The Wellness Roundup With Dr. Jill

It’s Ok To Be Picky: New research shows that being a picky eater may be a natural and protective phase of child development

I have been meaning to write this article for some time now since the topic of picky eating is a daily conversation during visits at Healthy Kids Pediatrics. The more I have been learning about ancestral living the more I realize how we can trace so much of our bodies’ and minds’ reactions to our current environment back to the way our cavemen ancestors reacted to their environment. Most notably for me as a pediatrician surrounds the concept of feeding our children, mainly because we need food to survive and the job of a pediatrician is to guide growth and development which hopefully ensures survival. I am also intrigued by the reaction of a parent when a child is not a “good eater”. Parents (and yes, mostly mothers and grandmothers) get very concerned and want to “fix” their child’s eating habits. When we think about it, what was one of, or maybe THE, largest threat to our ancestors’ survival? Famine, starvation, and death which would surely threaten the survival of the human species. So, it is not that difficult to understand how we have so firmly programmed into the primitive parts of our brains the notion that when a child does not eat he or she may die.

There is so much new understanding and research being conducted surrounding how stress affects modern day people. We are now realizing that our brains do not actually know or care that there is a difference between the stressors we face today in our relatively safe environment (like sitting in a traffic jam when we are already late or waiting impatiently for a reply text) and a tiger chasing and trying to kill us. That same level of understanding can be applied to the reaction of a parent when a formerly wonderful and varied eater at 12 months old quickly becomes an 18-month-old master of consuming a total of about four foods, none of which have much nutritional value. While I know that a picky toddler will eventually start to expand his palate, it has always been a challenge to convince the worried parent that if he or she just hangs in there, continues to offer healthy choices, and maintains food rules and boundaries with the child, he will come around.  I admit that I used to quietly become frustrated at the end of a visit when I did not feel as if I convincingly reassured the parents of a picky eater enough that this, too, shall pass. I am now more understanding of parents and I know that their fear is more than just an anxious parent and that the uprising of our ancestral patterning is playing a powerful role. I was happy to see a recent article from May 2020 in the journal Pediatrics citing research suggesting that “picky eating at age 4 years is stable over an approximately 4-year period and that it is associated with a lower body mass index (BMI).”

The study was conducted by Carmen Fernandez, MPH, and colleagues to specifically examine picky eating in a low-income population of children since children of lower-income households are at greater risk for being both overweight and picky. The study found that “picky eating was associated with lower average BMI, in the healthy BMI range, suggesting that picky eating could be a protective factor against overweight and obesity,” said Fernandez. She went on to note that “we did not find evidence that picky eating was associated with being underweight”, but we do know that the low-income population results may not apply to other populations and moreover, we definitely need future research to determine the long-term weight gain trajectories of picky eaters into adulthood.

The results of the study do suggest that if parents intervene earlier than 24 months old when children are more receptive to exploring new tastes they may be able to blunt or altogether avoid the picky eating stage, but that is definitely easier said than done! I always reference a mom at my practice who is a chef by trade. During the first year of life, her twin boys enjoyed a diet that rivaled the most sophisticated Michelin star restaurants in quality, flavor, and variety which often made her husband jealous! Well, by the time those boys hit toddlerhood one continued to eat relatively well, but the other boycotted most foods and became the epitome of a picky eater! Given the information from the small research study by Fernandez et al, I find myself reassured that passing through a picky stage may enable a child to maintain a healthy BMI while still having enough energy to grow, gain weight, and develop both physically and cognitively. Our bodies are so much more intelligent than we think and while young children have not yet lost the innate understanding of hunger and satiety it may just be best to allow them to dictate when and how much they need to eat in order to survive and thrive.

On the other hand, experts recommend that researchers explore and examine the impact of an “authoritarian feeding style”, which combines elements of authoritarian and indulgent feeding styles, on a child’s willingness to explore foods. A style such as this one allows for structure and guidance while also being sensitive to the child’s needs without judging or constantly correcting the child. Researchers Dr. Nancy Zucker, PhD, and Dr. Sheryl Hughes, PhD in the department of psychiatry and behavioral sciences out of the Children’s Nutrition Research Center at Baylor College of Medicine in Houston, note that “we can think of children with elevated picky eating as having thousands of negative memories about food (e.g., conflict, unexpected tastes, discomfort) and so caregivers can work to create positive memories and experiences around food (e.g., cooking, gardening) to help picky eaters expand their preferences. However, it is critical that caregivers let go of their need for a child to taste something and instead focus on accumulating pleasant experiences.”

My take on this research publication is that parents I work with at Healthy Kids Pediatrics are doing the best they can to keep our children well fed, healthy, and happy. Parents are battling multiple barriers in their quest to ensure adequate nutrition for their children, including a fast-paced life filled with easily accessible fast-food meals on the go, a pandemic that has amplified the habits of sedentary screen time and snacking, and the food industry’s crippling hold over the choices, overall processing, and marketing of the food available to all of us. Add to all these factors our underlying and subconscious ancestral reflex of viewing a picky toddler as a potential threat to the continuation of the human species! I support encouraging our infants to eat what the family is eating whether it be through baby led weaning or the “traditional” style of starting with purees. I support encouraging parents to take a deep breath and give themselves the freedom to relax when a two-year-old refuses to eat the avocado and salmon dinner they once enjoyed six months before. I advocate for parents to not give in to offering unhealthy food choices when a child refused to eat all day, but is now hungry for a cookie at bedtime…all too often I hear “at least he had something in his belly when he went to bed”. Imagine if a parent allowed herself to believe that her child will, indeed, NOT go hungry by not eating for a day or two because first, we are in a society where there is a constant abundance of food and second, the child has a primitive instinct to survive and will eventually eat the healthy food when he is hungry enough and the healthy food is the only option? When parents of my patients experiment by offering healthy choices (the toddler often needs a choice in order to feel in control, but the parent gets to choose the options!) and then wait their child out for a few days they are amazed by the results.

I will finish with some take home points:

  • Children are very smart and manipulative.
  • The body knows how to keep itself functioning despite the toxins that are constantly bombarding us in our food, air, water, and environment.
  • Modern day children perhaps unwittingly take advantage of their parents’ innate desire to feed them and when much of our food is laden with chemicals and sugar that drive hunger and cravings a child’s persistence and tenacity can overcome even the most well-intended parent.
  • The picky eater is a natural and protective phase of child development that, in many cases, passes as childhood progresses.
  • From the very first meal an infant consumes, being mindful of creating a calm and happy environment devoid of judgment and criticism of the child or parent may be a very powerful way to prevent the physical and emotional outcomes we so often see regarding the health of the future of our human race.

– Dr. Jill

Dr. Jill Garripoli Pedalino is an award-winning Pediatrician and owner of Healthy Kids Pediatrics in New Jersey. She strives for open communication with parents so together they may guide their children to be the most successful, healthy, and productive adults possible. She works hard to be a role model for her patients and knows she’s in the right profession when a parent tells her, “Doctor Jill, you make a difference.”

Welcome Dr. Namm! Silver Linings for Healthy Kids Pediatrics

Welcome Dr. Rachelle Namm to the Healthy Kids Team!!

You have been asking for more same day sick appointments, greater availability of providers throughout the day, and more flexibility scheduling well visits. You expect sound advice and guidance from dedicated pediatric medical professionals with years of experience backed by a strong team of knowledgeable, caring, and competent medical assistants. We demand excellence in our delivery of loving, comprehensive care to your children and your family. You deserve all of this and we are so excited to be able to continue to provide our award-winning services with the addition of pediatrician Dr. Rachelle Namm!

Especially now, during the start of cold and flu season and with the potential for a surge in novel coronavirus cases looming, we must be diligent as we prepare our staff and our services to face the known winter-time challenges as well as the uncertainty of how COVID-19 will play a role.

In addition to adding telemedicine to our list of services and securing ample personal protective equipment to keep our team and your family safe during visits, the fortunate addition of Dr. Namm to our team allows us to do two really big things we were not able to do for the past few years!

1. Increase provider availability by adding an additional full day’s worth of appointments on all Wednesdays and Fridays as well as additional hours on Monday evenings

2. For a very limited time, open our doors to expectant families who were previously unable to attend our open houses as well as families who are looking to transfer into our practice.

The coronavirus pandemic has posed immeasurable challenges to all of us, but for many there has been a silver lining…a slower pace of living, more family dinners, potty training and bicycle riding successes, and a unique opportunity to be with your children and get to know them better than ever before.

The pandemic also caused the careers of many excellent pediatricians to become disrupted as a result of their practices downsizing or closing altogether. The silver lining for us was the unexpected and incredible opportunity we experienced when we discovered Dr. Namm.

We thank you for welcoming Dr. Namm into the HKP family and we know you will find her care to follow the same high standards of exceptional care and service you have come to expect and deserve!

-HKP

2020 Favorite Kids’ Docs – NJ Family Magazine – Congrats to Dr. Jill and the HKP Team!

Dr. Jill Garripoli Pedalino, Favorite Kids’ Doc 2020

Thank you to all of our families for voting Dr. Jill. P.J.,and the Healthy Kids Pediatrics Team one of NJ’s Favorite Kids’ Docs again this year!

It is our pleasure to continue to provide your children with exceptional care and to be your trusted medical home.

Way to go team! 💛👍 

-HKP

Should Kids Go Back to School? Dr. Jill Garripoli Pedalino Featured on The ModernMom Podcast

There are a lot of things to consider regarding children eventually going back to school whether it’s in-person, virtual, or hybrid format. Kudos to Winnie Sun and ModernMom for providing their viewers with an informative, polite, and judgment-free discussion with a pediatrician (Dr. Jill) and a teacher (Hedreich Nichols).

Everyone agreed that there are no perfect solutions to the current situation, but there are several safety and lifestyle measures that can put in place to minimize your child’s everyday risk from inevitable challenges that our country faces now and will inevitably face in some other form in the future.

Hedreich mentioned something that most of us don’t consider. From a learning perspective, she’s more concerned about the disruption in a child’s daily routine that might occur with a hybrid schedule for her son so she’s opting for a 100% virtual format when school reopens.

Dr. Jill also mentioned something that most of us don’t consider. From a long-term health perspective, she’s more concerned about the current health habits and lifestyles of Americans which are significantly decreasing the effectiveness of their immune systems and their ability to fight this virus and many other preventable diseases like obesity, which affects 20% of our children and 70% of our adults.

Thank you ModernMom for inviting Dr. Jill to participate and featuring her on your podcast! We wish all of your viewers continued health and happiness.

-HKP

The Healthy Kids Team Pays It Forward with a Gown Donation to Colleagues

A few months ago, a few very generous people donated some PPE to the Healthy Kids Team when we were in need. 🙏 

After finally securing a large shipment of isolation gowns for our own practice to help protect our patients and our families, Dr. Jill donated 500 isolation gowns to some of her fellow physician colleagues across the country. 👍 

Let’s all keep taking care of each other and paying it forward. 

💛Stay healthy and happy! -HKP

Level 1 Polypropylene Disposable and Fluid Resistant Isolation Gowns Have Arrived for Dr. Jill and P.J.!

Our PPE shipment of fluid resistant disposable PPE gowns have finally arrived!

In this excerpt from the latest HKP update video, Dr. Jill and P.J. demonstrate the effectiveness of their new polypropylene (40 gsm) isolation gowns. We waited over 2 months for these specific gowns to arrive. They are lightweight & breathable, yet constructed and pre-treated in a way that prevents fluid exposure, microorganisms, and other harmful substances from penetrating the gown.

This is a huge deal for the protection of our patients and our families as it greatly reduces the risk of potential cross contamination between sick and well patient visits throughout the day. It also helps protect Dr. Jill and P.J. so they can continue to stay healthy.

It was a considerable expense due to the national shortage and rampant price gouging, but absolutely worth the peace of mind.

-HKP

Positive Survey Feedback, Isolation Gowns, and Important Scheduling Updates for Healthy Kids!

In this episode of HKP Q&A, Dr. Jill and P.J. discuss: -the arrival of our new disposable fluid resistant polypropylene isolation gowns. -an update to our sick and well visit scheduling as a result of increased appointments. -a Fall flu clinic preview -the positive feedback that HKP received from our recent survey regarding the additional preparedness, cleanliness, and safety measures we’ve implemented in our office. (*Patients love the daily mandatory temperature scans and questionnaires that our team has to fill out at the beginning of each shift as well as knowing that all of our patients are screened as well upon arrival.) Wishing all of our families a happy and safe 4th of July weekend!

-HKP

Healthy Kids Pediatrics Hosts Its First Ever VIRTUAL Open House!

That was exciting! Dr. Jill and P.J. brought their informative and helpful prenatal event right to your living room! Healthy Kids Pediatrics welcomed 25 expecting couples to join them for a comprehensive open house and tour from the comfort of their favorite couch.

Guests received some useful tips on how to be awesome first-time parents, they learned what to expect from our medical home and what we expect from all of our families in return, and they saw why Healthy Kids Pediatrics has earned its award-winning reputation.

If you or someone you know is an expecting parent, we invite you to reserve a spot for our next event (which is hopefully going to be in-person at our Nutley NJ location). Please call our office for more details. 844-437-5455.

Best wishes,

-HKP

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