The skinny on kids' diets.

Health and medicine explained.
Dec. 19 2006 11:07 AM

The Skinny on Kids' Diets

Revisiting 1928 wisdom.

Ever since I became a pediatrician many moons ago, parents have been pressing me for advice on feeding their children, and I have been blithely reassuring them that the best thing they can do is to pay no attention to what their children eat. In support of my laissez-faire position, I have cited the pioneering studies of Clara Davis, a Chicago pediatrician who began publishing in 1928. Truthfully, I cited them even before I actually read them, because what I thought they said suited my message about eating—"leave kids alone!"

When I actually read Davis' papers, my sense of them turned out to be about right. Davis was a skeptic who questioned the conclusion of the time that medical science had definitively established the precise nutritional requirements for children, and that parents needed to follow these rules exactly. Three-quarters of a century later, that rule-bound view still seems suspect. Davis' findings, on the other hand, appear to hold up—but must be adapted to the era of the Twinkie.

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A recent article in the journal of the Canadian Medical Association by Stephen Strauss, a journalist who is writing a book about Davis, depicts the historical context for Davis' work. Davis seems to have been remarkably brave, willing to confront the inflexible authority of the leading pediatricians of her day. Her attack on their dietary and behavioral prescriptions was based on a model of childhood centered on joy, pleasure, and self-determination—a radical notion then (and, for some, even now).

In Davis' day, some medical authorities went so far as to recommend essentially starving recalcitrant children until they submitted to the prescribed dietary regimen. Dr. Davis, by contrast, believed in the "wisdom of the body." Offer children a range of simple, healthy foods, she counseled, and without direction they will assemble for themselves a healthful, balanced diet, one that even would correct nutritional deficiencies.

Davis set out to prove her theory with an experiment that would be unthinkable today. She conducted a long-term study of the foods children self-select by stocking nurseries in two Midwestern hospitals with orphans and children whose mothers couldn't support them, and rigidly controlling the foods to which they had access. The experiment began with three orphans aged 7 to 9 months (there is a hint that she later adopted two of them) and ultimately included 15 children. Davis began studying each child just as he or she was being weaned, so later food choices wouldn't be affected by earlier eating experiences. She studied some children for as long as 4½ years, offering them foods drawn from a list of 34 ingredients, plus water. These included such instant baby-pleasers as turnips, cabbage, spinach, bone marrow, sweetbreads, brains, liver, and kidneys. To be fair, there were also other vegetables, fruit, whole grains, eggs, beef, lamb, and chicken. Distinctly absent were candy, soda, ice cream, and prepared foods, and even foods like soups or bread that could be made from the 34 ingredients on the list. Food was never served, but simply made available. Nurses trained not to encourage or discourage eating, or to influence food choice, were present as needed to help with the feeding.

Did the experiment work? For my purposes, very well, since the results pretty much support the advice I've been giving parents. Davis found that each of the 15 kids she studied selected a unique diet for himself or herself. The kids might binge on foods that attracted them at one meal, but by the end of the day (or, truth be told, several days), the total food they'd eaten added up to a nutritionally perfect and complete diet for every one of them. The kids grew well and Davis described them as unusually happy and healthy ("rollicking and rosy-cheeked").

This was surely the largest and most comprehensive study of dietary self-selection by children that has ever been done—indeed, that is ever likely to be done, since we would no longer permit children to be placed and observed for years in an orphanagelike ward, no matter how jolly the hospital or laudable the research. Modern study of children's dietary preferences is more focused on simpler questions: Are children born with a preference for sweet taste? (Yes.) At what age does preference for salt emerge? (About 4 months.) Can we successfully change children's eating habits? (Maybe.) These questions bear on the foods children are likely to select if they get to pick. But they cannot replace research in which children are observed to see how they exercise choice.

So, however problematic, Davis' results continue to be of great value. And they reinforce my beliefs in the power of individual taste and the idea that parents don't need to tell their kids what to eat. At the same time, this wasn't much of an experiment. Only 15 kids in an unnatural setting, cared for by staff, eating weird foods, and under constant observation. And then, at the end, the result of this weirdness was compared with—what?

Is it valid to apply Davis' findings to contemporary children? As she herself pointed out in a lecture to the Canadian Medical Association summarizing her life's work, probably not. The children in this study were limited to an experimental diet based on a very narrow range of choices. There were no prepared or specially flavored foods, no sweet desserts (except a little fruit) and no rich, fatty foods. We have no idea how the experiment might have turned out had the children also been able to choose from these ingredients.

But we do have some suspicions. If kids today were asked to self-select from foods that included healthy options but also potato chips, chocolate chip cookies, Coca-Cola, cheeseburgers, and candy bars, I am skeptical that their diets would end up as well-balanced as the children in Davis' study. They would have to contend with our innate taste preferences for the sweet, the rich, and the delicious.

Still, Davis' work suggests some feeding strategies that are likely to have a better outcome than either choosing everything that goes on your child's plate or giving in to every request for snacks and dessert. Provide kids with a choice of healthy foods, keeping less-healthy ingredients out of the house. As best you can, resist your impulses to try to control your child's diet. Then (as with everything else involving kids), stand back, bite your tongue, and hope it works.

Sydney Spiesel is a pediatrician in Woodbridge, Conn., and clinical professor of pediatrics at Yale University's School of Medicine.

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