How To Raise a Healthy, Adventurous Eater in a Chicken Nugget World with Nimali Fernando, MD, MPH

In this episode, Dr. Nimali Fernando, pediatrician and creator of the Dr Yum Project, discussed how to raise a healthy eater despite the many obstacles. Feeding is a developmental task which does not necessarily come naturally. We CAN teach kids to love healthy food! 

Dr. Nimali Fernando is a board-certified pediatrician and the founder of the nonprofit, The Dr. Yum Project. She is also co-author of the award-winning book ”Raising a Healthy, Happy Eater.” She is the co-creator of the “Dr. Yum Adventure,” a research-backed nutrition curriculum that teaches young children to enjoy fruits and vegetables, and of “Touchpoints,” a family-centered intensive health behavior and lifestyle program for children. Her food-as-medicine approach has been featured nationally in the New York Times, NBC Nightly News, and Voice of America.

https://www.doctoryum.org/

https://www.ahealthieramerica.org/articles/free-resources-for-clinicians-and-champions-of-first-foods-981

https://www.amazon.com/Raising-Healthy-Happy-Stage-Stage/dp/1615192689

Cover art by Charlotte Feldman

Please note that while I am a pediatrician, I am not your child's pediatrician. This podcast is for informational purposes only and does not constitute medical advice. For any medical concerns or decisions, please reach out to your child’s health care professional.

Transcript

0:11

Welcome to Kids Matter. I'm Dr. Elisa Minkin. As a pediatrician, mom and grandma, I understand how challenging it can be to help our kids grow into their best selves. We are so much more powerful together. Here I will be sharing the knowledge and wisdom of a wide range of people who understand and care deeply about children. I'm hoping for your input as well because kids really do matter. They are our future.

Alisa Minkin 0:43

Welcome back to the Kids Matter podcast. I'm really honored and really excited to be here today with Dr. Naali Fernando, otherwise known as Dr. Yum. Dr. Fernando is a board certified pediatrician and the founder of the nonprofit, the Dr. Yum Project. is also co-author of the award-winning book, raising a Healthy. Happy Eater. She's the co-creator of the Dr. Yum Adventure, a research back nutrition curriculum that teaches young children to enjoy fruits and vegetables and of touchpoints, a family centered, intensive health behavior and lifestyle program for children. Her food as medicine approach has been featured nationally in the New York Times, NBC, nightly News and Voice of America. These. Are incredible accomplishments, and I am so honored and so excited to be doing this with you. There is so much negative talk right now, right about how impossible it is to feed kids and ultra processed foods

Dr. Nimali Fernando 1:40

Yes.

Alisa Minkin 1:40

and food deserts and all that kind of stuff. And I love that you are doing preventative and proactive things out there. And so I'm really excited to talk to you about this. I'm also gonna say first of all, here's your book for people who are watching the video. Raising a healthy, happy eater. It's amazing. I highly recommend it. Your website, the Dr. Young Project is gold. It is money in the bank. Everybody should be on that, whether it's a parent, whether it's a teacher, whether it's any kind of clinician. I'm also gonna say that your co-author of this book, Melanie Potok, is a feeding and speech therapist who is amazing and I'm separately planning on interviewing her at least twice. Ice. So we're not gonna do the same topics as I'm doing with her, which is really more about the basics of feeding and then feeding issues that come up. We're gonna talk about other things. I'm really excited about that. So I wanna start, I wanna go right into it. And I wanna start with, first of all, how did you get into this?

Dr. Nimali Fernando 2:36

Thank you for all of that and I'm excited that you're interviewing Melanie too. She has taught me so much over the years and is such a great, good friend to me. Yeah this really started out of a desire to help parents. I actually grew up around. Food. We were very connected to food. My parents were immigrants. They came from Sri Lanka and my father came to do his medical training and my mom decided to stay home and raise the family full-time. And so she was really careful in making sure we stayed connected to our culture. Through the robust foods that are part of the Sri Lankan cuisine, so highly spiced curries and deviled fish and

Alisa Minkin 3:22

Fish

Dr. Nimali Fernando 3:22

vegetables and she was always cooking those things, but she was really curious to learn how to perfect the perfect. Thanksgiving dinner,

Alisa Minkin 3:32

dinner,

Dr. Nimali Fernando 3:33

Turkey with all the trimmings. And so she was always learning about food and and I was often her sous chef helping her. And so I really learned

Alisa Minkin 3:42

learned

Dr. Nimali Fernando 3:42

to cook from a young age.

Alisa Minkin 3:44

age and

Dr. Nimali Fernando 3:46

I learned how important meal times were too, because she always made space for mealtimes. And for that connection that happens,

Alisa Minkin 3:53

happens.

Dr. Nimali Fernando 3:54

we know it's not just about the food, it's about

Alisa Minkin 3:57

it's

Dr. Nimali Fernando 3:57

connection at mealtime.

Alisa Minkin 3:58

mealtime.

Dr. Nimali Fernando 3:59

And,

Alisa Minkin 4:00

And,

Dr. Nimali Fernando 4:00

I went into pediatrics I felt really lucky that I grew up in, with all of those great advantages, but I was seeing so many families with children who were struggling with food and often there was this sort of family kitchen in crisis. And,

Alisa Minkin 4:18

and

Dr. Nimali Fernando 4:18

a lot of

Alisa Minkin 4:19

a lot of the,

Dr. Nimali Fernando 4:20

the. Problems that I was seeing were obesity and,

Alisa Minkin 4:24

and

Dr. Nimali Fernando 4:25

constipation and really things that were very connected to diet. And, And

Alisa Minkin 4:30

and

Dr. Nimali Fernando 4:31

at the same time I was starting to raise my own family with two young, busy boys and a husband that also had a

Alisa Minkin 4:40

had,

Dr. Nimali Fernando 4:40

career in medicine. And I. Really started to see, it's really hard to raise curious, confident eaters.

Alisa Minkin 4:46

and

Dr. Nimali Fernando 4:46

it really is. There's time pressures. There's

Alisa Minkin 4:50

There's,

Dr. Nimali Fernando 4:50

Different styles of learning. I had two children who are very different in the way that they learned.

Alisa Minkin 4:55

learn

Dr. Nimali Fernando 4:55

And,

Alisa Minkin 4:56

and

Dr. Nimali Fernando 4:57

and I found myself getting

Alisa Minkin 4:59

getting

Dr. Nimali Fernando 5:00

by all of this very highly marketed, very easy, kid friendly convenience foods that would.

Alisa Minkin 5:05

that would

Dr. Nimali Fernando 5:06

Check the box at the end of the day,

Alisa Minkin 5:08

a day.

Dr. Nimali Fernando 5:08

we got dinner done.

Alisa Minkin 5:09

I'm done.

Dr. Nimali Fernando 5:10

And so I was starting to feel like if I am struggling with this this task of raising confident eaters, then how is anyone else supposed to do this? And there were a lot of

Alisa Minkin 5:21

lot

Dr. Nimali Fernando 5:22

families I saw that had a lot more barriers than me. Kids who were neurodivergent and kids who didn't have access to foods, kids who had differences in their,

Alisa Minkin 5:32

there,

Dr. Nimali Fernando 5:33

that they learned to eat. And so I was looking for resources for those patients and for myself. Lily, how do I do this better? So I was looking for things that were practical and uplifting and that weren't really judgmental, right? And it was hard for me to find them. So I just started sharing recipes. It was very simple, and I put them on

Alisa Minkin 5:56

put

Dr. Nimali Fernando 5:56

website and I would tell patients at the end of their visit, okay, here's my website and here's what's working in my family. Why don't you give some of these recipes a try?

Alisa Minkin 6:06

Dragon And

Dr. Nimali Fernando 6:07

really, I was surprised they went to the website and they tried the recipes and they shared their successes and we could,

Alisa Minkin 6:14

we could,

Dr. Nimali Fernando 6:14

really share each other's in each other's successes too. And it was

Alisa Minkin 6:18

it

Dr. Nimali Fernando 6:19

really fun for me to see these small wins. And so I decided to make the leap and start a practice of my own where I could really have more robust conversations about nutrition. And I put a teaching kitchen in the middle of this practice.

Alisa Minkin 6:35

So cool.

Dr. Nimali Fernando 6:36

garden. So I could really create this human lab where we could through a nonprofit team, which was the Dr. Yum project, which we eventually created. We could figure out

Alisa Minkin 6:49

figure

Dr. Nimali Fernando 6:49

those barriers were and let families to test our solutions in real time in our teaching kitchen,

Alisa Minkin 6:55

engine,

Dr. Nimali Fernando 6:56

be recipes or curriculum classes, whatever it may be. And so for 10 years.

Alisa Minkin 7:01

years

Dr. Nimali Fernando 7:01

perfected what worked and that really became the ecosystem of the Doctor M Project. With all of its free recipes and resources for families and programs that we've created,

Alisa Minkin 7:14

I. love it so much, and I love that you shared it For everybody else, everybody listening, go right now. Stop the podcast, check

Dr. Nimali Fernando 7:21

I.

Alisa Minkin 7:22

of the features, and for people listening to you speak now you are available to speak elsewhere, to talk more about your programs because This is what you do now,

Dr. Nimali Fernando 7:34

This is what I do. Yeah. At some point about two years ago, I was seeing the great need for programming like this and, for instance our adventure Dr. M's Adventure program is now in 44 states, and I've been able to really put more time into getting that program out because I put the pause on my practice to really focus on the nonprofit work. And that's been a great joy for me because I've been able to see the impact and the ways that we are helping. Teachers and parents to

Alisa Minkin 8:11

to

Dr. Nimali Fernando 8:11

treat nutrition with a more uplifting tone.

Alisa Minkin 8:15

I love this so much and I love how you talk about feeding, eating as a skill that needs to be learned as a developmental task. Similar to say, reading. Don't expect kids to learn to read without help. Why do

Dr. Nimali Fernando 8:27

yeah,

Alisa Minkin 8:27

them to learn to eat?

Dr. Nimali Fernando 8:29

it's absolutely true. So in that 10 years where we were learning, I. I decided I needed to bring other professionals that understand feeding and nutrition and child development,

Alisa Minkin 8:42

development

Dr. Nimali Fernando 8:43

teachers and create something that was really more robust and informed. By all of these different disciplines. And one of the people that I called was Melanie Potok, who is a specialist in feeding. And she sees kids with all different types of feeding challenges. And what I learned through my friendship with her is that feeding is a developmental process. And

Alisa Minkin 9:07

and

Dr. Nimali Fernando 9:08

and I also learned in that 10 years that parents really want to do what's right for their children. But it is a struggle because of the heavily marketed food, because of time constraints, access to food, but also because children learn to eat differently, right? Just like children learn to read differently on a different timescale.

Alisa Minkin 9:30

scale

Dr. Nimali Fernando 9:31

a child struggles with reading, though, we don't blame the parents, right? We don't blame the child or stigmatize the child and call them a bad reader. We can employ. An uplifting evidence-based framework to teach that child to read and eventually get them across the finish line. And so I was seeing that we really could apply that same framework to feeding,

Alisa Minkin 9:55

reading.

Dr. Nimali Fernando 9:56

If we can train. Teachers and parents to think about feeding as a developmental process, to walk them through that development, whether it's slowly or quickly, right? Knowing that it's going to be different for every child and not apply labels to them along the way. Call them fussy eaters or picky eaters to their face, right?

Alisa Minkin 10:17

right?

Dr. Nimali Fernando 10:18

And,

Alisa Minkin 10:18

and,

Dr. Nimali Fernando 10:19

them the framework that they need an early intervention when necessary if they're struggling. Then we could have a huge public health impact at.

Alisa Minkin 10:30

We really could. And I'm glad you mentioned early intervention, but I wanna talk about that just for a minute because I am. Seeing a lot of kids with feeding issues and feeding therapy is a thing. However, it can be very hard for families to access this early intervention for to qualify for early intervention, at least in New York where I am, you need to have a 33% delay in one area, or 25% in two or more, and I don't believe feeding alone. Qualify

Dr. Nimali Fernando 10:57

Yeah

Alisa Minkin 10:57

so if you have, say, a speech delay and a feeding problem and you meet criteria,

Dr. Nimali Fernando 11:01

sure.

Alisa Minkin 11:02

is definitely something to consider getting evaluated for. But what if you have a feeding issue and you don't qualify for feeding therapy? Then what?

Dr. Nimali Fernando 11:10

Yeah, I think the first stop is your, to your pediatrician to learn about the steps that you might be able to take and to really ask for that follow up from your pediatrician too. Make sure that the growth is still on track because there may be other things going on along with feeding.

Alisa Minkin 11:27

along with feeding

Dr. Nimali Fernando 11:28

might,

Alisa Minkin 11:29

might,

Dr. Nimali Fernando 11:30

you that referral to a specialist that could give you the help that you need.

Alisa Minkin 11:34

you need.

Dr. Nimali Fernando 11:35

but really our focus is preventing those feeding disorders by starting so early that we can write those little behaviors from the beginning and give parents a toolbox and also give them the confidence. To know that children really are curious, but sometimes they just need a little bit more time and patience and more variety and that's why we do it in schools too, to be able to,

Alisa Minkin 12:01

able to,

Dr. Nimali Fernando 12:01

for parents who may not

Alisa Minkin 12:02

may

Dr. Nimali Fernando 12:03

have access to novel nutritious foods

Alisa Minkin 12:05

foods

Dr. Nimali Fernando 12:06

all times, we can provide that experience with teachers leading that charge in the schools.

Alisa Minkin 12:12

school. I love that and I love having the schools. be a place where kids can learn this because pediatricians are really busy. And I'm going to say, yes, speak to your pediatrician, but not all pediatricians are. As knowledgeable about the developmental aspect of feeding,

Dr. Nimali Fernando 12:30

Sure.

Alisa Minkin 12:31

say to you, okay, your child is growing and gaining fine. There is no problem where your child actually does have feeding issues that need to be addressed. So I'm gonna say to the parents, listen to your gut.

Dr. Nimali Fernando 12:43

Yes,

Alisa Minkin 12:44

Ask, for a separate visit and ask if the pediatrician and the. Which pediatrician in the practice, if there's multiple ones, is best at feeding issues. You always want that for anything. 'cause

Dr. Nimali Fernando 12:53

sure.

Alisa Minkin 12:54

we're not jack of all trades we're humans.

Dr. Nimali Fernando 12:56

to be.

Alisa Minkin 12:57

there are areas that we know more about that we're more interested about. So for me, I get those patients because I have an adult order on the spectrum who didn't eat food for four years. Okay?

Dr. Nimali Fernando 13:07

Yeah,

Alisa Minkin 13:08

was a very severe feeding disorder. So I'm super passionate about feeding issues, but also about preventing them, which is why I'm so excited to be doing this with you today. So I wanna move on to what you call the parenting passport. And I'm gonna help you through

Dr. Nimali Fernando 13:22

Okay.

Alisa Minkin 13:23

I have it in front of

Dr. Nimali Fernando 13:24

Yes.

Alisa Minkin 13:24

You have Severn, different passport stages or steps or whatever. And I really like them 'cause it breaks it down into components. The first one is celebrate each step.

Dr. Nimali Fernando 13:35

Yes. So we created these passports. We think, we think of all of this,

Alisa Minkin 13:39

of all of this.

Dr. Nimali Fernando 13:41

journey of feeding as an adventure, right? So we thought it would be fun to create these passport. Stamps and,

Alisa Minkin 13:48

and

Dr. Nimali Fernando 13:49

yeah. So the first one is take each step, and that is really trying to let parents know that this process of teaching your child to eat can be really a longer process than you might realize. And so offering broccoli three times and doesn't, and their, your child not showing.

Alisa Minkin 14:14

showing.

Dr. Nimali Fernando 14:15

that they love it, yet it's just the beginning, right? For some kids who are very sensitive, just putting it on their plate and making friends with it, that's what we call it in

Alisa Minkin 14:26

plate.

Dr. Nimali Fernando 14:26

Dr. Yam Adventure. Let's just make friends with, let's look at how beautiful it is. Let's put it on our plate and maybe smell it or touch it and talk about how bumpy and strange it feels. Those are wins. For so many children who are very hesitant, those little baby steps are wins, and so we have to be able to celebrate the wins and know that the biggest win, which for a parent might be that they take a bite and they enjoy it. That will come in the future. We have to take these little steps first.

Alisa Minkin 14:58

Really love that. So the second one I have related is understanding developmental stage.

Dr. Nimali Fernando 15:04

Yeah. As we said, feeding is a developmental process and there are all of these sort of sub developmental skills that make up the umbrella feeding that are under the umbrella, feeding oral motor skills, fine motor skills, gross motor skills. Cognitive skills, taste training, and we can be working on all of those skills. For instance, when a child is getting their tummy time as an infant, before they even take a bite of food,

Alisa Minkin 15:33

food

Dr. Nimali Fernando 15:33

working on core muscle strength. And that core muscle strength is so important for them to be able to sit in a feeding chair

Alisa Minkin 15:41

chair

Dr. Nimali Fernando 15:41

feel comfortable and be able to focus on eating and enjoy it. So understanding that there are steps. That we have to take and we can nurture that development and be proactive in service of feeding and understand that,

Alisa Minkin 15:59

that

Dr. Nimali Fernando 16:00

there are,

Alisa Minkin 16:01

are,

Dr. Nimali Fernando 16:01

Little red flags along the way that we can be watching for so we can have those conversations early with our pediatrician and avoid those bigger feeding issues down the line. It's super important.

Alisa Minkin 16:13

It really is, and I'm thinking of my two youngest grandkids who were nine months and a year, and thank God they're both turning into great eaters. But the difference between them in the beginning, two different kids. So one of them at nine months, no, maybe he was like five months old. I remember I gave him Bomba and he pounded them to quote my dog.

Dr. Nimali Fernando 16:34

Yeah. Yeah.

Alisa Minkin 16:35

He is just a natural eater and my granddaughter needed to scientifically inspect the food, toss almost all of it up. Maybe all of it all are highchair for months And you had to be a little more patient with her. But they're both great

Dr. Nimali Fernando 16:50

Yes.

Alisa Minkin 16:51

daughters are rocking it. You guys are awesome by the way.

Dr. Nimali Fernando 16:54

I love that.

Alisa Minkin 16:55

Shout out to my

Dr. Nimali Fernando 16:56

I

Alisa Minkin 16:56

for raising healthy eater adventurous eaters.

Dr. Nimali Fernando 16:59

kids have their own personalities and they approach feeding differently too.

Alisa Minkin 17:03

Personalities, but also

Dr. Nimali Fernando 17:05

And development. Their development may be different. yes,

Alisa Minkin 17:08

can't expect this to just happen naturally to all kids at whatever age we think is the normal

Dr. Nimali Fernando 17:13

yes.

Alisa Minkin 17:14

work like

Dr. Nimali Fernando 17:14

It doesn't,

Alisa Minkin 17:16

So avoid fear and anxiety is clearly they're all related, okay? Because what happens when your kid is not at that

Dr. Nimali Fernando 17:22

I

Alisa Minkin 17:22

stage? Other kid, another kid at Anxious.

Dr. Nimali Fernando 17:25

You get anxious. Yes. And I think one of the things that we've lost. Culturally is this confidence that children will learn to eat these foods? And I think there's a number of reasons that has happened. I just am reading this incredible book by Helen VI called Ticky. Yes. And and I think that is a major theme. Back in the 18 hundreds, parents just knew that kids would eat all these food. S they didn't question that. And I think for a number of reasons throughout our culture, we've lost that confidence and we question and we worry more. And to parents out there, I would say just take a deep breath and know that over time most kids will learn to eat these foods if we give them the time, the space, and we continue to bring joy to the dinner table.

Alisa Minkin 18:20

The, they add something to that. It's a very interesting book, by the way, picky by Helen Vi, VITI believe

Dr. Nimali Fernando 18:28

yes.

Alisa Minkin 18:28

should probably link it in the show notes, but it's more for historical

Dr. Nimali Fernando 18:31

It's

Alisa Minkin 18:31

A feeding

Dr. Nimali Fernando 18:32

correct.

Alisa Minkin 18:33

a physician just saying, and she does have all these ideas at the end that I'm not sure I a hundred percent agreed with. In terms of anxiety, what we're seeing now is we're seeing. A lot of parents who have trouble tolerating the distress of their child. So if this child has more sensory issues, may not even be overtly neurodivergent or maybe their tone is low or whatever reason, and they're a little slower, and then it's hard for them, and then the parent becomes anxious.

Dr. Nimali Fernando 19:02

Yes.

Alisa Minkin 19:02

a vicious cycle of

Dr. Nimali Fernando 19:03

it does.

Alisa Minkin 19:04

not wanting to have the child tolerate distress.

Dr. Nimali Fernando 19:07

Right.

Alisa Minkin 19:07

So again, have a low threshold to get help. I'm gonna say even if you don't qualify for early intervention there are, there's private therapy and even if, can't afford a full price speech therapist or feeding therapist, you may be able to access one at a reduced cost from say a learning institution.

Dr. Nimali Fernando 19:26

Yes, as Mel, as Melanie taught me, if a family feels stressed right, and they're not getting the answers. And they maintain that stress, that vicious cycle can start to bleed into family dynamics too, right?

Alisa Minkin 19:40

right?

Dr. Nimali Fernando 19:40

so it is worth asking for that referral if there is stress.

Alisa Minkin 19:45

And also from the pediatrician standpoint, okay. Or clinician or whatever. Who's seeing this child? Please do not put fire, add oil to the flames or whatever. Do not make this worse by how you approach it, right? If the child isn't gaining weight adequately, be very careful to tell the parent, this is not your. Fault

Dr. Nimali Fernando 20:04

Sure.

Alisa Minkin 20:04

not to add pressure for feeding, even if they're gaining properly, but they're having feeding problem. Just be careful

Dr. Nimali Fernando 20:10

Yes.

Alisa Minkin 20:10

what you say can really make it a parent who is already gonna be prone to anxiety about this even feeling worse.

Dr. Nimali Fernando 20:16

It is true. I hear a lot of parents saying, my pediatrician said I'll grow out of it. And for a lot of kids that may be true, but I think it, if a parent is coming to us, we need to pay attention. And so I may do something as simple as ask them to give me a, a feeding journal.

Alisa Minkin 20:35

journal,

Dr. Nimali Fernando 20:35

see what it looks like really.

Alisa Minkin 20:37

really,

Dr. Nimali Fernando 20:37

in reviewing the journal, we may find out there is actually a lot of variety here and this seems really age appropriate and keep doing what you're doing.

Alisa Minkin 20:45

doing what

Dr. Nimali Fernando 20:46

we may

Alisa Minkin 20:46

we might

Dr. Nimali Fernando 20:47

out, wow, this is

Alisa Minkin 20:48

this

Dr. Nimali Fernando 20:48

maybe a little more severe than originally advertised and maybe we do need to pay attention and get some help involved. So

Alisa Minkin 20:54

So I

Dr. Nimali Fernando 20:55

Offering that help

Alisa Minkin 20:56

that

Dr. Nimali Fernando 20:56

and follow up is really important and it really makes a difference to parents that they are feeling heard.

Alisa Minkin 21:03

feeling heard. And feeling heard is really important and having, trusting your own gut instinct as a parent and the pediatrician or other clinician, trusting the parent's gut instinct is

Dr. Nimali Fernando 21:11

Sure.

Alisa Minkin 21:12

if you don't have time to get the diarrhea, they don't come back with it or whatever. If a parent is worried, that needs to

Dr. Nimali Fernando 21:18

Sure. Exactly.

Alisa Minkin 21:20

right? I'd rather make a referral that didn't need to happen than. Not make it at

Dr. Nimali Fernando 21:24

Ignore.

Alisa Minkin 21:24

ignore it. Dismissing the concern is the flip side of unfortunately en enhancing anxiety by saying your child's not gaining or growing

Dr. Nimali Fernando 21:31

right,

Alisa Minkin 21:32

And I just wanna put one thing out there for a PediaSure and related that is a bandaid. Okay.

Dr. Nimali Fernando 21:39

Exactly

Alisa Minkin 21:40

is not the solution to, restricted eating. So not that there's no role in it for

Dr. Nimali Fernando 21:46

there. There can be a role in it, but I do feel it is overused Of cases. Absolutely

Alisa Minkin 21:53

So another one that I love is waiting.

Dr. Nimali Fernando 21:57

waiting. I think that really ties in with patience, right? And and not pushing. And I think sometimes we over celebrate when we see kids making little progress and having having moments where they're finally taking the bite. We. We are a little overzealous in our praise, and this is a side note to the waiting, but I think we should play it cool and give space and time for feeding to happen and when it's happening to not overpraise, because sometimes that can be stressful for a child like, oh, now I have to do this every time. We have to celebrate every win and really wait and be patient through the feeding process.

Alisa Minkin 22:42

I think it's a nuanced thing because say you have an older child and that child has tried new food and you really wanna celebrate them being brave and trying the new food.

Dr. Nimali Fernando 22:50

Of course,

Alisa Minkin 22:51

But when a child is just doing what they're developmentally meant to do and you're making a big deal about it.

Dr. Nimali Fernando 22:56

Yeah. Yeah.

Alisa Minkin 22:57

I see that as an issue. And also the negative pressure to eat Very often, backfires.

Dr. Nimali Fernando 23:02

It's true.

Alisa Minkin 23:03

So understanding the next milestones, which is anticipatory guidance. As a pediatrician, this is what we're supposed to be doing

Dr. Nimali Fernando 23:10

Yes. I always, for my patients who often have a copy of my book, I tell them, read the chapter ahead of where you are. So you know what's coming and you can be ready. You can anticipate when I see 12 month olds. Babies. I often will tell the parents, your child's appetite is about to tank, so enjoy these last moments where your child is very hungry, because right now they're growing very fast. But as they become a toddler, their growth really slows down and you'll notice a

Alisa Minkin 23:46

a

Dr. Nimali Fernando 23:46

drop in appetite and also their.

Alisa Minkin 23:48

and also

Dr. Nimali Fernando 23:49

They're learning how to navigate the world. They're learning to say no. They're learning to get around and use their voice. And so food becomes much less exciting and important and their body doesn't crave it because their growth is slowing. And you're lucky to get a good meal or two in a, into a toddler, and it's interesting when you tell parents that ahead of time, once they get there. They're not as worried 'cause they're like, oh, she told me this is gonna happen. I just need to put the food in front of them and if they're hungry they're going to eat it. And if not, we go to the next meal. If I hear that they ate a great meal in daycare, but they're not eating that great at home when we get home, I'm not worried 'cause they got that one or two good meals away from the home.

Alisa Minkin 24:31

them.

Dr. Nimali Fernando 24:31

That really helps parents navigate that stage so much more effectively. They're not worried, they're not pulling out the highly processed food just to see their child eat and steering their preferences towards the salty, sweet, foods. So I love to have that proactive approach when I am guiding families through feeding.

Alisa Minkin 24:55

that is really a lot of bang for your buck. I know that pediatricians are pressed for time. I get that, but just that one line, just planting that in the head before. problems

Dr. Nimali Fernando 25:06

Yes.

Alisa Minkin 25:06

like it. The nine month visit to be proactive about the switch to cow's milk because one problem I see very commonly is where they are drinking a lot of formula or a lot of breast milk,

Dr. Nimali Fernando 25:15

Yep.

Alisa Minkin 25:15

switch to cow's milk and they're filling up on that and they're not hungry. so I'd like to tell them, by the time your child is one, I'd like them to be having three meals, two snacks, and not more than 24 ounces of milk. And so they know what to expect by one and hopefully will prevent that over overdoing of the milk and underdoing of the food.

Dr. Nimali Fernando 25:34

Yes that's absolutely true. I can't say enough about that proactive approach. So much so that we I, the Doctorian project partnered with the Partnership for Healthier America around the veggies early and often campaign. So it's a whole campaign that was centered around this research that showed that early. And frequent vegetable introduction is super important for kids to learn to eat their vegetables and single ingredient vegetables, so not vegetables, mixed up with fruits. Really getting kids to experience the taste of vegetables in all their bitterness and complexity. So as part of that campaign, we wrote a whole feeding series for parents that can be distributed through pediatrician's offices, through Head Start, through WIC offices. And they, it's a stage by stage guide of feeding and it really takes it in a proactive way and answers all of those frequently asked questions.

Alisa Minkin 26:28

questions.

Dr. Nimali Fernando 26:29

multidisciplinary team that came together to create that series, and all of us

Alisa Minkin 26:34

of us

Dr. Nimali Fernando 26:34

knew from our careers what are those?

Alisa Minkin 26:36

what

Dr. Nimali Fernando 26:36

Frequently asked questions and we made sure to answer them in that series.

Alisa Minkin 26:40

series.

Dr. Nimali Fernando 26:41

is free and available on the website of Partnership for Healthier America and the Dr. Yum project.

Alisa Minkin 26:47

I love that so much, but also the whole family has to be on board.

Dr. Nimali Fernando 26:52

yes. So we made it so that it's a handout. When you get it from your pediatrician, you can take it home and share it with other caregivers, with maybe grandma who is using her

Alisa Minkin 27:03

paper

Dr. Nimali Fernando 27:04

knowledge from years ago, which may be outdated at this point, based on the evidence we have,

Alisa Minkin 27:09

we have.

Dr. Nimali Fernando 27:10

things like early.

Alisa Minkin 27:11

early

Dr. Nimali Fernando 27:11

Allergen introduction is not something that we did. It's not something that I did. Introducing peanuts at six months was a big no-no. But now we know

Alisa Minkin 27:19

know

Dr. Nimali Fernando 27:20

through scientific studies that can be really important in hopefully preventing food allergies. So we made it into a handout so it can be shared with all the caregivers so everyone can be on the same page and so parents can feel comfortable saying. That's maybe not what I heard from my pediatrician here. It isn't writing and everyone can

Alisa Minkin 27:39

can

Dr. Nimali Fernando 27:40

around the same strategy.

Alisa Minkin 27:42

I love that. And I wanna underscore that you mentioned vegetables not mixed with fruits because the pouches that are out there now, are sneaking the vegetables in with lots of fruit sugar.

Dr. Nimali Fernando 27:53

Yeah. It's true. So there's.

Alisa Minkin 27:55

I'm anti pouch. I don't wanna be judgy, but I'm judging.

Dr. Nimali Fernando 27:57

No I'm right there with you. I feel like there's a time and a place for pouches And I call it disaster food. Like it's nice to have in the diaper bag for when you're out if you need it. But there are two things about it. A lot of the pouches do rely on blend. And so they're not introducing those vegetable flavors in their pure form, and they're a lot of fruit with some of the vegetables in there. And so we're not really teaching kids. We're not giving kids that taste training that 10 or 15 tries that kids need with those challenging vegetables that develop the liking and also. I think kids are staying on those pouches too long, right? We really want to advance texture quickly. We want kids to learn to use their muscles of mastication and learn to swallow complex textures. And a lot of kids, unfortunately, I see relying on those pouches way too long and not developing those skills, and they're slurping their food instead of learning to chew and swallow it.

Alisa Minkin 29:00

Not just that, but if you look at the pureed vegetables, especially the green ones I'm sorry, but I just think they're disgusting and I think a lot of babies agree with.

Dr. Nimali Fernando 29:11

And it doesn't teach kids to eat those vegetables in the way they're going to be presented with them at the family table. Eating carrots or green beans out of a pouch or a jar. It's not the same flavor as eating your grandma's seasoned roast carrot recipe, right? We have a big mantra, which is one meal, one family at the Doctor Yum Project. If you go to our website and click on our recipes, you'll see foods that are labeled baby food options. And if you

Alisa Minkin 29:40

If

Dr. Nimali Fernando 29:40

click on that, you'll see all these incredible, diverse recipes that don't look like baby food, right? They're family recipes. But we've provided a little shortcut to help babies,

Alisa Minkin 29:52

babies

Dr. Nimali Fernando 29:52

foods safely. So essentially, the babies are eating the same food with the same spices, the same flavors,

Alisa Minkin 29:58

flavor,

Dr. Nimali Fernando 29:59

we're, maybe we're making it safe by smushing it up in a way that's safer for new eaters, but. Babies crave flavor. There is an incredible flavor window till about 12 months where kids are hungry and they are loving that flavor that we can provide. And a lot of those spices and things have their own.

Alisa Minkin 30:20

their

Dr. Nimali Fernando 30:21

Health properties and benefits, but we're training the palate early. And in a lot of cases it makes life easy, right? If you can just smush up the food that you're eating and not make anything separate or buying anything separate there's always room for

Alisa Minkin 30:36

for,

Dr. Nimali Fernando 30:37

bought baby foods and pouches and things, but

Alisa Minkin 30:40

but

Dr. Nimali Fernando 30:40

to make

Alisa Minkin 30:41

make

Dr. Nimali Fernando 30:42

meals, part of the routine really does train the palate from such a young age too.

Alisa Minkin 30:48

And it is developmental to learn how to eat. So I, we're not gonna really go into purees versus baby lid weaning here. That's gonna be for me to talk about with Melanie.

Dr. Nimali Fernando 30:56

Yes,

Alisa Minkin 30:57

but I love the idea of family meals. And what you could do is feed the baby the purees first if you're doing purees, and then sit the baby down at the table and think about that as exploring food because parents will worry. How's my child going to get calories in? Nothing is actually getting in. It's all ending up on the floor.

Dr. Nimali Fernando 31:13

Yes. Yes. The good thing is in those first months, we are getting the vast majority of

Alisa Minkin 31:20

of

Dr. Nimali Fernando 31:20

our calories, nutrition, protein, fat.

Alisa Minkin 31:22

protein,

Dr. Nimali Fernando 31:23

Through breast milk and formulas. There's not as much pressure to get everything in, but there's, I think

Alisa Minkin 31:28

I

Dr. Nimali Fernando 31:29

parents should feel like this is a great time to explore flavor. Without the pressure of needing to get so many calories in.

Alisa Minkin 31:35

And in the book, picky, it's fascinating how it the idea that children are like invalids from back

Dr. Nimali Fernando 31:41

Yeah.

Alisa Minkin 31:41

were sick so much. And that food should be bland 'cause it should be invalid food. And then you look at the baby purees that have no flavor, like Oh,

Dr. Nimali Fernando 31:47

That's how we got here.

Alisa Minkin 31:49

I see how we got here. I see how we got here. So two more. We didn't get to two more passport stamps. One is consistency boundaries and the other is mindfulness present. I just wanna go through them really quickly 'cause I have so much more.

Dr. Nimali Fernando 32:02

Yeah. So I think consistency is, it goes back to, like the idea that Alan Satter had of the division of responsibility, right? Parents are responsible for deciding what, when and where we're going to eat, and children are responsible for deciding if they're going to eat and how much kids crave structure. If we can

Alisa Minkin 32:23

can

Dr. Nimali Fernando 32:25

with how we approach food. This is what's on the menu tonight.

Alisa Minkin 32:28

tonight,

Dr. Nimali Fernando 32:28

you'd like to try it, you can. Rinse and repeat. That's how children learn. We can't keep moving the goalpost and changing the rules. It's too confusing for children,

Alisa Minkin 32:38

And it's not your job to make your child happy all the time. And it's

Dr. Nimali Fernando 32:41

right?

Alisa Minkin 32:41

your job to get calories. Your child to ingest the food. It's their job.

Dr. Nimali Fernando 32:45

Exactly. Exactly.

Alisa Minkin 32:47

really, important. And mindfulness presence is what you need to do that.

Dr. Nimali Fernando 32:50

Yes. Yes. And I think taking a beat at mealtimes and being mindful about the fact that this is not just about calories, right? Kids who explore Meal have mealtimes regularly with their families. They're more likely to be able to communicate with the adults around them. They're less likely to engage in risky behaviors. There's so much beyond how many bites of broccoli we're getting. There's that. Connection and we should take time to appreciate the food too, right?

Alisa Minkin 33:19

And that's why you don't want it to be a time of tension and pressure.

Dr. Nimali Fernando 33:22

Exactly.

Alisa Minkin 33:23

And by the way, kids, especially young ones, are not gonna sit at that table for that full meal time, and that's normal.

Dr. Nimali Fernando 33:29

normal. Yeah. We have to be realistic about what kids have the capacity to do.

Alisa Minkin 33:34

exactly. And it's a good idea, by the way, to have a mat under that high chair.

Dr. Nimali Fernando 33:38

Are you speaking from personal experience?

Alisa Minkin 33:40

Oh, yes. I get one just from my granddaughter. It comes, oh my Lord. Okay, so I just wanna ta take a second to say for neuro diversion kids, it's really the same. Only there's more likely to be issues of development, of sensory issues, but they still gonna have the same passport milestones. You just might need to get more help with them,

Dr. Nimali Fernando 34:02

It may, yeah, it may be instead of the usual 10 to 15 tries, it may be a few dozen tries. And I think,

Alisa Minkin 34:10

think,

Dr. Nimali Fernando 34:11

in my experience providing that multisensory ex regular consistent exposure to foods like we do in our food adventure.

Alisa Minkin 34:20

adventure, we

Dr. Nimali Fernando 34:20

We play with food. We,

Alisa Minkin 34:22

We

Dr. Nimali Fernando 34:23

we have, we do science experiments, we do art. All of those things we're seeing for neurodivergent kids really do make a difference. They're gaining that sensory confidence without the pressure to try. And so we have a lot of kids whose parents,

Alisa Minkin 34:36

parents.

Dr. Nimali Fernando 34:37

tell us kids who are autistic that have other feeding challenges that tell us. Wow, this is great because they can do this and feel included and they're making progress. It's might be slower, but it's progress and I think that's really gratifying to see.

Alisa Minkin 34:54

do, you have a separate one for Neurodivergent kids? A separate food adventure.

Dr. Nimali Fernando 34:57

don't, it is the same food adventure. However, we have a lot of feeding therapists who use the adventure in feeding groups for kids with more severe challenges. And and that population of feeding therapists who are learning about the adventure and seeing how it could meet a need in their community for kids with feeding challenges is growing.

Alisa Minkin 35:20

I love that. I really do love that. And more about that is available on your website. And when we get off the podcast, we're gonna talk some thoughts about how to expand that further. So I also want to talk about your Touch Points program just briefly, please.

Dr. Nimali Fernando 35:36

Yeah. So Touch Points was a program that I wrote after the American Academy of Pediatrics. Came out with some new guidelines on the management of obesity in 2023. One of the. Sort of foundational pieces of advice that we were given, or guidelines that we were given is around lifestyle treatment. So the idea that when we see children with a high BMI, we should be offering a certain bank of hours of lifestyle treatment, 26 hours of. Guidance on how we can improve sleep, we can improve diet, we can increase activity, reduce stress and anxiety. All these things that we know are important to maintaining a healthy BMI. And so I saw a lot of stress around this from pediatricians, like, how are we gonna do 26 hours? Ideally that would be done in a multidisciplinary. Clinic where you have lots of people who can work on this with a family. Healthy weight clinics throughout the country do exist, but for many of us, we don't have enough capacity in those clinics to see all of our patients.

Alisa Minkin 36:43

Inpatient.

Dr. Nimali Fernando 36:44

And so the onus really falls on the pediatrician to do that. So because we've been doing this work for over a decade I felt like we had. The bones of a curriculum that we could give to pediatricians to walk them through lifestyle guidance. And we created a program that could meet those 26 hours through 21 uplifting modules around lifestyle using some of the Doctor Yum resources like our meal planners and our meal matic recipe tool. Lots of great tips and shortcuts. Addressing things like sleep and activity, food insecurity. So we created this,

Alisa Minkin 37:22

this

Dr. Nimali Fernando 37:22

of modules that can be customized according to a family's needs. What's great about it is it's not really focused on weight. It is focused on uplifting a whole family with learning healthy lifestyle behaviors, which they can carry with them through life. So one of the ground rules that we try to lay. If the beginning is this is not a weight program, this is a health program, a healthy lifestyle program, and it's not just about the child, it's about everybody in the family. So everyone's gonna participate in this. And I have personally seen such incredible results and kids really. Not just achieving a healthy BMI, but really having fun along the way and feeling empowered and proud of the achievements that they have. We, again, it's baby steps, right? So with each module we assign a little homework assignment, we make sure it's something achievable and something that the child's gonna enjoy working on, and we check in with them in the begin, in the, midpoint between visits. And I often find that. The children, I don't have to follow up with them. They're sending their homework back and saying, look what I did. So it's been really fun to see how that can impact families. And we have several dozen pediatricians across the country who are using that with great success.

Alisa Minkin 38:45

I love it. It's a paid program. It is not that expensive though, just saying.

Dr. Nimali Fernando 38:48

No, and it can be used it can be used for unlimited amount of patients. And, those visit visits for the pediatrician are billable visits, right? We have a nurse practitioner in South Carolina who has been getting referrals from across this. State and she does touch points almost exclusively now

Alisa Minkin 39:07

Now

Dr. Nimali Fernando 39:07

and has had incredible results. She sent me BMI charts

Alisa Minkin 39:11

chart

Dr. Nimali Fernando 39:11

And shared stories, heartwarming stories of success. She now is a six month wait for touch points. Yeah.

Alisa Minkin 39:20

It is really hard. I'm in New York and it's the New York City, long Island area, and it's really hard to find places to send people, and that's if they wanna go

Dr. Nimali Fernando 39:31

Exactly,

Alisa Minkin 39:32

go,

Dr. Nimali Fernando 39:32

yes

Alisa Minkin 39:33

so many barriers to that. It's beyond. So to be able to have something from the pediatrician's office, pediatricians had this has been put one more thing put on their shoulders and I just wanna give a big hug to

Dr. Nimali Fernando 39:42

all.

Alisa Minkin 39:42

pediatricians out there right now. It's not your fault. It's really hard. It's just it's so much on us.

Dr. Nimali Fernando 39:50

Yeah,

Alisa Minkin 39:50

this program, and yes you need to make them be separate visits. You can't do this all on your will visit. But while I've said all that, I really wanna emphasize how important it is to speak carefully

Dr. Nimali Fernando 40:02

exactly.

Alisa Minkin 40:04

when

Dr. Nimali Fernando 40:04

Exactly.

Alisa Minkin 40:05

weight. I dunno if you wanna say anything about that. I could go on forever.

Dr. Nimali Fernando 40:08

No, I, again, one of the ground rules is we actually have an opening sheet that we give parents who are, they sign on to do touch points. And in that information we talk about how this is a lifestyle program.

Alisa Minkin 40:22

program,

Dr. Nimali Fernando 40:22

are not going to talk about weight. I actually.

Alisa Minkin 40:25

I actually

Dr. Nimali Fernando 40:25

encourage pediatricians to do many of these visits as telehealth visits so that we're not having to weigh them every time and have moments where people, people might be focusing on the weight and how many pounds did you gain or lose

Alisa Minkin 40:39

lose,

Dr. Nimali Fernando 40:40

this is a journey, right? And we don't wanna create an obsession around way. Kids are so impressionable and they listen and they hear and internalize so many, so much of the messaging around them. And

Alisa Minkin 40:53

And so

Dr. Nimali Fernando 40:54

I really try to

Alisa Minkin 40:55

to

Dr. Nimali Fernando 40:56

lay that groundwork for the be from the beginning. If the weight comes off great, but we wanna do this in a way that's sustainable and healthy and uplifting for the family. What's been really interesting though, is I have seen that, that parents.

Alisa Minkin 41:13

parents often

Dr. Nimali Fernando 41:14

because they're modeling and doing this as a family. I've had stories of parents losing weight and feeling healthier and like, how is this happening? I'm not even trying, I'm just modeling for my kids. And so there's been all these fun ripple effects that can happen when we take that

Alisa Minkin 41:32

that

Dr. Nimali Fernando 41:32

really healthy approach that's not just focused on the number on the scale.

Alisa Minkin 41:38

I wanna put a plug there for not talking about weight in front of children when there's a concern to the parents that telehealth can be great for that because it could be when the child's at school. So there's many ways to do this, but please don't, as a clinician don't do that. It's just it's more counterproductive than productive. And there's two different ways you may see it as a clinician you may see the BMI rising. That they're gaining more weight than they're growing over time, and that is a concern.

Dr. Nimali Fernando 42:06

Sure.

Alisa Minkin 42:06

you might just see a child who's just living in a larger

Dr. Nimali Fernando 42:09

Exactly.

Alisa Minkin 42:10

Especially for the taller kids, their BMI may skew higher without it necessarily being a problem. So I've had conversations right in front of the child saying, I'm not concerned and this is why I'm not concerned. But if I am concerned, I'm not having that conversation with the child.

Dr. Nimali Fernando 42:23

And I think, one of

Alisa Minkin 42:24

without speaking to the parent

Dr. Nimali Fernando 42:26

right,

Alisa Minkin 42:26

And getting a game plan. I'm not afraid of talking about it eventually, Right? But first I wanna talk to the parent,

Dr. Nimali Fernando 42:31

I think, you can't just rely on that growth curve. There's a story, the growth curve tells, and then there's a story of the habits that are happening in that family. And that's why before the program starts, we do an intake to see what are we doing great, what are we doing? What could, where? Where is there room for improvement? That child who's living in a larger body, who's following a growth curve that's consistent, who's actually getting a lot of activity, who's eating a great diet? Like why are we bothering to have a conversation about that and worrying the family unnecessarily. When they may be just doing great.

Alisa Minkin 43:05

great.

Dr. Nimali Fernando 43:05

So it's a,

Alisa Minkin 43:06

it's,

Dr. Nimali Fernando 43:06

like to

Alisa Minkin 43:07

like

Dr. Nimali Fernando 43:07

establish what's happening in the family too, so we know how to how much to be worried and where to apply effort, and not worry the family unnecessarily.

Alisa Minkin 43:18

And there's also the issue of triggering an eating disorder because it is

Dr. Nimali Fernando 43:21

A hundred percent.

Alisa Minkin 43:22

story for a child to come out of that visit and say, I'm fat.

Dr. Nimali Fernando 43:27

Exactly, and we know, everything that was bad before the pandemic worsened through the pandemic. And that's one of the things that we saw that all of those pressures around the pandemic also led to this epidemic of eating disorders. And so we certainly don't want to add to that burden.

Alisa Minkin 43:47

Absolutely. And again, since the pandemic, I'm seeing more picky eating. Know how much of that is due to the rise in neurodivergence, which we're also seeing, autism and A DHD rates are rising. How much is due to anxiety in the family or in the child? I don't know, but whatever reason it is, I'm seeing more of that. Do you have a separate program for being more proactive about picky eating?

Dr. Nimali Fernando 44:15

A, again, I think our whole approach in schools, the food adventure is really with that in mind, really showing. Teachers in schools and parents through the outreach that we do,

Alisa Minkin 44:28

do

Dr. Nimali Fernando 44:28

how to watch for those signs where feeding may be going awry. How to right the ship early. how to apply some of Melanie's incredible techniques in real time when you're ha. Seeing mealtime issues when you're seeing a child who's gagging excessively with certain textures, what do you do in that moment? And we're

Alisa Minkin 44:47

and

Dr. Nimali Fernando 44:48

teaching that in the classroom and through outreach to the parents. I think that's the biggest way that we're doing that from a public health standpoint. I,

Alisa Minkin 44:57

know

Dr. Nimali Fernando 44:57

working heavily through Head Start programs and through YMCA early learning centers where a lot of families get their childcare.

Alisa Minkin 45:07

I'm seeing it in kids under three. So for those kids, I guess it would still be on the pediatrician to maybe use your handouts and focus on the anticipatory guidance and referrals. Also I will be doing those episodes with Melanie. One will be on

Dr. Nimali Fernando 45:19

Yes.

Alisa Minkin 45:20

will be on feeding issues.

Dr. Nimali Fernando 45:21

Yes.

Alisa Minkin 45:22

between these three together, that will help Parents and clinicians help be more proactive. So I really, I, we could talk about this all day, but I really respect your time and I want to. End here. But I wanna thank you so much for doing this with the me. I'm gonna link to all the good things you're doing.

Dr. Nimali Fernando 45:40

I really appreciate this opportunity. It's been such a fun conversation. And yes, everyone tune into Melanie's episodes because she has such a wealth of knowledge.

Alisa Minkin 45:50

Thank you so much for doing this with me. I

Dr. Nimali Fernando 45:52

Thank you for having me. It's been such a great time.

Alisa Minkin 45:55

really appreciate it.

45:59

Thank you for listening to Kids Matter. Raising Healthy, happy Children Takes a village, and I'm grateful you are part of ours. If today's conversation resonated with you, please share this episode with another parent, grandparent, teacher, or anyone who cares about kids. Together we can build a supportive community our children deserve. I'd love to hear from you. Share your thoughts, questions, or suggestions for future topics at Kids Matter podcast@gmail.com. With no explanation for your voice truly matters. Until next time, keep advocating for the children in your life because kids really do matter. They are our future. I'm Dr. Elisa Minkin and this has been Kids Matter. Please note that while I am a pediatrician, I am not your child's ped. This podcast is for informational purposes only and does not constitute medical. For any medical concerns or decisions. Reach out to your child's healthcare professional.