Moms Talk with Dr Varisa Perlman [episode #2]: Picky eaters

Cecile: Hello, welcome to our moms chat! Hello Varisa, good morning. We’re waiting for a few more people to join us.

Dr Varisa Perlman: How’s the weather there?

Cecile: Oh, it’s fantastic! Florida in the winter is the best.

Dr Varisa Perlman: so, yes, I would say for everyone on my, uh, I've moved from Miami to New York and this is our first winter back up north for like 12 years and I always say that as it comes closer and closer to December. This is where the Miami, Florida people just start to glow, right?

Because they know, as we descend into a bit of the darkness of the cold, they're just. They're just blooming.

Cecile: Exactly, we're like, we're really Taking advantage of this time. We have no shame.

Dr Varisa Perlman: It's really, it's hard. We just saw some friends from, uh, who bought our apartment in, uh, Miami and just talking about the view and the water and everything.

We just you just don't get [00:01:00] that anymore anywhere else. people ask me, do you have a view? I'm like, I like brick now. Like I brick is my new beach.

Cecile: We get tired of watching the beach. Yeah, for sure. Hi everyone. Everyone who's joining, hello, hello. We're super excited to have you.

So while we are waiting a little longer, why don't you tell us, whoever is in here, if you're here for the Picky Eater topic, why don't you write in the comments, everybody, why do you consider your little one a picky eater? Like what is it that makes you be here today? Like what, what's the one thing or the couple of things that you think is like, Oh, that, that's that's considered picky to me.

And we'd be happy to dig more into that. And we have Fanny who's going to join today, who she wasn't sure if she could join. So she's coming in now if the system lets us so we'll see. Here we go. Hi Fanny. Hi.

Fanny: Hey. Sorry I'm late.

Cecile: Welcome. Welcome. You didn't want to miss the party.

Fanny: Yeah. That's an interesting topic for me actually.

Cecile: See, that's perfect.

Fanny: I'm right in a picky eater period for both of them, so.

Cecile: Yeah. How wonderful. We were just asking the audience. We have a lot of people who just join what it is that make their little one picky.

Dr Varisa Perlman: So, uh, while we're waiting for just to throw in as they're thinking about what makes their kid picky.

I want them to also think about what eater are you and your husband or your partner? I'm sorry So just a little little side look think about your kid, but also think about yourself . What eater are you and what eater is your partner? What eater are the other people who live in your household like because I think there's some relevance to that I'm gonna throw that into that for later.

Cecile: So we already have a few comments. Somebody's saying that they have a seven year old who only eats pasta and bread and veggies, only soup and no meat at all. Yeah, that's interesting. Um, we have people saying that, again, no vegetables seems to be a good one.

Cecile: Um, plays with the food but doesn't eat really. Yeah, that, that was my daughter too. She loved to play with it. Like playing Lego with the food. All done, huh? Um, mostly soup. Somebody's saying no, mostly soup. That's the only thing that goes down, soup.

Dr Varisa Perlman: I think soup is awesome. Actually, I'm going to throw that in. I think soup is a little bit of a gateway modality just because you can put all kinds of things in soup.

Cecile: That's interesting. That's interesting. Because you can see some people say it as being a, uh, an issue, I like to say, okay, we'll see what soup can bring to the table. And then whenever Fannie is back, she can also tell us what her issue is with her um, little ones.

Dr Varisa Perlman: I'm curious when we had talked before Cecile, you had really wanted to start out with that question. Yes. Can you go through why, why you thought that that was a good question to start out with? I thought that was an interesting response.

Cecile: Well, it's um, so, because I, I feel like there is two aspects to picky eating, it's the content of, of what the kid eats, but also the, the attitude towards the meal, right?

Like, so as I was talking to other parents, uh, as we were preparing for this it seems to be a mix of like, oh, they only eat this or that and not enough of this or should be more of that, but also like, The meal time in general is painful for the family and sometimes it's linked together. So I'm wondering if by the definition of picky eating, are we talking about mostly the content of the plate or the interaction with the food in general, which is together, right?

So that's why I wanted to get back to the, to the, the definition of picky eating, because as a professional, you probably see a lot more range of what people come to you and what do they generally come to you with. First of all, is it common for people to be complaining about having a picky eater?

And also, what is it they complain in general? Is it more towards what's in the plate or the attitude toward the food?

Dr Varisa Perlman: Oh, so I'm just going to bring in for those who have joined and are not aware both Cecile and Fanny are from France and the French are really pretty exquisite when it comes to really spending time to be present, to think a little bit about this topic, because the thing that you're trying to distinguish is What you eat and how you eat it.

It's two, there's two very different things. So the question becomes, I get this and this and this into my kid, but I literally am chasing them around the house to get it, right? Is that like a success or a fail? Like, what is that? Right, because the food is theoretically in the stomach does, don't I get points for that, right?

Yeah, you totally get points for that, right? Like you got the food into their stomach, right? But I will see, being in Miami, of course, I saw patients from everywhere, right? So particularly my French patients, it really became a question of how you eat. Yeah are you sitting at the table? Are you chewing your food?

I have heard stories, sometimes horror stories from adults who were like, my grandfather made me chew a hundred times per bite. I think it's obviously a bit of an exaggeration, but the fact that there's even any like rule, or dialogue about chewing your food is like the Americans are I don't even know what you're talking about like I don't I don't even chew like I mean, I'm eating in the car as I'm driving on the way to somewhere. I don't think the chewing really happened.

I'm not sure what happened. So I think that, without realizing, you guys are showing a little bit of your cards. The fact that you distinguished the two, because I do think that I would see, I would, if I, sometimes I work with a French family, the what they got in was amazing, was great, but the two year old wouldn't sit at the table for the whole meal.

And they were like, this is terrible. I had the picky eater and I was like, hold on. Right. Yes. There are elements that behavior wise at the same time, what you got in was you got carrots in and you got meet in you got like some grains and like you did a great meal. And I think that the reason why I think this is not, I'm not there to distinguish it, but I think that you can improve both by looking at both.

So what I would say sometimes is that I would see situations where the kids willing to eat the food, for example, sometimes we're busy in American life, right? So we chase them around. We want to eat, eat, eat, and they want to feed their kids quickly, right? The problem becomes that sometimes some kids are like, I don't want to be fed.

Don't feed me. I want to feed myself. And I literally had this very charming little boy who was a picky eater. The mom was “he's a picky eater”. Mom is Jewish and the dad is French. And they were very busy. Their life was really, really busy. And I said just out of curiosity, when you come like when you guys go sit down to eat does everyone sit with him? And they're like no, no, no, no, we don't have time.

Literally. We have the food. We try to feed him. We run, we do the laundry, but no one sits with him. And I said why don't you start sitting with him? Let's just just humor me and sure enough, this little boy was more French than anyone, right? Literally, would only eat if everyone else sat with him, had their plate too, was eating too, and they were conversing.

That's the only time that he would let any food touch his mouth. So it was like a fascinating idea of like how, so we got him to eat. A lot of diverse food by assessing the how, as opposed to just the what.

Cecile: That, that's uh, that's interesting because I, I feel like I remember my kid, uh, when she was 18 months old. Started to have that, Oh, I don't want to eat anything. Or at least that's what I was saying, because food was not an issue before. And all of a sudden they're like, no, no. And that's as a parent, you're like, Oh my goodness. I thought I had that thing figured out. Right. And now I'm like going reverse.

And I realized that if I offered two or three different food, meaning instead of putting the carrots and the cucumber together, I'd put two plates. Like, which one do you want? Then she'd be like, Oh, I’d pick that one. And then that, that was the end of it, of like her expressing her, her control and will of being like, Oh, I'm going to pick. And sure enough, she ended up picking one of the two, but the fact that she had control over that situation made it, made us go through that phase because I knew it wasn't something about the food itself, but more about. Her interaction with it, like do I get to pick?

Fanny, what do you, what do you have now with your, you said the two of them, you would consider them as picky eater.

What's your challenge?

Fanny: Zoey is more like the quantity that she wants to eat. So maybe it's, it's like an unfair fight because maybe she doesn't need that much food. But I always have the impression that she got not enough, so, uh, but even for the thing that she likes for example, pasta, she, she won't ask for more she, when she's done, done.

So for things that she doesn't really like, I need to push until that I have the impression she had enough. But yeah, that's more the quantity for her. And for Martin, it’s more like the, the texture, I think he's like learning all of the taste, everything. So that's for him. It's more like trying different things and made him like eat and like right.

And then he focus on the meal and don't throw it all over the kitchen. That's more like, but that's the age I think he's like at this age or he's like discovering the food. And Zoe, she’s always been a small eater. Even as a small baby, she, she was not like the, uh, a big eater. So, I don't know, it’s me that wants her to eat more that she really needs. I don’t know.

Dr Varisa Perlman: Yeah, I think that I always tell people, cause, we do start talking about food exploration around six months old, right? They start saying like the food starts to come in, but the milk is still more important, until nine months, right? So the nine months is when we crossover where milk takes a backseat and the food comes forward, right?

So we talk a lot about there's some thoughts of like maybe that weaning and the idea of like touching their food and that thing. But the idea is that, I always tell people, and that's the reason why I have you pause when you have discussions or thoughts about, wow, my kid is picky. The first thing that I do is I pause and say, well, how do you and your partner eat?

Like what, who's around them? Both genetics and environment, right? Because some people, both there are so many variations and eating style. You inherit that. Some people love to see big piles of food. Some people need everything to just like they get overwhelmed. They want it to be small amounts, right?

Some people eat a little bit walk away for a little bit. Eat a little bit. My oldest was notorious for that: eat a little bit, walk away, play, you think they're done, you're about to clean up, and then they come back They're like, okay, they're eating a little bit. I mean, it was just the way that they ate They just weren't all at once big users.

They're not like that even now there's not change, but I think the reason why I call it an arena is because it's one of the first places where what you come to the table with matters, right? So if you're somebody, it's so, there are so many if you were someone that your parent forced you to eat a lot, you might come to the table and say, I don't want to do that to my kid, or fall right back into that, that pattern because we come with our own baggage. So this is the first place where we get to get a look as to what's for better for worse trick during us, right? And what like thought process comes in and it's so fascinating because I know it sounds crazy, but control is a big deal.

Control is a big deal. This is what you're bringing to your mouth, right? This is what you're eating, putting into your body and being able to follow your cues of satiety, meaning like how full you are. It's something that we need people to still feel, right? And I think that when you are trained from a very young age to almost disregard that oh, you're full, it doesn't matter, you gotta still finish this.

My mother was notorious. My parents have very strong accents still. But my mother, we would be at McDonald's. Like, it's just random. I But the burger was like a dollar why? And you just get full, and she's like, no, no, you finish the meat, finish the meat., she'd open up the thing, but you have to eat it.

I don't even know what that was. Like, I don't know. But it's that thing where like, it didn't matter if I was full. It was just like, no, you have to finish this. And it's that thing where, it became, it, it, it, it became a control thing, where I almost don't remember being asked, Hey, are you full?

Oh, you're full? Okay, good. You can step away. Like, it, that wasn't in my, it was like, I will determine how much you eat.

Fanny: So we, we need to trust our kids on their own ability to say to us, I'm full. I'm full.

Dr Varisa Perlman: That's now, if they say I'm full, I want more dessert that that's different, right?

Fanny: So if they are full for the veggie, you still allow it. For me, it's a no.

Dr Varisa Perlman: no, no, no. And you may not even need a dessert because they're smart too. They're like, wow. If I say I'm full earlier, I get the dessert earlier. Yeah., you're right. ? But if it's more of a situation where like, I'm full and like say, okay, then you can step away from it's.

I think that it depends on what they got full on say, like I think that's, I mean, I was, I work with a nutritionist too, and I've worked with one, and she has this whole thing about not, trying not to like glamorize sweets, and that they're almost like, like on the plate.

Right. And so it's like that control piece is there. Um, I think that that's an interesting idea. I think that sometimes we underestimate how addictive sugar is. So I think that that's tricky too um, even for myself or for anyone. I think that like you alluded to this idea of like, not allowing the sweet to show up until later in the day if possible just because it starts to turn on that, that cue.

Um, but I think that if we're going to talk about people and kids being picky, we do need to take just a moment to understand that they live within an environment. And I think that we have genetics. I had one person that had written like, I eat everything, but my husband's picky and sometimes that might like loom over our head.

And be like, Oh my God, I don't want my kids to be like my husband or but there's a little bit of that thought that we could change that. And I think that eating style is something that's hard to like, change to shift. You have to work with it. Um, I think the thing that I really, really try to steer people away from is being afraid of mealtime, afraid of eating, afraid of food.

 We do a great job of that in our world of medicine., we do a lot of talks about, Oh my God all the allergies you can have, all the choking hazards. Like we do a really good job of making everything very scary for everyone. So good for us. So the, is that when children are like, if you're hovering over that kid, there's a lot of that.

How could mealtime be good? Like, how could eating be fun? And enjoy enjoyable and expressive and it it just can't be. So, sometimes we gotta check ourselves and say like, what are we carrying? And like, how do we interact with this kid? Because it's one of the first times where we do have to let go.

Cecile: That's a good point that you're bringing. You mentioned earlier that Fanny and I are from France, and France is known for their like, eating protocol and eating there is a lot of like French and food that goes together that is so like deep into who we are, but also what the exterior world think that we are.

And it comes with a lot of pressure because in French culture, if your kid doesn't eat according to the standards, you get like seen as a bad parent. Yeah, and I I feel that for me I'm sure a lot of people from the French community feel that and it's also creating putside pressure to like, oh my kid should be eating this, or my kid doesn't eat that, and a lot of it is also now in today's age becomes, has become, counter intuitive with what medicine now tells us or like what science tells us like, oh, lots of breads, you have to eat like a lot of milk and they have to eat all of that stuff and, and now it's going against what the beliefs are.

So it's also difficult. And now we're just talking from the French culture here, but I'm sure there are all the different cultures for different people of like the pressure from the outside of like what, how your kids should be behaving and eating and doing around mealtime because food is very deep into people. It's like a very strong belief system, right?

Dr Varisa Perlman: I mean, there's a lot of something called that we're starting to recognize as performative parenting. It's like, I think we've shifted from the concepts of helicopter parenting and now we're calling it performative parenting because now it's no longer that we're so focused on making sure that our kid is doing everything right.

We're looking around to make sure that everyone's watching us do a great job and that really gets funky right because now you're not looking at seeing like hey, well, what do you want to eat today? I mean, I think that your kid has a right to choose. Should I have right? Should I have celery today or should I have carrots, those are both good choices. And by being like hearing her and saying, what, I think she just wants to have a little bit of agency, right. And what she wants to eat today. It's a big deal. It's a huge deal. Now, the thing that I think it's a little funky., so, so, so you're not supposed to be looking at what would make you look like a good parent, right?

You're looking at what makes sense for my kid. So, the sooner you can drop that gaze, where you're like, I'm not, this is not about what everyone else says I should feed my kid. This is what, I think this is what my kid is like. Based on like, who their parents are like based on what the environment this is how I think it will make sense to this kid, right?

Now I think that, somebody had written, in the comments we're only eating like bread, we're only eating like sugars we're not really eating anything like alive, right? The thing that is tricky is that processed foods are addictive. They're made to be addictive.

 Unfortunately, frankly, I mean, there's no, we live in this world now and I think in many ways, it like, caught us, because we were in between age, where we were stuck in this place where we were, everyone was running from like, cooking all day. There's this whole thing of like, well, isn't this wonderful?

I could just buy a box of something and then I can buy a box of this and I can buy a can of this and I don't have to be in the kitchen all day. So it became like this, like the more processed food you ate, like the richer you were the more modern you were. Right. And then we hit a wall where no one knows how to cook anymore.

Right. We don't really have you don't, we don't walk into the house. I had a, I had a mom and I had a pediatrician, like a developmental pediatrician, Chinese medical doctor, he's like, everyone talks about picky eaters, but like, if no one is cooking, right, then it becomes a situation where...

You don't want to walk in and there's no smell in the air, right? Of like, food cooking, right? He's like, hunger being open to other food is not just about like, choosing one or the other. It's like, you have to start to like, smell something that smells good. Wow, that smells pretty good., and then eventually as you take little steps, food is not as scary.

So what somebody had written in the comments well, what do I do if they're only choosing those things? Absolutely. I mean, I think that that's the reality a lot of people have, I think that there might be a moment that you might want to think how do I, can I cook with my kids? Like, can my kids be in the kitchen with me or like at the grocery store, like choosing the food?

Can they, how do I bring them into that process? Um, I'm a big fan of that just because I feel like we live a very busy life and I would almost prefer that they cook with you than they, versus go to like three classes every day after school. Like I, I would, I'm, I'm a little old school like that.

Like how do we slow down time a little bit because cooking is a very important unwind for all of us we're touching things., we're like processing the day. There's a lot of things that happen with cooking that can be very good um, and I think that, if you start to unwind a lot a lot of the the tension and the hurry. It might be interesting to see as you start to like have them taste. My kids or I'm known for literally they'll be doing their homework studiously being so good and I'm cooking and I will literally come in with a spoon, right?

And they’ll be like “What is that?”. And I’m like “You must just try it, try this.” And they know, they don’t have a choice. They're gonna be trying it and I mean if that means but like a little kid that you let them like oh you want to try it? Let them put their, take a little bit out make sure it's not hot and let them just touch it and and eat it with their hand and like taste it and they feel “oh, this is this is interesting”. There's a chance right touching it and like experiencing it might start to make those foods a little bit less unattractive.

Fanny: Yeah.

Dr Varisa Perlman: Um, I love the soup because the soup is a great place to mix in all kinds of things so like, if you can, try to go savory. Bread and sugars are coming in sugars, like as you would know them, but also like in carbohydrates and sugars, there is less sugars in fruit. I do think that fruit is a better option.

Have I seen people over fruit in Miami? Yes, I've seen kids who are literally eating like six servings of fruit a day and nothing else. That's a lot. That's, that's a lot of fruit. So I feel like sometimes that can take over, but as much as you can in the beginning of the day, go with your less sugary things.

If you're going to use, if you're going to have like a bread or a cracker, try to spread something on that, whether that be peanut butter almond butter and, or even like a piece of cheese or two, because a little bit of that fat will slow down the breakdown of the sugars.

So they won't as much of a high: glycemic index changes. Sometimes they found that like if you've cooked rice and you leave it in the fridge and then you take it out and you heat it, that just makes it, it doesn't break down as fast. I know it sounds bizarre. Um, multigrain products are good. Again, just trying to sneak a little bit of that protein in so they're not getting that rush from the sugars.

Cecile: So you're saying the fat associated with the grains is better than just the plain grains.

Dr Varisa Perlman: Yes. It just, it doesn't shoot that sugar up so high and then pull that, that craving and so it slows down that whole process. So that, the addictiveness, the craving for sugars is blunted, not taken away, but it's blunted.

Yeah. Lentils are great because you're just trying to get those proteins in and just like and it could be legumes in any way. Butter is not bad. I'm sorry. I'm going to. I'm going to. I'm going to. I'm going to get very French with that. Butter is not bad. It's a fat., it's a good fat. It's a beautiful one.

You just want to make it so, and, and the less and less that you can have, and I know this is like a really tough role, the less processed stuff that you can have in the house the better. It's so hard. I'm not a huge fan of the pouches because I think it takes out the what. I know that there's kale in there, but there's also like mango and pineapple and one vegetable for like six fruits, so they know what they're doing.

I'd rather your kid take a spoon and learn how to take soup. I think that the squeezy things are easier and faster and maybe like in a pinch, right? It works, but I remember I was working in Miami and there's an abuela and she was giving, beautiful black bean soup to the kid while they were waiting in the waiting room for me to come in. And so I said: “Oh, I guess is that dinner?” But she was “no, no: snack”.

And in her mind, she was wondering “why does a snack need to be a chips? Why does it have to be in a bag? I just brought a little container and that's your snack”. Soup is an incredible snack. And I think that, in many ways, we have a lot of old school tricks that they use to get good nutritious food in that, makes a little bit more sense maybe for a younger kid.

I don't know if you guys have seen, there's this thing going on in TikTok where this woman took like a play kitchen and she customized it so that real water would come out that the kids could use. And it has a real fridge and the kids can train with.

Her kids are maybe around one and a half, or two years old. And they're coming out and they're opening the mini fridge, and she gave them their own cups and then she even gets an apple slicer. And so they can apple slice. What started because she thought “I’m lazy, I don't like to get up in the morning”, but then she started to see how much pride they had in doing their own care and doing that works for them. It was really aligned with a lot of Montessori ideas of like sense of ownership.

Think about chores. If you live on a farm, even in the U. S., I mean, you do chores for the minute that you can start to walk., we got you working. And they've found with ADD, which is something that we talk about a lot these days, one of the greatest therapies, is that kids who do chores at a young age had better outcomes with attention issues. The first way that we used to learn how to do things and monitor our attention was through chores.

Related to this whole discussion about food, eating, ownership: today we have a whole generation of older kids and have a lot of anxiety, and we're not sure where it comes from. Why are they like this?

And there's some thoughts as we're looking back and saying maybe it was from a lot of this helicopter parenting and literally ‘pulling the rug out from underneath our kids’ and by saying “No, you can't do that. You're not able to do that. I'm going to do it for you. I'll do it better for you.”

What's the long game? They will eventually be out of your house, right? Somewhere along the way, they must be able to know that they can do it. Imagine how terrifying it is for young adults to think: I'm supposed to go through that door, but I don't know anything. I don't know how to do anything. And we (parents) did that.

Like we've created that monster, we've created that space. How do we undo that? How do we do with young kids, Fanny's kids age? How do we start to give whatever we can back to them? So that they have ownership over it again?

Cecile: So you're saying that for parents who are deep into this right now and are looking at picking eating habits as their main struggle; you would encourage them to focus more on the long term view, and see that as an opportunity to give their children the keys to handle it forward. That the pressing issue seems to be picking eating but it might be time to take a step back and reflect on your parenting style and patterns in resolving conflicts and disagreement with your child.

Dr Varisa Perlman: The “picky eating phase” is the first moment where we – parents - get to see how we are. Your first instinct might be fear and you’ll hear yourself say “no, no, no, eat that one more bite. Come on, please!”

I had a friend. I love her. And she's a pediatrician and we'd sit down to eat, I think her kids were four or so, and she would start singing: “red is good, green is better.” As I stared at her in shock, she goes: “I have to sing, or they won't eat. If I don't sing, they won't eat.”

That's not normal. You shouldn’t do that. But she'd gotten so terrified of failing that she didn't know how to interact with her kids besides the superstitious singing routine or a constant plea: “How about that bite? What about one more?”

We all fall into that, I do that to my kids now (who are in college) and I hate it. I've been trying to like undo that myself because they literally shut down when I do so. They sense that we're not interacting at that point, we are fricking out.

On the contrary, I would love to use the food conversation as a tool.

How can we use this arena as a place where food is positive?
How food teaches you about satiety?
How it teaches you about control?

This idea that what you're putting into your body, you're gonna take ownership over it. It teaches you about doing chores, how to clean up after yourself, and to be a part of the family unit.

These are all things I didn't just make this up. I mean, you read books and again, I'm just gazing as an outsider of the French school system for instance. Lunchtime in France, they consider lunchtime as like a classroom experience. It's a learning experience. And they really expect kids to emerge from their education system with a clear understanding of like, to eat well is a responsibility and that is crazy for Americans, right?

Because we – Americans – talk a lot about “how do I make my child eat better?” Right? And I feel like the French are more “how do we teach our kids to take responsibility for how they eat?” That's very different.

Cecile: That's a good, that's a good point of view. Fanny, do you feel like it is like this for you too? Does this resonate with you?

Fanny: Yes, I really try to teach Zoey to understand which food she can prioritize, over others. Especially for sugar because she's very, very drawn to sugar. And when she eats sugar, she wants more sugar. Yes, so I really try to make her understand that yes, she can have sugar but is not a meal. A meal must a little bit of everything.

And I try to teach her, what is the protein, what is the veggie, what is the grain, … And for her to know from the very beginning that she has to have a little bit of everything to constitute a meal. And yes, she can have sugar, but sugar needs to be like dessert or like a little treat.

I’ve really tried to make her understand that from the beginning, so she grows with this idea that sugar is not evil. She can have sugar but alongside a little bit of everything else.

Dr Varisa Perlman: Well, actually scientifically, I was at this conference, and it was talking about glycemic index of various food. They gave this example of  a Snickers bar (that has nuts in it, and caramel, chocolate on it) and just a plain piece of wheat bread. The higher glycemic index is with the wheat bread.

Fanny: Yeah. Some breads are full of sugar.

Dr Varisa Perlman: Bread by itself yes. And so again, the French are brilliant, right? Cause they take the baguette and they put a huge slab of butter. And I don't see a lot of the French taking only the sugar, where it's like a sugar bomb, where all it is is sugar. They tend to throw in a little bit of protein with that, or fat. And that’s the trick, so that sugar doesn't punch so hard.

When you get that glycemic index and it gets thrown up..., what happens if the insulin tries to match it. So the insulin says “okay, I got to get rid of this”. The problem is that the sugar gets metabolized as you're not continually eating it. But the insulin is still high, and the insulin's tell your brain “come on, I need more sugar!”

Can you relate? I am personally notorious for it. If I eat something really sweet, I can feel the sugar. I have diabetes in my family so I can feel the sugar before I can taste it. It feels like I just got an injection or something.When this happens, what I do is I grab a handful of nuts to trying to get my sugar back down.

Some nutritionists suggest putting dessert on the table at the same time as the rest of the meal. Not such a horrible thing if you eat something sweet and you go back to the savory afterwards. You go back and forth between sweet and savory. It balances each other out. What's not great is, honestly, if you put everything out, obviously, and the kid doesn't eat anything else but the sugar, then you've defeated the purpose.

But I think there's something to be said about the whole idea of “if you're good... I'm going to give you (plain) sugar.” This is tricky. And this is why we get a little bit of a problem, sometimes in school, “Oh, you were so good today, I'm going to give you a lollipop.” I understand the Pavlovian idea, I understand what you're trying to do with my kid. I get it. But frankly, if I eat too much sugar, I feel sick. Probably as sick as if I was, if I was hung over, I don't feel that good. So I hate this idea of my kids having this psychological attachment to something that probably doesn't always make me feel so good. Like being rewarded by something that feels bad. That’s a whole different problem.

Cecile: You bring up a good point because, we are parents, we are all trying really hard to do good at home in the environment that we control to some extent.

But, as our kids get older, they spend more and more time outside of home. And whether it's daycare, whether it's preschool, whether it's school friends, relatives, they are out of our controlled environment. And it's difficult to continue on that path of making suggestions, giving them control, including them into cooking or teaching them the good of having everything into one plate. So how can one do to cope with it. Is it a lost battle?

Dr Varisa Perlman: I'd like to think it’s not. I mean, I'm hearing more and more schools unfortunately more magnet and smaller schools and private schools make conversations about food.

You know, no one's really brought it to the level of the French government and the French schools. American public schools are definitely not like that, but I think that what you do is always worth it. I think that what you learn at home is just as important as what you learn in school. So I would never give that up. I think it's hard because I would love is for people to become more and more involved in the conversation so that we can make schools better and enact that space.

But I think in many ways, we culturally live a fast life. And I know the conversation about cooking is a hard one because it is time consuming and it does require you to learn. I think soup is a great thing to learn, right? You just throw a bunch of stuff in the pot and it generally turns out pretty good actually. So I think that's not bad to start with.

I know I taught myself how to cook later in time and so that's why it became such a powerful thing for me. My mom cooked every night, but she also was the worst teacher ever so she never had any intention of teaching me how to cook. And I was of that generation when she'd rather have me study than help her in the kitchen. I would have probably preferred to help her in the kitchen, but she just didn't want to have it. And in many ways, I'm part of that generation that had to rediscover ourselves.

And so my husband was the main cook for a good portion of our life, about 10 years. And after that, I realized I speak so passionately about food, but yet, I can't cook. I felt like there was a disconnect. And so I though myself to it. And my kids can attest to it, I would go “tonight is German night!” and there would be five German dishes on the table. “And tomorrow is Nigerian!”

Cecile: I think cooking is intimidating. Because some people also make a big deal out of it when cooking can be as easy as putting eggs in a pan. It doesn't have to be this very elaborate.

Cooking is just the fact of transforming something raw or getting something out of the fridge to make it into something that's consumable. So, for example, at my house, we do a ton of salads. We're lucky we live in Florida, we don't necessarily need a ton of warm food.

Making a salad is super interactive. Everybody can pick what they want in it. It has a wide range of flavors to it because you can add sweet, salty, fat, whatever. And it is cooking because you get something on the table that has intent and thoughts into it.

Don’t be intimidated by the word “cooking”. Cooking does not necessarily mean that you are running a restaurant. The intent of bringing something to the table that is not microwaved or just out of a box is key. Transforming raw ingredients into something that can be eaten. More than cooking like an Instagram chef.

Dr Varisa Perlman: Absolutely. Yeah, it doesn't have to be a hot food. No, it's the idea of working the different ingredients.

Cecile: It doesn't have to be something super intricate that cooks for five hours.

Dr Varisa Perlman: Yeah, I definitely came out of that frantic phase. I still try to do things here and there, but to me, I think what was really joyful was the process.

My son Andre was a kid who was not really finding his space. He was a decent student, like A/B, but he was that kid that would fidget a lot, move around a lot would play video games: your typical kid at the elementary school age. And then somewhere along the way, I had this cooking epiphany. And I told him “Fine, you will be my sous chef!” and I would grab him from whatever he was doing to help me.

“Saute that and just shake it around” and in the beginning his response was “I can't! I can't! It's hot! I don't know!” but we kept on going and each time we would get a little closer to it. So I was learning at the same time as he was and I know that it sounds crazy but just that act of being in the kitchen paying attention, aligning his physical movements to his attention, he started becoming a straight A student.

He did much better in school, which was like wacky. Because I didn't really realize how much, again, this chore - that we had taken for granted - was probably a helpful way for him to learn how to work with his body and then work with his expectations, judge things, work with a little bit of his instinct. And I will always, always give credit to cooking.

I always tell parents that the answer is usually right in front of us. And what’s hard is that we always feel like everything is stuck. “We have to do it this way”  or “we have to do it at this time”.

So, I'm always recommending to start ‘basic’. Even if it means that everyone just sits down for five minutes together. And just grab something to eat. Start there. Even just the act of it can have an impact.

And then maybe start cooking. But you don't have to feel like you have to do everything at once. You don’t need to have these amazing gourmet meals, like every night, all at once. You're never gonna do it, it's just too intimidating. It’s not the way that it works.

Cecile: Can we also throw in that to try to stay away from the norm? So what, what is the norm and what is for you as a professional, what is out of boundaries?

When should parents say “that's really a problem. Now, I have to seek help”. Compared to what is just within the range - a very wide area of options - around mealtime and food and kids and ‘picky eaters behavior’.

Dr Varisa Perlman: Yeah, that's a great question. I think that there's a couple elements that I think needs to be watched. One is growth. If your kid is having growth issues then you probably need to have a really deep conversation with your Pediatrician and some follow ups to track their growth and track their intake. If growth is affected, then it is no longer a ‘style’ but a substantive problem that can affect their health.

And I'll be honest with you: when I see kids who are only eating carbohydrates and sugars, growth gets funky. The protein is needed, especially as you start, inching into like six years old, seven years old. Girls get their period sometimes at nine. I know that sounds crazy. My point is that puberty is right around the corner so that's a heavy growth period that needs resources.

Toddlers, who are literally like running up and down everywhere, if they're not getting any protein, they just burn it all up. So a lot of times, whether it be legumes or fats, or nut butter, I'm always encouraging parents to try to get those in at least in the morning. I had some kids we I resorted to a spoonful of almond butter for breakfast. There's nothing pretty about that. There's nothing elegant about that, but at least it gets that protein hit and I something is just starting to go.

After school, they're starving. Don't grab snacks. Back then, I would pick up my kids and we would go to a dinner, and I would be like: “okay, here's some soup”. It’s almost like having a mini-meal. Because timing is everything. Don't give them a big glass of juice (I'm not a big fan of juice in general, because it's all sugar), but don't give them a big drink, even a big glass of water. Don't give that right before you're about to eat, because where their stomach can only hold that much and you don’t want to fill them up with “the wrong things”.

There are two reasons to be picky: One is if they're full, or two, if they're addicted.

If there is a lot of sugars showing up (without the fats) pulling them all day. Then they have a hard time being able to resist more sugar. Try it yourself, if you eat something really sugary in the morning, you'll see your desire for sugar the whole day. You're like: “I just want more”. You just physically can't see anything else. It's just the way that sugars are these days for us.

So, that would be the first alarming aspect: if growth is really bad.

Second reason to seek help, if there is an incredible amount of fear around food. Instances where the kid is literally screaming, yelling, tantrums, hitting people because they're not getting the food they want, and a lot of that extreme behavior. I know this is the part that I might get some flak for, but when you are having a kid that has a lot of sugar in their day, and you start to decrease it, you have to treat it like an addiction.

Which means that there is frank withdrawal, where sometimes it makes them aggressive. They go through frank withdrawal. And I had a mom, she was like: “ No, my kid's not addicted to the cookies.” And I said, “okay, fine. Just put them up on the cupboard. Hide them. And I'll see you in a month.”

I saw her a month later and told me: “Oh, I'm so sad. I put the cookies up on the cupboard and came in to find my three year old climbing the shelves to get them”. Her kid would rather risk his life to get the cookies. I don't think that people realize that stuff's real, that withdrawal: it hurts, it's painful.

I obviously I'm exaggerating, but I did not realize that like being in pediatrics would be similar to being in a drug rehab. I have had to detox so many kids from sugar.

Cecile: But it is real. It is real. And again, when you start getting your kid out of your house. The problem is also like all those addictive foods are also coming back into their, into their life, into the system. I remember you as my pediatrician (because I don't know if everybody here knows, but you used to be the pediatrician for my kids and Fanny's kids when you were in Miami) you mentioned that ideally at home you would give them everything opposite to what they eat outside of home.

You mentioned one day, that if you can be as extreme as being no carbs and no sugar, that's golden because whenever they step out of the house, the one thing they're going to eat for sure is either carbs or processed food or sugar.

So there is, they're not going to have a lack of that in their diet And I took that with me and I was like, damn, like it's intense. But if we want to make a balance, we have to take into account what they eat outside of the house. And what they eat outside of the house is all the easily accessible stuff and the sugar.

Add to achieve a balanced diet, one need to reach for the extreme at home: kinda no sugar at all. It's, it's a hard balance to keep.

Dr Varisa Perlman: Yeah. Yeah. It's really hard. It's really hard. And I think that we just don't always live in a society that supports this eating mindfully at home being able to like chew your food and being in a good space. And I think that's just the reality of it and you may go extreme at the beginning just to detox everyone (and you can maybe bring in a little bit here and there) but I think that sometimes if you can understand that you are fighting a little bit of societal space that isn't going to be the most supportive on many levels because again we value convenience more.

Many people are spending after school running around to 2 or 3 different activities every afternoon after school. And I mean, that's not when is the cooking happening? And what snacks can we bring? In Thailand my father and my uncle would have these metal dishes that were all stacked up where in the American culture, we'd have like chips or like some crackers or some bar.

And literally my dad would have a little meal right there at 3 o'clock. And it was that thing where we've subscribed to this whole idea of like convenience here is the U.S. We're a part of it too. I would have parents who tell me “well, I don't really eat a lot of meals, I do a lot of smoothies and whatnot.”  Then why are you surprised that your kid won't sit down for a meal? In their mind, you kid in probably thinking: “I’m going to pouch while you take that smoothie. That's our meal time together.”

Sometimes we just need to like take a moment. And if your kid is growing, and you are relatively healthy, and you realize that you aren't home at a great time to be able to do this and that, give yourself a little bit of grace.

One step at a time: one meal a week I'm gonna cook, or this one time of day I’m gonna do this, and it has to start small. Because it's not fair, you can't do it all at once.

Maybe instead of giving a bag of chips and assuming my kid can eat nuts outside of the school, switch to nuts. I think the nuts are much better it doesn't give you that high, And they're really hungry because usually mealtimes are terrible at schools, And so like they're running around most of the kids are not eating. If they are eating, I don't even know what they're eating, it's a mess.

So let's assume that they're really vulnerable at three o'clock when you pick them up from school, that's the time to get some good food cause they're starving and use those opportunities to broaden their palate a bit because they're so hungry, you can use that in your favor

Cecile: That's a good point you’re bringing. To listen to their cue of “I'm hungry now” and even if it 4pm. Again, we're going to talk with the French filter that we have because at four o'clock for French people, it's sweet snack.

In France, you get an afternoon four o'clock snack, but maybe you could have a meal at that time and it's okay. It doesn't comply with the French way of doing things, but it might be more fulfilling in giving more things to your kid. And worst case scenario they're not gonna have that memory of the afternoon snack, but they can have a memory of the morning snack of another type of snack.

Dr Varisa Perlman: I'm gonna defend the French again.

Okay, that's, I just came from Paris and, yes, we did participate. I don't know why: 3 o'clock, I was like: “I think it's time for an éclair. I think I need an eclair.”. Do I do that here? No, I don't, I don't randomly need an eclair at 3 o'clock. But all of a sudden everyone seems to be getting one so why not.

And when you look at it, an éclair there's cream in it. So it's not all sugar, there is fat as well. And I was perfectly happy, and I will tell you, as usual, I went to Paris and I've lost weight. I know that sounds crazy I would take an eclair over a bag of crackers any day.

Cecile: That’s a very good point and a great take away from today's conversation: don’t fear the sugar but add protein or fat to it. Because it's easier to add to something than removing something. Especially for kids: “Oh, you want bread? Sure. You can have bread. I'm going to put butter on it.”. As a parent, this makes me feel like I don't have to fight to say no to the bread.  

Dr Varisa Perlman: Right. And I think that that's very doable. A little bit of a doable segue. To helping then with the satiety. Not giving the sugar high. Having boundaries, yet still allowing some of it to be there. I think those are all ways to work within what you have.

And honestly, if you have like a spouse or yourself and you've a little bit of pickiness, use this opportunity: “how do I get a little unpicky? What would work for me?”. And I think I love using children and your experiences with children to better yourself.

To heal whatever weirdness that you might have with stuff. And you're right: some people just don't like this or they don't like this. They have every right to not like everything in the world, but you have to be willing to try it. And maybe once you learn how to cook it, well, maybe if you learn that if you make it with this, it will taste a little bit better, and so on. So that's where the ‘using the cooking and the tools’ gives you a little bit of an open door.

Cecile: Well, we'll wrap up on that. It's been an hour. I don't know if anybody in the comments or here watching got some valuable information on this topic. It was a pleasure to see you ladies and we'll talk again in two weeks for other topics which we haven't determined yet.

Thank you very much Varisa. It was fantastic having you and thank you for your valuable insight as always. Have a good one. Bye Fanny, good luck with your little one.

Dr Varisa Perlman: Bye!

Fanny: Bye! Bye!

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