Ask the Experts

Written by Various

Our Experts on Picky Eaters, Language Development and Cavity Prevention

July Experts

Holly Mosier is a healthy lifestyle expert and the acclaimed author of "Stress Less, Weigh Less." She resides in Lake Forest with her family. For more information, visit HollyMosier.com.

Stephanie Peterson is a pediatric speech pathologist and team member at Children's Learning Connection. For more information, visit www.ChildrensLearningConnection.com.

Dr. Dora Lee, DDS, is a leading pediatric dentist in Los Alamitos. For more information, visit www.DoraLeeDDS.com.

Pleasing the Picky Palate

Q (Grade School): My son has a limited variety of foods that he will eat and I am worried that he is not getting proper nutrition because of this. How can I encourage him to eat better?

A: As a mother of two and step mom to two, I hear you and I feel your pain! It seems that each of our children went through a very challenging picky phase in which there were only a handful of foods they would eat. Let me share the solutions I found.

Finger Foods

These are always a hit with kids. It instantly communicates "fun" food, even if the food packs some serious nutrition. You can go with traditional raw veggies with dip but I found once I made eating with fingers okay, there was a much wider variety of foods I could get into that kid! For example, I started roasting veggies so they were crisp, tasty and (believe it or not) took on a bit of a "french fries and onion rings" taste and quality. Try my Roasted Veggies recipe - it's quick and easy and the whole family will love it. Here it is:

1. Preheat the oven to 425 F.
2. Cut a variety of vegetables into small pieces (my kids' favorites are broccoli, bell peppers, carrots and thinly-sliced onions but you can use any vegetable).
3. Put them in a large bowl and thoroughly coat them with cooking spray as you stir them around. Add garlic salt and pepper to taste.
4. Place the veggies on a cookie sheet sprayed with cooking spray and bake for about 20 to 25 minutes, until they are brown and crispy.

These are so delicious that even my pickiest eaters will stand by the oven waiting for them to come out so they can grab the crispiest ones.

And there is always the old standby of celery sticks or apple slices with peanut butter - which is a high protein, heart-healthy fat. Kids will almost always eat these and, if needed, drizzle some honey on the apple and peanut butter slices to sweeten the deal.

Let Them Help Prepare the Meal

I have found when kids participate in the food preparation, they are much more likely to eat it. In fact, they become advocates, encouraging the others to eat it. Participating in the preparation lets them modify the food somewhat to make it palatable to them and helps us understand their particular taste. They also take pride in what they've created, making them much more amenable to sampling new foods.
 
Once I included the picky eater in the food preparation, I was surprised to discover that, many times, my child was actually not so averse to the specific food itself but to the way it was prepared or the seasonings used. Once he or she modified it a bit, many times that food became a favorite.
 
And here's another trick that has served me well. Make food preparation an art project. For instance, if you are using the Roasted Veggies recipe, assign your son different colors of veggies to choose from. Let him select his two or three favorite colors to include in the dish. For example, he could select one red bell pepper, one orange carrot and one green veggie, like broccoli. Different colors of veggies contain different nutrients, so this is a clever way to nourish him.
  
Dips

These are also popular with kids. Any food they can dip into a sauce, seasoning or dressing stands a much better chance of making it into their stomachs. I have used everything from the tried-and-true ranch dressing (they will dip anything into it - even pizza or slices of a baked potato), honey and barbeque sauce to Greek yogurt for more of a nutritional punch. Here's an idea I just started using recently with great success. Add a half-teaspoon of cinnamon to a small container of Greek yogurt (which is packed with protein and calcium) and let your son dip slices of apple or banana into it. Tasty! This is a well-balanced after-school snack. And as recent studies are confirming, cinnamon has a number of health benefits, including helping to keep blood sugar levels steady.
  
Protein Bars

Particularly the ones that masquerade as candy bars are a good option. There is a tremendous selection of bars available at grocery stores, or even at drugstores, so these have saved me from visiting the fast-food drive-through many times. Check the labels and you'll find that many of them have a well-rounded array of vitamins and minerals, even if they are coated with chocolate. I always have a stash of these available and, if you add a glass of milk, it can be a complete meal with a good balance of proteins, carbohydrates and fats.
 
By the way, if your child plays sports, studies are finding that chocolate milk replenishes and energizes athletes better than most sports drinks. And, of course, milk cannot be beat for calcium content, a critical nutrient in growing years. So what if you add a little chocolate to it? My philosophy is that if we are eating well most of the time, a little chocolate is not going to kill us - and it's good for the soul.

Bring Humor To The Situation

As parents, we fret about our kids' wellbeing and when they refuse to eat, we worry. I have found bringing a bit of levity to the situation works wonders in lightening the atmosphere surrounding mealtime. Beyond just nourishing our kids when they are young, we also want to encourage healthy attitudes toward eating, which can go a long way in warding off all manner of eating ills and disorders later. Bring a bit of laughter to the situation.  It won't harm him to only eat a limited variety of foods for a while. One of my kids went through a phase where she would only eat peanut butter and crackers (with the occasional apple). Her pediatrician told me it wouldn't kill her. So we made light of it - called her "peanut" - and you know what? After a few months, she was over it and very ready to expand her horizons.
 --Holly Mosier

Finding the Words

Q (Toddler): My 2-year-old seems to use fewer words than other children his age and I have some concerns about his speech development. My child's pediatrician says to give it more time. What should I do to help my child?

A: Parents are often the first to notice a possible delay in their child's speech or language development. Speech refers to the production of sounds used to make words. Language refers to the use of words and sentences. Perhaps your child's speech is not clear. Or, your child may use fewer words or shorter sentences than other children the same age. By the age of two, your child should be able to:

• Use a vocabulary of 50 words
• Say a word for almost everything in daily life
• Use two-word sentences. As they approach age three, children will begin using three and four-word sentences.
• Be understood the majority of the time by those familiar with them. As they approach age three, they should be understood the majority of the time by unfamiliar listeners.
• Follow two-step directions ("Get your shoe and bring it here")
• Use early developing pronouns (I, me, mine)
• Direct attention to objects by naming and commenting about them 

It is important to discuss early speech language development and any concerns you have with your pediatrician. Using developmental milestones, you and your pediatrician can compare your child's development with that of other children the same age. Some speech and language skills seen in 2-year-olds are provided below. However, it is important to note that all children develop at their own pace. It can be difficult to tell whether a child is just immature in his ability to communicate or has a problem that requires professional attention. This is the job of a speech-language pathologist (SLP). An evaluation by an SLP may be warranted if your child:

• Has experienced chronic ear infections
• Is not understood by playmates or others outside the immediate family
• Is frustrated when trying to communicate and the situation does not improve over a couple months 
• Shows a delay of six months or more in developing speech and language skills

If you have concerns about your child's speech or language development, ask your pediatrician for a referral to a pediatric SLP. The "wait and see" approach is not recommended. A pediatric SLP will sit down with you and your child, listen to your concerns, observe and evaluate your child. They will give you information about normal speech and language development and explain to you your child's unique pattern of development. Following the evaluation, the SLP will be able to provide you with parent-education about how you can enhance your child’s speech and language development at home.

Things parents can do at home to enhance the speech language development of their 2-year-old:

Model Clear, Simple Sentences Be sure to slow down and get down at your child's level.
Repeat What Your Child Has Said and Expand On It If your child says, "Big car," you respond by saying, "Yes, that is a big car. A big red car. Let's make it go fast." This can be done during play, at the grocery store, or wherever your day takes you and your child!

Make It a Game The above concept can be turned into a simple game using a bag filled with common objects from around the house. Have your child pull out one object at a time. You repeat whatever your child says, then expand on it.
 
Reading Expand your child's vocabulary through reading books with simple sentences on each page.
  
Describe People With Simple Sentences Look at family photos together and use simple sentences to describe the people, places, objects and actions. For example, "There is daddy! Daddy is sitting on the sand. He is at the beach."
 
Use Family Photos To Create Your Own Books Write a simple sentence on each page below a single picture. Your child will enjoy reading these homemade books with you while enhancing early literacy skills!

Sing Simple Songs and Tell Nursery Rhymes These songs and games introduce your child to the rhythm and sounds of language.

Offer Your Child Choices To Help Him Communicate Better Rather than asking your child, "Do you want milk?" you could ask, "Do you want milk or juice?"

Praise Successful Communication Attempts This helps build self-confidence for your child and lets him know that he has something important to say!

If your child requires some more specific intervention, the SLP will let you know what type of speech language therapy your child will benefit from and provide any appropriate referrals. For children who do exhibit true speech and language delays or disorders, early intervention is the key to success. Social development, behavior, later literacy and academic skills are built on a solid foundation of speech language development.  --Stephanie Peterson

Beyond Brushing: Protecting Against Cavities

Q (Grade School): I brush and floss my kid's teeth everyday but they still keep getting cavities. What am I doing wrong?

A: There's nothing more discouraging for a child and parent (and even the pediatric dentist) during a dental visit than to find out that the child has a cavity. It's doubly worse when efforts have been made to get checkups twice a year, avoid cavity-causing foods and follow a daily regimen of brushing and flossing. Historically, water-fluoridation, sealants and other preventive methods have definitely helped curb the potential impact of decay on school-aged children. But statistics show that tooth decay is still prevalent. So you're not alone. In fact, since the 1990s, there's been a slow yet steady increase in incidences of tooth decay in children. The NIH reported in a 2004 study that 40 percent of children between the ages of 2 and 11 have had a cavity on a baby tooth.

While there's no magic pill that will make cavities disappear forever, there is some encouraging research that may one day make that possible. The University of California San Francisco is currently working on regenerating tooth pulp and enamel using stem cells. Imagine the day when we can "grow" enamel or even new teeth to replace our old, worn out dentition! The University of Florida is also doing research on creating an antibiotic for cavity-causing bacteria. Since we can't warp ourselves into the future and enjoy the fruits of these brilliant scientists, what can we do in the present?

It's important to understand what causes cavities in the first place. Certain types of bacteria that live in our mouth cause tooth decay. The bacteria feed on the foods we eat and produce acid as a by-product. This acid sits on our enamel and begins to dissolve the minerals, making our teeth vulnerable. Our body's response to these acid "attacks" is saliva, which has minerals and fluoride to help replenish these vulnerable areas and neutralize the acid. But it's not that simple. Our entire mouth is in a constant state of acid/alkaline balance. That means every time we eat or drink something acidic (fruit juice, soda, sports drinks), the acid levels in our mouth go up. When we drink something neutral (water), the acid levels go down. Though we have saliva to help protect our teeth and neutralize the acid, it takes time for the mouth to be back to its happy state. If we don't have enough saliva, if there's too much bacteria or if we snack too frequently then the cavity-forming process begins.

Decrease How Often Snacks and Drinks Are Consumed

Frequent snacking/drinking prevents our mouth from ever reaching its ideal neutral state. Consider limiting juices to mealtimes and limit the number of snacks consumed between meals. If at all possible, avoid drinking juices and sports drinks, as they have a high acid content. However, if necessary, consider using a straw, rinsing with water and avoid brushing for 30 minutes afterwards. In between meals, milk and water are best. Milk is slightly acidic and contains a sugar called lactose that bacteria can break down thus contributing to plaque buildup. However, milk contains calcium and a wonderful variety of proteins that also help strengthen teeth.

Reduce The Amount of Plaque-Causing Foods In The Diet

Namely foods containing fermentable carbohydrates. These are foods that are broken down into sugars as you chew. The most common, obvious carbohydrates are the familiar sugars (sucrose, fructose, glucose). However, we often don't realize that starches (pasta, bread, crackers) are also broken down into sugars in the mouth. All of these types of carbohydrates give bacteria the nutrients to produce plaque. Since we can't avoid all types of carbohydrates, consider combining starchy foods with healthy nutritional sides, such as cheese to go with the crackers, or limit them to mealtimes only. Choose your snacks wisely: reach for the crunchy fruits and veggies over the sticky, chewy ones (raisins, dried fruits). Avoid foods that are highly processed such as instant breakfast meals and instead opt for whole grain cereal or oatmeal.

Increase Exposure To Xylitol-Containing Products

Xylitol is a naturally occurring sugar that has the amazing ability to weaken plaque-causing bacteria in the mouth. Xylitol can be found in chewing gums, a powder form for cooking, candies and toothpaste as well as other products. It is best to find products that have 100 percent xylitol (usually found in health food stores) or products that list it as the top ingredient. More companies such as Xclear and DrJohns are making great-tasting xylitol products that are readily available to the public. Parents are highly encouraged to consume xylitol as well. Research shows a correlation between the oral health of the mother and the child so healthy habits should begin with the parents!

Diagnostic Testing

For your teenager (or yourself), consider asking your dentist about diagnostic tests to see the levels of bacteria present or to determine the pH of the mouth. Though uncommon in children, we shouldn't ignore the possibility of high bacterial levels or a very acidic oral environment as being a cause for cavities.

Of course brushing, flossing and fluoride intake are the foundation to a healthy future but there's more to the cavity story. Hopefully some of these tips and thoughts will help clarify and broaden your perspective. --Dr. Dora Lee