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The Critical Role of Nutrition in Therapy

This guest blog was written by Betsy Hjelmgren, MS, RDN, CSP, LDN, owner and founder of Feed to Succeed.

Essential to every person, especially a growing child, is healthy nutrition. This is especially true for children who require therapy for health issues. As a registered dietitian, not a day goes by that I Blog-Nutrition-Main-Landscapeam not reminded that proper nutrition underlies the health and well being of every child.

I recently worked with an early intervention (EI) patient with developmental delays. When we first met, he wasn’t meeting the expected milestones for his age, such as walking and talking. His parents and therapists complained that he lacked energy whenever they tried to work with him, and yet, when they encouraged him to eat, he was too tired and weak for this seemingly simple task. I recommended a feeding tube for the short term, and in one month, the child gained three pounds and began to walk and talk.

Of course, not every child who would benefit from working with a registered dietitian requires such intensive therapy. Many children, however, do benefit from an adjustment in their diets so that they have the energy and strength to meet milestones in therapy and can improve outcomes.

A child who doesn’t have the proper building blocks in his muscle and nerve endings needs proper nutrition in order to thrive in occupational or physical therapy, for example. Similarly to a garden, where a plant needs soil, nutrition and water to grow, a child needs proper food, nutrition and care to ensure the best outcome in his development.

While all children who don’t receive proper nutrition cannot function to their highest potential, in some cases, it is not obvious that they are lacking nutrition. It’s once a child responds to a new diet that it is obvious how effective nutrition is. For example, a child who is allergic to cow milk may not be getting enough protein to build muscle and may not be growing as tall as she could. Nutrition guidance, education and support can provide a more well-rounded diet.

Following is a screening tool for parents to use in order to determine when a child would benefit from receiving nutrition therapy:

  • A child who has not gained weight over 2-3 consecutive months or has not grown in height over 3-6 months
  • A child who frequently has a poor appetitive or is extremely picky
  • A child who seems thin, tired or pale
  • A child who has frequent chronic constipation or vomits
  • A child who completely avoids certain food groups
  • A child on a modified or restricted diet.
  • A child who receives supplemental feedings, such as a feeding tube or Pediasure

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee. 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!

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BetsyBetsy Hjelmgren, is the owner and founder Feed to Succeed in Glenview, Ill. She has been a registered dietitian, licensed in the State of Illinois, for over a decade. Registered dietitians are the only nutrition experts regulated by the Academy of Nutrition and Dietetics, and licensed to provide professional nutrition advice. Betsy is credentialed with Early Intervention for qualifying children aged 0-3 years old and is also the mother of two children. Follow her on Twitter @feedtosucceed and on Facebook.

Food Milestones: From Mashin’ to Munchin’

Mealtime and achieving food milestones can be a stressful time for many families, especially for those whose kids demonstrate Food Milestonesdifficulty consuming a variety of flavors and textures. Instead of stressing over consuming those calories and pumping on the weight, take time to relax and enjoy a meal. Take away the stressors from your day and use mealtimes as an opportunity to bond with your little one. There is great variety in the development of infants and toddlers due to differences in the rate of physical and mental development as well as how often these skills are promoted by caregivers. As children develop their preferences for different foods (tastes & textures), they learn to accept or reject specific foods, which is OKAY!

The old mother’s tale “you can’t get up until you finish your peas” has proven to be an ineffective way to have children smoothly go through the realm of trying different foods. Instead of “forcing” your child to eat different foods, give them options…”you can eat 5 or 6 peas…you pick!” Give great verbal praise despite how big of a gain the child has made that meal.

Please see the developmental chart below that guides you through a variety of food milestones while providing ideas on how to keep mealtime positive!

Age Strategies and foods that should be introduced Tips and Tricks
Birth-2 months
  • Nipple feeding by breast or bottle
  • Semi-reclined position during feeding

Foods:

  • Breast milk or formula (approx. 18-28 ounces)
  • Sing songs or tell stories while you feed your infant, build a rapport
2-3 months
  • Start forming a consistent schedule

Foods:

  • Breast milk or formula (approx. 25-32 ounces)
  • Make silly faces with your infant, make meal time a reciprocal relationship
3-4 months
  • Infant starts to put hands on bottle during feedings

Foods:

  • Breast milk or formula (approx. 28-39 ounces)
  • ˷4 mo, rice cereal trials
  • Always avoid television or electronics during meal time, practice songs or rhymes
  • Have your infant sitting at the table during adult meal times

 

5-6 months
  • Start to introduce pureed spoon feeds
  • Tongue will continue to “mash” the food to consume

Foods:

  • Breast milk or formula (approx. 27-45 ounces)
  • Overly ripe fruits/vegetables
  • Oatmeal
  • Rice or wheat cereal
  • Puree a food that you are having for dinner to make it easier with food preparation

 

6-9 months
  • Moves to a more upright position during feeds
  • Helps caregiver with moving spoon to mouth

Foods:

  • Breast milk or formula (approx. 24-32 ounces)
  • Sweet potato mash
  • Cottage cheeses
  • Puff cereal bites
  • Encourage infant to hold bottle independently
  • Think of a variety of different flavors to introduce, even mix flavors based off babies preference
  • Take small trials of foods from your plate to give baby to try
9-12 months
  • Progresses from pureed to more textured food
  • Increases finger feeding
  • Introduction of straw based cup or open cup
  • Moves to a more “munching” formation with jaw and tongue

Foods:

  • Breast milk or formula (approx. 24 ounces)
  • Egg-free noodles
  • Variety of fruit/vegetables
  • Mild cheese slices
  • Offer new foods without the expectation of eating the food (he/she can poke, smell, lick, etc)
  • Always offer small portions on a child sized bowl or plate (don’t overwhelm)

 

12-18 months
  • Grasps utensils and self-feeds
  • Complete transfer from bottle to straw based cup or open cup

Foods:

  • White potato mash
  • Chicken
  • Beef
  • Beets
  • Offer foods of different textures: pudding, soup, crackers, mashed sweet potatoes, etc
  • Have child come with you to the store to pick out their “special cup” to encourage discontinued use of nipple based bottle
18-24 months
  • Primarily self-feeding
  • Able to chew different textures and flavors

Foods:

  • Eggs
  • Lentils
  • Beans
  • Cantaloupe
  • Never ask a child “Do you want ____” because you will have to respect if they say “no”
24-36 months
  • Holds open cup independently
  • Eats a wide variety of solid foods

Foods:

  • Cleared to try any food
  • Have your toddler “get messy” with their food, spread the different textures on their hands, face, or even nose
Continuum into childhood
  • Continue to use choices to give your child the “control” during mealtimes
  • Have your child participate in mealtime prep as much as possible

 

Remember, mealtime goals shouldn’t be about consumption, but about a positive experience for the child. Always consult your pediatrician about diet concerns or questions.

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee. 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:

Developmental Stages in infant and Toddler Feeding., Infant & Toddler Forum., 2014.

McCarthy, Jessica., Feeding Infants & Toddlers: Strategies for Safe, Stress-Free Mealtimes. Mosaic Childhood Project, Inc., 2006.

1998, The American Dietetic Association. “Pediatric Manual of Clinical Dietetics”. 1998.

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Picky Eater

Picking Apart the Picky Eater: 5 Tips to Address Your Child’s Problem Feeding

In an era with Whole Foods, Paleo diets, and organic produce at our fingertips, how do we improve a child that is a picky eater? Modern day life can be hectic and as the result feeding may reflect fast, convenient options that taste good but are not always the most nutrient-dense. So, how does one correct picky eating to support a more balanced diet?

5 Tips to Address a Picky Eater

  1. Re-create expectations around feeding. Eating does not just have to be about pleasure, it can be about sustenance, nutrition, and a time for social interaction/community. To frame feeding in terms of just for pleasure, we overemphasize the role of taste in our feeding practices; if it doesn’t taste goodPicky Eater or initiate our pleasure receptors, we shouldn’t eat it. Really, we eat for a variety of reasons and taste can be one of them. If we re-create our expectations to encompass eating for nutrition, sustenance, as well as taste it can become easier for your child to engage with non-preferred, more healthful foods.
  2. Motivate compliant behaviors through incentives. Feeding is a behavior just like any other so if you want to target increased compliance with eating certain foods, provide incentives to encourage the desired behavior. For example, if your child refuses to eat vegetables with dinner, create a log that tracks compliance with trying at least 3 bites of the non-preferred food. Upon completion of the bites, the child can get a sticker, equating with a long-term prize at the end of the week for compliant behaviors or result in shorter-term gratification which can look like being served dessert. Identify what may motivate your child the most to get through challenging tasks and work with this to create investment towards a new mode of eating. The 3-bite rule can help the child also determine if this is truly a food they like or not as they engage with it more.
  3. Debunk negative thinking. Chances are your child’s refusal of food is due to negative thoughts around how they perceive the food to taste or impact them. For example, if a child fears that a food will make them gag, taste disgusting, or make them sick, it would make sense that they would want nothing to do with these foods. The fact of the matter is, there may be limited to no evidence supporting these interpretations so it is important to challenge or debunk this negative thinking. If the child asserts that they don’t like broccoli, inquire about what they believe will happen to them if they eat it. Will they gag? Will they dislike the taste? Will it make them sick? Likely, they will report they just won’t like the taste. If that is the reality, this is a small problem that they can overcome with practice, perseverance, and supplemental positive thinking. Thinking that broccoli is just “ok” but nothing bad will come as the result can facilitate easier engagement and consumption with the non-preferred food item.
  4. Pair foods together. No one says that a meal will only consist of just preferred or just non-preferred foods so it is important to teach balance This can look like pairing favored foods with non-favored foods to emphasize this point; incorporating chicken nuggets with vegetables or fruit instead of French fries or dipping peanut butter and apples together can make unpleasant foods more pleasurable.
  5. Model. Model. If you want your children to get healthy foods and interact with a balanced plate so do you! Align with your child and demonstrate for them that these foods are good and good for you.




NSPT offers Sensory Processing Disorder (SPD)  and Nutrition 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!

IBS Versus IBD: What Is The Difference And How Can Diet Help?

Does your child suffer from gastrointestinal pain, bloating, diarrhea, or even vomiting episodes? Have you researched the symptoms or spoken with your pediatrician? You may have come across the terms IBS (Irritable Bowel Syndrome) and IBD (Irritable Bowel Disorder). These two gastrointestinal disorders can present with similar symptoms, so it may be confusing to decipher what’s really going on at first. However, there are distinct causes and ways of diagnosing them that determine whether a patient has IBS or IBD.

Irritable Bowel Disorder (IBD)

IBD is a term used for two specific gastrointestinal diseases.  One form of IBD is Crohn’s disease.

Symptoms– Painful “flare-up” episodes. The pain can occur anywhere in the gastrointestinal tract. The flare-ups cause diarrhea and sometimes vomiting, either of which may contain blood. These episodes may be accompanied by fever and/or fatigue. Weight loss can also occur.

Causes– A variety of factors that trigger an autoimmune, inflammatory response.

How it is diagnosed– A gastrointestinal doctor will perform a “scope” (endoscopy and colonoscopy) of the suspected areas affected in the gastrointestinal tract. This involves being sedated, having a tiny camera inserted into the gastrointestinal tract, and biopsies taken. The doctor can diagnose Crohn’s based on what he or she observes from these tests. If the inflammatory sites are located in patches or varying locations along the gastrointestinal tract anywhere from esophagus to anus, it is indicative of Crohn’s.

Treatment– During flare-ups, doctors will evaluate and may prescribe steroids, antibiotics, pain killers, and a modified diet that is low in fiber and other foods that may trigger inflammation such as lactose. In severe flare-ups, patients may be hospitalized and required to be on bowel rest, which means consuming nothing by mouth. When not having a flare-up, patients with Crohn’s are encouraged to eat a healthy diet with good sources of fiber. “Trigger foods” should also be avoided in general, which may include high fat or fried foods, excessive amounts of dairy, caffeine, and others.

The other form of IBD is Ulcerative Colitis.

Symptoms– Pain and cramping focused in the lower intestines. Diarrhea, sometimes with blood. Weight loss and fever can occur as a result of severe inflammation and diarrhea.

Causes– Inflammation that can be caused by a variety of factors and becomes chronic. Inflammation is in the colon and may progress continuously up the lower intestine.

How it is diagnosed– A gastrointestinal doctor will perform a colonoscopy with biopsies.

Treatment– Similar to treatment of Crohn’s.

Irritable Bowel Syndrome

IBS is a bit more of an ambiguous condition than IBD, and can be difficult to identify and treat.

Symptoms– Abdominal pain, bloating, gas, diarrhea and/or constipation, general maldigestion and discomfort which may or may not be associated with eating any particular foods.

Causes– Definite causes of IBS are still unknown, but are currently being researched.

How it is diagnosed– IBS is diagnosed by closely tracking symptoms and ruling out all other diagnoses.

Treatment– Individualized modifications in diet and lifestyle which differ from person to person and may change over time. Some IBS sufferers trial “elimination diets” where common problematic foods are eliminated (such as wheat, dairy, corn, eggs, soy, etc.) to see if symptoms improve. Another recent diet therapy for IBS is the FODMAP diet, which eliminates high fructose corn syrup, some legumes, wheat, and various fruits and vegetables, among other things.

If your child suffers from IBS or IBD and you would like more guidance on diet therapies, schedule an appointment with a registered dietitian at NSPT. 877-486-4140.

Get the Family Healthy in 2014, Part 2 of 2

Last week, I discussed three New Year’s resolutions to help get your family healthier in 2014. Here are some more ideas. Like I said in last week’s post, adopt as many of these as you think are realistic for your family. Or pick one change to implement each month as the year goes on. By summer, you will see some real changes!

More Fixes for Healthy Family Eating:

1. Eliminate sugary beverages, including juice. This change is pretty simple and can have a huge impact. Sugary beverages are problematic because it’s easy to quickly consume a lot of calories without feeling full. Juice and sports drinks are not ideal drink choices either, as they are just as calorie-dense as other sugary beverages like soda. It is better to get the vitamin C and electrolytes from healthy food choices. Kids rarely need sports drinks to replace electrolytes during or after physical activity unless they are involved in multiple hours of continuous physical activity and are sweating a lot. Chocolate milk is also considered a sugary beverage, and should be replaced with plain milk. If you are wondering how much sugar is in some of your family’s favorite drinks, measure out one teaspoon of table sugar for every 4 grams of sugar in the “Total Sugar” content on the Nutrition Facts Label. Be sure to look at what the serving size is and how many servings your family member is consuming. I have done this experiment with many families, and they are always shocked since no one (not even the kids) would consider drinking that heap of table sugar.

2. Do something active for at least 60 minutes, every day. Encourage your child to be active by having plenty of outlets for physical activity all year round. For days the weather is not conducive for outdoor play, have a bin filled with things like jump ropes, hula hoops, balls, and other toys. Encourage your child to participate in sports or other hobbies that involve physical activity. Be a good example. Find ways to be physically active as a family, such as walking places within a mile or so instead of driving. This is possible even in cold winter months as long as you dress warmly. If your child is resistant to doing fun physical activities, then offer another option— house chores.

3. Limit screen time to less than 2 hours per day. When you think about how many hours your child spends sitting at school, then how many hours they spend sitting doing homework, then how many hours they spend sitting watching TV or playing on the computer—it adds up to a pretty sedentary lifestyle. This is one of the biggest implications of childhood obesity in our culture today. We have transitioned from a society that relied on physical labor to complete daily tasks, to a society that relies on convenience. Kids used to play outdoor games and sports for fun, and now they play video games. I have had some school-age kids tell me that they just don’t know how to play. Set boundaries around screen time. One idea is to have the kids earn screen time by doing 60+ minutes of physical activity and completing homework.

Any of these New Year’s resolutions will make a healthy impact on your family, especially if the whole family is on-board and participating together. The resolutions described are all simple changes, but can be challenging to implement and sustain without commitment. For more personalized planning and troubleshooting, make an appointment with a registered dietitian at North Shore Pediatric Therapy.

Click here if you missed part 1 of this series, Get Your Family Healthy in 2014.

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

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

Nutrition Implications of Pediatric Congenital Heart Defects

Congenital heart defects in the pediatric population are a serious condition. Many defectscongenital heart defects require surgical intervention to correct or improve the problem. Often, there are nutrition-related implications associated with heart defects. Here is more information about how nutrition may be affected to help you understand this aspect of your child’s health.

The Link between Nutrition and Congenital Heart Defects:

  • Digestion and absorption of nutrients. The major job of the human heart is to pump blood throughout the body. The blood carries nutrients and oxygen to be used for energy and to support all body functions. With a heart defect, blood circulation may be suboptimal, since the heart may not be pumping strongly or efficiently. This can result in poor blood flow to the gut, which means that the gut is not getting the nutrients and energy it needs to perform digestive functions effectively. Nutrients may not be absorbed well, which can lead to poor weight gain and general intolerance of feeds (diarrhea, reflux, delayed gastric emptying). Read more