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WOW 2019 EARLY INTERVENTION NUTRITION THERAPY RESOURCE

Tamara H. Little, RD, LD NutriLevel Consulting LLC

1311 Circle Dr, Oxford AL 36203 O: 334-329-8212 | F: 334-472-2364

tlittle@nutrilevelrd.com

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STRATEGIES FOR FEEDING YOUR CHILD USING MY PLATE FUNDAMENTALS

Importance of Nutrition At no other time in the lifecycle is nutrition delivery more important for health, growth, and development than during early childhood (birth to 3 years). The right amounts of macronutrients like protein, fat, and carbohydrates and micronutrients like vitamin A, iodine, iron and zinc are essential to brain and motor development for all children. Nutrition Therapy in Early Intervention Research shows that as many as 90% of children with developmental delays will have at least one nutrition risk indicator. Nutrition risks can include failure to thrive, obesity, poor feeding skills, sensory disorders, altered growth, increased or decreased energy, partial or total dependence on tube feeding, and/or frequent sickness. As a part of Early Intervention Services, Nutrition Therapy focuses on teaching parents and caregivers ways to promote and support a child’s nutritional growth. Being a Positive Role Model

A child’s most effective teacher are those with whom they have a nurturing relationship and with whom they spend the most time, such as his or her mother, father, grandparent, or primary caregiver. Children are impressionable, especially at a young age, so it is important to set a good example with your own habits.

Eating is no different, and the way parents talk about food, cook meals and eat are the most important influence of developing healthy eating habits for a child. Children watch and imitate adults and look to them to learn everything from saying please and thank-you to fitness and nutrition behavior. As role models, parents and caregivers need to make sure they're demonstrating a healthy attitude toward food so their children do, too.

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MyPlate Food Guide MyPlate is a great tool to help parents plan and practice healthy meals habits with their children. MyPlate is the current nutrition guide published by the USDA Center for Nutrition Policy and Promotion. It replaced the USDA's MyPyramid guide in 2011, ending 19 years of USDA food pyramid diagrams. MyPlate illustrates the five food groups that are the building blocks for a healthy diet, using a familiar image—a place setting for a meal. Before you eat think about what goes on your plate, in your cup, or in your bowl. The goal of MyPlate is to have half of your plate filled with fruits and vegetable and the other half filled with grains/starches. Portion sizes for infants and toddlers are usually smaller than portion sizes for adults and older children. Typical portion sizes for toddlers are explained in each food group below.

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Offer a variety of healthy foods: Vary your protein foods. Include beans and peas at dinner at least once a week. Eat your colors. Offer dark-green, red, or orange vegetables at dinner. Make half your grains whole grains. They are good for your heart and digestion and can help you maintain a healthy weight and good overall health. Strong bodies need strong bones. Offer fat-free or low-fat (1%) milk at meals. Be mindful of sweet drinks and other foods: Offer water instead of sugary drinks like regular soda and fruit drinks. Other foods like hot dogs, burgers, pizza, cookies, cakes, and candy are only occasional treats. Focus on the meal and each other: Your child learns by watching you. Let your child choose how much to eat of foods you provide. Children copy your likes, dislikes, and your interest in trying new foods. Be patient with your child: Children enjoy food when eating it is their own choice. Some new foods take time. Give a taste at first and wait a bit. Let children serve themselves by taking small amounts. Offer new foods many times. Forcing your child to eat: It turns out that forcing usually leads to the child eating less. Forcing also teaches children to ignore their own sense of hunger and fullness, which doesn’t lead to healthy eating habits or good self-esteem. Nagging or making deals about food: Strategies like, “Just two more bites,” and “If you eat your vegetables, you can have dessert,” will not work in the long run. Children catch on quickly if there are rewards to be won and will soon bargain around many behaviors. Worrying about your child being picky: Even though many parents worry about their children’s food intake, most of them are getting enough nutrition. Ask your health care provider if you are worried about your child’s weight, growth, or eating habits (keeping a food diary for a week can help with this conversation).

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Remember that meals are about more than just food. They are a time to connect with your child and support his overall development. Turn off the TV, silence the cell phones, and make mealtimes screen-free for everyone. Sit together as a family, and take time to talk together and enjoy one another. This simple mealtime routine helps build strong family relationships, and a healthy relationship with food. Food Safety for Families When feeding young children, avoid:

All unpasteurized foods and beverages, including raw milk and unpasteurized juice and ciders

Raw or partially cooked eggs or foods containing raw eggs Raw or undercooked meat and poultry Raw and undercooked fish or shellfish Raw sprouts Honey, until after the baby's first birthday because it can harbor

spores of toxic bacterium that can cause botulism, a severe foodborne illness caused by a bacterium which occurs in soil.

Avoid feeding young children straight from a container that is going to be stored again for later use — such as a baby food jar. The "double dipping" from spoon-to-mouth and back to container, introduces bacteria from your child's mouth into the rest of the food. These bacteria can continue to grow in the leftovers and may cause food poisoning. A safer method is to spoon baby food from the jar into a separate dish and then feed from the new dish instead. Throw away all uneaten food from the dish. Food that has not been in contact with the child’s mouth can be stored in the refrigerator according to the guidelines below. For safe food storage, reseal the container of food that has not been used to feed the child and store it in the refrigerator (at 40°F or below).

Opened containers of strained fruits can be saved for up to three days

Strained meats can be stored for one day Vegetable and meat combinations can be kept for two days Unopened jars of baby food have the same shelf life as other canned

foods.

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OH TASTE AND SEA:

“Expanding Your Family’s Palette with Exotic Fruits and Berries”

Beyond common apples and oranges, there’s a whole world of weird and wonderful fruits to explore. Exotic and unique-looking produce is mostly native to tropical and sub-tropical regions of places such as Southeast Asia, New Zealand and South America, but now is grown in warm regions of other countries, too, including the United States. While you might find some of these fresh fruits in your regular supermarket on occasion, they’re more widely available at Asian, Latin and gourmet supermarkets, or from online specialty produce purveyors. Growing seasons vary by location and fruit, with some growing year-round in temperate or tropical climates. Canned, jarred and dried fruits are available year-round, as are products made from these fruits, such as jellies and jams. Like other fruits, exotic options are typically good sources of vitamins A and C, potassium and fiber. Inside and out, their vivid colors, varying textures and sweet to tart tastes may be a pleasant surprise. Their curious appearance may be one reason why specialty fruits are among six of the top 10 fastest growing categories in grocery stores, according to a 2015 Nielsen study. And Nielsen’s previous report found that dollar sales of fresh global and exotic items grew 9 percent in 2014. That’s not surprising, given the culinary trend of fusion cuisine and a desire to eat healthier. Restaurant

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chefs are looking for ways to infuse unique and unexpected flavors into their dishes — and once chefs jump on a trend, consumers typically follow. Showcasing exotic fruits on television cooking shows also has helped introduce them more broadly to audiences who might otherwise never know what a dragon fruit looks like, for example. Traveling is another way consumers become familiar with foreign fruits; once they try it on vacation, they may look for the fruit upon returning home. It’s hard to remember, but mangoes and kiwis once were considered “exotic” and now they’re everyday staples in many people’s grocery carts. Dragon Fruit This grenade-shaped member of the cactus family (also called “pitaya”) has a leathery exterior ranging from yellow to bright pink with lime-green spiny tips. Flecked with tiny black seeds, its juicy flesh can be white or red and has a refreshing and light flavor. Guava Several varieties of guava are available varying in size (small egg to apple), shape (round or pear-shaped), texture (rough or smooth- skinned) and color (yellow, green, red or purple-black, with flesh that is pale yellow to bright red), and with small edible seeds or seedless. To eat fresh, guava should be very ripe. Horned Melon Known also as a “kiwano” or African horned cucumber, this bright yellow-orange fruit has horns that make it look like a small spacecraft. Its jellylike interior has a mild flavor that tastes like a combination of banana and cucumber. Jackfruit A relative of the breadfruit and fig, jackfruit is the world’s largest fruit — it can weigh up to 100 pounds. Inside, its many edible starchy seeds are encased in irregular clumps of yellow flesh that can be eaten raw, cooked, dried or pickled. Jackfruit has gained popularity as a meat replacement for vegetarian versions of foods such as tacos and pulled pork. Passion Fruit This edible fruit from the passion flower is also known as “granadilla.” The most common variety looks like a purple egg and has a sweet-tart flavor

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and strong tropical scent. Since there is only a small amount of golden, jelly-like filling, passion fruit often is used as a flavoring. Papaya The papaya tree, native to South and Central America, is believed to have been first cultivated in Mexico. Despite its proximity to the United States, papayas are often labeled as “exotic” fruits, which may be intimidating to consumers. Papayas contain a large number of nutrients, including vitamins C and A, folate, magnesium, potassium and fiber. Papayas also contain papain, a digestive enzyme that can be used to tenderize meat. These nutrients give the papaya a multitude of health benefits such as the promotion of good cardiovascular, immune and digestive health. Berries: The Perfect Pick Sweet-tart berries deliver fiber, vitamin C and a delightful taste of summer. Berries are an important source of phytochemicals including anthocyanins and ellagic acid, which may help defend against heart disease and cancer. Though berries deliver the goods, the bioavailability of these compounds in humans is still unknown. Nevertheless, berries are a perfect pick for healthy eating. Berries are delicate, so look for firm, plump ones without bruises. Moisture harms berries as they are highly susceptible to mold. Choose berries that are dry and not leaking juice, which may hasten spoilage. To extend berries' shelf life, wash them just before eating. Freeze fresh berries immediately or store unwashed in the refrigerator for three to six days. Fresh, frozen and dried berries will have similar nutrition profiles, although some vitamin C may be lost during processing.

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Choose dried fruit without added sugars. Also, keep in mind that dried fruit is calorie-dense and ½ cup dried fruit is roughly the equivalent of 1 cup fresh fruit. Some berries such as açai are difficult to purchase whole fresh, frozen or dried. While açai can be eaten fresh, it's highly perishable and more commonly available as a freeze-dried powder or juice. Generally low in carbohydrates and calories and high in water, fresh berries are a diabetes-friendly fruit that's also ideal for weight management. Berries are perfect as a snack, added to yogurt, smoothies or cereal, tossed into a salad or relished as dessert. Ideal for adding color and intense flavor to any plate, berries' nutrition benefits are undeniable. Blackberry These sweet, earthy berries are an excellent source of vitamin C and fiber. Blackberries' anthocyanin richness shows in their deep-purple color. Enjoy blackberries as a snack or in salads, sauces or desserts. Blueberry Adored for their deep-blue hue and sweet-tart flavor, fresh blueberries are a good source of vitamin C and fiber. Blueberries contain free radical scavenging compounds anthocyanins, resveratrol and alphatocopherol, which may provide heart health and cancer-fighting benefits. Enjoy fresh or cooked as a compote or baked dessert. Cranberry Fresh cranberries are an excellent source of vitamin C and fiber. Cranberries' anti-adhesion properties may play a role in preventing recurring urinary tract infections. Cranberries release their full flavor when cooked. Savor fresh cranberries from October to December, or enjoy them dried and frozen year round. Goji Berry (Lycium) Native to China, the bright red goji berry is not a botanical berry. Typically available dried in the U.S., goji berries are an excellent source of vitamins A and C. Traditionally, goji berries are prepared boiled as a tea. Raspberry Whether red, gold or black, raspberries are low in calories and high in vitamin C and deliver a whopping 8 grams of fiber per cup. An intensely flavored and fragile fruit, raspberries keep for just two to three days

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refrigerated. In season May to November, raspberries are delicious fresh or in preserves. Strawberry A member of the Rosaceae family and not a botanical berry, strawberries are high in vitamin C and folate. Strawberry season peaks in May. Choose fragrant berries and enjoy them raw when in season. Use frozen strawberries when fresh are not available. * Nutrition information based on 1 cup frozen berries.

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Snacking Tips For Kids Getting kids involved in the kitchen will not only teach them about healthy foods, but it will also impart valuable skills that will stick with children for life, from eating right and safely handling foods to building math, science and fine motor skills. Get started by whipping up these easy, no-cook snacks with your little ones. Snack Kebabs Cut raw vegetables, fruit and low-fat cheese into chunks. Skewer them onto thin pretzel sticks. Veggies with Dips Did you know that kids might be more likely to try new fruits and vegetables if they helped prepare them? Get kids involved in age-appropriate tasks. Cut various vegetables such as celery, zucchini, cucumbers and carrots into small pieces. Dip them into prepared salsa, hummus or low-fat dressing. Banana Pops Peel a banana. Dip it in low-fat yogurt. Roll in crushed whole-grain cereal. Freeze. Fruit Slices and Peanut Butter Spread peanut butter on apple or banana slices. Fruit Shakeups Combine ½ cup low-fat fruit yogurt and ½ cup cold 100-percent fruit juice in a non-breakable, covered container. Make sure the lid is tight, shake it up and pour into a cup. For even more fun, have kids sing a song like “Hokey Pokey” and dance as they shake up the mixture. Sandwich Cutouts Cookie cutters aren’t just for cookies! Let your kids use fun-shaped cookie cutters to cut slices of low-fat cheese, lean meat and whole-grain bread. Then assemble sandwiches. Food Safety Tip: Some people are more vulnerable to the effects of food poisoning, including older adults, young children, pregnant women and those with weakened immune systems. If you are at a high risk of food poisoning, avoid riskier foods including deli meats and soft cheeses.

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Peanut Butter Balls Mix peanut butter and bran or cornflakes in a bowl. With clean hands, shape the mixture into balls. Roll the balls in crushed graham crackers. Ants on a Log Fill celery with peanut butter. Arrange raisins along the top.

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5 Tips For Healthy Kids

Encouraging kids of any age to eat a healthy, balanced diet is an uphill battle for many parents. Fussy eating and allergies are two of the biggest food obstacles facing new parents. Listed below are some tips to encourage kids to eat more healthy. Get Them Involved in Food Decisions Children can take an active role in every aspect of food planning. Picking out fresh produce at a local farmers market or grocery store is a great time to teach them about which fruits and vegetables are in season and how they can be cooked. Get Tech-Savvy Children nowadays are much more technologically minded. Many will have social media accounts and be experts in using different devices. Apps have opened a huge opportunity for parents to educate children about nutrition. Search “apps that teach kids about nutrition” for some great examples. Grow Your Own A garden is a fun way to get kids excited about healthy food. This might not be so easy for city dwellers, so an alternative could be growing herbs in the window. In either case, kids can learn about the history of the plants and how they can be used in lots of interesting and tasty recipes. Make Meals and Snacks Fun Getting creative in the kitchen can boost a child’s interest in everyday foods. Try blending fruits and vegetables into a smoothie, making real fruit popsicles or turning every day, mundane dishes such as sandwiches or pieces of fruit into an animal or superhero!

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Early Feeding Strategies During the infant or baby stage of life, it's almost all about the milk — whether it's breast milk, formula, or a combination of the two. Breast milk or formula will provide practically every nutrient a baby needs for the first year of life.

At about six months most babies are ready to start solid foods like iron-fortified infant cereal and strained fruits, vegetables, and pureed meats. Because breast milk may not provide enough iron and zinc when babies are around six to nine months, fortified cereals and meats can help breastfed babies in particular.

Once you do start adding foods, don't go low-fat crazy. Although the AAP guidelines state fat restriction in some babies is appropriate, in general, you don't want to restrict fats under age two because a healthy amount of fat is important for babies' brain and nerve development.

Toddlers and preschoolers grow in spurts and their appetites come and go in spurts, so they may eat a whole lot one day and then hardly anything the next. It's normal, and as long as you offer them a healthy selection, they will get what they need.

Calcium, the body's building block, is needed to develop strong, healthy bones and teeth. Children may not believe or care that milk "does a body good," but it is the best source of much-needed calcium. Still, there's hope for the milk-allergic, lactose-intolerant, or those who just don't like milk. Lactose-free milk, soy milk, tofu, sardines, and calcium-fortified orange juices, cereals, waffles, and oatmeal are some calcium-filled options. In some cases, pediatricians may recommend calcium supplements.

Fiber is another important focus. Toddlers start to say "no" more and preschoolers can be especially opinionated about what they eat. The

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kids may want to stick to the bland, beige, starchy diet (think chicken nuggets, fries, macaroni), but this is really the time to encourage fruits, vegetables, whole grains, and beans, which all provide fiber. Not only does fiber prevent heart disease and other conditions, but it also helps aid digestion and prevents constipation, something you and your child

Stage 1 (about 6 months) Puréed foods, starts with quite thin (‘runny’) consistency, gradually getting thicker as your baby gets used to taking foods from a spoon. The aim is to introduce your baby to solid food and a variety of tastes. Introduce each food on its own for 2 days before introducing another food, for example baby rice, then pureed carrot. The closer to 26 weeks your baby is when you introduce solids foods, the quicker your baby should progress to stage 2. Stage 2 (6-9 months) Moves to mashed foods from a spoon, gradually becoming lumpier in texture. Soft finger foods introduced. Starts to take drinks from a beaker or cup. The aim is to introduce variety into the texture of your baby’s food. Offering a wide variety of foods at this stage has been shown to increase the variety of foods accepted by a baby as they grow. From 7 months you should encourage your baby to take finger foods.

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Stage 3 (9-12 months) Moves to minced and chopped family foods. More textured finger foods. By 12 months of age bottles should be stopped and all drinks other than breastmilk should be taken from a beaker or cup. The aim is to move your baby onto eating family meals without added gravies, sauces, salt or sugar. Introducing lumpy foods is important to develop their ability to:

speak, chew a wider variety of foods, and increase the variety of their diet in later childhood

Stage 4 (24- 36 months) At this stage your child may be self-feeding and eager to make their own food choices. Your toddler may begin to drink from a small cup with a spill-proof top. Later, let your toddler practice drinking from a small cup without the spill-proof top The aim is for your toddler to eat a variety of foods every day. MyPlate is a good guide to follow when planning your child’s meals. Make sure you limit high sugar and high fat foods so your toddler has room for healthy foods. Too much milk, juice, or sugary drinks can “fill up” a toddler. Your toddler may then have a poor appetite and not eat other important foods that would help him or her to grow and be healthy.

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References Position of the American Dietetic Association: Providing nutrition services for infants, children, and adults with developmental disabilities and special healthcare needs. J Am Diet Assoc. http://www.eatright.org United States Department of Agriculture; www.ChooseMyPlate.gov/preschoolers-meal-and-snack-patterns. World Health Organization; Early child development – Nutrition and the early years; https://www.who.int/topics/early-child-development/child-nutrition/en/ Samour, P., & King, K. (2012). Pediatric nutrition. (4th ed.). Sudbury, MA: Jones & Bartlett Learning. Academy of Nutrition and Dietetics. Pediatric Nutrition Care Manual. Chicago, Ill: American Academy of Nutrition and Dietetics; 2012. Behavioral Heath Nutrition DPG/Pediatric Nutrition DPG. Academy of Nutrition and Dietetics Pocket Guide to Children with Special Health Care and Nutrition Needs. Chicago, Ill: American Academy of Nutrition and Dietetics; 2012 American Academy of Pediatrics. Caring for Your Baby and Young Child: Birth to Age 5. 6th ed. Bantum Publishing, New York, NY; 2015 US Department of Agriculture. Dietary Guidelines for Americans, 2015-2020. 8th ed. https://health.gov/dietaryguidelines/2015/guidelines/ Satter E. Ellyn Satter’s division of responsibility in feeding. https://www.ellynsatterinstitute.org/how-to-feed/the-division-of-responsibility-in-feeding/. Accessed April 4, 2018.