The Nourished Toddler

A CONVERSATION WITH DR JULIE BHOSALE

IT’S FUNNY HOW OFTEN A Grapevine story gets born when a book with an intriguing title crosses the desk. The other day we came across one titled The Nourished Toddler by Doctor Julie Bhosale.

What’s so tough about filling toddlers up with good nourishment, you might ask? Well, if you have to ask, it means you’ve probably never had to weather the screaming-dinnertime-heebie-jeebies, with junior spitting out every morsel on the plate and hurling your lovingly-crafted savoury delights on the floor. And walls, sometimes! And ceilings (not unknown)!

If you have had that sort of experience, you’ll be as keen as we were to discover more of the hints, tips, routines and recipes in this useful book. We caught up with Dr Julie in her North Shore home and asked her (for starters) … what, exactly, is a toddler anyway?

GRAPEVINE: Your book opens with your own colourful definition of toddlers:

“Toddlers (noun): The craziest, messiest, most infuriating, emotionally unstable, unreasonable, frustrating, tiring little people that you cannot imagine your life without.”

Are you serious?

DR JULIE: Yes – I’d say that description’s pretty accurate!

GV: So what on earth made you decide to write a book about these ‘mealtime terrorists’?

Dr J: Well, I was more or less ambushed! Parents who’d read and enjoyed my first book, The Nourished Baby, were keen to hear what to do next. At that time, a lot of new research was coming out about solid food for babies, and I’d also been advising plenty of parents who were struggling with feeding their toddlers – particularly here in New Zealand where our guidelines are … well … not all that up-to-date! 

So I’d actually already been thinking about a second book on toddlers – it just happened sooner than I’d planned!

GV: When I told my daughter-in-law I’d be interviewing an author who was an expert on toddlers and food, I got an unexpected reply … something along the lines of, “Oh no – not more counsels of perfection and ‘rules’ to produce perfect little people!”

Is your book about rules and perfection?

Dr J: Not at all! Right from the outset, I put a section in the introduction about the raw reality of life with a toddler, and warned against aiming for ‘perfect’. I try to keep that sort of ‘get real’ focus in all I do – in writing, in social media, and in my work with mums.

GV: I’m pretty sure that the number one question most readers will want to ask you is … how do you cope when your toddler says he doesn’t like it and won’t eat it? When he doesn’t even want his food in the same universe as him? When he flings his dinner off the highchair tray and all over the floor?

Dr J: Yep. Been there! And one of the most useful mantras I use is: Hungry children will eat! I’m pretty straight-up about that because I think we’re far too PC today about parenting issues. I advise lots of mums (some dads too) struggling with this, many who spend sleepless nights worrying what their toddler is eating … or isn’t eating.

GV: Are they worrying that their toddlers might to starve to death unless they can shovel in enough food?

Dr J: Exactly! And it’s very hard to break down those socio/cultural things. But that’s really one of my bottom lines – hungry
children will eat! And it’s really true!

GV: We’re using this generic term ‘toddlers’, but you divide them up into three basic groups, don’t you? Tell me about that.

Dr J: Yes, that’s right. Toddlers, from a scientific point of view, cover all children aged one till about three, although we’ve got some toddlers who are into ‘toddlerdom’ even before the age of one and some who develop a bit later. But, within that range of ages, it’s important to realise there are different nutritional needs. So, those aged from one to two (the first thousand days) are the early stage, and their needs are quite different from those from two to four, which I call the mid-range. And then there are the older toddlers who can sometimes stretch into four- and five-year-olds. 

GV: So, the biggest challenge parents face here is getting their children to try new food and new tastes, right? And if (or when!) their darling resists? What can they do?

Dr J: Well, there are a few strategies. It depends on the time of the day and the particular meal. But there’s a big difference between battling a child first thing in the morning, and battling them at five o’clock at night when you’ve pretty much lost your last few threads of sanity and you need them in bed and asleep. So, it’s about being strategic. The underlying truth here is that, whether they’re babies or toddlers, consistent repeated exposure is the key. And the research backs that up.

Which is fine in theory. But what parents need are practical strategies of HOW to get the children eating.

GV: Okay, so let’s hear some!

Dr J: Well, one of my top strategies would be to try and get vegetables (the foods they desire least but are most vital) into them first thing in the morning.

GV: Really? Mashed or pureed or what?

Dr J: However they like it! Whatever works best! I think the focus needs to be on what children are eating. How they eat it is secondary. You’re going to get
children who are fussy about foods that are touching each other on the plate; they’ll insist on it being separate. However, some toddlers will want them all mixed together and ‘hidden’. 

GV: You write in rather warm and approving tones about insulin being the ‘fat-storage hormone’. I’d always thought that fats – all fats – were a great big no-no.

Dr J: I was the same. I was brought up on the idea that fat – all fat – was the root of all evil, and very low fat was the best diet! Oddly enough, our rates of childhood obesity and other nutritional issues hasn’t changed despite that emphasis. In fact, everything’s got worse. And you’re right, insulin is a key. Insulin is our blood-sugar hormone, but it’s also called our fat-storage hormone. Pretty much anytime carbohydrate (of any sort) is ingested, insulin gets released which enables the uptake of carbohydrate into the cells. However, as soon as insulin’s released, it effectively cuts off our ability to burn fat. 

So to clarify, I am pro fat – provided it’s the good, natural sort. It’s not only good – it’s essential. What we really don’t want is trans-fats – the processed fats that show up in things like cakes, pies and similar. We want to avoid those. Even with toddlers, we are setting them up for life and we want them consuming healthy fat and burning that fat as a fuel since that really helps set up their metabolism.

GV: And where does sugar rate in all this – because that’s the other big ‘no-no’ isn’t it?

Dr J: Well, sugar is your most refined carbohydrate, and World Health Organisation guidelines are very clear. Children (so that’s toddlers under the age of two) shouldn’t have any added sugar at all … and I completely agree with that.

Now, we all know that it’s going to come. They are going to get that tempting taste! But at the very least, we shouldn’t feed them any added sugar until they’re old enough to ask. Unfortunately, our food environment is stacked against us, and our children need us to help them develop good and healthy tastes.

GV: You say that the toddler’s gut has to mature between the time the child is weaned and when she or he becomes a pre-schooler. What does this mean in choosing the best foods?

Dr J: Well, let me highlight the early-stage toddler here, because their gut isn’t mature until he or she is two-years-old.

GV: So they can’t digest some foods earlier?

Dr J: It’s a bit more complex than that. The gut is the hub for lots of bacteria which forms about 80% of our immune system. And, in those early years, it’s about trying to avoid those food groups that might upset things.

GV: You talk about whole grains and refined grains. What exactly is the difference? And which is better nutritionally?

Dr J: Hmm – good question! Effectively, all of our grains are processed, because we humans just can’t eat a ‘raw’ grain off a crop … it’s not possible. So with grains, it’s the level of processing that makes the difference. What we call ‘whole’ grain is going to be less processed because it’s still got as much of the grain left as possible.

GV: So what about the role of milk … cow’s milk I mean? Do toddlers need milk?

Dr J: Another good question! Toddlers, technically, are above the age of one. And there’s a lot of confusion at the moment because, here in New Zealand, it’s recommended that no cow’s milk should be given to those under the age of one. That’s quite clear, because cow’s milk is not breast milk or a formula substitute. However, World Health Organization guidelines suggest it’s best to breastfeed until the age of two. So that leaves this window between the ages of one and two where “what do I do?” isn’t so clear.

You don’t have to introduce cow’s milk to your toddler – but you can. You also can keep them on formula until your child hits two, but you need to watch that it’s not a ‘toddler milk’ – it’s still formula.

Children definitely need sources of calcium. So when a mum is breast feeding, that ticks the box. If she’s no longer breast feeding, her toddler needs to have an alternative good source of calcium. The reason cow’s milk is often recommended is that it’s the easiest, highest source of calcium for a toddler. Your alternatives are … well … you’re looking at things like kale, and almonds, and sardines – and you try getting sardines into a two-year-old! You might manage it, but it’s probably going to be a battle.

GV: Okay then. Is it safe and reasonable for parents whose diet is vegetarian (or even vegan) to put their toddlers on a similar diet – or do their little ones need to have at least some meat and dairy?

Dr J: Woah! You love the big, curly questions, don’t you? The basic answer is … yes. It is possible to avoid meat and dairy … BUT there are some big considerations. The research is clear here. You can have babies and toddlers on vegetarian and even vegan diets. But with vegan diets, they absolutely need to be supplemented with vitamin B12

GV: And how do we get Vitamin B12 into toddlers? 

Dr J: If a toddler doesn’t get any
nutrients from animal sources, you must feed them a supplement. So it’s important that you go into it with your eyes wide open – and be prepared for a lot of work. Vitamin B12 is absolutely essential, as they don’t, on a vegan diet, have any other way of getting it. That’s why I repeat … it will be a lot of work.

GV: So what are your golden rules about toddlers and food? Say, the top three?

Dr J: My top three? Well … 

GV: I suppose most of us who are grandparent age remember tense dinner scenes with a child battening down the hatches and refusing to eat, and the parent insisting: “Well, you’re not getting anything else! No dessert till you finish that!” And, in some cases, putting the offending dinner in the fridge to be dished up again at the next meal time. Is that still a recommended approach?

Dr J: I wish it was! (And I’ve done that!) To be honest, I wish more parents had the confidence to take a strong line sometimes. Within our current PC climate, they will often feel like they’re being a bad parent if they show tough love like that. My oldest, in particular, has got a terribly stubborn streak. And so I tried that approach. I only had to do it twice in his life. Once at the age of two. And then he kind of forgot and I had to do it again when he was four and needed a reminder. He never did it again.

GV: How important is it for mum and dad to back each other up in the middle of those tense scenes where you’re saying, “eat that … eat it all … or no dessert!”?

Dr J: Essential. 100%. The two of you, mum and dad, need to talk about it together well in advance of mealtime. And, even if you can’t totally agree with each other, you must agree to support each other. There’s absolutely no point in mum taking the hard-line if dad is going to take the child out of the situation and feed them something else! And it’s not actually fair on the toddler either – because now they’re really confused.

GV: What do you think about ‘grazing’ or snacking between meals for toddlers?

Dr J: I’m pretty right-winged on that!

GV: So it’s a ‘no-no’?

Dr J: Well, look at where the word comes from … ‘grass’! I can promise you that most toddlers are not grazing on healthy green stuff – in other words, vegetables! If they are going to graze, it needs to be on the good stuff, not cakes and biscuits.

Some heavy-duty research came out earlier this year showing that toddlers who were having more than two or three snacks a day had a seriously increased risk of obesity. And not only that, but snacking undermines the main meals as well. I find it hard enough prepping breakfast, lunch and dinner for my two without having to also provide an anytime-array of nutritious snacks.

GV: You talk a bit about toddlers throwing tantrums when faced with having to eat something they don’t fancy – or being denied something they want. Are mealtime tantrums normal?

Dr J: Yes. Very normal. And I think they’re actually a healthy sign. At least your toddler’s letting those emotions out. If they never threw a tantrum, that would be abnormal! It’s important to understand that toddlers literally don’t have impulse control. 

I’ve been asked by parents: how do you say “NO” to a toddler? And it’s not as simple as just saying no. There’s a lot of processes to unpack … 

GV: Particularly when you know it’ll all just go away if you give them a lolly!

Dr J: Yes – or plonk them in front of TV! One way or another, you’re going to have some work to do.

GV: You use an interesting term … “neophobic”. Meaning, I guess, that toddlers are averse to trying anything new. Do you find they’ll be more willing to try something new if they’ve had some part in its preparation – even if it’s just licking the spoon?

Dr J: Oh, absolutely! All that food-preparation is kick-starting saliva. It’s kind of like Christmas Day. Everyone gets excited about food then, and that’s because we’ve spent ages planning it, shopping for it, cooking it and presenting it. There’s no reason why we can’t do a little bit of that all the time. Getting kids in the kitchen is half the battle.

GV: Do you recommend a ‘stickers and reward’ system for encouraging picky eaters?

Dr J: No – not at all! And the research shows that this approach doesn’t work in the long term. Your very intelligent (and usually strong-willed) child will just find a way around it. And kids shouldn’t be ‘rewarded’ for eating. That’s like admitting that eating food is some terrible trial they have to endure. We don’t want that message.

GV: How important is it to start teaching good table-manners to toddlers – eating as cleanly as the child can manage, taking part in conversations, saying please and thanks? And how and when do we start?

Dr J: I’m a huge advocate for manners. As well as teaching our children what to eat, we’re also modelling for them the how (with the good social behaviour). I don’t tell parents what to do. How they do it needs to be right for them. But it’s something I’m really big on – and I see it dwindling in lots of homes today. 

I teach 18-year-old students, and just quietly I wish I could instil manners into some of them!

GV: You say that movement for toddlers is vital, promoting bone-density and helping co-ordination. Are you seeing this affected by the amount of time young children spend these days in front of electronic screens? TV, iPads and so on?

Dr J: Oh yes – absolutely.

GV: So would you recommend a maximum daily time-limit you’d allow kids to be in front of a screen?

Dr J: Well, NONE would be great! But we’re in the real world, and that’s just not going to happen. However, I encourage families to set up their own media diet. Take mornings, for example. Mum and dad are struggling to get everyone ready for going out the door. This is a time where we probably do use the television-as-babysitter. But then there are definitely other times when children should NOT be in front of it.

GV: What advice have you got for mothers of toddlers if they’re coping with, say, grandparents, babysitters or other people who, for whatever reason, pop sugary treats into little mouths to get some peace and quiet?

Dr J: I actually put a message to grandparents in my book, explaining why this is undesirable. So blame me – let me be the bad guy! Just say to them, “Look. Read this, please!” But in all seriousness, it’s really hard. They are family, but at the same time you are the mum and/or dad. You call the shots. You want to feel grateful for their help, but if the ‘help’ is just jacking the kids up on sugar, then that’s not a long term ‘help’ at all. It’s counter-productive. 

I encourage talking as much as you can … trying to get clear expectations: what they can have, what they can’t, and when.

GV: How bad do feeding problems need to be to warrant taking the child to a professional? And how do you know if the professional you’ve picked is any good?

Dr J: I’m really strong on encouraging parents never to be afraid of getting advice. And if the first advice you get isn’t working, get second and third opinions. If the advice you’ve been given doesn’t sit comfortably with you, or it’s not working … just go elsewhere. Don’t be afraid of offending someone. Trust your own instincts – they’re usually really reliable.

GV: Any final advice for mums and dads who are really struggling with a picky, fussy eater and it looks hopeless and overwhelming?

Dr J: For starters, I’ve been where they are. The struggles I had with my eldest really humbled me … time and time again. My second son has been easy by comparison. So if I’d had my first second and my second first, I guess I could’ve easily been one of those smug researchers who will tell you blandly, “Just make them eat everything you eat!”

Oh yeah? 

My eldest is six years old now – and he isn’t perfect. We still have our moments. But all of that hard work we’ve put in over those years – it’s worth it in the end. Hang in there. 

It does get better, and you’re not alone …

‘THE NOURISHED TODDLER’ BY DR JULIE BHOSALE IS AVAILABLE AT ALL GOOD BOOKSTORES.
FOR MORE INFORMATION, CHECK OUT WWW.JULIEBHOSALE.CO.NZ