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Feeding is Truly a Developmental Process



As the first weeks of the school year go by, we come to a place where we can do some fine tuning of routines. One thing we have noticed is the number of children who bring food pouches to school. 


These food pouches can be so convenient. They are a relatively good snack choice on the go - definitely better than sweets, cleaner, and easier to manage. However, they should be very limited for a number of reasons - nutrition (without the fiber, the sugars in fruits and vegetables are unmitigated), development of eating skills, oral development and language development, and the development of a sense of independence and competence. The building of these skills go way beyond infancy and toddlerhood. Preschool aged children also benefit greatly from having nutritious whole, unprocessed food as much as possible.

Rethinking Baby Food Pouches

They are so convenient — but experts say they can be a gateway to bad eating habits


Credit...Tony Cenicola/The New York Times By Rachel Cernansky June 19, 2018


Pouches of puréed baby food can seem like a godsend to busy parents, but some experts say that babies and toddlers who use them too much can miss out on the developmental skills that will contribute to healthy eating habits.


The popular pouches, introduced about a decade ago, now account for 25 percent of baby food sales in the United States, according to Nielsen's Total Food View.


They seem to offer the perfect combination of healthfulness — containing mostly puréed fruits and vegetables, often organic ones with no added sugar — and convenience, with a seemingly endless variety of flavor combinations ready at the twist of a cap. You can hand one to your cranky toddler in the supermarket and she can suck down the food herself, without the need to pause and dirty a bowl and spoon.


The features that make pouches so convenient, though — the smooth texture and squeeze packaging — have some experts concerned. They caution against relying on them too much, saying that they can be a gateway to bad long-term snacking habits and routine overeating (not to mention the environmental impacts of the single-use packages).


With particularly excessive use, pouches may also fail to challenge children at a crucial stage of feeding and oral development — when they are learning to chew and swallow soft foods, which helps with speech, and when they need varied and multi-sensory experiences, which helps develop a palate for a wide range of foods later on.


“Parents are feeling reassured that their kids are getting the fruits and vegetables because they’re having the pouches that have all these vegetables mixed in,” said Dr. Natalie Muth, a pediatrician and spokeswoman for the American Academy of Pediatrics. But “when it’s all mixed up in a pouch — or when it’s mixed up in a green smoothie, because that comes up all the time too — it’s good, the kids are getting the nutrients, but it’s less good in the long run,” she said. “Kids need the taste of what the actual food is to come to like it later.”


The primary ingredient in most pouches is a sweet food like apples or pears. That masks the taste of the other ingredients, so while children may ingest spinach or kale through pouches, they do not necessarily learn to like those foods. If given these pouches when irritable, children also run the risk of learning to associate sweet snacks with calming down, and to think of snacking in general as an activity to satisfy emotional rather than physiological needs.


“Kids are probably getting these things a lot when they’re not actually hungry,” Dr. Muth said. Using pouches to stop whining, she said, “sets up snacking as being a habit that happens frequently throughout the day or for reasons other than hunger. Kids thrive and respond well to routines, whether they’re good routines or not.”


That can snowball when mealtime comes around and parents are anxious about children not eating their dinner. “Then the child’s actually overriding their body’s own cues for hunger and fullness,” Dr. Muth said.


In the first few years of life, eating is supposed to be an educational experience as much as a nutritional one. What and how children eat early on plays a role in their food preferences later in life, and whether they are picky or open-minded about food in general; they’re also learning how to eat in a very basic, mechanical sense. Early exposure to different textures encourages that learning.


“The mechanics of sucking something and swallowing it is completely different to having a spoon, placing food on the tongue from a spoon, moving it around the mouth, moving it to the back and swallowing it,” said Lucy Cooke, a member of Britain’s national steering group for childhood feeding disorders. “It’s really important that children learn to do that. And the pouches have sort of encouraged moms, I think, to just hand them to the child.”


Babies are born with the ability to drink, relying on a front-to-back movement of the tongue to suck milk or formula down. Around six months, they begin to be ready for more complex foods and to learn to move the tongue from side to side — the foundation of learning how to chew. Eating from pouches is more like drinking and does not develop the shift to chewing.


But there’s no cause for alarm when kids occasionally eat from a pouch. Kara Larson, a speech-language pathologist and feeding specialist at Boston Children’s Hospital, said that children would need to be sucking on pouches for prolonged periods of time for it to interfere with their speech development. She advises parents simply to use them judiciously. “If you’re just given four to five pouches a day to just suck out of there, you may not be developing the other feeding skills that you need to,” Ms. Larson said.


Create a Routine

Ms. Muth recommends that families have established times for meals and snacks — pouches and otherwise — rather than “drinking or pouching the calories throughout the day.” She also recommends having the whole fruit or vegetable whenever possible.


Have Family Meals

The American Academy of Pediatrics recommends that by about 12 months, kids should be eating meals with the rest of the family and following the same diet. That may mean breaking up the green beans and cauliflower on the parent’s plate into smaller pieces the child can handle — and there will often be an adjustment period with new foods.


“If it’s within the first few weeks of introducing a new texture of food, kids need time. It’s like learning any motor skill that they need to practice,” said Amy Delaney, a feeding and swallowing researcher and speech-language pathologist at Children’s Hospital of Wisconsin. New tastes can take time, too; it can take 10 or more tries before a child likes a food.


Limit the Use of Pouches

Pouches are unquestionably a better choice than cookies or chips or other low-nutrient foods that are high in calories and salt or sugar, and they can be left in a backpack or car for much longer than fresh foods like carrots or apples. But many experts say you should limit their use.


When you’re at home, give children real, whole foods that you serve from a bowl. Save pouches for travel, and when using them, Ms. Larson suggests squeezing the food into a bowl if possible, or at least feeding from it with a spoon — and ideally, with older babies, giving the spoon to the baby to practice self-feeding.


“Over time, I think there’s going to be a whole generation of parents who think, ‘Oh, now it’s time to introduce pouches,’” said Melanie Potock, a pediatric feeding specialist in Longmont, Colo., and the author of “Adventures in Veggieland.” She added: “Just like sippy cups, pouches were made for parents’ convenience, not for a child’s mouth or oral development.” She said she would like to see parents minimize the use of pouches because it’s hard to pinpoint the line at which detrimental effects could start to show.


“Feeding is truly a developmental process, just like learning to crawl, walk, run. We would never do anything to keep a child from crawling,” Ms. Potock said. “Let’s not do anything that would stall them in the development of eating.”


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