An Open Letter to: AIA, Sovereign, Gemma McCaw, Cory Jane, NZ Teachers, Educators and Parents

22nd August 2018

To ‘The Healthiest School Challenge’ development & support team, Gemma McCaw, Cory Jane, New Zealand teachers, educators and parents.

We are writing to you express our concerns with the recently launched ”AIA The Healthiest School” challenge. We are healthcare providers working in the field of eating disorders, body image and anxiety around food and bodies. 

We commend and support AIA & Sovereigns interest in health promotion (and extra funding toward sporting equipment) however we believe the risks associated and potential harm caused albeit inadvertently by this program outway the perceived benefits. The Healthiest School competition and its intended us of pedometers by school aged children is problematic for the following reasons:

* Any motivation for children to move their bodies is all externally driven, there is no intrinsic motivation. Is this something that is going to encourage children to engage in health behaviours long term? We predict children will most likely lose interest either before or after the 6 week mark. At best, this competition/initiative  is likely to be ineffective, and at worst extremely harmful.

* This challenge reduces health to a number – and just one aspect of health (exercise) at that. Sending this message to children who are concrete thinkers puts children at risk of disordered thoughts and behaviours around health. This program does not consider a child’s emotional or mental health.

* The use of pedometers encourages children to disconnect from their body, instead relying on technology to tell them how much to move. Furthermore the use of pedometers and other devices measuring steps or energy expenditure teaches children to ignore important intrinsic body signals informing us when to move and when to rest. This ability to rely on internal regulation – a feedback system that is unique to each of us and communicates on the specific needs of our body should be nurtured not stomped on by the repeated silencing of body signals and reliance on external cues for movement and exercise.

* Inititiatives prioritising exercise further reinforce the dominant pedagogy currently used in nutrition and health education to school children – one that is deeply healthist, discriminatory, stigmatising and exclusionary (it is inaccessible for our most economically and socially deprived children, children of ethnic minorities and children living in larger bodies). Programs designed to target childhood obesity, through the promotion of measured energy expenditure and/or intake further reinforce the currently accepted, and incorrect narrative, that the size, shape and weight of our body is a good and accurate representation of our health status and wellbeing – and that deliberate, controlled and measured exercise will attain a body symbolic of “health”.

* This challenge is exclusionary to less physically able, those with health conditions and children with less access to extra opporutnities for movement outside of the school environment.

* The competitive nature of the challenge introduces an opportunity for children to build a self-concept (or view of self) that is rooted in deficit, not measuring up or being “good” enough, or “contributing enough” to the collective effort. School children experience a range of developmental changes both physically and emotionally, including navigation of interpersonal relationships, coping with conflict, bodily changes and development of puberty that are all associated with an increased body preoccupation. We do not need to introduce monitoring and measuring devices that will further encourage engagement in body checking behaviours and potentially facilitate the development of eating and exercise pathologies.

*Self-esteem becomes linked with a number on a pedometer with pride associated with a high step count, however this a case of diminishing returns resulting in children seeking to acquire higher steps than the previous day/week or competition school in ways that do not protect a safe relationship with movement and body. This creates a space for children to develop an antagonistic body relationship, one of guilt, shame and anxiety.

* We have been unable to find any materials associated with the program that offer guidance, advice and tools to assist in the screening of eating disorder behaviours or the predisposing risk factors for the development of an eating disorder, anxiety or obsessive compulsive behaviours – children whom are at most risk of disordered eating/exercise thoughts and behaviours have the potential to be triggered by this program.

* We encourage the inclusion of information and support for teachers to be able to competently recognise harmful behaviours/obsessions in children and outline steps to take after identifying these children in order to access timely intervention and support.

We ask if the possibility of a temporary increase in a child’s physical activity, through an initiative that has not demonstrated an extension into fostering a healthy relationship with exercise or body, worth triggering disordered eating, eating disorders or pathological exercise behaviours in children who may already be susceptible through varying levels of trauma – bodily and/or psychosocial – by inviting an initiative encouraging the use of pedometers/step counting, stigmatisation and discrimination of bodies? 

In permitting this program to go ahead unchallenged, we would be failing in our responsibility to work proactively in Eating Disorder prevention as; providers of eating disorder recovery services, a mother, and size diversity and body liberation advocates. We hope you will reconsider the appropriateness of this initiative in light of the concerns shared here in and we are keen to work with you to modify or redevelop this program should you see value in these concerns and recognise the serious risk of harm.

Many thanks,

Sarah Peck & Jessica Campbell

Eating disorder dietitian, mother- of-3- girls, nutritionist, medical student and size diversity & body liberation advocates.

Sarah Peck is Auckland’s Body Balance Dietitian supporting eating disorder recovery. Sarah specialises in childhood and family nutrition, food flexibility and improving relationships with food and your body.

As a non-diet approach Dietitian Sarah can support you to regain trust in your body through intuitive, mindful eating practices and self-compassion.

Sarah is available for 1:1 consultations and facilitates the in school program “Feeding our Futures” supporting teachers to engage in safe conversations about food and bodies, and the delivery of developmentally appropriate nutrition education in the classroom.

Jessica Campbell BSc PgDip, is a Non-Diet Nutritionist & Medical Student passionate about weight inclusive healthcare practices and Eating Disorder prevention & therapies. 

Jess is a New Zealand based non-diet nutritionist and owner of Body Balance Nutrition, a provider of food and body positive nutrition and dietetic care and eating disorder recovery services New Zealand wide.

Jess is active in the HAES New Zealand working group and co-facilitates the NZ Diet Free Nutrition and Health Professionals online network.

Coeliac disease in children – treating the whole child

By Sarah Peck NZRD | Eating Disorder and Family Feeding Specalist Dietitian

 
**The focus of this piece is on coeliac disease, there are similarities, but also differences, between managing various health conditions requiring food restrictions, please keep that in mind when reading**

I am a dietitian and a mum of three girls. My nine-year old twins have coeliac disease, for which they require a strict gluten free diet to help manage symptoms and health outcomes.

For many, there is no choice but to restrict certain foods from a child’s diet. My experience is that our health and medical profession have done (and continue to do) a good job in caring for the physical health of my children.   However, and also in my experience as both a parent and dietitian, I feel that we are missing a piece of the puzzle when treating conditions like coeliac disease in children. Emotional well-being is often left out of the equation. The intention of this article is not to induce fear, but an attempt to raise awareness and  a call for us (health professionals) to engage in these conversations with families to provide ALL the information we need to care for both the physical and emotional well-being of our child(ren).

Coeliac disease is an autoimmune disease that can have serious health consequences, it comes with a long and varied list of symptoms that may affect quality of life, result in nutrient deficiencies, higher risk of poor bone health and other autoimmune diseases including type 1 diabetes, thyroid conditions, and some cancers. At present, the only treatment for coeliac disease is following a strict gluten free diet FOR LIFE.  There are no medications or pharmaceutical drugs to effectively manage this disease.

Let’s take a look at another health condition that can also have serious health consequences……Eating disorders.

Eating disorders are a serious threat to our physical and emotional well-being and in fact have the highest mortality rate of all mental health disorders. The origins of eating disorders or disordered eating are varied and complex. But let’s explore for a moment, just some of the risk factors and how they relate to managing coeliac disease, allergies and intolerances in children.

Biological

much like coeliac disease we know that genetics can play a role in the development of eating disorders and can co-exist with other genetic health conditions including allergies, coeliac disease, type 1 diabetes and other autoimmune diseases as well as mental health disorders e.g. anxiety disorders. Like many health conditions, being genetically predisposed does not guarantee you will develop an eating disorder but it does make someone at higher risk especially when exposed to other biological and environmental factors.

Trauma & Stress

Traumatic and stressful events can trigger disordered eating thoughts and behaviours. Having being diagnosed myself with a chronic health condition and our twins with coeliac disease, it’s fair to say facing a diagnosis of a life long condition is very stressful. It is a common and very human reaction when we learn we don’t have full control over our health (or our children’s health) to become focused on the areas of our health we think we can control, e.g. our body size or the food we eat.

While engaging in health promoting behaviours to help manage conditions is a reasonable thing to do, hyper-focusing on food and weight can lead to disordered eating and taking us further away from our original goal of improved health.  Research shows that food restriction puts you at higher risk of disordered eating thoughts and behaviours. The tricky part being that when you are diagnosed with coeliac disease, you have no choice but to be hyper-focused on food and feeding practices if managing your disease is a priority for you. Your physical health relies on it.

Another consideration is food insecurity. While quite different to the level of anxiety stemmed from not knowing when you can next provide a meal for yourself and your family, managing a health condition with food restriction does contribute to a certain level of food insecurity.  The stress of not knowing if there will be food or enough food to eat at a school or family event, on a school camp, a friend’s birthday. While some children may externalise their anxiety, many may internalise their feelings of stress around food. We need to consider the daily compounded stress and impact on our children from this type of food anxiety. While parents of coeliac children work extremely HARD to avoid situations like this for them (exhausting right?), we just can’t control every situation.

Social aspects

As a child grows, particularly towards adolescence they naturally seek more independence when it comes to feeding themselves – usually wanting to eat out more with their friends.  Adolescence and older children also tend to avoid standing out as being different. This can lead to those with food restrictions choosing to rather not eat than draw attention to themselves by trying to find something that fits within their food constraints.  Compounding those factors along with a period in their life when peer pressure, body dissatisfaction and dieting are rife, is it any wonder we are seeing an increase in food anxiety and eating disorder thoughts and behaviours in this age group.

For me, a dietitian but mostly a mum, the distress of my children’s diagnosis 4 years ago came down to that the fact that the management of one serious disease (coeliac disease) puts my children at risk of another serious disease (an eating disorder).  

WHY ARE WE NOT TALKING ABOUT THIS MORE? As an eating disorder and family feeding dietitian it’s my mission to ensure these conversations are being had with families.

So as parents, what can we do?

  1. Impose the least amount of food restrictions as possible on your child. It is tempting as a parent to want to fix our child’s health. Conflicting and often well-meaning advice can leave us trying to remove further food groups. If you suspect there are other intolerances (which does happen) I recommend seeking advice from a NZ Registered Dietitian before restricting your child’s diet further. If looking to improve nutrition, think about what you can add in rather than take away. I recommend to all parents (including those with coeliac disease, allergies and intolerances) to follow Ellyn Satter’s Division of Responsibility when feeding children.
     
  2. Have compassion for yourself and your child in this health journey. Parents and caregivers are their number one support and heavily responsible with how their health is managed but we do need to teach children to manage their own condition for their life-time and that does mean accepting they will make mistakes along the way – much like acquiring many other skills. You will also make mistakes. I’ve made mistakes, mostly due to the highly stressful situations clouding my judgement and thoughts. If your child has an anaphylactic allergy on top this adds another level of stress to the situation but I still recommend compassion for yourself and child while doing your best to follow the advice of your allergy specialist in managing their allergy.
     
  3. Your child is going to have autonomy over their health and food choices as they grow, reframing the disease management from restriction to self-care can help them learn to manage it with increasing independence. Every human being has different needs in terms of looking after their health and well-being. For children diagnosed with coeliac disease, threading through the dietary management as part of looking after themselves and their body can help them to WANT to manage their health and take care of themselves rather than something we say they just HAVE to do. Of course, it is important that they understand the serious consequences of not managing coeliac disease but I have seen instances when scare tactics have led to the naturally and understandable rebellious actions of not following a gluten free diet.
     
  4. If your child experiences food anxiety that impacts their daily life– please get your child extra support. Your GP will be able to refer you to a counsellor, psychotherapist, psychologist, or dietitian experienced in this area. Look at other risk factors for disordered eating that you can influence  e.g. creating a body positive environment, less exposure to dieting, coping mechanisms for anxiety disorders, avoidance or careful management of participation in aesthetic or appearance-based sports e.g. gymnastics. There are some children who will go on to develop eating disorders regardless of managing other risk factors, please know that is not your fault but early intervention is key.
     
  5. Seek support for yourself. You may experience a certain level of anxiety and feel the need to be hyper-focused on food and food labels, however try not to transfer your anxiety on to your child. Having support and your own coping mechanisms can definitely help with that. Whether it is through a health professional, friend or support group that understands your stress. It is well worth seeking that support for yourself.
     
  6. Gain further awareness of the side effects of food restriction. The health and medical profession is letting us down on this one. You should be made aware of the side effects of a pharmaceutical drug prescribed to your child. Why are we not being made aware of the side effects of food restriction to manage health conditions? Unfortunately, we aren’t given many choices on managing this condition for our children but at the very least if we are made aware of the possible side effects, we are able to watch carefully and be proactive to care for our children’s physical AND emotional well-being. I know as a parent, that is all that we can hope for.

For more information about eating disorders visit:

www.thebutterflyfoundation.org.au   

http://www.feedyourinstinct.com.au/ 

 

Sarah Peck is Auckland’s Body Balance Dietitian supporting eating disorder recovery. Sarah specialises in childhood and family nutrition, food flexibility and improving relationships with food and your body.

As a non-diet approach Dietitian Sarah can support you to regain trust in your body through intuitive, mindful eating practices and self-compassion.

Sarah is available for 1:1 consultations and facilitates the in school program “Feeding our Futures” supporting teachers to engage in safe conversations about food and bodies, and the delivery of developmentally appropriate nutrition education in the classroom.

Can my baby be allergic to breast milk?

JESS CAMPBELL
Nutritionist. Medical Student. Nigella Fangirl. Bookshelf elf. Tiramisu Connoisseur. Diet Non-conformist.

I’ve reached the age and stage where friends are marrying and starting their families. Unsurprisingly I frequently find myself chatting babies and nutrition with my girlfriends.

A common question circulating conversation is about transient infant allergies or intolerances and whether mums diet affects babies symptoms through the breast milk she produces?

“Breast milk provides baby with the optimum nutrients and mums nutrition tees this up.”

As a degree qualified nutritionist I am a believer in ‘breast is best’ up to 4-6 months of age. Breast milk provides baby with the optimum nutrients and mums nutrition tees this up. Sure, there may be a few dietary implications for mums when it comes to breastfeeding but as a general rule-of-thumb if mum is fed well, baby will be well fed too.

Here are a few general tips for breast feeding mums:

  • A balanced diet maintains the nutritional quality of your milk. It is important to eat a variety of foods and include some iron-rich foods (breast milk is naturally low in iron), as well as low-fat dairy products for their calcium!
  • Drink plenty of water – don’t hesitate to drink 2 litres of water a day!
  • Only about 1% of caffeine is absorbed into human milk, but large amounts of caffeine-based beverages can cause sleeplessness and irritability in your infant.[1]
  • Substances such as tobacco and recreational drugs should be avoided because their effects are transferred to your milk. 

 

Food Protein-Induced Proctocolitis (FPIPs)

Food Protein-induced Proctocolitis (FPIPs) and Transient Lactase Deficiency, potentially related to Colic, are two common gastrointestinal issues presenting in infants. 

Food Protein-induced Proctocolitis is an immune mediated gastrointestinal disorder causing mucousy, loose stools with spots or streaks of bright red blood in an otherwise healthy infant. It’s not uncommon for affected babies to be difficult to settle or irritable. FPIPs usually presents around between 2 to 8 weeks of age, with a range of 1 day to 6 months and the majority of cases occur in exclusively breastfed infants reacting to maternal dietary proteins excreted in human milk.

The condition goes by a few names; allergic proctocolitis, allergic colitis, dietary protein-induced proctocolitis of infancy, food-induced or benign eosinophilic proctocolitis, or Milk/Soy Protein Intolerance. You guessed it… the most common antigen is cow’s milk protein, thought to affect around three-quarters of babies with FPIPs, although other food proteins, most notably; eggs, soy and corn can play their part. Babies may react to one, or a combination of ‘trigger’ foods and a very small group may not respond to maternal dietary modifications (an approach to managing the condition)[2].

The treatment for FPIP is the elimination of the offending protein(s) from babies tum and for breastfed babies, this means mum should eliminate the offending food from her diet. Since cow’s milk protein is most frequently implicated in FPIP, eliminating all sources of cow’s milk protein for a minimum of 2 weeks is the first step (of course this is best done under the care of a dietitian, registered or degree qualified nutritionist).

“Cow’s milk protein is most frequently implicated in Allergic Proctolitis.”

Colic

Colic is known as “prolonged and uncontrollable crying and irritability in an otherwise healthy infant” and is caused by pain developing in the baby’s developing digestive tract [3]. There are a number of factors that could cause this unsettling and one possibility is a lack of the enzyme Lactase in baby’s digestive tract.

Lactase is used to digest lactose, a sugar found in mammalian milks. When someone cannot digest lactose, the result is often gas, bloating, abdominal cramps, and in babies, fussiness and bouts of prolonged crying. Lactose intolerance is relatively common in adults however when this condition shows up in new-borns it is called transient lactase deficiency because it is often only temporary[4]. In infants who do not have enough lactase, the symptoms should improve once their digestive tract starts producing lactase – around four months of age.

While some evidence suggests that colic may be helped if you cut out cows’ milk, dairy products, eggs, wheat, nuts and caffeine there’s little scientific support for this.

Ultimately if you do have any concerns it is important that you contact your GP or Paediatrician in the first instance. If you are interested in making some dietary changes it is best to contact a dietitian, registered or degree qualified nutritionist. If there’s no improvement after you’ve made changes for a fortnight, go back to your normal diet.

 

References

[1] https://www.nestle.co.nz/nhw/nutritionlifestage/babynutrition/breastfeeding
[2] https://www.uptodate.com/contents/food-protein-induced-proctocolitis-of-infancy
[3] https://www.uptodate.com/contents/colic-excessive-crying-in-infants-beyond-the-basics
[4] Heyman MB. 2006. Lactose Intolerance in Infants, Children, and Adolescents. Paediatrics 118(3):1279-1286.

Introducing Solids to Your Infant

There seems to be a lot of confusion surrounding introducing solids to infants these days, especially to reduce the risk of developing allergy, asthma and coeliacs. This confusion has been brought to my attention again recently and I would like to share my thoughts with you.


Here is where I stand on the introduction of solids. (Please note that whilst I strongly advocate for breastfeeding of infants, there are circumstances where formula feeding is necessary or simply your choice. And that is Okay – how you choose to feed your infant is your choice to make. This piece is intended to inform parents about RECENT developments in the introduction of solids).

Firstly EVERY baby is different and like weight management or any other aspect of nutrition no one-size plan/recommendation will fit all. This simply isn’t realistic, babies are unique and each will develop differently. 

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