Tag Archives: Nutrition

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.

What is Tongue-Tie and How is it Treated?

By: Valerie Heneghan, M.A. CCC-SLP/L

The topic of tethered oral tissues or tongue/lip tie is evolving and controversial among professionals in the medical field.  The controversy often stems from first diagnosis. Is it truly a tethered oral tissue? And second the remediation. Is surgery necessary or is the child able to compensate without intervention? 

As a parent, I know it is a difficult decision as you want the best for your children.  You want to support your child’s development without unnecessary medical procedures.  My suggestion is to work with a professional who has experience in this area who can discuss these considerations and how they impact your child specifically. 

When discussing considerations regarding tethered oral tissues (e.g., tongue, lip, and cheek) it is important to include these 4 components:  

  1. Symptoms of mother/infant
  2. Mobility
  3. Function
  4. Location

The conversation on whether to move forward with medical intervention should include symptomology, structures, and function.  One child upon visual inspection may look to have a tethered oral tissue without any symptoms. While another child may have a tethered oral tissue that is not as visually apparent, however may have several symptoms impacting activities of daily living.

Below are interdisciplinary symptoms that could potentially be attributed to tethered oral tissues that you may want to consider:

  • Breastfeeding issues: Nipple pain, difficulty latching, inefficient nursing (e.g., feeding until becomes fatigued rather than full, nursing around the clock, etc.)
  • Lack of weight gain or growth
  • Difficulty moving to solid foods or won’t tolerate a variety of foods
  • Difficulty with cup, straw or bottle drinking
  • Delayed production of single words or imprecise articulation
  • Dentition (e.g., gap in front teeth) or malocclusion
  • Open mouth posture or congestion
  • Asymmetrical motor skills (e.g., preference for one side at young age) or Torticollis
  • Issues with sensory regulation, fine motor skills or vision
  • Coordination or balance issues
  • Gut Health issues or GERD
  • Sleep apnea

What are the next steps? 

It is important to find a medical professional who has experience in this area. A Pediatrician, ENT, or Dentist can diagnose a tethered oral tissue.  Often a Speech-Language Pathologist or Lactation Consultant may be referred, as these professionals work closely with oral motor skills therapeutically.

If a frenectomy (i.e., surgical cut to release the frenulum) is warranted, seek a medical professional (e.g., ENT or Dentist) who has experience in the following:

  • Has knowledge and expertise in releasing tethered oral tissues  
  • Recommends post-surgical program (i.e., stretches, therapeutic feedings, etc.)
  • Procedural experience using both scissor and laser for best possible outcome.

For more information on Easterseals DuPage & Fox Valley Speech-Language services, including those that treat children with Tongue Tie conditions, visit: http://www.easterseals.com/dfv/our-programs/medical-rehabilitation/speech-language-therapy.html

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.

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.

peblog5

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.

Help children receive the nutritional therapy they need!

By: Cindy Baranoski, MS, RDN, LDN – Pediatric Nutrition Therapist

Excellent nutrition is one of the most basic requirements for a child to grow and thrive. A study published by Pediatrics found 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. fun-with-food-054

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.
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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.

7 Tips for Raising Happy, Healthy Eaters

By: Jessica Drake-Simmons, M.S. CCC-SLP

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.

Photo by Nancy Kerner
Photo by Nancy Kerner

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!

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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!
  6. 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.
  7. 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:speech pinterest

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

Beyond the Nutrition Basics

By, Cindy Baranoski, MS, RDN, LDN

Earlier this month, I provided some introductory nutrition resources and tips for infants to children. Now as we continue to celebrate National Nutrition Month, we will look at the next steps to aid our children’s nutrition needs.

Photo by Nancy Kerner
Photo by Nancy Kerner

Seeking the help of a dietitian can be invaluable in helping to determine so many particulars about nutrition, especially if your child has specific needs. A dietitian can help with determining how much nutrition your child actually needs. Typically based on their age, weight, length or stature, sex, and activity, no two children need the same amount of nutrients.

Calories change with weight gain and length growth. They continue to change over time, and what your child needs today will not be the same in a month. Monitoring growth and diet is helpful, especially when your child is not gaining enough weight, or possibly gaining too much. It’s not necessary to count calories, so tools such as SuperTracker are not always necessary.

Using MyPlate Daily Food Plans are an easy way to ensure children are not over or under eating. When in doubt, asking a dietitian for some help can give you the basics on calories so you can monitor them on your own over time.

Protein is similar to calories, and will change with growth and age as well. Most every food contains some protein, and the amount needed is much less than most people would think. If your child is not the best eater, they may be getting enough protein, regardless. A dietitian can help you determine how much is needed, and how much is actually in your child’s diet now. They can also give suggestion on food sources that work for your child.

The government provides guidelines on vitamins and minerals, as well as essential fatty acids, but many conditions can change needs. Some medications interfere with absorption of certain vitamins, while vitamins can interact with some medications. Knowing this information, a dietitian can better guide with changes to help limit the interactions, and allow medications and vitamins do what they do best. Use of a supplement may be needed, and this can be a discussion with the dietitian, about which kind, brand, gummy, liquid, chewable, single nutrient, or multivitamin mineral supplements would be best.

Photo by Lauren Vitiello
Photo by Lauren Vitiello

Hydration is the last of the overlooked nutrients in the diet, and although most of us think we drink an adequate amount of fluid in a day, most often this is not the case. With infants most of their hydration comes from breast milk or formula, so no added fluid is necessary. With introduction of baby foods, hydration is still achieved as most baby foods are very watery. But as children reduce and eliminate these primary sources of nutrition, they are replaced with solids. Nearly all foods provide fluid, so we do get fluid from foods, but the body has to work to remove the fluid from the molecules it is bound to when the food is more solid in form. Drinking water is the best way to hydrate a body, and as a rule of thumb, drinking half your body weight in water is an achievable goal.

Easter Seals DuPage & Fox Valley offers exceptional Nutritional Therapy for anyone who feels their child is struggling with nutritional development. Our registered Dietitian/Nutritionist will first asses your child’s nutrition and then provided a individualized plan specific to your child’s needs.

Click here to learn more about this great service, or to schedule an appointment, call our intake coordinator at 630.261.6287.

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