Stimulant Medications in the Pediatric Population

ADHD diagnosis and stimulant medication prescription is slowly increasing overtime. Most of these diagnoses and prescriptions come from the pediatrician. The FDA approved the minimum age for most stimulants is 6 years old.

Mental health diagnoses in the pediatric population commonly included ADHD, Depression, and Anxiety. Although Depression and Anxiety are treated with SSRI’s rather than a stimulant medication as in ADHD, children may still have side effects pertaining to their nutritional intake.

Case Study - Pediatrics, 2015 [1]

Joey, a 6-year-old, 20-kg boy, presents to his pediatrician, Dr Smith, with complaints of significant hyperactivity, impulsivity, and defiance that are problematic in the classroom and at home. Presentation in the office and parent and teacher Vanderbilt rating scale scores* are consistent with a diagnosis of ADHD, and other medical, psychiatric, and learning issues are ruled out. Dr Smith provides psychological education about ADHD, refers for parent management training, and recommends school accommodations for classroom symptoms. After ensuring no contraindications, he prescribes dexmethylphenidate extended release (ER) (Focalin XR) 5 mg every morning (qAM).

At subsequent weekly or biweekly follow-ups, the dose is titrated to 10, 15, and 20 mg qAM based on parent and teacher Vanderbilt scores demonstrating little or no improvement. At the fourth follow-up, Dr Smith switches to amphetamine/dextroamphetamine ER (Adderall XR) 20 mg, after which parent and teacher report notable improvement in hyperactivity and impulsivity, although Joey experiences appetite suppression. Dr Smith counsels on high-protein and high-calorie nutrition, but Joey’s weight decreases to the point of crossing a weight percentile. The amphetamine/dextroamphetamine ER dose is decreased to 15 mg then to 10 mg over subsequent visits; although Joey’s appetite and weight improve toward baseline, Vanderbilt scores demonstrate return of hyperactivity and impulsivity, although not to the degree of severity of initial presentation. Dr Smith augments amphetamine/dextroamphetamine ER 10 mg qAM with guanfacine ER (Intuniv) 1 mg at bedtime (qHS).

Three weeks later, parent and teacher Vanderbilt scores endorse satisfactory ADHD symptom management, which is maintained through the remainder of the school year, and Joey’s weight gain follows an age-appropriate trajectory.


Cases like Joey’s are very common when first addressing the mental diagnosis with medication. Finding what medication best suits your needs is a slow process to ensure the side effects are minimized. One of the side effects evident in Joey’s case was suppressed appetite. During a period in Joey’s life where he is still growing and developing, it is extremely important for him to follow his natural weight/height trajectory. When children are growing, they should not be losing weight. Weight loss can lead to developmental delays, including delayed onset of puberty, stunted growth, and stagnant bone growth. To prevent these serious symptoms from occurring, it is important to discuss intake and nutrition with your pediatrician and psychiatrist. If needed, get a registered dietitian involved in your child’s care to address strategies to ensure your child is eating enough to follow their age-appropriate trajectory.

[1] Southammakosane, C., & Schmitz, K. (2015). Pediatric Psychopharmacology for Treatment of ADHD, Depression, and Anxiety. Pediatrics, 136(2), 351–359. doi: 10.1542/peds.2014-1581

Food, Why Can't I Escape It?

“You’re the apple of my eye”
“You’re so cute, I could just eat you up!”
“There's nothing like Grandma’s cooking”
“You’re sweeter than pie”

Food is everywhere. Its in our stores, on our commute to work, people eat every day, its on our billboards, in our sayings, in songs and advertisements. Just like I tell my clients, the hardest part of seeing a dietitian when you are someone who is struggling in their relationship with food is having to face the fact that food is everywhere. It is hard to sit in a room with a dietitian and talk about food for the entire hour. Eating disorders and disordered eating is a huge burden on individuals. Food is not something you can escape, avoid or ignore.

I suppose some of you reading this could look out your window and see a restaurant, grocery store or food stand a stones throw away. The war we let our emotions set on food is a war without an ending. Spoil alert, your emotions will lose eventually.

Food is neutral. It is not intentionally trying to harm you, give you a chronic disease or alter all the work you put into changing or maintaining your appearance. Your emotions and beliefs that you cast on food is what is effecting those things. Food is actually trying to help you! To keep you alive, to feed your organs and keep you young. Food is not the enemy.

Food is the scapegoat. Society tells us over and over “carbohydrates will give you diabetes.” Or shouting diet statements at you such as “Lose weight quick by participating in a 20 hour fast!” - surely we all can understand the concept of starving ourselves by not eating for 20 hours can cause weight loss… because you’re not eating!! But does fasting work for everyone? Not really, no. Because no matter how hard we try to fight our biology, our body will do whatever it can to protect us and get the energy it needs during the other 4 hours your emotions allow it to eat.

Ok, i’m off my soapbox now.

You all know this. I’m not telling you anything new. I may be telling you something you don’t want to hear, and that is, you can not escape food.

But really! Why would you want to escape food?! How amazing and easy life would be if you could walk into Panera and not immediately have to think about calories, what else you ate today, what is the “cleanest”, what is balanced, etc. I have had almost everything on Panera’s menu and I can tell you, you will survive. Your body is much stronger, much more resilient than you think. When was the last time you gave your body the chance to prove to you it can handle all the foods in the world? (Minus those with allergies of course :P).

Think of your body as the sweet, precious child you are too afraid to let grow up. Would you starve that child? Keep them isolated and unable to try new things? Eventually all you are doing is causing the child more harm in the long run. Give the child some of their own control. Its ok to start small so you can learn one step at a time that the child can handle the power it is given. Eventually the trust will come and the burden will be lifted from your shoulders. Your relationship with the child will be that much stronger and trust will come easily.

If this is too hard to do on your own, that is where a dietitian, a therapist, a doctor, significant other, etc. comes into play. Everyone needs support and that is what we are here to provide. To help your body win the war.

Food may feel like the enemy right now, and that’s ok. But you can’t escape it, so lets first learn how to live with it.

Orthorexia- When Healthy Eating Becomes an Obsession

Do you eat healthy? Great! Do whatever works for you and makes you feel good. Bamboo Nutrition in Columbia, MO is one place to look if you feel your healthy eating may becoming an unhealthy obsession.

Orethorexia is a termed coined by Steven Bratman. What began as an individual wanting to eat healthy for their own reasons (i.e. energy, longevity, activity, etc.) turned into an obsession. This obsession with healthy eating caused social anxiety, withdraw, irritability, poor sleep, and much more. The thought of food consumed this person’s thoughts all day and night. At this point, this individual may have orthorexia.

Steven Bratman’s definition of Orthorexia states: “Orthorexia is an emotionally disturbed, self-punishing relationship with food that involves a progressively shrinking universe of foods deemed acceptable. A gradual constriction of many other dimensions of life occurs so that thinking about healthy food can becomes the central theme of almost every moment of the day, the sword and shield against every kind of anxiety, and the primary source of self-esteem, value and meaning. This may result in social isolation, psychological disturbance and even, possibly, physical harm. “

In other words, When healthy eating becomes unhealthy.

Don’t get me wrong, just because a person eats healthy and likes to eat organic or follow the latest trends in the food industry does not mean they have orthorexia.

Steven Bratman’s self-test is a good place to start:

The Bratman Orthorexia Self-Test*

If you are a healthy-diet enthusiast, and you answer yes to any of the following questions, you may be developing orthorexia nervosa:

(1) I spend so much of my life thinking about, choosing and preparing healthy food that it interferes with other dimensions of my life, such as love, creativity, family, friendship, work and school.

(2) When I eat any food I regard to be unhealthy, I feel anxious, guilty, impure, unclean and/or defiled; even to be near such foods disturbs me, and I feel judgmental of others who eat such foods.

(3) My personal sense of peace, happiness, joy, safety and self-esteem is excessively dependent on the purity and rightness of what I eat.

(4) Sometimes I would like to relax my self-imposed “good food” rules for a special occasion, such as a wedding or a meal with family or friends, but I find that I cannot. (Note: If you have a medical condition in which it is unsafe for you to make ANY exception to your diet, then this item does not apply.)

(5) Over time, I have steadily eliminated more foods and expanded my list of food rules in an attempt to maintain or enhance health benefits; sometimes, I may take an existing food theory and add to it with beliefs of my own.

(6) Following my theory of healthy eating has caused me to lose more weight than most people would say is good for me, or has caused other signs of malnutrition such as hair loss, loss of menstruation or skin problems.

*There are many self-tests on the internet to use in determining if you may have orthorexia or be on the verge of developing orthorexia, however, this is the only self-test that Steven Bratman approves.

Why Self Care?

You may be thinking, “I don’t need self-care. That’s for people who need therapists and yoga.” Mmmmm….. Not quite.

Self care is something us mental health professionals preach and preach because surely enough, we all could use some TLC.

What does self-care look like?

  • A bath or shower

  • Curling up with your fur baby, or real baby!

  • A nap

  • Doing something that makes you feel beautiful such as buying new makeup, getting a haircut, getting your nails done

  • Finding a place in nature and being by yourself

  • Going for a walk or to a work out

  • Baking

So many forms of self-care! But really, it comes down to doing what re-energizes YOU.

Self care is for all of us. It’s for when our battery needs recharged. When we’ve had a bad day. When our motivation is low.

Bottom line. Self care means taking care of yourself. And we all need it.

Don’t keep pouring from your cup without refilling it. In order to be the best version of yourself and serve those around you, you must take care of yourself too. It is not selfish, it is only giving back to yourself so you can continue to brighten those around you.

What’s your self care?

Isn't Intuitive Eating Just Another Diet?

This is a common question I get from clients, especially clients who have been dieting for many years. It can be really difficult to feel the difference between intuitive eating and a diet in the beginning. As you begin learning how to become an intuitive eater you may feel as though you are “abusing the rule book” or possibly “failing” another diet.

I assure clients that with intuitive eating there is no rule book and it is not possible to fail.

The main difference between a diet and intuitive eating is the sense of control. It may feel like you’re in control on a diet, but really, the food and the diet routine itself is the one in control. You are a slave to the limitations and restrictions that the diet places around food. Intuitive eating puts you in the drivers seat. It offers you the control and freedom to eat whatever you’d like whenever you need. There are no limitations or restrictions. No time frames that you must eat between. You are in control when you are an intuitive eater.

The subconscious dieter, inside all of those who have been on many diets before beginning to learn to eat intuitively, may slip out more than once in the beginning of your new anti-dieting journey. What is the subconscious dieter? It is the one telling you to restrict, to eat like it is the last time you will have certain foods, the one telling you to go 20 minutes longer on the stair stepper. When you are practicing eating when you’re hungry and stopping when you’re full, the subconscious dieter is the one telling you that you are full all the time or that you may feel hungry but its not really necessary that you eat. The subconscious dieter is a hard voice to quiet down. It may always be there, those precipitating thoughts and feelings will come every so often but what matters is how you respond to them.

Is intuitive eating another diet? It is not meant to be a diet, but the opposite of a diet. However, if you allow your subconscious dieting mind to take the wheel, intuitive eating may very well feel like another diet.

Remember, you cannot fail at intuitive eating. It takes time and no one is perfect all the time. Be kind to yourself as you retrain your mind to eat freely without guilt or other emotions. Eventually you will be stronger than the subconscious dieter voice and when those thoughts and urges arrive, you will quickly be able to refute them and move on.

5 Steps Towards Becoming An Intuitive Eater

…Eat mostly whole grains, limit added sugar, eat 4-5 servings of vegetables and fruit per day, drink around 8 cups of water per day… - Dietary Guidelines 2015 [1]

As a dietitian, I went through my schooling abiding by the dietary guidelines and preaching these (and more) recommendations to the general public. The more I preached, the more I began to feel as if I was telling people to go on another diet. Although the dietary guidelines are great recommendations and backed by more scientific evidence than ANY diet known to man…. it may still come off as restrictive and confusing.

The truth is…. majority of you all already know how to eat “healthy.” You KNOW how to feed your body the right nutrients and a balanced plate. It is not rocket science and there are plenty of resources out there to guide you if you don’t. [2]

You know how to eat well… so why don’t you? I think we all know it is not that easy. What are your reasons for not eating well for your body? Could it be that you are too focused on weight or weight loss? Could it be you prefer to chase the next fad diet? Or perhaps you are not willing to give up the foods you love so much and you feel any diet or preaching of the guidelines will take those pleasure foods away from you.

Here’s Something I Know You’ll Like.

Intuitive Eating

What’s intuitive eating???

Intuitive Eating is obtaining complete satisfaction from eating. It is listening to your body’s hunger and fullness and eating on your time. It is realizing that you cannot eat perfectly all the time and that’s ok.

So How can you begin this process???

  1. Mourn the loss of diet culture. How did it serve you? How did it harm you?

    By choosing to become an intuitive eater, you are giving up the fixation and obsession with dieting. In this case, holding on to dieting while practicing becoming an intuitive eater may only bring more guilt and frustration, not to mention this process will only be prolonged. So I encourage you to DIVE IN! Feel the FREEDOM that comes with mourning diet culture.

  2. Give yourself permission. There are no “good or bad” foods.

    Next, you need to remind yourself that intuitive eating is not another diet. You do not need to go through the "last supper” phase where you eat all the forbidden fruit before beginning the next diet. Being an intuitive eater means there are no foods off limits and you can keep all the foods you love in your meal plan. However, part of the dieting mentality is feeling guilty for eating some of your pleasure foods. Now you must retrain your brain to not feel that guilt, but instead give yourself permission.

  3. Listen for hunger and fullness.

    Let’s tap back into your inner bodily cues. As a child, you have an innate trust of your body’s hunger and fullness cues. You never have to tell a baby when to eat or how much, they will let you know when they’re hungry and they will stop when they are full. As we age, we begin to trust our body less and less because of rules that society places around eating. Intuitive eating includes regaining those hunger and fullness signals, but this takes practice. To begin, use the hunger scale below at a couple meals or snacks every day and practice listening to your body.

hunger scale

4. Use all 5 senses while eating.

It is easy to eat in distraction and instead of being present and intentional, you may be eating mindlessly. One step you can take to combat mindless eating, is getting in touch with all 5 senses- touch, smell, taste, sight, and listening. I know, this may sound silly…how does “hearing” my food help me become an intuitive eater. All I can say is don’t knock it until you try it! Notice the texture of your food. How does it look? Really taste it. Smell your food like a wine connoisseur would smell a glass of wine. Lastly, listen to the sounds. Does it crackle like Rice Krispies? How does it sound when you chew it?

5. Lastly, I want you to practice making peace with your body.

One thing that will hold you back in becoming an intuitive eater is if you are still trying to manipulate your weight. Intuitive eating is not a diet and is not meant to cause you to lose or gain weight. Could weight fluctuations be a symptom of intuitive eating? Yes. However, that is not its purpose. Practice giving yourself positive affirmations whether it is about a specific body part, or about its function. Be as kind to yourself as you would be to others. You are deserving of kindness!!

Practice these 5 steps throughout the next couple weeks. It may be a lot to do all at once, so perhaps focus on only a couple steps at a time. Be patient and understanding with yourself because intuitive eating is not meant to be a 30 day mastering course. It is a lifestyle and takes practice!



How to Offer Support to a Loved One with an Eating Disorder

This is such a common question from parents or loved ones who are trying to support someone with an eating disorder.

No one ever said providing support comes naturally.

What prevents someone from offering good support?

  1. Fear

You may feel fear that if you say the wrong thing or trigger them, they will self-harm, hate you, run away, whatever it may be. Yes, those things could happen, but do you know what else can happen? The eating disorder can win. The eating disorder can cause them to withdraw from their loved ones, starve themselves, force them to act upon thoughts that their authentic self does not want to do. Do not let fear stand in the way of supporting your child or loved one.

2. Guilt

There is no one to blame for the development of an eating disorder. Eating disorders can develop due to many things, one strongly being genetics. An easy analogy for this is- the genetics loads the gun, the environment pulls the trigger. Environment is something that is very difficult to control. This is not your fault, it is not anyones fault.

3. Pain

It is definitely painful watching someone you love treat their body in a harmful way. Eating disorders effect the individual mentally and physically. It takes a team of multi-disciplinary professionals to treat it, and one of the multi-disciplinary professionals is you. Family and friends play one of the largest roles in their loved one’s eating disorder treatment.

4. Misunderstanding

As mentioned before, no one asks for this illness to fall upon them. If you’re struggling supporting a loved one with an eating disorder because you simply do not understand, educate yourself. There are great resources at

After you conquer the barriers preventing you from providing good support… what do you do?

  1. Be present with them at meals and snacks, help distract them by talking about light topics that are unrelated to food.

  2. Make sure they have accessibility to food and beverages.

  3. Text or write them uplifting notes.

  4. Make sure they make it to their appointments with their treatment team.

  5. Be their rock- consistent and strong

  6. Do not talk about your own issues with food. Keep topics of diets, calories, weight, your eating struggles taboo.

  7. Ask them how they are doing around meal times, or in general.

  8. Empower them to tell their treatment team about behaviors they are acting upon.

Those are just a few ways you can support someone with an eating disorder. The other most important thing to do is to support other supporters. Do not knock each other down because you are all a part of a team and will succeed through positive affirmations from one another.

I would love to hear your stories in how you support your loved one! Post in the comments below, or send me an email at

Intuitive Eating

What is this non-diet way of eating that everyone keeps talking about? Can it help me lose weight?

Intuitive eating is based off of 3 pillars:

  1. Emotions

  2. Instinct

  3. Thought

Think of these three pillars as forming a triangle. This means that the rational thoughts can interfere with your emotions and your instincts. If you can find the balance between the three, this will be your best ability to listen to yourself. You will be able to follow your survival instincts and feel hunger and fullness, as well as listen to your rational thoughts and your emotions.

Intuitive eating is more complex than “Eat when you’re hungry and stop when you're full.” It is not merely a substitution for a diet or a weight-loss program. Instead, Intuitive eating is a form of freedom around food. For most, it is to have more pleasure and satisfaction when eating. For others, it is to regain control over food and learn how to achieve the balance between the 3 pillars, emotions, instinct, and thought.

We have natural instincts at birth that slowly get lost as we get older. Societal influences and social pressures begin to change the way we eat and how we perceive our health and well-being. Intuitive eating is a journey and takes time and practice. It is not a quick-fix or a program that you practice for a couple weeks then move on to the next trendy diet. Intuitive eating is meant for those who have come to the realization that diet trends are not for them and they would like to begin letting their body be their guide again rather than following “rules”.

“Rules”… this brings me to the liberating piece of intuitive eating. There are no rules or “good and bad” foods. All foods fit and have a purpose for either satisfying your instincts or emotions. Satisfaction is connected to hunger and fullness as well as making peace with food. It cannot be very satisfying to eat foods that you think are “bad”, “wrong”, or “not allowed.” So how can you get satisfaction from those foods? You must work on taking away those labels from foods. There are no “good or bad” foods. All foods serve a purpose and everything is best in moderation.

If you’re going to your favorite restaurant, would you eat a peanut butter and jelly sandwich on your way?

If you’re going to your favorite restaurant, would you eat nothing all day?

Intuitive eating is finding the balance between receiving full satisfaction while keeping your body nourished and energized.

If you would like to begin working towards becoming an intuitive eater, one great place to start is purchasing the book Intuitive Eating by Evelyn Tribole and Elyse Resch. If you feel you may need more support, look for a non-diet, or Intuitive eating, and HAES registered dietitian and/or therapist.

If you’d like to work with me directly, ask me about my Intuitive Eating Book Club and Skills Group!