Tips and Tricks on Diet and Nutrition

1. Tipsand Tricks on Diet and Nutrition Tammy Cooper, RD CHEO Connects! February 6, 2012

2. Objectives Explore reasons that may contribute to feeding difficulties • Review appropriate nutrition for Toddlers and Preschoolers • How it relates to their developmental stages • Demonstrate portion sizes • Discuss challenges and strategies for picky eaters Offer resources and ideas

3. How Do I Get My Kid to Eat ? What should our kids be eating, how much, how often?  What to do about picky eaters? How do I get my child to stop talking and eat? Does it really matter if we sit down at the table and eat?

4. Feeding Conflict Feeding resistance Parental pressure to eat Chatoor I. Diagnosis and Treatment of Feeding Disorders in Infants, Toddlers, and Young Children. Washington, DC: Zero to Three; 2009.

5. Medical Reasons for feeding problems • Reflux • Undiagnosed Food Allergies • Constipation • Dental Problems • Excessive Juice or milk intake • Autism If you suspect that your child has any of these, contact your family physician

6. 5. Excessive Juice or Milk Intake - Recommended drink for children is water - Recommendations are no more than 250mL (1 cup of juice) per day - Recommendations for milk are 2 cups (500mL) per day - Liquids (except water) should only be offered with meals and snacks after the food has been eaten.

7. Picky vs. Problem Feeders PICKY Eat fewer than 30 foods Eat at least one food from almost all textures Eat the same food every day (food jag) Tolerate new foods on their plate Adventurous to taste new foods Willing to eat new foods after repeated exposure 15-25 times PROBLEM Eat fewer than 20 different foods Restricted range or variety of foods and textures Foods lost to food jags are NOT re-acquired Cries and “falls apart” when presented with new foods Adds new foods in more than 25 times

8. Selective Eating Extreme picky eating can cause growth problems, nutritional deficiencies, severe dental decay, dehydration, and constipation. Keep a food diary Is your child’s diet varied enough? Try to understand what, where, and how your child prefers to eat • Don’t label your child as “picky” “problem” or “fussy” eaters in front of them

9. 1 Year of Age – begins to eat more independently • Family foods encouraged (may need to be softer in texture depending on the food) • Encourage small frequent feedings • Food jags/dislikes: try again later • Supervise during meals and snacks for safety • Promote Healthy Eating Habits

10. .... 2Years of Age + - definite likes & dislikes, wants to eat only one food, conflict at mealtime • Develop a sense of taste and an acceptance and enjoyment of different foods • Give small quantities of new foods • Portion sizes appropriate for age • Energy dense, nutrient-rich foods • Comfortable setting without distractions

11. Ages 2 Years + • Appetite is variable with growth • Increase independence & experimentation with foods (colour, texture, taste) • Avoid pressuring child to eat – be a good role model • Child will determine how much food is enough - listen to cues e.g. turning head away, refusing to eat.

12. How do I get my kid to eat? Tips and tricks on diet and nutrition. •    Be a good Role Model •   Get your child to participate in cooking, baking, shopping etc. •    Give appropriate serving sizes (many parents give too much)

13. How do you as a parent ensure your child is getting what they need?  Follow Canada’s food guide recommendations for all food groups. Smaller children need small portions. Talk to a health professional if your child: Is missing out on a specific food group (a food diary helps). Regular visits with your family doctor to check growth.

14. How to get your fussy eater to eat?  • Same as getting any kid to eat, ignore negative behaviours at mealtimes and reinforce positive ones. • Have the same food on your plate • Make sure they come to the table hungry (it has been 2 hours since their last meal/snack)

15. How to get a child to eat more variety? Offer a “nibble tray” Let children cook or help prepare food Serve new foods over and over again Prepare new foods in ways your child prefers (same shape, color, texture) Set a good example Ignore “food jags”

16. ....Setting the Stage New foods are introduced one at a time every 3 to 7 days Start with 1 Tbsp of a new food Introduce it first with foods the child likes Be positive Be sure the child has not eaten too close to the meal

17. Feeding Strategies Feed foods your child likes Don't force your child to eat foods he/she cannot tolerate If a new food causes distress, remove it and try something more closely resembling a preferred food Do not push your child to try new foods Always respect your child's aversions

18. Mealtime Routines Set a schedule (3 meals and 2-3 snacks spaced 2 hours apart) Offer solid foods first Give 30 minutes to complete a meal (including drink) Give 15 minutes to complete a snack Ensure child is seated during meal or snack

19. Nutritional Requirements Nutrients are required for maintenance, growth and development Amount needed depends on the individual. Most reliable guide to energy requirements is regular, frequent measurements of body weight, and monthly measurements of length/height

20. Macronutrients • Energy – Needs vary based on age, size, activity, rate of growth, and overall health • Fat – No need for low fat before age 2 • Fluids – 4-5 cups per day • Protein -Required for growth, tissue repair, enzymes & antibodies, hormones, etc.

21. Multivitamins Most children who are selective eaters require a daily multivitamin Aim for a children’s complete multivitamin with iron, calcium, vitamin D If children are getting 3-4 of each food group at a meal and 2-3 of each food group at a snack from Canada’s Food Guide for Healthy Eating they should be meeting their needs

22. Meat and Alternatives: 1 serving Cooked fish, shellfish, chicken, turkey, meat (2.5 ounces or ½ cup) Cooked legumes (lentils, chickpeas, beans) (3/4 cup) Tofu (3/4 cup) Eggs (2 eggs) Peanut or nut butters (2 Tbsp) Nuts and seeds (1/4 cup)

23. Milk and Alternatives 2 servings per day • Milk or Powdered Milk (1 cup) • Canned milk (1/2 cup) • Fortified Soy or Rice beverage (1 cup) • Yogurt (3/4 cup) • Cheese (1.5 ounces)

24. Vegetables and Fruit 4-5 servings per day Fresh, frozen, or canned vegetables (1/2 cup) Leafy vegetables (1/2 cup cooked; 1 cup raw) Fresh, frozen or canned fruit (1 fruit or ½ cup) 100% real juice (1/2 cup)

25. Grain Products 3-4 servings per day • Bread (1 slice) • Bagel (1/2 bagel) • Flat breads (1/2 pita or ½ tortilla) • Cooked rice, bulgur, quinoa (1/2 cup) • Cereal (3/4 cup) • Cooked pasta (1/2 cup)

26. Simple Steps to a Lifetime of Healthy Eating • Serve and eat a variety of healthy foods • Make smaller portions • What, when and where is Parent’s responsibility • How much or whether to eat is Kid’s responsibility

27. Recommended websites Eat Right Ontario - www.eatrightontario.ca or call 1-877-510-510-2 to speak to a dietitian Dietitians of Canada-Healthy Start for Life www.dietitians.ca/healthystart Health Canada –Eating Well with Canada’s Food Guide www.healthcanada.gc.ca/foodguide

28. Resources Nutrition resource centre (www.nutritionrc.ca) • Ottawa Public Health – Nutrition - Ottawa.ca/nutrition Ottawa Public Health (613) 580-6744 Ottawa.ca/health

29. Recommended Books • A SMART START for Feeding Your Toddler: A guide for moms, dads and caregivers of families with children aged 1-6 years. (Ottawa Public Health 2008) • Secrets of Feeding a Healthy Family. (Ellyn Satter. Kelcy Press, 1999). • Child of Mine (Ellyn Satter, Bull Publishing Company, 2000). • Better Food for Kids. (Joanne Saab & DainaKalnins. Robert Rose Inc. 2001)

30. Thank You ! Questions?