Katharine Jeffcoat is a Registered Dietitian Nutritionist focused on kids and families. She provides personalized nutrition therapy to help families and children achieve optimal nutritional health, from prenatal and infant feeding issues to teenage athletes.
Learn everything you need to know about Katharine and Portland Pediatric & Family Nutrition on her website: portlandpediatricnutrition.com
Topics discussed in this episode:
Background on Katharine and her private practice
Main nutrition concerns that she encounters
How she works with picky eaters
Introducing new foods
Sugar strategies
Weight concerns
Some practical advice
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Dr. Stafford: Hi, this is Dr. Michelle Stafford at World of Smiles Pediatric Dentistry and our podcast, Mixed Dentition. And today my special guest is Katharine Jeffcoat. Welcome. Thank you for coming.
Katharine: Thanks for having me.
Dr. Stafford: And your business is Portland Pediatric and Family Nutrition and nutrition is a topic near and dear to my heart, I'm so happy to have you here today so we can talk about things.
Katharine: I'm looking forward to it.
Dr. Stafford: So I guess why don't we start off by you telling our audience a little bit about yourself and your business?
Katharine: Okay. I've been a dietician nearly 22 years now, which is a dating maze, but mainly that time has been focused in pediatric nutrition where I have worked at hospitals and with baby formula and the last four years I've worked in private practice. And I have offices here in Portland and in Vancouver, Washington.
Dr. Stafford: Wonderful.
Katharine: My practice really focuses on helping families. I miss that about working in baby formula and at the hospital. So back to helping families and just that more like individual support.
Dr. Stafford: That's wonderful that you help families with nutrition. And so when families come to you, are they coming with a specific topic or issue to address with you?
Katharine: Yes, most definitely. And probably the main nutrition concerns I hear from families is their child is a picky eater or they have weight concerns for their child, I'm seeing a lot of teen eating disorders and then food allergies or food sensitivities. Those seem to be the majority of nutrition related concerns.
Dr. Stafford: I hear that everyday too. "Oh, my child's a picky eater." So, where do you start when a family comes in and they talk about, their child is a picky eater and only wants to eat these five different items, how do you begin that process with them?
Katharine: Well, we dig into hopefully discovering where this all began and what the structure is at home. Is it supporting this behavior? Is it making it worse by how parents are responding to it at home? And then we work on ways more about the how of feeding. When it comes to picky eating, I really dig into that how of feeding, as in it goes back to the... Ellyn Satter, the Division of Responsibility. Ellyn Satter is a dietician and therapist. She's been around since the 80s writing books and doing research about that feeding relationship with children. And so that relationship, it's more that Division of Responsibility, the parents get to decide the what, when, and where of feeding. Children decide the how much and if I'm going to eat and this makes such a huge difference in that feeding relationship.
Katharine: And so parents are no longer short order cooks, they are providing that family meal, the child's coming to the table and they can decide. They're not required to have a clean plate or eat everything. They can come to the table and make choices and decide how much. And so this is really a starting point. It's a foundation of helping these families because often how they get there is parents begin... Most children go through a typical phase of picky eating and I sure know, mind did. And it's how parents respond, if they turn into a shorter cook and say, "Okay, you don't want this, what do you want?" That will only reinforce if they have a fit, they get what they want. So those fits and that food refusal only keeps happening. And so it doesn't have to be that hard.
Dr. Stafford: I love that you say that. My kids are pretty good about trying things and sometimes they like it, sometimes they don't. But we still require them to try things and I'm like how you say, not becoming a short order cook. And I think a lot of parents fall into that category. They start just kind of preparing separate meals for each of the family.
Katharine: It's a lot of work.
Dr. Stafford: It's a lot of work and kind of exhausting as a parent.
Katharine: Yes, they give up. I don't blame them.
Dr. Stafford: So that can be really tough. So what about introducing new foods to these kids that you know are categorized as picky eaters? Are there techniques to introducing new and different foods?
Katharine: Yes, and certainly it starts with exposure. Some children can go from seeing a new food, to tasting it all in one exposure. But some children, especially if there's high sensory components involved as in they're a super smeller, super taster, they're most often making up their mind about how that food is going to taste just by seeing it. And so parents are better off having family meals, always having variety of foods on the table, encouraging their child, not forcing it, but that exposure as in seeing is very helpful. Cooking with their kids, finding ways to increase those exposures because just by seeing it, smelling it, even touching it, younger kids, we get into food play ways that after the meal or you could have kids involved with touching their food, more interactive food play.
Katharine: And so it really does take 10 to 15, the research shows it's true, 10 to 15 exposures for a child to accept a new food.
Dr. Stafford: Oh wow.
Katharine: And I mean, eating is brand new to kids and so it's the first time they're ever seeing something, just realize that they refuse it, most parents give up after the third time they serve something and they never see it again and they don't have those exposures.
Dr. Stafford: That's really interesting. 10 to 15 times. Yeah, that's very interesting.
Katharine: So if it's the parent's favorite food, keep serving it, keep bringing it out, and make it a neutral experience. Because the biggest mistake parents make is making meal time anxiety producing, where what they do as in requiring bites, requiring their child to sit at the table with the food on their plate that makes them uncomfortable. This often can cause anxiety in children and anxiety sets children up for that fight or flight response, zaps appetite with that adrenalin rush, the child doesn't have an appetite. So regardless of what it is, they no longer have an appetite and so they're not going to eat. And I see this happen over and over again, just real stressful meals.
Dr. Stafford: Right. And causing that stress. And that's stressful for the whole family.
Katharine: Yes, yes.
Dr. Stafford: Oh that's really interesting. So I'm going to switch gears from picky eaters and talk about sugar. I'm sure you must have an opinion about sugar in our society. And if you've been doing this for 22 years, are you seeing an increase in how much sugar kids are getting now in 2019 versus say, 20 years ago?
Katharine: Yes. In 2015 the dietary guidelines for the first time added a sugar component to the recommendations. For us as Americans, the recommendation is to keep our sugar at 10% or less of total calories. And so for the first time it's just been awareness, as in, "What does that mean? And how many grams is that?" And also the food label's changing to actually require specifying how much sugar is added. For let's just say a 10 year old child, that's roughly 50 grams, 45 grams of sugar or less. For a four year old, that's more like 25 to 30 grams of sugar or less. And so when you see a food label and it has 10 grams of added sugar, this is just how much... It just helping parents more balance that out as in trying to make better other choices. And I hate to... Sugar is just part of our making food taste good. So I hate parents feel like they need to do sugar-free everything. Then the child, everything feels like they're not getting any of their favorite foods and they feel they're seeking it out other places.
Katharine: But just being aware like, "Okay, making some swaps of cereal." If your kid likes Cheerio's excellent, versus the high sugar Trix, you can save probably 10 grams there. Occasionally having a chocolate milk is fine, we don't count fruit sugar or milk sugar, we just count added sugar. And so a chocolate milk, it may have 30 grams of sugar, but half of that's milk sugar and so ends up being 15 grams of added sugar. If the limit is like 50 grams for a day, occasional chocolate milk is fine.
Katharine: So just encourage parents to take it in balance, make some swaps, maybe pick a snack bar that's a little bit less sugar versus the higher sugar ones. Make some swaps, not having pancakes with syrup every morning, maybe just on Sunday mornings. And these are just ways that with awareness and some swaps, we can swap it out because the changes were made by the dietary guidelines because they're seeing some research with links of high sugar diets to heart disease, to diabetes, to... And so it's just we as Americans all need to be aware because sugar is stuck in everything.
Dr. Stafford: Yes. I guess one of the biggest changes I've seen in my career is just this explosion of candy everywhere. And now as a parent with kids in school, I feel very strongly when my kids get candy in the classroom and it's supposed to be a no candy school that we're in. And then occasionally they have the substitute and they get candy and I'm like, "Ah, but I don't want my kids to have that kind of added sugar." So talking about sugar and this increase of sugar, even in my 15 years that I've been practicing and working with kids, I've seen kids that are struggling with weight issues and I feel like I'm seeing that more and more, more recently. Is that an issue that you talk about with parents as well and families and work with?
Katharine: Yes, I definitely have a lot of families who reach out to me with weight concerns in their child. And it's always important that when we address weight concerns, we look at not just energy in and energy out, really the causes of weight gain, we need to look at the stress and bullying in school. This is linked to weight gain, in addition to lack of sleep and children not sleeping well. So I just like to look at it as a whole picture. I mean certainly there are families that their diets are changing, they are eating more sugar. So we can address certain things as, are we doing more fast food? Are we doing more high sugar? Are there swaps we can make? Adding more movement, especially here in Oregon, sometimes it's seasonal that the kids actually move and so trying to look at all the things.
Katharine: I'm a strong believer in genetics too, of looking at that feature about genetics and how parents grew themselves as children and also keeping in mind that for a girl from eight to 11, that pre-puberty state, it's... All preteens, that's the second biggest growth spurt for kids and so I get a lot of calls around that time if they're noticing their daughter doubling their appetite, gaining more weight. I like to remind them this is nature, this is how the body's intended to grow and to put on fat and estrogen and for these young girls starting their periods. And so that's just an important awareness for parents to not be too alarmed. It's more harmful to put your child on a diet and restrict and shame them. The research shows that long-term effects of that is more negative than as the whole, the family just start eating more balanced, get out for more movement and activity, make sure a child's getting good sleep. All those are great ways to start.
Dr. Stafford: Oh, I love that. I love that you're looking at the big picture. I think sleep is so important for our children especially and honoring the fact that they probably need more sleep than they're getting, especially if they're waking up early for school and things like that, in addition to diet and movement and yeah, that's wonderful that you're looking at the full body. I love that.
Katharine: It all goes together.
Dr. Stafford: It all goes together
Katharine: For us too as moms.
Dr. Stafford: Great, that's so true. So Katharine, we've talked a lot about a few things today and I wanted to just revisit a couple of our topics and maybe give our listeners a couple tidbits of advice. So for picky eaters, for instance, can you give our family members listening a couple quick tips?
Katharine: Yes. Yes. Have family meals, eat with your children, serve a variety of foods and so that's what the family meal does. It brings families together. Parents are good role models.
Dr. Stafford: Yes parents are good role models. And what about sugar and addressing that in addition to kids that may be a little bit overweight?
Katharine: Well, with sugar in general, just reading food labels, see if you can swap some foods out where you just really won't miss the changes. And if weight concern's involved, then it's the whole family eating that way. It's not one specific child and family in whole can benefit from reducing sugar just by making the few swaps of some foods they have in the pantry.
Dr. Stafford: Yeah, that's great. I love that you talk about swapping foods out Katharine. I think that's so great. I think for me, when I'm talking to families, when they talk about candies and fruit roll ups and like, "How about we switch that out with some real fruits?" And I love that you talk about doing a swap. And talking about the whole family too, because kids will do what they see parents doing and you can't ask a child not to drink soda pop if dad's drinking a six pack of Coca Cola every day.
Katharine: Yes, exactly.
Dr. Stafford: Parents are great role models. You really nailed it with that. So thank you. Well, thank you Katharine for being on our podcast today and if any of our audience members would like to learn more information, what is your website?
Katharine: My website is portlandpediatricnutrition.com, you can find me on Instagram at pdx_nutrition.
Dr. Stafford: Awesome. Thank you. And thank you to our listeners out there and remember, fill the world with smiles.