Blog

Taking Care of Elderly Loved Ones: The Difficulties We Do Not Talk About

When people talk about being caregivers, most often they are talking about taking care of their young children.  However, there is a large segment of the population who are taking care of their aging parents or other family members either instead of or in addition to their own children.  Although the needs and concerns of this group often resemble the needs of the young parents, in a lot of ways, their job is even harder.

When an adult child finds themselves taking care of an elderly parent, they learn about a world of concerns that they were often unfamiliar with. Unlikely in the case of a child, where the needed care is often relatively standard based on age, the needs of a parent vary greatly, in both the physical and emotional realm.  As the adult child struggles to meet these demands, what they are often left with is guilt.  They walk around with the self-deprecating thought that they are not doing enough.  However, rarely do they stop to think about what “enough” would look like.  If they did, they would likely realize that the source of the guilt is that they do not measure up to their ideal caregiver – the magical person who does it all and never complains.  They do not generally acknowledge that this person does not exist.   Thus, if people are trying to deal with the guilt they are experiencing, a good place to start would be to say to themselves, “My parent is well cared for, and their needs are met.  Are there ways I can be more perfect – certainly – but if I am not perfect does not mean that I am doing a bad job.”  Changing how one thinks does not actually change anything in the real world and does not alter the extensive assistance that the caregiver needs to provide for their parent, but it does help to lessen the guilt, and that alone makes the job easier.

Perhaps if caregivers reached out to others in similar situations, they would realize that the guilt they are experiencing is common and others may be able to normalize the experience.  However, another problem that caregivers face is that when they try to talk to others about their hardships in order to get support, they are told that “They are lucky that their parent is alive, so they should not complain.”  However, being grateful that your parent is alive does not make the day-to-day job of caring for them any easier.  Also, just because you are struggling with managing their care, does not mean that you love your parent any less.  Again, the only thing that you can change is to be honest with yourself and acknowledge that although part of loving your parent right now involves doing these tasks, it does not mean that you have to love the tasks themselves.  Give yourself a chance to seek the support you need.  If you find that you are getting responses similar to the one above, then find the support elsewhere because it does exist.   On the other hand, some people do not ask for help because their care-giving role makes them seem like “saints,” and they do not want to jeopardize that image.  In these situations the person needs to acknowledge what is more important to them: preserving the image or getting the help.

Speaking of help, caregivers often feel like this burden is only theirs to bear, and they do not use their resources.  Frequently people say that they do not have any help because they “can’t afford it.”  However, a large part of getting help is identifying what resources you do have and pairing them with the needs that you have.  For instance, you may not be able to leave and go grocery shopping, but your friend is already at the store, have the friend pick up the milk since the milk doesn’t care who buys it. Also, places such as senior centers and religious institutions may offer help, so seek them out and ask.  They may be able to offer help, but they do not know that you need it until you ask for it.  Similarly, if there are distant relatives who voice the concern that they are unable to help out, perhaps they can send money since that allows for a greater amount of resources and allows them to contribute to the care remotely.

Another thing that often gets overlooked and glossed over for the sake of fitting into this role is that if the caregiver and the parent never had a positive or close relationship, it is unfair to assume that now because the parent needs help the nature of the relationship is changed.  The adult child may step into that role out of a sense of responsibility or duty regardless, but the conflicts in this kind of situation may be even more frequent.  In such a situation, it is important to say to yourself that it is likely that the conflict is only marginally related to the fact that the parent is now elderly.  This conflict has been going on for years, and nothing has changed just because the parent is ill or needs assistance.  People do not become perfect angels just because they become ill.  In fact, the opposite is true.  People who are ill and require extensive help may be more irritable and demanding than in the past making being their caregiving that much harder.  Regardless of what the situation is, the caregiver needs to accept that caring for an elderly loved one is difficult, and they need to do what they can to get the support and assistance that they need.

Advertisements

An Elderly Adult is Not a Child: Important Differences for Caregivers

People often say that taking care of an aging parent is like taking care of an infant.  What they mean by this is that often the aging parent can no longer meet their own needs, cannot make sound decisions and cannot plan for their own care.  However, there are in fact many ways that caring for an elderly parent is not like caring for an infant, and these differences is what makes the latter job significantly harder.

The main and most obvious difference, although one that is frequently overlooked, is the fact that an aging parent had been an independent adult for many years prior to their current condition while an infant has not been.  Thus, a parent often remembers a time when they were able to do all of these things by themselves, and are frustrated by their inability to do so now.  For example, after 80 years of walking, it is very difficult to accept the fact that you cannot do this simple thing anymore.  This realization creates a host of negative emotions ranging from frustration to anger to resentment to self-loathing.  When the caregiver comes to help, all of these emotions are triggered and often directed at the care giver.  On the other hand, an infant who has not yet learned to walk does not see his lack of ability as a personal failure, he sees it as something cool that older kids do and that he may want to put some effort in figuring out how to accomplish and reacts accordingly.  When a caregiver understands and acknowledges what the loss of independence means for the parent, it can help to both build compassion and provide the caregiver the opportunity to help their parent grieve, in the true sense of that word, the loss of whatever function they are no longer able to do.

In some ways, the caregiver’s job becomes even harder if the parent refuses to acknowledge that there are tasks that they are no longer able to do.  This may be something as major as driving or cooking or something mundane as getting to the bathroom on their own.  However, regardless of the magnitude, the parent’s continued effort to do this task can result in serious injury to at the least themselves and frequently others.  The parent who attempts to cook but cannot remember to turn off the stove is putting the entire residence at risk while the parent who insists on getting up to go to the bathroom by themselves is constantly at risk for falls.  In such a situation, not only does the caregiver have to take on the task, but they also need to have this conversation and get the parent to agree.  Unfortunately, initiating this conversation is likely to make the caregiver the target of the parents’ anger.  Despite their parent’s potential wrath, the adult child still must put a stop to the dangerous behavior.  In this way, the caregiver’s job is similar to a parent’s, where they get to enforce decisions that won’t make them particularly popular.  To help the caregiver take this necessary step, they can say to themselves “Although this conversation is going to be hard and my mother will be angry with me, that is nothing compared to how angry I will be with myself if I do not do something about this and she falls.”

It is important to understand that in addition to changes in self-image, which loss of functioning creates, there is also a sense of loss of control.  Thus, whatever the caregiver can do to help the parent feel in control will help to ease this transition.  It may also help to address the sense of “demandingness.”  For example, if the parent is asking to be taken to the bathroom every 10 minutes, and this is preventing the caregiver from getting anything else done, they can develop a schedule where the caregiver takes the parent to the bathroom during the first ten minutes of every hour or however long is determined to be an appropriate interval.  It is helpful to develop a time table where the caregiver can check off the times, and this can serve as a visual are reminder.  Such a plan will help the caregiver get other things done without being constantly pulled away, but even more importantly, it will help the parent since they will no longer have to ask and wait.  They will know when it will happen and this returns some sense of control to them.  This intervention can be used for many different frequent requests.

Another major difference between a parent taking care of a child and a child taking care of a parent is the conflicting feelings about the future.  Parents of young children may have to provide a lot of grueling care, but they do so with the knowledge that with each passing day, their child will require less and less care.  They know that the child will soon be an adult and no longer require their care.  Also, they know that the stage they are in now is temporary, and afterwards, they will maintain the relationship with their child, but it will no longer be so demanding on them.  This is the opposite of the knowledge that adult-children enter their caretaker role with.  They know that they may be taking care of their elderly parent for an extended period of time, that the care is only going to get more extensive and that the only way they will be able to stop taking care of their parent is when they die, which is not something that most people can “look forward to” as a way out of their situation. This is a very difficult situation to be in.  People would benefit from being honest with themselves and develop a plan of care that is sustainable.  For instance, if the parent requires 24-hour supervision, the adult child may be able to provide that for a week, but not for the next ten years.  An honest stock of the real care needs will likely result in the child having to have many more difficult conversations, such as the need for outside help.  Moreover, when looking into the future, it may be helpful for the caregiver to understand that being exhausted by the work of the care is not the same thing as wanting their parent to die.  The caregiver needs to give themselves permission to acknowledge how exhausted they are and how burdened because only then will they seek appropriate support and resources.

Moreover, the work itself tends to be harder and less “cute.”  Babies even at 2am can snuggle up and give the mother that sense of peace and tranquility.  Let’s be honest, there is very little that an elderly person can do at 2am that will be seen by their caregiver as endearing.  Furthermore the work itself is physically more difficult and demanding.  The elderly are heavier and are often in pain making handling them not as easy as lifting an infant.  Also, while children are resilient and a cut or a bump heals easily, for an elderly person a small cut can potentially cause serious illness, thus raising the stakes for the caregiver to provide “flawless care.”  Such high risks and demands contribute to the burn out found among caregivers.  It is not only the emotional burden of the constant demands and the guilt from not “doing enough” as discussed in my previous post, but it is also the physical demands of the care.

If the physical aspects of the care are wearing the caregiver out, they need to take an honest look at what is happening. For instance, if their parent does need to go to the bathroom every hour, but they are heavy and in pain and each one of these trips takes half an hour and results in a hurting back for the caregiver and in a hurting everything for the parent, maybe diapers or a bed pan need to be considered.    It is likely that the parent will be upset by this discussion, but as discussed above, that does not mean that this conversation should not take place.  The parent may “refuse to think of themselves as someone in diapers,” but the caregiver must protect themselves.  What good will they be to their parent if they hurt their back? After the caregiver has assessed exactly where the problem areas are, they can research the available resources and medical supplies.  Since they are likely not the only one who is having this problem, it is likely that someone has thought of a solution.

Another major difference is the stage of life when the “caregiving” takes place.  When a family is first starting out, it is “expected” that they will have children and that the early years will center on raising children.  While in the midst of caring for their young children, spouses often saying that they will be able to do those things that they like “when the kids are grown.”  Furthermore, most of the families around are at the same stage of life.  As a result, there is both social support and a social group for the family to fit into.  For example, it may be normal to meet friends for breakfast instead of dinner because that is a better time to go out with small children.  However, when an adult child finds themselves taking care of an elderly parent, this often occurs later in life, when the couple may have been past caring for children for some time and was beginning to enjoy their independence.  Now, similar constraints that were in place when they had young children are back.  For example, the couple may not be able to go out to dinner without securing someone who can care for the parent.  However, this may be even more difficult than getting a babysitter since the parent’s medical needs may necessitate someone trained to do the job.

This loss of independence can put strain on a couple.   The first strategy for addressing this issue, as with all the scenarios described above, is to be honest with yourself. Acknowledge that the couple has lost the accustomed freedom and that this may be troublesome for both partners, but especially for the partner who may now feel abandoned.  Talk to the spouse about the concerns you have regarding how this may impact the marriage.  Understand what is actually concerning.  Is it that you can never plan anything because there are constant emergencies? Is it that you never have time alone? Is it that you can no longer go on vacation? Depending on the specific problem, solutions may be available.  On the other hand, what is not helpful is for the spouses to begin to resent each other.  The spouse who is not the primary caregiver may feel abandoned, as mentioned above, while the spouse who is providing the care may feel unsupported and feel like their spouse does not understand that “they have no choice.”    Honest, albeit, difficult discussions may help both spouses serve as a resource for each other at this difficult time instead of being another source of stress.

Caregiving is never easy, but it is especially difficult when the work is physically demanding, there is little social support and the end of the work can only happen with the parents’ death.  In such situations even the small steps that the caregiver can take to relieve the burden can be beneficial.  Whether through the development of schedules or from enlisting the help and understanding of the spouse , the caregiver must acknowledge that they do not only have to take care of and protect themselves in order to continue to be a caregiver, but that they also deserve to take care of themselves.

 

Not All Free Time is Created Equal

When people think about their hectic lives, a frequent theme comes to mind, “I wish I had more free time.”  Although this wish is common, some segments of the population appear to be most affected by being “leisure poor,” as this concept is known in the literature.  Predictably, this group is mothers, and especially mothers who work full-time.  Working mothers as compared to other groups often shoulder the responsibility for the household and the childcare, as well as their job, leaving minimal time for other things.  This has been supported by research which found that after subtracting paid employment, childcare and household tasks, women in this group had an average of ten hours per day left.  Although that may seem like a lot at first glance, remember that these 10 hours need to include: sleeping, eating, showering and all other activities that are not explicitly paid work, childcare or household tasks [i].  To gain an even clearer understanding, one study looked at how much does each child “cost the mother” in free time, and it was found that for a married parent, the cost of one child is the loss of 1.4 hours of free time per day and 2.6 for two children.  If a child is under age 3, then there is an additional cost of 2.4 hours per day.  The length of any individual period of leisure time is also shortened when the child is young.  It was found that women get this time by taking it out of leisure activities and self-care[ii].  The minimal amount of free time is associated both with the sense of being rushed, as well as low satisfaction with the free time that does exist[iii].

Although there may be very little that mothers can do to increase the amount of free time they have, there are things that can be done about the level of satisfaction if the cause of the dissatisfaction is identified.  For some women it may be the kind of activities that are being considered as leisure.  It was found that women spend 30 minutes less per week eating, 3 hours less per week watching television, 1 hour less per week socializing and doing sports and 30 minutes less reading than men[iv].   Thus, it is possible that if a woman who is an avid reader has to sacrifice reading in order to sleep, eat and exercise, she may be unsatisfied with her “leisure time” since she derives potentially no pleasure from the tasks she engages in.  There are several ways to address this problem.  Ideally, there is enough flexibility in the schedule, where the desired task can be added into the schedule on an infrequent but regular basis at the expense of something that can be either delegated or skipped.  For example, one can say to herself, “I will create the time to read for one hour each week.  I will do this by ordering pizza for the family once a week for dinner.  Doing this will give me the hour that I need because I will not need to cook or clean up.”  If this works, and the needed time is created, the important thing then is to protect that time and use it for the activity for which it was intended.  So, if after ordering pizza, the woman spends the hour mindlessly reading through Facebook, this is unlikely to improve her satisfaction with her leisure time.

Nevertheless, very often such changes are not feasible since the schedule is already as leveraged as it could possibly be.  In these situations, the satisfaction needs to be derived by changing how one thinks about the free time.  Specifically, instead of saying to yourself, “I can’t believe I don’t have the time to spend on the things that I love to do,” try saying to yourself “This may not be ideal, but I am getting a break from work, and since this is what I am able to do, I may as well enjoy it.”   Another way to think about it is “If I did not have this time to do _____ (insert less preferred activity), I would be doing _____ (insert work/household/childcare…).  This is definitely better” or  “I am not enjoying this thing that I am doing because I keep wishing I was doing something else.  Continuing to do this will make me feel like I did not have this free time at all, and I refuse to waste the limited free time that I have.”  Changing how you think about the activity that you are engaging in may help to alter how you perceive your free time.

An additional issue is that not only do women have less free time, but they are also responsible for “providing the setting” for free time[v].  For example, if the “leisure activity” is having friends over, then the woman is often the one who, in anticipation, is cleaning the house and cooking the meal, thereby creating additional housework  This means that the free time comes at a price.  The cost of the leisure activity may at times feel too high to engage in.  However, this then leaves the woman feeling like all she does is housework, work and child care, which in effect turns out to be true.  To address this issue, it may be necessary to readjust what kind of leisure activities happen and/or readjust expectations for prerequisite activities. For example, if a woman had always cooked a full sit-down meal for company, she would need to determine what part of that activity is important to her.  If the important element is being able to socialize with friends, then she may have to learn to be okay with store-bought appetizers instead.  Although this may at first feel disappointing and like she is not living up to her own standards, the woman has to remind herself that she needs to stay focused on the targeted element, in this case socializing, and the less important element, the food, is the obstacle.  It is also important to remember that the feeling of disappointment in herself is preventing her from enjoying the leisure activity she had created.

The above example sheds light on another critical finding, which is that free time is less restorative for women than it is for men[vi].  The authors proposed that this may be due to the fact that women continue to worry about everything that they have to do while engaging in leisure activities.  It is also possible that women often engage in free time activities for the sake of the family rather than because it is something that they want, and as a result they are less restored by it. Some women may also view themselves as less deserving of free time, and the guilt interferes with the restorative effect.  This is an excellent opportunity for other adults in the woman’s life to intervene and help the woman get as much out of her free time as possible. For example, a husband knowing that his wife plans to give up something that she wants to do, such as read a favorite book, in order to have family over for dinner, may suggest that he will find another time that they can see the family, so that she can spend the time on herself, or he can propose to make reservations for a favorite restaurant and make arrangements for everyone to meet at the restaurant instead of coming to their house.  However, it is important that he takes on these tasks because if she needs to take on the coordinating of the changed plans, it will use up all of the time that she was trying to create for reading.  Also, an offer of this type from her husband reaffirms that he believes that she “deserves” the time she is setting aside for herself.

The other issue that needs to be considered for leisure activities is the fact that for many people, and especially mothers, leisure time is “contaminated” by other activities, meaning that the person is engaging in several activities at ones in order to meet all of their time demands.  It was found that parents spend approximately 1.25 hours per day of their free time with their children with about half of that time spent alone with their children with no other adults present.  This is important because under such circumstances, free time can turn into childcare very quickly.  For example, the mother may be playing a board game with her children-free time, but the children begin to argue and she ends up having to separate them and address the arguing- child care.  In this example, it is unlikely that the woman walked away from that experience refreshed. Also, if the woman is alone with her children for a large part of her free time, it limits the kind of activities that she can engage in.  For instance, she may not be able to go play tennis because she has to be with the children.  Again, if the family recognizes the importance of making sure that the mother has adult free time, which is the type found to be most restorative[vii], a plan can be developed where her time alone to engage in the things she enjoys is protected from other activities and responsibilities.

This topic is critical because with every year people feel more rushed as lives get busier and busier, and this trend has been steady since 1965[viii].  However, it appears that having restorative free time is an effective coping technique for this pace.  Since life circumstances make it difficult for women to experience such restorative free time naturally, it is important that it is created using the strategies above.

[i] Ekert-Jaffe, O. (2011). Are the Real Time Cost of Child Equally Shared by Mothers and Fathers? Social Indicators Research, 101, 243-247.

[ii] Ekert-Jaffe, O. (2011). Are the Real Time Cost of Child Equally Shared by Mothers and Fathers? Social Indicators Research, 101, 243-247.

[iii] Gimenez-Nadal, J. I. & Sevilla-Sanz, A. (2011). The Time-Crush Paradox. Social Indicators Research, 102, 181-196.

[iv]  Gimenez-Nadal, J. I. & Sevilla-Sanz, A. (2011). The Time-Crush Paradox. Social Indicators Research, 102, 181-196.

[v] Mattingly, M. J. & Bianchi, S. M. (2003). Gender Differences in the Quantity and Quality of Free Time: The U.S. Experience.  Social Forces, 81(3), 999-1030.

[vi] Mattingly, M. J. & Bianchi, S. M. (2003). Gender Differences in the Quantity and Quality of Free Time: The U.S. Experience.  Social Forces, 81(3), 999-1030.

[vii]  Mattingly, M. J. & Bianchi, S. M. (2003). Gender Differences in the Quantity and Quality of Free Time: The U.S. Experience.  Social Forces, 81(3), 999-1030.

[viii] Mattingly, M. J. & Bianchi, S. M. (2003). Gender Differences in the Quantity and Quality of Free Time: The U.S. Experience.  Social Forces, 81(3), 999-1030.

Messages from the TV: How Television Impacts Children’s Food Habits

Children have a special relationship with television. Even as many children transition to tablet watching instead of network programming, children generally have some exposure to network programming and its commercials.  Moreover, even newer forms of programming, such as YouTube, have commercials, and parents can be sure that those commercials are even more targeted to their audience, and thus, have an even greater effect.  However, the data is not as extensive for those medium, so here we will focus on television, but the concerns raised here likely still apply.

In 2006, a report from the Institute of Medicine estimated that children are exposed to approximately 10, 000 food commercials per year.  Most of the commercials aired during children’s programming are for unhealthy foods and snacks.  An analysis from 2007 found that 98% of the food commercials viewed by children 2 to 11 and 89% of commercials viewed by children 12 to 19 were for foods high in fat, sugar or sodium[i].  In the 1970s, it was estimated that children see approximately 20,000 commercials per year, and in the 1990s, this number doubled.  Researchers believe that this is because children are able to spend money given to them by parents on food, and children these days have more influence over what their parents buy.  In 2004, this influence was estimated at $200 Billion per year[ii].  At this point, the link between television viewing and poor eating habits has been clearly established.  For example, it has been found that even a 10 to 30 second commercial shown to a 2 to 6 year old child, can influence their preference for the food shown, and this effect doubles after a second exposure to the same commercial[iii].   In order for parents to fight against this strong source of influence, they need to understand what exactly causes this relationship.

First, parents need to understand that children pay attention to and remember the commercials they see, especially when the commercials are for food.  One study found that when commercials for toys and food were compared, children remembered the food commercials better[iv].  Other research has found that when children are exposed to a commercial for a snack, it increases the children’s preference for this food and increases how often they ask their parents for it[v].  Children also perceived advertised food as more tasty and cool[vi].  This is a very explicit process of influence.  Thus, all the parent has to do is not give in to the child’s request for the particular advertised food.  This seems clear enough, and most parents may believe that this represents the extent of the problem.  Unfortunately, the affects are much more profound though obscure.

One study found that children who watched a cartoon with commercials for food as compared to children who watched the same cartoon with commercials for non-food items during the program ate almost 9grams more.  The authors extrapolated that at that rate, the children who viewed television with food commercials for thirty minutes per day would experience a weight gain of 10 pounds over one year[vii].  To make matters worse, viewing extensive food advertisement prompts children to eat unhealthier food across the board.  For example, one study found that when compared to children who viewed commercials for toys, those who viewed commercials for food selected more high-carbohydrate and more high-fat foods than those children who saw the toy commercials.  The foods they selected were not branded and were not necessarily even similar to those presented in the commercials[viii].   The effect was the strongest for those children who watched a lot of television outside of the study; this groups of children was found to be the most susceptible to the effects of advertising.  Another study expanded on this idea and found that viewing food commercials increased children’s eating of all available food.  Not only did those children eat more, but they also ate for a longer period of time. The level of hunger did not predict how much the children ate.  Interesting, the children in this study were also more likely to eat healthy snacks after viewing the commercials.  This led the researchers to theorize that commercials increased the likelihood of eating anything and everything.    Moreover, this effect continued to be seen as far as the next meal[ix].  Due to this strong influence, parents need to be mindful of the kinds of foods and how much food the child has access to during TV time and for some time after.  For example, a rule may be established that says that the child is only allowed to eat one apple while watching television.  The amount of food can be similarly limited after the end of the show.

A critical element of the problem is that children, especially very young once, do not understand that the purpose of advertisement is to get them to do something, and thus, they are less likely to be able to resist its influence[x].  Here again, the effect seems to be cyclical, with the children who were the most unhealthy eaters being least able to identify that the commercial’s purpose was to persuade.  The unhealthy eaters also identified the advertised foods as more nutritious and healthier.  In another study, children who watched a lot of television reported that meals from fast food restaurants are as nutritious as those cooked at home[xi].  It is possible that children with unhealthy habits have less knowledge about what healthy food looks like and therefore are more influenced by the commercials they see.  Thus, to mitigate this effect, parents not only need to establish healthy eating habits for their children but need to explicitly explain what makes a food healthy versus unhealthy, so that children have information to base their decisions on.

In addition to the problems caused by commercials, the food and eating patterns displayed on television further exacerbate the problem. Characters on television rarely eat because they are hungry, but instead they eat because they are socializing or to address an emotional need[xii].  Moreover, they do not eat meals, instead they usually snack on unhealthy snacks and drink soda or alcohol instead of water.  Despite these behaviors, characters  remain slim, fit and, most importantly, healthy.  Rarely does one see a television character suffer an illness due to their poor eating habits[xiii].

For young children television characters do not remain only inside the TV, but they come into the child’s world.  They enter in the form of branded merchandise. In a similar way that a Disney character can make a t-shirt more “attractive,” it can make a food “taste better.”  For instance, it was found that 4 to 6 year olds reported that the same gummy bears and graham crackers tasted better when they had a character on the package[xiv].  Interestingly, the appeal of carrots was not improved by the presence of a character.  Furthermore, a branded healthy snack was still not as appealing as an unbranded unhealthy snack.  However, children were more willing to try healthy snacks that were branded with a favorite character[xv].  This finding can be useful to a parent who is trying to diversify the child’s diet.

When “pronutritional” messages are aired on television to combat the barrage of sugary snacks and salty foods, this massaging does not look as professional or as attractive, which results in them having less impact[xvi].  Furthermore, even when segments are designed specifically to deliver nutritional messages, they do not appear powerful enough to change children’s pattern of consumption even though the children confirmed learning the nutritional information.[xvii]   The authors concluded that consumption is driven by more factors than just information regarding nutrition and health.  This was supported by findings that children who ate in the presence of peers, and the peers displayed behavior in line with TV commercials, the effect of the commercials was very strong.  However, if the children ate with a peer who ate differently than suggested by the commercial, the effect of the commercial was decreased[xviii].  Thus, it is critical to expose children to peers who eat healthy and discuss with the children why their peer’s choices are better than the ones they see on TV.  Moreover, watching pronutrious programming can provide children with the skills needed to evaluate what constitutes a healthy snack and what does not.

“So, what now?” you may ask.  What can parents do in the face of such powerful influence other than prevent their child from watching all television programming.  Although that is by far the most impactful strategy, it is probably an unrealistic one for most parents.  However, a parent can substitute some television watching with programming that is devoid of commercials.  However, even more important is to understand that although television may affect preference and make it more likely that children eat the wrong thing and lots of it, the parents still have the ultimate control.  So, your child may prefer to eat only Oreo cookies for every meal, but if such meals are not made available, the child will have to accept alternatives.  The critical thing to realize is that the effects of television are much more far-reaching than most people think, and thus, every way that television exerts its influence needs to be addressed, from teaching children how to decide whether something is nutritious to imposing portion control after television watching to prevent the tendency for the child to overeat.  With this level of diligence parents can regain their rightful control over the development of their children’s food habits.

[i] Powell, L. M., Szczypka, G., Chaloupka, F. J. & Braunschweig, C. L. (2007) Nutritional Content of Television Food Advertisements Seen by Children and Adolescents in the United States. Pediatrics, 120(30),

[ii] Caroli, M., Argentieri, L. Cardone, M. & Masi, A. (2004). Role of Television in Childhood Obesity Prevention. International Journal of Obesity, 28, S104-S108.

[iii] Caroli, M., Argentieri, L. Cardone, M. & Masi, A. (2004). Role of Television in Childhood Obesity Prevention. International Journal of Obesity, 28, S104-S108.

[iv] Boyland, E. J., Harrold, J. A., Kirkham, T. C., Corker, C., et al. (2011). Food Commercials Increase Preference for Energy-Dense Foods, Particularly in cCHildren Who Watch More Television. Pediatrics, 128(1), e93-e100.

[v] Williams, L. K., Veitch, J. & Ball, K. (2011). What Helps Children Eat Well? A Qualitative Exploration of Resilience Among Disadvantaged Families. Health Education Research, 26(2), 296-307.

[vi] Lioutass, E. D. & Tzimitra-Kalogianni, I. (2014) “I Saw Santa Drinking Soda!” Advertising and Children’s Food Preferences. Child: Care, Health and Development, 41(3), 424-433.

[vii] Harris, J. L., Bargh, J. A. & Brownell, K. D. (2009). Priming Effects of Television Food Advertising on Eating Behavior.  Health Psychology, 28(4), 404-413.

[viii] Boyland, E. J., Harrold, J. A., Kirkham, T. C., Corker, C., et al. (2011). Food Commercials Increase Preference for Energy-Dense Foods, Particularly in cCHildren Who Watch More Television. Pediatrics, 128(1), e93-e100.

[ix]  Harris, J. L., Bargh, J. A. & Brownell, K. D. (2009). Priming Effects of Television Food Advertising on Eating Behavior.  Health Psychology, 28(4), 404-413.

[x] Lioutass, E. D. & Tzimitra-Kalogianni, I. (2014) “I Saw Santa Drinking Soda!” Advertising and Children’s Food Preferences. Child: Care, Health and Development, 41(3), 424-433.

[xi]  Signorielli, N. & Lears, M. (1992). Television and Children’s Conceptions of Nutrition: Unhealthy Messages. Health Communication, 4(4), 245-257.

[xii] Signorielli, N. & Lears, M. (1992). Television and Children’s Conceptions of Nutrition: Unhealthy Messages. Health Communication, 4(4), 245-257.

[xiii] Caroli, M., Argentieri, L. Cardone, M. & Masi, A. (2004). Role of Television in Childhood Obesity Prevention. International Journal of Obesity, 28, S104-S108.

[xiv] Roberto, C. A., Baik, J., Harris, J. L. & Brownell, K. D. (2010). Influence of Licensed Characters on Children’s Tst and Snack Preferences. Pediatrics, 126, 88-93.

[xv] Kotler, J. A., Schiffman, J. M. & Hanson, K. G. (2012). The Influence of Media Characters on Children’s Food Choices.  Journal of Health Communication, 17, 886-898.

[xvi]  Signorielli, N. & Lears, M. (1992). Television and Children’s Conceptions of Nutrition: Unhealthy Messages. Health Communication, 4(4), 245-257.

[xvii] Peterson, P. E., Balfour, J., Bridgwater, C. A. & Dawson, B. (1984) How Pronutrition Television Programming Affects Children’s Dietary Habits. Developmental Psychology, 20(1), 55-63.

[xviii] Stoneman, Z. & Brody, G. H. (1981). Peers as Mediators of Television Food Advertisements Aimed at Children. Developmental Psychology, 17(6/), 853-858.

Helping Children Learn to Eat Healthy

Helping Children Learn to Eat Healthy

Last week we talked about some of the factors that come together and result in children becoming “picky eaters,” and we talked about ways to mitigate it. However, establishing long-term healthy eating patterns is a larger task than just avoiding forming bad ones.  This post will attempt to give parents guidance for the kind of things that help children develop life-long healthy eating habits.  Please note, that according to research, eating habits are established earlier than many people think. It was found that eating patterns are set by age two, especially as it relates to the consumption of fruits, vegetables and junk food[i].

What Works:

  • Allowing the child’s hunger level to dictate how much they eat rather than an external requirement, such as “finish everything on your plate.”
    • This is only affective if the child cannot get any more food until the next meal. It may be difficult for the parent to think of their child as hungry, but a child is unlikely to suffer any serious consequences from being hungry for a couple of hours.  If a parent cannot tolerate the child’s claim of hunger, the child can be offered the remainder of the food they had refused earlier.
  • Offering fruits or vegetables as the first option for snack, and no other snack can be discussed until a snack from those categories has been selected and eaten.
  • Parents actively promoting healthy food choices and limiting access to unhealthy treats to special occasions.
    • It also helps to offer healthy alternatives rather than simply refusing the child’s request. This is especially critical when children are young, and the parents have more control. Research has found that although taste dictates a child’s preference for a food, the child’s actual eating of the food is determined mostly by a parent’s permission[ii].
  • Having the parent encourage moderation and prevention of excessive eating[iii].
  • Having the child eat with friends and peers who have healthy eating habits and eat a variety of foods[iv].
    • This is especially important if the child is in an environment where they may be teased for eating healthy, once the child is of an age where their friend’s opinions matter,. For example, if the child is eating broccoli in the school cafeteria, and the children nearby call it disgusting, the child may be less willing to eat it in the future, even though they themselves see nothing wrong with the broccoli.  In such case, having friends who eat similar foods can help provide social acceptance.  The group of children who eat healthy food can also create the “healthy section” of the cafeteria.
    • It may also help to talk to the child about the fact that sometimes doing the right thing for themselves means doing the unpopular thing. This will be a good early lesson for dealing with peer pressure in general.
  • Adding fruits and vegetables to meals.
    • This normalizes the presence of these food groups as stand parts of meals, and frequent exposure to a food leads to it being more accepted.
    • Note: this applies to junk food in the same way as it applies to fruits and vegetables, so be mindful of the long- term effects of frequent exposure.
  • Establishing healthy food rules. Some examples:
    • Always eat breakfast;
    • Eat X pieces of fruit per day;
    • Eat X number of vegetables of a different colors per day.
  • Growing your own fruits and vegetables (if you can and are willing).
    • This has been found to lead to children eating more of these foods[v].
  • Avoiding take out whenever possible
  • Involving children in cooking meals for the family

What Does Not Work:

  • Establishing very strict rules for which foods the child may and may not have.
    • This has been found to lead to an increased desire for the food[vi].
  • Rewarding children with an unhealthy food (dessert) for eating a healthy food.
    • This arrangement makes the reward food seem even more desirable and increases the chances of wanting it[vii].
  • Watching parents diet negatively affects children’s food choices.
    • This is especially impactful if the parents’ diet is very restrictive, and as a result, the child’s access to food variety is limited[viii].
  • Giving children open access to snacks, such as candy
    • Predictably, this results in children eating less fruits and vegetables[ix].
  • Following some food norms which originated in a culture of food scarcity.
    • If a family’s food practices were established in another culture, and that culture had a scarcity of food, feeding the child as though they are still living under those conditions does not prepare them to deal with and make healthy choices in the face of the excess of easily available food in this culture.
  • Eating in front of the television.
    • This promotes mindless eating and makes it less likely that the child will listen to their internal cues.

In summary, “Adults are responsible for what to eat and when to eat, and children are responsible for how much to eat (i.e. determining when they are full) and whether to eat.[x]

[i]  Chan, L. Magarey, A. M. & Daniels, L. A. (2011) Maternal Feeding Practices and Feeding Behaviors of Australian Children Aged 12-36 Months. Maternal and Child Health Journal,15, 1363-1371. 

[ii] Williams, L. K., Veitch, J. & Ball, K. (2011) What Helps Children Eat Well? A Qualitative Exploration of Resilience Among Disadvantaged Families . Health Education Research, 26(2), 296-307.

[iii] Williams, L. K., Veitch, J. & Ball, K. (2011) What Helps Children Eat Well? A Qualitative Exploration of Resilience Among Disadvantaged Families . Health Education Research, 26(2), 296-307.

[iv] Campbell, K. J., Crawford, D. A. & Hesketh, K. D. (2007) Australian Parents’ View of their 5-6 year-old children’s food choices. Health Promotion International, 22, 1-8.

[v] Williams, L. K., Veitch, J. & Ball, K. (2011) What Helps Children Eat Well? A Qualitative Exploration of Resilience Among Disadvantaged Families . Health Education Research, 26(2), 296-307.

[vi] Birch, L.  L. (1999) Development of Food Preferences.  Annual Review of Nutrition, 101, 539-49.

[vii] Birch, L.  L. (1999) Development of Food Preferences.  Annual Review of Nutrition, 101, 539-49.

[viii] Birch, L. L. & Davison, K. K. (2001) Family Environmental Factors Influencing the Developing Behavioral Controls of Food Intake and Childhood Overweight.   Pediatric Clinical North America Journal, 48, 893-907.

[ix] De Jong, E., Visscher, T. L. S., HiraSing, R. A., Seidell, J. C. & Renders, C. M. (2014) Home Environnmental Determinants of Children’s Fruit and Vegetable Consumption Across Different SES Backgrounds.  Pediatric Obesity, 10, 134-140.

[x] Coleman, G., Horodynski, M. A., Contreras, D. & Hoerr, S. M.