Guiding Kids To Health: Preventing Hypertension

Yamileth Cazorla-Lancaster, DO, MPH, MS

I’m doing fantastic. Thank you so much for having me at the summit. It’s such a pleasure.

Laurie Marbas, MD, MBA

Well, it’s an important topic that we speak about, and not too many people understand that we can do things to prevent hypertension. One, maybe getting us as young adults, teens, and older, but as a pediatrician, what are some of the things that we can do as parents, grandparents, or caretakers of this wonderful blessing that we have in our care to try to prevent the onset of chronic disease?

Yamileth Cazorla-Lancaster, DO, MPH, MS

I’m so glad that you asked that question because a lot of people don’t realize how upstream chronic disease is. One of the best gifts that we can give our children and our grandchildren is our nieces and nephews. All the beautiful children in our lives have habits and behaviors that are going to set them up for health, well-being, and longevity, so we can get started even in pregnancy, believe it or not, with what a mother chooses to eat while she is pregnant with her unborn child. We can start early by installing and instilling in them all of these positive habits and behaviors for life.

Laurie Marbas, MD, MBA

Well, that’s fantastic. You’re exactly right because that epigenetics piece is so important. While someone is being cared for, like what my mother ate, which probably affected my daughter because of my growth in eggs and everything. When it comes to parenting and instilling these healthy habits in kids, why don’t we even start, especially if this is a new concept? They were going through the drive-throughs and trying to get through the day. How does a parent even begin to do this?

Yamileth Cazorla-Lancaster, DO, MPH, MS

Well, let’s start by saying you just have a brand new baby and you haven’t done anything yet. We’ll start with that. If you can breastfeed, definitely do that. that not all people can breastfeed. If not, no worries. You’re still doing the best you can. But if you can, that helps. While you’re breastfeeding, make sure that you’re eating a good diversity of plant foods: lots of green leafy vegetables, lots of beans, and lots of fruits. Try to make sure that you’re doing that because, as you’re breastfeeding, that baby is tasting the foods coming through your breast milk. It’s helping them get used to becoming familiar with those flavors. Once your child starts to explore complementary foods, somewhere between four and six months of age, expose them to diversity in a variety of flavors. I like having my patients start with green, leafy vegetables from the beginning. Not all physicians do that, but I like to start that first because we have this very narrow window of opportunity where the brain is particularly receptive to bitter flavors, and it’s between five and seven months of age. If we can get those bitter flavors early, it will take fewer exposures for children to learn to accept those flavors. then you just keep doing that. You just keep offering them a diversity of foods—a diversity of whole-plant foods. You don’t give up because what happens is that when they become toddlers and preschoolers, they will develop what’s called neophobia. Suddenly, the food that they loved so much that they were just broccoli lovers, they have thrown it off of their highchair. That’s when parents start to panic. They panic, and they’re like, my child isn’t eating anything. They’ll eat chicken nuggets. I’m just going to give them chicken nuggets and mac and cheese. That’s where we start to give in to our fears and our anxiety, and the habits change. 

So I’ll pick up from there, from families, and say, You didn’t know this information; you’re just doing the best you can, and we’re all just doing the best we can. Congratulations for even just being able to parent a child. But I’m glad you’re listening to this now. If you’re at that stage where we’re in the mac and cheese and chicken nuggets phase, then what I want you to do is expose your child. Now, the most important concept in this is that you expose, but without judgment or expectation. Because if we put broccoli, like, say, we just put one piece of broccoli on that child’s plate, and then we’re just like, okay, you got to taste it. You had to do something. You can’t eat your dessert until you have broccoli, or we give them the mom look, or we scold them for not eating the broccoli. That’s not helping them learn to like those foods. We want to restrain the mom’s face and the judgment and just expose, expose, and expose with so much patience because it can take 25 or more exposures before a child even starts to taste that food. You don’t have to put a huge amount on their plate—just a little bit, like a tablespoon of black beans and a piece of broccoli, whatever. Just start to integrate that without judgment or expectation. That’s called the division of responsibilities. I talk about that more in my book, but that’s what you can start doing now if you feel like you’re already at that stage where you’re not offering your child a variety of foods.

Laurie Marbas, MD, MBA

Now, that’s fantastic advice. Could you speak to your book just a little bit and share more about that, please?

Yamileth Cazorla-Lancaster, DO, MPH, MS

Sure. I wrote a book, A Parent’s Guide to Intuitive Eating: How to Raise Kids Who Love to Eat Healthy. The reason I wrote this book in particular is because what I see in my practice over and over again is that parents intellectually know what they want to feed their kids. They know that they want their kids to eat more fruits and vegetables. Every parent knows that, but they just don’t know how to do it. Like I said before, the stress and anxiety of raising kids between the ages of one and five in particular. The majority of parents are going to classify or categorize their children as picky between the ages of one and five. Which means what? Which means it’s normal. All kids go through this, and when parents start to panic, that’s when they’re like, We’re just going to give them whatever they want to eat. It turns out to be just goldfish crackers, fruit snacks, chicken nuggets, and mac and cheese, and then they’re feeling desperate. How am I going to get my child to eat more fruits and vegetables? I wrote the book specifically to help hold the hands of parents who are feeling anxious, because, believe me, I had to make all the mistakes to learn what to teach other parents and just to help them relax and enjoy the process and to reassure them that children, their metabolism, they’re smart. If we offer them the right foods, they’re going to eat the amounts that they need to grow and support their specific genetic potential.

Laurie Marbas, MD, MBA

We can get away from, there are starving children in Africa so eat everything that’s on your plate.

Yamileth Cazorla-Lancaster, DO, MPH, MS

Yes, please. That’s something we don’t want to do. We just don’t want to force or cajole our child when it comes to food in any way. We want to be empowered and make decisions. Yes, I’m going to cook this meal. It’s going to be a healthy, nutritious meal. I’m going to offer it to my child. But once that offer is made and that food is placed on the child’s plate, your job is done. then they take over, and they have autonomy. So whenever we start crossing into the autonomy of the child, that’s when things start breaking down. They become pickier. They start rejecting food more, and we get more stressed. It’s just like this vicious cycle. Everybody ends up crying at the dinner table. Believe me, I’ve done it before. I’ve been there and done that. exactly how it goes.

Laurie Marbas, MD, MBA

When we speak to kids, especially because we’re talking about pregnancy, neonates to 18, let’s say in general, are there any specific guidelines that we need to pay attention to ensure certain nutrients, or maybe there’s supplementation that we need to be paying attention to, especially during those picky eaters? How do you generally guide people to focus on what nutrients they need the most?

Yamileth Cazorla-Lancaster, DO, MPH, MS

That’s a great question. all exclusively breastfed babies from the beginning. I am going to want them to be on vitamin D supplementation, and that can be done either by giving the baby drops or through the mother super supplementing herself with at least 6400 international units of vitamin D per day. That’s first and foremost. Some pediatricians may also start iron drops between four and six months of age to make up for any losses that are happening.

I tend to try to steer them towards the right nutrients to eat once they start eating complementary foods. Then we check for anemia when they’re one year old. But then once your baby is weaning from the breast or formula, I like to get kids on a multivitamin that has vitamin D B12 and then also omega three DHEA, EPA. Sometimes that has to come in a separate product because most multivitamins don’t have all three of those in there. But the reason is that we are seeing more and more evidence that children are just not getting enough of these omega-3 fatty acids in their diet, especially plant-based eaters. But I will say that generally you’re just not going to have little kids that are eating salmon and anchovies, like it’s just not what if they’re having fish? It’s like fried cod, which is very low in omega-3. All kids, and I supplement all of my patients. If you are going to raise your child exclusively plant-based, which I support, and that they can thrive with that diet, you just want to make sure that they are getting sufficient amounts of B12, vitamin D, and Omega-3, DHEA, and EPA, and then depending on if there are any differences in the diet like allergies, nut allergies, or legume allergies, there might be some other important ones. But those are the basic three that I want to make sure pretty much all of my patients are supplementing.

Laurie Marbas, MD, MBA

Perfect. Then, as far as the variety of foods you’re mentioning, let’s say kids love fruit because it’s sweeter, and parents may be pushing more of the fruit. How do they know to do it? A balanced approach. What are some of the important pieces to look at in all the different food categories?

Yamileth Cazorla-Lancaster, DO, MPH, MS

I will say fruit is incredibly healthy, and thankfully, fruit is probably saving a lot of our patients from getting scurvy because I do treat patients that have autism, and they’re just very restricted, and they qualify as having a restrictive eating disorder. But even they like fruit. It’s okay to give your child fruit. Fruit is not bad. It’s not like, say recently, you’ve heard people saying don’t eat fruit because it’s got too much sugar, things like that. But fruit is a very healthy food, promoting foods high in antioxidants. It’s got fiber, and it’s health-promoting. When it comes to variety, what I tell parents is that the variety doesn’t need to be meal-to-meal or even day-to-day. I’m thinking a variety more week to week, month to month, because, as we see, seasons last a few weeks. Here, we’re in an agricultural valley; we have lots of fruit, and fresh apples are going to last a few months. Cherries are going to last a month; we’re going to have the seasonality of foods, but it’s not just one day. It’s okay if your child is into apples or bananas right now. Change it next week or next month, but don’t be stressed that the variety has to be like every single hour of the day.

Laurie Marbas, MD, MBA

Now, that’s a wise decision for everybody because everyone’s like, I need to have 30 varieties of this in one day. I’m like, no, just let’s go from week to week. That’s a great way to approach that. When it comes to, let’s say, nondairy milk, do you have a preference for what most young children consume?

Yamileth Cazorla-Lancaster, DO, MPH, MS

For our kids who are under the age of two, what we have to be careful about is that their stomachs are small, so our stomach is typically just the size of our fist. As a little one, they don’t have very big tummies, so we don’t want to fill them up with things that don’t have enough calories and nutrients because, when it comes to toddlers, their job is to explore their world and play. They’re not all about having long, drawn-out gourmet meals and sitting and then having a large volume of food. We do want to make sure that what they eat has a good bang for their buck. So that applies also to our nondairy, our plant milks. I want to make sure that the milk that they’re drinking has sufficient calories, and a good choice is going to be unsweetened soy milk. There are also so many new products out there that I like, but one of them would be pea protein milk because it’s got enough calories. It is also a little bit higher in protein. is soy milk. Soy milk is a great choice. But now they have all these other very delicious milk, such as not milk or next milk, which are good choices. But even then, your child should not be getting the majority of their calories from milk. I like to limit it in my family to no more than 16 ounces total per day, preferably sitting at snack time or meal time. I don’t want them to skip it in between their meals and snacks because that’s not good for their teeth or their metabolisms.

It’s very good advice, and I love every bit of it. But let’s see that we have older kids. Let’s say they’re 12 to 13, 14, 15, and me, 20%. I’m assuming that’s the same most recent data that I recall of kids being overweight or obese, which is quite remarkable. But parents are worried. Maybe they’re having a little bit of high blood pressure when they’re checking it at the doctor’s office, or they’re worried about prediabetes, diabetes, or other things that might be developing. How do we start those and engage these older children, who have more autonomy and are respectful at the same time, but also lead them down a better pathway? Because it’s a difficult path to walk in any case. But now we’re worried about their chronic health issues.

It’s so stressful, and it can be very difficult. I especially see it as a difficult situation when children are living in more than one household. when there’s a parent who’s separated or divorced and one parent is trying hard, but then half of the time the child’s going to another household where the lifestyle is completely different. I don’t like to put pressure on the child at all. Now, if a child is older like they’re about to graduate high school or go to college, they’re nearly an adult. That’s different. But for these children, even though they’re older, their school-age depends on their mom and dad. It’s our responsibility. It’s our job to change the lifestyle at home and do as much as we can to control it. This is not to say that you’re going to watch every single morsel that your child eats and tell them every few seconds, Don’t eat so much; stop eating. It’s more about how we can change what we’re offering at the house and how we can remove those things that we see as becoming a problem. I recently had a patient, and I saw a big jump in their weight and body mass index, even though I didn’t call attention to that at the visit, I asked, What habits have changed? Have any habits changed regarding food and eating? This is a toddler and he likes to never stop moving. that he’s very active. So Mom said, Dad, move back into the house. Dad loves to snack; he has his snacks out, and then the child wants to snack with Dad. Mom already knew that that was a problem. I said I talked to Mom. Can we talk to Dad and tell him how important this is? We are influencing these children with our habits. We have to take responsibility into our own hands and be role models. We sometimes have to make the change for that to trickle down to children. But once those habits change, you do see an effect. I just want families to take that responsibility for themselves. You want to change the whole household, not point the finger at one child and try to make them change, because that’s not the responsibility of the child.

Laurie Marbas, MD, MBA

No, that’s perfect. It’s a great point for a break here. But thank you so much for joining us today. I hope you found this conversation insightful and engaging. If you’re a summit purchaser, stay right here, because we’re about to dove in a little deeper into this amazing conversation. Excuse me. If you’re not, please click on the button below or the site and get access to the rest of the conversation. If you’re watching this, thank you for being a valuable member of our community. Let’s continue with a few more questions. This has been fabulous. Let’s say you have a young school-aged kid or older child, and they’re embracing these healthier habits. What type of advice can we give them as they go out into the world and have peer pressures and discussions? How do we help them learn to navigate outside of our four walls?

Yamileth Cazorla-Lancaster, DO, MPH, MS

One of the best things that we can do is teach our children about flexibility, because when we get to black or white, all or nothing, it’s hard for us as adults, but it’s hard for children’s brains. then that can lead to, well, fine, I’m not going to do anything, and I’m just going to eat whatever I want, whenever I want. the way that I raised my kids, which,  you can choose, of course, how to raise your children, but we a whole food plant-based at home.  When they were out at events, gatherings, and other things, they could make their own choices. However, because I wasn’t forcing them or telling them that they were bad for making certain choices, they were able to tune into their bodies so that they could make those decisions, knowing that, “Hey, if I decide I’m going to have cheese pizza, I’m not going to feel great afterward.” Maybe they would have the cheese pizza every once in a while. But the majority of the time, they wouldn’t because they wanted to feel good. So when we empower our children, give them that autonomy, and teach them the foundations at home without judgment or pressure, they do well.

Laurie Marbas, MD, MBA

I would have to echo that completely. I went 12 years ago. The kids were 13, 15, and 18, and now they’re almost 30, 27, and 25. There was that transition piece. They would go home. I’m like, this is what we got. But outside the walls, they made choices, and for a year or so, you start seeing them make different choices even when they had other options. One, because they didn’t feel well. I had another patient who was seven when her family went plant-based, and they did the same thing. But so she’d go to birthday parties, and she’d have birthday cake and ice cream, and she did not feel well. Now she’s promoting plant-based eating to her buddies because she’s like, I’m not eating because I didn’t feel good, and you shouldn’t be. They advocate for their health and that of others. So that’s fantastic. When you come to the end of this discussion, a question would be: when we are looking at chronic diseases across childhood, can you give us some things to be paying attention to as parents? For example, hypertension in adulthood is difficult to diagnose because so many people don’t pay attention to it or don’t go to the doctor very often. Are there any clues or things that we need to be paying attention to for any chronic disease in our kids? Is it a change in behavior or different things, like, can you help us with that?

Yamileth Cazorla-Lancaster, DO, MPH, MS

Yes. First of all, as a pediatrician, I’m a big advocate for getting into those well-child exams because, just like you said, they’re silent. Nobody knows until it’s checked in the office. We get that blood pressure, and we get those vital signs. But I’ll say if you’ve noticed a change in your child and I don’t want to just focus on body size, you’ve seen either rapid weight gain or rapid weight loss or just changes in their habits. Maybe they seem to be sneaking food, hoarding food, or even just completely avoiding food. I’m going on both ends of the spectrum here, then bringing them in for an evaluation. If you feel like you can’t have that discussion with them at home, bring them in. We can talk about it. We can talk to them about it and determine if there’s an issue that’s happening. Because, like you said, a lot of these things, especially in childhood, are completely silent. Now when it comes to things like diabetes. If a child’s developing diabetes, you may see, especially if it’s like type 2 diabetes, some changes with excess thirst and excess urination. But sometimes, even though the body adapts so well, you may not see it as well. I would say if you’re noticing rapid weight gain, a change in eating habits, or a change in lifestyle habits, it’s better to come in and get it checked. If we’re also agreeing with that, we run labs and make sure that there’s not a metabolic syndrome that’s brewing. When I see kids, if they have one, they often have more than one. If they’re going to have high blood pressure, I see that their insulin levels are high or that their hemoglobin A1C is high. So I’m seeing more than one thing. by the time we see that there’s one chronic condition.

Laurie Marbas, MD, MBA

That’s a good point. These don’t typically run by themselves; they run in pairs or gangs. to speak.

Yamileth Cazorla-Lancaster, DO, MPH, MS

Sure.

Laurie Marbas, MD, MBA

Well, this has been very enlightening and helpful, and I hope it encourages the parents among us or grandparents to have more conversations with kids and help educate them to make better decisions for their current health and their future generations of health, and whoever they may have, children, friends, or whatever. thanks again. We so appreciate your time today.

Yamileth Cazorla-Lancaster, DO, MPH, MS

Thank you so much. Dr. Marbas.