Will My Child Survive the Chicken Finger and French Fry Diet?

Transcription

1 Will My Child Survive the Chicken Finger and French Fry Diet? Lisa Leatham MS, RD, LD, CNSC, CSP Disclosures I do not have any relevant financial/non financial relationships with any proprietary interests Objectives Review the nutritional recommendations for children from infancy to adolescence Recognize how environment, parent/child dyad, and child's exposure to food shape food preferences and intakes Identify strategies to improve diet quality

2 Infants Generally meet with formula/breast milk intake to promote adequate/consistent growth trend. Exception vit D for EBM only/formula intake less than L/day (400 IU/day) Iron for exclusively breast fed infants@ 4 months Recommendations to exclusively breast feed for the first 6 mo with benefits up to year On demand, every 2 3 hours for ~8 2 feeds/day If formula used, standard 9 20kcal/oz with iron Similar feeding frequency and volume. Possibly more time between feeds 2/2 more delayed gastric emptying Benefits of Breast Feeding Associated with reduced use of pressure and restrictive feeding practices at and 2yo Thought to increase infant exposed to different flavors and increase food acceptance when solids are started Associated with lower protein intake and lower weight compared to formula fed infants Lower kcal intake for infants who breast feed directly compared to infants bottle fed formula/expressed breast milk Decreased incidence of encouraging infant to override satiety cues Parental Influences Maternal age/duration of breast feeding/maternal education Positive correlation with diet variety/fruit and veg intake Low parent health literacy associated with obesogenic infant care behaviors More formula fed Immediately feed when child cried Bottle propping Allowing infant to watch TV Inadequate tummy time Infant oriented vs parent oriented feeding practices Higher weight with parent oriented feeding practices

3 Complementary Foods Introduction of solids 4 6 months when infant shows signs of developmental readiness Introduction of iron fortified cereal or meats first, source of vit C introduced by 6mo to help with absorption of non heme iron sources (fortified cereals) Introduction of complementary foods after 6mo reduced odds of picky eating/limited diet Infant/Pretoddlers Age (months) Food (Portion Sizes) Feedings Per Day 0 4 Breast milk or infant formula (2 4oz) Breast milk or infant formula (6 8oz) 4 6 Infant cereal ( 2Tbsp) Breast milk or infant formula (6 8oz) 3 5 Infant cereal (2 4Tbsp) 2 Crackers (2), bread (/2 slice) Juice (0 3oz) Fruit or vegetable (2 3Tbsp) 2 Meat ( 2Tbsp) or beans ( 2 Tbsp) Breast milk or infant formula (6 8oz) 3 4 Cheese (/2 oz) or yogurt () Infant cereal (2 4Tbsp), crackers (2), bread 2 (/2 slice), pasta (3 4 Tbsp) Juice (0 3oz) Fruit or vegetable (3 4Tbsp) 2 3 Meat (3 4Tbsp) or beans (/4 cup) 2 Strategies Introduction of solid ~6mo Early introduction (<4mo) associated with increased risk for obesity Baby led weaning observational studies suggest improved eating habits Early introduction of lumps/texture (</=6 9mo) resulted in greater variety of foods Introduction of lumps/texture after 0mo More difficult to feed and more defined likes/dislikes Long term feeding issues/decrease consumption of fruit/veg in infants introduced to lumpy foods after 9mo. Observed up to 7yo.

4 Parent Behaviors Assumptions that infant doesn t like food Humans are biologically programmed to be skeptical of new foods until it is confirmed that they are safe to eat (esp bitter foods) Fear that infant will choke Unrealistic expectations for intake/serving sizes Toddlers Foods Servings/day Serving Size Fruit 2 3 each = to ½ cups High vitamin C Whole or sliced (preferred) Canned (in juice) or fresh chopped Juice Other fruits 2 ½ small /3 cup /3 cup Vegetables 2 3 each to s High vitamin A (red, orange, and green) Cooked, canned or fresh chopped Juice Starchy, peas, beans Whole or sliced Cooked or canned ¼ cup ¼ /3 cup ¼ /2 piece ¼ /3 cup Toddlers Foods Servings/day Serving Size Dairy to 2 ½ cups Milk or yogurt ½ cup cheese ½ oz Meats 2 2 to 4 oz Beef, pork, poultry, fish 3 Tbsp Legumes, nuts 2 4 Tbsp Eggs, small Grains 6 = 5oz Bread, loaf Bagel, bun Ready to eat cereal Cooked cereal Rice, pasta Fats, Added Sugars and Sodium ¼ /2 ¼ /2 /3 ¼ ¼ /3 cup Solid fats and sugar Oils Sodium </= 20kcal/day 4 tsp <2 3g/day

5 Toddlers Supplements? Generally not needed in healthy children who are growing normally Possibly needed for children with limited food acceptance/food allergies that impact diet variety/certain medical conditions/limited diets/regular intake of medication that increases need or affects absorption/utilization Vit D Omega 3 Iron Calcium Issues Common Problematic Eating Behaviors Not always hungry at mealtime Trying to end meals after a few bites Picky eating Strong food preferences Parent Child Interaction During Feeding Authoritative High control, high responsiveness Control of food offered at meals, allows child to determine what/how much they will eat Authoritarian High control, low responsiveness Restricting access to food, pressuring to eat, little regard for child s food preferences Indulgent/Permissive Low control, high responsiveness Total freedom with food choices and amount consumed (nutritional neglect) Neglect/Uninvolved Low control, low responsiveness

6 Parent Child Interaction During Feeding Authoritarian Increased risk of being overweight compared to authoritative Indulgent/Permissive and Neglect/Uninvolved Twice a likely to be overweight compared to authoritative Authoritative Associated with more positive weight outcomes Parent Child Interaction During Feeding Authoritarian Restricting unhealthful Increases preference for food Decreases self control Shifts attention away from internal satiety cues Forcing children to eat Decreases enjoyment Increases fussiness, slowness, early satiety Parent Child Interaction During Feeding Indulgent/Permissive and Neglectful/Uninvolved Lower fruit, vegetable, dairy intake

7 Strategies Continue exposure to new foods/textures By 8mo child s fruit/veg consumption and energy contribution from each food group becomes fixed Kids can t eat what they are not given an opportunity to try Division of Power Parent: what, when, where Child: if and how much Strategies Food rules applicable to children beyond infancy (Anne Claude Bernard Bonnin, MD, FRCPC) Scheduling Regular mealtimes; only planned snacks added Mealtimes no longer than 30 min Nothing offered between meals except water Environment Neutral atmosphere (no forcing of food) Sheet under chair to catch mess No game playing Food never given as reward or present Procedures Small portions Solids first, fluids last Self feeding encouraged as much as possible Food removed after 0 5 min if child plays without eating Meal terminated if child throws food in anger Wiping child s mouth and cleaning up occurs only after meal is completed Strategies Persistence and consistency Offer up to 0 20 times Offer in different forms Expectations Don t expect the child will not like it because it isn t kid friendly or the parent doesn t like it Children have a decrease in wt gain/growth velocity = lower food intake Children do not have to clean their plate Being a little hungry is OK Model behavior Fruit/veg intake consumption by 8mo mirrors the adult American diet (~0% energy from fruit/veg)

8 Signs of Problem Eating Eating less than 20 foods Gagging/vomiting at the sight of unaccepted foods Ignoring new foods ( will not look at or touch) Will not eat any food on plate presented with the new food Refuses entire categories of food textures Cries and falls apart when presented with new foods Preschool Foods Servings/day Serving Size Grains (at least ½ whole grains) 6 = 5oz Bread, loaf Bagel, bun /2 Ready to eat cereal Cooked cereal Rice, pasta Crackers 4 6 Dairy 3 3 cups Milk or yogurt 3/4 cup cheese 3/4 oz Meats 2 5 oz Lean beef, pork, poultry, fish Legumes, nuts Eggs Fats, Added Sugars and Sodium Solid fats and sugar Oils Sodium 3 Tbsp 4 5 Tbsp </= 20kcal/day 4 tsp <2 3g/day Preschool Foods Servings/day Serving Size Fruit 3 = ½ cups Other fruits 2 Whole or sliced (preferred) Canned (in juice) or fresh chopped Juice High vitamin C ½ small Vegetables cups High vitamin A (red, orange, and green) Cooked, canned or fresh chopped raw Juice Starchy, peas, beans 2 ¼ ½ piece

9 Strategies Hide ingredients Vegetable enhanced entrees almost doubled preschool children s vegetable intake Continue to offer vegetables on the side as well Involve in shopping/cooking Provide smaller portions/serve on smaller plates Serve dessert with dinner Increase variety of fruit/vegetable offered at meals School Age/Adolescent Foods Serving Serving Size Vegetables and Fruit 5 6 (3 5 cups/day) ½ cup cooked cup raw medium piece ½ cup juice ¼ cup dried Grains 4 7 slice ½ bun pasta, rice 3/4 cup cooked cereal cup cereal 4 6 crackers Milk 2 4 cup milk ½ cheese ¾ cup yogurt School Age/Adolescent Foods Serving Serving Size Meats/Meat Alternatives 2 2 eggs ¾ cup beans ¼ cup nuts/seeds 2 Tbsp nut butter ¾ cup tofu 2.5 oz meat, fish, poultry Fats, Added Sugars and Sodium Solid fats and sugar Oils Sodium </= kcal/day 2 3 tsp <2.3g/day

10 Common Issues Skipping breakfast Higher percentage of calories from snack foods/sugar sweetened beverages Increased number of meals/snacks eaten away from home Peer pressure Strategies Family Meals Family centered focus on increasing intake of health foods instead of a focus on decreasing less healthy foods Offer fruits/vegetables/dairy at every meal Increase the number of vegetables offered at meals Role Modeling Education Meal preparation How to choose foods away from home How what you eat affects health Will Children Survey the Chicken Nugget and French Fry Diet?

11 YES But surviving is setting the bar too low We want children to THRIVE not survive. Resources Dietitians Eatrightsa.org Nutrition Therapy Associates LoneStar Nutrition LLC SOS Feeding Therapy Therapy Links Inc. Kim Redding (SOS Therapy) Websites Ellynsatterinstitute.org Sosapproach conferences.com Choosemyplate.gov Kidshealth.org Actionforhealthykids.org