Pediatrician Dr. T. Berry Brazelton offers practical guidance for raising a healthy child. Few issues cause parents to fret more than food and nutrition concerns. Today Dr. T. Berry Brazelton and his colleague Dr. Joshua Sparrow answer reader questions about kids, food and nutrition.
My 3.5-year-old son will NOT eat vegetables at all, except (very occasionally) a couple of baby carrots. He has thus far defeated every one of the strategies I’ve used to sneak in veggies. He will eat certain kinds of fresh fruit, so I give him those whenever possible. We also avoid sweets and use whole grains rather than refined flour. But I worry that he’s getting poor nutrition — his diet is so heavy on meat, cheese, pasta and bread (in addition to whatever fruit he will eat, the current favorites being cantaloupe and red grapes). For his age, he’s only in the 25th percentile for height, while 50th for weight. Our pediatrician said he didn’t need a multivitamin and she didn’t see any cause for worry about weight. What do you think? . — Michelle
Dr. Brazelton responds: Vegetables! I hated them as a child — and I still hate them. My younger brother hated them more. As I watched my mother hover over him for hours trying to shovel vegetables into him, while completely ignoring me, I began to hate my brother even more than vegetables. Now you know why I became a pediatrician — to stamp out vegetables, and to overcome my guilt at wanting to kill my brother!
When I turned 50, I began to get along with my brother — of course we both had to wait for this moment until our mother had died. But I’ve never forgiven her for vegetables. So every time I am asked about young children and vegetables (and in the course of 50 years of practice, I have discovered that my mother was not the only mother who cared so deeply about vegetables), I tell mothers, and grandmothers, “Forget about vegetables.”
They turn pale. Open their eyes wide. Feel faint. I offer them a seat, and repeat, “Forget about vegetables.”
As they gasp for breath, I continue, “When a young child struggles with you over food, you won’t win. The more you struggle, the more he’ll hate whatever you’re trying to shovel into him. Back off. Apologize. Let him know that you know that only he can swallow the stuff you prepare for him.”
As they begin to recover, they stammer, “Really? No vegetables? No green vegetables? No yellow vegetables?”
“Really,” I say. “You can cover them with a multivitamin during this temporary period — usually between 2 and 3 years old – when any battle over food will backfire into even worse nutrition. They’ll make it through this with enough milk, meat, eggs, grains and fruit.” (See our book “Feeding Your Child: The Brazelton Way,” published in 2005 by Da Capo Press, for specific nutritional requirements and strategies for feeding picky eaters. Specific nutritional requirements vary with a child’s age, size and activity.)
As a pediatrician, I would carefully monitor for growth and general health. Height and weight need to be considered not only separately, but together, and not just at one single moment in time, but over time. The context of a child’s overall health, eating habits and activity level, and his parents’ height and weight, also need to be factored in. Any parent who is concerned about a child’s weight, height or eating certainly deserves to have this taken seriously by the child’s pediatrician.
Of course, the truth is that science is still working to identify all the active ingredients of vegetables, and how they promote health — and not all of these are contained in multivitamins. Yet even once this has all been fully worked out, there still will be certain basic bodily functions — such as eating, and breathing — that we can’t take over or control for children.
Jessica Seinfeld has written an intriguingly entitled book, “Deceptively Delicious,” in which she whips up a number of child-friendly disguises for vegetables. If you try this kind of maneuver, try not to make an issue of it, or to take your stealthy nutritional missions too seriously.
Instead, keep mealtimes relaxing and enjoyable, and focus talk on fun things, but not on food.
Many children take time to acquire tastes for new foods, and their taste-sensing equipment actually matures with age. So in the meantime, you can introduce a vegetable over and over, in very small amounts, so that there is no pressure to try it. The tiny bit of new and different food should just repeatedly appear — without commentary, without pressure, without monitoring of or reaction to whether or not it is consumed. On the sixteenth time, you may be surprised to see the child give it a try, and you may be disappointed as you watch him spit it out. In the meantime, if you avoid processed sweets, and salty and fried foods, your child’s palate will not become overwhelmed with and addicted to these easy-reach taste blasts, and will be more likely to welcome the more subtle tastes of — vegetables.
Is it really at all healthy to limit fats and other caloric nutrients in otherwise healthy and growing young children? — MK
Dr. Brazelton and Dr. Sparrow respond: Children under the age of 2 years (or 3, according to some experts) actually need the fats contained in whole milk for the rapid brain development that occurs in the first years of life.
Calories are not bad, but necessary, in the right amounts. Children have specific caloric needs that depend on their age, size and activity level. The word “calories” is just a measure of the energy a food contains. However, foods that offer only calories and have no other nutritional value are best avoided since they run the risk of filling a child up with “empty” calories before all of her nutritional needs have been met.
Are young children [age 10 and below] at risk from a high cholesterol diet — for example, from eating lots of egg and cheese sandwiches and similar foods? — Ole Holsti
Dr. Brazelton and Dr. Sparrow respond: Cholesterol and triglycerides can be a problem for children, especially if their diet is high in saturated fats, if they are obese, or if there is a family history of coronary artery disease or high triglycerides.
Eating habits and preferences do not begin in adulthood. Why start and reinforce unhealthy eating in childhood and then struggle to undo it later?
Please comment about how much vitamin D children need as they are growing up. Also, does the location of where a child lives make it necessary to supplement vitamin D? My husband and I, in our early 60s, take supplemental vitamin D per the advice of our rheumatologist. We live in Atlanta. — Pam
Dr. Brazelton and Dr. Sparrow respond: A commonly accepted recommendation for older children for vitamin D — necessary for bone absorption of calcium — is 400 International Units per day. For babies, beginning by the second month of life, the American Academy of Pediatrics recommends 200 International Units per day. Formula should be fortified with vitamin D, but breast milk may not contain enough, even though it contains all kinds of important ingredients for health that are not in formula: antibodies, digestive enzymes, and just the right kinds and amounts of fats. Parents should ask their pediatrician to advise them about vitamin D drops for their breast-fed infants.
As your question suggests, vitamin D requirements vary with exposure to sunlight, since sunlight is required to convert vitamin D to its active form. Children living in Northern regions, who are dark skinned, or who spend every daylight hour swaddled from head to toe are more likely to need supplements.
Good dietary sources of vitamin D include fortified milk, eggs and fish. Vitamin D is sometimes added to orange juice, but dairy products other than milk are usually not fortified with vitamin D.
Vitamin D supplementation has reduced the incidence of rickets — weak, bowed bones due to poor calcium absorption that can occur with a Vitamin D deficiency — a great example of the power of prevention.
From Tara Parker-Pope: Tomorrow, Dr. Brazelton and Dr. Sparrow will answer questions about naps and toilet time. And in case you missed it, yesterday they answered questions on “Self-Esteem, Discipline and Learning From Your Kids.”
The doctors ask us to remind readers that their responses are not intended to constitute or to substitute for medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, please consult your child’s health care provider.
Although the Well blog is no longer taking questions for Dr. Brazelton, you can contact Dr. Brazelton and his colleague Dr. Sparrow care of The New York Times Syndicate, 500 Seventh Ave., 8th Floor, New York, N.Y. 10018. Questions may also be sent by e-mail to: nytsyn-families@nytimes.com.
Healthy living doesn't happen at the doctor's office. The road to better health is paved with the small decisions we make every day. It's about the choices we make when we buy groceries, drive our cars and hang out with our kids. Join columnist Tara Parker-Pope as she sifts through medical research and expert opinions for practical advice to help readers take control of their health and live well every day. You can reach Ms. Parker-Pope at 
The easiest and most pleasurable way to eat well is to cook. Recipes for Health offers recipes with an eye towards empowering you to cook healthy meals every day. 
From 1 to 25 of 52 Comments
Most kids do not like vegetables and I never pushed them on my kids. What I did do that worked is give them carrots and celery sticks in their own special kid-sized cup with their own special dipping sauce (Ranch, Russian, whatever they liked). Kids just love the idea that something is ‘their own’. This went on for many years, until they each decided they liked vegetables. Both my kids were slim and healthy, but I must add that we did not have dessert after dinner every night, only as a treat once a week…I just couldn’t afford it. I couldn’t afford juice either, although they always had apples and oranges (cut up…remember all kids love their food cut up!). In the end, not being able to afford desserts, chips, and junk food it turned out to be the best thing I ever did for their health.
— MouseA high cholesterol diet is only dangerous when eaten in combination with sugar and grains. If you don’t eat sugar and grains, the dangers from a high cholesterol diet are non-existant. This has been demonstrated over and over in populations that ate essentially nothing but saturated fat without suffering from a single case of heart disease.
I do happen to agree that we are overly obsessed with the supposed healthful effects of eating vegetables. Other than a mother’s breast milk, the only food that offers all essential vitamins, minerals, proteins, and fat is….meat! Assuming you include organ meats, and stay away from ridiculous abominations such as boneless skinless chicken breast, one can live on nothing but meat and be healthier than 99.99% of the world’s population.
— HughWe must remember that breastmilk is not deficient in vitamin D by nature, but that many breastfeeding moms are themselves deficient in it due to low intake from diet and low sun exposure, and that babies don’t usually get as much sun exposure as they evolved to expect.
— RosemaryMy 4 year old son has struggled with constipation for two years now, which in turn has affected his potty training. Currently he gets a daily dose of magnesium glycinate to ensure a soft stool, and additional fiber. However, because of earlier painful stools, he withholds his b.m.s, avoids sitting on the potty to try, and often “accidentally” has b.m.s in his pullup while napping or in his underwear when by day 6 or 7 he can no longer hold it in. (He is perfectly potty trained for peeing.) We will see a child psychologist next week who specializes in potty issues. Any dietary recommendations? Other tips? We’re all pretty distraught at this point.
— DinaMy son (now 9) love vegtables. I get requests from other parents for “tips.” The Doctors are right, just offer without issue. Since my son was a baby, all I asked was for him to taste the vegtable I was offering. If he didn’t like it, he didn’t eat it, but I told him how proud I was that he tried. That’s it. My proudest moment about veggies (and I wasn’t even there….) was when he went out to dinner with another family this February. Yes, he ordered the chicken fingers, but instead of fries he asked the server if there were any vegtables. Shocked, the server offered that he had broccoli. “That’s great, I’ll have that instead,” said my son. He’s a big kid, plays football, has friends, he’s normal. He just likes his veggies. I would not be surprised if he comes to me as a teenager and tells me he’s going vegitarian.
— PeeWeeMomMy 11 year old son recently decided to become a vegetarian - no red meat, poultry or fish. He’s still eating dairy and eggs. I’m concerned that he will not get enough protein. I am supplementing his diet with some soy products, but I’ve also heard that those may not be the best thing either and I’m not very adept at cooking with them! He’s a relatively good eater - but he’s not big on beans. Do you have any dietary suggestions?
— P. RossFROM TPP — Dr. Brazelton is no longer taking questions but here is some advice on kids and vegetarianism from the Nemours Foundation. CLICK HERE>
There you have it from the horse’s mouth! How is it possible that so many people go through this amnesia when they have kids, and no longer remember how they felt as children?
Forcing is bad. It will only generate a lifelong loathing of the food forced down your throat.
— SusannaI have 2 children a 9 year old girl and a 4 year old boy both my kids are obese I ‘m obese I have been trying to find a diet program or plan on how to feed my kids I mean a menu to follow as breakfast, lunch, dinner etc. and what to avoid not to feed them. Should they take vitamins and what kind of vitamins. If i have a menu i think it will be easier for me to stick to it, I have seen nutricionists but no one gives me a food menu to follow.
Thank you for your help,
Irma
from California
FROM TPP — Well I think you need to go back to a nutritionist and insist on the advice you need. Or talk to the pediatrician — there are many programs for overweight children in California that can help you.
— irmaThank you Dr. Brazelton. Our copy of Touchpoints is already well worn and our baby is only 3 months old.
— DatMelWanted to take the opportunity to make note of a disordered eating problem of children and teens that never seems to get any attention: Social anxiety. That is, children and teens who are anxious about eating in public (or in certain situations) that leads them to develop disordered eating or poor nutrition.
From the time I started school until my young adulthood, I had great difficulty eating in public due to social anxiety. Even more than talking to people or the usual social anxiety related things. I would go the entire day at school without eating (or would have only a bag of junk food or packet of cookies, which were quicker and more discreet to consume than a full lunch). My mother would make lunches for me every day, and I would throw them away every day. One time my first grade teacher found rotting old lunches stuffed in my desk! (I don’t think she ever told my mother though…)
Then, of course, at the end of the school day and in my comfortable home where I felt free of anxiety — starving — I’d come home and binge on anything I could get my hands on, usually junk food. The fact that my mom worked late didn’t help matters.
I didn’t hate food. I loved food. I just hated eating it in front of others. Apparently I was afraid I would “do it wrong” or look like a slob, and would be ridiculed. It wasn’t so much a fear of looking like a “fat person” (I wasn’t), but a fear of making a mess somehow or grossing someone out.
At one point later in life I went to a therapist and mentioned the problem in relation to social anxiety; she’d never heard of such a thing.
I gradually got over it in adulthood and lunch meetings, etc cause little to no tension (although sometimes I don’t enjoy eating in front of others, particularly with finger foods). But I have never seen this cause of poor nutrition or disordered eating mentioned anywhere. Surely I can’t have been the only child to have suffered from it.
— JenChildren even beyond the age of two or three need the fat soluble vitamins found in full-fat dairy, organ meats, and some natural saturated fats. These traditional, wholesome foods are not what’s causing obesity or cardiovascular disease! Still, it’s an improvement to hear someone point out the benefits of dairy fat for young kids.
Cod liver oil is also a great source for vitamin D.
Debs
— Deborah GardnerSeattle Local Food
Dr. B, unless your’re an Inuit, eating lots of oily fish and whale blubber, we weren’t meant to get vitamin D from our diet. Everyone, including babies, should be exposed to regular sunlight.
Dr. Michael Holick from Boston University and others have done studies to support this. We’re not talking about sunburn here, but only a fraction of the exposure it takes to turn your skin red. Unfortunately, this does not happen due to swaddling and SPF 45 every day.
The danger of skin cancer under these circumstances is minimal. In fact, Dr. Holick also a dermatologist, argues that lack of vitamin D is a more clear and present danger than skin cancer.
— jackMy 10-year old son is overweight. Could you share some practical tips for helping him to lose weight? Should I be concentrating on nutrition first, exercise first, or something else? Should I put him on a diet?
My own history is that I was a chubby child and often dieted when I was young. They didn’t work in the long run and just made me self-conscious about my body and weight. As an adult, I have lost weight with a combination of Weight Watchers and exercise. However, I am worried that putting my son on a formal diet program will make him feel as bad about his body as I did at his age. What’s the best way to go about this?
— NancyDina, we’ve had good luck with blueberries (fresh or frozen). Yogurt seems to help as well. Also, we reduced milk portions and served no bananas until the issue resolved itself.
Hope this helps.
— ErinWe don’t eat meat at our house, and my 3 year old loves vegetables, as do I. I just keep giving them and not making a big deal out of it. He goes through phases and resists things he’s never seen before but I am pretty low-key about it, and he sees me eating and enjoying this food. Also I do make him try everything - one tiny little bite. I saw that Parker-Pope counseled against doing this yesterday, but I have not noticed it backfiring. Frequently he will decide after tasting something that in fact he does want to eat more! (I do NOT bribe him to eat new things, but I do give him a little piece of green bean or whatever, and tell him he has to just eat the one.)
What we do struggle over these days is feeding himself. He wants to play at table while we spoon-feed him. I am tired of this and have begun to refuse to feed him, saying that he must feed himself. The result is that he hardly eats. I am trying to stay strong but it is so hard to do when you have spent the time and energy creating a healthy meal from scratch!
— ChristyAny advice would be much appreciated: my 7-month old is now completely refusing milk (we have fed her formula for some months now). We have tried switching formulas, to no avail. She avidly eats solid food (fresh mashed vegetables, rice cereal, etc) but refuses all but 1 or 2 ounces of her milk. We are told she needs the formula for essential vitamins, until she is at least one year old. What to do? Thank you.
— SarahI wanted to answer Nancy too:
exercise is important for being healthy but the biggest factor in weight loss is calorie consumption - you have to eat fewer calories. You have had poor success with restrictive diets, which makes sense as they are no fun at all! So try to just make little changes that are manageable: use olive oil instead of butter, hard cheese instead of soft, cut down on sugar as much as possible. If you want to give a treat make sure it is one small cookie, not a whole bag. And don’t let your son “drink his calories.” That means he should only be drinking water or milk. Not juice or soda.
— ChristyDina, we’ve had luck with prune juice & lots of water; also, noticing when a b.m. might be coming (you probably know your son’s cues) and taking our child in a pull-up to a special private spot (like behind a chair) where I’d sit beside, calmly talking him through it or gently talking about something unrelated to distract. Good luck.
— SLFor constipation……a child’s bowel movements shouldn’t be “formed”. Actually, adults shouldn’t be either. They should be quite soft. There is a contraction of the large bowel during defecation. With a soft stool, half or more of the large bowel will empty naturally during that contraction.
For the diet……Figs: dried, stewed or fresh. The proverbial prunes and plums. Children love them like candy. Give the child three or more with their meal. Apples and applesauce are very good. Give a child free access to apples. Buy small apples, put them in a bowl on a low shelf or table. I don’t think a child can eat too many of them. They are an easy to digest carbohydrate. People in the pioneer era used to eat them by the pound, daily.
To a child, the quantity of the fruit is more important than it’s exoticism. Cherries, berries, and such are fun fruits but they aren’t good staple foods. Refined fruits: juices, popcicles, and sorbets shouldn’t be thought of as fruit servings.
Make sure the child has access to water. Fill a couple of water bottles, strawed covered cups or sippy cups, two or three times a day and leave them where they can be accessed. Also, offer them with meals.
If you need to “help” the child along after they are constipated, offer watermelon, cantalope, stewed/canned fruits, and large servings of stewed fruit cocktail.
Have the child tested for Cystic Fibrosis and gluten intolerence. And anything else the doctor thinks might cause constipation.
The large bowel is treated as water storage by the body. A healthy body will add water to the bowel or take it away to maintain the body’s optimum hydration level. But, after a certain level of dehydration, the bowel isn’t good about replenishing the water in the stool. I think the stool must have enough “drawing power” to have it’s moisture replenished.
Thinking of how soil acts is a good metaphor. Soil in a potted plant must have some moisture left to be able to draw water up from a reservoir. Lots of fiber in soil keeps it from turning to hard, baked, clay. And the fibers efficiently store water where the plant can find it.
There are two kinds of edible fibers. The pectins which form mucilages (like those in apples) and hold lots of water. And those which are celluloselike (which are harder, harsher and don’t hold much water (like bran). Children should have fruits and vegetables which contain pectins. Celluloselike fibers are “harsh” and far less useful.
Muffins and all other baked goods can be made with applesauce, carrots and other fruits and veggies. Just add applesauce into a simple cake mix and bake it as a loaf or loaves. Cut slices and serve every day.
When you serve ordinary carbohydrates, offer microwaved/baked whole potatoes, brown rice, popcorn, creamed corn, tortillas, and other less refined types. Whole wheat breads. Ordinary breads, cakes, and refined grains are constipating.
Give fats in their natural sources if available. Avocados, corn, the common bland, canned olives (which have iron as well), ground up nuts (not whole, because kids don’t chew well). Not roasted nuts because it roasting forms hard to digest proteins which can cause allergic reactions. Bland nuts like Almonds and brazil nuts. Creamed rather than chunky peanut butter.
Chicken skin on the chicken and butter.
What is constipating? Cheese, plain bananas (not the baked or fried kind), meat, refined flours, plain white rice, breads, common types of cakes and muffins.
— JCAJen, you weren’t the only one. And I still hate to eat in public.
— perraI like this forum! My daughter went on a hunger strike last week and I was a bit concerned. She flatly refused dinner (veggies, meat & rice). She used to love oatmeal. Now she rolls her eyes when I give her a bowl. I figure as long as she looks and acts healthy I don’t worry about it. Sometime she loves fruits! Other times, she won’t eat them. She usually doesn’t eat meat and really favors fruits & breads. So I feel like you eat what I serve you or go hungry… But I will adjust what I give her next time based on previous responses.
— JLenaMy system with vegetables was to require that the kids “Take a taste to see if you are old enough to like it yet.” It worked with young guests at our table, too. Sometimes they decided that they had gotten old enough; sometimes not. The guest usually had not heard that tastes changed as you got older and seemed to like the idea. It is blessedly true, also, and not a manipulative move on mother’s part. Not only does the experience of tasting change as we get used to the taste itself, but that taste buds on the tongue change also and give us a different experience as we get older. Moreover, how a vegetable is prepared changes the taste so a child who keeps trying may find a recipe which works for him.
— Anna MarieRidiculous. My mother (coming from the Caribbean) never had the luxury of allowing us children to be finicky or fussy over food. We basically had no choice; eat the wholesome, homemade food (including plenty of cooked veggies) in front of us, or, simply, go without (which of course didnt last very long as we could not ignore hunger). My mother also mixed in the vegetables with the rice or potato portion and meat or fish, so it wasn’t separate from the rest of the meal. The result? we ate what she ate, and when she ate it. In short order, we children began to expect veggies as a normal (and tasty!) part of a meal. This actually forced us to practice good and balanced nutrition, a habit and lifestyle we have retained well into our adult years. Simple, simple, simple.
— KairaWe need not know that the wonderful anf helpful Dr. BB hated and hates vegetables and his brother. I hated vegetab les as a child except carrots cooked in chicken soup.When the nanny was not looking we disposed of the vegetables in the carpentry of the dining table. Our household h elper who cleaned on Fridays knew exactly who it was who deposited the vegetables but she never ratted. I have come to LOVE vegetables of any size, xcooked or raw, thanks to Mom’s ingenuity when we no longer needed a nanny. Raising my son presented no eating problems whatever. Food is glorious.
— Zohar DeeJen,
— pamelaIn regards to your post on Social Anxiety Disordery, and not eating in public - my son is 6yrs old and went every single day of kindergarten without being able to eat at school. He was so anxious that he couldn’t eat anything at all from 8:30 am to 3:00 in the afternoon, it just broke my heart. After couseling, and especially medication, he is relaxed enough to be able to eat at school. He too would come home starving and tired. Not eating enough only made his anxiety worse as he never had any energy. He’s a different, and happy boy now.