nutrition-concerns-for-children-with-autism-spectrum-disorders-photo

Nutrition Concerns for Children with Autism Spectrum Disorders – Part 1

by with No Comment Child & Family NutritionPicky Eating

Autism Spectrum Disorder (ASD) is a complex developmental and neurological condition that typically appears during the first three years of life. ASD includes:

  • Autism 自闭症
  • Asperger Syndrome 阿斯伯格综合症
  • Pervasive Developmental Disorders (PDD) 广泛性发育障碍
  • Rett’s disorder 雷特氏症
  • Childhood Disintegrative Disorder (CDD) 儿童期崩解症 or Heller syndrome 海勒症候群

People with ASD have trouble with social interaction and communication. They may also have unusual interests, activities, and behaviours. (CDC).

It is about four times more common in boys than in girls.

PREVALENCE

According to the Centres for Disease Control Prevention, one in every 59 children in United States is diagnosed with autism. In Malaysia, there is no official registry for the number of individuals diagnosed with autism. The only statistics which shed some light into the occurrence of autism in Malaysia is a local survey conducted in 2008 which revealed that autism affects one in 625 children.

SIGNS & SYMPTOMS

  • Trouble communicating with people include delayed talking
  • Trouble interacting with people including not wanting to be held or cuddled and poor eye contact
  • Behaviour that is different than other people
  • Lack of interest in playing with other children
  • Lack of interest in food or uncommon food preferences
  • Trouble with motor skills including picking up small objects, catching a ball and riding a bike

Autism affects each person differently and can range from mild to severe.

DIAGNOSIS

There is no medical test, like a blood test, to diagnose the disorders. A medical diagnosis of ASD is most frequently made by a Family Physician, Developmental Pediatricians, Child Neurologists, Child Psychologists or Psychiatrists. (CDC).

ASD can sometimes be detected at 18 months or younger. By age 2, a diagnosis by an experienced professional can be considered very reliable (here).  However, many children do not receive a final diagnosis until much older. This delay means that children with ASD might not get the early help they need.

CAUSES & RISK FACTORS

There is no known cause for ASD, but both genetics (here) and environment are believed to play a role, such as advanced parental age (here), medications during pregnancy (here, here), parental obesity (here) and environmental pollutants (here).

TREATMENT

There is no known cure for autism. Treatment is based on individual, such as early intervention, physiotherapy, speech therapy, occupational therpy, behavioural therapy, to help individuals cope with their symptoms.

Behaviour modification needs to be tailored to each individual child and family situation.

NUTRITION CONCERNS

Child with ASD often repeat behaviors and have narrow, obsessive interests. These types of behavior can affect eating habits and food choices, which can lead to the following health concerns.

  • Social impairment. It may limit a child’s ability to learn eat through modeling. The child may not be motivated by eating with peers or family members.
  • Restrictive, repetitive and rigid behaviours. The child may have difficulty accepting new foods due to sensitive to the taste, smell, color, texture, temperature and packaging of foods. They may limit or totally avoid some foods and even whole food groups. Rigidity may also lead to an insistence on sameness in food, including the presentation of food, utensil use, brand and location where to eat. Common dislikes include fruits, vegetables and slippery, soft foods; prefer crispy and crunchy foods (potato chips, French fries, crackers).
  • Not eating enough food. The child may have difficulty focusing on one task for an extended period of time. It may be hard for a child to sit down and eat a meal from start to finish. Allergies or intolerances appear to be more common in children with autism and can decrease overall food intake.
  • Constipation. This problem usually is caused by a child’s diet low in fibre and high in processed foods, abnormal function of GI tract and sensory response (withholding due to discomfort with the sensation of defecation).
  • Medication interactions. Some stimulant medications used with autism, such as Ritalin, lower appetite. This can reduce the amount of food a child eats, which can affect growth. Other medications may increase appetite or affect the absorption of certain vitamins and minerals. If your child takes medication, ask your healthcare provider about possible side effects.

STRATEGIES FOR DEALING WITH SELECTIVE EATING

Because children with ASD often have restricted diets as well as difficulty sitting through meal times, they may not be getting all the nutrients they need, particularly iron, calcium and protein. Here are some nutrition strategies that you can use to help make feeding a little easier. These strategies may help in the slow and steady process of improving feeding issues.

1. Be Prepared for Pickiness

Many parents find their child’s sensitivity to tastes, colors, smells and textures the biggest barriers to a balanced diet. Getting your child to try new foods — especially those that are soft and slippery — may seem nearly impossible. You may find that your child avoids certain foods or even entire food groups.

  • Get your child involved. Have your child visit the supermarket with you to choose a new food. When you get home, research it together on the internet to learn about where it grows. Then, decide together how to prepare it. When you are done, don’t worry if your child doesn’t want to eat it. Simply becoming familiar with new foods in a low-pressure, positive way eventually can help your child become a more flexible eater.
  • Avoid snaking all day. This decreases appetite, willingness to try new foods, and the number of total calories taken for the day.
  • Limit mealtime. Limit mealtimes and snacks to 15-30 minutes.
  • Use the rule of 3. Work to broaden the variety of a child’s diet expanding on already accepted food groups. A good rule of thumb is to only offer three foods at a time. Include one to two foods your child already likes and one food your child does not yet like. If your child will not tolerate the new food on his or her plate, place the new food near him or her on a separate plate to help get your child used to the new food.
  • Food presentation. Present new foods in small bites and in fun, creative or familiar ways to make it more likely that your child will eat it. 
  • Reward positive behaviours. Offer praise when your child approaches or tries new foods. Immediate rewards, such as a sticker, can be helpful to encourage new feeding behaviors. Remember that rewarding good mealtime behaviors will increase the likelihood that they will happen again.
  • Ignore Negative Behaviors. When possible, ignore your child when he or she is doing things such as spitting, throwing or refusing food. Remember, you don’t want to encourage these behaviors by paying attention to them. 

2. Make Mealtimes Routine

A child with ASD will have to work harder at mealtimes because a busy kitchen, bright lights and even the way the furniture/utensil is arranged all are potential stressors.

  • Set a feeding schedule and routine. Serving meals at the same time and same place every day is one of the simplest ways to reduce stress. You can use visual timetables and visual schedules. Written timetables or picture symbol schedules detailing when and where they will eat, what will be eaten and the type of behaviour expected at meal times makes mealtimes more predictable and a less anxious occasion for the child.
  • Provide comfortable and supportive seating. Place your child in a high chair or booster seat that he or she is ale to sit upright without leaning or dangling his or her feet. This physical stability promotes good feeding behaviours and reduces distracting behaviours by allowing them to feel “grounded” and safe.
  • Remove all distractions. Distractions such as the TV or iPad which can take the focus off the food and the task at hand. Feed your child only when he or she is alert and attentive. If your child is sensitive to lights, try dining by candlelight.

3. Regular Bowel Movement

Traditionally, a high-fiber and fluid diet, as well as regular physical activity are recommended to treat constipation but this is not always an effective recommendations. Making a dietary change is a long process but is necessary. First is to make it safe and comfortable for the child to have bowel movement.

  • Stool softeners or lubricants may be used to reduce the potential of pain with defecation.
  • Regular bathroom routine are needed to reduce anxiety and facilitate normal bowel movement.

BOTTOM LINE

Caring for a child with ASD can be challenging on many levels, and healthy eating is no exception. For children with ASD, a nutritious, balanced diet can make a world of difference in their ability to learn, how they manage their emotions and how they process information.

Changes in dietary intake will be a slow process and not all strategies will work for each child. 

A Dietitian can identify any nutritional risks based on how your child eats, answer your questions about diet therapies and help guide your child on how to eat well and live healthfully.

AUTISM RESOURCES IN MALAYSIA 

The National Autism Society of Malaysia (Nasom).

Autism Behavioral Center

Early Autism Project Malaysia 

If you enjoyed this post, you may also be interested in learning about Special Diet for Autism.  

Disclaimer:

The above information is not meant to diagnose or treat and should not take the place of personal consultation, as appropriate, with a qualified healthcare professional. 

The Important of Family Meals

The Important of Family Meals

by with No Comment Child & Family NutritionPicky EatingToddler Nutrition

We are busy! It’s challenging to find time to eat meals with friends and family. But, it’s important to share meals, because it opens dialogue, connects people and helps us eat a more balanced diet. It’s an enriching experience for people of all ages to share meals — from children to older adult.

WHY SHARE MEALS WITH OTHERS?

The biggest barriers to eating together are busy schedules like work and evening activities. It takes creativity to balance busy schedules, but it’s worth the effort because everyone benefits when you eat in the company of others!

  • Children who eat with their family have more nutritious diets, better academic performance, a lower risk for being overweight and less risk of eating disorders. Plus, children tend to have increased intake of vegetables and fruit, and a decreased intake of sugar-sweetened beverages.
  • Teens who share family meals get better grades, and are less likely to smoke, use drugs or alcohol, or to participate in serious fights.
  • Adults who eat with friends and family tend to eat more vegetables and fruits, drink less pop, eat fewer meals at fast food restaurants, and have lower body mass indexes.
  • Older adults who eat as part of a group have better diets, improved nutrient intake and lower rates of malnutrition.
  • People who come together in communities can eat together at community kitchens, where they learn to cook, share meals, try new foods, have fun and learn about nutrition.

START A CONVERSATION

For many people, sharing meals is a favourite time of day to interact with family and friends. It allows people to connect share traditions, learn, communicate and listen. If you are new to family meals, here are some Do’s and don’ts:

  1. DO give everyone at the table a chance to speak.
  2. DON’T use it as a time to scold or discipline picky eaters.
  3. DO ask questions that require more than a “yes” or “no” answer. So, instead of “did you have a good day?” try asking “tell me something interesting that happened today.”

Grab your FREE Mealtimes Conversation Starters list  HERE .

BOTTOM LINE

Sharing family meals doesn’t only mean dinner! If your evening schedule is hectic, share breakfast meals or have brunch together on the weekends. Most studies done on the benefits of family meals start with sharing at least four meals together per week. So, they all count!

Let’s enjoy the benefits of bringing families and friends together with food. How often do you have family dinner and how do you make it successful?

Adapted from the Dietitians of Canada’s Nutrition Month campaign materials. 

Teaching Children to Cook

Teaching Children to Cook

by with No Comment Child & Family NutritionPicky EatingToddler Nutrition

Starting from a young age, inspiring children to shop, cook and prepare food can set them up for a lifetime of healthy eating. A great way to teach children about food is to let them SHOP and COOK with you. Yet, a recent Ipsos survey found that 38 per cent of parents rarely or never let their child prepare a meal or snack – it’s a missed opportunity, but it can be easily fixed!

FIVE TIPS FOR COOKING WITH CHILDREN

It’s fun and rewarding to involve children in meal preparation – whether it’s at breakfast, lunch or dinner. Here are five tips for getting your children involved:

  1. Pick a recipe together: Children need to be part of the plan from the beginning, and it helps if they prepare something that they love to eat. Shop for groceries together too!
  2. Incorporate learning: Build on lessons they learn in school, such as math, social studies, media literacy, spelling, science and reading. Younger children can practice fine motor skills.
  3. Keep it fun! Imaginative play helps children get deeply involved. Make a theme night or turn your kitchen into a restaurant or reality cooking show.
  4. Be a role model: If you’re excited, they will be too. Try a new food, describe the flavour and be adventurous to inspire your eaters to do the same. Get other members of the family involved.
  5. Be cool about the mess: Spills and accidental messes happen, and it’s important to remain calm about little mishaps. Keep kitchen towels handy for cleaning up spills.

Children are much more likely to eat what they make, so cooking at home is a great tip! If you have picky eaters. It’s fun for them to eat their art creation!

Cooking with children helps reduce mealtime battles and boost their willingness to try new foods. It’s great for their self-confidence too.

WHAT CAN MY CHILD DO?

Here’s a guideline of kitchen skills based on age:

  • 2-3 year olds can wash vegetables and fruit or tear lettuce and salad greens
  • 3-4 year olds can mash potatoes and bananas or mix together batters
  • 4-6 year olds can measure dry and liquid ingredients or set the table
  • 6-8 year olds can toss salad ingredients together or make a simple breakfast
  • 8-12 year olds can make their own school lunch or help to plan meals
  • Teens can follow more complicated recipes or assemble and mix most ingredients. They can also be in charge of making one meal per week.

Did you teach your children how to shop and cook? Share your fun story. 

Adapted from the Dietitians of Canada’s Nutrition Month campaign materials. 

Top 5 Tips For Staying Cool When Feeding Kids During CNY

Top 5 Tips For Staying Cool When Feeding Kids During Chinese New Year

by with No Comment Child & Family NutritionPicky EatingToddler Nutrition

When I think about Chinese New Year in the past, many of my memories involve food. Cooking with my Mom, buying homemade cookies, preparing deep-fried spring rolls and sipping sugary-sweetened beverages or fake alcoholic drinks.

No matter what your Chinese New Year traditions are, food is always a huge part of the celebration. That’s why I think it’s important to put all weight loss goals on hold, give yourself a break and enjoy holiday foods without feeling guilty. I also think it’s important, as parents, to let our children enjoy holiday foods too — without being a food police and monitored our children’s diet for  24/7.

The Chinese New Year, in fact, present a great opportunity for our children to learn about moderation and mindfulness, if we give them the chance.

TOP FIVE TIPS FOR HOW TO MANAGE INDULGENT HOLIDAY FOODS WITH YOUR CHILDREN 

1. Have a healthy breakfast 

If there is one meal that should be non-negotiable, it’s breakfast. Children are hungry in the morning, so it’s a great opportunity to take advantage of their rumbly tummies and serve your children a balanced meal. We know that eating breakfast offers a wide range of benefits, but when protein (such as yogurt, milk, nuts, meat, eggs etc.) is included, it can tame the cookie monster later on by helping to control appetite and blood sugar levels. Breakfast is often the only meal that we can rely on timing-wise during the holidays (and even this can be random), so try to maximize nutrition here.

2. Throw your timetable out the window 

Without completely disregarding the time and allowing a food-free-for-all, try to be flexible when it comes to meal and snack timing during the holidays. Although you should ultimately maintain your role as the feeder (deciding what, when and where your child eats), it’s ok to relax a little during the holidays and go with the flow. Meals are often served earlier or later than usual, and snacking tends to be more frequent. When you do have some control over what is served (I focus on breakfast), try to include a nutritious variety of food, with milk or water to drink, and let the rest unfold as it will — holiday eating is random and fun and everyone (including children) should enjoy it.

3. Let your children decide 

At family gatherings, there will be platters of delicious foods that everyone is going to want to try (including your children). If there is a buffet, let your children explore different foods by guiding them through and allowing them to choose what they would like to try (not what you want them to eat). Try not to steer them towards healthy foods, but instead give them control over what goes on their plate. Allowing them to explore different foods that aren’t offered at home on a regular basis will help to widen their palate and give them a sense of independence and confidence when it comes to food.  Children will often choose some nutritious foods and some dessert foods–this is ok (and normal)! If you can, wait to visit the dessert table after your child has filled up on mealtime foods (or if you can’t avoid it the first round, visit it last). Sweet foods like chocolate, candy and cookies will almost always be gobbled up prior to nutritious mealtime foods, so children are more likely to fill up on them if given the chance.

Encourage balanced eating and mindfulness by modelling. Try to include veggies and fruits, lean protein-rich foods and some indulgent delicious foods too. Eat slowly and enjoy every bite. Leave foods that you don’t love (or that you’re too full to eat), behind, and have seconds of foods that you love and are hungry for. Modelling mindful, normal eating (regardless of what time of year), will benefit your child greatly, because they view how you eat as “normal”.

4. Don’t restrict treats and sweets 

The holidays present a great opportunity to teach your children about moderation and handling easy-to-love indulgent foods in a mindful way. After all, there will come a time when they’re exposed to unlimited amounts of these foods, and you want to prepare them for that. The idea is to raise children who are relaxed around indulgent foods; who make mindful, matter-of-fact decisions about when and how much they indulge (long term). Evidence shows that children who are restricted in their indulgent food intake eat more of them when they get the chance and are more overweight than they might be otherwise!

But how do parents teach their children about moderation?

Ellyn Satter, who is a leader in the field of child nutrition and feeding (and the master-mind behind the “Division of Responsibility in Feeding“), suggests including some savoury, high-fat foods like chips or fries at a meal sometimes (along with nutritious foods), and if dessert is offered, including a small serving for everyone who wants it (allowing everyone to decide when to eat it–before, during or after a meal). The reason she suggests limiting desserts to one serving at a meal is because children will take the easy way out and fill up on dessert otherwise. To counteract this scarcity created at mealtime however, Satter suggests periodically letting kids have unlimited access to sweets at a sit-down snack time, where they aren’t competing with other mealtime foods. For example, putting out a plate of cookies and a glass of milk, and letting your children eat as much as they’d like. When children feel that treats are limited or forbidden, they’re more likely to go crazy on them. And snack time presents a good opportunity to let them have unlimited access (periodically), and naturally learn about moderation.

It’s true, children will often go crazy at first (which is normal), but the novelty will wear off and they will tend to eat less and less. Try doing this not only during the holidays, but throughout the rest of the year too. Satter suggests offering nutritious sweets when you can, such as oatmeal cookies or banana bread, which will make it easier for you to trust the process!

5. Focus on family time, not food

Instead of fighting with your children to sit down to the table to eat dinner, let them know that they don’t have to eat if they don’t want to (after all, they have likely filled up on yummy snacks all afternoon with their siblings, friends or cousins) but that they do need to sit down at the table with everyone to visit, laugh and catch up. When you take the pressure off of children to eat, they are often more open to trying foods and being less “picky” with their choices. You may be surprised at how much your children end up eating, and even if they don’t, it’s OK. You will enjoy yourself so much more if you resist telling them to have “three more bites” and focus instead on creating happy holiday memories.

Happy holidays from my family to yours!

If you enjoy this post, you might also interested in reading about how to get your kids back into routine after Chinese New Year. 

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How to Deal with Halloween Candies

by with No Comment Child & Family NutritionPicky EatingToddler Nutrition

Halloween is here! As parents, many of us face the yearly challenge of a pillowcase full of treats or candies that lands on our kitchen table or living room floor, whether it is this year or in years to come. The question is: how will you handle it? Will you let your children have a candy free-for-all so it disappears quickly, or will you allow just one or two treats per day to make it last until Christmas? Maybe you’ll make the treats disappear in other ways, like encouraging your children to trade them for non-candy alternatives or even donating the haul.

Last year, my son was still young enough not to fully grasp what was going on. Candy hadn’t yet become the main attraction for Halloween. Instead, he was just excited to put on his “Superman” costume and head out for trick-or-treating.

Halloween 2016

How you choose to manage Halloween candy as a parent is personal. There’s  no single “right” way to do it. But why should we be concerned about our children consuming lots of candy? If sugary treats are eaten too frequently and in large amounts, they can contribute to poor dental health, displace nutrient-dense foods, and lead to unhealthy weight gain.

So, how can we teach our children about “treats” in general?

As a dietitian and mom, I take the approach that there are NO BAD FOODS, JUST BAD DIETS. What matters most is what we do between this Halloween and the next – what happens on October 31 is only one day.  Fun foods like candy and chocolate are delicious (let’s be honest!), and if we restrict them too much, they can become even more tempting.

This year, my son has a better idea of what Halloween is all about. And while part of me feels the urge to put on my “dietitian hat” and play the “Treats Police”, I try not to. I don’t want to take the joy of Halloween away from him. Instead, I use this time to teach him how to manage his treat intake on his own, both now and in the future, so he doesn’t feel the need to sneak, hide, or overeat treats. My goal is to use this fun holiday to help him build a healthy relationship with food.

Halloween 2017
Halloween 2017

Here’s what I’ve done now that my son has reached the stage where candy takes priority over cute costumes.

THE LAST MINUTE BUYER 

Grocery stores are clever, they position huge piles of Halloween candy right at the entrance when your cart is empty AND where you can’t help but see them as you wait in the checkout lane. Therefore, I wait until the day before (or maybe a week) before Halloween to buy candy. This way, I don’t have to deal with the “SEE-FOOD SYNDROME“. I also make sure to buy least favourite treats to hand out – lollipop, gummy candies, smarties, etc. If I were to buy chocolate, well, that would be a different story.

If your favourite candies/treats are in the house, you and your family are more likely to eat them ALL. Remember: Out of sight, out of mind; In your sight, in your mind. 

FULE UP BEFORE TRICK-OR-TREATING

Start the day with a wholesome, filling breakfast; encourage a healthy lunch, and make sure to serve a balanced dinner to fill their tummies before heading out for trick-or-treating. This way, you can prevent your children from turning into “candy monster” by the time they come home.

POUR IT OUT AND SORT IT OUT 

Use a small bucket or bag and limit the number of houses your children visit, so their candy collection starts out smaller. Once you’re back home with your child’s little sack of goodies, before you do anything, pour it out and sort it out together. Have them separate “the favourites” from “the least favourite”, and ask if they’d like to share any with will you. This is a great opportunity to teach them to be “picky” about their choices. Observe how much they consume without making any comments or rules, you may be surprised how many children can self-regulate and eat only a few pieces.

SWITCH WITCH 

Children can choose a few of their favourite candies and then leave the rest out for the “Switch Witch” who takes it away and replaces it with a desired toy or non-food gift, such as movie tickets, books, crayons or cash for older kids. Also, some families have their children donate extra candy to a local food bank or dental office.

LET THEM ENJOY

On Halloween night, I let my son pick two or three candies to try. For older children, you might allow them to enjoy as much as they want.

Forbidding them from having any candy can sometimes increase their desire for it.

Trust me, your child may surprise you by having a few pieces, then choosing to save the rest, or by gorging until they feel a little sick. Enjoying fun foods like candy and chocolate occasionally (even daily in moderation) is normal, and it’s important that children don’t label these foods as “bad” foods. This approach reduces the likelihood of them sneaking or over-indulging on candy when you’re not around.

And remember, one night of indulging in treats won’t affect their long-term nutritional status or weight. Often, the children seem to grow bored with their candy after a few days if it’s not overly restricted or rationed.

BOTTOM LINE

How can you make sure Halloween isn’t a nightmare for you or your children? Think of it as a perfect opportunity to teach them about MODERATION, BALANCE, MINDFUL indulging.

Happy Halloween !!

Did you know I offer personalized nutrition counseling for children and families? If you’d like to learn more, check out my service here. 

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My Child Refuses to Eat

by with No Comment MotherhoodPicky EatingToddler Nutrition

Many parents are worried about their child is not eating enough; or their child is small compared to other children and isn’t growing properly; or their child has very few foods that he will eat.

When it comes to mealtimes, toddlers or young children can be hard to predict. Some days they may not eat much. Other days it seems like they are eating all day long. They may want one food every day for weeks, and then suddenly not like it anymore. And how much your child eats may be very different from how much another child eats.

Picky eating is typical toddler behaviour. Most toddlers are picky eaters. This is one area of their life where they can exert some control. By refusing to eat, your child is practicing his or her independence. It’s your job as a parent to provide healthy food choices and teach good eating habits.

Here are the most common reasons why your child is refusing to eat at meals, and what to do about it.

TOO MUCH PRESSURE 

If your child feels any amount of pressure to eat or senses that you as the parent are anxious at mealtimes, he will likely back off and choose not to eat. Toddlers and young children sense pressure, even if it’s not as direct as “Eat your broccoli NOW !” If you focus too much on WHAT and HOW MUCH he is eating during a meal, instead of allowing him to simply be another eater at the table while everybody is eating, he will back right off.

Most common indirect pressure:

  1. You bring the food right in front of him
  2. You watch him every move
  3. You hover over him
  4. You continually take uneaten food off of his plate and replace it with new food
  5. You talk about his eating habit
  6. You pick up food and bring to his mouth without his cueing to do so

The more you push your child to eat, the more likely that your child will not enjoy eating. 

What to Do

Let your child self-feed and eat at his own pace at meals, provide lots of food variety at meals in manageable amounts, and let him be in charge of whether and how much he eats. Try your best not to hover over your child. I know it is extremely difficult, especially when he is hardly touching his food. Sit back and engage in conversations with the whole family, including your child. If you can think about mealtime more so as “family bonding time” than “I need to get my child to eat time”, your child won’t feel as pressured and will be more open to try new or previously rejected foods.

BOREDOM

Are you serving the same dish/recipe over and over again. Most parents get stuck in “food ruts” as their children are only eating certain foods. You prepare it as you know he will eat it. However, this is not a long term solution, it is your job to help your child grow up with a healthy relationship with food, not to get them to eat their meal RIGHT NOW.

What to Do

We get bored of certain foods and so do our children. Be creative, discuss with your child and come up with a few new and different snack or meal option for him, you can try to rotate so that he doesn’t get bored again.

NOT ENOUGH SAY 

The research has shown that children eat better when they involve with shopping, preparing, cooking and serving their meal. That’s why it is important to include children in meal prep, even letting them to mix together ingredients or set the table. From the previous blogpost, you have learned, parents should be in charge of the “what’s” of feeding, children might feels that they have no control over what they’re fed if parents don’t include them in choosing food once in a while. They may not like the way that their foods are placed on their plate, perhaps they grow bored of what you serve them.

What to Do

It is important to set healthy boundaries and meet your responsibility of “what”, “when” and “where”, but it’s okay to let your children be a part of the process. Get them involved in shopping, meal planning, preparing, cooking, serving and cleaning up. This process can be messy and longer, maybe a bit more frustrating. However, the benefits are huge and it’s worth it. You just have to be patient.

SIMPLY NOT HUNGRY

We know that children’s appetite can be unpredictable and erratic at the best of times. After the age of two, growth slows and stabilizes which meals that toddlers aren’t as hungry as they used to be. Your children can have “hungry days” (your child out-eats everyone at the table) or “full days” (your child doesn’t eat much at all). As long as you are maintaining your feeding roles and staying consistent with mealtime boundaries, your child should be in charge of whether and how much he eats. It is possible that your child is simply not physically hungry when a meal is served (for whatever reason) and that’s ok.

What to Do

  1. Accept “I’m not hungry” as an acceptable answer for now, and reminding your children that the “Kitchen will be closed after dinner, are you sure you’re done !!”.
  2. You may also want to consider having dinner a little bit later.

TOO MANY DISTRACTIONS 

Allowing your children to watch TV, IPAD or play with toys at the table is a recipe for distraction. Screen distractions can work in two different ways (negative). When a child is watching a show or playing a video game while eating, he is focusing ALL of his attention on the show he’s watching or game he’s playing. There is no attention left for eating his meal, not to mention listening to his hunger/fullness cues.

Also, I found that some parents like to spoon-feed their children (especially young infant) in random time (not at regular mealtime), so having random family members/strangers walk in and out to the kitchen, can be very distracted. Younger children have a hard time focusing on their meal with minimal distractions, older children can easily under or over-eat because they’re just not paying attention.

Playing with siblings at the table while eating can be very distracted too.

What to Do

  1. Set healthy boundaries by not allowing any electronic devices or toys at the table while eating.
  2. Seat children strategically so that they can’t touch each other.
  3. Eat together as often as possible. This helps to teach your child healthy eating habits, table manners and how to use utensils. It also provides a time to role model healthy eating.

LARGE PORTIONS 

Some children turn their plate away simply because the portion that they’ve been served is too large and overwhelming. Some parents thinks that their children appetite should be same as other children of the same age.

What to Do

Every child is different, even appetite. Continue serve a balanced meal with small portion, let him ask for more.

TOO MANY SNACKS 

Are you having a snacker/grazer at home? Children who graze between meals often come to the table feeling too full to eat. Research has shown grazers can eat up to 50% less than those with more regular meal and snack times. This is why it is so important to establish a mealtime structure.

What to Do

Set regular meal and snack times. Offer 3 meals and 2-3 snacks at regular times each day. You need to give your kids a chance to build an appetite for meals, otherwise, they won’t eat much and it can become harder for them to learn self-regulation.

TOO TIRED 

After a long day of playing, daycare, preschool, kindergarten, some kids just don’t have the energy to bring foods to mouth by the end of the day. During dinner time, if you’re finding that your child is fussy, easy to cry, rubbing the eyes or yawning, that’s probably what’s happening.

What to Do

Try to encourage him to fill his tummies before bed as best as he can, and remind them that there is no more food until next morning. You can also consider having earlier dinner.

NOT FEELING WELL OR SICK 

If your child is sick, it is likely that he will not eat well at a meal. In this case, make sure to keep your child hydrated, and offer “easy to digest” foods such as porridge, banana, bread, crackers, smoothie popsicle, soup and apple sauce until his appetite returns.

What to Do

Offer foods more often when you child is sick, but don’t push or force them. Fluids are most important.

TOO MUCH MILK OR JUICE 

Too much milk or juice can spoil the appetite. Milk contains fat and protein (two nutrients that make kids feel full). Juice contains excess calories and sugar.

What to Do

  1. 1-2 years old, offer 3 cups (24 oz/750 mL) of milk per day
  2. After 2 years old, 2 cups (16 oz/500 mL) of milk per day
  3. Offer only water in between meals and snacks for hydration
  4. Avoid or limit fruit juice to no more than 1/2 cup per day. You can water it down.

Do you have any questions about your picky eater? 

secret-behind-feeding-relationship-photo

The Secret Behind Feeding Relationship

by with No Comment MotherhoodPicky EatingToddler Nutrition

In my nutrition counselling practice, I often meet with frustrated and worried parents of picky eaters. Most scenarios, children are in charge of what, when and where food is served, and parents are trying to bribe or force their kids to eat at least two bites of some nutritious foods. This feeding relationship are completely reversed and parents have no idea.

THE FEEDING RELATIONSHIP 

The “Feeding Relationship” (Division of Responsibilities in Feeding) is a concept developed by Ellyn Satter, a dietitian and social worker. There are separate roles in feeding for the parent and for the child.

If these roles are respected, the child will be less likely to be picky and will grow up having a healthy relationship with food. 

PARENT’S FEEDING RESPONSIBILITIES  

When

There should be structured meal and snack time every day, so that your child knows when to expect another chance to eat. Children should be offered 3 regular meals and 2 or 3 snacks in between. Avoid grazing or snacking throughout the day. This timing structure will help your child build up a healthy appetite for the next meal.

Where

The child should be eating at the table with the family, with no distractions like TV or IPad. When your children eat in front of a screen, they aren’t focusing on their foods, or their inner hunger, or fullness signals; they’re instead focusing on what they’re watching.

What

As a parent, you get to decide what your child eats. Ideally, you should offer foods from each food group (with different colours, flavours and textures) at every meal if you can – a fruit or vegetable, a grain product and a meat or alternative and dairy.

Example: blueberries (cut in half) with slices of bread, cooked egg yolk and yogurt.

At family meals, your child should be served the same foods that the rest of the family is eating.

BABY/TODDLER’S FEEDING RESPONSIBILITIES 

How Much and Whether 

It is completely up to your child to take the lead role in eating. The child is responsible for how much or whether to eat the foods that you’ve served. Many parents are concerned their child is not eating enough, however children are good at regulating their appetites and will not starve themselves. They may eat a lot one day and almost nothing the next and that is ok. If they don’t eat much at one meal or snack, they’ll make up for it in the future meals or snacks, or even by the end of the week. Read 20 Strategies to Raise a Mindful Eater. This way you do not set up power struggles with eating.

Remember, it might take up to 15 tries before the baby or child will actually eat the food.

BOTTOM LINE 

We need to take a step back and let our kids decide if they are going to eat their food and how much they are going to eat. No pressure, no forcing and no bribing. We, as a parent, have to respect their hunger and fullness cues. If we’re respecting this feeding relationship, the power struggles and stress around your family table will dramatically decrease.

Do you have a picky eater at home? You need more meal ideas? You need some strategies to deal with your little picky eater at home. Contact Me about starting a personalized nutrition consultation program.

Introducing Solids to Your Baby: Baby-Led Weaning Vs. Spoon Feeding

Introducing Solids to Your Baby: Baby-Led Weaning Vs. Spoon Feeding

by with No Comment Infant NutritionMotherhoodPicky EatingToddler Nutrition

When I was a nutrition student, I was taught at school that there is ONLY one way to introduce solids to baby – the traditional “puree, spoon-fed” way.

After being a first-time mom, I was first introduced to the concept of “Baby-Led Weaning” by a friend of mine when my son was around 6 months of age. I had never heard of this before and didn’t know what to think, the questions keep popping in my head “what about the importance of iron-rich foods when first starting solids?” and “what about choking?”. I was so curious and I decided to do some research to learn more about it.

WHAT IS BABY LED WEANING? 

The name itself is a bit misleading (I was fooled by it for a while) as we usually think of weaning as the process of stop breastfeeding. Baby-led weaning is DIFFERENT. It is the term used to describe a way of introducing solid foods where babies feed themselves starting about six months of age. Breastfeeding (or formula feeding) continues during this process. For their first solid foods, babies are given larger pieces of soft foods that they can grasp and eat instead of the more Traditional Method of feeding where parents spoon-feed mashed or minced foods to babies. The idea behind baby-led weaning is that the baby can share the same (or similar) foods that the rest of the family is eating and that they sit and participate in the family meal while everyone eats.

TWO APPROACHES TO INTRODUCING SOLIDS TO YOUR BABY 

Baby-led weaning and the Traditional Method of introducing solids have similarities. They both recommend you:

  • Start introducing solids at about 6 months of age (when baby shows they are ready)
  • Let your baby choose how much to eat
  • Introduce safe finger foods starting at 6 months
  • Encourage eating with the family
  • Move toward offering the same foods as the rest of the family
  • Never leave the baby unattended while eating

WHAT YOU NEED TO KNOW BEFORE CHOOSING AN APPROACH 

Age: Start at 6 months

For both approaches, it is recommended to start at 6 months when your baby can sit up and control her/his head movements. Most babies can grasp larger pieces of food and will try to put them in their mouth at this stage.

Follow Baby’s Hunger and Fullness Cues

With whatever method you choose, practice responsive feeding. This means watching for the cues and clues your baby gives you. Follow your baby’s lead and make sure that she/he decides whether or not she/he eats, what she/he eats (of what you offer), how much she/he eats and how fast or slow she/he eats.

Type of Foods: Offer Iron-Rich Foods as First Foods

Babies need a lot of iron (11 mg/day at 7-12 months of age) and that is why it is recommended that the first foods offered to babies be iron-rich. Please read: Best Started Foods for Baby-Led Weaning

With baby-led weaning it may be more difficult to ensure your baby is getting the iron she/he needs. Some parents will start with vegetables and fruit as first foods because they are easy finger foods. However, these foods don’t have enough iron to meet baby’s needs. Offering iron-rich food at least twice a day will help give your baby the iron she/he needs.

Safety: Avoid Foods that are Choking Hazards

The risk of choking is a concern with infants no matter what method of feeding you use. To minimize the risk, always ensure that your baby is sitting up and facing you when eating, learn about how to avoid/decrease the risk of choking and brush up on your infant first aid/CPR course to help keep your baby safe.

DIETITIAN’S THOUGHTS 

Self-feeding usually takes longer than spoon-feeding, so allow time for your baby to eat. Some babies will be better than others at getting food into their mouths and eating it. If you’re trying BLW and find that baby continues to have a hard time, try a mixed approach (TW+FF). Offering some food on a spoon in addition to finger foods may help them meet their energy, iron, and general nutrition needs. It may also help them avoid feeling frustrated if they want to eat but don’t quite have the movements down. I certainly don’t think that you should be made to feel guilty about the way you choose to introduce solids.

If your baby was born early, is not growing well, is developmentally delayed or has a condition that makes chewing or swallowing difficult, then BLW may not be appropriate for them.

Whether you choose to try BLW, traditional approach or a combination of the two, the main goals are:

1) to provide your baby with the nutrients and energy she/he needs

2) to expose her/him to new flavours and texture

3) to help her/him safely learn eating skills in a relaxed environment with no parental pressure or distractions

In the end, the best approach is the one that makes you both feel comfortable and confident. Feeling good about how things are going helps to make the eating experience pleasurable for the whole family.

Do you have any questions about feeding your baby? Worry about choking? Contact Me about starting a nutritional counselling program.

Adult Picky Eating

Adult Picky Eating

by with No Comment Picky EatingWeight Management

People ask me this big question all the time “My child is a picky eater, what can I do next?“. Well, there is no easy and solid answer. As a dietitian and mom, I get it! Parents want what is best for their children, but they don’t know how to provide it. Parents are always in search of the “secret recipes” to get their picky eater to eat healthier or more, but there isn’t one. Up to 35% of children are described as “picky” by their parents, so you’re not alone in the struggle! It is not an easy task to incorporate healthy foods into their diet every single day. Although it may sound very challenging, there are strategies parents can use to help encourage their children to eat healthier. There are no quick and easy fixes here, and no one strategy will work for all children.

First things first, is your child a picky eater or are there other things going on that affect his/her eating? Upon further inspection in my practice, I commonly find that parents are picky eaters too. They don’t eat together with their children or they don’t share the same type of foods.

Children love to copy their parents. If your child sees you eating a diverse range of foods, they are more likely to do the same.

I’ve plenty of adult clients telling me they were labelled as “picky eater” when they were young. They grow up. Now, they don’t want to raise another “picky eater” in the family. Most parents know avocado, butternut squash, oatmeal, quinoa, millet, Greek yogurt, salmon are good for their babies who are just starting to eat solid foods. However, they end up stop offering them because they don’t know how or they do not know of alternatives to boiling or steaming.

ADULT PICKY EATING  

Being a picky eater is not necessarily a problem. There is no rule that says you need to like every single food that exists in the world. If picky eating causes you anxiety or prevents you from socializing, it may be more of a concern (Read this article about Avoidant/Restrictive Food Intake Disorder [ARFID]). Otherwise it can be a health concern if you’re not meeting your nutritious needs or living on a super restricted diet.

Ellyn Satter states that while some aspects of picky eating are socially acceptable, such as choosing which foods you want , leaving unwanted food on your plate, and taking more of one food even if there’s uneaten food on your plate. However, it is not socially acceptable to draw attention to your food refusal or request food that is not on the menu.

I recently tried a Brussel Sprouts recipe. I have never tried Brussels Sprouts in my life, ever !! My mum never made it (she didn’t even know how to prepare it). After some thought, I bought fresh brussels sprouts and roasted them with only a few ingredients, and promptly loved them! Changing the method of preparation can significantly alter the appearance and taste of a food, making it a lot more palatable and enjoyable.

So, before complaining about your children not eating the broccoli that you serve for dinner, why not start looking at your dinner plate. Are you a good role model? Do you have some foods that you absolutely hate it? Are you eating all your servings of vegetables and fruit each day?

HOW TO BECOME A GREEN LOVER 

What do you do if you want to try introducing more vegetables (or other foods) into your daily.

  • Buy fresh vegetables and fruit when on sale to save money.
  • If you are short on time, buy convenience items in the produce section. Try pre-cut, pre-washed vegetables – a bag of salad, spinach, baby carrots, snap peas, or broccoli.
  • Start your meal with a salad made from spinach, lettuce, or grated carrot. Top it off with chopped vegetables or fruit, like orange, apple, strawberries or pomegranate.
  • Keep washed and sliced carrots, celery, peppers, zucchini, or cucumber at eye-level in the fridge for a quick snack or to add to a lunch bag.
  • Add fresh or frozen vegetables to spaghetti sauce, soups, stews, chilli, casseroles and curries.
  • Double up on the vegetables in recipes. A soup called for a carrot? Add two, A stir-fry calls for half a pepper? Add a whole one.
  • Choose or make pizza topped with mushrooms, zucchini, red or green peppers, broccoli, spinach, shredded carrots, tomato slice, or pineapple.
  • Adding simple flavours to vegetables. Try new seasonings – garlic, onion, ginger, a bit of olive oil, and a sprinkle of pepper can transform vegetables.
  • Put lots of sliced or shredded vegetables on sandwiches and in wraps.
  • Pairing your favourite veggie with guacamole or hummus.
  • Add green leafy veggies such as kale or spinach to morning smoothie.
  • Scrambled eggs with chopped spinach, mushrooms, and tomatoes can be eaten as both as side dish at dinner with rice, or as a breakfast item in the morning.
  • Add sliced fresh fruit to cereal or yogurt or mix into pancake batter.
  • Have a bowl of washed fruit on your kitchen counter for an easy to grab snack.
  • Freeze fruit that has become too ripe, to use later in baking or smoothies.

Stop labeling yourself as a “non-veggie eater”.

True, a diet with many fruits and vegetables will likely be more colourful and nutrient dense than one with only 3 or 4 choices, but progress over perfection, it will allow yourself a judgement free, unpressured environment to congratulate yourself on your veggie success, and when ready, slowly introduce new foods and/or methods of preparation.

INCREASE VARIETY IN YOUR DIET 

As Ellyn Satter advises, provide yourself repeated, unpressured opportunities to introduce new foods. Don’t force yourself to try a new food, allow yourself the freedom to try it and the freedom to not finish it. By regularly exposing yourself to a new food, you just may trick yourself into liking it!

STEPS TO INTRODUCE MORE VEGGIES

If you are a picky eater, and want to try introducing more vegetables (or other foods) into your family daily repertoire, here’s the step by step:

  • Take inventory of the vegetables you DO like eating and eat them more often!
  • Chose a new veggie (you either have never tried or haven’t purchased in a very long time), and prepare it along with a favourite food.
  • Don’t force yourself to eat the new food, and don’t feel bad if you weren’t able to enjoy it.
  • Keep introducing and re-introducing new veggies – it will likely take many times of tasting until you’re used to a flavour, texture and taste, but don’t give up! Having a larger food base to choose from gives you more flexibility around meal time and can also lead to a healthier you!

Choosing veggie and fruit is about making an EVERY DAY food decision, not just going by taste. It’s about FUELING your body well, and if you don’t eat enough currently, developing healthy habits that your brain learns as the path of least resistance. 

Do you have a food you think you should be eating more of? How do you introduce yourself to new foods? 

Cranberry and Dark Chocolate Chip Cookies

Cranberry and Dark Chocolate Chip Cookies

by with No Comment Picky EatingRecipesWeight Management

It is time to say HELLO to a new chocolate chip cookies. When you have a craving for a classic chocolate chip cookie, bake up a batch of these! You won’t regret.

These were good and very kid friendly, crunchy, thick and delicious, strong enough to hold together in children’s lunches and small enough that you don’t feel too guilty sending them to school for a treat. I put the high fibre All-Bran Flakes cereal in the recipe.

Don’t forget to pair with a glass of low fat milk!! Enjoy !

This is a super delicious recipe and my go to for late night “Oh my god, I need a cookie” moments.

Recipe adapted from All Bran 

If you like this recipe, you might also want to try this delicious Oatmeal Cranberry Chocolate Chip Cookies.

Cranberry And Dark Chocolate Chip Cookies

Print Recipe Pin Recipe
Prep Time 10 minutes
Cook Time 12 minutes
Total Time 22 minutes
Course Dessert, Snack
Servings 33

Ingredients
  

  • 1.5 cups whole wheat flour
  • 1 tsp baking powder
  • 1/4 tsp baking soda
  • 1/4 tsp salt
  • 3/4 cup butter, softened
  • 3/4 cup brown sugar
  • 1 egg
  • 1/2 tsp vanilla
  • 1.5 cups all bran flakes cereal
  • 3/4 cup dried cranberries
  • 3/4 cup dark chocolate chips

Instructions
 

  • In medium bowl, stir together whole wheat flour, baking powder, baking soda and salt. Set aside
  • In large bowl, cream together butter, and brown sugar. Beat in egg and vanilla. Stir in dry ingredients, mixing until well combined.
  • Stir in All-Bran Flakes cereals, dried cranberries and dar chocolate chips.
  • Drop dough by rounded 1 tbsp measure about 1 inch apart onto lightly greased (or parchment lined) baking sheets.
  • Bake at 350F (180C) for 8-9 minutes, until golden brown. Let cook for 2 minutes, then remove to racks and cool completely. Store in airtight container.