Expert Q&A: Early Childhood Nutrition guidance with pediatrician Dr. Rebecca Unger

Tell us a little about yourself and your practice.

I have been a pediatrician at the Northwestern Children’s Practice in Chicago for the past 36 years.  We have a team of doctors and nurse practitioners with many collective years of experience to support our families and provide guidance about healthy habits right from the start. We help families develop these healthy habits and patterns regarding nutrition, sleep, development and safety from birth through adolescence. 

What are some of the biggest misconceptions you see when it comes to baby/toddler nutrition?

I think families often do not understand how important it is to be a good role model for children. This is how children develop habits for eating healthy meals and snacks. This highlights the importance of eating together as a family (at least one parent). Parents provide healthy choices and children decide what to eat. This works best when caregivers are good role models. 

The American Academy of Pediatrics recommends starting solid foods, as well as introducing allergens such as peanuts, between 4-6 months. Some parents are hesitant to follow these recommendations and they wait until their baby is older. This delay can actually  increase food allergies. In addition, babies who drink too much breast milk or formula without adding the solid foods can become anemic. 

What are the biggest nutrition mistakes you see parents making today?

Common nutrition mistakes include enabling children to graze on snacks throughout the day, offering  ultraprocessed food, especially in “crinkly bags”, being a “short order cook” by making separate meals for each child, expecting children to “clean their plates”, and eating meals in front of screens. 

Picky eating is something many parents struggle with. What are your best tips for encouraging healthy eating habits without making mealtimes stressful? When should parents be concerned and what is considered just a normal phase?

Picky eating in toddlers is very common. I recommend meeting with your health care provider if you are concerned about your child’s growth pattern. Keep in mind that picky eating is very common, especially in toddlers.  

Offering 3 regular meals and 2-3 planned out healthy snacks each day can reduce picky eating. When children graze on snacks throughout the day, they are less likely to eat hearty meals because they are not hungry. Avoiding juice and other sugary  beverages can improve a child’s appetite. 

If your child does not want to sit at the table and/or has tantrums around mealtime, I recommend creating an inviting space at the table for the family meal. Ideas include lighting a safely placed dinner candle and, as much as possible, encourage everyone to sit at the table with positive feedback and role modeling. If your child engages in an undesired behavior such as throwing food or a temper tantrum, ignore your child until the behavior resolves. This does not make for a pleasant meal, but in a short time, your child will learn that the undesired behavior is ignored and by being helpful and/or engaged in the meal, your child will enjoy positive attention and feedback. 

Are there any nutrients that children are commonly deficient in?

It is important to offer some protein along with  fruits or vegetables at most meals. Many children have carbohydrate heavy meals and snacks and can be deficient in protein, iron and fiber. 

Is it okay) for children to take a daily multivitamin, or should they get everything from food?

It is okay to take a “complete” chewable (not gummy) multivitamin. However, it is not necessary to take a vitamin unless there is a food group that is missing in your child’s diet. Ideally your child should get what they need from 3 meals/day along with a few healthy snacks, but if you feel like your child is not eating from all food groups, I recommend adding a complete chewable multivitamin. 

How much sugar is too much for kids, and what are some simple ways to reduce it without eliminating treats?

Added sugars are in juice and soda. I do not count sugar in fruits as added sugar. The best way to reduce sugar in your child’s diet is to avoid sugary beverages. The 2025-2030 Dietary Guidelines for Americans recommends no added sugars for children under age 2. The American Heart Association recommends limiting sugar to 6 teaspoons/day for toddlers. This translates to giving 4 ounces or less of juice/day.

It is important to understand that toddlers who include sugary beverages in their diet can have a dose- related faster weight gain and an increased chance of obesity by six years of age.  For more information, check out the American Academy of Pediatrics parent resource website, healthychildren.org.

How can parents encourage healthy eating habits without creating a negative relationship with food?

As I mentioned, being a good role model is essential for children to develop healthy eating habits. Including your children in food preparation and planning is also helpful. Setting an inviting table with fun placemats, perhaps made by your young toddler- artist, makes family meals more fun. Recognizing that children do not have to join the “clean plate club” makes meals less stressful. Most importantly, you will reduce stress and encourage healthy eating by practicing  the “parents provide and children decide” motto. Also, when your child tries a new food, stays at the table during mealtime, engages in the family meal or  has other positive behaviors, “catch them being good”.  Positive praise (think jumping for joy, doing a cartwheel!) goes a long way!

What would you say to parents of children who have a child around a year old who needs to move away from drinking out of a bottle (especially a child who has been formula fed)  but isn’t really interested in drinking milk out of a cup? 

Just do it! I encourage getting rid of the bottle around 12 months of age, or within a few months after that. As I mentioned, too much milk in a bottle can cause anemia because children might not be hungry for meals. Parents do not have to worry if their child drinks less milk for a while during this transition. Parents can offer more yogurt or kefir during the transition to ensure enough calcium and vitamin D intake. Be sure to read the food labels because not all yogurt and kefir brands have vitamin D. If children enjoy milk before bed, once they have been weaned off the bottle, they can still have milk in a sippy cup before bed. This can still be a soothing part of the nighttime routine. 

If you could give parents just one piece of nutrition advice that would have the biggest impact on their child's health, what would it be?

As parents continue to be a role model by eating healthy foods with healthy patterns, recognize that your child is learning from you every step of this process. Some studies show that family meals can reduce risk taking behaviors in adolescence, so start those family meals early!

Is there anything else you'd like to share with our readers or any encouragement you'd offer to parents navigating the early years as it relates to food and nutrition?

Continue to learn from your children, shop together, cook together, keep healthy foods around, and turn off screens during mealtimes!