Taking the Battle Out of Getting Kids to Eat Healthier and Move More: Child &...

is outlined in the program agenda today. So we're going to describe how to help parents build skills, tactics, and strategies to address modifiable family practices in early childhood feeding, as well as describe parenting techniques that promote lifelong, healthy eating and activity. And one thing that's very important, we want to make the point that weight is not a behavior. Weight is not something, losing, weight loss is not something that a child can go home and do. Um, so we wanted to, um, focus in on those healthy habits as providers, focus on those, uh, because all children need a healthy habit goal. So in that way, if we focus on the health behaviors, this is going to hold true and we can use these, um, evidence-based Approach for every child, no matter what size and shape they are, no matter whether they're underweight, uh, average size, overweight or obese, we can focus in on those healthy habits, and then those are going to help drive and stabilize weight over time and hopefully, um, we'll see an improved, um, BMI if the child grows into that. OK. OK. Um, so, and we're gonna be going over some of the common issues that you may see every day in your office. With your patients, um, for one of those you may hear parents complain about their child being picky, um, overeating, complaining of hunger, sneaking and hiding food, and excessive fast food intake, which is a very big problem across the board with families, and we're going, and so also with, and then in regards to physical activity, of course common issues you'll see are child resisting activity or indulging in excessive screen time. And we're gonna talk with you about um a basic premise that um we use in trying to define what those um parenting um duties are, what are the roles of, in the, uh, of the parent versus the roles of the child. So when you see parents come in, you're gonna see a lot of different parenting styles, and these are gonna sound very familiar to you. And some of these parenting styles are going to be going uh result in the very um behaviors that we don't want to see and that the parents are complaining about. So, let's run through these parents styles quickly, and I think they're gonna sound familiar to you. Um, the first is the authoritarian parent. This is gonna be the controlling, strict parent. This is gonna be the parent that says, I, just because I said so, and they're gonna probably say that a lot. These are the parents who are gonna, are going to control the amount of food, try to dictate the amount of food that their child eats, um, or they may restrict intake in some instances, uh, with their child. This might be the parent that's actually hand feeding their child to try to control that intake long after it's developmentally appropriate. Next, we have the opposite of that, the indulgent parent. This is gonna be a permissive parent, um, where the child is in control much of the time. This parent's more of a friend than a parent. This is a parent that may use um food as a comfort or as a reward to um control behavior, and really, the child's in control much of the time, um, in this situation. Then we have the uninvolved parent. This is a parent that in, in many ways is neglectful, uh, that, uh, they don't have any demands, any, uh, type of expectations with their child. This is a child that even at a young age, they're responsible for choosing their own food and deciding how much that they're going to eat. So this is a child that's really largely completely in charge and on their own. And this leads us to, uh, the, the main um one that we would like to see. Which is, of course, the authoritative parenting style. And again, as Lisa mentioned, that's the one that we want to see. And this is really the ideal responsive parent. This is a parent that sets structure for the child, has limits and clear roles and expectations. This is a parent or a caregiver that communicates warmly and respects their child's opinions or views, but does not give in to all of their demands or their indulgence. Um, in this case, the child will learn that the caregiver will respond to their needs. Um, while the child is learning to self-regulate their own food intake, to self-feed, enjoy mealtime, and enjoy being active as well. OK And, um, so if our goal is healthy habits and developing healthy habits and seeing those in our kids, um, and we want to see healthy food intake in an active child, we like to use a strategy called the P's and C's to help get us there. So this is gonna be the strategy that we encourage parents to use to try to help take that battle out of getting kids to eat healthier and to move more. So let's take a look at what that looks like. So the P's and C's really identify specific ways families can support healthy behaviors. The P's and C's clearly define the roles and the responsibility between the parent and the child when it comes to healthy feeding, healthy eating, and activity behaviors. So, Very briefly, we'll run through and then we'll dive into them a little deeper. The parents' jobs, which are the three P's, are to plan, prepare, and provide. And the child's jobs, which are identified as the three C's, are to choose to or not to choose what and choose how much. Now, let's look at the first parent's job and that is to plan. And so when it comes to feeding, we want to not only plan the, have the meals planned, but plan for a positive eating experience. And this is going to include scheduling regular meals and snacks, um, planning meals ahead of time, um, so that we're ready to go with that and enlist the help of the kids in this and making um those selections, setting rules and expectations for mealtime. This could include, uh, Teaching table manners, um, and, um, just eating together with our family. Uh, that's, and those types of rules and expectations for mealtime, and also to make mealtime pleasant. So that includes no toys at the table, get rid of all technology, no cellphones, no, uh, computers at the table, so that you can have a pleasant mealtime just focusing on the task at hand, which is eating and time with family. So now, let's briefly address how a parent, just like we discussed for nutrition, how can a planet, a parent plan for a positive physical activity experience? So, part of the parent's role is to plan when. Just like they may be sitting down at the beginning of the week to plan out their meals for the week. That's a great time. Time for the family to sit down and plan when they're gonna be physically active that week. I'll, I encourage parents to write it on their calendar with a pen, stick to it. If it's on the calendar, it's much more likely to happen. It's a part of the schedule. It, it will get done a lot more likely than if it's not planned into the calendar. Um, and then again, plan what brainstorm activities as a family. This is a great way to engage the family. Ask the children what are some activities they would like to participate in, and the parents' role is to try as best as they can to fit some of the desires of the child and the activities they'd like to participate in into those weekly schedules. Um, is it something, can, can the family play soccer at the park together? Can they throw the frisbee in the backyard, have a dance party in the den? Um, again, that leads us to make it fun. It should be something that gets the entire family up and moving, that they engage in together, and that they're having fun together in. And now we come to the second parenting job, and that is to prepare. So, um, it's not only is the parents' job to prepare and put food on the table, but we want, um, parents to prepare a variety of food because that's going to, um, give the child more of an opportunity to choose something that they want to eat. Um, so I always encourage parents, um, for example, if, um, and I had a question with a parent this past weekend, what do I do, um, if, you know, I can't get my child to eat? Well, that You want to set that up on the front end. If a child, for example, my child doesn't like um her food to touch. So if all I do is prepare a chicken and rice casserole with the broccoli all mixed in and she doesn't like her food to touch, I really set her up for failure. So prepare a variety of food, sort of deconstruct that meal on the front end, and leave out some of the rice and some of the chicken and some of the broccoli separately, and then prepare the, the casserole for the family. So then that will allow that child to have more of a variety of foods to choose from instead of that one casserole, um, that she doesn't when she doesn't like her food to touch. Also, ask your child to help and when it's a bit, uh, development, developmentally appropriate, get the child in the kitchen, help them, um, get their input on food selection. Do that as a family so that everybody's likes and dislikes are taken into consideration the meal planning. And then again, similarly, how can you prepare for activity? How can you encourage parents to prepare for activity? Um, and parents and caregivers should give notice. Families like to know what, what they're going to be doing, when they're going to be doing it, and where they're going to be doing it. Words matter. I think this is so important, using words such as play or be active versus exercise or workout. Playing and being Active sounds a lot more fun to a child or us as adults even rather than exercise or workout, which sounds like work. It's not motivating. It doesn't sound engaging or fun at all. So we wanna stick to again, words that are like play or be active. Limit screen time. It's important for parents to limit screen time because time spent in front of a screen is time spent not being active or not doing other things. Um, that are just as important that, that are non-screen time as well. So, um, a key thing there is we also wanna remove screens or, or encourage parents to remove screens from the bedrooms. We encourage good sleeping habits as well. And then the parents, we should encourage them, encourage the parents to help their child prepare. So help their family prepare for a positive, um, physical activity experience. Are they going to To the park, do they have the proper, excuse me, do they have the proper attire on? Do they have the proper shoes on? Are they wearing tennis shoes versus shoes that will give them blisters when they run? Is it going to be cold? Do they have a jacket? Should we take a ball to the park? Will there be water? So all of those things that can help prepare for a positive physical activity experience. And of course, as the child gets older, they can engage in that preparation themselves. Now we're gonna go to the 3rd, um, job for parents, and that is to provide. And sometimes this can be one of the more challenging ones to provide with patients. So offer and um during feeding time, during dinner time, and meals and snacks, offer new and previously refused foods. So I'll hear parents a lot of the time say, well, I've only um offered carrots a few times because they didn't like them. We encourage parents to offer, keep offering those foods that they may have previously refused because research shows us that it could take 10. 15 or more times for a child to look at a food item and think, oh, that's not so strange anymore. I think I'll try it. And also the power of suggestion from friends. Maybe they see a friend, um, eating carrots and think, oh, carrots are cool now. Maybe they'll decide to eat them. Um, so that's really important. So offer new foods to them and also those foods, um, that, that you know that they like, along with those foods that they've refused before. Be a role model. It's really gonna be hard for a child to try a food if the parent doesn't like the food. So be a role model, sit with the child, be supportive. Don't dictate intake, but be a role model and eat those foods that you have on the table that you've served and prepared. Um, and let the children serve and feed themselves. As we see the little child in this, um, the top right, she's making a mess, and that is OK. So as parents, we don't want to dictate the neatness and how much they eat, and, uh, uh, a dish or a plate is not even necessary really at that age. So it's OK for kids to make a mess. That's part of their developmental, um, uh, development that's important to them. And then for physical activity, um, we say that, um, we encourage parents to provide with encouragement. So to provide is really up to the parent to provide a safe place. They may or may not feel like it's a safe place for their child to play in their front yard. Is there a park within walking distance they can take their child to? Is there a local rec center they can take their child to? But it's really up to that parent to provide a safe place for their child to play. Um, also provide opportunities. Is there a new activity or physical activity that their child would like to get involved in that the parent, the parent can support them in? Is there a new sport that the child is wanting to engage in or would like to try? And that's something that the parent is willing to support and it's feasible for that parent. Excuse me. And then again, that last piece, which is what Lisa just mentioned with the nutritionist. So important is be a role model. Um, kids are great imitators. They are much more likely to be active and engage in it if, if they see that their family is active, their caregivers are active, um, you know, even if the parent says, Hi, so enjoy my walks after dinner, why don't you come and do it with me? We could talk about our day. So really role modeling that behavior and inviting their child to join the wall. So now that we've now that we've addressed the parents' um responsibility in regards to the three P's, very briefly, we just wanna run through some counterproductive parenting behaviors that should be avoided, um, that again, you probably see, um, often. And what happens is, is non-responsive behaviors stem from the parents either taking too much control by forcing, pressuring, restricting, forbidding, um, or they give the child too much control by indulging or bribing, or they simply just ignore the child. So what happens when a parent takes too much control by Do the things that we mentioned, um, they're overriding their child's internal hunger and fullness cues or their, their need or desire or want to be active or inactive. When they give the child too much control, it teaches the child they can get their favorite food by whining or crying, or that they deserve screen time in order to run errands. And then finally, by ignoring the child's needs, it teaches the child that their needs are just not important. So again, these are the counterproductive parenting behaviors that we want to avoid. So now that we've addressed, again, the parent's role, which is to plan, prepare and provide, um, we're gonna briefly talk about the child's job, which is to choose. All right. So when it comes to eating, it's the child's job for everything else, to, to choose what to eat. So, um, it's OK if, if the child says, OK, I don't want to eat this. It's OK. And this is a good learning opportunity for them because then they're gonna learn to eat the food when it's prepared and provided. Um, so in this, in this particular, um, uh, picture that you see on the screen, this is One of our colleagues, our fellow dietitians, Monica's uh daughter, Grace, and this was her first introduction to solid foods. And uh mom is so busy taking a photo op here uh of Grace in her first time with solid foods. Grace is saying, hey, mom, stop taking my photo and feed me. And so she's definitely choosing to eat, and then mom follows suit and really um looking at those cues and, and following those. Um, we also want the child to choose what to eat. So that again, um, if we set the child up for success when we offer a variety of foods, both new foods and foods that we know that they like, um, so that they had an opportunity to have something to choose. We only offer one selection that really cuts down on the, the child's opportunity. So the child has to choose what to eat, And parents should not offer any commentary and judgment on what that is. Also, the same thing is the child chooses how much to eat. And this can be very confusing for parents because what's right for the toddlers, not right for the teen, what's right for an active child is not right for um a more sedentary child. So, it's the child, only the child can tell us They're full and when they're not, and when a parent tries to override that by dictating how much a child eats, it overrides, and it really, the, the parent hijacks the child's job and tries to do it for them. So the child needs to choose what to eat, um, to eat it all, and how much to eat. So those are their jobs. So, so Lisa. That, that always sounds great, and I think it's really hard for parents to, to let that go. Is there anything you can suggest as ways that might be easier to say, hey, you know, for them to not feel like I'm not feeding my kids? A parent asked over the weekend, what do I do with my A child who's my thin child who could eat and eat for days, never gains an ounce. Then I have my other child who is overweight, and I really do try to control the amount of food that she could eat. And I said, by using, and we talked the um parents about the P's and C's over the weekend. And um It, so the thing to think about with that is, um, if we use the P's and C's and not offer that commentary, we have a variety of food and just allow the kids to eat each one without offering any, any, um, advice along the way, that's gonna help those children automatically eat to their own fullness level. Another thing that I tell parents is think about what What is going on before that meal? Have they skipped a meal? What are they eating for snacks? And we're gonna cover this again in a minute. If they have set that child up for success along the way with structuring regular meals and snacks and not allowing them to go too long without eating, like certainly not over 4 hours, then they're going to be able to eat a more normalized, um, optimal amount for them. They're going to be able to gauge those hunger fullness cues a lot more, a lot better. So Lisa, so what about my 13-year-old son who You know, if, if, if all he had for breakfast was a blueberry muffin, he'd be happy. He's skinny as a rail, and you know, you know, and I tried to redirect him to make healthy choices, and he says he wants to make healthy choices, but he picks the blueberry muffin. How do, how do you manage that? Well, one thing I think no matter what age the child is, they like choices. So we have to, as parents, if we offer the blueberry muffin, and we have that available, we have to be comfortable with the fact that they chose the blueberry muffin. So, we have to have a couple of equally acceptable choices, the blueberry muffin, Uh, a bagel with cream cheese, whatever we have to offer them. Um, and we have to be OK with what that choice is. So we have to make it really upfront, from a parenting perspective, we have to make those choices available for them upfront. And then hope they just sit back and let them make those decisions and without commentary. OK. All right, so now is any other questions? Those are awesome questions, and I hope that those answers were helpful for you. Yes, thanks. OK. So in regards to physical activity, the child has the same job. The child has the job to choose. And I think that we often say that, oh gosh, the child has the easiest job. The parent has to plan, prepare, and provide. All the child has to do is choose. But I think this is oftentimes where the parents have the hardest time because, um, for choosing for both nutrition and choosing for, um, physical activity, they're essentially having to kind of give up that authority and allow the child. To choose and make the decision. So same thing in regards to physical activity. The child gets to choose to move. Um, again, this is a little bit of a hard concept, but if the parent is doing everything they can, they can do to provide the opportunity to take them to the park, for example, so their child has expressed interest. The park is something they would like to engage in. The parent provides the opportunity to take them to the park, and then for whatever reason they get to the park that day and the child is intimidated or doesn't feel. Like they want to participate or play in the park right then, that's OK. The parents should lead but not forced, encouraged, but again, not forced. Um, now what this doesn't mean is that a child can sit on the park bench at the park and be on his phone or playing video games at the park, right? So this is a screen-free time. Um, the child, if he's not ready to participate, that's OK. They can sit and watch and maybe they will learn, maybe they'll get comfortable, maybe they'll find something else they want. To do that's active while they're there. But again, this is a screen-free time. So choosing to move or not to move is not choosing to play on their phone versus, um, being physically active. Um, the second thing is choose how much to move. Um, I also need to remind parents that, um, it's OK that their kid wants to move one day, um, more one day than the next day. That's normal. That's OK. So the child should really choose the activity level that suits them best that day. And then the child. Again, should choose the way to move. So the parents should engage the the child in conversations about how it is they would like to move, um, activities they'd like to get involved in, whether it be a sport, it may not be a sport. Again, they don't have to participate in a sport to be active. It could be dancing, it could be playing, you know, at the park, um, but really engaging that child in conversation about ways they would like to move and try to include that in their weekly schedule. All right. So if we're allowing C's and C's, um, if they're working and if, if the parents are doing their job with planning, um, preparing and providing, and allowing the child to do their job, uh, their optimal job is selecting, then our ultimate goal is to develop the attributes in our children as a healthy eater. What does that look like? So, that is a child that enjoys a variety of many food. They're willing to try new foods. They have a positive attitude about foods or towards foods in general, and they're able to rely on their own internal cues to regulate food consumption. This is key. So again, their ability to rely on their internal cues to regulate food consumption. This is going to be a critical life skill that's going to help them maintain their weight. Over time, um, one thing that I do like to tell parents is that breastfeeding is really, I like to think of it as the first introduction to the family table. So when a, a baby breastfeeds, they're really getting used to all the different flavor profiles from what the mom eats. If they, um, Only um have formula, they're gonna have the same flavor profile over and over again. So a baby that breastfeeds is really gonna be set up to prevent those picky eating tendencies later on down the road. Also, it's very important to know what those cues are and read those cues, because, for example, if a baby's crying, That can mean a lot of things. The baby could be wet. So we don't want a parent to automatically think the baby's crying, they're hungry, I'm going to soothe and feed them with food, when crying could mean something totally different. So we really want to get that parent in tune with what the baby's cues are, so they can feed on demand, um, when, with those appropriate cues. Um, and so I know Doctor Moon is gonna talk about that more this afternoon. Um, also, when we get into, um, older, um, infants, 6 to 12 months, they're gonna be feeding themselves, they're gonna, they're, that's when that introduction of solid food. Foods comes into play, and you can see the little one on the top right, she's making a big mess. She is, um, throwing her plate of food all over her, um, highchair tray, and that's OK. So really, again, like I said earlier, plates probably aren't necessary. If she continues to eat the food on her tray, the parent needs to listen to that cue and continue to let her eat. If she starts throwing it all over the floor, that's a cue at the end of mealtime. So really, um, being, um, in tune with those cues is very important. Toddlers, um, toddlers are Beginning to be more, much more independent. Um, and this is where the parents can begin to set those rules and expectations. And like, for example, no toys at the table, that would be a very easy one to institute at this time. And they like choices. They like to make those choices so that again, what we talked about earlier, um, if you want to give them a choice, but they have to be an equally accessible choice. Do you want to drink out of the blue cup or the red cup? Do you want an apple or banana? So we have to be comfortable with either choice and not, no judgment, no matter which one. Preschoolers, um, again, we wanna just expect inconsistency. It's OK if they skip a meal. And so, um, and it could apply to the questions earlier, if they do skip a meal, then we need to let them know that, and this is the thing that's hard for parents. It's OK, they're not, it's not gonna kill them to skip a meal. So, let them know, OK, you, you're not gonna have a chance to eat until the next meal or snack. Water will be the only thing served. And the more they learn that at a very early age, It's going to set them up for success with eating when the food is provided. It's really hard to start those types of um rules and limits when they're older. Like if you try to start that when they're a teen, it's gonna be really, really hard to set those in place. So starting very early is important. Um, school-age kids and adolescents, very important to be in tune with their school schedule, set them up for not Skipping long periods of time without eating, or they're gonna, we're gonna get complaints about them being starving when they get to the dinner table. Um, so we set them up for those, um, structured intentional snacks after school, get them involved in meal prep, get them involved, um, in choosing and selecting, um, making those choices at the grocery store, because those are all crucial life skills that are gonna serve them well. And then again, if we are practicing the P's and C's, um, efficiently or effectively, I should say, um, again, the goal is that we have a physically active child. Well, what is that, of course, it's self-explanatory, but it's just a child that enjoys being active and that limits sedentary time and screen time. So again, the parents' role looks a little bit different, um, as far as the opportunities they provide with different developmental stages in regards to physical activity. So, um, just like we did with nutrition, very briefly, we'll just run through um the different opportunities parents should be providing at the different developmental stages. So, Starting with infants, um, parents should limit time spent in objects that minimize movement. So a car seat, for example, um, they really wanna limit that time that an infant spends in, and the item that limits, restricts movement. On the flip side, they want to provide opportunities for the infant to have supervised, um, kind of movement time or help with movement. So that could include tummy time. It could include, um, putting a toy. In front of them, so they reach, they grasp, they pull, um, any of those type of movements. And then, of course, the AP recommends that for infants, they should have no screen time. Um, so that's another thing that we want to promote to to parents as well. Um, for toddlers, um, toddlers, it's recommended that they need at least 30 minutes of structured physical activity daily, and then at least 60 minutes and up to several hours of unstructured physical activity. They should not be sedentary for more than 60 minutes at a time and less sleeping. And then, of course, again, as you know, the AAP recommends that if they're 2 years and older, um, they should have no more than 2 hours of screen time daily. And if they're 2 years and younger, again, no screen time. So that's something that, um, you know, parents really need to limit and watch. Um, preschoolers need a little more structured physical activity. So that's, um, about at least 60 minutes of structured physical activity daily. And then, again, at least 60 minutes and up to several hours of um unstructured physical activity. And the sedentary and screen time recommendations are the same. School-age kids, they just need to be active 60 minutes a day. Um, so most of that activity, as you know, should be aerobic, uh, moderate to vigorous intensity. But of course, the muscle and bone strengthening activities and movements are important as well. Um, so what I like to tell parents, and then of course the screen time is the same, um, recommendation, so understandably so when we're talking to parents they can get bogged down by these recommendations, and I understand that it's a lot of numbers. It seems like a lot of planning and preparing and providing, to be honest, um, but what I like to tell parents is really the most important thing is just that their child is active and not get bogged down by all of this. Um, if they are, their, their child should be, um, participating in a variety of age-appropriate activities that are fun, and then again, a variety, um, so for example, if a parent, going back to my example, if a parent takes their child to the park, what is the child most likely gonna be doing at the park? Running, jumping, skipping, hopping, pulling, climbing, pushing, all of those movements. So there's all of the recommended movements right there. So again, child just needs to play and be active. Um, another important thing I like to remind parents is that activity can be broken up throughout the day. So the 60 minutes of physical activity sounds a lot less overwhelming to parents when they know that their child can be active for 20 minutes before school, 20 minutes when they get home from school, and 20 minutes after dinner as an example. So Kathleen, I don't know, can you hear me? Yes, I can hear you. OK. So when you tell a parent that you need to, uh, that they need to do moderately vigorous activity, so what does that mean? Because you know, as a parent, I don't know, you know, does that mean that my kid's running around on the slide, you know, as you know, there's some people define vigorous differently, and maybe for some parents it's different, you know, walk around the block may be tough for one kid, but for another kid they have to run a 5 km to sweat. Right. So, that's a really great question and one that we actually get a lot from parents. And what I like to tell parents, I like to really keep it simple and I tell parents that what's most important is that when we're active, is that our bodies are working. So, that could be different, as you mentioned, for every child, you know, one child could run a 5K and one child, um, you know, they're, it's like their bodies are really working when they walk around the block. So, I like to teach parents and their child kind of their body cues. So, what are the The things that, that symbol that your body is working. So an increased heart rate. And that is OK. And a lot of times, um, especially kids that haven't been physically active previously, they don't recognize those body cues or they see them as a sign of, oh my goodness, something's wrong. My heart rate's increasing, I can't breathe, um, so I need to stop. So, I do like to teach them that, um, an increased heart rate is a good thing. Um, you know, they will start to sweat, their muscles can get tired. Um, they can get short of breath. And again, those are just cues, um, that their bodies are working. Of course, we don't want to take it too far, you know, if they, if they can't breathe, if they feel like they're gonna pass out, um, that's a different story. But, but, um, so rather than kind of, you know, bogging parents down with the specifics of moderate to vigorous, I just encourage them, um, learn your body cues. Um, are you sweating? Are you getting tired? Is your heart rate increasing? Those are good signs because it means your body's working. And Kathleen, I think you brought up a really good point, and that is just getting the kids to go out there and move, right? The kids normally, I always say you bring a kid to the park and it's sort of like adult boot camp, right? That's what we pay people to take us out and do all those things that kids naturally. Do when they go to the park, so you're right, we get bogged down with all of these specifics that we're supposed to do and they should be able to do this, that and the other and really providing that environment where they just have the opportunity to run around and do stuff does, does make the difference. That was a really good point. That's right. And that's why we just do, you know, why even for us, I just went through kind of the overview of, OK, let's, you know, a reminder, what are the recommendations. But even myself, I have a 2.5 year old, and I look at some of those and go, oh my goodness, you know, am I being successful in that? And so, they just can seem so overwhelming to parents. And so, again, what I always tell them is, let's just get our kids active and moving. Um, so, yeah, so that's the point that we try and make. Great. Kathleen, one other, while, while we're, while we're talking about this, one other question I have is really about structured versus unstructured play. So it seems like now I know that, you know, we spend a lot of time in the car driving our kids around all over the place whether it's the soccer practice, baseball, football, dance, uh, you know, so what is there any, is there any, is, is one more valuable than the other? Is it, is it OK to exclude one to, to the, to the other? Yeah, I think that um both are important, but a lot of times they get both in the activity. So, um, structured, and again, structured for a 2.5 year old versus a 13-year-old looks very different. So, um, structured for a 13-year-old may be that they are going to, they're going to basketball practice. 2.5 year old, it could mean that we're just working on catching the ball, you know, which seems to hit him in the face. more than it probably should. But, but so the skills are very different. But, but structured movement is really taking that time to work on specific motor skills, um, specific skills. It's more organized. It may be a team sport. It may just be the parent working with them one on one. the unstructured play is really just giving that that child time to explore kind of their own world. So, you know, again, Again, for a 2.5 year old, it could look like taking them in the backyard and they could spend hours, you know, looking at sticks and comparing the sticks, um, versus, you know, that may, that will look different for a 13-year-old. But, um, even for, you know, going on a nature walk for a 13-year-old and letting them kind of explore the world around them. So it's just kind of, in my mind, giving them a way to um practice direct, like motor skills with them. What are those specific skills we can work on, but also giving them an opportunity to explore the world around them, decide ways that they like to move themselves, decide, you know, how their body work and move differently, um, and so again, a lot of times they overlap because the structure can turn into unstructured, and it just again turns into play, which is what we want to see kids do. Does that make sense? Yeah, no, good. All right. Now we're gonna have some fun. We're gonna do some message makeovers, and we're gonna share with you some of the ways that as providers, you're gonna be hearing parents tell you that they're responding to their kids in terms of feeding, eating, and activity. And these, these message makeovers, when you hear the parents respond in ways that are not in line with the P's and C's that we've just outlined, we want to help you. with some tips on how to reframe those messages so that they fall in line with, with these suggestions. And before we go into these, I just want to make a really important um note. We want to make sure that we're praising our parents for their good intent, for their well-meaning intent. Um, and we encourage the use of patient-centered counseling. So we want to, um, it could be as um simple as asking open-ended questions. asking permission to talk about this topic or to offer our tips and suggestions before we begin to give them and set them straight and bend them to our will, in a sense. So, here we're gonna start out with some message makeovers for feeding. So, you may hear a parent um respond to their child like this. If there is still food on her plate, I tell her to finish the last few bites, then she can get up from the table. Well, this sounds like that authoritative, um, controlling parent, and it's gonna say because I said so. Um, so anytime that a parent controls and dictates the amount of food a child eats, it's overriding the child's own internal hunger cues. We're all born with that innate sense of when we're full. And when we have these, um, sorts of, um, controls placed on us, we lose that skill as a child. So it's very important um for the parent to, to, um, to, to respond differently. So, once you find out if the parent is interested in hearing your suggestions and talking about this topic, then you could respond and uh encourage this type of a response. Have you ever tried not saying anything? It's important to let her be the judge of when she's full. So then the next message makeover, you may hear um a parent say, well, if she doesn't like the meal I prepare, I'll just get up and make her a peanut butter and jelly sandwich. Well, this sounds like that indulgent parent that we talked about, that's the short order cook, and we want to encourage parents not to do this. So, once we find out what's important to the parent, and it's OK to offer our suggestions, let's encourage a response more like this. Instead, let her know what's on the menu for dinner, and that she can have peanut butter and jelly for lunch one day during the week. So, when we um become a short order cook, And that doesn't do anything but disrupt the meal, and it shows the child that they can get what they want without that structure. So we want to make sure that we set that child up for success on the front end again by preparing a variety of foods that some we know they like, some possibly knew, some possibly that they've um refused before. This gives the child the opportunity to do something, and it cuts down on the chance that they're gonna refuse food and want something different. So here's another one. This is a good one. I told him last night, you can have a brownie if you eat your broccoli. So again, um, this sounds like that indulgent parent that's using bribery. That's what this is, bribery. So, what this parent is teaching the child that to eat vegetables is a task that is yucky, and in order to do it, we're gonna use the County for a reward. So we don't want to set that up for that. So, in terms of dessert, I think this is one situation where the parent can choose the frequency with which they offer dessert. But if they chose to put dessert on the menu, everybody in the family should have the opportunity for a brownie, regardless of whether they ate the broccoli. So, let's encourage a response like this. I love that you're considering vegetable intake, but the best approach is don't say anything. Just give him the brownie, so everybody gets one serving of a brownie no matter what else they ate. So that's, that's what happens, um, when you choose to offer dessert. Um, here's another one. I think that's a really important point, and that goes back to the whole piece, right? It's your job to decide and prepare what days are we gonna have dessert this week, and those are the days you're having dessert. It really doesn't matter what you had for dinner necessarily. So there are days you don't have dessert. There are days you do have dessert, but you, as a parent are in charge of those days, and that's just, that's just when it's gonna be. But you're right, I see this all the time, and it's, it's, it's almost hard not to do right when they're asking for dessert before they've even really gotten up from the dinner table. It is, it is a very and that is a challenge, and this is probably one of the hardest concepts for parents to try. But as we use these concepts in clin uh concepts in clinic, and we, and the parents actually. Try them out. They're always, I think, amazed at just how well they do work, and it just takes that power struggle out, and it lets the child do their job. And if we're always doing their job for them and the picking and the choosing, they're not gonna learn how to do it. So once the parent relinquishes that control, it really does work. And so when you're thinking about this type of situation, encourage this kind of a response. I mean, just don't make vegetable intake contingent on. Getting a reward because that sets the child up for thinking, wow, veg vegetables are yucky. So, it, it is, it is a challenge. And um here's another one for you. Um the parent says, well, when she finishes her meal, I say, good job. I'm so proud of you for eating all of your food. So when you praise the child for finishing all of their meals, that sets them up for wanting to finish all their meals the next time to get praise again. That, and it overrides their own hungerfulness cue. Maybe the child doesn't want to eat all their meals that, for that time, and that's fine. One meal they may, might want to eat two bites, the next meal, a whole plate, and that's OK, because that's gonna change. So let's encourage a response like this. I love to hear that you're praising about asking because she feels full. And praise her for doing a good job listening to her tummy, not cleaning her plate. So that's what we should be praising our kids for is listening to their hunger keys and knowing when they're full, not, um, trying to make them be part of the clean plate club, right? Well, these are really important because these are how we can help our parents say what they really need to say, right, because There's, I mean, all these statements, parents are saying things of love towards their kids, yet they're saying it in a way like you're saying that could be promoting overriding their hunger cues or trying to please us by eating more, which, you know, is not really what we're looking for. So these are, are small differences, but they really do make a difference in how the kids hear what, what the parents are saying. And it really all stems from that parenting style, and the, it's well-meaning. These parents, they, they have good intent, but what, because of their parenting style and how they choose to word things and just do things in the control and the uh types of um controls they're placing on the child, it drives them to the very behaviors that we don't want to see. Um, and here's another good example. I told her yesterday, if you are good during your brother's play, we can get ice cream on the way home. So, this is setting up, again, this is bribery. This is setting up in order to be good, I, I'm gonna be good if I get a reward. And so this is not what we want to see. Food should not be part of a reward system. So let's encourage a response like this. It's nice to have rewards, but not with food. How about saying we should be respectful of your brother's class and stay quiet during the play, period. Because good behavior is an expectation with or without any type of rewards. So at least, so what, but what about using it? You know, it's kind of hard, but what about using food? I, I see it all the time, you know, with team sports, OK? You know they won, they won the game, so we're gonna go get ice cream. So is that, is that, is that bad? We shouldn't. Should we, should we say, oh, you won the game, we're gonna go get broccoli, or, you know, what can we do? So I definitely think you've got a really great point. I mean, I think we have to have a balance, um, because we can't, you know, draw that line all the time, but, um, and I think it's not that It, uh, we see it in schools, we see it everywhere where you make a good grade on a test, here, here, here's the candy, you answer that question right, here's some candy. And we, and kids become conditioned to expect that. And I think we have to be, we really have to pick and choose and we can't be so um hardened with it all the time. So I think, you know, if they, if they win the, the, uh, uh tournament, have some pizza but have some salad with it. Uh, because I always tell parents, if all you have is pizza, that's all they're gonna eat. So have some balance. Have, if you're gonna offer pizza after the game, have some other things with it, for example, salad, maybe some fruit, so there is the opportunity to choose some other things. So that would be my best, best advice on that type of thing. And I think some of it is too being celebratory, right? So if you're getting together with your team and you're doing something, you're all together. It's not necessarily. About the ice cream as much as it is the being together, right, because I mean we certainly when we were growing up we got together for celebrations and there were usually meals involved. It was never about the food. It was always about being together and I think that's the piece that gets lost. We, we shifted from the being together or being proud of what you accomplished to it being about the food, and, and I, I think that's been the subtle shift, but a big and important shift over the last several years. It is, it is, and so I think, yeah, you're exactly right, it's, it's how, it's where we place our focus, I think that's important. So it's the celebration, not, not the food, absolutely. But if we draw attention to it constantly, we don't wanna tie that food to that reward system, um, and, and that, that's the that's the distinction, I believe. And what I like to say is a great reward for, um, this, you know, if, if there's well if the child was well behaved during their, their brother's play, what if the parents said, man, you were so well behaved, let's go by the park on the way home. That's a great. Physical activity and being that togetherness is kind of, so, um, Kathleen, uh, earlier someone made a mistake, asked about a question actually Matthew Smiley asked a question about parents mistaking moving for physical activity. So I mean, and I know that we see this sometimes with the kids in clinic who say that, yeah, you know, I, I walk all the time and you find out they're walking between classes at school and how, how do you make that distinction. So again, we, you know, all movement is important and every little bit counts, right? So we don't want to discourage them from even if it's just walking, even if it's in between classes or, you know, however little it may be, all moving is important, so we do wanna encourage that and again, you know, say that's great that you see the value in moving, but what I would do in that situation is bring them back to the. Intensity, um, but in a, you know, the, just kind of the conversation about, that's great. So it sounds like you're moving a good bit. Let's talk about, um, how your body feels when you're moving and then kind of regroup going back to, um, remember, it's important that, that when we're active, um, that we try, we get our bodies working hard again, right? So some of the time that you're walking in between class, While that is important and while movement is great, um, we want to make sure in order for our bodies to get the benefits, um, from the most benefits from our movement that our bodies are working hard. So let's take them back to the cues. So, are you sweating? Are you, is your heart rate increasing? Are you, um, you know, getting tired or, you know, so again, taking it back to those body cues. Another, another question that came up on the uh chat board from Laura Hamilton is, and I guess it's probably for both of you, is how do you transition older kids to take on the three P's for themselves? Oh, that's a great question. I think the best way to set that up is allow them to be part of the process early on with meal prep, with, uh, making, you know, helping the family decide on what the menu's gonna be for the week, grocery shopping, all those types of things, and then if we've done our job. As parents on the, um, the planning, preparing, and, and, um, providing and allowing our child to practice at the earliest age with making those choices, listening to their own hunger cues, knowing when they're full, all those things, I think we, we can't just all of a sudden decide to do this as a teenager and then become um very proficient at it. I think it takes, uh, Really, um, implementing that at a very early age and allowing that process to take, to, you know, to take place so that they'll be set up for that, um, when they're, when they're older. And I, and I think that's a, a really good point also because that's really in theory, the whole reason why we've set up the P's and C's, right? So if we go back to the parenting styles and we have a parent that is overcontrolling or overindulging and they're not, um, kind of being that. Responsive and reacting to the child's cues, the child will never learn how to self-regulate themselves when it comes to physical activity or when it comes to eating. So, um, we actually just talked to some parents the other day, and one of the parents said, yeah, because if I, if I, you know, force them to be physically active or I control their portion size, this is what happens when they leave the house because they don't have that regulated, so they, they're not capable of taking. On those pieces themselves, so involving them early on and, and like you said, the planning and preparing process it's gonna make them, um, you know, set them up for success in their choices and then also make the transition, um, when they are, you know, kind of transitioning into the piece themselves, make that transition easier, and I think that's great. I mean, obviously starting all this early on would, would be ideal, but I don't think it's ever. Late to start to do some of this, right? It's never too late to start to be that role model at the table, to show, you know, eating good habits, to make mealtime pleasant, to take the battle out of food because people have battles over food even when their kids are teenagers, you know, they've been having the same battles for years. So I think at any time you can start implementing some of this on your job as the parent and then see how the, how the parents are, um. are responding to that. And the kids will then respond. That's we do hear whenever, even with the oldest, our older teens, when I work with parents to start implementing these things, it's hard. It's definitely hard upfront to relinquish that control as a parent, but I always hear positive responses from the parents. So there, there's less struggle. There's less confrontation, um, when they allow the child to make some of those, those choices for themselves. Mhm. Now we're gonna have fun with message makeovers for activity. OK, so similar to how we just did for nutrition, right? So, um, of course we, you know, uh, engage with parents of all different, um, personalities and parenting styles, all of which can affect how I don't, I don't want to stop you because just, uh, just as a follow up to the last point, um, I guess that Laura's saying, but what, what about when you get patients that are teens. So with the, with the three P's, do you, do you do anything different for the patients that are, that come to you, you know, 1516, 17 with the three P's? Well, I think we, we, we, it would be a new concept for them, but, and what we would do is start slowly with just one area just like picking one thing that they'd like to work on and then trying it out with, with maybe in one area, not in a large way. But certainly, we will go over the concept of P's and C's with them. Go over some examples in their life and how to, they can implement that for themselves. So try to practice through some of the things they're going through, some of the challenges they're going through, maybe with um meal selection or with activity, and really practice with them in a real way on some of the scenarios that they're experiencing, but applying the three pieces with that. With some of their just real life scenarios and that I found to be very helpful and it goes you can start using motivational interviewing and and like you're saying find out what's important to that team and start very small and really work on them being successful at it. Right. And again, I think for teenagers, I think when we're trying to get them on board with this, right, so a lot of times the parents, it's the parents, um, their role, what we're asking them to do looks very different from what they've done, um, but you know, so them taking the initiative to plan. Ahead for the week. That's different for them, but it may be for the child, you know, he, the child doesn't want to give up their favorite meal. So, again, that starting small is, well, maybe with that favorite meal, the parent also introduces broccoli or any vegetable they can try or in the flip with physical activity. I had a parent of a teenager the other day say, my child just, just does not like to be outside. He tells me that all the time. He doesn't like to sweat, right? And that's a teenager, so we're having to kind of um how do you work with that when you're telling the child they have the ability to choose whether to be active or not active. And when you engage them in the conversation, um, you know, almost as soon as that parent said that, I had another parent said, my child said the same thing, and then we got a dog and he Started walking that dog 3 days a week. Now, I'm not saying the solution is for all families to get dogs, but what I am saying is that, you know, sometimes that that child or that teenager just hasn't explored enough or found something that they enjoy doing. So again, going back to the motivational interviewing, engaging in a conversation, saying, OK, I understand. I'm hearing you that you don't like to be outside and sweat, but is there something that you would like to try and do? And what we find is the more Before we really talk to, you know, with that motivational interviewing and talk back to them and respond to what they're saying, they eventually get to something that they would like to try. And so if they start trying that activity, you know, it could just stem from there and they go, wow, I really liked that, or I really didn't like that. Let's try something else. So engaging them in that conversation, um, and then again, when the parents are doing their jobs and preparing and planning ahead of time, then it takes that struggle away. And also as part of the motivational interviewing and that patient-center approach, many of our, um, overweight kids, they don't like to be active because of some type of barrier. Maybe someone's made fun of them, maybe they feel very self-conscious about being active and moving, finding out what those barriers are, and then maybe they would love to be active, but some of those barriers are getting in the way. And so really examining what that. Be, um, can really help with maybe pave the way to, to be more active in, in healthy eating, and the barrier could be as small as the parent looking at themselves and saying, OK, my role, what, what have I been doing with, you know, my teenager, and I have been, you know, telling my teenager to turn off the TV and let's go exercise, and it could be something as small as if they plan. In ahead for the week, you know, the child already knows that they're going to the park. It's going to be active versus having that struggle on the back end of the screen time and turning it off, um, but, but again, you know, inviting that child rather than saying go outside and exercise, it could be, you know what, let's just go have fun. Let's go play. Let's go do it together and as a family, and it could be something, um, just as different as that, that for a teenager makes a difference. It's true. OK. So, um, if that answers your questions, we'll kind of dive into some of these message makeovers for activities. So, again, as we look at these, you may hear a parent say, I know John needs to be more active. I signed him up for soccer, but he hates it. Well, what's the problem with this message is that the, the parent is really being overcontrolling, right? Pushing a child into a sport that he doesn't want to participate in. So, while sports is a great way to um get kids involved in organized activities, If that's something they want to do. Um, if the child doesn't want to do it, they're not going to be motivated to go, they're not going to be motivated to stick to it, and they're not going to be motivated to be active when they're there. So what you can make over this message is, again, by encouraging the parents, think you're right, it's important for our bodies that we find ways to be active. Have you tried asking your child what are some things he would like to do to be active? Maybe you can try something new together. Again, it doesn't have to be the sport. It could be, you know, something else that the child enjoys. Another, um, message you may hear from parents is I tell Claire every day that it's time to turn off the TV, go outside and exercise, right? So this is similar to what we both, what we just talked about. You're saying this to a teenager, the likelihood is the conversation is not gonna go well. I say this to my 2 1/2 year old, but the likelihood is the conversation is not gonna go well. So, um, again, it's important that parents that Limits on screen time. But the main message, uh, in this, um, the main point of this message is that word exercise. Um, when the parent says go outside and exercise, it just doesn't sound appealing. The child is not going to be motivated to do it. So, um, again, that's great. You're encouraging your child to be active. Maybe it would help if you invite your child to go outside and play rather than exercise. Do an Activity Claire thinks is fun to do it together. Again, if they plan ahead for the week and it's on the calendar, and Claire knows that when she gets home at school at, at 4 o'clock, and, um, you know, then she's going to the park with her friends, she already knows that's in the schedule. So that takes the struggle away from Claire sitting down on the couch watching TV and then the mom asking her to turn it off. Um, another one we hear is oftentimes when my child is misbehaving, I discipline them by not allowing them to go outside and play. Um, to this, of course, we would encourage the parent to go a different direction. So, um, a lot of times what parents, um, forget is that their child, if they're misbehaving, being active could just be the thing that helps them kind of get their behavior and their conduct back in order and in check. Especially, say, for example, if this is after school and they've been spending most of the school day and they come home, they've got a lot of pent-up energy. Um, so again, It's we're disciplining by taking physical activity away, which is tempting to do because kids wanna, want to play, so it's an easy thing to take away. Um, but again, it could be just the thing that they need to kind of re-engage, um, and refocus. So again, we could say, well, I know it's often difficult to find effective ways to discipline your child. It's important that you not take away physical activity when they're misbehaving. Now, on the flip side, We have a parent that could say, sometimes my child can be so disrespectful. I tell him, go outside and run 3 laps around the house. So, to this, I would just say, please find another way. So, again, if a parent is using physical activity as punishment, the child is going to associate that physical activity is something to avoid. They're never gonna want to do it if they Associate that if I'm sad or I'm misbehaving, then I have to be physically active. That's not gonna motivate them to participate this, participate in this now or lifelong. Um, so, a full disclosure on this message, of, um, you know, I, I am not a, um, a expert on parent disciplining. Um, if somebody is, you can call me afterwards and tell me. My 2.5 year old, but, but the point here, um, of course, because, you know, disciplining, um, is, um, uh, relative to the age of the child, parenting styles, the severity of the deed, all of which we won't get into, but the key message here is just that if we discipline our child with physical activity, it's just counterproductive to what we're trying to do, which is get the child to enjoy being active and be motivated to do it themselves. So Kathleen, um, what do you think about, uh, treadmills in front of TVs? Another question from our, uh, chat board here. That's actually a really good question, um, because again, it is screen time and um they are being active. Um, you know, uh, If, if they, for example, are, you know, going to the lunch there, going to the gym, and there is a TV there, um, and they're, you know, uh, the only thing I would be cautionary of is that sometimes when we disengage by watching TV or we listen to, you know, music too much or when we're active, we're not paying attention to our body cues as much. Um, however, if it's getting, if it's getting a child or a teenager or even ourselves active, um, and they are, you know, engaging in screen time while they're running or being physically active, and it keeps them motivated and keeps them doing it longer, I would not necessarily, um, say you can't do it. Um, I would say, you know, it's important to also try and get outside and engage, you know, in physical activity that way and maybe experience You know, trying to go for a run in their neighborhood if they really like running, um, so I would not discourage it if it's something that's getting them active and gets them motivated to do it. But I think you make a good point. Take that break every 5, 10 minutes and take a check-in with your body and see how you're feeling, because I know if, if I have something like that in front of me, I tend to be much less vigorous than what I'm doing. So you need to sort of stop every little bit and check in, right, exactly. And the corollary to all this is I'm assuming you think it's OK to take away screen time as a punishment. Uh yeah. That would be a great thing. Yeah, that's right. So, um, you know, again, I think it should be limited anyways. So if they are overindulging in it to begin with, um, I think there should be limits. But yes, I think taking screen time away would be a good way to, um, you know, curb behavior. I do have a quick question about screen time because, you know, kids are on the computer a lot for school. So if they need their computer for homework in the evenings, does that count towards their screen time allotment or not? That's a really great question. So when we talk about screen time, we're usually talking about unproductive screen time. So we understand, right? And even us as professionals sometimes have to spend 8, 10 hours in front of our, um, laptop. Um, so I even had a parent one time say, I'm gonna go to work and say I was told I can't. Computer for two hours. That is not what I'm saying. Um, but it is, there is a difference between productive and unproductive. So, of course, technology gives us so many benefits right now, um, you know, so, you know, doing homework, doing it at school, all of those things are important. Um, if a child comes home and is working on their homework and it's productive screen time, then that is needed. What we're really talking about here is the screen time when they, the child disengages. They're not working on homework, they're not at school, they're just, you know, mindlessly watching TV, playing video games, and that's time that they're not doing something productive that could be spent if they're being active or doing something else more productive that doesn't involve the screen. OK. So, that actually takes us, you set me right up for my last message makeover, which is something that we hear a lot, which is my child never has time to play outside during the week, he has too much homework. Um, this is not uncommon, and of course, homework is a great thing. We don't want to discourage, um, away from homework. Um, but the, the way to make over the message here is, you know, you could say, homework is important. Have you ever Considered encouraging your child to take a brain break before he gets started on his homework to refocus his brain. When they're finished with their homework, they can play. So a brain break is something we use, and it's just something that gets the child up and moving, even if it's just for a few minutes, gets the heart rate up a little bit. But when they have been sitting or thinking or working on school all day, it's a great way to kind of get them up and moving, re-engage with their. bodies and refocus their brains. Um, so that's, hence the, the brain break. It kind of take a break from that, get moving, refocus, and sit back down. So, um, even if the child, if the child just, you feel like has so much homework, but it's something that the parents for, you know, 10 minutes or the caregiver, whoever's with the child, if they could be active, play a game with the child even for 10 minutes before they start their homework. Um, it's a Great way to re-engage the child. They'll be more efficient with their homework. It's also a great way to, if the child, while they're working on their homework, often encourage parents to, um, encourage their child to get up and take breaks while they're working on their homework. A lot of parents, um, will think, well, that my child is being inefficient. They're getting up, they're moving around, um, but it actually can make the child again, refocus and make them more efficient. When they're working on their homework. Um, another great way is, again, if you have that physical activity planned and you have homework time planned into the day and it's on the schedule, that's a great way to do time management. So you know, you'll have enough time to be, um, to do homework after they're physically active. And then, of course, you know, encourage, um, parents that when they're finished with their homework, they can play. And that's a great time to, to be active as well. One thing with parents as well is just going over the schedule because the schools that are at such different times. The kids come at 3 o'clock and let's say it's winter and you know it's dark by 5, can they readjust the schedule, but a lot of kids in middle school aren't even getting home until After 4, between 4 and 5, and that does put a lot of pressure on trying to get outside time and still get your homework done. So it's really, if you work with their schedule and talk it through, you might be able to find some more creative ways to help families encourage the activity. That's right. And again, if they plan ahead of time versus, you know, feeling like, oh, the child wants to play and have outside time, but he has so much homework, if you have looked at that schedule and planned ahead, you know, OK, he can have an hour to play because then he has from this time until dinner to work on homework and then see, so it's, you know, it takes a little bit of that stress away from it because it's planned and built into the schedule. All right. Now we're gonna put all of the things that we talked about together in a few case studies. So we have a case study that relates to feeding and a case study that relates to activity. So, here we go. This first one is one that you're gonna hear, um, quite frequently as a provider. This is the raiding the pantry, um, example of the case study. This is an 11-year-old, um, patient. Her BMI is over 85th percentile, so she's in the overweight category. She has gained 6 pounds in the past 2 years. And, um, in terms of the Later, the child gets home from school and raids the pantry, and then mom thinks she eats too much at dinner as well. And what is going on with the struggle in this home is that mom is trying to put limits on portions at dinner, but the child bleeds for more food. So this is creating quite a power struggle in this home. So, um, as a provider, what I would encourage is asking those open-ended questions about, um, what's going on during the day before she gets home and raids the pantry. Is she eating breakfast? Lunch, um, or she's skipping either of those meals. Um, what about the snack schedule and what is available for the child to eat when she gets home? Um, and what I tell, uh, parents is if the only thing that's in their pantry are chips and crackers and, and, um, you know, tortilla chips, whatever that's there, those are not gonna satisfy the child. So that's where they get into that sort of a grazing, just keep going back to the pantry. The chips and then for the cookies. And then if there are no um boundaries or there's no plan for that, the child's just gonna keep eating things that don't fill them up. Because I, I tell parents there's not enough chips to fill a child up. And the crucial thing here is that it lacks protein. Protein needs to be involved. It's a really crucial component in snacks to help keep a child feeling full, so that when she gets to dinner, then she's gonna be able to eat more of a, a normalized portion, listen to her hunger performance cues better, and that hopefully that will keep mom from um feeling like she needs to limit portions at dinner. So really, this is an open-ended discussion with the family, and don't make those decisions for the family on what she needs to eat lunch, she needs to eat this intentional snack, those types of things. Ask them to brainstorm what those would look like. Well, what could we do to um help you eat? For, um, help you eat lunch. Find out about that. Well, what do you have to offer for snacks? What are some ideas that you would like to have for snack? Because if the mom, if that's all they have in the pantry or all these snacky junky foods, we cannot get upset with the child for wanting to eat those foods. So we want to make those healthier choices available, brainstorming the family, uh, what that looks like, what the schedule looks like. Try to help them and prevent them skipping meals and having that intentional snack and that schedule in place, which will set that child up for success at mealtime. And then our next case study. So now we have a case study in regards to excessive screen time. So it's very similar to kind of all the questions that we've talked about and all the parenting styles and um the child's role in this um when it comes to physical activity. So, this is a family that you have, um, as an eight year old boy with a BMI um greater than the eighty-fifth percentile. Um, so the health history is that you're seeing an abnormal weight gain and elevated lipids. And so you engage the parents in the conversation about, let's talk about what's going on in the house. And the parents said, well, the child gets home from school, does homework, and then spends the remainder of the evening watching TV or playing video games. And then both parents have hectic work schedules and grandmother stays with the son after school until the parent gets home. Um, so this is a tough one because we know that most grandparents like to spoil their grandchildren. Um, the problem here is that since grandmother is with her grandson every day, the behaviors he does with her become habits because they're, they're happening daily, right? So, um, what I would do in this case is engage the Parents in a conversation of, um, can you engage grandmother in a conversation about, hey, let me tell you about, you know, how we're really trying to make these changes with our family. Health is important. Um, it's important that our son kind of limits screen time and physical activity. Um, let's talk about what that may look like for us. And then sit down with the grandmother and the son and engage them in a conversation. Um, again, ask the son, hey, what are some physical activities that you would like to participate in? Um, is it going to the park, um, and then engage grandmother in the conversation? Again, is this something you can support him in? So, if he's expressing that he would, he would like to go to the park and that's something he'd like to participate in, is that something grandmother can support? Can she drive him there? Can she walk him there? Is there a sport that he'd like to get involved in that grandmother can drive him to or support him in? Um, so again, engaging the son in conversation about things he'd like to do, and then, and then getting grandmother on board to saying, can you support this? And then again, um, the family should with the grandmother and the son right there, get out their weekly schedule, um, look at that and say, OK, let's, let's see when we're going to fit in this physical activity. What time are you home from school? How much daylight do we have? What days of the week? We do we have this? And then write it into the schedule, the days that they're going to be active and what it is they're going to be doing on those days. Again, write it with a pen, so they're more likely to stick to it and it becomes a part of their schedule. Um, and then again, the child is less likely to come home and just crash on the couch and watch TV if there's something on the schedule that he knows he's doing that day and the grandmother can support him in. Um, again, I would remind the parents that, um, even though they have hectic work schedules, that, of course, they're an important part of their child being active as well. Um, it's something that the parent can engage the child with during the weekends and physical activity that they would like to participate in then. But also, do they have time after dinner to go on a family walk? Um, that can be a great way for the parent to talk to the son, especially if they haven't seen him all day about, about the school day, about their friends, about, um, what's going on in their life. Um, So it can be a great way for them to connect with their son while getting some movement in. And then even though the parent may be exhausted, it could be, you know, the much-needed kind of brain break for the parent to get them re-energized for the rest of the night. Um, so all kinds of Ways that you can engage the parent in conversation about, um, ways that they can, again, plan, prepare, and provide opportunities with the grandmother involved, um, so that they can set the child up for success when it comes to being physically active. Uh, great, great. Um, so I think it's, it's time for us to start wrapping up before our, uh, first break.