Category Archives: nutrition

Nutrition/Feeding Clinic at Easterseals DuPage & Fox Valley –The Comprehensive Approach 2021

By – Cindy Baranoski MS, RDN, LDN and Laura Van Zandt OTR/L

Updated February 2021

In January 2019, a groundbreaking article was published in the Journal of Pediatric Gastroenterology and Nutrition describing children challenged with feeding problems and their care. Pediatric Feeding Disorders (PFD) is the term the expert team of authors define as “impaired oral intake that is not age-appropriate, and is associated with medical, nutrition, feeding skill, and/or psycho-social dysfunction.” It establishes the basis for creating and implementing a medical diagnosis code that would support children identified as having problems in any of these four areas, which are impaired by or impairing a child’s ability to eat a diet that is expected for age.

It concludes with the primary need for children to be identified early and receive interdisciplinary evaluations and interventions instead of seeing one practitioner alone to try and help all areas. Interdisciplinary thinking, evaluations, and treatment have been the core practice of Easterseals DuPage & Fox Valley’s Feeding Clinic for the past 21 years, since its inception in 2000.

What Brings You Here

From the moment we are born, feeding and eating is something that is supposed to come naturally to everyone. When a baby is born, we feel an overwhelming sense of love and a strong desire to watch over, protect, and nourish to grow. When it’s time for feeding, our bodies are already preparing the necessary tools to breakdown and process what is provided. Feeding involves more than just our mouths. At play are the sights (color, shape, size), feelings (warm, hot, cold, crunchy, chewy, soft, sticky), smells (sweet, stinky), sounds (loud, quiet), and most significantly, the way our body works. From how our muscles work together to align our trunk in sitting, allowing our arms to reach, grasp, and explore, to coordination of suck, swallow, and breathe, and manipulating the food in our mouths, everything sets the foundation for a good relationship with mealtimes and foods. Our past and current experiences all shape our belief around feeding and nutrition. Your body must work all together to receive and process nourishment.

For some children, however, this process isn’t easy and doesn’t always come naturally. Many children struggle to coordinate their bodies to eat or drink and have GI systems that do not process foods well, leading to constipation, diarrhea, vomiting, and gastroesophageal reflux, which then leads to poor growth, frustrations, fear, and worry. For children with respiratory conditions, poor coordination of breathing, overall weakness, eating a meal like other children their age is nearly impossible. Yet, they still need what other children need – nourishment, socialization, variety, scheduled mealtimes, and interaction with foods. For children, who may be fed through a tube, eating may not be the primary mode of nourishment, but all the other factors promote development, health, and good growth.

As a parent, there is nothing more important than watching your child grow and thrive, and nothing is more heart-wrenching than watching them struggle. When a child does not eat, parents feel blame and guilt. We ask ourselves why? Did I do this? What could I have done differently? We try a host of different strategies. We Google and seek advice from family, friends, and medical providers. We fall back to what we know, which may or may not work.

Who We Are

Our Feeding Clinic at Easterseals DuPage & Fox Valley consists of a team of individuals who have a passion for helping kids with feeding, mealtimes, tolerance, health, and growth. Our team assesses the many different reasons why a child might be struggling. We are not just looking at their ‘behavior’ but dig deeper and aim to understand the core source of the behavior and what it is communicating. Eating is so much more than bringing food to the mouth, chewing, and swallowing.

Our Clinic consists of a pediatric gastroenterologist/integrative medical practitioner, registered dietitian nutritionist, speech and language pathologist, occupational therapist, and parent liaison. The team has over 230+ years of combined expertise and has gone on for extensive training in many areas, such as NeuroDevelopmental Therapy (NDT), Sequential Oral Sensory (SOS) Approach, DIR/Floortime, Respiratory and Rib Cage Development, Homeopathy, and Chinese medicine.

As a team, we review your child’s birth and developmental history before the appointment, with a thorough analysis of the diet record you submit. We ask you to let us know your evaluation expectations when filling out the paperwork, both online and written forms. Our goal is to meet these expectations. During the actual meeting we are looking and listening for red flags that clue us into issues driving the challenges your child is having. A list of possible reasons why your child might be seen by our feeding clinic is found in Table 1.

Table 1

What Happens, What We Do, and What’s Next

In this unexpected time of a pandemic, Easterseals DuPage & Fox Valley has seamlessly moved to a more virtual experience for nearly all services, including our Feeding Clinic. Keeping our clients, their families, and our staff safe is a number one priority while continuing to be one of the most impactful Feeding Clinics around. Our clinic has been providing virtual evaluations since April 2020, and our use of HIPPA compliant Microsoft Teams platform has allowed everyone to participate fully. When your child is referred for an evaluation by the team, our Clinical Admissions Coordinator will guide you through our secure system of the intake process. We have revamped the process to make it easier for you and provide written suggestions to help you prepare for the evaluation day. Being in your own home for the evaluation has so many benefits but also can seem overwhelming, so we offer tips on setting up your space to allow a more successful evaluation of your child with the least amount of stress for you.

During the interdisciplinary evaluation, the full team meets with your family virtually. Engaging with and helping your child feel comfortable, the speech and language pathologist and occupational therapist will give suggestions while listening and performing their physical assessment. We have worked hard to create a safe, calm, effortless process to continue to successfully support our Feeding Clinic evaluations, which continue to be very much in demand even in a pandemic. Parent’s positive comments and impactful outcomes of our evaluations speak for themselves.

Medical & Nutrition

First the team reviews and establishes your child’s medical health and overall nutrition status. Many medical complications from birth can impact a child. Undiagnosed medical and gastrointestinal (GI) problems often come to light in the clinic.

Think of your child’s health as the foundation of your house. If your foundation is weak, then the floors above it will compensate for weakness. If your child struggles from constipation, diarrhea, dysmotility, gagging, GE reflux, they are most likely subconsciously learning to connect food and drink to feeling poorly. Additionally, understanding your child’s nutrition helps the team understand what might be contributing to what is not medical, allowing the team to make appropriate recommendations to ensure optimal growth and health. Analysis of current nutrition includes what is expected for your child, balance, the timing of meals/snacks, calories, protein, fluid, hydration, vitamins/minerals, route of nutrition, and growth. Understanding both medical health and nutrition status allows for changes from the foundation first and foremost.

Speech and Language Pathology & Occupational Therapy

Observing how your child interacts and engages during the evaluation can help the speech and language pathologist and occupational therapist before they move on to assess the physical portion of eating and drinking. No matter where your child is in their journey with food and feeding, our goal is to have a positive relationship during the process. While observing your child, both therapists also look at their underlying motor skills and evaluate if any postural supports might be beneficial. Mary Massery, a well-known physical therapist, has said “breathing always wins”, and she is not wrong. Breathing dominates. Where your body is in space and stability is its second priority. Swallowing and feeding behavior must continually adapt to changing respiratory and postural systems.

The speech and language pathologist works to get a better sense of your child’s oral motor skills while the occupational therapist observes potential underlying sensory processing difficulties and relationship issues with food. Anxiety around meals and feeding can increase adrenaline which suppresses our desire to eat. Assisting with overall regulation is essential for comfort at mealtimes.

Social Services

The emotion with feeding and nutrition difficulties can be overwhelming for both the parents and child. Often, a child’s survival from birth and medical health is the primary focus, as it should be. When a child becomes more stable, a parent can start to see beyond the medical fears and begin to focus on other things such as the experience of feeding. With this new focus, the emotions, fear, concerns, and hope are still there. Whether your child is struggling to be an oral eater or being fed by tube, the emotions can be immobilizing. Our parent liaison is a vital team member in our clinic, helping every parent know they are not alone. She provides support, empathy, and connections to any number of resources.

Wrapping Up

By the end of the evaluation, the team confers together, with immediate and long-term recommendations being made. Often, these recommendations focus on gut health, breathing, positioning, or establishing improved nutrition, before working on some of the more therapeutic needs such as oral motor skills or sensory processing/relationship interactions. Sometimes recommendations are made to work on several key things simultaneously to help your child be more clinically stable, or a single recommendation that may be central to all other concerns identified. Returning to our 90-minute clinic for a follow-up visit may be one of the recommendations made.

Final Thoughts

Wherever you are at in your child’s journey, there are many aspects to feeding disorders in the pediatric population. Therefore, identifying and addressing all of them is a priority that should not be overlooked. Easterseals DuPage & Fox Valley’s Feeding Clinic has been and continues to view your child and his care from this interdisciplinary “Pediatric Feeding Disorders” approach, involving a skilled and expert team of professionals. Nutrition issues is an area that brings an enormous amount of stress and anxiety to a child and his caregivers. Our team is uniquely qualified and experienced to assist children at all levels of feeding, instilling hope and helping them be their very best.

Every child is unique, and each intervention is tailored to fit your child and family. While you research options you have, consider the following –

  • Aim to help your child feel their best. They need to feel well – this is key for success in any area.
  • Ensure your child is receiving sound nutrition, regardless of what they are currently receiving. There are many ways around getting your child good nutrition.
  • Assess their positioning with mealtimes and feeding to be sure they are fully supported. Positioning is key. Seated on a firm surface with feet flat on the floor or chair rail, with head and shoulders aligned over hips, equal weight bearing, is the most optimal positioning. Allow her arms to rest on her tray or table with shoulders down.
  • Ensure a regular schedule. Regardless of if your child is orally fed or through a tube, a mealtime plan is essential, and helps your child learn hunger and fullness, allows their bodies to sustain through the day, can improve their overall tolerance, and should have a positive beginning and end.
  • Patience – feeding therapy is a journey with bumps and curves along the road. Share your compassion and empathy. Learning to eat and mealtimes, after a rough beginning, might involve reshaping many memories. You might have to start over to build trust. Remember even the tortoise finished the race with the hare.
  • Expose, expose, expose and don’t limit opportunities for exposure. Have fun and play with food. Model appropriate food reactions – don’t “yuck someone else’s yum.” Continue to find ways to present food to your child even if he is not ready to taste them. You can read books together about food, visit different grocery stores and markets, kids cooking classes, and find ways to get them involved in mealtime preparation without eating. And even if it involves a tube feeding.

To learn more on our Feeding Clinic and Nutrition Department at Easterseals DuPage & Fox Valley visit our website at: https://www.easterseals.com/dfv/our-programs/medical-rehabilitation/specialized-clinics/feeding-clinic.html.  Contact Clinical Admissions at 630.261.6287 or mscholtes@eastersealsdfvr.org  for questions or to schedule an appointment. 

Understand and Boost Your Immune System

By: Manager of Nutrition Therapy, Cindy Baranoski MS, RDN, LDN

Better Immunity is Achievable

What better time than now to start building your defenses against illnesses? With coronavirus or COVID-19 here, there is a lot of fear and a feeling of helplessness to do anything. But you should know that there are things you can do to help protect yourself and your family’s health overall.

As a human we are bound to become ill, but how that illness manifests in us, how extreme are the symptoms, how long does it last, when does it go away, and can we get it again, can be under a bit of our control if we do the right things to keep our body’s immune system and defenses strong.

What Protects Us From Illness

Many components make up our defense system, some we can control and others we cannot. A human body contains trillions of microorganisms or microbes that outnumber our cells by 10 to 1. The term ‘microbiome’ refers to the genetic material all of these microbes contain, and their total genetic material is 200x more than the number of genes in a human body. Many of these microbes are pathogenic, or able to cause disease, but coexist with a human body never causing disease. Consider that two to six pounds of a 200-pound person would be bacteria!!

The immune system

Our immune system is made up of cells that perform the ‘immune response’ to foreign invaders, such as disease causing bacteria, viruses, fungi, parasites or any other foreign matter. B cells, T cells and Memory cells are all mobilized in some manner when they determine there is an antigen – a toxin or foreign substance – that has entered the body. The response is antibodies matched to an antigen, like a key in a lock, helping to neutralize or destroy the antigen.

Physical protection from foreign invaders

Our body has many physical systems in place to keep us healthy and protect us from foreign microbe invaders, or the ones living within us, from causing disease.

  • Skin – is a physical barrier, with a pH that discourages growth of organisms, and our secretions of sweat and oil can kill many bacteria.
  • Stomach – acid in the stomach can kill organisms.
  • Tears – will wash away any foreign matter and contain enzymes that kill bacteria.
  • Saliva – helps clean microbes from our teeth, tongue and oral area.
  • Respiratory tract – including our nose, which contains fine hairs to trap foreign matter, mucous lining the system to trap invaders, and cilia to sweep away trapped organisms.
  • Large intestines – contains bacteria that help keep invaders in check. This ‘gut microbiome’ makes up 70% of our immune system.
  • Bladder – urine washes away microbes from the area leading to the outside world.

What we Have Limited Control Over

Chronic noninfectious conditions, such as cancer, diabetes, hypertension, high cholesterol, heart disease, inherited genetic conditions all play a role in diminishing the defense system of the human body. Those that are most notable include the following –

Heredity – is one of the greatest factors that influence our noninfectious disease risk. Our genes play an important role in what conditions, such as diabetes, cancer, hypertension, may occur in our lives. These conditions impact our immune system, and can leave us more susceptible to disease.

Age – after 40 years of age the human body is more vulnerable to chronic diseases, though very young children whose immune systems are still developing, or those over 65, are especially vulnerable.

Environment – and the ability to have clean, sanitary living conditions is key to keeping us healthy. Though our bodies need to be exposed to microorganism to help our immune systems develop resistance. Too clean doesn’t allow our systems to recognize good and bad microbes. Additionally, conditions that include the presence of drugs, chemicals, pollutants, waste in food and water, or the absence of medical care, increase risk for disease.

Microorganisms – severity of or resistance to pose challenges as well. For some, only one cell is needed to create drastic illness in the human body. Bacteria that become resistant to antibiotics from overuse by us have mutated to be able to bypass the antibiotic’s effectiveness.

What We Have Control Over

Though we cannot see most of the microbes that cause sickness, they are there, and we can create an environment within and outside of our body that prevents them from causing illness. Stress, personal hygiene, nutrition, fitness, sleep, substance use, environment, and behaviors are all under our control.

Stress, such as what we are experiencing right now diminishes our ability to fight disease. When we are stressed our body will divert its energy away from nonessential functions to those that are essential – the Fight, Flight or Freeze response. Our blood is redirected to muscles to run or fight, breathing is faster, heart rate increases, pupils dilate, and hearing is keener, ready to take on the Sabre Tooth Tiger that generally doesn’t exist. What our body prepares to fight remains invisible, but it is prepared at all times. This leaves body functions required to exist in an unstressed state diminished in their ability.

Reducing Stress

If you’ve not already received numerous emails or suggestions from friends, there are many ways to manage your stress. Any one of these should be done with care, intent, and in such a gradual manner a snail could pass you by. Safety is key, to not create an injury or situation that will cause you more stress.

Exercise is one way, and has more than just stress reduction benefits. A workout club or gym may not be available to you, but you have so much in your home that is available!

Walk out your door for 15 minutes, turn around and come home. You’ve just walked for 30 minutes.

Turn on some fun music and simply march or walk in place for 20 minutes.

If you live in a condo or apartment building, do the stairs (taking precautions with social distancing and face masks right now.)

If you don’t have weights, you can use cans, bottles, something of weight that you can use for dumbbells.

Floor exercises that are easy, safe and you do not over do such as sit ups, leg raises, push ups. You only need to do a few, or even just one.

Yoga can be done on your own, without one piece of equipment. There are recorded and live streams of yoga all over the Internet today. As a yoga instructor, I can share that anyone can do it! Yoga is not just for bendy, flexible, skinny-legged sweaty 25-year-olds.

Chair yoga is amazingly beneficial, and is done by 85-year-olds around the globe.

Restorative yoga is one of the most relaxing forms of yoga, where you are supported by props, which increases your parasympathetic nervous system, slowing your heart and relaxing your body.

The yoga many are familiar with regular upright movement, is a wonderful stress reliever-though remembering if you’ve never done yoga, it may contribute to more stress.

And if nothing else, just laying on the floor, on your back, legs and arms out on the floor (or knees bent), known as savasna, is one of the most important poses in yoga. Lay there for 10 minutes.

Meditation may sound all “woo woo,” but it is more than just crossing your legs into a pretzel, closing your eyes and chanting ‘ommmm’. Meditation is simply anything you do to direct your mind to become focused on one thing, taking you away from this world momentarily. It reduces the physical reactions to stress mentioned above, slows your breathing, quiets your organs, increases your parasympathetic nervous system, and quiets your racing mind. The benefits of meditation are not IN the meditation, but in your body’s response when not meditating. By helping to maintain the ‘quiet’ your body should be in, your immune system can work it’s best.

Reading a book, gardening in the yard, coloring, drawing or painting, and praying are all forms of meditation.

Traditional meditation takes practice, and yes, sitting quietly, not moving, eyes closed, is what many think of. Try sitting still for 1 minute with your eyes closed. You’ve just started meditating. Now, get comfortable in a supportive seated position, and try it for 5 minutes. This is how you start to meditate with intention to do so, knowing it can only help.

Numerous meditation apps exist now, with timers, streamed and recorded meditations from 1 minute to many. Examples include:

Laughter should not be discounted by any means. Laughter is the best medicine! It can decrease stress hormones, relax muscles, and decrease pain. Ten minutes of laughter is better than any drug!

Sleep is a time when our body heals, rests, and prepares for our next day. Restful sleep is often not possible when we are stressed. 7-8 hours a day for an adult, and more for children and teens. There are many activities that can impact restful sleep, including technology, alcohol, eating before bed, and stress. Helping reduce your stress will promote restful and restorative sleep. Aim to create a bedtime routine for you and your family with no technology, eating, bright lights, noise – good sleep equals less stress, and less stress equals good sleep.

Personal Hygiene is something we take for granted. We have soap, water, tooth brushes and toothpaste, showers, baths, shampoos, hand sanitizers and hand soaps. Just so many forms of how we can keep ourselves clean on a daily basis. We forget this is not available to everyone in our area or the world. But keeping ourselves clean is something we can do, easily, by washing our hands routinely – especially now.

Improving Personal Hygiene

The greatest source of infection is our hands. We touch everything, then ourselves, transmitting to someone or us, germs and potential antigens. Wash your hands – for 20 seconds – with soap and water, between the fingers, back side of the hands, under the nails and wrists.

When you cough or sneeze, cover up! Most of the time we have on shirts, right? Pull it over your nose and mouth, use your elbow and sleeve, and if you use your hands, wash them after.

And now we have face masks. So treat your face mask like you do your underwear

only wear it if it’s clean

don’t touch it or adjust it – especially in public

don’t lend it to anyone

don’t borrow anyone’s

make sure it fits well

wash it after wearing

if it’s stained or torn, throw it away I

From A Chalkboard a Day

Nutrition is one of the key contributors to the immune system. Remember, we are built on what we consume and do with our bodies. The ingredients for a great body include what we consume, and if all we eat and drink is lacking in nutrients, then that is who we become. Under nutrition or malnutrition is not reserved exclusively for poor families and children who are skinny and wasting away. Malnutrition is found in obese individuals as well as healthy weight ones too. http://www.MyPlate.gov shared by the USDA gives a basic outline of what should be consumed for variety of all the nutrients, including Carbohydrate, Protein, Fat, Calories, Fluid and 29 known vitamins and minerals. We are what we eat! To learn more about helping a child with nutrition or feeding issues, visit: https://www.easterseals.com/dfv/our-programs/medical-rehabilitation/nutritional-therapy.html.

Improving Nutrition 

  • A balanced diet containing of all the different food groups is the starting place. Review your family’s diet, and see if you have foods representing Fruits, Vegetables, Protein, Dairy (animal or plant), Grains (whole) as well as fat. Is there enough fluid each day? Are there vitamin/mineral supplements taken already. Are there nutritional drinks being consumed each day, and what might these be replacing or supplementing if they are used regularly. What about processed foods, high sugar, fat and salty foods that are being consumed more than they should be. Are fresh foods represented well? And is one food group consumed in a much greater quantity than it should be? You need to review your diet before you know what to change to make it better.
  • Protein is one of the most important nutrients, helping make antibodies of the immune system. We all need varying amounts of protein, but we also don’t need as much as we think we need. An average adult needs about 50 grams of protein a day, and consumes about 100 grams a day in the US. Children need less than this, yet often consume more than they need as well. Main food sources include meat, fish, poultry, egg, legumes, dairy.
  • Malnutrition and under nutrition exists in this country, and includes lack of calories and protein, but often times our society consumes more than enough of these two nutrients, however, lack many vitamins and minerals. A recent government study shows potassium, calcium, Vitamin E, C, A, D and magnesium are all less than optimal in our diets. All vitamins and minerals are ingredients of our immune system.
  • A few nutrients identified in research as key to the immune system and it’s response, that you should be sure you are receiving adequate amounts of, include the following –
    •  Zinc – found in tuna, beef, poultry, pumpkin and hemp seeds and dairy. Caution, over consumption of zinc, or taking large supplements, can interfere with copper balance in the body.
    • Selenium – found in Brazil nuts, tuna, sardines, salmon, chicken egg, brown rice.
    • Vitamin C – found in acerola extract, rose hips, camu camu, black currents, guava, lemons, limes, oranges, strawberries. Though higher doses can cause loose stools.
    • Vitamin D – does not have many great food sources. Fortified animal and plant milks will contribute when consumed in the right portions. Short periods of exposure to the sun without sunblock allows for production of Vitamin D beginning in the skin. However, with the concerns for skin cancer, sun exposure is limited. Supplementation of Vitamin D3 is the most reliable source.
  • Probiotics are beneficial for the human body. Studies have shown their benefit to the digestive tract, and ultimately the immune system, by ensuring the line of defense in the gut microbiome is balanced and working well. They are found naturally in some foods, and more common are manufactured supplements taken orally. ‘Prebiotics’ are food for the probiotics and are found naturally in our gut through consumption of fiber, but can also be found along with probiotic supplements.
    Important Note on Vitamins, Minerals and Probiotics – Taking large amounts of any supplements, or consumption in large amounts of any individual or multivitamin/mineral supplement is not advised. If you are choosing to do this for you or your child, you are directed here to speak to a physician or dietitian.

Environment and Behaviors could be discussed in so much more detail than this post can provide. But know your behaviors are under your control. What you do impacts anyone and everyone, including our world. The environment is not just something that happens, but is changed by everything we do. Being thoughtful of ourselves is so important, but if we become so self absorbed and focused in the long run, our world will become more skewed from what it should be, which ultimately comes back to our ability to be healthy in this world.

In summary
Creating a place in your world that is safe, clean, nutritive, and supportive of your immune system is totally within your reach, taking time and attention. The scary world of viruses and diseases that are out of your control can be managed, and the impact it has on health – yours, your family’s, friends, and society – is pretty significant. There is so much more, but I hope some of the thoughts and ideas mentioned here might stir you to rethinking your role in this world of immunity.

I wish you and your family the best health. For more information on our nutrition services, please visit: https://www.easterseals.com/dfv/our-programs/medical-rehabilitation/nutritional-therapy.html.

Nutrition/Feeding Clinic at Easterseals DuPage & Fox Valley –The Comprehensive Approach

By: Laura Van Zandt, MS, OTR/L & Pediatric Nutrition Therapist Cindy Baranoski MS, RDN, LDN

In January 2019 a groundbreaking article was published in the Journal of Pediatric Gastroenterology and Nutrition describing children challenged with feeding problems and their care. Pediatric Feeding Disorders (PFD) is the term the expert team of authors define as “impaired oral intake that is not age-appropriate, and is associated with medical, nutrition, feeding skill, and/or psycho-social dysfunction.” It goes on to establish the basis for creation and implementation of a medical diagnosis code that would support children identified as having problems in any of these four areas, which are impaired by or impairing a child’s ability to eat a diet that is expected for age.

It concludes with the primary need for children to be identified early, and receive interdisciplinary evaluations and interventions, as opposed to seeing one practitioner alone to try and help all areas. Interdisciplinary thinking, evaluations, and treatment have been the core practice of Easterseals DuPage & Fox Valley’s Feeding Clinic the past 20 years, since its inception in 2000.

What Brings You Here

From the moment we are born, feeding and eating is something that is supposed to come naturally to everyone. When a baby is born, we feel an overwhelming sense of love and a strong desire to watch over, protect, and nourish to grow. When it’s time for feeding, our bodies are already preparing the necessary tools to breakdown and process what is provided. Feeding involves more than just our mouths. At play are the sights (color, shape, size), feelings (warm, hot, cold, crunchy, chewy, soft, sticky), smells (sweet, stinky), sounds (loud, quiet), and most especially, the way our body works. From how our muscles work together to align our trunk in sitting, allowing our arms to reach, grasp, and explore, to coordination of suck, swallow, and breathe, and manipulating the food in our mouths, everything sets the foundation for a good relationship with mealtimes and foods. Our past and current experiences all shape our belief around feeding and nutrition. Your body must work all together to receive and process nourishment.

For some children, however, this process isn’t easy and doesn’t always come naturally. Many children struggle to coordinate their bodies to eat or drink, have GI systems that don’t process the foods well leading to constipation, diarrhea, vomiting, GE reflux, which leads to poor growth, frustrations, fear, and worry. For children with respiratory conditions, poor coordination of breathing, overall weakness, eating a meal like other children their age is nearly impossible. Yet, they still need what other children need – nourishment, socialization, variety, scheduled mealtimes, and interaction with foods. For these children, who may be fed through a tube, eating may not be the primary mode of nourishment, but all the other factors play into what promotes development, health, and good growth.

As a parent, nothing is more important than watching your child grow and thrive, and nothing is more heart wrenching than watching them struggle. When a child doesn’t eat, parents feel blame and guilt. We ask ourselves why? Did I do this? What could have I done differently? We try a host of different strategies. We Google and seek advice from family, friends, and medical providers. We fall back to what we know, which may or may not work.

Who We Are

Our Feeding Clinic at Easterseals DuPage & Fox Valley consists of a team of individuals who have a passion for helping kids with feeding, mealtimes, tolerance, health, and growth. Our team assesses the many different reasons why a child might be struggling. We are not just looking at their ‘behavior’, but dig deeper and aim to understand the core source of the behavior and what it is communicating. Eating is so much more than bringing food to the mouth, chewing, and swallowing.

Our Clinic consists of a pediatric gastroenterologist/integrative medical practitioner, registered dietitian nutritionist, speech and language pathologist, occupational therapist, and parent liaison. The team has over 230+ years of combined expertise, and have gone on for extensive training in many areas, such as NeuroDevelopmental Therapy (NDT), Sequential Oral Sensory (SOS) Approach, DIR/Floortime, Respiratory and Rib Cage Development, Homeopathy, and Chinese medicine.

As a team, we review your child’s birth and developmental history prior to the appointment, with a thorough analysis of the diet record you submit. We ask you to let us know your expectations of the evaluation when filling out the paperwork, both online and written forms. Our goal is to meet these expectations. During the actual meeting we are looking and listening for red flags that clue us into issues driving the challenges your child is having. A list of possible reasons why your child might be seen by our feeding clinic is found in Table 1.

Table 1

What Happens, What We Do, and What’s Next

During the interdisciplinary evaluation, the full team meets with the family. Engaging with and helping your child feel comfortable in the room, the speech and language pathologist and occupational therapist are also listening while beginning to perform a physical assessment.

Medical & Nutrition

First the team reviews and establishes your child’s medical health and overall nutrition status. Many medical complications from birth can impact a child. Undiagnosed medical and gastrointestinal (GI) problems often come to light in clinic.

Think of your child’s health like the foundation to your house. If your foundation is weak, then the floors above it will compensate for weakness. If your child is struggling from constipation, diarrhea, motility, gagging, GE reflux, then most likely they are subconsciously learning to connect food to feeling poorly. Additionally understanding your child’s nutrition, assists the team in understanding what might be contributing to what is not medical, allowing the team to make appropriate recommendations to ensure for growth and health. Analysis of current nutrition includes what is expected for your child, balance, timing of meals/snacks, calories, protein, fluid, hydration, vitamins/minerals, route of nutrition and growth. An understanding of both medical health and nutrition status, allows for changes from the foundation first and foremost.

Speech and Language Pathology & Occupational Therapy

Observing how your child interacts and engages during the evaluation can help the speech and language pathologist as well as occupational therapist, before they move on to assess the physical portion of eating and drinking. Our goal, no matter where your child is in their journey with food and feeding, is to have a positive relationship during the process. While observing your child, both therapists are also looking at their underlying motor skills and evaluating if any postural supports might be beneficial. Mary Massery, a well-known physical therapist, has said “breathing always wins”, and she is not wrong. Breathing dominates. Where your body is in space and stability is its second priority. Swallowing and feeding behavior must continually adapt to changing respiratory and postural systems.

When your child sits down with the therapists, it is about getting a better sense of your child’s oral motor skills from the speech and language pathologist. The occupational therapist is observing potential underlying sensory processing difficulties and relationship issues with food. Anxiety around meals and feeding can increase adrenaline which suppresses our desire to eat. Assisting with overall regulation is important for comfort at mealtimes.

Social Services

The emotion with feeding and nutrition difficulties can be overwhelming for both the parents and child. Many times, a child’s survival from birth and medical health is the primary focus, as it should be. When a child becomes more stable, a parent can start to see beyond the medical fears and begin to focus on other things such as independent feeding. With this new focus, the emotions, fear, concerns, and hope are still there. Whether your child is struggling to be an oral eater or being fed by tube, the emotions can be immobilizing. Our parent liaison is a vital team member in our clinic, helping every parent know they are not alone. She provides support, empathy and connections to any resources.

By the end of the evaluation, the team confers together within the same space as your family, and immediate and long-term recommendations are made. Often, these recommendations focus on gut health, breathing, positioning, or establishing improved nutrition, before working on some of the more therapeutic needs such as oral motor skills or sensory processing/relationship interactions. Sometimes recommendations are made to work on several key things simultaneously to help your child be more clinically stable, or a single recommendation that may be central to all other concerns identified. Returning to our 90 minute clinic for a follow up visit, may be one of the recommendations made.

Final Thoughts

Wherever you are at in your child’s journey, there are many aspects to feeding disorders in the pediatric population. Therefore identifying and addressing all of them is a priority that should not be overlooked. Easterseals DuPage & Fox Valley’s Feeding Clinic has been and continues to view your child and his care from this interdisciplinary “Pediatric Feeding Disorders” approach, involving a skilled and expert team of professionals. Nutrition issues is an area that brings an enormous amount of stress and anxiety to a child and caregivers. Our team is uniquely qualified and experienced to assist children at all levels of feeding, instilling hope and helping them be their very best.

Each child is unique, and each intervention is tailored to fit your child and family. While you research options you have, consider the following –

  • Aim to help your child feel their best. They need to feel well – this is key for success in any area.
  • Ensure your child is receiving sound nutrition, regardless of what they are currently receiving. There are many ways around getting your child good nutrition.
  • Assess their positioning with mealtimes and feeding to be sure they are fully supported. Positioning is key. Seated on a firm surface with feet flat on the floor or chair rail, with head and shoulders aligned over hips, equal weight bearing, is the most optimal positioning. Allow her arms to rest on her tray or table with shoulders down.
  • Ensure a regular schedule. Regardless if your child is orally fed or through a tube, a mealtime plan is essential, and helps your child learn hunger and fullness, allows their bodies to sustain through the day, can improve their overall tolerance, and should have a positive beginning and end.
  • Patience – feeding therapy is a journey with bumps and curves along the road. Share your compassion and empathy. Learning to eat and mealtimes, after a rough beginning, might involve reshaping many memories. You might have to start over to build trust. Remember even the tortoise finished the race with the hare.
  • Expose, expose, expose and don’t limit opportunities for exposure. Have fun and play with food. Model appropriate food reactions – don’t “yuck someone else’s yum.” Continue to find way to present food to your child even if he/she is not ready to taste them. You can read books together about food, visit different grocery stores and markets, and find ways to get them involved in mealtime preparation without eating.

To learn more on our Nutritional Feeding Clinic visit our website at: https://www.easterseals.com/dfv/our-programs/medical-rehabilitation/specialized-clinics/feeding-clinic.html. And contact our Intake Coordinator at 630.261.6287 or mscholtes@eastersealsdfvr.org to ask questions or schedule an appointment for a feeding evaluation. 

Clarifying the New Drink Guidelines for Children

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.

Cabinet with baby formula options.

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.

Child laying on couch drinking bottle.
Photo by tung256.

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.

Description of drink guidelines for children under 5.

Not Recommended

  • Artificially sweetened beverages
  • “Low-calorie” or “Zero- calorie” drinks
  • Toddler and flavored milks
  • Sugar sweetened beverages
  • Caffeinated beverages
  • Soda

Juice Recommendations

  • 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

Milk recommendations

  • 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

Water Recommendations

  • 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.

For more information visit: eastersealsdfvr.org/nutrition or contact our Intake Coordinator at 630.261.6216.

Protein and Vegetables: What’s the Big Deal?

By: Nutrition Graduate Student, Cristal Medina and Pediatric Nutrition Therapist Cindy Baranoski MS, RDN, LDN

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.

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Protein

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.

leafy greensA 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*

Protein Food Common Portion and Servings  
Meats 1 small steak = 3.5 to 4 servings
1 small hamburger = 2 to 3 servings
Poultry 1 small chicken breast half = 3 servings
½ Cornish game hen = 4 servings
Seafood 1 can of tuna, drained = 3 to 4 servings
1 salmon steak = 4 to 6 servings
Eggs 3 egg whites = 2 servings
3 egg yolks = 1 ounce-equivalent
Nuts and Seeds 1 ounce of nuts or seeds = 2 servings
2 tablespoons peanut butter = 2 servings
Beans and Peas ½ cup cooked beans (example: pinto, black, or kidney) or peas = 2 servings

1 cup split pea soup = 2 servings
1 cup lentil soup = 2 servings
1 cup bean soup = 2 servings
1 soy or bean burger patty = 2 servings

2 tablespoons of hummus = 1 serving

*Adapted from https://www.choosemyplate.gov/protein-foods

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*

INGREDIENTS

  •  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

DIRECTIONS

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!

*Adapted from: https://choosemyplate-prod.azureedge.net/sites/default/files/misc/GOYAcookbook-EN-HealthyTastyAffordableLatinCooking.pdf

Vegetables

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.

spinach
Dr. Praeger’s Food

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*

INGREDIENTS

  •  2 cups pineapple
  • 1 cup baby spinach (great way to consume veggies!)
  • 1 banana
  • 1 cup unsweetened almond milk
  • 1 cup ice
  • ¼ tsp ground cinnamon

DIRECTIONS

  1. Combine pineapple, spinach, banana, almond milk, ice and cinnamon in blender. Cover; blend until smooth. Makes 2 servings.

*Adapted from: http://www.dole.com/recipes/p/Pineapple-Pit-Stop-Smoothie

To learn more about nutrition therapy through Easter Seals DuPage & Fox Valley, please visit eastersealsdfvr.org/nutrition.

 

References:

  1. https://health.gov/dietaryguidelines/2015/guidelines/
  2. https://www.choosemyplate.gov
  3. http://www.dole.com/en/recipes
  4. https://drpraegers.com/
  5. https://happyfamilybrands.com/

 

 

Got Calcium?

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.

leafy greensCalcium 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.

Table 1. Calcium content of various calcium-rich food sources. (from the National Institute of Health’s website.

Food Item Recommended Serving Size Calcium Content (mg)
Milk 1 C
·         Cow’s milk, nonfat, with added vitamins A and D 299 mg
·         Silk Soymilk, unsweetened, with added calcium, vitamins A, D, B12, and riboflavin 299 mg
·         Rice milk, unsweetened, with added calcium and vitamins A and D 283 mg
·         Hemp Milk, Living Harvest Tempt, Vanilla 300mg
·         Oat Milk, Pacific Foods, Organic Oat Original 350mg
·         Coconut milk, Silk Original 450mg
·         Almond Dream almond milk, with added vitamins A, D, and B12 300 mg
·         Ripple Milk 450mg
·         Silk Protein Nut milk 450 mg
Yogurt, plain, low fat 1 C (8 oz) 415 mg
Mozzarella Cheese, part skim 1.5 oz. 333 mg
Cheddar Cheese 1.;5 oz. 307 mg
Orange Juice, Calcium-fortified 6 oz 261mg
Tofu, firm, made with calcium sulfate ½ C 253 mg
Fortified Cereal ½ C 100-1000 mg
Spinach 1 C 216 mg
Green Vegetables ½ C 60 mg
White Fish or Salmon 3 oz. (1 filet) 70 mg
Nuts (Ie. Peanuts or Almonds) ¼ C 60 mg
Chocolate 5 squares 50 mg
Eggs 1 egg 25 mg

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.

My Kid is a Picky Eater and I Need Help!

By: Laura Van Zandt, OTR/L

peblog2Around 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:

  1. 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.
  2. 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.
  3. peblog1Recruit 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.
  4. 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.
  5. feast for 10.pngThink 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
  1. 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.

Learn more about our occupational therapy services at http://www.easterseals.com/dfv/our-programs/medical-rehabilitation/occupational-therapy.html. 

Simple Strategies for Picky Eaters

By: Mandy Glasener, Lead Preschool Teacher and Danni Drake, Teacher Assistant

As pre-school teachers, we are all too familiar with this battle. How do you get a 3-year-old to try something new or eat their vegetables? We will share with you some of our tried and true secrets!

peblog1

The key is to disguise it!

We managed to get a whole classroom of preschoolers to eat their peas and want more! Crazy! Right?

We made pea pancakes.  A savory treat full of fiber, protein and fun!

Focusing on the aesthetics makes it fun for all kids to eat. Can you eat the nose? Who will eat his eyeballs first?

Not only are you making it a learning experience, you are eating healthy right along with your child.

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Also, we LOVE Pinterest. We have found many easy recipes that are quick and healthy that the children love and ask for us to make together. Some of our favorites are below!

  1. The rice cake face.  You can change it up and use fruit and yogurt too! The possibilities are endless!
  2. A favorite pre-school activity is mixing and making zucchini bread is a winner to make for snack time every time!
  3. Dips are popular too! This ranch hummus dip is a winner!

peblog4.jpgWe 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!

picky eating blog 2

Please share your favorite healthy snacks in the comments.

Happy snacking!

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.

 

 

Preventing illness through clean hands, food and home

By: Cindy Baranoski MS, RDN, LDN

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.

The Centers For Disease Control and Prevention (CDC) has a dedicated web page to washing hands, with clear instructions and tips such as:

  • 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 foundbac 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.

bacCLEAN – Wash hands and surfaces often

  1. Wash your hands with warm soapy water for at least 20 seconds before and after handling food, using the bathroom, changing a diaper, or handling your pets. (Check out the hand washing guide from the CDC).
  2. 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.
  3. Use paper towels for clean up, or if you use cloth towels be sure to wash them on hot.
  4. Rinse all fruits and veggies under water. For those with firm skins, use a vegetable brush.

SEPARATE – Don’t cross-contaminate

  1. Separate raw meat, poultry, seafood and eggs from other foods in shopping cart and bags, as well as your refrigerator.
  2. Do not use the same cutting board for meat and fresh produce.
  3. 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

  1. Use a thermometer to measure internal temperature when cooking meat, poultry and egg dishes.
  2. Cook roasts and steaks to no less than 145°F. Poultry to 165°F. Ground meat to 160 °F. Fish to 145 °F.
  3. Cook eggs until the yolk and white are firm.
  4. Be sure there are no cold spots when cooking foods.
  5. Heat leftovers thoroughly to 165 degrees Fahrenheit.

CHILL – Chill foods immediately

  1. 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.
  2. Refrigerate foods as soon as you get home from the store.
  3. 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.
  4. Marinate food in a refrigerator – and do not use marinate from raw meat, fish, poultry as a dipping sauce.
  5. Divide large quantities of foods into shallow containers to allow for faster cooling when storing foods, such as leftovers.

Your Refrigerator

eat-rightWatch 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.

nutrition blog.pngYou can access more Home Food Safety resources at the AND website including:

  • Apps like Is My Food Safe?
  • Videos on how to wash fruits and vegetables
  • 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.

Be Aware

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?

nutrition-therapy
Photo by Rich Howe

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.

For more information on Nutritional Therapy and scheduling an evaluation at Easter Seals DuPage & Fox Valley, visit our website: http://www.easterseals.com/dfv/our-programs/medical-rehabilitation/nutritional-therapy.html.

Everyone Sitting at the Table: The Power of Family Meals

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

myplate_greenChild 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.

Maggie_1.jpgBenefits 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.

fun-with-food-035What 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.