NAVIGATING PEDIATRIC NUTRITION

Transcription

1 NAVIGATING PEDIATRIC NUTRITION Candice Candelaria, MS, RD Registered Dietitian Southwest Human Development U of A Integrative Health Center Metabolic Zen Nutrition Consulting

2 PROTOCOL FOR EFFECTIVE NUTRITION EDUCATION AND GROWTH MANAGEMENT Accurately Plot and Evaluate Growth Determine Nutrient Needs Evaluate Current Intake Focus information/education on the nutritional gaps Discuss feeding behaviors and how to navigate them Avoid labeling terms/excuses (stubborn, picky eater, etc.) Remind parent of feeding goals and the big picture (lifelong feeding relationship) Make appropriate referrals if needed

3 OBJECTIVES Establish accurate growth patterns/trends Review data collection protocol and equipment Review interpretation of growth charts Identify nutrient needs Nutrient needs chart Feeding Calendar Appropriate portion sizes and intuitive eating Address Feeding Difficulties Implement the Division of Feeding Responsibility Outline mealtime recommendations Utilize community resources for appropriate nutrition diagnosis and treatments Employ presented information to more effectively interact with families regarding their child s nutrition and growth management

4 PLOTTING AND EVALUATING GROWTH

5 GROWTH CHARTS What we know: Growth charts: our clinical tool to measure and track growth, cornerstone to growth evaluation Weight, length/height, and head circumference should be measured at each visit Trends should be monitored = growth evaluation What we see: Dietary changes/recommendations made after only one abnormal data point, inappropriate chart used, equipment not calibrated, measurement protocols not followed resulting in inconsistent measures, parental misinterpretation of charts, etc. What we can do: Calibrate equipment regularly All staff measurement in-service regularly. Clinic protocol posted at measurement station to remind staff and parent of measurement protocolincreasing consistency. Educate families on the growth chart, their child s individual trend, and the importance of multiple data points

6 WHO CHARTS 0-2 YEARS Data utilized to develop WHO chart is representative of breast and formula fed infants.

7 CDC CHARTS 2 20 YEARS BMI: Measure of density not fattiness Stigmatizing, significantly impacts nutritional and emotional wellbeing Use cautiously as an indicator of growth

8 GROWTH EVALUATION BOTTOM LINE: Compare the child only with itself- factor in mid-parental height Most common source of distorted feeding behavior and growth? arbitrary cutoffs/percentiles for overweight or failure-to-thrive, in conjunction with imprecise measurements/plotting Growth Chart misjudgments can have lifelong implications

9 DETERMINING NUTRIENT NEEDS

10 HOW TO DETERMINE NUTRITIONAL NEEDS Determine Age and weight in kg Refer to Energy and Protein Needs Chart Utilize the kcal or g/kg values only *Infants Appropriate timing of introduction of solids Refer to Recommended Feeding Pattern handout

11 Energy and Protein Needs Reference: Bunting, K. Dawn., and Steven Abrams. "Table 1.10 Estimated Energy and Protein Requirements for Infants through Adolescents." Pediatric Nutrition Reference Guide Houston, TX: Texas Children's Hospital, Print.

12 Appropriate Portion Sizes Food Ages 1-3 years Ages 3-5 years Ages 6-8 years Ages 8+ Meat, Poultry, Fish 1-2 Tbsp 1 oz 1-2 oz 2 oz Eggs 1/4 egg 1/2 egg 3/4 egg 1 egg Cooked Dry Beans Pasta, Rice, Potatoes 1-2 Tbsp 3-5 Tbsp 5-8 Tbsp 1/2 cup 1-2 Tbsp 3-5 Tbsp 5-8 Tbsp 1/2 cup Bread ¼ slice 1/2 slice 1 slice 1 slice Vegetables 1-2 Tbsp 3-5 Tbsp 5-8 Tbsp 1/2 cup Fruit 1-2 Tbsp or 1/4 piece 3-5 Tbsp or 1/3 piece 5-8 Tbsp or ½ piece Milk 1/4-1/3 cup 1/3 1/2 cup 1/2-2/3 cup 1 cup 1/2 cup or 1 piece Fats, Oils To appetite To appetite To appetite To appetite Sugars, Sweets Note: Children may eat more or less, but this is how much you can serve them to start with. Reference: Satter, Ellyn. "Figure O.2 Portion Sizes for Children." Child of Mine: Feeding with Love and Good Sense. Palo Alto, CA: Bull Pub., Print.

13 FEEDING DIFFICULTIES Children learn to eat or not eat- from the way they are fed. ~Ellyn Satter

14 INFANT/CHILD LED FEEDING What: Providing the child with the food and feeding environment they need, and trusting the child to eat what they need to grow appropriately. Why: The feeding relationship, and growing out of that- the trust model of feeding and eating, is based on the idea that, given appropriate context for our eating, we all have within us the capability of knowing what and how much to eat. We don t have to be so controlling with ourselves or our children. ~Ellyn Satter

15 FEEDING RESPONSIBILITIES How: Division of Feeding Responsibility Parents: What When Where Infant/Child: How much Whether they eat or not

16 MEALTIME RECOMMENDATIONS Maintain the divisions of feeding responsibility Do: provide the child 5+ opportunities to try new foods Do not: pressure/force child to eat, bargain, bribe, promise special food, take over feeding, withhold food, punish, or reward good behavior with food. Keep up routine times of meals and snacks Exhibit the behavior you are expecting of the child Ie: Parent to eat with the child, calm/relaxed behavior, etc.

17 AGE SPECIFIC CONSIDERATIONS Infants: Evolving their palate and focusing on the progression Flavors: Bland, Savory, Sweet Texture: Pureed, Mashed, Chunky Toddlers: Sneaking up on new foods neutral exposures before accepting a new food School-age children: Exploring food combinations Playing with food and it s possibilities Adolescents: Starting to correlate social and functional components of meals Foods to build muscle, lose/maintain weight, clear skin What are their friends eating

18 CULTURE, EMOTION, AND GROWTH Goal is to convey your absolute respect for the parents and your genuine desire to help them do the best possible job of raising their children. Culture: Ethnic cultures Internet culture Academic/Clinical cultures Emotion: Perception of how situation reflects on parent/parenting skills Perception of the one advising Perception of outcome

19 RESOURCES Ellyn Satter _id=53 Feeding Matters Growth Charts Southwest Human Development Feeding Program Texas Children's Pediatric Nutrition Reference Guide

20 FEEDING MATTERS INFANT AND CHILD FEEDING QUESTIONNAIRE The ICFQ was created to improve PCP early identification and referral of children at risk for feeding/swallowing problems and appropriate intervention: Web-based questionnaire feedingmatters.org/questionnaire Created by nationally-recognized pediatric feeding and swallowing experts from multiple disciplines in partnership with Feeding Matters

21 A parent cannot give the child anything that they do not have or understand Eating is about the experience (touching, smelling, tasting, exploring). Feeding is about guidance (what, when, and where of food). Feeding + Eating = happy, healthy, growing child Candice Candelaria, MS, RD Metabolic Zen Nutrition Consulting metaboliczen.com