Pragmatic Mom

January 12, 2010

Visiting the Nutritionist Deja Vu

Is it me or is it weird to visit two different nutritionists for the same child — at age 2 because she is underweight and then at age 8 because she is overweight?  The first visit to the nutritionist, we were skeptical parents:  show me a growth chart for an Asian girl and THEN tell me she’s underweight.  We could be a little haughty … “she’s not underweight and we’re NOT adding oil back to her food!”   Instead, we  fed her more pasta.  She always well when it was spaghetti.

Time travel forward six years.  Now we are getting sent to a nutritionist by the same pediatrician whom we love.
When we refused to go to the first nutritionist again, he sent us to the nutritionist he used when his daughter drank a bad carton of milk at McDonalds and then went on an extended milk strike.  “How could this happen?”, we asked.  We eat exactly the same, if anything, we are eating healthier.  He says, “Well, maybe you overfed her because she used to be underweight.”  Ouch!  Nothing like setting off some mommy guilt.

But with the help of a food diary and those years of pre-med training to clinically observe and study my child’s behavior, I figured it out:  we are serving the same food, but she’s just not eating the same food she used to.  My daughter, over the past two years,  has systematically eliminated foods until basically only carbs remained.  Help was needed and help came the way of a great nutritionist.

Read on if you want $85 worth of great nutritionist advice  that is not reimbursed by your medical insurance! company.  But note that some of my own, unproven ideas are thrown in.

There were many impressive things about our nutritionist.  She looks  10 years younger than she actually is.  She had the most beautiful glowing skin I have ever seen.  She was leading researcher at Children’s Hospital on studies for underweight and overweight children and…ta da…they have the same issues:  too much screen time.  She is a mom and isn’t going to give crazy, advice no sane parent can actually execute.  She’s truly a testament for you are what you eat!

She gave some simple rules of thumb that had almost immediate results:

— Always pair a carbohydrate with a protein.

–3 dairies a day:  milk, cheese, yogurt

–3 fruits a day; more if you can’t get them to eat enough veggies

–1 flintstone vitamin a day

–After school snack should be a mini-meal; junk  foods don’t fill you up.  Her suggestions:  smoothies, soup, 1/2 grilled cheese sandwich, pizza, chicken sausage, warm applesauce.  These foods are satiating.  You can not starve a child; it simply won’t work.

— Increase veggies at dinner but not all in raw form.  Raw veggies throw off so much water they don’t make you feel full.  1 veggie needs to be cooked; portion size to shoot for is 1/2 cup.  She was totally flexible when I said, That ain’t gonna happen with this one here.  She won’t eat green stuff.”  She said the next best thing was to increase the fruit then.

— Have a no thank you plate which means you have to try it but you can reject after one bite.  Most children need food introduced 25 times before they will accept it.  One try should equal 1 tablespoon.

— A serving of carbs equals one fist (kid size not mama sized)

Eat Less:  sugary cereal, bagels (too dense), ice cream[especially at night as dessert], no Nutella [trans fats].


Sugary cereal:  try Barbara’s Puffins (they are not bad but my kids hate it), Kix, or put a handful of sugary cereal on top of good cereal.

Bagels:  try English muffins [Thomas Light Whole Grain].  That didn’t go over too well, but we did cut back on bagels.  Multi-grain toast.

Ice Cream:  try Tofutti cuties.  My kids like the vanilla flavor ice cream with chocolate cookie outside not the graham cracker one.

Snack food: try Kashi TLC Rule of 5 bars.  For bars, you want 5 grams of fiber and also check out the protein and sugar amount.  High protein/low sugar = good.  Try chips with mild salsa.  Popped pop corn is good; it’s a whole grain but watch the fat content.  Try hummus as a dip.

Realize that these foods are veggies with lots of starch:  peas, potatoes, corn, sweet potatoes so go easy on these plus go easy on rice and pasta.  Bananas also are not a fruit your child should eat regularly.

Smoothies:  make with 2% greek yogurt [try vanilla flavored].  Freeze leftovers to make smoothie pops.

Oatmeal:  make steel-cut oats and keep in fridge.  Microwave a portion as needed.

Brown rice:  soak overnight in water and then add to white rice  so it cooks at the same rate– I mix 50% each.  My mother-in-law taught me that trick. She also adds pressed barley which is a Korean thing and the kids will hardly notice.  You can get the pressed barley at an Asian store or at

Pasta:  switch white pasta for whole wheat, or try Barilla high protein/multigrain.  Overcook the whole wheat and the kids will barely notice the difference.  Use red sauce for the Barilla and the kids will not notice.  Try soba noodles made from buckwheat (recipe in Easy Dinners is child friendly).  Try Asian clear noodles, made from mung beans, so it must be higher in protein although I can’t read the label; it’s in Chinese!

Finally, little by little, try to eliminate unhealthy habits such as sodas, juice or chocolate milk .  Substitute 2% milk (more satiating than 1% or skim) or water.  It is ok to use Ovaltine to flavor milk [the creamy chocolate tastes great!  my kids love it]  Drinkable yogurt is also good, but my IFF mom friend says to buy organic yogurt as the other stuff has scary additives that are not listed on the label for flavor and texture and she would know because that is her job!

And so, we embark on the world of healthy choices.  We talk about making healthy choices and recognize good choices but allow for treats.  It’s an ongoing educational process for the entire family and we all fall off the wagon like anyone,  but it’s nice to see the ownership shift from parent to child.  Note to self:  I need to call my pediatrician to tell him it’s not my fault!  I am now officially turning my mom guilt meter OFF!

Here’s a link  for food substitutions from less healthy to more healthy:

My go-to Pediatrician guru author has always been Dr. Sears.  I am reading his book on Lean Kids and find it to be very helpful.  Dr. Sears’ Lean Kids:  A Total Health Program for Children Ages 6-12 by Dr. William Sears, Dr. Peter Sears, and Sean Foy.



  1. My oldest is two and we had to go to a nutritionist a few months ago because she was underweight. She would only eat turkey and chicken, veggies, and fruits. She loved milk and cream cheese and yogurt. Everything she told us to do I was already attempting to do (from making food with cream sauces to letting her have cream cheese on everything) and it cost us $125 since the insurance only covered malnutrition and not “failure to thrive”. She is starting to be more adventurous with food (it helps that she is around other kids a lot) but you have certainly reminded me that as she begins to eat other things and as she grows that we may want to reevaluate our diet as a family.

    Comment by Joy — January 13, 2010 @ 9:05 pm | Reply

  2. Thank you! For the lice advice and now the nutrition advice. We’ve a small girl, 18 months, 18 pounds and yet happy, smart and vibrant. Getting loads of crap from the ped to feed Pediasure but instead just doing much of what your nutritionist recommends. Thank you for sharing!!

    Comment by anie — January 17, 2010 @ 8:01 pm | Reply

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