By: Cindy Baranoski MS, RDN, LDN Manager of Nutritional Therapy
Maybe you heard about this in the news last week, or maybe not. Either way, trying to make sense of what we should be offering our children to drink is always a dilemma. From the moment a baby is born, the question becomes, breast milk or formula. Breast milk being the optimal choice, but that’s not always possible, so formula is available.
Children less than 12 months of age should never be offered a bottle of straight up milk, but after 1 year, it is the go to drink recommended by everyone. Juice is often offered, but it is not the same as eating the fruit or vegetable. And sometimes in infancy, prune juice is given to help with stools, but that’s not a rule. Many children do not like milk, once done with breast milk or formula, and parents begin to offer anything to help ensure their child is hydrated.
Bring in the new options available for children to drink and it can be confusing to know what is best to offer. For example, plant based milks are all the rage now for many reasons, including allergies, family preferences, cultural reasons, and last resorts for a picky eater. They are flavored, unflavored, sweetened, and unsweetened. And the selection continues to grow, including rice, almond, coconut, soy, oat, hemp, split pea, cashew, and blends to name only a few. Though these may seem like a great alternative to cows milk, each one of them can be found fortified, unfortified, with added protein, or original version. Most plant milks are going to be lacking in protein, fat, and potentially key vitamins and minerals found in cow’s milk. Diet modifications can be made to help ensure what is lacking in a plant milk can be found in other sources in the diet. But if cow’s milk cannot is not the choice for whatever reason, plant milks with diet modification can work.
Juices have changed as well, with many companies offering non sugar
sweetened fruit and/or vegetable juices. Some companies offering cold pressed
and fruit/vegetable smoothies with additives, such as greens, protein and
vitamins. Use of sweeteners such as grape juice or artificial sweeteners
replace sugar and high fructose corn syrup. Juice is not the best option for
anyone to be consuming regularly, or in quantity, when the food brings so much
more nutrition to the diet that has yet to be identified or quantified.
And then there is water, but not just tap water, but bottled water, flavored water, sweetened waters, artificially sweetened waters, vitamin boost waters, and sparkling waters. As a general guideline, plain old regular water with nothing added or changed, is the best choice.
To help, the Academy of Nutrition and Dietetics, The American Academy of Pediatric Dentistry, the American Academy of Pediatrics and the American Heart association have made some updated recommendations.
Artificially sweetened beverages
“Low-calorie” or “Zero- calorie” drinks
Toddler and flavored milks
Sugar sweetened beverages
Less than 1 year of age: Do not offer juice
1-3 years of age: 4 ounces a day or less a day
4-5 years of age: 4-6 ounces a day or less a day
1-2 years of age: 16-24 ounces of whole milk a day
2-3 years of age: 16 ounces of skim or low fat milk a day
4-5 years of age: 20 ounces of skim or low fat milk a day
6-12 months of age: 4-8 ounces a day
1-3 years of age: 8-32 ounces a day
4-5 years of age: 12-40 ounces a day
Finally, whenever something is happening out of the ordinary with any child, and there is a struggle or question of fluids, seek the advice of a Registered Dietitian Nutritionist to help guide what would be best. Looking at the child as a whole, their full diet, development, family choices, help with recommendations being made for fluids. This will ensure children receive optimal fluids, contributing to best growth and development.
Most parents know it is important for children to eat a balanced diet. What exactly does a balanced diet mean? Generally, it means eating a variety of foods and getting enough of each food group. The five food groups are fruits, vegetables, grains, protein foods, and dairy. Although every food group is important, it seems as though protein foods and vegetables receive the most attention. You may be wondering why these two food groups are so important, how much of each is needed, and how to get your child to meet the recommendations. We will cover all this, but let’s start with how much food your child needs.
Protein is a key nutrient for everyone from growing babies to elite athletes. It is necessary to build, maintain, and repair tissue. We need protein to form healthy bones, muscles, cartilage, skin, and nails, as well as to make enzymes, hormones, and other chemicals. Protein foods are also important sources of nutrients such as iron, niacin, vitamin B12, vitamin B6, riboflavin, selenium, choline, phosphorous, zinc, copper, vitamin D, and Vitamin E. These vitamins and minerals offer a myriad of benefits to a growing child.
A common misconception is that protein is only found in animal-based foods, like meat. However, protein can also come from plant-based foods, like beans (example: pinto, black, kidney beans) and soy products (example: tofu, tempeh, edamame). The protein food group includes meat, poultry, seafood, beans, peas, eggs, processed soy products, nuts, and seeds. Dairy foods such as milk, cheese, yogurt, and cottage cheese will also provide your child with protein. Your child’s protein needs vary based on age, sex, and activity level. (Please see Table 1 above for recommended intake amounts.)
A serving from the protein food group, also referred to as an ounce-equivalent, is 1 ounce of meat, poultry, or fish, 1 egg, ¼ cup cooked beans or peas, ¼ cup tofu, 1 ounce of tempeh, 1 falafel patty, 2 tablespoons of hummus, 1 tablespoon of peanut butter, or ½ ounce of nuts or seeds. Please see Table 2 for common protein food portions.
Table 2. Common Portions and Servings of Protein Foods*
Common Portion and Servings
1 small steak = 3.5 to 4 servings
1 small hamburger = 2 to 3 servings
1 small chicken breast half = 3 servings
½ Cornish game hen = 4 servings
1 can of tuna, drained = 3 to 4 servings
1 salmon steak = 4 to 6 servings
A couple examples of convenient and kid-friendly protein foods are hamburger patties (examples: McDonald’s, White Castle [yes, fast food is okay]), fish sticks, chicken nuggets, Boca vegan burgers, and milk (examples: cow’s milk, Ripple milk, hemp milk). If your child prefers to drink rather than eat, try supplementing with a nutritious drink (examples: Kate Farms, Vega, Orgain, PediaSure). If your child does not eat solid foods, you can puree meat, poultry, seafood, and tofu, mash beans and peas, and provide foods like creamy nut butters, hummus, blended soups, and smooth yogurt. If your child relies on formula given through a feeding tube or drinking a supplement for most or all of his/her daily nutrition intake, s/he may be getting enough protein if s/he is consuming enough. Make sure to speak to a registered dietitian if you have any concerns about your child meeting his/her protein needs.
QUICK RECIPE: Black Bean Quesadilla*
¾ cup pico de gallo
1 can (15.5 oz) black beans (great protein source!)
½ cup shredded Colby and Monterey Jack cheese
2 tablespoons chopped cilantro
4 eight-inch flour tortillas
½ teaspoon olive oil
1. Using small-hole strainer, drain liquid from Pico de Gallo; discard liquid. Transfer leftover tomato mixture to medium bowl. Mix in black beans, cheese and cilantro until combined.
2. Divide black bean mixture evenly over half of each tortilla (about ½ cup each). Fold tortillas in half.
3. Heat large griddle or skillet over medium-high heat. Brush with oil. Place filled tortillas on griddle. Cook, carefully flipping once, until tortillas are golden brown and crisp and cheese filling melts, about 5 minutes. Cut quesadillas into wedges. Makes 8 servings.
Optional: For additional protein, add chicken or your favorite meat!
Vegetables are full of nutrients including dietary fiber, potassium, iron, vitamin A, vitamin C, vitamin K, copper, magnesium, vitamin E, vitamin B6, manganese, thiamin, niacin, and choline. These nutrients can help your child build healthy bones, heal cuts and wounds, protect against infection, support heart health, promote healthy aging, and maintain healthy eyes, skin, teeth and gums.
The vegetable food group is made up of vegetables and 100% vegetable juice. Vegetables come in a variety of forms to fit any diet. They can be raw, cooked, fresh, frozen, canned, dried/dehydrated, whole, sliced, mashed, pureed, or juiced. Please see Table 1 above for recommended intake amounts.
A serving, or cup-equivalent, from the vegetable group can be 1 cup of raw or cooked vegetables, 1 cup of vegetable juice, or 2 cups of raw leafy greens. There are some great brands out there that sell kid-friendly, veggie-containing foods. Two examples of brands are Dr. Praeger’s Purely Sensible Foods and Happy Family. Dr. Praeger’s line of foods includes a variety of “Puffs”, “Cakes”, and “Littles” (these are shaped liked stars, dinosaurs, and bears!) that are made with ingredients like broccoli, spinach, kale, and carrots. Happy Family sells everything from bars, to squeeze pouches, to puffs (some of these are also shaped like dinos!). These foods can have veggies like tomato, kale, spinach, and carrots. Their foods are appropriate for all ages, from infants to adults.
You can also try incorporating vegetables into other foods at home. Combine leafy green vegetables, celery, carrots, or beets with fruit to make a juice or smoothie. Store-bought, single serving vegetable juices and smoothies (example: Bolthouse Farms or Naked Juice) are also an option if you are on-the-go. You can also try blending pureed cooked cauliflower in mashed potatoes and mixing pureed cooked sweet potato or carrot into a cheese or pasta sauce. Blending cooked pumpkin, carrot, squash, or sweet potato into a tomato or vegetable soup can also increase your child’s vegetable intake. These ideas are also appropriate for children who do not eat solids.
If your child relies on a tube feeding formula or an oral supplement, s/he may be meeting all vitamin and mineral needs if s/he is consuming enough. If not, your child may benefit from a multivitamin. A registered dietitian can help you plan on the best way to get more nutrients into your child. If you are interested in adding blended vegetables to your child’s tube feeding regimen, a registered dietitian can also help you get started with blenderized tube feedings.
QUICK RECIPE: Pineapple and Spinach Smoothie*
2 cups pineapple
1 cup baby spinach (great way to consume veggies!)
1 cup unsweetened almond milk
1 cup ice
¼ tsp ground cinnamon
Combinepineapple, spinach, banana, almond milk, ice and cinnamon in blender. Cover; blend until smooth. Makes 2 servings.
By Dana Sivak, Easter Seals DuPage & Fox Valley Dietetic Intern and Northern Illinois University Student
“Got milk?” is a saying originally part of a campaign generated by the dairy industry to remind consumers of the importance for consuming milk on one of the premises that it serves as a good source of calcium. But why, we might ask, do we need to focus our energy on consuming calcium? Calcium is the most abundant mineral in the body, with 99% of it found in bone and teeth. Throughout the course of the day, calcium is constantly being broken down, reabsorbed, and resourced back to form new bones. In children, especially, the turnover rate of bone is ever-present to support growth and development. By age 24, on average, humans reach peak-bone mass, and thus it is important that we maximize our efforts to nutritionally meet our body’s calcium needs– so encourage your child to sport that milk mustache proudly!
The Recommended Dietary Allowance (RDA) for calcium changed last November after further research determined a greater need for calcium in our diets. The following are the US Food and Nutrition Board’s updated RDA values for calcium based on age:
0-6 months = 200 mg
7-12 months = 260 mg
1-3 years = 700 mg
4-8 years = 1000 mg
9-18 years = 1300 mg
19-50 years = 1000 mg
51-70 years = 1000 mg (male) or 1200 (female)
71+ years = 1200 mg
Now you might ask, how do I know if I’m meeting my child’s needs? (…and yours?! Your health matters, too!) The simplest answer for this is to check the nutrition label for the exact content of calcium provided for the food items typically consumed in your household.
Calcium rich foods are commonly thought to be those that exist within the dairy food group, such as milk, cheese, yogurt, and ice cream. These types of food provided a natural, readily available, and rich source of calcium to our diets. But what if your household is “dairy” free or someone in your household either has a lactose intolerance or cow’s milk protein allergy? Not to worry! There are other rich food sources of calcium to consider, too! Non-dairy sources of calcium include dark green leafy vegetables such as spinach and kale, as well as broccoli, green beans, and green bell peppers. Other sources included fortified food products such as cereals, fruits juices (orange juice) and cow’s milk alternatives. Smaller amounts of calcium can be found in seafood (sardines, scallops, shrimp, whitefish/salmon), tofu, legumes and nuts, eggs, and yes – even chocolate! Table 1 demonstrates the calcium content comparison for these various food sources.
· Silk Soymilk, unsweetened, with added calcium, vitamins A, D, B12, and riboflavin
· Rice milk, unsweetened, with added calcium and vitamins A and D
· Hemp Milk, Living Harvest Tempt, Vanilla
· Oat Milk, Pacific Foods, Organic Oat Original
· Coconut milk, Silk Original
· Almond Dream almond milk, with added vitamins A, D, and B12
· Ripple Milk
· Silk Protein Nut milk
Yogurt, plain, low fat
1 C (8 oz)
Mozzarella Cheese, part skim
Orange Juice, Calcium-fortified
Tofu, firm, made with calcium sulfate
White Fish or Salmon
3 oz. (1 filet)
Nuts (Ie. Peanuts or Almonds)
Inadequate intake of calcium over time can cause osteopenia, a less severe and reversible precursor to osteoporosis. Those who do not sufficiently meet their calcium intake, are at an increased risk for skeletal fracture injuries. Similar to vitamin D deficiency, additional at-risk populations are those who spend most of their time indoors and those who live north of the equator. This is because Vitamin D functions with calcium to aid in its absorption. Without adequate Vitamin D, the calcium of foods eaten may not be fully functional once digested. Lastly, those who do not partake in weight-bearing activities on a routine basis are more likely to have an increased need for calcium. This is because bone is not able to be broken down and thereby calcium is not able to help contribute to the reformation of new bone. Annual bone-DEXA testing is recommended for those who are at risk.
Efforts should be made to maximize bone development during critical stages of an infant, toddlers, and child’s growth to minimize future risk of osteoporosis. If efforts cannot be made from a physical activity standpoint due to a disability, one’s calcium intake in the form of food or possible requirement for supplement should be highly prioritized. To help with such planning, it is recommended to advocate for your child’s welfare and seek out further information for the level of risk your child is at by discussing this with their physician. Furthermore, it is recommended to meet with a dietitian who can assess the diet specific to calcium and offer suggestions for ensuring adequate intake.
If you find your child has nutrition problems including failure to thrive, obesity, poor feeding skills, sensory disorders, and gastrointestinal disorders or others, schedule a nutritional evaluation with Easter Seals DuPage & Fox Valley today. Learn more at eastersealsdfvr.org/nutrition.
Around 2 years of age, children enter the age of autonomy where they become aware of their individuality and become increasingly independent. This is also the age where they become increasing comfortable testing limits. Around this age, kids are most likely to start becoming “picky eaters.” By the time children enter preschool, many have begun to move past this phase and start to expand their food preferences; however, some children don’t move out of the picky eating stage and continue to refuse foods. Foods once liked may become dropped and not added back into their diet. The big difference between typical picky eating and avoidant /restrictive food intake disorder (AFRID) is that typical picky eating fades away in conjunction with repeated food exposure and a positive mealtime environment.
Children with ARFID may also have other health issues or conditions such as attention deficit hyperactivity disorder, autism, sensory processing, food allergies, constipation, and/or anxiety. Some children who were born prematurely may have required breathing and feeding tubes during hospitalization which can increase oral sensitivity. A child who had a choking episode in the past, was forced to eat, or who had multiple respiratory infections at a time when she was learning to eat may have developed negative associations with eating. Some children may have a sensory system which is offended by the texture, smell, odor, or appearance of food. These sensitivities may alter how kids experience food and result in their refusing to eat many foods. Anxiety can stem from the food itself, especially if it’s unfamiliar or disliked, or it can result from other factors such as pressure to eat at mealtime or a negative memory of eating. Older kids may experience social anxiety around their peers.
Parents often have good intuition and know when something is not right with their child’s eating patterns. Some signs of AFRID include refusing food due to its smell, texture or flavor, or a generalized lack of interest in eating. Children may have poor eating or feeding abilities, such as preferring pureed foods or a refusal to self-feed. They may be underweight or demonstrate slowed growth due to inadequate or poor nutrition. They may also show signs of anxiety or fear of eating. If you feel like your child’s eating patterns is moving beyond typical picky eating, please schedule an appointment with a pediatric occupational or speech therapist that specializes in feeding.
What can be done:
Schedule a comprehensive evaluation with an occupational or speech therapist can assist you in helping rule in/out other medical conditions which may also be influencing your child’s eating behaviors and patterns. A therapist may also be able to make recommendations to further evaluate nutrition or evaluation for gastrointestinal issues causing discomfort or pain influencing feeding. They will help develop a comprehensive treatment plan that addresses all different angles of feeding.
Read occupational therapists Maureen Karwowski’s blog regarding playing with your food. Research suggests that when too much negative pressure is placed on the child for eating, the child’s appetite may also decrease and could spur an emotional response leaving the child to dread mealtimes. Vice versa, additional research also suggests that when children are allowed to mess with their food and are given permission to touch, handle, and even squash foods they are actually more likely eat them. Allowing your child to handle food without the expectation to eat the food allows them to gradually desensitize their body to the sights, smells, and feeling of a variety of food. Allowing your child to play with food helps to build new brain pathways that help to reshape prior negative experiences with food.
Recruit your child’s help. If you do not already meal plan, start meal planning and involving your child as much as possible in the process. When at the grocery store, ask your child to pick out food on the grocery list (even if it is not food your child regularly eats). At home, encourage your child to help rinse fruits and vegetables, stir batter, use scissors to cut herbs, or set the table. During mealtimes, serve dishes family style where everyone passes the different food bowls.
Be patient and start very small. Your child might need repeated exposure to try a new food. You may also need to start by presenting a single bite of a vegetable or a fruit versus presenting a lot of the food immediately off the bat. Sometimes, even reading books about different foods, might be the place to start with your child.
Think of fun and creative ways to present the same food. For example, if you child is learning how to like pizza, you can try serving pizza on a tortilla shell or on an English muffin. The following are a few books on food that are good to read with children:
Eating the Alphabet: Fruits and Vegetables from A to Z by Lois Ehlert
Cloudy with a Chance of Meatballs by Judi Barrett
I Will Not Ever Eat a Tomato by Lauren Child
The Seven Silly Eaters by Mary Ann Hoberman
Growing Vegetable Soup by Lois Ehlert
Feast for 10 by Cathryn Falwell
Enroll your child in a food group. Easter Seals has routinely been offering an occupational therapy and speech therapy group called “Fun with Food” that helps children learn how to explore foods using all their senses, including touch, smell, sight, and taste. Each session will utilize sensory “warm up” games prior to heading to the kitchen for our snacks. Parents are encouraged to continue with food exploration at home based on weekly recommendations following each session.
We use the hummus as “glue” and go fishing for goldfish with our veggie stick rods! Not only are you eating an amazing, fiber, protein packed snack, you are also having fun playing a game!
Growing a garden (even a few small containers) is a rewarding experience even for the youngest of gardeners. Everything is more delicious when you grow it all by yourself!
We grow our own vegetables here at “The Lily Garden” and harvesting is always a very exciting time. We have tomatoes, pumpkins, cucumbers, zucchini and broccoli growing this year. In the past we have done rainbow carrots, kale and potatoes too!
Involve your kids in the food preparation and it will make them want to try it too. Research shows that if your child is involved with the meal prep they are much more likely to eat it. Also be a role model and show them that you like to eat your fruits and veggies too!
Please share your favorite healthy snacks in the comments.
The Lily Garden Child Development Center incorporates a play-based program philosophy. We understand that children learn best when provided with experiences in an environment that is positive, nurturing and developmentally appropriate. Learn more about the Lily Garden Child Development Center here.
Bacteria and viruses are everywhere, all around us. They live in our bodies and on our bodies. Even our digestive and immune systems depend upon their presence to provide us with optimal health. While viruses create illnesses we all remember, bacteria are the culprits more often, bringing us foodborne illness or that nasty ‘stomach flu’. With bacteria the obvious places, such as the kitchen sink, bathroom, garbage can, are usually associated with ‘germs’ and the potential for some sort of illness. But bacteria are an invisible society living among us. Bacteria’s numbers are in the millions, and the types of bacteria we are exposed to can bring illness and health.
Wash your hands!
One of the easiest ways to prevent illness is to keep clean. Our hands, foods, kitchens, bathroom, anything we come into contact with in our world. If we simply wash our hands regularly, and not touch our eyes, noses, mouths, our chances of becoming infected by bacteria are significantly lessened.
Wash hands before, during, and after preparing food
Before eating food
Before and after caring for someone who is sick
Keep your food and kitchen clean!
In kitchens, we have a ton of opportunities to come into contact with bacteria that can bring on an illness. With millions of bacteria found in the tiniest of places, imagine the size of your kitchen and just how many places are teeming with the little critters.
The Partnership for Food Safety Education at www.fightbac.org has a wonderful website loaded with helpful information on food safety. If you visit their site, you can find answers to many questions about the food you buy, prepare, eat, store, throw away and reheat. One of the most helpful sections of their site is The Core Four Practices. These are simple practices for food safety.
Wash items in the kitchen – dishes, utensils, counter tops, cutting boards with hot soapy water, after you use an item and before you use it on something else.
Use paper towels for clean up, or if you use cloth towels be sure to wash them on hot.
Rinse all fruits and veggies under water. For those with firm skins, use a vegetable brush.
SEPARATE – Don’t cross-contaminate
Separate raw meat, poultry, seafood and eggs from other foods in shopping cart and bags, as well as your refrigerator.
Do not use the same cutting board for meat and fresh produce.
Do not place cooked food on a plate that had raw meat, poultry, seafood or eggs on it.
COOK – Cook foods to a safe internal temperature
Use a thermometer to measure internal temperature when cooking meat, poultry and egg dishes.
Cook roasts and steaks to no less than 145°F. Poultry to 165°F. Ground meat to 160 °F. Fish to 145 °F.
Cook eggs until the yolk and white are firm.
Be sure there are no cold spots when cooking foods.
Heat leftovers thoroughly to 165 degrees Fahrenheit.
CHILL – Chill foods immediately
Refrigerate foods quickly to 40°F or below. Use an appliance thermometer to be sure of the temperature. Freezers should be 0°F or below.
Refrigerate foods as soon as you get home from the store.
Never allow raw meat, poultry, eggs, cooked food or fresh fruits or veggies to sit at room temperature for longer than 2 hours. If the room is warm, then less than 1 hour sitting out. Do not defrost food at room temperature. Allow foods to thaw in the refrigerator. In a pinch you can use cold water or microwave for thawing, but these foods need to be cooked immediately.
Marinate food in a refrigerator – and do not use marinate from raw meat, fish, poultry as a dipping sauce.
Divide large quantities of foods into shallow containers to allow for faster cooling when storing foods, such as leftovers.
Watch this video from the Academy of Nutrition and Dietetics (AND) on keeping your refrigerator clean. Wiping the inside and outside down, cleaning the shelves and the front grill are as important as the counter tops you use to prepare foods. Going through your refrigerator often to toss outdated foods is something you should do on a regular basis. Know that foods have ‘use by’ dates which refers to food quality, and ‘expiration’ dates to know when to throw something away that is no longer consumable.
Safety tips on Holiday cooking to raw milk or keeping lunch boxes clean,
Food safety with hiking and camping, as well as keeping fruits fresh and reducing food waste are at this site as well.
Use common sense with foods and have respect for the fact that much of what we consume comes through a process where many people have been in contact with our food before we even purchase it. Who has picked the apple from the tree? Where did the chicken egg even come from? Who prepackaged your deli meats? Was the tomato you purchased ever rolling around the grocery store floor before you picked it off the shelf?
Certainly we don’t want to become so focused on cleanliness that we bring more harm than good to our bodies. Remember that millions of bacteria depend on our bodies for their home. When these bacteria are living in a symbiotic relationship with us, we have health. And when they have a good life, we do as well. But when the good bacteria are outnumbered by the bad bacteria, we have illness. An awareness to clean hands, foods and areas that support our mealtimes is great place to start.
Excellent nutrition is one of the most basic requirements for a child to grow and thrive. A study published by Pediatricsfound that diagnosis-specific, structured approaches to nutrition issues among children with developmental disabilities significantly improved energy consumption and nutritional status. Yet, nutrition disorders and compromised nutritional status are very frequent among children with developmental disabilities.
Research shows that as many as 90% of children with a developmental disorder have at least one nutrition risk indicator. Nutrition problems can include failure to thrive, obesity, poor feeding skills, sensory disorders, and gastrointestinal disorders, to name only a few. Individuals with special needs are also more likely to develop co-existing medical conditions that require nutrition interventions.
Thanks to two significant grants from Hanover Township Mental Health Board and Special Kids Foundation, Easter Seals DuPage & Fox Valley can now offer nutrition services for children, regardless of insurance, in areas currently underserved immediately north and west of DuPage County. This includes full financial support for those uninsured, underinsured or on Medicaid; and partial support for those in Early Intervention or with insurance. Children who qualify will receive a nutrition evaluation and follow up nutrition therapy as needed.
Qualifications for children (birth to 21 years of age) to receive this service include:
Eligible medical diagnosis or identified eating concern AND
Easter Seals DuPage & Fox Valley Nutrition Therapy provides care that is difficult to find elsewhere in a community or medical setting. Training and specialties include assisting children with improved oral and digestive tolerance, modifications to help improve growth, adjusting diet for improved variety, volume and complexity of foods and fluids, balancing the diet of those with food allergies or sensitivities, help with transitioning (off of or onto) a tube feeding, and homemade blenderized formula and diet modifications.
Evaluations are performed at the Center, in the family’s home or community setting. Our goal is to provide optimal nutrition care to children with developmental disabilities through an inter-disciplinary approach, addressing their nutrition risks and disorders and helping them to lead healthier lives.
Please refer parents, other specialists or anyone else with questions about the program to our Nutrition Therapy intake coordinator, Christy Stringini, who can be reached at 630-261-6126 and cstringini@EasterSealsDFVR.org.
Learn more about Easter Seals DuPage & Fox Valley nutritional therapy and feeding clinic at www.eastersealsdfvr.org.
I often get asked the question “Should my child use a sippy cup?” It’s a difficult question to answer. Sippy cups were initially invented in the 1980s by a mechanical engineer who was sick and tired of cleaning up his son’s juice mess around the house. He uniquely devised a prototype for the no spill mechanism and just like that problem solved! He eventually sold his patent to Playtex ® and the rest is history as this became the go to type of cup for babies learning to transfer from bottle to cup.
I am sure you probably see tons and tons of children walking around the mall, playing at the park, and in the car with their sippy cups. This is the era of “to go” cups. Everyone, including adults bring their drinks (coffee, tea, water) to their next destination. I understand the convenience of sippy cups for parents and quite frankly I get it, but hopefully I can convince you to try out some other convenient cups that will support your child’s oral motor and speech development.
So why are they really SO bad?
Promote immature tongue movement pattern or suckle
Sippy cups promote an anterior-posterior tongue movement pattern, similar to the way an infant extracts liquid from a bottle or breast (suckle pattern). We want to begin to promote a more upward and backward swallow pattern for infants and toddlers by way of an open cup or straw cup. Sippy cups promote a suckle pattern especially with continued use.
Promote inappropriate tongue position for swallowing
The spout on the sippy cup can anchor the tongue tip down during swallowing. The only way for the tongue to move is forward. During a mature swallow pattern the tongue tip elevates to the area behind the upper teeth (alveolar ridge) as the tongue moves upward and backward.
Promote speech sound errors
Continued and overuse of sippy cups (and pacifiers!) promote the tongue to rest forward in the mouth. This inappropriate resting tongue position can directly impact your child’s ability to produce certain sounds. For example, a child may produce the ‘th’ sound (a frontal produced sound) in for an ‘s’ sound (‘tho’ for ‘so’). It is important to note that not all children who use sippy cups will have speech sound errors. My thought is though let’s set our children up for success by using developmentally appropriate cups!
Poor dental development and Dental Caries
Sippy cups can cause cavities and tooth decay. If your child is sipping on fruit drinks, milk, or any other sugary drinks, sugar can be left on their teeth which will cause the enamel to erode away. Sippy cups (and pacifiers!) can also cause misshaped oral cavities and affect resting tongue position.
Risk of Injury
In my research on sippy cups, I came across a study proving sippy cups can be dangerous?! Who would have thought?! A study conducted in 2012 by Dr. Sarah Keim at Nationwide’s Children Hospital in Columbus, Ohio stated every 4 hours a child in the U.S. is rushed to the hospital due to an injury from a sippy cup, bottle, or pacifier. Dr. Keim stated this likely occurs due to the child learning to walk. As they are learning to walk, they trip and fall often. If they have a bottle, pacifier, or sippy cup in their mouth they can injure themselves.
So what’s the alternative?
Many parents think I am crazy when I suggest an open cup for a young child. Yes, it may seem a bit ambitious, but an important step in the development of good oral motor and feeding skills! When children drink from an open cup they are developing a more mature swallow pattern. A smaller open cup (with a smaller rim) will allow your child to have better motor control of the liquid. You can first try giving your child an open cup to practice without liquid (place a preferred pureed on the rim of the cup) or you can use thickened liquid in the cup for a slower flow.
It may take your child some time to learn how to extract liquid from a straw, but be patient and the skill should develop! When choosing a straw cup choose a straw that is thin versus thick. Also make sure the straw is not too long. It is possible for young children to drink from a straw cup with a suckle pattern. Some children are able to extract liquid from the straw by placing the straw under their tongue. To avoid this, you can slowly cut the straw ¼ inch at a time until the straw is short enough that the child cannot place his/her tongue underneath it.
Here are a few of my favorite open cups and straw cups!
To learn more about development milestones and speech-language therapy services, visit eastersealsdfvr.org.
In my house growing up, meals were serious business. My parents had rules around “dawdling”, and playing with food was an absolute “no no”. Now, in my work as a pediatric occupational therapist, I advise the families that I work with to break these rules (and for good reasons).
Many of the children that I work with have sensory processing difficulties. Sensory processing challenges occur when a child has difficulty interpreting and responding to the sensory experiences in daily life. It is estimated that 1 of 20 children are impacted by a sensory processing deficit (Ahn, Miller, Milberger, McIntosh, 2004).
For some children with sensory processing difficulties, they have heightened sensitivity to textures, smells and tastes. These sensory over-reactions negatively impact a child’s ability to tolerate diets with a wide variety of textures, looks, smells and tastes. I have clients who eat foods that are similar in color, for instance all shades of white (crackers and chips). Other children eat foods that are munchable in texture, so graham crackers, chicken nuggets, and macaroni and cheese. One little boy that I worked with could not even be in the kitchen while his mother was cooking because the smells were so offensive to him. I remember clearly that he told me “food is not fun for me like it is for you”. That was a profound statement from a child of 5 years of age.
The good news is that I have seen great results in helping a child to expand their diet with work in therapy, and with the parents’ work at home. Many children do well with an individual while others do their best in a group with other children. I always start with a thorough occupational therapy evaluation, and assess the child’s sensory processing skills, motor coordination and fine motor skills. I work closely with speech therapists and a dietitian who specialize in working with children with feeding challenges. I want to rule out any oral motor and medical concerns before starting any kind of therapy with feeding.
The goal of my therapy sessions is to explore foods in a fun and low pressure manner. So dawdling and playing with food are an integral part of the work with my clients. Picture making towers of cucumber slices, while my client knocks them over repeatedly. Picture using those cucumber slices as goggles to look through. How about blowing peas off the table and into a bowl? I love making shapes and letters with cooked spaghetti noodles. These types of games provide my clients with the sensory experience of the food, but in a way that is very low pressure. The goal is not to eat the food initially, but to explore the foods in any way that the child can tolerate it. As the child is more comfortable with the touch, smell, look and taste of a food, the more likely they would be to eat the food.
For parents at home, I do suggest a time where the parent and child are having fun with exploring food, in any way that they can. I encourage families to have the child help with carrying food to the table, or pick out the vegetables at the market. Can the child mash potatoes? How about toss a salad? A child is much more likely to explore a food if they know that their parent is not expecting them to taste it.
Consult your child’s therapist to determine if your child would benefit from a sensory approach to feeding or contact Easter Seals DuPage & Fox Valley for information about our summer feeding groups.
Eating can be a daily struggle and constant stressor for many families. The eating battles can be a point of looming contention at any given moment in a day.
It is important to keep the ultimate objective in the forefronts of our minds when it comes to feeding our little friends. Our goal is not to get kids to swallow vegetables through teary eyes during dinner tonight. Our goal is to develop children who like a variety of healthy food. We want to raise children who will grow up enjoying nutritious foods, not just viewing them as an obligation.
There are not quick fixes to turning a selective eater into an adventurous eater overnight. However, with consistent implementation of the following strategies, you will be on your way there!
Encourage Food Exploration! Join your child in exploring new or non-preferred foods and make it fun! This may help decrease anxiety caused by new foods. We experience food through our eyes, nose, mouth, and skin prior to tasting a food. Having a hesitant eater experience the temperature and texture of foods smushed between their fingers can be a beneficial step before expecting the child to smush that food between their teeth. Expose your children to foods by letting them touch, smell, kiss, lick and bite the presented foods. Let your child PLAY with their food! Don’t worry about the mess! Food should be a joyful experience. Talk about the food and describe what it looks like how it feels, how it smells and how it tastes. Let your child help you prepare meals. The Kitchn provides ideas for the many simple steps in cooking that even young children can help with! Learn about food! Plant a garden. Visit the farmers market and the grocery store.
Make the meal time about being together as a family. Meal time should be a pleasurable experience for everyone and an opportunity to spend quality time with the family. If a child is a part of a joyful low-stress meal experience, he will be more likely to independently consume more of the presented foods.
Be positive and supportive but… Beware of rewarding your child by paying a great deal of attention to what the child is NOT doing. When we constantly cheer for our children, we can be reinforcing the pursed lips that are rejecting the airplane spoon. Rather, make a single statement about the action you would like to see occur (e.g.. “Maybe you would like to try giving your apple slice a kiss?” “It would be awesome to see you knock the corn kernels on your teeth!”) and praise the desired behavior after it occurs. Pay little or no attention to the negative behaviors.
Don’t force a child to eat! Policing a selective eater’s food consumption fosters negative feelings with the nutritious foods we want them to eat! We want positive and happy feelings associated with meals in order to support healthy eating habits! Letting children be in control of the foods you provide helps them feel calm and promotes a positive experience with the foods. It also allows them to learn to listen to their bodies and be in control of nutritious choices.
Offer small portions. If someone put a plate of eel in front of me and told me that this was dinner and I had to eat it or else… AHHH!! No way! I would probably gag at the site. But, if I was encouraged to try just one tiny bite? Well, I could probably do that. Putting a small portion of a new food on your child’s plate will present an obtainable expectation. It may even provide the child with an opportunity to request more!
Rotate and repeat! Regardless of whether your child liked the food, repeating the food will build familiarity. Repeated positive exposures to a food can be essential in learning to eat the food. Don’t think of uneaten food as wasted. A small portion of uneaten food on a plate is a valuable learning experience for a hesitant eater.
Pair foods together. Present dips and spreads like hummus, peanut butter, ketchup or salad dressing to make non-preferred foods more pleasurable. Pair mealtime favorites like chicken nuggets with a small serving of a new vegetable.
Selective eating can stem from GI issues, food allergies or food intolerance and therefore will require medical attention. If your child is particularly resistant or consumes a limited diet, don’t hesitate to seek guidance from an occupational therapist or speech-language pathologist.
Easter Seals DuPage & Fox Valley offers a feeding clinic which provides an interdisciplinary team consisting of a gastroenterologist, speech-language pathologist, registered dietitian and parent liaison to assess and provide recommendations related to feeding challenges. Contact our Intake Coordinator at 630.261.6287 to ask questions or schedule an appointment.
Here are some great resources to make happy and healthy eating obtainable in your home:
Feeding My Kid is dedicated to helping parents impact their child’s life-long eating habits through tips, videos and recipes.
The mission of The Doctor Yum Project is to transform the lives of families and communities by providing an understanding of the connection between food and overall health, as well as empowering them with the tools to live a healthy life.