6 Tips To Consider Before Conception

Photo credit:  Negative Space

Photo credit: Negative Space

Now that you’ve decided to expand your family, there are a number of things you can do to prepare for your pregnancy and get started on the road to conceiving, and birthing a full term, healthy baby!

This stage of conception is called periconception and it’s an important time because there are certain nutritional measures you can take to optimize conceiving, pregnancy and the growth, development and health of your baby.

The periconceptional period starts one to three months before conception, and lasts from one to three months after conception, so it’s great that you are starting off on the right foot now, before you become pregnant.

Folate and iron are two important nutrients to consider during this time. If you don’t have enough folate, there is a greater risk for the development of birth defects like those involving the neural tube (resulting in spina bifida for example). Neural tube defects can develop within 21 days of conception or even before you know you’re pregnant. It is recommended therefore that you take a folate (not folic acid) supplement in addition to the folate you get from your diet.

Iron deficiency prior to pregnancy can increase the risk of iron deficiency anemia for you, and can lead to your baby being born low iron stores. If you are iron deficient you are also at greater risk for having a preterm baby. The good news is that it is easier to build up iron stores before you become pregnant as opposed to after. You can make sure you have enough iron by having your levels assessed, and by eating the right foods.

Getting ready for pregnancy also requires building healthy bones, and if there is not enough calcium in your diet, your developing baby might pull the calcium out of your bones for her own needs and this will put you at greater risk for osteoporosis later in life.

Weight loss and/or undernutrition in you and your partner can have negative effects on fertility. In women, being underweight can lead to lower levels of important hormones that are necessary for the proper functioning of the female reproductive system. In men, a low calorie diet can lower sex drive, and have negative effects on sperm viability and motility. Being overweight also negatively affects fertility in both women and men.

It’s possible that if you are having difficulty conceiving, you and/or your partner may have low levels of antioxidants. For example, vitamin E and selenium can improve sperm quality in infertile men, and vitamins C and E can increase sperm number and motility. Zinc is also important for reducing oxidative stress in men and it can improve sperm quality and the production of testosterone. When it comes to antioxidants and minerals, it is better to get them from your diet instead of from supplements. We always start with diet.

Alcohol can decrease testosterone levels and have negative effects on the normal functioning of the testes (which can affect sperm production). In women, alcohol consumption can have negative effects on the fetus during pregnancy, and if you aren’t pregnant yet, it may even lead to possible birth defects in the baby once you become pregnant, so if you are trying to conceive, it’s best to stay away from alcohol.

Tips for healthy conception:

  1. Make sure you are getting enough nutrients from the foods you eat including folate, iron, vitamins, antioxidants and minerals, start with a healthy diet, and get professional guidance for supplementation

  2. Eat a whole, real foods, anti-inflammatory diet

  3. Maintaining a healthy weight is important for both you and your partner

  4. It’s best to eliminate alcohol from your lifestyle

  5. Exercise regularly

  6. Manage stress

For women, it’s best to begin these practices up to 3 months before you conceive and continue to maintain them throughout your pregnancy. For men, it is also recommended to start paying attention to these factors up to 3 months before conceiving. 

Brown JE. Nutrition Through the Life Cycle, Fifth Edition. United States: Cengage Learning; 2014.

Steegers-Theunissen RP, Twigt J, Pestinger V, Sinclair KD. The periconceptual period, reproduction and long-term health of offspring: the importance of one-carbon metabolism. Hum Reprod Update. 2013;19(6):640-55. Doi:10.1093/humupd/dmt041. Epub 2013 Aug 19.

Cetin I, Berti C, Calabrese S. Role of micronutrients in the periconceptional period. Hum Reprod Update. 2010;16(1):80-95. Doi:10.1093/humupd/dmp025.

Rumball CWH, Bloomfield FH, Oliver MH, Harding JE. Different periods of periconceptional undernutriton have different effects on growth, metabolic and endocrine status in fetal sheep. Pediatric Research. 2009;66:605-613. Doi:10.1203/PDR.0b013e3181bbde72

Nutrition Before Pregnancy. University of Rochester Medical Center, Health Encyclopedia. https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P02479. Updated January 9, 2016. Accessed January 15, 2016. 

Gropper SS, Smith JL. Advanced Nutrition and Human Metabolism, 6th Edition. United States: Wadsworth Cengage Learning; 2005.

Protect Your Toddler From Lead

Photo credit:  Pixabay

Photo credit: Pixabay

Now that your baby has become a toddler, you’ll want to do all you can to keep her healthy, happy and developing physically, mentally and emotionally!

Did you know that almost 2% of kids ages 1 to 5 have high levels of lead in their blood?

The main sources of lead exposure for kids include airborne lead, and leaded chips and dust, which mostly come from lead paint that has deteriorated.

Toddlers are more at risk for increased levels of lead in their bodies because they tend to put things in their mouths, which may have lead in or on them.

Lead exposure can be dangerous because it can affect the brain, the blood and the kidneys, and even if there is just a little bit of exposure to lead, it can result in decreased IQ and it can also have negative effects on motor, behavioral and physical abilities. It can also decrease growth.

Lead based paint (found in homes built before 1978), lead piping, contaminated water, and some canned foods (from other countries) can all be sources of lead exposure. If you or your partner works with sources of lead, you might even carry dust and debris on your clothing home and this can also increase the risk for lead exposure for your child. If your toddler has a brother, sister, or playmate has high levels of lead in their blood, your toddler is also at greater risk themselves for exposure to lead.

If you are enrolled in Medicaid services, or if you are familiar with your local health department, you may already know that it is recommended that some toddlers get screened for lead exposure. This screening, when indicated, should be done when your toddler is between 9 to 12 months old, and then again when she is about 24 months old. If you are concerned that your child may be at risk for lead exposure, ask your doctor if lead screening is indicated for her.

Your toddler may also be at risk for increased exposure to lead if she isn’t eating a healthy diet and getting the right nutrients, or if she has iron deficiency anemia. Iron can be found in foods like beef, pork, chicken, turkey (especially dark meat), fish, leafy greens like broccoli, and legumes like green peas.

Vitamin C can help clear lead out of the body. Some great sources of vitamin C are papaya, oranges, broccoli, kale, and strawberries.

Calcium might reduce the amount of lead that gets absorbed in the body, and your child can get lots of calcium from seeds, canned salmon, sardines, beans (white, red, pinto), lentils, almonds, some leafy greens (collard, spinach, kale), broccoli, amaranth, dried figs, oranges, and yogurt, cheese and milk (if your family and child eat dairy).

The most important things to do for lowering the risk of lead exposure are to:

  1. Eliminate sources of lead - make sure your toddler isn’t exposed to sources of lead like lead based paints

  2. Ensure your toddler is eating a well balanced diet - include food sources of iron, vitamin C and calcium

  3. Prevent iron deficiency anemia - see your healthcare provider to make sure your child isn’t iron deficient, and that she’s screened for lead exposure if needed

Jennifer Caryn Brand Nutrition, Lead Prevention



Brown JE. Nutrition Through the Life Cycle, Fifth Edition. United States: Cengage Learning; 2014.

Centers for Disease Control and Prevention. Lead. Cdc.gov. http://www.cdc.gov/nceh/lead/. Last updated October 26, 2015. Accessed November 17, 2015.

Mayo Clinic. Lead poisoning. Mayoclinic.org. http://www.mayoclinic.org/diseases-conditions/lead-poisoning/basics/definition/con-20035487. Published June 10, 2014. Accessed November 17, 2015.  

Centers for Disease Control and Prevention. Lead Poisoning. Available from: http://www.cdc.gov/nceh/lead/tools/5things.pdf . Accessed November 17, 2015. 

Gropper SS, Smith JL. Advanced Nutrition and Human Metabolism, 6th Edition. United States: Wadsworth Cengage Learning; 2005.


Adolescent Nutrition

Photo credit: A L L E F . V I N I C I U S Δ

Photo credit: A L L E F . V I N I C I U S Δ

Adolescence is the period of life from 11 to 21 years of age. There is profound biological, emotional, social and cognitive development as a child grows into adulthood. During this important stage of development physical, emotional and cognitive maturity is reached, and there is development of personal identity and a value system that is unique and separate from parents and other family members.

 

This can be a challenging time for an adolescent as she struggles for personal independence, yet recognizes the need for economic and emotional family support. Adolescents are also adjusting to their new bodies that have changed in shape, size, and function.(1) Keep these challenges in mind when viewing the adolescent as being difficult or irrational. Your adolescent is dealing with a lot!

 

Because of the dramatic physical growth and development during this stage, there is an increased need for energy (calories from food), protein, vitamins and minerals.(1) Unfortunately at this stage the struggle for independence often leads to health compromising eating behaviors like excessive dieting/caloric restriction and following fad diets, skipping meals, and using unconventional dietary supplements that may cause more harm than good.(2) With guidance, your adolescent can channel their struggle for independence into healthy behaviors like eating a healthy diet, participating in physical activities, and living a healthy lifestyle overall.(1)

 

During early adolescence, puberty occurs. Sexual maturation, increased height and weight, accumulation of skeletal mass and changes in body composition are observed. The age of onset, duration and tempo of these events varies greatly within and between individuals. Because of these differences, nutritional intake and needs should be based on biological growth and development rather than on chronological age. “Tanner Stages” (sexual maturation rating or SMR) is used by health professionals to assess pubertal maturation, regardless of chronological age.(1,3) SMR is based on the development of breasts and pubic hair in females, and on testicular, penile and pubic hair development in males.(1,3) Table 1 demonstrates the Tanner Stages of development in females and males.(4)

 

In females, the first signs of puberty include the development of breast buds and sparse, fine pubic hair around age 8 to 13 years. Menarche occurs 2 to 4 years after the first signs of puberty, and is typically around SMR stage 4.  The average age of menarche is about 12.4 years, but it can occur as early as 9 to 10 years of age, or as late as 17 years of age. Girls that are highly competitive athletes (female athlete triad)5, and those who severely restrict caloric intake to limit body fat may detrimentally delay menarche. In girls, 15 to 25% of final adult height will be gained during puberty, and linear growth spurts cease on average by age 16 years in most females. Some females will have small increases in height until about 19 years of age. Caloric restriction can slow or delay linear growth.(1,6)

 

The first signs of puberty in boys are enlargement of the testes and change in coloring of the scrotum. This occurs typically between the ages of 10.5 to 14.5 years (11.6 years of age is the average). Development of pubic hair is common during SMR stage 2. The average age of spermarche is about 14 years of age in males. Linear growth peaks in velocity in males during SMR stage 4, either coinciding with or following testicular development and the appearance of faint facial hair. On average, peak velocity of linear growth occurs at 14.4 years of age. Linear growth continues throughout adolescence and ceases at about age 21 years in males.(1,6)

 

Up to 50% of ideal adult body weight is gained during adolescence in both females and males. Body composition changes dramatically in females during puberty.  Lean body mass percent decreases, and body fat percent increases. During puberty females can experience a 120% increase in body fat.(7) In order for menarche to occur, 17% body fat is necessary, and then body fat must be at 25% for the development and maintenance of a regular ovulatory cycle.(8) While this gain in body fat in females is normal and required for normal physiologic function, it is often viewed as negative, leading to compromising health behaviors (excessive dieting, restriction, and exercise, and use of diet aids and laxatives for example) that can lead to serious disordered eating and eating disorders.(1)

 

Peak weight in males coincides with the timing of peak linear growth and peak muscle mass development. Adolescent males may gain an average of 20 lbs per year during peak weight gain.(1) Body fat decreases, and by the end of puberty, males on average have about 12% body fat.(1)

 

By age 18, more than 90% of adult skeletal mass has been formed.(1) Adequate nutrition during childhood and adolescence is therefore critical to support optimum bone growth and development, where a variety of dietary nutrients are necessary for building bone tissue.(1)

 

Eating patterns and behaviors of adolescents can be influenced by a variety of factors including peer influence, parental modeling, food preferences, availability, cost, convenience, personal and cultural beliefs, media and body image.(1,9,10,11)

 

During adolescence, there are dramatic biological changes related to puberty that occur.The development of body image and an increased awareness of sexuality become predominant themes. The dramatic changes that take place can lead to the development of poor body image and unfavorable health behaviors, factors that must be addressed by family members and health practitioners when identified.(1)

 

Peer influence is strong during adolescence. The need for adolescents to fit in can affect nutritional intake, either adversely or beneficially.(1,11) Males that are late bloomers may be more prone to use anabolic steroids and other supplements to fit in with their peers that have matured faster, and females that are early bloomers may resort to disordered eating and present with poor body image.(1) Female early bloomers also may be more likely to take part in adult-like behaviors, such as smoking, drinking alcohol, and engaging in sexual intercourse.(1)

 

Talking to your child about the variations in tempo and timing of growth and development, modeling healthful behaviors, and educating them about making healthy nutritional choices can help them navigate this tumultuous time, and develop healthy body image and health related behaviors to last their lifetime.(1)

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Need assistance or have questions? Contact me today!

 

References:

  1. Brown J. Nutrition through the Life cycle 4th ed. Belmont, CA: Wadsworth; 2011.

  2. Eating disorders in adolescents: Principles of diagnosis and treatment. Paediatrics & Child Health. 1998;3(3):189-192.

  3. Antiretroviral Therapy for HIV Infection in Infants and Children: Towards Universal Access: Recommendations for a Public Health Approach: 2010 Revision. Geneva: World Health Organization; 2010. ANNEX H, SEXUAL MATURITY RATING (TANNER STAGING) IN ADOLESCENTS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK138588/.

  4. Tanner, JM. Growth at adolescence 2nd Edition. Oxford, England: Blackwell Scientific Publications; 1962.

  5. Raj MA, Rogol AD. Female Athlete Triad. [Updated 2017 Feb 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2017 Jun-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430787/.

  6. National Research Council (US) and Institute of Medicine (US) Forum on Adolescence; Kipke MD, editor. Adolescent Development and the Biology of Puberty: Summary of a Workshop on New Research. Washington (DC): National Academies Press (US); 1999. Available from: https://www.ncbi.nlm.nih.gov/books/NBK224695/doi: 10.17226/9634

  7. Frisch R.E. Fatness, Puberty, and Fertility The Effects of Nutrition and Physical Training on Menarche and Ovulation. In: Brooks-Gunn J., Petersen A.C. (eds) Girls at Puberty. Springer, Boston, MA; 1983.

  8. Frisch RE, McArthur JW. Menstrual cycles: fatness as a determinant of minimum weight for height necessary for their maintenance or onset. Science. 1974;185(4155):949-51.

  9. Videon TM, Manning CK. Influences on adolescent eating patterns: the importance of family meals. Journal of Adolescent Health. 2003;32(5):365-373.

  10. Wade TD, Lowes J. Variables associated with disturbed eating habits and overvalued ideas about the personal implications of body shape and weight in a female adolescent population. Int. J. Eat. Disord., 2002;32:39–45. doi:10.1002/eat.10054.

  11. Story M, Neumark-Sztainer D, French S. Individual and Environmental Influences on Adolescent Eating Behaviors. Journal of the American Dietetic Association. 2002;102(3):S40-S51. doi.org/10.1016/S0002-8223(02)90421-9.

Child and Preadolescent Nutrition

Photo credit: Patricia Prudente

Photo credit: Patricia Prudente

The growth and developmental stage of children ages 5-10 years can be described as middle childhood, or school age. Preadolescence is the developmental and growth stage of children ages 9-11 for girls and ages 10-12 for boys.(1)

 

Nutrition plays an important role in helping to ensure children reach their full potential for growth, development and overall health.(1) Nutrition related problems that can occur during this stage include under-nutrition, and weight issues on both sides of the spectrum. The prevalence of childhood obesity is on the rise, and the beginnings of disordered eating can be present in children at this stage.(1,2,3) Adequate nutrition and establishing healthy eating behaviors are important factors for preventing immediate health problems, and for promoting a healthy lifestyle to avoid chronic disease in the future. Something as simple as eating breakfast daily has been linked to improved performance in school.(4)

 

During middle childhood, there is an increase in muscle strength, stamina, and motor coordination allowing children to participate in dance, sports, and other physical activities.(1)

 

Percent body fat reaches a minimum of 16% in females and 13% in males during this stage.(1) This percent will increase in preparation for the adolescent growth spurt, which typically occurs around age 6. This increase is known as BMI rebound.(5) The increase in body fat that occurs with puberty happens earlier in females than males. In females the increase in body fat is about 19%, and in males it is about 14%.(1) This increase may cause concern, especially in girls, that they are becoming overweight. Be aware that this increase is a normal part of growth and development.(1) It is important to reassure your child that these changes are normal. Take care not to reinforce a preoccupation with size and weight, which can lead to disordered eating behaviors and eating disorders.

 

Cognitively, children in this stage develop a sense of self, and self-efficacy, which is the knowledge of what to do and the ability to do it. They can focus on several parts of a situation at the same time, have cause and effect reasoning, and can classify, reclassify and generalize.(1,6) They also are able to see others’ points of view (they are no longer egocentric as they are during the toddler and preschooler years). Children become more independent and learn their roles within their families, at school, and in their communities. More time is spent with friends, at others’ homes, watching television, on the computer, and using other methods of technology. External influences from the environment begin to play increasingly important roles in all aspects of the child’s life.(1)

 

During childhood, the use of eating utensils is mastered. Involvement in simple food preparation and the assignment of chores related to mealtime (like setting the table) can be important for helping your child develop healthy behaviors around food and nutrition. Children of this age are strongly influenced by the eating behaviors of their parents and older siblings, who can help shape the child’s attitudes towards food and food choices, as well as their food likes and dislikes.(7) Parents are responsible for creating the food environment in the home, the availability of a variety of foods for the child to select from, determining when the child is served, and providing guidance so the child can make healthy food choices when away from home. The child is responsible for how much food she eats.(1,7)

 

Eating meals with the family together is encouraged, as is allowing time for pleasant conversation. Avoiding reprimanding and arguments during mealtime is recommended. There are associations between families eating dinner together and the overall quality of the child’s diet, where children that eat dinner with their families have better dietary intakes of fruit, vegetables, fiber, calcium, folate, iron, B vitamins, and vitamins C and E.(1) Family dinners together can become more challenging as the child gets older and has extracurricular activities to take part in.

 

Because children at this stage spend more time outside of the home, peer influence, and influence of teachers, coaches and others increases and extends to attitudes toward food and food choices.(8) The media also plays an increasingly larger role in shaping your child’s attitudes towards food and food choices.(9)

 

Snacking helps children meet their nutritional needs because they are not able to consume large amounts of food in one sitting at this stage.(1) Giving them access to a variety of foods, nutrition education for helping them make their own food choices, and knowledge of some basic food preparation techniques can allow them to begin to prepare their own breakfasts and snacks.(1)

 

Children have the innate ability to internally control their energy (calories from food) intake, and these internal cues can be altered by external influences, which increase during this stage of childhood development.(1,10) Children of parents who control their child’s eating have a lesser ability to innately respond to their own energy needs, meaning these children lose the ability to respond appropriately to their innate nutritional needs, and their internal controls of hunger and satiety.(1,10) 

 

Parents who experienced difficulty controlling their own intakes may impose more restrictions on their children, and this transfer of unhealthy eating behavior may influence children as early as preschool age.(1,10)  If mom is on a diet, her daughter is likely to follow suit. The preadolescent increase in body fat, especially in young girls, is often seen as the beginning of a weight problem, rather than normal growth and development.

 

Imposing controls and restrictions over dietary intake can actually promote increased intake of ‘forbidden’ or ‘restricted’ foods, and may be a risk factor for developing obesity in the future.(1,10)  Dieting, dietary restrictions and controlling child feedings ignore internal cues of hunger and satiety, and can contribute to the onset of obesity, and the beginning of eating disorders.(1,10 )

 

There is a slow and steady growth rate during this developmental stage, energy needs reflect this, and are based on the individual child’s activity level and body size.(1)

 

Predictors of childhood obesity include having parents that are obese (in particular the mother(11), lower socioeconomic status, early BMI rebound (the normal increase in BMI that happens after BMI decreases to its lowest point, around 6 years of age), and more than 2 hours of screen time (television, computers, etc.) per day.(1,12) With the increased prevalence of overweight and obesity in children comes an increased risk for cardiovascular disease, insulin resistance, metabolic syndrome and type 2 diabetes, chronic conditions that used to be associated only with adults.(1,13)

 

Regular physical activity is important.(13,14) Set a good example for your child by being physically active and joining her in physical play activities. Encourage your children to participate in physical activities at home, at school and with friends, and limit their screen time to less than 2 hours per day.(1) Generally girls are less active than boys, and physical activity decreases with age. Seasons, climates and weather affect a child’s outdoor activity levels, and physical education in schools has decreased.(1)

 

Children are children first. This means that even if your child has special health care needs that change their nutrition, medical and social needs, they can still be expected to become more independent in making food choices, assisting with meal preparation, and participating in mealtime with other family members. Modifications can be made to help your child be successful. Children do not benefit from being treated in a ‘special’ manner when it comes to mealtime, and providing consistency and structure to support a child’s development is important. This structure can include regular meal and snack times, and an increasing responsibility in assisting with food preparation in the home. Energy and nutrient requirements may be higher, lower, or the same for children with special health needs compared to those without such needs, depending on the child’s condition.(1)

  

Need assistance or have questions? Contact me today!

 

References:

  1. Brown J. Nutrition through the Life cycle 4th ed. Belmont, CA: Wadsworth; 2011.

  2. Centers for Disease Control and Prevention. Healthy Schools. Childhood Obesity Facts. Updated January 25, 2017. Available from: https://www.cdc.gov/healthyschools/obesity/facts.htm. Accessed January 4, 2018.

  3. National Eating Disorders Association. Parent Toolkit. Available from: https://www.nationaleatingdisorders.org/sites/default/files/Toolkits/ParentToolkit.pdf. Accessed January 4, 2018.

  4. Adolphus K, Lawton CL, Dye L. The effects of breakfast on behavior and academic performance in children and adolescents. Frontiers in Human Neuroscience. 2013;7:425. doi:10.3389/fnhum.2013.00425.

  5. Dietz WH. Critical periods in childhood for the development of obesity. Am J Clin Nutr. 1994;59(5):955-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/8172099.

  6. Cincinnati Children’s. Cognitive Development. Updated April 2017. Available from: https://www.cincinnatichildrens.org/health/c/cognitive. Accessed January 4, 2018.

  7. Birch L, Savage JS, Ventura A. Influences on the Development of Children’s Eating Behaviours: From Infancy to Adolescence. Canadian journal of dietetic practice and research : a publication of Dietitians of Canada = Revue canadienne de la pratique et de la recherche en dietetique : une publication des Dietetistes du Canada. 2007;68(1):s1-s56.

  8. Salvy SJ, Elmo A, Nitecki LA, Kluczynski MA, Roemmich JN. Influence of parents and friends on children’s and adolescents’ food intake and food selection. Am J Clin Nutr. 2011;93(1):87-92. Available from: http://ajcn.nutrition.org/content/93/1/87.full.

  9. Harris JL, Bargh JA. The Relationship between Television Viewing and Unhealthy Eating: Implications for Children and Media Interventions. Health communication. 2009;24(7):660-673. doi:10.1080/10410230903242267.

  10. Scaglioni S, Arriza C, Vecchi F, Tedeschi S. Determinants of children’s eating behavior. American Society for Nutrition. 2011;94(6):Suppl 2006S-2011S. doi: 10.3945/jcn.110.001685.

  11. Rooney BL, Mathiason MA, Schauberger CW. Predictors of obesity in childhood, adolescence, and adulthood in a birth cohort. Matern Child Health J. 2011;15(8):1166-75. doi: 10.1007/s10995-010-0689-1.

  12. Gable S,  Lutz S. Household, Parent, and Child Contributions to Childhood Obesity. Family Relations. 2000;49: 293–300. doi:10.1111/j.1741-3729.2000.00293.x.

  13. Hills, A.P., King, N.A. & Armstrong, T.P. The Contribution of Physical Activity and Sedentary Behaviours to the Growth and Development of Children and Adolescents. Sports Med. 2007;37:533. doi.org/10.2165/00007256-200737060-00006.

  14. Harsha DW. The benefits of physical activity in childhood. Am J Med Sci. 1995;310(Suppl 1):S109-13. Available from: https://www.ncbi.nlm.nih.gov/pubmed/7503112.

Preschooler Nutrition

Photo credit: Kazuend

Photo credit: Kazuend

Preschool aged children are between 3-5 years old and during this developmental stage there is increased autonomy, broader engagement in social circumstances (attending preschool, playing with friends, and staying with friends or relatives), increased language skills, and a better ability to control behavior.(1)

 

For preschoolers to reach their full growth and developmental potential, adequate intake of energy (calories from food) and nutrients is important. Nutritional deficiency, or under-nutrition, during this time can hinder cognitive development. Providing adequate nutrition in a supportive environment can prevent long-term effects of under-nutrition, like failure to thrive and cognitive impairment.(1)

 

Children of this age continue to refine their gross and fine motor skills. A sense of egocentrism begins where the child may not be able to accept the views of others. They begin to learn to limit behaviors internally rather than relying on demands of parents and caregivers to do so. Control becomes a central theme. Preschool aged children will test their parents’ limits, and may resort to temper tantrums to get their way. Tantrums tend to peak around age 2-4 years. The child wants to become independent, and parents must balance this desire by setting appropriate limits while also letting go (a parallel to adolescence).(1)

 

At this age, children can use a cup, fork and spoon. Using a knife to cut foods may need refinement. Children should be seated at the table for all meals and snacks. Eating may not be as messy as it was during the toddler years, however spills are normal and will occur. Choking may still be a risk, so cutting grapes and meat into smaller bites for example is advised. Adult supervision at mealtime is also important.(1)

 

The child’s rate of growth at this stage remains slow as it is during toddler years, therefore appetite may be small. Growth occurs in spurts and there will be an increase in appetite and food intake before a growth spurt, causing children to gain weight that will be used for the soon to occur growth in height. Thus, the appetite of children at this age can be variable.(1)

 

This is a good age to involve children in food selection and preparation, in that they want to be helpful and please their parents. Taking them to the supermarket, and better yet a farmer’s market, to have them ‘help’ with food selection can provide an opportunity to introduce your child to a variety of fruits and vegetables. Children also can help prepare foods for meals. For example tearing lettuce, rinsing fruit and vegetables, squeezing citrus fruits, stirring batter, peeling eggs, bananas and oranges, or even measuring liquids as they are able are ways they can become involved in meal preparation.(1)

 

A very important cornerstone of nutrition is that young children have the ability to self-regulate food intake. If they are allowed to decide when to eat and when to stop eating without external interference, they will eat as much as they need. Children also have an innate ability to adjust their caloric intake to meet their energy needs.(2) Intake may fluctuate day to day, however it will remain relatively stable over the course of a week. Interfering with a child’s self-regulation of eating by asking them to clean their plate or by using food as a reward is asking the child to over or under eat. While they can self regulate caloric intake, they do need to be guided to select and eat foods that are part of a well balanced diet. This is a time when their food habits and preferences are established. Modeling healthy eating behaviors, and providing your child with healthy foods to select from is important for helping her learn to enjoy a variety of foods that are rich in nutrients to promote overall health and development. Keep in mind that children and their eating behaviors can be influenced by other children and adults, siblings and family members, and by the media.(1,3)

 

Preschool aged children may be described as picky eaters.(4) This can be because eating familiar foods is comforting, or your child may be trying to exert control over this part of her life.  To avoid having the dinning table become a battleground, serve child sized portions in an attractive way. Young children may not like their foods to touch on the plate, or to be mixed together like in salads or casseroles, and they may not enjoy strong tastes (sour or bitter) or spicy foods. It is important not to allow snacking or grazing indiscriminately between meals because this can blunt appetite at mealtime. Children should not be forced to stay at the table until they have eaten a certain amount of food determined by the parent.(1)

 

Children naturally prefer sweet and slightly salty tastes.(1,5)  Children eat foods familiar to them, and this emphasizes the importance of environment in their food choices. Familiarize them with healthy and varied food choices and they will learn to gravitate towards them. With repeated exposure, children will learn to like new foods that are unfamiliar to them. It can take 10-20 or more tries of a new food before a child will take to it. Be patient and persistent, and remember that modeling the behavior you want your child to learn plays an important role in the process. If you eat a variety of foods, you child is more likely to do so as well.(1)

 

Children tend to prefer foods that are energy dense and therefore those higher in sugar and fat.(3) This may be because they have pleasant feelings from eating these foods, such as satiety, or because these foods are associated with special occasions like birthday parties. Keep in mind that foods served on a limited basis or used as rewards become more desirable.  Restricting access to certain foods may increase the desire for them and lead to disordered eating behaviors, and obesity later in life. Remember that children can innately regulate their food and caloric intake, and studies have shown that allowing children this flexibility results in healthier eating behaviors long-term.(1,2)

PRACTICAL APPLICATIONS OF CHILD FEEDING RESEARCH FOR TODDLERS AND PRESCHOOLERS(1)

 

  • Respond appropriately to the child’s hunger and satiety cues

  • Focus on long-term goals of developing healthy self-controls of eating

  • Look beyond concerns regarding the composition and quantity of foods consumed or fears that your child may eat too much and become overweight

  • Trying to control food intake by attaching punishment or reward to eating is not recommended

  • Severely restrict treats is not recommended because this may make such foods even more desirable

  • Model positive eating behaviors, like eating a variety of fruits and vegetables, and help your child develop preferences for a wide variety of foods consistent with a healthy diet and lifestyle

  • It may take repeated exposure to a new food before your child takes to it, this is normal, be patient and persistent

  • Serving appropriate portion sizes is important, and it’s better to keep them smaller and have your child ask for more if she wants it

  • Mealtimes should take place in a positive, secure and happy environment with the family, and with adult supervision

  • Children should not be forced to eat

  • If your child has low interest in eating, long mealtimes (more than 30 minutes), prefers liquids over solids, refuses foods, or needs to be offered foods as if she is younger than her chronological age, feeding problems may be indicated and further evaluation can be helpful

 

Need assistance or have questions? Contact me today!

 

References:

  1. Brown J. Nutrition through the Life cycle 4th ed. Belmont, CA: Wadsworth; 2011.

  2. Fox MK, Devaney B, Reidy K, Razafindrakoto C, Ziegler P. Relationship between portion size and energy intake among infants and toddlers: evidence of self-regulation. J Am Diet Assoc. 2006;106(1 Suppl 1):S77-83. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16376632.

  3. McNally J, Hugh‐Jones S, Caton S, Vereijken C, Weenen H, Hetherington M. Communicating hunger and satiation in the first 2 years of life: a systematic review. Maternal & Child Nutrition. 2016;12(2):205-228. doi:10.1111/mcn.12230.

  4. van der Horst K, Reidy K. Picky eating: Associations with child eating characteristics and food intake. Appetite. 2016;103(1):286-293. doi.org/10.1016/j.appet.2016.04.027.

  5. Mennella JA, Bobowski NK, Reed DR. The Development of Sweet Taste: From Biology to Hedonics. Reviews in endocrine & metabolic disorders. 2016;17(2):171-178. doi:10.1007/s11154-016-9360-5.


Toddler Nutrition

Photo credit: Jelleke Vanooteghem

Photo credit: Jelleke Vanooteghem

Children between the ages of 1-3 years are considered toddlers. During this stage of development there is a quick increase in gross and fine motor skills, along with an increased desire for independence, exploration of the environment, and development of language skills.(1)

 

For toddlers to reach their full growth and developmental potential, adequate intake of energy (calories from food) and nutrients is important. Nutritional deficiency, or under-nutrition, during this time can hinder cognitive development. Providing adequate nutrition in a supportive environment can prevent long-term effects of under-nutrition, like failure to thrive and cognitive impairment.(1,2)

 

Toddlers have an increased need to express their own will and this expression may come in the form of negativism and temper tantrums.(1,3) This is where the term “terrible twos” comes from. With increased motor development and an increased desire for independence, toddlers may try to do more than they are able, and this can lead to frustration for them, therefore some of the ‘difficult’ behaviors parents identify at this age.(1,3)

 

Weaning from breast or bottle-feedings typically occurs around 9-10 months of age, and the intake of solid foods increases. Drinking from a cup also tends to begin at this time. It is important for parents to pay attention to cues of readiness for weaning. For example, there may be a lack of interest in breast or bottle feedings. Weaning is a sign that the toddler is becoming more independent and is typically complete by age 12-14 months. Depending on the toddler this age can vary.(1)

 

Toddlers are able to chew different textured foods, and to feed themselves. By 12-18 months of age, they gain more tongue mobility and therefore can eat a wider variety of chopped or soft table foods. By 12 months of age they can pick up small objects and put them in their mouths, like cooked peas and carrots. They may also begin using a spoon. Between 18-24 months they should be able to handle meats, raw fruit and vegetables, and foods of a variety of textures.(1)

 

Due to the strong need for independence with self feeding, toddlers may start to use the phrases like “I do it!” and “no!”. This type of response is normal as they reduce their dependency on parents and caretakers.(3) Self-feeding can be messy as fine motor skills continue to develop. Parents should let children practice self-feeding, while minimizing environmental distractions during mealtime, like television. Adult supervision is important because there is a high risk for choking on foods. The toddler should eat seated with the family, and not be allowed to eat on the run, as we tend to do as busy adults.(1)

 

Toddlers have a need for rituals, and they may develop food jags (strong food preferences and dislikes).(4)  They may go through periods of refusing foods they previously liked. To mitigate this, serve new foods along with familiar ones. New foods are better accepted if they are introduced when the child is hungry and if she sees other family members eating the same foods. Toddlers are curious and they are great imitators, including imitating eating behaviors of others.(1)

 

Mealtime is not the time for battling over food and forced feedings. This is a time for toddlers to practice language and social skills and to develop a positive self-image. Eating breakfast is an important habit to establish for your toddler, and is a healthy eating behavior to continue throughout life. Also, mealtime with the family is important for modeling healthy eating behaviors for children.(1)

 

Toddlers naturally have a decreased interest in food because there is a slowed rate of growth at this age, along with which comes a decreased appetite. With their newfound gross and fine motor skills, they have interests in their environments beyond food and eating, and this is normal.(1)


Portion size for toddlers follows the rule of thumb. One rule of thumb for serving size is 1 tablespoon of food per year of age. That means that a serving for a 2 year old would be about 2 tablespoons. It is preferred to give toddlers smaller portions and have them ask for more rather than to serve larger portions. Overestimating and over serving children can lead to the child being labeled as a picky eater because toddlers can’t eat large amounts of food at one time.(3) Snacks therefore are important, however allowing your child to graze on unhealthy snacks like chips, cookies and sweetened beverages should be avoided because they can blunt the toddler’s appetite for healthy foods at mealtime. Toddlers can control the amount of food they eat by hunger, so allow your child to ‘voice’ their hunger and satiety cues without pressuring them to eat more, otherwise over or underfeeding can occur.(1,5)

PRACTICAL APPLICATIONS OF CHILD FEEDING RESEARCH FOR TODDLERS AND PRESCHOOLERS(1)

 

  • Respond appropriately to the child’s hunger and satiety cues

  • Focus on long-term goals of developing healthy self-controls of eating

  • Look beyond concerns regarding the composition and quantity of foods consumed or fears that your child may eat too much and become overweight

  • Trying to control food intake by attaching punishment or reward to eating is not recommended

  • Severely restrict treats is not recommended because this may make such foods even more desirable

  • Model positive eating behaviors, like eating a variety of fruits and vegetables, and help your child develop preferences for a wide variety of foods consistent with a healthy diet and lifestyle

  • It may take repeated exposure to a new food before your child takes to it, this is normal, be patient and persistent

  • Serving appropriate portion sizes is important, and it’s better to keep them smaller and have your child ask for more if she wants it

  • Mealtimes should take place in a positive, secure and happy environment with the family, and with adult supervision

  • Children should not be forced to eat

  • If your child has low interest in eating, long mealtimes (more than 30 minutes), prefers liquids over solids, refuses foods, or needs to be offered foods as if she is younger than her chronological age, feeding problems may be indicated and further evaluation can be helpful

 

Need assistance or have questions? Contact me today!

 

References:

  1. Brown J. Nutrition through the Life cycle 4th ed. Belmont, CA: Wadsworth; 2011.

  2. Goh LH, How CH, Ng KH. Failure to thrive in babies and toddlers. Singapore Medical Journal. 2016;57(6):287-291. doi:10.11622/smedj.2016102.

  3. Hoecker JL. Mayo Clinic. Infant and toddler health. April 21, 2016. Available from: https://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/expert-answers/terrible-twos/faq-20058314. Accessed January 2, 2018.

  4. Pitman T. What to do when your picky eater goes on a food jag. Today’s Parent. September 29, 2015. Available from: https://www.todaysparent.com/toddler/what-to-do-when-your-picky-eater-goes-on-a-food-jag/. Accessed January 2, 2018.

  5. Fox MK, Devaney B, Reidy K, Razafindrakoto C, Ziegler P. Relationship between portion size and energy intake among infants and toddlers: evidence of self-regulation. J Am Diet Assoc. 2006;106(1 Suppl 1):S77-83. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16376632.

Infant Nutrition

Photo credit: Sadık Kuzu

Photo credit: Sadık Kuzu

Full-term infants (39 to 40 weeks gestation1) can do a lot! They can hear, and move in response to familiar sounds like their mother’s voice. They have four states of arousal ranging from sleep to fully alert. Recognizing your infant’s state of arousal is important for being able to nurse successfully. Within hours after birth, newborns have reflexes allowing them to root, suckle and coordinate swallowing and breathing.(2)

 

The mouth of a healthy newborn provides a source of pleasure and exploring, and represents a form of early learning. Anything that interferes with the mouth at this stage, such as an extended period of respiratory support, may lead to your infant associating her mouth with discomfort and this may lead to feeding problems. From a sensorimotor perspective, the stage when infants are sensitive to food textures is also when they begin showing their speech skills.(2)

 

The development of the digestive system in infants can be confusing. An infant with soft, loose stools for example may be thought to have diarrhea. This however is typical for breastfed infants. Another source of confusion is that stomach discomfort may interfere with weight gain. It can take 6 months for the gastrointestinal tract of an infant to mature, and this time can vary depending on the infant.(2,3)

 

During the third trimester of pregnancy, the fetus swallows amniotic fluid. This stimulates the lining of the intestines to grow and mature. At birth, the digestive system of an infant is mature enough to digest fats, protein, and simple sugars. It can also absorb fats and amino acids.(2,3) Infants often have conditions that reflect how immature the gut is. These conditions may include colic, GERD (reflux), unexplained diarrhea, and constipation. Generally, these conditions do not interfere with the absorption of nutrients, and they do not interfere with your infant’s growth.(2,4)

 

Colic should be addressed by rocking, swaddling, or bathing your infant, or by other ways of calming her, by positioning the baby well for eating, or burping her to relieve gas. Colic may be caused by the mother’s diet while breastfeeding and foods that commonly cause this problem include milk, and onions, so changes in the maternal diet can be helpful. Probiotics may be helpful.(2,4,5,6)

 

Using acid blocking medications to manage digestive symptoms such as colic or reflux can lead to problems with the digestion and absorption of nutrients, an increased risk for pneumonia, infections of the gastrointestinal tract, and over time can adversely affect your infant’s growth and development, as well as her overall health and wellbeing.(2,7)

 

Diarrhea can be caused by viral and bacterial infections, food intolerances, or changes in fluid intake. Young infants have more stools each day than older infants, and have them soon after feeding. Breastfed infants tend to have soft stools, and infants fed soy formula experience more constipationTo avoid constipation ensure adequate fluid intake, and avoid medications unless they are prescribed. Using prune or other juices for their laxative effects may result in fluid imbalance and diarrhea. High fiber foods present a choking risk, so they are not recommended for constipated infants.(2) When an infant presents with diarrhea, it is recommended to feed as usual during the bout. Breast milk does not cause diarrhea (it may help prevent it), and during a bout, continuing adequate intake of breast milk or infant formula is usually sufficient for preventing dehydration.(2,8)

 

Temperament refers to your infant’s emotional reactions to new situations, activity level, and sociability. Learning your infant’s temperament may take some time, and understanding it is important for you to appropriately respond to her cues of hunger and fullness. For example, she may feed better when there is not a lot of loud noise, or when you are feeling calm as opposed to being under stress.(2)

 

Most breastfed infants, or those who get the recommended amounts of formula, meet protein requirements without the need to add foods to the diet. There are no recommendations for fat intake, however restricting dietary fat is not recommendedCholesterol intake also should not be limited in infants because it is important for testes, ovary, and brain development. Fat is also needed to provide energy to the liver, brain, and muscles, including the heart. Full-term breastfed babies do not need to supplement fat or essential fatty acids (DHA and EPA). Essential fatty acids are required to make hormones, and for normal growth and development. Carbohydrates are also important because without enough of them, your infant’s body will use protein for energy by pulling it from her muscles, and this can interfere with proper growth and development.(2,9)

 

Infants ideally should be breastfed exclusively during the first 6 months of life, and then for an additional 6 months. For infants less than 6 months of age, no other liquids or foods are recommended in addition to breast milk (or formula). The volume taken in is not the best indicator of nutritional adequacy. Rather, focus on the growth rate and health of your infant.(2)

 

Using cow’s milk (whole, skim, reduced fat, etc.) is not recommended during infancy.(2,9) Iron deficiency anemia can be linked to early introduction of cow’s milk in infants, where calcium interferes with iron absorption in the body.(2,10)

 

Soy based formulas are not recommended because they contain hormone like substances that may adversely impact development, and have long-term reproductive risks.(2,11)Lactose-free and hydrolyzed formulas may be alternatives to soy for infants that are not breastfed and cannot be fed cow’s milk.(2,9)

 

Infants are born with the innate ability to regulate their energy (food) intake.(2) Learning their hunger and fullness cues can prevent under and overfeeding.(2)

 

By age 6 months, infants may be ready to eat from a spoon. If your infant is able to move her tongue from side to side without moving her head, and she can keep her head upright and sit with little support, it is time to try spoon-feeding. Other cues she may give when it comes to feeding, hunger and fullness include:(2)

 

  1. Excitedly watching the food being opened in anticipation of eating it

  2. Tight fists or reaching for the spoon to demonstrate hunger

  3. Showing agitation if the pace of feeding is too slow or if the person feeding her stops

  4. Playing with her food or spoon as she starts to get full

  5. Slowing the pace of eating or turning away from food when she is feeling full

  6. Stopping eating or spitting out food when she has had enough to eat

 

The introduction of solid food can be a challenging time for your infant, and for you. Begin offering food on a spoon in small quantities the size of 1-2 tablespoons for a meal, with one or two meals each day. The goal of offering food on a spoon to infants at 6 months of age is to help stimulate the development of mouth muscles, rather than to provide nutrition, which ideally is being done via breastfeeding.  Spoon feeding involves two new experiences for your infant in that a spoon has a different mouth feel than a breast, and the food does not feel the same as breast milk does on the tongue.(2) For tips on introducing solid foods, see “Getting Toddlers to Eat Solids and Ideas for Picky Eaters”.

 

The position of your infant during feeding is important to avoid choking, discomfort while eating, and ear infections. For the first few months, semi-upright, as your infant would be seated in a car seat or infant carrier, is recommended. Propping a bottle or placing your infant on a pillow can increase the risk for choking, and result in overfeeding. For spoon-feeding, your infant can have better control of her mouth and head if seated with good back and foot support. Sit directly in front of her when offering the spoon, and make eye contact without making her have to turn her head. Using a high chair is appropriate when your infant can sit on her own without assistance. Her hips and legs should be at about 90 degrees, and this position is important for digestion. More spitting up is likely if she is sliding down and out from under the tray of her high chair.(2)

 

Some infants may be resistant to learning new feeding skills or react to food introductions unusually. Problems like this may indicate general health or developmental difficulties. They may also indicate your child is a picky eater. For tips on navigating picky eaters, see “Getting Toddlers to Eat Solids and Ideas for Picky Eaters”, and talk to a qualified health care provider if you are concerned there are deeper issues at play.(2)

 

Weaning from your breast is recommended when your infant is 12 to 24 months of age.(2,12)If your infant is breastfed for the first year of life (as is recommended), introducing a cup for water and other fluids after 6 months of age is recommended. This is around the same time it is recommended to begin attempting spoon-feeding. Developmental readiness for a cup begins around 6 to 8 months of age. The typical portion size of fluid from a cup is about 1 to 2 ounces. Moving from a bottle to a sippy cup developmentally is not the same as moving to a regular cup. Keep in mind the same mouth skills that help your infant control liquids help encourage speech development. We want to foster this development by introducing a cup. Weaning from the breast or bottle too soon may result in a plateau in weight if your infant is not taking in enough energy (calories), and may cause constipation if she is not receiving enough fluids.(2)

 

At 6 months of age, infants go from swallowing only fluids to being able to handle pureed and soupy foods. An infant’s mouth is extremely sensitive to texture and if food with soft lumps is presented too soon, she may choke. Offering lumpy yet soft foods around 6 to 8 months of age helps to stimulate jaw movements that simulate chewing. At 8 to 10 months of age infants can chew and swallow soft, mashed foods. Mature chewing skills are not mastered until toddler age, so offering foods that require little chewing is important.(2)

 

Baby cereal is generally the first food recommended for infants at 6 months of age. Rice cereal is commonly recommended because it is easy to digest and hypoallergenic.(2,12) Note that adding baby food is not recommended to help improve your infant’s sleep as is commonly believed.(2)

 

Fruits and vegetables are also first foods for infants. It is recommended for 6 month olds, that parents introduce only one new food at a time, and to offer it over 2 to 3 days, and the purpose of this is to identify any possible negative reactions to new foods. This timing and spacing of food introductions is important, especially in families with histories of food allergies and intolerances.(2)

 

Commercial baby foods are not necessary for infants.(2) As a parent, you can prepare baby foods at home in your blender or food processor, or by mashing it with a fork. Adding salt and sugar to baby foods prepared at home decreases their nutritional quality. Preparing baby foods at home can save money, provide a wider range of foods for your infant to try, and can be more nutritious (if you do not add salt and sugar to the foods for example). Commercial baby food on the other hand is convenient.(2)

 

Portion sizes for infants should be based on their appetite, keeping in mind their innate ability to control how much food they eat based on their cues of hunger and fullness.(2) Also keep in mind that commercially prepared products such as fruits with added tapioca or baby food desserts and snack foods are not recommended for most infants. Many new parents inadvertently select foods such as these for their infants based on their own likes and dislikes, rather than on the needs of the infant. Regular applesauce, yogurt, soft cooked green beans and mashed potatoes, are examples of foods that can be eaten by infants, as well as other family members once the infant reaches 9 to 12 months of age, making food preparation for your family easier and more streamlined.(2)

 

Examples of foods that present a choking risk include hot dog pieces, hard candy, jelly beans, peanuts and other nuts, chunks of nut butters, whole grapes, uncut stringy meat, sausage, sticky foods (marshmallows, gum, gummy candies), hard fruits or vegetables like raw apples and raw green beans.(2)

 

For the first 6 months, breast milk or formula provides enough water for your infant. All forms of fluid contribute to meeting the water needs of your infant. Replacing infant formula or breast milk with juice, sports drinks, soda or tea contributes to lower quality dietary intake and is not recommended.(2,12)

 

Infants have a limited ability to signal thirst, especially when they are sick. Vomiting and diarrhea can lead to dehydration quickly. Over the counter remedies (like Pedialyte and Gatorade) can easily become overused. Juices are not needed to meet fluid needs. Juice and other sugar containing beverages are not recommended for use before 6 months of age. They increase the risk for overweight and obesity later in life, and they should never be used at bedtime in a bottle because sugar in the mouth can easily lead to the formation of cavities.(2,13,14) Juices can be used after one year of age, and are not recommended for use prior to this time. Juice should be offered in a cup (if it is offered) and never in a bottle. Limiting juice at this stage is important so that it does not become a habit later in life. It is an unnecessary source of added dietary sugar. Excessive use of a baby bottle at bedtime can lead to cavities and ear infections so limit use of bottles as part of your bedtime routine.(2,14,15)Again, offer juice in a cup and not in a bottle, and if offering a bottle for sleep, only fill it with water. Make sure to clean baby teeth to prevent the formation of cavities.(2)

 

During your infant’s first few months of life, the oral need to suck can be easily confused with hunger. Also, not all signs of infant discomfort are related to hunger. A crying baby does not always want or need food. Infants may want to be held, changed, or calmed by movement or touch. Overfeeding is often the result as parents try to comfort their infant, and overfeeding is less likely to occur with breastfeeding compared to formula feeding.(2)

 

Infants typically move their tongue forward and backward. During their first attempts at spoon-feeding this may appear as if your infant is rejecting the food. It may look like your infant is spitting out her food but rather she is learning to swallow. If choking occurs, it may be due to the position of the spoon on the tongue, and not due to dislike of the food being offered. The mouth is very sensitive, particularly toward the back, and if the spoon is placed there, it can cause a gagging reaction, which has nothing to do with the taste of the food.(2)

 

Infants learn food preferences based on their food experiences.(2,16) Breastfed infants can be exposed to a wider variety of tastes within breast milk compared to infants who are formula fed. What the mother eats flavors her breast milk. Breastfed babies may have a quicker acceptance of new foods after the first year of life because of this. There is a genetic predisposition toward sweet tastes(17) and against bitter foods, which can affect food preferences. Lifelong habits are born out of food preferences developed in infancy, so it is important to incorporate a variety of flavors into your infant’s nutritional regimen.(2)

 

The immune system of infants develops over the first few years of life.(18) While breastfeeding, the mother’s immune system may pass some immunity to the infant.(19) Adverse reactions to foods are more common in infants than in children. The most common allergic reactions are respiratory and skin problems (wheezing and skin rashes).(2) You can lower your infant’s risk for food allergy or intolerance by breastfeeding. In families with known food allergies and intolerances, you can lower your infant’s risk by postponing the introduction of foods that are commonly known as allergens, such as peanuts, wheat, eggs, milk, nuts, sesame, fish, and various fruits and vegetables.(2,20) Otherwise, restriction of foods is not recommended because doing so can increase the risk for nutritional inadequacy and reinforce behaviors like rejection of foods, and limiting variety. Breast milk is recommended for infants that are at risk for allergies, soy is not recommended. Also consider the role of environmental allergens in your infant’s symptoms. Often dust and grasses are to blame rather than foods.(2)

 

Recognizing an infant’s needs and responding to them appropriately is important. Infants that are offered only a limited variety of foods without much interaction during mealtime may refuse to eat as a way to get attention, and infants who learn to manipulate the behavior of adults will become even more successful at this when they become toddlers.(2)

 

Need assistance or have questions? Contact me today!

 

References:

  1. The American College of Obstetricians and Gynecologists. ACOG. OB-Gyns Redefine Meaning of “Term Pregnancy.” Published October 22, 2013. Available from: https://www.acog.org/About-ACOG/News-Room/News-Releases/2013/Ob-Gyns-Redefine-Meaning-of-Term-Pregnancy. Accessed January 2, 2018.

  2. Brown J. Nutrition through the Life cycle 4th ed. Belmont, CA: Wadsworth; 2011.

  3. Abrahamse E, Minekus M, van Aken GA, et al. Development of the Digestive System—Experimental Challenges and Approaches of Infant Lipid Digestion. Food Digestion. 2012;3(1-3):63-77. doi:10.1007/s13228-012-0025-x.

  4. Gelfand AA. Infant Colic. Seminars in pediatric neurology. 2016;23(1):79-82. doi:10.1016/j.spen.2015.08.003.

  5. Anabrees J, Indrio F, Paes B, AlFaleh K. Probiotics for infantile colic: a systematic review. BMC Pediatrics. 2013;13:186. doi:10.1186/1471-2431-13-186.

  6. De Weerth C, Fuentes S, de Vos WM. Crying in infants: On the possible role of intestinal microbiota in the development of colic. Gut Microbes. 2013;4(5):416-421. doi:10.4161/gmic.26041.

  7. Slaughter JL, Stenger MR, Reagan PB, Jadcherla SR. Neonatal H2-Receptor Antagonist and Proton Pump Inhibitor Treatment at US Children’s Hospitals. The Journal of pediatrics. 2016;174:63-70.e3. doi:10.1016/j.jpeds.2016.03.059.

  8. Turin CG, Ochoa TJ. The Role of Maternal Breast Milk in Preventing Infantile Diarrhea in the Developing World. Current tropical medicine reports. 2014;1(2):97-105. doi:10.1007/s40475-014-0015-x.

  9. Raiten DJ, Raghavan R, Porter A, Obbagy JE, Spahn JM. Executive summary: evaluating the evidence base to support the inclusion of infants and children from birth to 24 mo of age in the Dietary Guidelines for Americans—“the B-24 Project.” The American Journal of Clinical Nutrition. 2014;99(3):663S-691S. doi:10.3945/ajcn.113.072140.

  10. Burke RM, Leon JS, Suchdev PS. Identification, Prevention and Treatment of Iron Deficiency during the First 1000 Days. Nutrients. 2014;6(10):4093-4114. doi:10.3390/nu6104093.

  11. Westmark CJ. Soy-Based Therapeutic Baby Formulas: Testable Hypotheses Regarding the Pros and Cons. Frontiers in Nutrition. 2016;3:59. doi:10.3389/fnut.2016.00059.

  12. Centers for Disease Control and Prevention. Breastfeeding. Last updated June 16, 2015. Available from: https://www.cdc.gov/breastfeeding/faq/. Accessed January 2, 2018.

  13. Sonneville KR, Long MW, Rifas-Shiman SL, Kleinman K, Gillman MW, Taveras EM. Juice and water intake in infancy and later beverage intake and adiposity: Could juice be a gateway drink? Obesity (Silver Spring, Md). 2015;23(1):170-176. doi:10.1002/oby.20927.

  14. Avila WM, Pordeus IA, Paiva SM, Martins CC. Breast and Bottle Feeding as Risk Factors for Dental Caries: A Systematic Review and Meta-Analysis. Clifford T, ed. PLoS ONE. 2015;10(11):e0142922. doi:10.1371/journal.pone.0142922.

  15. Ear infections. Paediatrics & Child Health. 2009;14(7):465-466.

  16. Moding KJ, Birch LL, Stifter CA. Infant temperament and feeding history predict infants’ responses to novel foods. Appetite. 2014;83:218-225. doi:10.1016/j.appet.2014.08.030.

  17. Mennella JA, Bobowski NK, Reed DR. The Development of Sweet Taste: From Biology to Hedonics. Reviews in endocrine & metabolic disorders. 2016;17(2):171-178. doi:10.1007/s11154-016-9360-5.

  18. Simon AK, Hollander GA, McMichael A. Evolution of the immune system in humans from infancy to old age. Proceedings of the Royal Society B: Biological Sciences. 2015;282(1821):20143085. doi:10.1098/rspb.2014.3085.

  19. Hanson LA. Breastfeeding Provides Passive and Likely Long-Lasting Active Immunity. Annals of Allergy, Asthma & Immunology. 1998;81(6):523-534. doi.org/10.1016/S1081-1206(10)62704-4.

  20. Valenta R, Hochwallner H, Linhart B, Pahr S. Food Allergies: The Basics. Gastroenterology. 2015;148(6):1120-1131.e4. doi:10.1053/j.gastro.2015.02.006.

Tips for Picky Eaters

Photo credit: Jennifer Brand

Photo credit: Jennifer Brand

Is your child a picky eater?

Did you know it can take multiple introductions of a single food before a taste is developed for it?

It can take 10, 20, 100, or even more tries of a food before it’s accepted. Don’t give up on adding healthy foods just because it didn’t work the first, second, or tenth time.

Baby develops his taste patterns by 9 months old, so you’ve only got a few month to prevent picky eating habits! First solid food introductions (around 6 months old) don’t need to be baby cereals. Think puréed vegetables, fruit and finely chopped meats for protein (well-cooked too, to avoid a choking hazard). Mashed ripe banana, avocado and sweet potato are all nutritious options.

Now I’ll explain this picture. This is my dad. He’s a picky eater. He always has been. When he was a child, if he didn’t like something, my grandma never had him try it again.

I think I finally rubbed off on him. He’s recently eaten kale chips, and Brussels sprouts, and admitted they weren’t horrible!

We went out to dinner, and guess what?! Here’s dad, eating a BBQ chicken sandwich! If you know my dad, you know this is huge (he once told me ketchup is spicy)! He really enjoyed the sandwich. If I can get my dad to eat new foods, I know you can get your child to!

Why is overcoming picky eating important?

Your body runs off of nutrients from foods you eat, when nutrients are missing imbalances develop and symptoms and health problems follow.

Healthy skin for example requires a wide range of nutrients from all food groups and categories of foods. One of the first things I explore with children who have eczema is making sure their diet is rich in these nutrients. We often have to dig deeper to find the root cause, but we always look at nutrition first and this may surprise you, but it’s not about taking more foods out. In fact adding foods back in can help significantly.

Tips for Picky Eaters

 

  1. Remember you are in charge! YOU decide what your little one needs to eat. It’s up to you to make sure his diet contains all the nutrients he needs to grow, develop, repair, function and thrive.

  2. Keep offering the food to your picky eater. He doesn’t have to eat it. Simply exposing your him to it is an important part of the process. It is ok for him to pick up the food, play with it and feel it. This helps him get used to it.

  3. Offer soft foods cut up in small pieces, and cut them smaller than you think may be necessary, avoiding anything that might be a choking hazard.

  4. Give your child a spoon and let him feed himself. Giving him control of the situation may encourage him to eat a few bites.

  5. Wait to offer a new food until your picky eater is truly hungry. If he’s just eaten or snacked, there won’t be much motivation to try something new.

  6. Prepare meals with your picky eater as your co-chef! Give him a few bites of a new food while you are preparing it so he can get familiar with it.

  7. Take your picky eater to a store that gives out samples like Whole Foods or Costco, and you might be surprised at what he’ll try!

  8. Children are very impressionable and are great imitators. They will be more likely to want what you are eating, and to avoid foods you show disgust or lack of interest in when trying.

  9. If you give them healthy foods, they will eat, and learn to enjoy them.

  10. Having separate menus for different family members encourages habits we don’t want, and it’s too much unnecessary work! If your child has celiac disease and can’t eat gluten, to support him the whole family also should follow the same plan (there are lots of naturally gluten free grain options to choose from that aren’t processed gluten free products).

  11. Some children are sensitive to the taste, smell, or texture of different foods. Experiment with different tastes, smells, and textures and if you think your picky eater may have a sensitivity, talking to a professional can help to rule out medical issues that make it hard to swallow or digest certain foods.

What to avoid

  1. Forcing your picky eater to eat, this may make the behavior worse, and leads to an unhealthy relationship with food.

  2. Nagging your picky eater, trying to make a deal with him to have just a bite or two, or that he can have dessert if he eats his vegetables teaches him that there is a reward attached to everything (and this certainly isn’t the case in life). 

Be patient, be persistent, take small steps in the right direction, and you can get your picky eater to come around.

 References

https://parenting.stackexchange.com/questions/7235/how-to-get-a-toddler-to-start-chewing-and-eating-solids

Brown J. Nutrition through the Life cycle 4th ed. Belmont, CA: Wadsworth; 2011.

https://academic.oup.com/ajcn/article/94/suppl_6/2006S/4598037

https://www.sciencedirect.com/science/article/pii/S0195666314001573

https://onlinelibrary.wiley.com/doi/abs/10.1111/apa.12078

Introducing Solid Foods

Photo credit: life is fantastic

Photo credit: life is fantastic

Introduction of solid food begins with offering food on a spoon in small quantities the size of 1-2 tablespoons for a meal, with one or two meals each day. The goal of offering food on a spoon to infants at 6 months of age is to help stimulate the development of mouth muscles, rather than to provide nutrition, which ideally is being done via breastfeeding.  Spoon feeding involves two new experiences for infants in that a spoon has a different mouth feel than a breast, and the food does not feel the same as breast milk does on the tongue. Babies respond strongly new to new tastes or smells.

 

Tips for introducing solid foods include:

 

  1. Spoon-feeding experiences should occur when your baby is not too tired or too hungry, rather she should be active and playful.

  2. Use a small, shallow spoon, and consider the temperature of the spoon in that depending on what it’s made of, it may be hot or cold.

  3. Let your baby open her mouth and extend her tongue toward the food, and if she cannot extend her tongue farther out than her lower lip, she is not ready for spoon-feeding.

  4. Do not touch the spoon too far back on the tongue as it may trigger a gag reflex, keep it forward to the front of the mouth, and apply gentle downward pressure.

  5. Keep the spoon level, your baby’s chin should be slightly down to protect her airway, and using her gums to scrape food off the spoon is not recommended.

  6. Base the pace of eating on her ability to swallow so as not to induce choking.

  7. First meals may be of small quantities, about 5 – 6 baby spoons of food, they may last about 10 minutes, and should be based on your baby’s interest.

 

As your baby masters eating from a spoon, learn to follow her signs to indicate the rate at which she wants to eat.

 

In the absence of anatomical problems or health conditions that make it difficult or uncomfortable for children to eat certain foods, picky eating can just be a normal bump in the road of childhood development. For example, learning to control the tongue is a skill that has to be practiced, and sometimes kids just have issues with certain textures. This is particularly the case when a child transitions to eating solid foods. 


References:

https://parenting.stackexchange.com/questions/7235/how-to-get-a-toddler-to-start-chewing-and-eating-solids

Brown J. Nutrition through the Life cycle 4th ed. Belmont, CA: Wadsworth; 2011.