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>> Hi, everyone, and welcome to Eat the Rainbow, Discover Balanced Eating.
My name is Claudia Zurlini, and I'm a Senior Coordinator
with the Education Institute here at HSS.
We're so pleased to have you at this program today.
I'm pleased to introduce our speaker, Laura Gibofsky,
who is a Pediatric Nutritionist at Hospital For Special Surgery.
And she is our nutritionist for the SNEAKER or Super Nutrition Education
For All Kids Eat Right Program here at HSS.
So without further ado, I will let Laura take it away.
>> Thank you, Claudia.
I appreciate it.
So today we're going to talk about healthy eating for the pediatric population.
So if we could just have the first slide up.
So when we think about balanced eating, I always like to tell people that we want to make sure
that we're getting all of the different food groups in the right amounts,
and we're getting a diversity from all of those different food groups.
So we have our fruits, our vegetables, our whole grains, our protein and our -- and dairy.
And especially since we work at Hospital For Special Surgery and we're all
about musculoskeletal health, we do put a strong emphasis on making sure
that the kids are getting adequate calcium sources from their diet to make sure
that they're having those strong bones for growth and development.
And in terms of how do we know if we're getting enough, typically,
if we're eating a diverse diet with all the different food groups,
we should know that our body is getting what it needs.
The key to remember is -- that I always say is, we all need different amounts
at different stages of development.
But it doesn't mean that we can't eat the same foods.
So doesn't mean that we need to order off of a kids menu.
So a child can eat fish.
That is a fact or unless they have a food allergy.
But for some reason, we sometimes decide that children can't eat fish
and that they should be eating hot dogs instead.
That is not the case.
So we still want to make sure that we're including a diverse diet, again,
from all of our different food groups; that we're getting different colors,
different textures because those are going
to establish those healthy habits for later on in life.
Next slide.
>> It's coming.
Hold on.
>> In terms of talking to kids about food, sometimes the idea of saying,
Eat this because it's healthy doesn't always work,
especially when a child may not understand what healthy means to them.
So it's important to put it in terms that they understand.
So let's say that they have a cut.
You can say, Well, eating those yellow foods and blue foods
and green foods will help your cut heal.
Or if a child has glasses, well, we want to make sure that we're --
if even if they don't have glasses, making sure
that we're including our orange food groups helps to make sure
that we can see well in the daytime and at nighttime.
So, again, it's important -- and, again, this might change as they get older,
as I talk about in the next slide, you're going to want to cater your message
as your children age so that they can remember those important lessons
and take them into adulthood.
We know as adults, at least we hope at this point,
that we know what a healthy diet looks like.
Whether we're doing it or not, that's a different thing.
But we know that we should be including fruits and vegetables in our diet.
We know that we need a certain amount of protein.
We know that we need healthy fats, we know
that we shouldn't be eating the excess amounts of chips and cookies and cakes.
But, again, it's about making sure that our message is on point
so that we can establish those healthy habits so that they know those things later in life.
So here I just wanted to include so that you had as a reference, the different --
how we look at the different fruits and vegetables and the different color groups
and some of the benefits that they may have.
So a fun game that I often would play with my niece or my nephew in the car would be,
let's think of all the foods in the red -- that are red.
And it doesn't necessarily have to be a fruit or vegetable, but sometimes you can kind of --
you can do it that way and say, Let's think of all the purple fruits
and which purple foods that we'll eat.
And this way, then you could say, Oh, well, did you know that purple fruits actually help you
as you get older and strong -- so that you can be stronger, or it helps to make sure
that you have a good memory so that we can keep playing this game.
So, again, it's all about trying to find fun ways to connect with kids
at the different stages of their lifespan.
I always think it's important to talk about access and affordability
because often sometimes what I hear is I can't eat this way because it's more expensive.
And I know that sometimes that may seem like the case.
But if you actually dig deeper, it doesn't -- it actually isn't always true.
So if you shop at your local farmers markets, you can actually get really great deals
on fruits and vegetables because they're often --
they're taking out the middleman so that you don't have to pay that price increase
In addition, it's a great way because you get to know the local vendors.
And then they can tell you this was just picked
out of the ground yesterday or where it came from.
And that's sometimes really fun for kids to see that and to get engaged that way in terms
of the foods that they're eating and where it comes from.
They also accept at these local farm farmers markets the EBT and snap cards.
So that's a huge benefit in that sense.
The other thing is that it helps you because you're buying the produce in season.
And so, typically, those will have more flavor and that they're maybe more affordable
because you're not necessarily buying them from an area of the world where it's grown,
and that they're being imported in.
The other thing I always tell people is buy what's on sale.
Something that's on sale does not mean that it's bad or rotten.
It may be that it they bought too much of it, and they were expecting to sell it.
So the best example I always give, if you notice
around Superbowl time, avocados, they are everywhere.
And there's always deals because they know that people might be making guacamole at home.
And so you might be able to get deals in the same way.
They may have gotten a very good deal to get x pounds of broccoli
and that it wasn't selling as well.
So it is still important to examine the produce.
But it doesn't necessarily mean that it's bad.
The other thing is if you buy things in bulk or while it's on sale,
you can certainly take it home, cut it up, put it in a sealed bag and label it and date it,
so this way it doesn't end up in the back of the freezer with a 2019 date and it's 2021.
We don't want to keep things there endlessly.
But I always say it's a great way you can cut things up, put it in the freezer.
It's similar to the frozen foods that you would buy, which is another great option,
the frozen fruits and vegetables.
All that's done is that it's typically that the fruit or vegetable is picked immediately.
And then it's frozen so that it seals in the freshness and the veggies -- and the nutrients.
And so that's another thing.
And I've seen those where you can get X number of bags on sale, 3 for 5 or whatever it is.
So that's another great way.
And this way, you always have a vegetable that can be on the table within seconds.
The other thing that you can use is these new grocery services,
Imperfect Foods, Misfit Market.
So what these are is that they are the fruits and vegetables that may not look as nice,
but it doesn't mean that it's -- the quality is not as good by any means.
Typically, we buy with our eyes.
So when we see an apple that has a dent or a third little thing on top, we might think, oh,
there's something wrong with it when that's not the case.
The nutritional quality is still excellent.
And so you can get those foods which typically will lower the cost,
and they also have discounts and coupons to make it more affordable as well.
So that's another easy -- another thing that you can look at online.
Another great thing to look at in your local community is a CSA.
So it's a Community Shared Agriculture Program.
And so, oftentimes, they'll put together boxes with certain vegetables and fruits.
So it can be a lot, and it may not work for your family.
So even finding another family or a friend to share it with,
this way you can get this always having these different fresh fruits and vegetables.
And they typically, again, will offer it at a more reasonable price compared
to what you would get in a supermarket.
There are also great cookbooks and guides, and we have a reference that we'll provide you
at the end for a good and cheap cookbook that will help in terms of healthier recipes
and buying things at the supermarket that will be more affordable.
And as I mentioned previously, buying in bulk is a great way to save money,
and then you can freeze it or make dishes and put those in the freezer.
But this way, you never have to worry about not having something in the freezer.
The same way also with the frozen items, as I mentioned, it's a great something
to keep in your freezer at all times.
You can stick it in the microwave.
You can quickly put a little nonstick spray or olive oil in the pan.
Just stir it up with a protein and it can make for a really easy, quick weeknight dinner.
Next slide.
So, for me, of course, I always say the best way to get kids to want
to make healthier choices is to get the kids involved.
And so I wanted to just give you some fun ideas.
You can do different color weeks, and maybe we focus this week on orange fruits and vegetables.
Next week we do green, or even I say let's all come together as a family and we can all come
up with a different vegetable of the week.
And then you go to the supermarket and you can buy it together, and maybe that we try it
on the plate each day or we try it with different recipe, with broccoli or zucchini.
But just kind of a fun way.
And getting them engaged will help them want to eat those foods.
Another -- another way that typically always works, not always but it's a fun thing is
to just get fun plates and cups and utensils to make mealtime fun.
Sometimes putting a fun straw into a cup can make a big difference
if a kid will drink its water.
So just some fun ways so that they feel engaged and that it seems that eating
and eating healthy, it doesn't have to be a bore.
You can still have fun with different things.
The other thing is sometimes playing around with different shapes can be helpful.
So you can cut the carrots in a stick.
For some reason, anything in a stick form, even in sandwiches.
There's something fun about that.
That's why kids like chicken fingers.
So you can make chicken at home and put them in little strips.
It might help them in terms because it's fun, it's bite-sized.
They can put it in their mouth.
So sometimes it's this -- as easy as just changing the shape in which we're doing things.
So if you think about it, sweet potato fries, they're in strips.
You can do them in coins and bake them in the oven.
So there are always fun ways that we can think about foods in different ways.
I also fruit and vegetable Bingo is another fun one that you can play.
And, again, at the end, you can think of a healthy, inexpensive prize, even if it's --
I always like to say you don't want to use food as reward.
So even quality time with mom or dad or a special 15-minute activity
that you can do with just one kid.
This way, they like that they win.
Special private time is always a fun way, as well, as a good prize to offer.
Next slide.
So this is important.
I have to remind my adult patients of this as well.
But when we are -- typically it takes us 10 to 15 times
to decide if we actually like something.
So if you think about back when our children are first introduced to solid foods,
they may make a yucky face if they are exposed to something.
But we typically don't stop.
We will continue to offer it multiple times to make sure that they're eating it.
And the same goes as they get older as well.
We don't want to force them by any means because that could go in the opposite direction
where they then don't ever want to touch that food.
But we can certainly keep putting it on their plates and encourage them and, again,
try it in different -- different sauces or try it in different shapes, as I mentioned before.
And just keep offering it and encouraging it because the more times that we expose the child,
the more likely that they may start to try it.
So, again, if you know that your child also likes pita and they like hummus, you can try --
and you know that they like red pepper but they wouldn't necessarily put it together,
then you can try maybe serving it together on a plate.
But if you know that they're never going to touch hummus and red pepper,
I wouldn't necessarily offer them as a snack, hummus and red pepper together.
So you may want to even think about different separate foods.
And then once you know that your child is accepting of them,
then you can kind of pair them together.
So, again, if your child has never had whole grain toast before, the idea would be pair it
with something that you know that they like.
So if it's peanut butter, why don't you put the toast with some peanut butter on it
and even a banana and say, here's a great healthy snack.
So, again, you don't want to just try something out of the blue.
It might send them in the opposite direction.
So also try using the foods that you know that they
like with maybe something new or doing it separate.
Each child is different.
And it's -- remember.
You know your child better.
So it's important in terms of how you know it can help them get the food into their diet.
But, remember, it takes 10 to 15 times.
And as adults, we're not as good about doing that.
But I can honestly say that, in this past year, I started eating mushrooms and peppers.
And now I love that they're part of my diet.
I made roasted peppers and I put them on my salad or just eat them as a snack.
And I never used to do that.
But I kept trying because I would tell other people this so I wanted to see if it was true.
And it turns out it is.
So that's a fun thing that you can do as well.
Next slide.
So I know that mealtime can often seem difficult, especially I know in this last year
where we were homeschooling and working from home.
But the important thing is stick to a schedule.
Scheduling helps kids understand what's coming and also what is expected of them.
So if there's -- meal time is shifting at all hours of the day, it doesn't even help them
in terms of establishing those hunger cues of knowing when they would feel hungry
and when a snack time would be coming.
They can't manage that.
So this way, if we stick to a schedule with meals and snacks,
it helps them know what is to be expected of them.
And that also helps establish those hunger cues to say, I should be feeling hungry now
because it's been three hours since I last ate something.
Remember, we don't want mealtime to become a struggle.
And sometimes that can be the case.
It is our job as adults to put healthy food options for the children.
They can decide how much of it they want to eat.
So maybe on a certain day that they just don't feel like eating,
you don't want to force them to eat.
Again, they can't say, I don't want to eat what mommy or daddy or auntie or uncle cooked for me.
I want to eat McDonald's.
That's not how it works.
But if you make them the healthy option, they can decide if they want to eat it.
What is important is stick to your guns and not say, well, I'll make you something else.
That's what I hear a lot from parents.
And I always say, you're not running a diner at home.
If you want to say to your child when you're working with dinner, you can say,
let's come up with two options together.
I was thinking chicken or hamburger tonight.
Which one do you want?
So, again, they feel that they are a part of the decision-making process.
And by that, you can say, well, we chose hamburger together.
So I'd like -- this way, then they may feel, well, I chose this, so I'm going to eat it.
So, again, it's you get to decide of the options that you want, but you can include them
in that decision-making process so that they feel that they do have some choice because,
again, if you left it up to a child, What would you like for dinner?
The answer is likely pizza, chicken nuggets or ice cream every night.
And we know that we can't serve that.
So [inaudible] let's come up together.
Here are the two ideas.
You pick. So they feel in control, and that will help.
But, again, the last thing that we want is forced feeding.
Two more bites, three more bites before you can get up.
Again, the child will -- will remember those things later on,
and it can lead to them never wanting to eat broccoli again
because they will always come back to, I was forced to sit at the table.
I wasn't allowed to get up until I ate all of the broccoli.
And so those things stick with us as we age and can inhibit us
from eating those foods later on in life.
So, remember, allow them to tell you how hungry they are.
That's okay.
But it's your job to provide the healthy options.
It's their job to eat the options that you provide,
not to go off on all these different things.
Well, I'll make you this because you didn't need this.
If they are not hungry to eat what's on the table, then they're not hungry.
But it doesn't mean that they can be hungry to eat something else.
And so that's a really important rule that I always make sure that I enforce --
help my parents enforce because, otherwise, the kids will always try to get
from you the chicken fingers or the pizza.
And they will, and then that will become the habit of, well,
I did this; so I should be able to get this.
So the other idea is always make sure that there's one food that your child likes to eat.
And I don't want this to be French fries or ice cream.
But if you know that they'll eat broccoli, make sure that there's broccoli.
If they're never going to eat peppers, don't --
you can have peppers, but make sure you have broccoli as well and say --
this way, again, the option is there for them to try it, but it's not a forced situation.
And, again, as I mentioned before, stick to the meal provided.
You can be empathetic and say, I understand that you don't want to eat.
But don't start saying, I'll make you this, I'll make you this.
We're all guilty of it.
I've been guilty of it myself.
I don't want you to think that it's bad.
But it's just a habit that is not encouraged because, again, that one time, it may be okay.
But what they're -- they're going to build on that, and they're going to use
that later to get what they want.
And we don't want to serve chicken fingers every night.
We want to make sure as I mentioned earlier that we're getting a diverse diet
with all the different nutrients.
If your child will only eat chicken or will only eat certain things, again, that may be something
that you want to bring up to your pediatrician in terms of what else can I do
and to make sure maybe you do need to see a dietitian to make sure
that there aren't other areas that you're --
that is lacking in your child's diet that could be preventing them
from meeting those growth milestones that we talked about earlier.
Next slide.
So as I mentioned previously, I want to give you some references, just to have.
And so if you go to the second link, the cookbook, that's a great free PDF
that you can download with recipes, and those foods available
in the supermarket or at the farmers market.
But hopefully you can use your cooking.
And, again, I included a link to the farmers market so you could be able
to find a farmers market that's local to you.
And we had mentioned those community agriculture boxes.
And so you might be able to find one that's near you or a family member if --
again, if depending on the size of the box that would work for you and your family.
So I hope this helped in terms of getting through some healthy eating ideas
that you can incorporate with your family.
And, remember, when first it doesn't succeed, try, try again.
Just stay at it and healthy habits will form.
>> Amazing, Laura.
Thank you so much for sharing this incredible information today.
I sure learned a lot, and I hope you all did too.
If you have any questions or would like to learn more, please feel free to visit us at hss.edu.
And we hope to see you all soon.