By: Cindy Baranoski MS, RDN, LDN Manager of Nutritional Therapy
Maybe you heard about this in the news last week, or maybe not. Either way, trying to make sense of what we should be offering our children to drink is always a dilemma. From the moment a baby is born, the question becomes, breast milk or formula. Breast milk being the optimal choice, but that’s not always possible, so formula is available.
Children less than 12 months of age should never be offered a bottle of straight up milk, but after 1 year, it is the go to drink recommended by everyone. Juice is often offered, but it is not the same as eating the fruit or vegetable. And sometimes in infancy, prune juice is given to help with stools, but that’s not a rule. Many children do not like milk, once done with breast milk or formula, and parents begin to offer anything to help ensure their child is hydrated.
Bring in the new options available for children to drink and it can be confusing to know what is best to offer. For example, plant based milks are all the rage now for many reasons, including allergies, family preferences, cultural reasons, and last resorts for a picky eater. They are flavored, unflavored, sweetened, and unsweetened. And the selection continues to grow, including rice, almond, coconut, soy, oat, hemp, split pea, cashew, and blends to name only a few. Though these may seem like a great alternative to cows milk, each one of them can be found fortified, unfortified, with added protein, or original version. Most plant milks are going to be lacking in protein, fat, and potentially key vitamins and minerals found in cow’s milk. Diet modifications can be made to help ensure what is lacking in a plant milk can be found in other sources in the diet. But if cow’s milk cannot is not the choice for whatever reason, plant milks with diet modification can work.
Juices have changed as well, with many companies offering non sugar
sweetened fruit and/or vegetable juices. Some companies offering cold pressed
and fruit/vegetable smoothies with additives, such as greens, protein and
vitamins. Use of sweeteners such as grape juice or artificial sweeteners
replace sugar and high fructose corn syrup. Juice is not the best option for
anyone to be consuming regularly, or in quantity, when the food brings so much
more nutrition to the diet that has yet to be identified or quantified.
And then there is water, but not just tap water, but bottled water, flavored water, sweetened waters, artificially sweetened waters, vitamin boost waters, and sparkling waters. As a general guideline, plain old regular water with nothing added or changed, is the best choice.
To help, the Academy of Nutrition and Dietetics, The American Academy of Pediatric Dentistry, the American Academy of Pediatrics and the American Heart association have made some updated recommendations.
Artificially sweetened beverages
“Low-calorie” or “Zero- calorie” drinks
Toddler and flavored milks
Sugar sweetened beverages
Less than 1 year of age: Do not offer juice
1-3 years of age: 4 ounces a day or less a day
4-5 years of age: 4-6 ounces a day or less a day
1-2 years of age: 16-24 ounces of whole milk a day
2-3 years of age: 16 ounces of skim or low fat milk a day
4-5 years of age: 20 ounces of skim or low fat milk a day
6-12 months of age: 4-8 ounces a day
1-3 years of age: 8-32 ounces a day
4-5 years of age: 12-40 ounces a day
Finally, whenever something is happening out of the ordinary with any child, and there is a struggle or question of fluids, seek the advice of a Registered Dietitian Nutritionist to help guide what would be best. Looking at the child as a whole, their full diet, development, family choices, help with recommendations being made for fluids. This will ensure children receive optimal fluids, contributing to best growth and development.
Most parents know it is important for children to eat a balanced diet. What exactly does a balanced diet mean? Generally, it means eating a variety of foods and getting enough of each food group. The five food groups are fruits, vegetables, grains, protein foods, and dairy. Although every food group is important, it seems as though protein foods and vegetables receive the most attention. You may be wondering why these two food groups are so important, how much of each is needed, and how to get your child to meet the recommendations. We will cover all this, but let’s start with how much food your child needs.
Protein is a key nutrient for everyone from growing babies to elite athletes. It is necessary to build, maintain, and repair tissue. We need protein to form healthy bones, muscles, cartilage, skin, and nails, as well as to make enzymes, hormones, and other chemicals. Protein foods are also important sources of nutrients such as iron, niacin, vitamin B12, vitamin B6, riboflavin, selenium, choline, phosphorous, zinc, copper, vitamin D, and Vitamin E. These vitamins and minerals offer a myriad of benefits to a growing child.
A common misconception is that protein is only found in animal-based foods, like meat. However, protein can also come from plant-based foods, like beans (example: pinto, black, kidney beans) and soy products (example: tofu, tempeh, edamame). The protein food group includes meat, poultry, seafood, beans, peas, eggs, processed soy products, nuts, and seeds. Dairy foods such as milk, cheese, yogurt, and cottage cheese will also provide your child with protein. Your child’s protein needs vary based on age, sex, and activity level. (Please see Table 1 above for recommended intake amounts.)
A serving from the protein food group, also referred to as an ounce-equivalent, is 1 ounce of meat, poultry, or fish, 1 egg, ¼ cup cooked beans or peas, ¼ cup tofu, 1 ounce of tempeh, 1 falafel patty, 2 tablespoons of hummus, 1 tablespoon of peanut butter, or ½ ounce of nuts or seeds. Please see Table 2 for common protein food portions.
Table 2. Common Portions and Servings of Protein Foods*
Common Portion and Servings
1 small steak = 3.5 to 4 servings
1 small hamburger = 2 to 3 servings
1 small chicken breast half = 3 servings
½ Cornish game hen = 4 servings
1 can of tuna, drained = 3 to 4 servings
1 salmon steak = 4 to 6 servings
A couple examples of convenient and kid-friendly protein foods are hamburger patties (examples: McDonald’s, White Castle [yes, fast food is okay]), fish sticks, chicken nuggets, Boca vegan burgers, and milk (examples: cow’s milk, Ripple milk, hemp milk). If your child prefers to drink rather than eat, try supplementing with a nutritious drink (examples: Kate Farms, Vega, Orgain, PediaSure). If your child does not eat solid foods, you can puree meat, poultry, seafood, and tofu, mash beans and peas, and provide foods like creamy nut butters, hummus, blended soups, and smooth yogurt. If your child relies on formula given through a feeding tube or drinking a supplement for most or all of his/her daily nutrition intake, s/he may be getting enough protein if s/he is consuming enough. Make sure to speak to a registered dietitian if you have any concerns about your child meeting his/her protein needs.
QUICK RECIPE: Black Bean Quesadilla*
¾ cup pico de gallo
1 can (15.5 oz) black beans (great protein source!)
½ cup shredded Colby and Monterey Jack cheese
2 tablespoons chopped cilantro
4 eight-inch flour tortillas
½ teaspoon olive oil
1. Using small-hole strainer, drain liquid from Pico de Gallo; discard liquid. Transfer leftover tomato mixture to medium bowl. Mix in black beans, cheese and cilantro until combined.
2. Divide black bean mixture evenly over half of each tortilla (about ½ cup each). Fold tortillas in half.
3. Heat large griddle or skillet over medium-high heat. Brush with oil. Place filled tortillas on griddle. Cook, carefully flipping once, until tortillas are golden brown and crisp and cheese filling melts, about 5 minutes. Cut quesadillas into wedges. Makes 8 servings.
Optional: For additional protein, add chicken or your favorite meat!
Vegetables are full of nutrients including dietary fiber, potassium, iron, vitamin A, vitamin C, vitamin K, copper, magnesium, vitamin E, vitamin B6, manganese, thiamin, niacin, and choline. These nutrients can help your child build healthy bones, heal cuts and wounds, protect against infection, support heart health, promote healthy aging, and maintain healthy eyes, skin, teeth and gums.
The vegetable food group is made up of vegetables and 100% vegetable juice. Vegetables come in a variety of forms to fit any diet. They can be raw, cooked, fresh, frozen, canned, dried/dehydrated, whole, sliced, mashed, pureed, or juiced. Please see Table 1 above for recommended intake amounts.
A serving, or cup-equivalent, from the vegetable group can be 1 cup of raw or cooked vegetables, 1 cup of vegetable juice, or 2 cups of raw leafy greens. There are some great brands out there that sell kid-friendly, veggie-containing foods. Two examples of brands are Dr. Praeger’s Purely Sensible Foods and Happy Family. Dr. Praeger’s line of foods includes a variety of “Puffs”, “Cakes”, and “Littles” (these are shaped liked stars, dinosaurs, and bears!) that are made with ingredients like broccoli, spinach, kale, and carrots. Happy Family sells everything from bars, to squeeze pouches, to puffs (some of these are also shaped like dinos!). These foods can have veggies like tomato, kale, spinach, and carrots. Their foods are appropriate for all ages, from infants to adults.
You can also try incorporating vegetables into other foods at home. Combine leafy green vegetables, celery, carrots, or beets with fruit to make a juice or smoothie. Store-bought, single serving vegetable juices and smoothies (example: Bolthouse Farms or Naked Juice) are also an option if you are on-the-go. You can also try blending pureed cooked cauliflower in mashed potatoes and mixing pureed cooked sweet potato or carrot into a cheese or pasta sauce. Blending cooked pumpkin, carrot, squash, or sweet potato into a tomato or vegetable soup can also increase your child’s vegetable intake. These ideas are also appropriate for children who do not eat solids.
If your child relies on a tube feeding formula or an oral supplement, s/he may be meeting all vitamin and mineral needs if s/he is consuming enough. If not, your child may benefit from a multivitamin. A registered dietitian can help you plan on the best way to get more nutrients into your child. If you are interested in adding blended vegetables to your child’s tube feeding regimen, a registered dietitian can also help you get started with blenderized tube feedings.
QUICK RECIPE: Pineapple and Spinach Smoothie*
2 cups pineapple
1 cup baby spinach (great way to consume veggies!)
1 cup unsweetened almond milk
1 cup ice
¼ tsp ground cinnamon
Combinepineapple, spinach, banana, almond milk, ice and cinnamon in blender. Cover; blend until smooth. Makes 2 servings.
By Dana Sivak, Easter Seals DuPage & Fox Valley Dietetic Intern and Northern Illinois University Student
“Got milk?” is a saying originally part of a campaign generated by the dairy industry to remind consumers of the importance for consuming milk on one of the premises that it serves as a good source of calcium. But why, we might ask, do we need to focus our energy on consuming calcium? Calcium is the most abundant mineral in the body, with 99% of it found in bone and teeth. Throughout the course of the day, calcium is constantly being broken down, reabsorbed, and resourced back to form new bones. In children, especially, the turnover rate of bone is ever-present to support growth and development. By age 24, on average, humans reach peak-bone mass, and thus it is important that we maximize our efforts to nutritionally meet our body’s calcium needs– so encourage your child to sport that milk mustache proudly!
The Recommended Dietary Allowance (RDA) for calcium changed last November after further research determined a greater need for calcium in our diets. The following are the US Food and Nutrition Board’s updated RDA values for calcium based on age:
0-6 months = 200 mg
7-12 months = 260 mg
1-3 years = 700 mg
4-8 years = 1000 mg
9-18 years = 1300 mg
19-50 years = 1000 mg
51-70 years = 1000 mg (male) or 1200 (female)
71+ years = 1200 mg
Now you might ask, how do I know if I’m meeting my child’s needs? (…and yours?! Your health matters, too!) The simplest answer for this is to check the nutrition label for the exact content of calcium provided for the food items typically consumed in your household.
Calcium rich foods are commonly thought to be those that exist within the dairy food group, such as milk, cheese, yogurt, and ice cream. These types of food provided a natural, readily available, and rich source of calcium to our diets. But what if your household is “dairy” free or someone in your household either has a lactose intolerance or cow’s milk protein allergy? Not to worry! There are other rich food sources of calcium to consider, too! Non-dairy sources of calcium include dark green leafy vegetables such as spinach and kale, as well as broccoli, green beans, and green bell peppers. Other sources included fortified food products such as cereals, fruits juices (orange juice) and cow’s milk alternatives. Smaller amounts of calcium can be found in seafood (sardines, scallops, shrimp, whitefish/salmon), tofu, legumes and nuts, eggs, and yes – even chocolate! Table 1 demonstrates the calcium content comparison for these various food sources.
· Silk Soymilk, unsweetened, with added calcium, vitamins A, D, B12, and riboflavin
· Rice milk, unsweetened, with added calcium and vitamins A and D
· Hemp Milk, Living Harvest Tempt, Vanilla
· Oat Milk, Pacific Foods, Organic Oat Original
· Coconut milk, Silk Original
· Almond Dream almond milk, with added vitamins A, D, and B12
· Ripple Milk
· Silk Protein Nut milk
Yogurt, plain, low fat
1 C (8 oz)
Mozzarella Cheese, part skim
Orange Juice, Calcium-fortified
Tofu, firm, made with calcium sulfate
White Fish or Salmon
3 oz. (1 filet)
Nuts (Ie. Peanuts or Almonds)
Inadequate intake of calcium over time can cause osteopenia, a less severe and reversible precursor to osteoporosis. Those who do not sufficiently meet their calcium intake, are at an increased risk for skeletal fracture injuries. Similar to vitamin D deficiency, additional at-risk populations are those who spend most of their time indoors and those who live north of the equator. This is because Vitamin D functions with calcium to aid in its absorption. Without adequate Vitamin D, the calcium of foods eaten may not be fully functional once digested. Lastly, those who do not partake in weight-bearing activities on a routine basis are more likely to have an increased need for calcium. This is because bone is not able to be broken down and thereby calcium is not able to help contribute to the reformation of new bone. Annual bone-DEXA testing is recommended for those who are at risk.
Efforts should be made to maximize bone development during critical stages of an infant, toddlers, and child’s growth to minimize future risk of osteoporosis. If efforts cannot be made from a physical activity standpoint due to a disability, one’s calcium intake in the form of food or possible requirement for supplement should be highly prioritized. To help with such planning, it is recommended to advocate for your child’s welfare and seek out further information for the level of risk your child is at by discussing this with their physician. Furthermore, it is recommended to meet with a dietitian who can assess the diet specific to calcium and offer suggestions for ensuring adequate intake.
If you find your child has nutrition problems including failure to thrive, obesity, poor feeding skills, sensory disorders, and gastrointestinal disorders or others, schedule a nutritional evaluation with Easter Seals DuPage & Fox Valley today. Learn more at eastersealsdfvr.org/nutrition.
Around 2 years of age, children enter the age of autonomy where they become aware of their individuality and become increasingly independent. This is also the age where they become increasing comfortable testing limits. Around this age, kids are most likely to start becoming “picky eaters.” By the time children enter preschool, many have begun to move past this phase and start to expand their food preferences; however, some children don’t move out of the picky eating stage and continue to refuse foods. Foods once liked may become dropped and not added back into their diet. The big difference between typical picky eating and avoidant /restrictive food intake disorder (AFRID) is that typical picky eating fades away in conjunction with repeated food exposure and a positive mealtime environment.
Children with ARFID may also have other health issues or conditions such as attention deficit hyperactivity disorder, autism, sensory processing, food allergies, constipation, and/or anxiety. Some children who were born prematurely may have required breathing and feeding tubes during hospitalization which can increase oral sensitivity. A child who had a choking episode in the past, was forced to eat, or who had multiple respiratory infections at a time when she was learning to eat may have developed negative associations with eating. Some children may have a sensory system which is offended by the texture, smell, odor, or appearance of food. These sensitivities may alter how kids experience food and result in their refusing to eat many foods. Anxiety can stem from the food itself, especially if it’s unfamiliar or disliked, or it can result from other factors such as pressure to eat at mealtime or a negative memory of eating. Older kids may experience social anxiety around their peers.
Parents often have good intuition and know when something is not right with their child’s eating patterns. Some signs of AFRID include refusing food due to its smell, texture or flavor, or a generalized lack of interest in eating. Children may have poor eating or feeding abilities, such as preferring pureed foods or a refusal to self-feed. They may be underweight or demonstrate slowed growth due to inadequate or poor nutrition. They may also show signs of anxiety or fear of eating. If you feel like your child’s eating patterns is moving beyond typical picky eating, please schedule an appointment with a pediatric occupational or speech therapist that specializes in feeding.
What can be done:
Schedule a comprehensive evaluation with an occupational or speech therapist can assist you in helping rule in/out other medical conditions which may also be influencing your child’s eating behaviors and patterns. A therapist may also be able to make recommendations to further evaluate nutrition or evaluation for gastrointestinal issues causing discomfort or pain influencing feeding. They will help develop a comprehensive treatment plan that addresses all different angles of feeding.
Read occupational therapists Maureen Karwowski’s blog regarding playing with your food. Research suggests that when too much negative pressure is placed on the child for eating, the child’s appetite may also decrease and could spur an emotional response leaving the child to dread mealtimes. Vice versa, additional research also suggests that when children are allowed to mess with their food and are given permission to touch, handle, and even squash foods they are actually more likely eat them. Allowing your child to handle food without the expectation to eat the food allows them to gradually desensitize their body to the sights, smells, and feeling of a variety of food. Allowing your child to play with food helps to build new brain pathways that help to reshape prior negative experiences with food.
Recruit your child’s help. If you do not already meal plan, start meal planning and involving your child as much as possible in the process. When at the grocery store, ask your child to pick out food on the grocery list (even if it is not food your child regularly eats). At home, encourage your child to help rinse fruits and vegetables, stir batter, use scissors to cut herbs, or set the table. During mealtimes, serve dishes family style where everyone passes the different food bowls.
Be patient and start very small. Your child might need repeated exposure to try a new food. You may also need to start by presenting a single bite of a vegetable or a fruit versus presenting a lot of the food immediately off the bat. Sometimes, even reading books about different foods, might be the place to start with your child.
Think of fun and creative ways to present the same food. For example, if you child is learning how to like pizza, you can try serving pizza on a tortilla shell or on an English muffin. The following are a few books on food that are good to read with children:
Eating the Alphabet: Fruits and Vegetables from A to Z by Lois Ehlert
Cloudy with a Chance of Meatballs by Judi Barrett
I Will Not Ever Eat a Tomato by Lauren Child
The Seven Silly Eaters by Mary Ann Hoberman
Growing Vegetable Soup by Lois Ehlert
Feast for 10 by Cathryn Falwell
Enroll your child in a food group. Easter Seals has routinely been offering an occupational therapy and speech therapy group called “Fun with Food” that helps children learn how to explore foods using all their senses, including touch, smell, sight, and taste. Each session will utilize sensory “warm up” games prior to heading to the kitchen for our snacks. Parents are encouraged to continue with food exploration at home based on weekly recommendations following each session.
We use the hummus as “glue” and go fishing for goldfish with our veggie stick rods! Not only are you eating an amazing, fiber, protein packed snack, you are also having fun playing a game!
Growing a garden (even a few small containers) is a rewarding experience even for the youngest of gardeners. Everything is more delicious when you grow it all by yourself!
We grow our own vegetables here at “The Lily Garden” and harvesting is always a very exciting time. We have tomatoes, pumpkins, cucumbers, zucchini and broccoli growing this year. In the past we have done rainbow carrots, kale and potatoes too!
Involve your kids in the food preparation and it will make them want to try it too. Research shows that if your child is involved with the meal prep they are much more likely to eat it. Also be a role model and show them that you like to eat your fruits and veggies too!
Please share your favorite healthy snacks in the comments.
The Lily Garden Child Development Center incorporates a play-based program philosophy. We understand that children learn best when provided with experiences in an environment that is positive, nurturing and developmentally appropriate. Learn more about the Lily Garden Child Development Center here.
Bacteria and viruses are everywhere, all around us. They live in our bodies and on our bodies. Even our digestive and immune systems depend upon their presence to provide us with optimal health. While viruses create illnesses we all remember, bacteria are the culprits more often, bringing us foodborne illness or that nasty ‘stomach flu’. With bacteria the obvious places, such as the kitchen sink, bathroom, garbage can, are usually associated with ‘germs’ and the potential for some sort of illness. But bacteria are an invisible society living among us. Bacteria’s numbers are in the millions, and the types of bacteria we are exposed to can bring illness and health.
Wash your hands!
One of the easiest ways to prevent illness is to keep clean. Our hands, foods, kitchens, bathroom, anything we come into contact with in our world. If we simply wash our hands regularly, and not touch our eyes, noses, mouths, our chances of becoming infected by bacteria are significantly lessened.
Wash hands before, during, and after preparing food
Before eating food
Before and after caring for someone who is sick
Keep your food and kitchen clean!
In kitchens, we have a ton of opportunities to come into contact with bacteria that can bring on an illness. With millions of bacteria found in the tiniest of places, imagine the size of your kitchen and just how many places are teeming with the little critters.
The Partnership for Food Safety Education at www.fightbac.org has a wonderful website loaded with helpful information on food safety. If you visit their site, you can find answers to many questions about the food you buy, prepare, eat, store, throw away and reheat. One of the most helpful sections of their site is The Core Four Practices. These are simple practices for food safety.
Wash items in the kitchen – dishes, utensils, counter tops, cutting boards with hot soapy water, after you use an item and before you use it on something else.
Use paper towels for clean up, or if you use cloth towels be sure to wash them on hot.
Rinse all fruits and veggies under water. For those with firm skins, use a vegetable brush.
SEPARATE – Don’t cross-contaminate
Separate raw meat, poultry, seafood and eggs from other foods in shopping cart and bags, as well as your refrigerator.
Do not use the same cutting board for meat and fresh produce.
Do not place cooked food on a plate that had raw meat, poultry, seafood or eggs on it.
COOK – Cook foods to a safe internal temperature
Use a thermometer to measure internal temperature when cooking meat, poultry and egg dishes.
Cook roasts and steaks to no less than 145°F. Poultry to 165°F. Ground meat to 160 °F. Fish to 145 °F.
Cook eggs until the yolk and white are firm.
Be sure there are no cold spots when cooking foods.
Heat leftovers thoroughly to 165 degrees Fahrenheit.
CHILL – Chill foods immediately
Refrigerate foods quickly to 40°F or below. Use an appliance thermometer to be sure of the temperature. Freezers should be 0°F or below.
Refrigerate foods as soon as you get home from the store.
Never allow raw meat, poultry, eggs, cooked food or fresh fruits or veggies to sit at room temperature for longer than 2 hours. If the room is warm, then less than 1 hour sitting out. Do not defrost food at room temperature. Allow foods to thaw in the refrigerator. In a pinch you can use cold water or microwave for thawing, but these foods need to be cooked immediately.
Marinate food in a refrigerator – and do not use marinate from raw meat, fish, poultry as a dipping sauce.
Divide large quantities of foods into shallow containers to allow for faster cooling when storing foods, such as leftovers.
Watch this video from the Academy of Nutrition and Dietetics (AND) on keeping your refrigerator clean. Wiping the inside and outside down, cleaning the shelves and the front grill are as important as the counter tops you use to prepare foods. Going through your refrigerator often to toss outdated foods is something you should do on a regular basis. Know that foods have ‘use by’ dates which refers to food quality, and ‘expiration’ dates to know when to throw something away that is no longer consumable.
Safety tips on Holiday cooking to raw milk or keeping lunch boxes clean,
Food safety with hiking and camping, as well as keeping fruits fresh and reducing food waste are at this site as well.
Use common sense with foods and have respect for the fact that much of what we consume comes through a process where many people have been in contact with our food before we even purchase it. Who has picked the apple from the tree? Where did the chicken egg even come from? Who prepackaged your deli meats? Was the tomato you purchased ever rolling around the grocery store floor before you picked it off the shelf?
Certainly we don’t want to become so focused on cleanliness that we bring more harm than good to our bodies. Remember that millions of bacteria depend on our bodies for their home. When these bacteria are living in a symbiotic relationship with us, we have health. And when they have a good life, we do as well. But when the good bacteria are outnumbered by the bad bacteria, we have illness. An awareness to clean hands, foods and areas that support our mealtimes is great place to start.
By: Emily Mitchell, Easter Seals DuPage & Fox Valley and Northern Illinois University Dietetic Intern & Candidate for Masters in Nutrition and Dietetics
When was the last time your entire family sat down for a meal together? You are an extremely influential role model for your child, and your actions and emotions are essential for your child’s growth and development. Your child learns through experiences and modeling behaviors, so try using meal time as a chance to work towards developmental milestones!
Family Style Meal Service
The environment in which meals are served can impact a toddler’s willingness to try new foods and develop healthy dietary patterns. Family style meals have been shown to be an effective approach in creating an environment conducive to establishing healthy behaviors in the home, as well as in schools and daycare facilities. Most importantly, family style meal service approaches mealtime as a learning experience.
The objectives of family style meal service include:
Helping children develop positive attitudes towards nutritious foods
Learning to engage in social eating situations
Developing healthy eating patterns
Child involvement is integral to the concept of family style meal service, and can be done by allowing children to do the following things:
Be the “produce picker” at the store
Assist with meal preparation
Set the table places
Engage in conversation during the meal
Assist with clean up
Involvement in meal time may look different for each child based on their developmental abilities. When establishing family meals, it is important that children are not only provided guidance through physical assistance and engaging in appropriate social exchanges, such as taking turns, but are also given age appropriate serving utensils and dishware to establish age appropriate portions.
Meal Time- It’s Not Just About Food and Nutrition!
Again, meal time is not solely about food and nutrition; it also provides parents the opportunity to model social, communication and motor skills. Approach mealtime as a learning experience and remember that meal time serves not only to help children develop positive attitudes towards nutritious foods, but also learn to engage in social eating situations, and develop motor skills.
In order to hone in on social, communication and motor skills, involving your child in meal time is key! Conversations during meal time provide an opportunity to enhance family connection and establish relationships among all members of the family. It is a chance to share information or news about your day.
Benefits and Barriers to Family Meals
Family meals have been shown to foster happy, well- adjusted kids. Research has shown that family meals have many benefits, including:
Opportunities for modeling healthy behaviors
Increase autonomy in children
Enhance communication and social skills
Heighten family connectedness
Develop motor skills
Encourage nutritious meals
Despite the many benefits of family meals, it can be trouble to do because of, child behavior problems, scheduling difficulties, and lack of self-efficacy in meal preparation.
What About My Child on Tube Feedings?
How do you involve everyone in the meal? Just as children consume food orally, your child on a tube feeding can use family meal time to socialize, interact, and learn. Have meal time conversations that are about more than the food. Look beyond the calorie nourishment of meal times and include your child receiving tube feedings in meal time, so they can receive the many qualities of meal times.
What is So Powerful About Meal Time?
The real power of meal time is the interpersonal quality. Kids like eating with their families, so allow for some fun! It is understandable that meal time may be frustrating at times, but try to make it as positive of an experience as possible. Dinner may be the one time during the day that a parent and child can share a positive experience—a yummy meal, a joke, or a story. Many children strive for autonomy, so as discussed previously, involve your kids in meal time and allow for learning and laughter! These special moments created at the table help gain momentum for your child’s development away from the table.
Your challenge–schedule time spent at the table with your family into your day! If you find your child has nutrition problems including failure to thrive, obesity, poor feeding skills, sensory disorders, and gastrointestinal disorders or others schedule a nutritional evaluation with Easter Seals DuPage & Fox Valley today. Learn more at eastersealsdfvr.org/nutrition.
Excellent nutrition is one of the most basic requirements for a child to grow and thrive. A study published by Pediatricsfound that diagnosis-specific, structured approaches to nutrition issues among children with developmental disabilities significantly improved energy consumption and nutritional status. Yet, nutrition disorders and compromised nutritional status are very frequent among children with developmental disabilities.
Research shows that as many as 90% of children with a developmental disorder have at least one nutrition risk indicator. Nutrition problems can include failure to thrive, obesity, poor feeding skills, sensory disorders, and gastrointestinal disorders, to name only a few. Individuals with special needs are also more likely to develop co-existing medical conditions that require nutrition interventions.
Thanks to two significant grants from Hanover Township Mental Health Board and Special Kids Foundation, Easter Seals DuPage & Fox Valley can now offer nutrition services for children, regardless of insurance, in areas currently underserved immediately north and west of DuPage County. This includes full financial support for those uninsured, underinsured or on Medicaid; and partial support for those in Early Intervention or with insurance. Children who qualify will receive a nutrition evaluation and follow up nutrition therapy as needed.
Qualifications for children (birth to 21 years of age) to receive this service include:
Eligible medical diagnosis or identified eating concern AND
Easter Seals DuPage & Fox Valley Nutrition Therapy provides care that is difficult to find elsewhere in a community or medical setting. Training and specialties include assisting children with improved oral and digestive tolerance, modifications to help improve growth, adjusting diet for improved variety, volume and complexity of foods and fluids, balancing the diet of those with food allergies or sensitivities, help with transitioning (off of or onto) a tube feeding, and homemade blenderized formula and diet modifications.
Evaluations are performed at the Center, in the family’s home or community setting. Our goal is to provide optimal nutrition care to children with developmental disabilities through an inter-disciplinary approach, addressing their nutrition risks and disorders and helping them to lead healthier lives.
Please refer parents, other specialists or anyone else with questions about the program to our Nutrition Therapy intake coordinator, Christy Stringini, who can be reached at 630-261-6126 and cstringini@EasterSealsDFVR.org.
Learn more about Easter Seals DuPage & Fox Valley nutritional therapy and feeding clinic at www.eastersealsdfvr.org.
In my house growing up, meals were serious business. My parents had rules around “dawdling”, and playing with food was an absolute “no no”. Now, in my work as a pediatric occupational therapist, I advise the families that I work with to break these rules (and for good reasons).
Many of the children that I work with have sensory processing difficulties. Sensory processing challenges occur when a child has difficulty interpreting and responding to the sensory experiences in daily life. It is estimated that 1 of 20 children are impacted by a sensory processing deficit (Ahn, Miller, Milberger, McIntosh, 2004).
For some children with sensory processing difficulties, they have heightened sensitivity to textures, smells and tastes. These sensory over-reactions negatively impact a child’s ability to tolerate diets with a wide variety of textures, looks, smells and tastes. I have clients who eat foods that are similar in color, for instance all shades of white (crackers and chips). Other children eat foods that are munchable in texture, so graham crackers, chicken nuggets, and macaroni and cheese. One little boy that I worked with could not even be in the kitchen while his mother was cooking because the smells were so offensive to him. I remember clearly that he told me “food is not fun for me like it is for you”. That was a profound statement from a child of 5 years of age.
The good news is that I have seen great results in helping a child to expand their diet with work in therapy, and with the parents’ work at home. Many children do well with an individual while others do their best in a group with other children. I always start with a thorough occupational therapy evaluation, and assess the child’s sensory processing skills, motor coordination and fine motor skills. I work closely with speech therapists and a dietitian who specialize in working with children with feeding challenges. I want to rule out any oral motor and medical concerns before starting any kind of therapy with feeding.
The goal of my therapy sessions is to explore foods in a fun and low pressure manner. So dawdling and playing with food are an integral part of the work with my clients. Picture making towers of cucumber slices, while my client knocks them over repeatedly. Picture using those cucumber slices as goggles to look through. How about blowing peas off the table and into a bowl? I love making shapes and letters with cooked spaghetti noodles. These types of games provide my clients with the sensory experience of the food, but in a way that is very low pressure. The goal is not to eat the food initially, but to explore the foods in any way that the child can tolerate it. As the child is more comfortable with the touch, smell, look and taste of a food, the more likely they would be to eat the food.
For parents at home, I do suggest a time where the parent and child are having fun with exploring food, in any way that they can. I encourage families to have the child help with carrying food to the table, or pick out the vegetables at the market. Can the child mash potatoes? How about toss a salad? A child is much more likely to explore a food if they know that their parent is not expecting them to taste it.
Consult your child’s therapist to determine if your child would benefit from a sensory approach to feeding or contact Easter Seals DuPage & Fox Valley for information about our summer feeding groups.
Poop. Pooping. Pooped. A word that is usually reserved for little babies, and usually not for anyone older. Though we all do it, discussion after infancy wanes and it is just assumed we do. Terms like ‘bowel movement’, ‘stool’, and ‘number 2’ replace the cute and friendlier term of ‘poop’. However, one of the most common challenges seen in all people, and especially our children, is the ability to produce a stool that is soft, formed, easy to pass, and on a regular basis. Otherwise known as constipation, this quirk in the gastrointestinal system is connected to a myriad of more problems that need to be addressed. Often the underlying root problem of constipation is overlooked, as parents, doctors, therapists all aim to solve the other problems. As a wise doctor once said, “You have to be able to make the package and deliver it”. So let’s look at what contributes to constipation, how this creates further problems, and some ways to make a package and deliver it.
The Gastrointestinal System
In simpler terms, the GI system is a long tube that starts at our mouth and ends at our anus. The process starts when we eat and drink, whatever that might be. Digestion begins in our mouth using our jaw, teeth, lips, cheeks and tongue, and then saliva is released into our mouths to help break the food down. We swallow this food down our throat, through our esophagus and into our stomach. In the stomach churning begins, pushing the food around and breaking it down further, as more secretions from the stomach are released to help water it all down as it makes its way to the end of the stomach, and in a timely fashion, is released into the beginning of the small intestines. At this point more chemicals are released out into the body, sending a message to the brain that nourishment is coming in, and beginning to decrease our hunger, while also telling the GI system to move things along.
In the intestines, more secretions, from the gall bladder and pancreas, are received by the newly arrived stomach contents, which further breaks the particles of food down in this very fluid environment. Muscular contractions, known as peristaltic waves, move the contents along the small intestines, and these minute particles of food and fluid are pulled into our system in the small intestines to provide the nutrition needed for our bodies to function. About two hours after eating, chemicals are released into the body again, telling the brain that it might be getting hungry. Back in the intestines, the peristaltic waves continue to push the mix out of the small intestines and into the large intestines. There a spectrum of bacteria are found to further help the digestive process by feasting on any fiber in the diet creating a small amount of gas, and water begins to be pulled back into the body, thus creating what will become flatulence (gas) and poop. As the formed mass sits in the rectum near the anus, nervous tissue senses the presence and helps further push the contents out of the body.
What causes constipation?
Unfortunately so many things can mess this finely tuned process up, and contribute to constipation. With children, abnormal anatomy function is one, and includes low and high muscle tone, neurologic disorders, Hirschprungs disease, anal atresia or stenosis, lack of activity and immobility. Medications can also mess up the process, and a few known include analgesics, anticholinergics, anticonvulsants, antidepressants or antipsychotics, chemotherapeutics, and long term use of laxatives. Factors such as fatigue, anxiety, changes in routine or lifestyle, lack of routine, negative associations with eating/stooling, improper positioning, behavioral withholding, encopresis and inability of a child to let a parent or caregiver know they need to use a toilet. Diet is most often deemed the culprit, and lack of fiber or fluid is the go to blame. Although these two areas do contribute to constipation, other associated areas of diet include, poorly chewed foods (oral motor delays, low strength and endurance with eating), difficulty swallowing liquids (thickened liquid diet, dysphagia, nipple size, breathing coordination), excessive fluid losses (drooling, vomiting, fevers, renal conditions), and dairy or soy protein sensitivity (IgG, IgE testing, improvement when removed from diet).
What might give one cause to consider if a child has constipation? Frequency of stooling is a clear identifier. But when a parent describes challenges with stools using terms such as rabbit pellets, Snickers bar, little smears, dry rocks, marbles, can pick it off of his diaper, goes into the corner and cries, paces the room first, we know when he’s pooping, and grunts loud and long an intervention should be considered. Other signs that a child is constipated can be very poor eating, small little portions of food or drink, behavioral challenges, vomiting, GE reflux, spit up, aversion to eating, and enlarged abdomen.
Causes of constipation are so many, and the resolution to this is not as simple as giving a child more fluid or fiber. In fact, more fiber with not enough fluid can compound the problem by increasing constipation. So when trying to help find the right solution, a multidisciplinary approach may be the best. Speaking to the child’s pediatrician is the first place to start, and sometimes the solution. Asking to consult with a
gastroenterologist may be the next step, or seeking the help of a registered pediatric dietitian/nutritionist to review the diet and make adjustments where needed. If the child is seen by any therapist, physical, occupational or speech, inquiring about tone, breathing, oral motor skills with eating and drinking can be helpful.
Physicians are often needed initially to help with the immediate concerns of constipation and alleviating the situation. Use of lubricants, bulk producers, stimulants and stool softeners can be very helpful. These include laxatives such as enemas, Senokot, Ex-Lax, Metamucil, Mineral oil, Colace, Miralax, and Lactulose.
Diet changes, assisted by a registered dietitian/nutritionist can include increasing sources of fiber in the diet through grains, fruit and vegetables. Increasing fluid intake through drinkable fluids, or higher watery foods such as fruits and vetetables, or pureed versions of these foods. Trialing off of dairy products, but incorporating other foods to help replace these nutrients. A physical therapist can help if the contributing factor is poor tone, and use of an abdominal binder, SPIO suit, abdominal massage, positioning, breathing coordination have been shown to help in some children. Occupational therapists can help children become more aware of their body, and learn to know when they need to stool if their awareness is poor, or help with managing behaviors that persist once the constipation has been resolved. Speech language pathologists trained in feeding can also ensure the child is managing their eating and drinking well, check respiration as well, and give solid points on positioning with feeding. Bowel management programs do exist, and these programs can help with management of stooling in a broader manner that includes much of what has been listed above, as well as management of timing through the day.
The bottom line (no pun here) is that everyone should be able to stool comfortably and easily on a regular basis. Food and fluid need to go in continually to help with growth and development of all children, and what goes in will ultimately have leftovers that need to come out. With little babies, management is much more controlled, as a parent has access to seeing what has come out in the diaper. But as children age, parents have less access to their child’s bodily functions, children are less vocal about what may or may not be happening, and challenges with pooping can go unnoticed and unresolved. The screaming, crying, pulling, difficulties with eating in infancy are clear signs of constipation that are not going to be seen as children age. But do know that older children who have constipation are going to demonstrate their discomfort somehow. Ensuring an older child is pooping comfortably on a regular basis is a must, and involves a bit more, uncomfortable at times, conversation. But in the end (again, no pun) it can solve a load (really?) of problems.