Question 2
Question 2:
As this
study states Sugar sweetened beverages are related to several cardiovascular
risk factors. If you had a client come
in with a child who was not overweight yet but after talking with the parent
you find that the child consumes several 8 oz glasses a day of SSB in the form
of sweetened fruit juice, chocolate milk, and pop. The client reports that the child is not a “a
very good eater” and therefore they let the child drink more of their
calories. How would you approach this
situation knowing that SSB increase the risk of high waist circumference and
future heart disease? What are some
techniques that could be used to reduce SSB? How could you motivate the
child/parent to make a change with something like future obesity or heart
disease being so abstract?
posted by Unknown @ 6:34 PM
36 comments
36 Comments:
If the child is drinking several glasses of sweetened beverages a day, my first suggestion would be to "water down" these drinks as much as possible. I have taught previous clients to fill a glass with 3/4 juice and 1/4 water and continue reducing until it becomes "flavored water". This is not to say they need to do this all the time, but it is a weaning mechanism. I would tell the parent of the child as with anything in excessive amounts it can be detrimental to your health. I do not think I would threaten the possibility of the child becoming obese or having some form of heart disease, but I would make the parent/child aware of the potential health effects that COULD occur if adjustments are note made in the child's diet.
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I would generalize the information about SSBs and weight gain/heart risks. I would review the necessity of drinking milk for calcium, vit D, and protein. I would also suggest that, perhaps the child doesn't eat well because they are drinking their nutrition instead of eating it. That was a concept used in WIC when people were letting their children drink too many calories.
The parent is only going to be worried about getting calories into their child at this point. Instead of telling them that these drinks will cause increased risk for heart disease later in the child's life, explain to them the nutrients the child is missing out on right now and how that will affect his or her physical and mental growth. This may impact them more than something that may affect the child when they are grown up and out of this picky eater stage. I think that telling a parent of an overweight child about the increased risk of heart disease later in life might hit home more than telling a parent of a child likely not consuming enough calories/nutrients.
With this child I would make sure they switch to purchasing low fat chocolate milk, 100% juice and eliminate SSB completely. However, the big trick is getting the child to eat more and decreasing the volume of sweetened drinks they consume. I would find out what the child does like to eat and have the parents make these things but sneak healthier foods in little at a time. I think it is important that the parent not make a fuss if the child refuses to eat it but slowly add new foods. They say putting pressure on a child to eat is the worst thing you can do!
Ellyn Satter recommends:
Pair unfamiliar with familiar food, not-yet-liked with liked foods.
Don't make special food for the child.
Be sure to put one or two foods on the menu that they ordinarily eat.
Let them pick and choose from what you put on the table.
Do not limit the menu to food your child readily accepts.
Do not talk about the food the child likes or dislikes
Do not let the child graze in between meals. Have regular snacks midmorning and midafternoon.
Sarah S said...
I would probably make the parent aware of the possible, future negative health outcomes if the child does not get adequate nutrition, but I would emphasize more how their short-term growth and development can be impacted by their eating habits. It would be important for the parent to start slowly by reducing the amount of SSB offered, instead offering regular meals and snacks which include foods that the child is familiar with and likes. Most importantly, I would encourage the parent to model the eating behaviors for the child by eating with them, and eating a variety of the foods offered for that meal/snack.
Sarah S said...
I really like Alana's trick about reducing SSB. That is a very good way to slowly reduce the child's intake of SSB without them really being aware of it.
In counseling this client I would focus on being proactive. I would explain to them the effects that their beverage choices they are making now could have on their health in the future. In order to reduce the SSB intake, I think several substitutions would need to be made. For instance, choosing regular milk instead of chocolate milk or 100% fruit juice or diluted fruit juice. Since he is not much an "eater" I think it would be important to assess the diet and find out what nutrient rich foods the child does like and increase the consumptions of those types of foods.
I wouldn't begin by addressing the future heart disease risks to this parent. If they are coming to you now they have some idea of the risks involved. Instead, providing ideas of how to decrease the SSB consumption and increase water consumption as well as increase whole food calories over liquid calories would be the best start. I like what Alana shared about slowly diluting the SSB to wean the child from the high intake. Choosing low fat milk and 100% fruit juice is also a way to start the process. Increasing whole fruit consumption instead of the fruit or making homemade "healthy" fruit smoothies without all the added sugar may be a fun way to get the child involved and reduce the empty calories from highly sugary fruit juices.
I think the best way to reduce the amount of soft drinks young children drink is to not serve it with meals, do not offer it at mealtimes and simply not having it in the house hold. Replacing soft drinks with other drinks that have been mentioned like milk and juice would be ideal. I think a lot of the decision is based on the parent's child-feeding practices instilled long before in infancy.
Obviously, I did not read the second question before answering the first one. I would recommend the parents to reduce SSB and slowly add to their diet milk in the form of milk shakes w/ fresh fruit or smoothies made with non-fat yogurt and fresh fruit. This way, the kids are offered something new, fresh, home-made, nutritious and feel satiated.
I agree with Sarah where parents are the role models for their children. It is important for parents to practice what they preach.
I think that I would educate the parent on possible healthy problems that could occur if the child does not get proper nutrition. I would inform her on ways to cut out her child's large consumption on SSB. For example I would tell her to replace chocolate milk with regular milk and to replace sweetened fruit juices with 100% juices. Also I will agree that you should talk to the child and figure out fruits and vegetables he likes and try to increase those in his diet. I also like the idea of fruit smoothies because he obviously enjoys sweet drink so he may like that for breakfast or a snack. Also hiding vegetables in the smoothies may be beneficial.
Carly Johnson said...
Well since it sounds like this child loves their drinks, I would suggest buying a juicer. It would be a little extreme at first, so the parent should add the SSB in with the fresh juice of fruits and veggies. Slowly over time, hopefully the child would grow into not being dependent on the SSB. The parent may complain about the price of the juicer, but in the long run it will save their child from being another statistic. I would also suggest that they shop at ALDI for their fruits and vegetables if they are apprehensive about affording all the fresh produce.
I also think that a reduction in serving size and serving frequency would be important instead of getting rid of it all at once. I can only imagine the tantrums! Slowly cutting back on these until you are down to a reasonable serving size that the child can have as a treat once per day would be a good short-term goal.
I also think that a reduction in serving size and serving frequency would be important instead of getting rid of it all at once. I can only imagine the tantrums! Slowly cutting back on these until you are down to a reasonable serving size that the child can have as a treat once per day would be a good short-term goal.
I would address the client's concerns by letting the client know that even though their child may seem like a "poor eater", he will start eating when his body calls for it. Kids have the same kinds of auto-regulations that we do, so that means sometimes they won't be that hungry. Provided there are no health conditions, the child will make up for that by being very hungry when he is growing or if the body is in energy deficit. Trying to make up for calories in nutrient-poor, sugar-rich foods is not a good idea because this will increase the risk of obesity and health problems later on such as diabetes, metabolic syndrome, and heart disease. If this concept is foreign to the client & child, I would make the use of visual aids, such as the amount of sugar in one soda, etc. to give impact. One thing the client could try for the pickier eater is giving the child a choice out of several healthy options. For example, they may offer a smaller portion of a food or beverage the child likes (e.g. 4 oz. of juice instead of 8 oz.), while expecting them to eat X number of bites of vegetable or food A or B for that night. Rotating the food choices would ensure the child is getting appropriate nutrients while introducing the child to new foods.
The client may gradually substitute chocolate milk for pop, then low-fat milk for chocolate milk. Milk is recommended for it's nutrient-density. Juice is alright in limited amounts, so as I said before I would suggest gradually decreasing the amount of juice the child is allowed per day. If the child getting enough energy is actually a concern, it may be appropriate to supplement the diet with something like PediaSure, which would be a better option than SSBs.
To Kelsey Ahlers, I think that is great advice. Giving the child choices while not being overly compromising encourages them to make intrinsically-motivated decisions while ensuring they don't become "spoiled" by learning to eat what others eat. One thing I've learned about kids is that if you just tell them to do something, they will be resistant and not want to; but if you give them options that still achieve the same result, they will be more receptive. Pairing the familiar with unfamiliar foods would help the child associate something new with something that is good, whereas the new food by itself might be too scary to try.
I don't know if I would slam them with the cardiac/weight risks at first, but just say that their child could be consuming more nutrient-dense foods/beverages. So I would frame it as, there are other things your child could be consuming to get more bang for your buck nutrient-wise. As far as the liquid thing goes, I would suggest smoothies incorporating fruits (such as frozen bananas and berries) and veggies (including leafy greens).
Awesome job suggesting Ellyn Satter stuff, Kels!
I am learning that this is very common at WIC. Something I have heard at least once/week. I agree with what several others have said about limiting the scary heart disease facts at first, but still mentioning them as facts after providing some potential solutions. I like all of Kelsey's ideas to encourage kids to eat more solid foods, and I would encourage parents to dilute, limit, and substitute for these SSB. Others have listed great ideas for this as well.
I would have the parent try to wean their child off of the SSB first and foremost. The child may not be eating very well because their stomach feels full from the beverages. Then, I would encourage the parent to make food fun for their child. Include him or her in making the food and ask them what they would like to have for dinner so they feel like they contributed something.
I like Carly's suggestion of buying a juicer and making real juice at home. The parent could also involve the child in that process and the child would probably be excited to drink his own creation!
I would first start off by doing a diet recall for the child and assess what the parent’s idea of “not being a good eater” is. I would also want to know how much of each drink the child is getting and figure out the total calories from food vs. beverage. I would then recommend that the child drink 100% fruit juice that is watered down, less chocolate milk and more lower fat white milk, and try to eliminate pop. As Alana had mentioned, I think a weaning system would be appropriate for this situation. From there I would want to inform that parents that overconsumption of these sugary drinks have the potential to lead to negative health factors such as heart disease and weight gain. I would also want to emphasize the importance of eating whole foods in order to consume the nutrients essential for growth and development.
Kelsey, I really like the tips from Ellyn Satter. I agree that those ideas would be a great starting point for parents with picky eaters and reminding them that introducing new foods to children is not a one-time thing.
I would approach this situation by inquiring what concerns the parent has regarding their child's poor appetite and SSB intake. Ultimately I would share the same advice (slowly reduce SSB intake and increase whole food consumption) within the lens of the parent's concerns whether it's growth-, weight-, or chronic disease-related. I agree with the practical advice Alana and Kelsey shared regarding juice dilution and whole food incorporation, respectively.
I would first focus on why the child is not eating well. What does the child normally eat? Are they snacking alot so they're not consuming their meal? etc. Towards the end of the discussion with the parents I would mention the SSB's lasting effects. Dietary habits begin in childhood, and reducing SSB consumption would help the kid in the long run, which most parents would want to keep their child and prevent overweight/obesity for the child. I would recommend just slowly replacing a n 8 oz cup of the SSB with a healthier option like nonfat milk or water, and gradually increase this replacement.
I also like Carly's suggestion of a juicer. Although I wouldn't recommend it drinking it all the time, it is still a good replacement for one of the sodas and will be much more filling.
I actually had a conversation with a mom with a similar situation while I was at WIC. Her 1 yr old daughter was overweight per the height to weight chart, and the mom reported she loved chocolate milk. Fortunately the mom was concerned and we had a great chat. I took the approach of emphasizing the need for nutrient rich foods for proper growth and development and discussed that all of the chocolate milk was filling her up so she wasn't hungry for the food she needed. Fortunately (or not depending on how it went), there would not be much negotiating with a 1 yr old. I encouraged the mom to only allow water between meals and plain milk with meals with chocolate milk being an occasional treat. I also made sure to talk about the fact that we don't ever want to put little ones on a diet but rather encourage healthy, adequate intake of nutritious foods.
For older kids, negotiation would probably be needed. The parent and child would need to agree on a reasonable level of SSB intake (e.g. 1-2/week) as well as come up with alternatives. Using fruit to flavor water would be an idea. Over time, hopefully the desire for the SSB would subside.
I think the future risk of heart disease would be a hard sell unless the family was personally affected by it. You could try to shock them with the prediction that todays kids are the first generation predicted to live fewer years than their parents. Or a field trip to the hospital to see the multiple health issues that come from overweight and heart disease would also be a real eye opener. But seriously, I don't really suggest we try those tactics. I look forward to reading other's more practical ideas on how to use future health risk as a motivator.
I agree with Sara and Teju in that parents need to be part of the solution. If the kids see caregivers drinking diet soda all day, they will think that it is OK. They will also have easier access to it. Over the years we have gotten to where we only have soda in the house on special occasions. It's awfully hard to drink it if it's not there and drinking water becomes the normal thing to do even at restaurants.
Like a few other people said, I would first try to determine what the child eats on a regular basis. It may not be the SSBs causing most of the problem. I would give the parents information on the importance of offering different foods to their child and reducing the amount of SSBs. I would also suggest that they start by watering down the drinks that their child consumes. Similar to juicing I would suggest they try to get their child into fruit smoothies. If they could eat one of those for breakfast their child could get a lot of nutrients from the fruit and vegetables without the child really knowing it.
I would first educate the parent that filling their child up on sugar sweetened beverages can cause them to miss out on important vitamins and minerals they would be getting by consuming actual food. Also, if a child is able to become full on beverages, there is no reason for them to want to eat foods. But, if a child is still hungry and not able to fill up on beverages, they will eventually start eating more food. After bringing this to the parent's attention, I would add in the possible risks of obesity and heart disease as further incentive for them to change their child's eating habits.
I agree with Alayna's suggestion on watering down the juice as well as using fat free milk to wean the child off of all the sugar they are consuming. I also agree with Kelsey's comment about introducing new foods with already liked food, not pressuring the child to eat food they do not want to, and only allowing snacking during regularly scheduled snack times. All of these suggestions will definitely promote the child to become less of a picky eater.
I agree with Beth and others that the parents need to be part of the lifestyle change. If you can't get the whole family on board, it would be difficult to make the change for one child in the family.
I also agree with Molly that soda should just not be an option. If it isn't an option at home, the child will not be tempted to choose it. But again, I think a whole family approach would be best.
I agree with Courtney. When you're filling calories with SSB then you're missing out on essential vitamins and minerals! Key point!
Me too! I agree with Courtney. Vitamins and minerals are essential and they come from real food not SSBs
I think Lynetta and Emily made good points of the importance of explaining the lasting effects in a way that the parents can relate to. If you help them to be able to fully understand or even picture the future then it could have a much bigger impact on them.
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