I mean what I say at the bottom of the newsletter. I can’t write back to everyone, but I do read all your emails. A lot of the time, I’m looking for trends — what do people want more and less of? Do a lot of you have the same questions?
And often you do! These days people want to hear more about kids and COVID (are there long term risks to even asymptomatic infection?) and more about variants. Some of you are also — gasp — tired of COVID and want more straight-up parenting content. I hear all of this, and I’ll use it to shape what comes next.
But sometimes it’s fun to dig into some specific questions. Maybe these aren’t the ones everyone has but…maybe you do see yourself in here! Either way, let’s go to the mailbag today, for a few questions (these have been lightly edited to remove anything identifiable about the senders). And I should say: if you have a question, send it!
Subject: Licorice Tea in Pregnancy?
I'm about 6.5 months pregnant and was making tea (as I do with some frequency) the other night and noticed that both the ginger and licorice teas that I like say not to drink them during pregnancy! In digging around it seems that too much black licorice (which is in both teas) can be bad for you. Have you come across this before? I think everything is fine, but now I'm a little concerned that I've been unintentionally screwing up and I need to avoid the teas I like...
Thanks in advance
-Anonymous Tea Drinker
You’re right that the concern with both these teas is black licorice (or, more precisely, glycyrrhizin for which black licorice is the most common source). There are concerns about this product in hypertension in non-pregnant people and it’s known that very high levels of consumption can cause metabolic issues for some people. There are a couple of studies which link very high levels of consumption to adverse outcomes in pregnant people or their babies. This includes one study from 2001 suggesting high levels of consumption might lower gestational age and one from 2017 which indicated children of mothers who consume a lots of licorice might have significantly lower cognitive performance.
These studies in pregnancy seem to target very high levels of consumption — the 2017 study defines high consumption as >500mg per week, which would be about 16 cups of licorice tea a week. Their low exposure group still has some exposure, just less — up to the equivalent of about 8 cups of tea. This population isn’t being exposed through tea, but through candy. And both papers are based on the same small cohort of 1000 Finish women, where the high exposure group is only about 50 people. And, of course, the licorice consumption isn’t randomized.
My overall read of this is that if you’re drinking a lot of tea, like several cups a day, you might dial it back. The limitations in the research and the low concentrations of the chemical in tea suggest to me there is no need to cut out all together. Oh, and here is a preprint saying it might protect you against COVID-19. So, there’s that.
Subject: Assessing Physical Risks to Kids
I'm not sure if you've covered anything like this, but I find myself often in a conundrum around what to forbid or not when it comes to my kiddo and taking physical risks. For example, if she wants to walk along a high cement wall, or hang off of precarious things, or get right at the edge of a cliff, etc. - I have distinct memories of taking some pretty extreme risks as a kid, and if my parents forbade it, mostly that just meant I did it alone rather than with supervision (which seems worse). I am often trying to gauge things like how likely is it that she'll fall and be hurt, how badly will she be hurt if she is, etc. and I feel like I'm estimating all of those things entirely based on a gut reaction. This seems wrong, especially since my gut reaction and my husband's gut reaction are on wildly opposite ends of the spectrum much of the time. Are there accident-related stats somewhere I should be referencing instead?
Thanks in advance!
-Overly or Under-ly Cautious?
For me, this really bleeds into a broader question about how much protection we provide our kids and how much supervision, even as they age. I remember as a kid running around our neighborhood with the other kids, playing in the parking lot down the street, climbing up to various people’s roofs, and so on. I cannot imagine that happening now. (Free Range Kids has an interesting perspective on this).
But you asked a much more specific question, which is: are there accident-related stats somewhere. Answer is yes. The CDC has some data here on causes of ER visits. It’s not super granular, so you cannot learn that (for example) trampolines are really dangerous (they are!). But I guess I’d take away a few things. For fatal injuries in kids, the vast majority are a result of car accidents (mostly occupants, some pedestrians.
For non-fatal injuries, it’s a lot of falls and being struck by something (probably also cars a lot of the time). The chance of a 1 to 4 year old going to the ER for a fall in a given year is about 5% (this is the highest risk group). This seems scary, I think, but most of these are treat and release and the child is fine.
In a sense, probably you and your husband are both “right”. If you let your kid walk on a concrete wall there is a chance they will fall and hit their teeth and you’ll have to take them to the ER (yes, this did happen to my kid). On the other hand, walking on a wall is fun. And the biggest serious risk is one you take every day (probably) by putting your kid in the car.
Subject: Write Another Book on Food
I wanted to ask if you could write a book about food and specifically getting children to eat a balanced diet. Is there evidence of what age you should expect them to do this? What works without damaging their relationship to food? I've read a lot about this but the "stronger" measures (eat this or you get nothing else) seem to be criticized as creating problematic long-term relationships with food while "softer" measures (keep offering broccoli) don't seem to work with stubborn toddlers like mine!
I just wrote another book! I’m tired! And, actually, The Family Firm has a chapter on nutrition and food for older kids. For littler kids, though, I talk about this some in Cribsheet. You are spot on in your read of the research. “Coercive” measures do not work very well and can backfire. In general, data on this (which relies mostly on videos of families during meals) shows that kids do better with prompts like “You might like prunes; they’re like big raisins!” than prompts like “If you don’t eat your prunes, no iPad time”. When I think about this I’m always reminded of my friends who told their son that tofu was “sushi cheese” to get him to eat it.
This advice seems basically right to me, and well intentioned, but also hard to follow since in the moment it doesn’t always work as well. If you tell your kid if they eat a tomato they will get an ice cream, that basically works in the short term even if it causes them to have some kind of tomato neurosis later. I myself definitely fall victim to the coercive prompting, especially when faced with the one of my children who doesn’t love veggies.
So let me give you three pieces of advice.
First: There is some literature showing that if you introduce veggies with dips, kids eat more of them and turn out to like them more. It’s a way in to get them to try them. So, veggies plus ranch dressing, or peanut butter, might be worth considering.
Second: Generally, people eat more of the first thing you offer them. Like, if I am starving I might even eat papaya (although probably not). Which means that if you offer your kid veggies first, you might get more consumption. As in: maybe you offer veggies a half hour before dinner, when they are so hungry and cranky they would eat their arm or possibly a baby carrot.
Or maybe not! Some toddlers are very stubborn and will just eat their own arm while they wait for pasta. Which brings me to my third piece of advice.
Three: Try not to think too much about this. People worry a lot that their kids are not eating enough or are vitamin deficient, etc, etc. I talk about this some in Cribsheet but the upshot is that most of this fear is misplaced. Unless your child eats an extremely restrictive diet they probably are fine on vitamins. You can keep offering them veggies and eventually they are likely to eat more of them (pickiness in foods does tend to wane as kids age) but it’s probably not something worth obsessing over.
Keep the thoughts coming. I don’t always write back, but I read everything.
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