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.

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.

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*

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.

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 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/

 

 

My Kid is a Picky Eater and I Need Help!

By: Laura Van Zandt, OTR/L

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:

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. 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.
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. 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

5. 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. 

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

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.

Nutrition for Your Children

By, Cindy Baranoski, MS, RDN, LDN

Although March is National Nutrition Month, and March 11 is Registered Dietitian Nutritionist Day, every day of the year is a nutrition celebration.

We eat, drink, or are fed every day, throughout the day, in order for us to survive, grow and thrive. As adults we tend for forget just how important nutrition is for us, unless we are diagnosed with a nutrition related disease, such as diabetes, heart disease or cancer. For children, however, nutrition is the key ingredient in helping them grow and develop into the best they can be.

At Easter Seals DuPage & Fox Valley, parents are learning more and more just how important nutrition is to their child at a very young age, and these parents are becoming very proactive in this area, to the benefit of everyone involved in their child’s world.

Most people have a difficult time even knowing where to begin. Nutrition is a degree that can be earned at all levels, including doctorate degrees. Although the detail and level of understanding to receive a degree is pretty huge, it doesn’t’ take a degree to provide good nutrition for yourself or your child.

How can you even begin to delve into this science of nutrition? Start by keeping it simple. The government has done a lot of research, and MyPlate is one of the easiest websites to find daily food plans, menus, recipes, tips for nutrition, videos, games and more.

MyPlate is the easiest way to know how much food to eat in a day for optimal nutrition. It’s divided into food groups, and one of the easiest tools on this site is the Daily Food Plan. Depending on your child’s age, or if you know a calorie level you are trying to aim for, it will give guidelines on how much to eat from each food group to achieve this goal.

Another resource on MyPlate, is SuperTracker. This resource is easy to use and you can put information into it for analysis of nutrition for you or anyone in your family. It’s not completely accurate, but it is helpful to determine how many calories, protein, vitamins and minerals were included in that diet.

Infants and Toddlers

If your child is an infant, there are limited tools available that tell you what they are supposed to eat or drink every day. However, if you go to Gerber you have an opportunity to access general information or create menus specific for your child.

Based on your child’s developmental level, they may need to only drink formula or breast milk, or they might be ready to start solid foods. Gerber’s website tools are helpful because they are based on development, and not necessarily ages. The website is geared for Gerber products, but the menu system can really be helpful to see 7 days of what your child could be eating or drinking, how many times in the day and how to keep their diet balanced.

Top Ten List  For Nutrition for Children Over 1 Year of Age

1. Keep your child on a schedule as much as possible.
2. Do not allow your child to graze through the day. Most children eat 4-6 meals and snacks each day.
3. If not an infant, offer three meals and 2-3 snacks a day, with 2-3 hours of time separating each of these eating times.
4. Offer water between all meals and snacks.
5. Ensure supported seating with mealtimes; the body should be at 90 degrees at the ankles, knees and hips. Be sure they

   

   Photo by McKenzie Burbach

   don’t fall to the sides in a chair – it should provide support in all directions. The table or tray of their chair should be at a level their shoulders are not too high up and fatigue.

6. Offer a source of protein, vegetable, fruit, grain and dairy at each meal. If they are an infant, this is not a rule.
7. Meals are for nutrition, snacks are for extra food or drink, or an opportunity to practice more challenging foods.
8. Be sure your child is stooling each day. Stools should be soft, easy to pass. Urine should be clear or light in color and often through the day.
9. A good indication your child is receiving enough to eat and drink in the day is how well they sleep at night.
10. When in doubt, speak to your child’s doctor or consult with a dietitian with who has skills with children.

Find a Dietitian in your area at Eat Right.org.

For more information about Easter Seals DuPage & Fox Valley please visit EasterSealsDFVR.org.