauren Falini Bariatric exercise physiologist, Nemours/Alfred I. duPont Hospital for Children
Hazel Guinto-Ocampo, M.D. Nemours duPont Pediatrics/Bryn Mawr Hospital
Rima Himelstein, M.D. Crozer-Keystone Health System
Anita Kulick President & CEO, Educating Communities for Parenting
Janet Rosenzweig, MS, PhD, MPA VP for Programs & Research for Prevent Child Abuse America
Beth Wallace Smith, RD Children's Hospital of Philadelphia
W. Douglas Tynan, Ph.D. Nemours/Alfred I. duPont Hospital for Children, Jefferson Medical Colg
Flaura Koplin Winston, MD, PhD Scientific Director of the Children’s Hospital of Philadelphia’s Center for Injury Research and Prevention
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