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Autism and a Gluten Free Diet

Should Your Child with Autism Avoid Gluten?

The Atkins Diet. Weight Watchers. Paleo. Coconut oil. Gluten Free. Casein Free. You may be familiar with some of these diet trends. People are constantly on a quest for the perfect diet that will shed the pounds and keep them off. Others are looking for diets that regulate their digestive systems and keep their stomach calm. And if you are a parent of a child with autism, you may have heard people maintain that a gluten-free or casein-free diet can be used to help manage behaviors associated with autism.

With the idea of placing a child on a diet for management of symptoms, many questions arise. Does aShould Your Child With Autism Eat a Gluten Free Diet? gluten-free diet make a difference for children with autism? What does the research say? How do you know if it’s working?

Let’s back up a little bit and look at why specific diets for children with autism are being considered. Gastrointestinal problems are often described in children with autism, however the prevalence of these issues has not been consistently proven to be higher than in the general population.

Unfortunately for the sake of determining benefits of a gluten free diet, every child with autism presents differently and will likely have different responses to dieting. Also, unfortunately, the literature is extremely limited and providing conclusive evidence that a specific diet improves behaviors associated with autism has yet to be done. Some studies have yielded positive results (improvements in symptoms), while others have yielded negative results (no improvements noted). It is important to note that none of these studies have provided conclusive evidence; studies reporting positive results were merely suggestive (the lowest level of certainty).

Now you may be thinking, what will it hurt to place my child on a gluten-free or casein-free diet? According to Mulloy et. al, these diets may put children at risk for nutritional deficiencies. Further, this population of children often encounters challenges to ingesting a typical diet to begin with, such as sensory processing difficulties that lead to limited food intake and restricted diets. This can make feeding your child difficult if they are already only accepting chicken nuggets and string cheese. Additionally, implementing a diet of this type is costly and time-consuming.

Should you decide to try a gluten-free diet for your child with autism, here are some important things to remember:

  • Keep objective measures: It will likely be hard for your child to accurately report how they feel given commonly associated language deficits in children with autism. Ask yourself, “How do I know that my child’s sleep is improved?”, or “How do I know that attention is improved?” Find a way to measure data for these questions, such as counting naps taken each day or minutes spent engaged in a task.
  • Involve others: Ask for help from people that spend a lot of time with your child. Ask them to objectively measure behaviors as best they can, and seek their results.
  • Keep a food diary: Track what your child eats for every meal, and any notable behaviors or improvements for each day. This ensures accurate implementation of the diet and gives you the ability to reflect on the weeks and months.
  • Be committed: In a systematic review, more positive results were yielded with longer implementation of the diet.  For example, studies yielding negative results were implemented for an average of 5 weeks while studies yielding positive results were implemented for an average of 18 months.
  • Keep other factors in mind: It is challenging to prove that improvement is due to one factor vs another. For example: If your child experiences improved sleeping patterns, perhaps eliminating sugary foods in general is the cause  as opposed to the removal of gluten. Always think twice before determining cause, and consider all potential variables at play.

If you are exploring diet options for your child, seek the guidance of a dietitian or nutritionist to ensure healthy implementation.

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NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

References:

  • Mulloy, A, et al. Gluten-free and casein-free diets in the treatment of autism spectrum disorders: A systematic review. Research in Autism Spectrum Disorders (2009), doi: 10.1016/j.rasd.2009.10.008
  • Buie, T. (2013). The relationship of autism and gluten. Clinical Therapeutics, 35, 578-583.

Lipid Labwork in Children: Understanding the Numbers and When to Seek Help for Dietary Changes

As adults, our primary care physicians often instruct us to have labs drawn to check our blood lipid levels. Most of us lipid panelprobably know someone who is on a “lipid lowering” medication for high cholesterol levels. These same labs are also being drawn more often for kids, especially if there is a family history of hypercholesterolemia (high cholesterol) or heart disease, or if the child is overweight or obese. Read on to understand what these labs look for in children, what the numbers mean, and what you should do after getting results.

The “lipid panel,” as the lab is called, measures these lipids that circulate in the bloodstream:

  • LDL cholesterol:  LDL cholesterol is associated with a risk for heart disease. The goal result for LDL cholesterol is <100 mg/dL, and <130 is considered acceptable.
  • HDL cholesterol:  HDL cholesterol is the “good” kind of cholesterol that scoops up the “bad” kind and helps get rid of it. The goal result for this type of cholesterol is >40 mg/dL. The higher the HDL is, the better, in most cases. Read more

Coconut Oil: Facts and Uses

Coconut oil has become popular, especially for its uses in cooking. Coconut oil has some unique properties that coconut oil facts and usesdifferentiate it from other types of oil. Here are some interesting facts about coconut oil and ways to use this food.

Coconut Oil Facts and Uses:

  • It is one of the only plant sources of fat that is solid at room temperature.
  • Coconut oil is very high in medium chain triglycerides (MCTs) which are absorbed from the stomach straight into the bloodstream. Other long chain fats require a more involved digestive process and are absorbed and transported via the lymphatic system. This is helpful for people with problems digesting fat. It can also be a good source of calories in some people with inflammatory digestive issues.
  • Medium chain triglycerides are “oxidized,” or metabolized, rapidly in the liver which means they have a low tendency to be stored as adipose tissue (fat) on the body.
  • It can be used in place of butter or margarine in many recipes, especially when baking sweets, since it has a slight coconut flavor.
  • Coconut oil can be used to grease baking pans instead of other hydrogenated products.
  • It can be used in place of other cooking oils when stir frying or pan frying various foods.
  • Because it is plant-derived, coconut oil is vegan and can replace animal-based fats in recipes. Read more

Infant Soy Formula: A Review of Recommendations from the American Academy of Pediatrics

Parents often ask me about giving their infant a soy formula when their infant shows signs of difficulty tolerating breast soy formulamilk or cow’s milk based formulas. Soy seems to be a common go-to alternative; however, there are actually only a few scenarios where soy formula is recommended. The American Academy of Pediatrics published a journal article that reviewed the use of soy based infant formulas in 2008. Here is a summary of the main points.

A Review of Infant Soy Formula:

  • Soy formula is not indicated as an alternative for breast milk or for cow’s milk based formulas except in the case of Galactosemia and hereditary lactase deficiency (both are rare diagnoses). Soy formula may also be an option for parents who desire a vegetarian diet for their infant, if breastfeeding is not possible.
  • Soy formula is not indicated for children diagnosed with cow’s milk protein allergy. Instead, an extensively hydrolyzed formula should be considered, because 10-14% of these infants will also be allergic to soy protein. Read more

Creative Ways for Kids to Get Five-a-Day

The general recommendation for fruit and vegetable intake is five servings per day. The serving size depends on age, but5 a Day a good rule of thumb is to get your family to consume 2-3 fruits and 2-3 vegetables each day. Does this sound difficult? With a little planning and some creativity, you can achieve this healthy goal.

Tips to Get Your Family to Eat 5 Servings of Fruits and Vegetables a Day:

  • Blend fruit, and even veggies, into smoothies or popsicles. Most kids like treats that come in smoothie, milkshake, or popsicle form. Use yogurt, frozen fruit, a banana, and a handful of spinach to make a smoothie that tastes so good your kids will never guess they’re getting several servings of fruits and vegetables. Freeze into popsicle molds for a healthy frozen dessert.
  • Make fruit and vegetable dippers. Some vegetables simply taste better with a little dip. You can make an easy, healthy, savory dip by mixing plain Greek yogurt with dry Italian or Ranch seasoning packets. Have fresh vegetables chopped and ready to go for snacks or meals ahead of time. Make it more fun by arranging several different colored veggies (such as carrots, celery, baby tomatoes and yellow bell peppers), and two dips (such as hummus and the yogurt Ranch dip) in a muffin tray with six cups. Kids love this fun presentation.  Fruit can be more appealing when dipped as well. Try a flavored yogurt, or mix plain Greek yogurt with a little peanut butter, honey, and cinnamon.
  • Create designs that appeal to kids. Take advantage of the variety of colors and shapes of fruits and vegetables to make your kids more interested in them. You can make rainbows skewers using fruits and vegetables from each shade of the rainbow.  For example you can create a fruit skewer using strawberries, mini orange slices, bananas, kiwis, blueberries, and blackberries. Or have your kids make funny faces using bananas, carrots, berries, kiwis, melons or peppers. Use broccoli, olives, pineapple, a banana, tomatoes, carrots, blueberries, blackberries, strawberries, and oranges to make Sesame Street characters! This is also a great option for a child’s party or barbecue.

Fruits and vegetables provide many essential vitamins and minerals, as well as phytonutrients that provide health benefits such as reducing inflammation and preventing cancer. These healthy foods also provide fiber, which promotes healthy digestion.

Feel like you have fruits and veggies covered?  Read here for ways to sneak more whole grains into your child’s diet.  If you have concerns about your family’s diet, click here to find out more about North Shore Pediatric Therapy’s Nutrition Counseling program.

Visit us anytime at www.NSPT4kids.com

The Scoop on Ice Cream and Nutrition for Kids

When you think of summers as a kid, at least one memory probably includes licking a delicious, melting ice cream cone. ice creamIce cream is a popular summer treat for families, but some parents worry it doesn’t fit into a healthy diet plan.  Parents need not worry, though.  Ice cream can be included as a summer treat if you follow the guidelines below.

How can you preserve the ice cream ritual while keeping nutrition in mind?

  • Balance: The phrase “everything in moderation” is especially applicable to nutrition. Ice cream should be an occasional treat as opposed to a nightly routine. Refrain from keeping huge tubs of ice cream in the house, and instead buy small containers that can be divided among family members in proper portion sizes.
  • Portion size: The serving size for most ice cream is ½ a cup. If you imagine a baseball is about 1 cup, then half a baseball is about the amount of ice cream that  should be in a serving. One serving of regular ice cream can have 250 calories or more in it. Eating an extra 250 calories per day will result in a half a pound a week weight gain. This is two pounds per month or six pounds over the whole summer. Read more

How to Get More Whole Grains into Your Kid’s Diet

Whole grains are an important part of any diet.  Whole grains are more nutrient-dense than their refined counterparts. Whole GrainsRefined “white” starches have been stripped of fiber, as well as vitamins and minerals. Some of the vitamins and minerals are re-fortified into these processed grains, but refined grains remain nutritionally inferior to whole grains. The fiber in whole grains also helps create feelings of satiety, which in turn helps prevent overeating. Many typical kids’ foods are not made with whole grains. However, it’s easier than you think to sneak these healthy whole grains into your child’s daily diet.

Children’s Foods Made with Healthy Whole Grains:

  • Whole grain Goldfish
  • Whole grain bagels or English muffins
  • “White” whole grain bread, or 100% whole wheat
  • Oatmeal
  • Multigrain pancakes or waffles
  • Whole wheat pasta
  • Soft corn tortillas (made with corn, salt, and water)
  • Brown rice cakes
  • Whole grain cereals (look for those with less than 5 g of sugar per serving and 3+ grams of fiber per serving)
  • Cooked quinoa or uncooked oats in meatloaf, meatballs, stuffed peppers, muffins, pancakes, etc
  • Multigrain crackers

How to Spot Whole Grains at the Grocery Store:

When at the grocery store, labels can be a bit confusing. There are two ways to tell if a product is truly whole grain. First, look for whole grain as the first ingredient listed on the ingredient list. In other words, look for “whole wheat” or “brown rice.” Second, look for a gold and black, whole grains symbol on the box. Just be sure that your whole grain pick is an otherwise healthy choice; whole grains are only a part of the whole healthy food equation.

For other ways to clean-up your family’s diet, read here for ways to add more fruits and vegetables to your kid’s meals or simple ideas for cooking greens.   If you find your family has a hard time transitioning from refined to whole grains, contact a dietitian. They can help brainstorm recipes, come up with creative ways to help increase acceptance, and educate your family on the nutritional benefits of whole versus processed foods.

To learn more about nutrition services at North Shore Pediatric Therapy, call us at 877-486-4140.

5 Things a Dietitian Can Do for You and Your Child (that you might not know)

When you think of a dietitian, you probably think of healthy eating and weight loss. But dietitians are trained to manage many more  areas of health than that! Pediatric nutrition is a highly specialized field since infants and children are continuously growing and developing.nutritionist Furthermore, there are several diagnoses that are specific to infants and children which require unique nutritional management. Do you know what a pediatric dietitian can do for you and your family?

5 Things a Dietitian Can Do for You and Your Child (that you might not know):

  1. Help with breastfeeding. Dietitians who specialize in pediatric nutrition can seek specific training and education on breastfeeding. They can then educate parents on technique, what to expect, and how to seek continued support. For new parents, it is best to learn as much as you can about breastfeeding before the baby is born, and a trained pediatric dietitian is a great resource. After the baby is born, the dietitian can continue to provide education, troubleshoot problems with breastfeeding, and perform frequent weights to ensure the baby is taking in enough volume to support expected growth. Dietitians can also help breastfeeding moms who may need to make changes to their diet if baby is showing signs of food allergy or intolerance to something in mom’s diet.
  2. Special nutrition care for preemies. Preemies have nutrition needs that are different from babies born full term. They also have different growth goals. Some preemies, especially those born before 32-34 weeks, may have difficulty with feeding. If they are not taking enough volume to support growth goals, a dietitian can help strategize to ensure the baby gets adequate nutrition. This support can also be helpful when the baby transitions to solids, as well as during the toddler years when kids tend to become more picky.
  3. Help uncover food allergies or food sensitivities. Food allergies and sensitivities are difficult to accurately test for, even with blood work. If your child has chronic symptoms without a clear cause, such as eczema, runny nose, ear infections, diaper rash, diarrhea or constipation, fussiness, or aversion to eating, a food allergy or sensitivity may be investigated. A dietitian can guide you through eliminating foods that might be causing symptoms, and also provide a nutritionally-complete diet plan.
  4. Provide nutrition care for digestive problems. Often, digestive issues can be improved by making diet changes. A dietitian can make nutrition recommendations to help with reflux, diarrhea, constipation, bloating, and stomach aches. Dietitians are also trained to manage nutrition for GI disorders such as ulcerative colitis, Crohn’s, Celiac, IBS, and more.
  5. Manage nutrition for children with special healthcare needs. Pediatric dietitians are trained to provide proper nutrition for children with a wide variety of diagnoses in which nutrition, growth, and/or feeding are affected. Examples include Trisomy 21, cardiac defects, cerebral palsy, developmental disabilities, trauma, chronic respiratory issues, tube feedings, and more.

If you or your child’s pediatrician have concerns related to your child’s nutrition, growth, or feeding abilities, contact one of our registered dietitians to set up an evaluation. Our pediatric nutrition experts can help your child achieve his or her best potential. 877-486-4140.

Preemies: Special Little Ones with Special Nutrition Needs

When going through pregnancy, most mothers expect to have nine months to prepare for a newborn. Caring for a preemie, however, is not something that pregnancy books and newborn care classes cover.

In terms of preemie nutrition and feeding, the following information can help prepare you or provide insight into what you may be experiencing:

Mother eating with infant

1. Nutrition support

This refers to an alternate route of nutrition for your baby. Babies may require nutrition support if they have low birth weight or other medical complications. If born before 34 weeks, he or she may not be able to coordinate sucking, swallowing, and breathing during oral feeding. Your baby may receive breastmilk or formula through a tiny tube that goes into the nostril or mouth and down to the gut (enteral nutrition). In cases of very early preemies, many have to receive parenteral nutrition, or nutrition through an IV (intravenous). This is because their digestive system is not yet developed enough to handle the full volume of breastmilk or formula that is required to sustain growth. There can be a number of factors that limit an infant’s ability to tolerate enteral nutrition, and parenteral nutrition becomes necessary.

2. Fortified breast milk or special formulas

Being outside the womb early presents challenges and demands on the infant’s body that can increase nutrition needs. Preemies with low birth weight need more calories, protein, vitamins and minerals than infants born at full term, to promote “catch up growth”. Human breastmilk has been analyzed from mothers of preemies and mothers of term infants, and preemie breastmilk actually contains more calories, protein, vitamins and minerals than term breastmilk. Often times, preemie breastmilk needs to be fortified further to meet the infant’s needs. There are also formulas designed for premature infants in the event that breastmilk is not available. Proper nutrition is critical for the development of vital organs like the lungs, heart, brain, and gut. Neonatologists and registered dietitians assess each baby in the NICU for nutrition needs, and create individualized recipes and feeding regimens. Sometimes these special recipes and feeding regimens need to be continued once the baby goes home from the NICU, and parents get educated by the medical team on how to do this.

3. Swallowing or oral feeding issues

Babies develop the ability to coordinate sucking, swallowing, and breathing around 33 or 34 weeks. There are a number of circumstances that may impact this developmental stage for preemies born prior to that. The baby may require a ventilator for oxygen, which would not allow oral feeding to occur. Or, the baby may require nutrition support during this time for a variety of reasons, and oral feeding attempts may not be possible. These scenarios can have lingering effects on how the baby feeds and swallows in the future. Babies may require special feeding techniques or “thickened” liquids if they have swallowing difficulties. Sometimes babies develop oral sensory issues and aversion to oral feeds, in which case tube feedings may continue until this is overcome.

An article published in Neonatology in 2008 titled “Strategies for feeding the preterm infant”, by Dr. William Hay, provides a review of preemie nutrition (for free full text, click here). As your infant gets older, his or her nutrition needs will change. Growth should be monitored closely by your child’s doctor.  Nutrition is critical, and expert care should be provided to ensure maximum development. If you or your doctor has concerns about growth, nutrition, or feeding, schedule an appointment with a dietitian at North Shore Pediatric Therapy.

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