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.

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.

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.

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.

Tips for Practitioners and Specialists: Considering the Full Reality of Patients and Clients’ Lives

By: Sharon Pike, Parent Liaison & Jordyn Holliday, Communications Intern

Many parents will tell you that trips to the doctors office, specialists, etc. can sometimes make for stressful moments for children and families. When a child has complex needs, the level of stress can be increased. Once you consider factors and obstacles such as medical emergencies and other personal issues that a family may be dealing with, those appointments become tougher to make.

It is important for doctors and other specialists to be mindful and reevaluate the judgments they make on parents and caregivers. Before drawing conclusions on why a child may be missing appointments, it is imperative to consider the entirety of that child’s life.

Here are a few tips on how specialists can be more understanding of families:

• Be Mindful: One important thing to remember is that in the vast majority of cases, no one is more concerned with the well-being of a child than that child’s parents and family. If there are appointments being missed or a lack of communication, there is likely a good reason behind it. Forming a solid grasp of this is a huge step in better understanding a client or patient.
• Check for Signs: Often times, it is possible to gain a sense that something external may be happening in a child or family’s life. When you are visited by a patient or client, try to look for signals. Are there any noticeable signs of stress? Are there any patterns in appointment cancellations? Asking yourself these questions can lead to meaningful answers.
• Appropriately Ask the Family: If you are unable to gain insight using the previous tip, think of a kind way to inquire information from the parent/caregiver. This can be done by simply asking how things have been going. By kindly asking how the child and family has been, or even asking about recent medical history, you are beginning dialogue that could help you understand the root of inconsistencies.

Acknowledging the lives of children and families outside of just the scope that you see them in as a specialist is a significant step in building better relationships with them. It’s important not to make assumptions, as they can often lead to uneasiness.

For more information on managing your child’s care and your own, connect with our parent liaisons and family services department at eastersealsdfvr.org/SocialServices.

Pilates for Kids

By: Laura Znajda, PT, C/NDT

A study in the British Journal of Sports Medicine last month ranked United States children among the least fit in the world—the US ranked 47^th out of 50 countries in physical fitness of our children!   With a sedentary lifestyle linked to heart disease, diabetes, and obesity, it is more important than ever to get our children moving and instill healthy behaviors that will last a lifetime.  It’s been shown that children whose parents exercise regularly are more likely to exercise and be active as adults.  Exercising together is fun and more motivating for both parents and their kids.

A good physical fitness program includes a variety of exercise and movement activities.  Pilates is just one of many exercise methods that is gaining popularity among adults, and with its focus on core strength, stability, and body awareness, this exercise method can be used with kids too–and with great benefits.  And since many Pilates exercises use body or limb weight for resistance strengthening,  little to no equipment is needed.  So  grab a piece of floor and perhaps an exercise ball, and have fun while being active with your kids!

Pilates Bridge is an exercise that strengthens gluteal (buttock) muscles and hamstrings, while providing a stretch to flexor muscles across the front of the hips.  It requires core muscles to work together, leading to good posture and balance for all future dancers, gymnasts and sports enthusiasts. To make it fun for kids, help them place feet (and lower legs if more support is needed) on an exercise ball and lift hips and spine off the floor.  Weight should be on the shoulders and feet.  You can stabilize the ball if needed, or have the child wedge the ball in a corner before starting.

Swimming Exercise strengthens extensor muscles of the back, hips, thighs and calves that kids need for running and jumping.   Lying flat on the tummy, have the child lift one arm at a time, keeping the legs straight and long.  As the child gets stronger, cue him to lift one or both legs off the floor , always keeping them stretched as long as possible.

Younger children might need help stabilizing one arm against the floor while they lift the other.  Make it fun by pretending to be an alligator chomping on his dinner or reaching for small objects.

Pilates Leg Circles are hard for many adults, and even harder for young kids who lack abdominal strength to stabilize the trunk while moving their legs above their body.  But working on the starting position for this exercise will help kids learn to engage abdominal muscles prior to moving their legs when climbing or kicking a ball. Ask the child to lie on his back and lift his feet above his body (hips at a 90 degree angle).  Make it fun by placing small bean bag animals on his feet or ask him to squeeze the animals between his feet.

Plank strengthens core muscles that are critical for a stable, balanced body, whether your child likes to exercise on the playground or by playing a competitive sport.  The key with plank is to only hold the pose for as long as you can keep good form.

Give your child the support of an exercise ball to start, bringing her forward onto her hands.  Keep the ball positioned under the hips if needed; move it to the lower legs as the child gets stronger.  She should be able to keep her tummy lifted and the back straight (not arched or sagging).  As soon as the trunk starts to lose its form, take a rest and try again after a minute or two.  Make it fun by singing a song while holding the plank position.

Proof that Pilates exercise can be used by everyone, many Pilates moves have been adapted for use in rehabilitation.  Pilates is used to rehabilitate orthopedic injuries in adults as well as to strengthen and improve body awareness for children with neuromuscular disorders.

Easter Seals DuPage & Fox Valley therapists are expanding their knowledge of using Pilates in therapy with a continuing education course taught by Sara Koveleski Kraut, DPT,  on January 21-22, 2017.  The course is open for registration by adult and pediatric therapists at eastersealsdfvr.org/ce.

Easter Seals DuPage & Fox Valley is also a teaching center that provides innovative continuing education courses that promote therapeutic excellence for speech and language pathologists, physical and occupational therapists, educators and other professionals.  To be added to the course email list, please email us.