Safe Ways to Introduce Nuts to Baby

Safe Ways to Introduce Nuts to Baby

by with No Comment Baby Led WeaningChild & Family NutritionFood Allergy

Undoubtedly, introducing nuts to a baby can be scary, as they pose both a choking hazard and rank among the top nine allergens.

However, introducing nuts to your baby between the ages of 6 and 12 months can actually help lower their chances of developing an allergy. So, how can you safely introduce nuts to your baby?

WHAT CAUSES AN ALLERGY

An allergy occurs when the immune system erroneously recognizes a protein in a specific food as a potential threat. Subsequently, the immune system becomes activated and releases substances like histamines to combat this perceived danger. This immune response triggers inflammation, which results in the symptoms of an allergic reaction.

BENEFITS OF NUTS FOR BABY 

Nuts offer a wealth of nutrients and health benefits, and there are numerous ways to include them in a baby’s diet.

Different nuts have different nutrient profiles, but generally, they are rich in fats crucial for a baby’s growth and development. Additionally, they provide essential protein for muscle growth and tissue repair, along with fiber to support a healthy digestive system. Nuts are also a source of important micronutrients such as calcium, iron, folate, vitamin E, zinc, and more.

WHEN TO INTRODUCE PEANUTS AND OTHER NUTS TO BABY 

Back in 2000, parents were advised to avoid the introduction of allergenic foods for the first 1 to 3 years of life, with the belief that this would reduce the risk of developing allergies. However, recent research has shed light on this matter, revealing that delaying the introduction of allergenic foods not only fails to provide protection against allergies but can actually raise the risk of developing them.

A significant study called the LEAP study, conducted in England from 2006 to 2014, focused on infants at high risk of developing peanut allergies, including those with severe eczema, an egg allergy, or both. This study found that babies who were introduced to peanuts before the age of one and consumed them regularly in their diet had an 86% reduction in peanut allergy compared to children who avoided peanut.

Specifically, the group of children who avoided peanuts had a 17% incidence of peanut allergy, while the group that regularly included peanuts had a substantially lower rate of 3%. These findings underscore the importance of early and consistent introduction of allergenic foods like peanuts to reduce the risk of allergies in high-risk infants.

In early 2017, the National Institute of Allergy and Infectious Diseases (NIAID) release new guidelines specifically addressing peanut allergies. These guidelines received endorsement from prominent organizations such as the American Academy of Pediatrics, National Institute of Health and the American Academy of Allergy, Asthma, and Immunology, Malaysian Society of Allergy and Immunology , Canadian Society of Allergy and Clinical Immunology .

These guidelines recommend the introduction of allergenic foods at around 6 months of age, when babies are developmentally ready for solids (not before 4 months), and that all babies should have these foods by 12 months. This includes babies at high risk of allergy, unless an allergy to that particular food has already been confirmed.

Furthermore, once allergenic foods are introduced, it is beneficial to continue to offering them regularly, approximately twice a week. This practice helps in maintaining tolerance and reducing the risk of developing allergies.

WHAT NUTS CAN BE INTRODUCED TO BABY 

PEANUTS VS TREE NUTS

Peanuts and tree nuts, despite both being categorized as ‘nuts,’ do not share a botanical relationship and originate from distinct plant families. Surprisingly, peanuts aren’t true nuts; they belong to the legume family, such as soybeans, chickpeas or kidney beans. Interestingly, most individuals with a peanut allergy can typically consume other legumes safely.

  • Peanuts
  • Almonds
  • Brazil nuts
  • Cashews
  • Chestnuts
  • Hazelnuts
  • Macadamia nuts
  • Pine nuts
  • Pecans
  • Pistachios
  • Walnuts

We know that peanuts are not related to tree nuts, so most people tend to be allergic to either peanuts OR tree nuts. However, approximately 1 in 3 individuals with a nut allergy are allergic to both peanuts and tree nuts.

It’s now known that there is some cross-reactivity can occur between different foods, as well as between pollen and certain foods or latex and certain foods. So, having a tree nut allergy doesn’t necessarily indicate an allergy to all types of tree nuts, but it significantly increases the risk of being allergic to others. For this reason, each type of nut needs to be introduced separately, ideally leaving 2-3 days between each one.

NUT BUTTERS

You have the option to prepare your own nut butter or purchase a commercially available brand of any of the nuts listed above. If opting for a store-bought variety, ensure that it is free from any additives like sugar, salt, oils, or preservatives. It should only contain the specific nut you intend to introduce.

After individually introducing each type of nut to your baby, using mixed nut butter can be a convenient method to continue exposing your baby to a variety of nuts simultaneously, rather than incorporating each nut separately. This approach simplifies the process of diversifying your baby’s nut consumption while ensuring they receive a broad range of nut-related nutrients.

A useful tip for nut butter: If your nut butter is too thick and clumpy, you can transfer a small amount to a microwave-safe bowl and heat it in 20-second intervals, stirring each time, until it becomes slightly warm. The heat will aid in smoothing out the nut butter and making it thinner in consistency.

GROUND OR FINELY CHOPPED NUTS

Another way to introduce nuts to your baby is by finely grinding them and then sprinkling them on top of pureed foods, oat cereal, avocado, banana, or other solid foods. To grind the nuts, you can take a small handful and pulse them in a blender or food processor until they are finely chopped. It’s essential to check the size of the nuts while pulsing every 20 seconds to avoid turning them into a paste or nut butter. Alternatively, you can finely chop a small quantity of nuts on a cutting board. Once you have the finely chopped nuts, you can sprinkle them onto your baby’s food, leave them as they are, or stir them in for added texture and flavor.

ARE NUTS A CHOKING HAZARD FOR BABY?

Whole nuts pose a choking hazard and should not be offered to children under the age of 4. Additionally, chunky nut butter with large lumps should be avoided for the same reason. To ensure safety, serve nuts to young children in alternative forms such as puffs, nut powder, finely chopped, in the form of flours, thinned nut butter, or incorporated into purees. These preparations minimize the risk of choking and make nuts more suitable for young children’s consumption.

ARE NUTS A COMMON ALLERGEN?

Peanuts and tree nuts are all classified as top food allergens, so it’s important to be vigilant about any potential reactions when introducing foods containing nut ingredients to your baby. Allergic reactions can occur within minutes to hours after consumption, so it’s advisable to offer such foods at a time when you can closely monitor your child for a few hours, rather than during dinner.

Be attentive to possible symptoms of an allergic reaction, which may include itchy rashes, hives, vomiting, difficulty breathing, swelling of the lips and tongue, and, in severe cases, anaphylaxis. If any of these symptoms occur, promptly contact your pediatrician. In the case of anaphylaxis, call for help immediately.

FEEDING TIPS WHEN INTRODUCING NUTS 

  1. Nuts pose a choking hazard for babies and young children, so it’s important to avoid offering whole nuts, chunks of nuts, or large dollops of nut butter to ensure their safety.
  2. Serve nuts earlier in the day: When introducing a new type of nut, offer it during breakfast or lunch so you can closely monitor your baby for any potential allergic reactions.
  3. Start with a small amount: You don’t need to give your baby a large serving to check for reactions. Begin with a small quantity to gauge their tolerance.
  4. Never rub on your baby’s skin: This will not help to identify a food allergy and can actually increase the risk of an allergy developing.
  5. Keep it on the menu: After successfully introducing a specific type of nut into your baby’s diet, aim to include it regularly in their weekly meal plan. This consistent exposure can potentially reduce the risk of developing allergies later in life.

HOW TO INTRODUCE PEANUTS OR TREE NUTS TO BABY 

Begin by introducing one type of nut early in the day, allowing you to closely monitor for any potential symptoms. To ensure safety and to thoroughly assess for any overlooked reactions, it is recommended to reintroduce the same variety of tree nuts or peanuts the following day, preferably around the same time. To monitor any allergy reactions, it’s best to wait 1-2 days before switching to a different type of nut.

Here are some of my favourite ways to introduce peanuts and tree nuts to your baby’s diet:

FOR TRADITIONAL WEANING 

  1. Add a small amount of warm water to a teaspoon of nut butter. Blend until you reach a smooth consistency, never serve a globs of nut butter as it can pose a choking hazard for young children.
  2. Infant cereal or oatmeal: Mix nut butter or finely chopped nuts into baby’s meal for added flavor and nutrition.
  3. Purees: Add a small amount of nut butter or finely chopped nuts to homemade baby purees for added texture and nutrition.
  4. Smoothies: Blend nut butter into a fruit or yogurt smoothie for a creamy, nutty flavor.

FOR BABY LED WEANING OR FINGER FOODS 

  1. Pasta tossed with pesto (if making at home, you can change which nuts or seeds you use as the base).
  2. Nut butter thinly spread on toast, pancakes, or waffles strips.
  3. Sprinkle finely chopped nuts on slices of banana, avocado, sweet potato wedges, oatmeal, applesauce, or yogurt.
  4. Mixed finely chopped nuts into the batter of pancakes, waffles, and muffins. Use a small amount of almonds to replace some of the regular flour used in baked goods.
  5. Nut butter yogurt dip.

The above methods offer versatility in introducing nuts to your baby’s diet, allowing you to choose the most appropriate option based on your baby’s age and preferences.

RELIABLE DIAGNOSIS OF FOOD ALLERGY IS IMPORTANT

It is important that allergies are accurately diagnosed and confirmed by a medical doctor. Your child’s doctor may conduct skin prick tests or blood tests to assess allergen-specific IgE levels, which can aid in confirming or ruling out potential allergens. However, it’s important to note that while these tests can establish the presence of an allergy, they do not predict the severity of an allergic reaction in individuals with allergies.

It’s also worth mentioning that some other forms of allergy testing lack scientific evidence and are therefore not recommended.

BOTTOM LINE 

Many foods are suitable for young children, but whole nuts are a choking hazard until at least age 4, and spoonfuls of nut butters can be too sticky for little mouths. The good news is that there are numerous delicious ways to serve nuts, providing healthy fats, protein, and essential nutrients. Nuts are rich in vitamins and minerals like Vitamin E and iron, making them a valuable addition to children’s diets for enhanced nutrition. I hope this blogpost can help you safely incorporate nuts into your baby’s diet while minimizing risks and promoting healthy eating habits.

Did you know that I offer personalized one-on-one nutrition counselling for children and families? If this is something you’s like to learn more about, check out my service.

Can My Baby Get Enough Iron Using Baby Led Weaning

Can My Baby Get Enough Iron Using Baby Led Weaning

by with No Comment Baby Led WeaningInfant Nutrition

While I’m a fan of Baby Led Weaning (BLW), the concern about not getting enough iron intake is real, especially since many moms like to offer fruits and veggies as starter foods for their babies. In fact, this is one of the top mistakes parents make when practising BLW!

Iron deficiency is estimated to be the most common deficiency worldwide. It can lead to anemia, impaired growth and development, as well as impaired cognitive function, including delayed attention, learning difficulties and social withdrawal. According to Malaysia’s National Health and Morbidity Survey (NHMS) 2022 Maternal and Child Health report, 46.5% of children between 0-5 years old were anemic. Therefore, in contrast to the popular saying, “food before 1 IS NOT just for fun.”

INCREASED NEEDS

By the age of 6 months, your baby’s iron stores, acquired during pregnancy, begin to deplete. This depletion is influenced by factors such as the mother’s iron levels during gestation, delayed cord clamping at birth, and the baby’s gestational age at birth. Around eighty percent of the baby’s iron stores accumulate during the third trimester of pregnancy. If your baby is born “overdue,” it can be one of the advantages in this context.

While breast milk contains a smaller quantity of iron (0.5 mg/L) compared to formula, but the iron present in breast milk is significantly more easily absorbed – approximately 50% absorption, as opposed to the 10% absorption rate in iron-fortified formula. Consequently, both breastfed and formula-fed infants receive comparable amounts of iron.

As infants reach six months of age, they continue to obtain some iron from their breast milk or formula, but introducing solid foods becomes crucial to provide a supplementary source. These solids are commonly referred to as “complementary foods,” as they complement the nutritional intake from a baby’s milk.

The question then arises: How much additional iron do babies require, and where should they get it from to ensure adequate intake?

HOW MUCH IRON DOES MY BABY NEED?

So, how much iron does a full-term, healthy-weight baby need?

In North America, the Recommended Dietary Allowances (RDA) for iron

  • BABIES 0-6 MONTHS: 0.27 mg/day
  • BABIES 6-12 MONTHS: 11 mg/day
  • TODDLERS 1-3 YEARS: 7 mg/day

In Malaysia, The Recommended Nutrient Intake (RNI)

  • BABIES 6-11 MONTHS: 9 mg/day (10% bioavailability); 6 mg/day (15% bioavailability)
  • CHILDREN 1-6 YEARS: 6 mg/day (10% bioavailability); 4 mg/day (15% bioavailability)

Therefore, I think it depends where you are. The good aiming point is about 7-8 mg of iron daily for 6-12 month olds who consume meat. For vegetarian babies, a better target is probably 9-11 mg per day.

It is important to note that 11mg (RDA) is an average requirement (from breastmilk/formula and food) for ages 7 to 12 months. Babies’ iron needs don’t suddenly surge overnight, it’s a significant increase that we should strive to approach as quickly as possible. There can be a big difference in size and appetite between a 7 month old and a year old child. 12-month olds will need more iron than seven-month olds, but they can also eat more food, so they will work up to this amount gradually. The great news is that babies progress very quickly to consuming a fair amount of food with BLW.

Furthermore, you do not need to be counting the exact amount in milligrams of iron your child consumes each day – this is wearisome and stressful. The main goal is to provide as many iron-rich foods throughout the day as possible.

SIGNS OF IRON DEFICIENCY

If you’re worried that your child isn’t getting enough iron, here are some signs and symptoms of iron deficiency you can watch for:

  • Slow weight gain
  • Little or no appetite
  • Pale skin
  • Always tired
  • Cold hands and feet
  • Brittle nails
  • Poor immunity (often sick or frequent infections)

To prevent anemia, the American Academy of Pediatrics recommends conducting a blood test on all 12-month-olds to assess their iron levels. In Malaysia, if you’ve concerns about your child’s iron intake or notice signs of deficiency, it is advisable to consult a doctor and request a blood test.

If the levels are significantly low, it is necessary to provide your child  with iron supplements for a few months, as relying solely on food is unlikely to be enough to restore iron levels to normal levels.

CAN BABY LED WEANERS GET ENOUGH IRON (RESEARCH)

According to Baby-led Introduction to Starting SolidS (BLISS) study, two hundred families from New Zealand were divided into two groups: the BLISS group and the control group.

In the BLISS group, parents were taught to prevent choking, growth faltering and how tonsure an adequate intake of iron-rich foods while self-feeding. They were encouraged to offer at each meal:

  • High iron food (e.g., red meat and fortified cereals)
  • Energy-rich food (e.g., cheese or avocado)
  • Easy-to-eat food ((e.g., fruit or veggie)

A study originating from the BLISS trial, titled “Impact of a Modified Version of Baby-Led Weaning on Iron Intake and Status: A Randomized Controlled Trial,” examined the effects. Nutrient intake at 7 and 12 months of age was assessed through weighted 3-day diet records. Additionally, the iron status of the babies was analyzed using a blood sample taken at 12 months of age.

The results indicated that 83% of babies in both the control and BLISS groups had adequate iron levels, with 5% in the control group and 7% in the BLISS group showing signs of anemia. No significant differences were observed between the two groups in terms of iron levels and stores at either 7 or 12 months of age.

This is indeed promising news! With additional education on the safe implementation of BLW, it has the potential to serve as a nutritious and safe approach to introducing solid foods.

So, Can BLW Babies Get Enough Iron?

The short answer is YES! It is possible.

The main source of iron for traditionally weaned babies is iron-fortified rice cereal, which is usually skipped in BLW. But, baby led weaners can absolutely get enough iron in their diets! In fact, BLW babies typically consume meat if it’s part of the family’s diet, whereas traditionally weaned babies might not eat meat right away at the beginning of starting solids. As long as parents focus on offering iron-rich foods at each meal, there is no significant difference in the iron status between babies following the BLW approach and those being fed purees.

Vegetarian and vegan infants might encounter more challenges in obtaining sufficient iron, yet this goal is achievable through strategic planning by parents. By conscientiously providing iron-rich foods or incorporating rice cereal, the necessary iron intake can still be achieved.

WHAT FOODS ARE HIGH IN IRON

There are two types of iron sources: heme and non-heme. Heme iron, is found in animal products like meat, fish, and poultry, the human body has a high absorption rates at approximately 20%. Conversely, non-heme iron is found in plant sources like soy, lentils, beans, and even eggs, but it is less easily absorbed by the body, with only around 10% uptake. It is crucial to recognize that iron sources vary in their bioavailability.

I don’t believe in focussing on numbers and exact amounts of iron/foods to give, as this approach can lead to unnecessary stress. However, I do think it is useful to know the amounts of iron found in realistic serving sizes of some of the foods mentioned below. Here are a few examples along with approximate iron levels:

HEME-IRON FOODS:

  • Liver (chicken, turkey, lamb), cooked* = 6.2-9.7 mg
  • Ground beef (75 g) = 1.3-2.2 mg
  • Ground chicken/pork (75 g) = 0.8-1.2 mg
  • Chicken (75 g) = 0.4-2 mg (dark meat has higher levels than white meat)
  • Sardines, canned (75 g) = 1.7-2.2 mg
  • Tuna, light, canned in water (75 g) = 1.2 mg

*While liver is an excellent source of iron, it contains an excessive amount of preformed Vitamin A, which could be toxic. The Upper Limit recommended for ages up to 3 years is 600 micrograms, whereas just 1 oz of liver contains over 5,000 micrograms. Plus, the liver is the filter for our body, and it can also contain metals.

How to serve heme-iron foods in BLW:

  • Ground meat sauce
  • Baby burgers or meatballs
  • Offer no-added salt canned sardines as finger food
  • Pressure or slow-cooked pork or beef roast, shredded
  • Pork ribs or chicken legs (removed of gristle)
  • Boneless chicken thighs, cut into finger-sized strips
  • Fish or salmon cakes

NON-HEME IRON FOODS:

  • Eggs (2 eggs) – 1.2 – 1.8 mg
  • Edamame (1/2 cup) = 1.9-2.4 mg
  • Tofu (¾ cup) = 2.4-8 mg
  • Lentils (¾ cup) = 4.1-4.9 mg
  • Beans (white, kidney, navy, pinto, black, etc.) (¾ cup) = 2.6-4.9 mg
  • Hummus (¼ cup) = 1.4 mg
  • Oatmeal, instant, cooked (¾ cup) = 4.5-6.6 mg
  • Wheat germ (1 tbsp) = 1.2 g
  • Spinach, cooked (½ cup) = 2.0 -3.4 mg
  • Hemp hearts (1 tbsp) = 1.4 mg
  • Blackstrap molasses (1 tbsp) = 3.6 mg

How to serve non-heme iron foods in BLW:

  • Eggs fried and sliced in strips or scrambled
  • Firm tofu strips sautéed or roasted.
  • Blend soft tofu into smoothies for variety.
  • Add blackstrap molasses to baking.
  • Sprinkle wheat germ or hemp hearts on yogurt or blend into a smoothie.
  • Serve hummus on a strip of toast.
  • Black beans are a good finger food to practice the pincer grasp.
  • Smush larger beans like chickpeas with your finger, so they’re not a choking hazard.
  • Bean or lentil patties.
  • Nut butters on toast fingers.

TIPS TO GET ENOUGH IRON WHILE USING BLW (6-12 months)

  1. Continue providing adequate breast milk or formula as the baby’s main source of nutrients. At this age, solid foods serve as complimentary options to to boost baby’s nutrient intake and gradually prepare their digestive system for a complete transition to solids.
  2. Ensure that every meal includes a source of iron, both heme and non-heme iron.
  3. Incorporate fortified powder infant cereal baked into finger foods. You can also substitute half of the flour in your pancake recipes with fortified infant cereal.
  4. Pair iron-rich foods with vitamin C rich foods, to increase the absorption of non-heme iron in the body. Consider top[ing fortified pancakes or cereal with fruit compote; serve lentils in stewed tomatoes and adding spinach to a fruit smoothie.
    Other good sources of vitamin C, including bell peppers, tomatoes, broccoli, citrus fruit and berries, etc. Ground meat in a tomato-based sauce forms an ideal combination.

  5. Cook with cast iron cookware. Cooking with cast-iron pots and pans safely introduces additional iron to the prepared dishes. If you don’t have one, you can try a product called the Lucky Iron Fish®. This is a simple, reusable and effective cooking tool that adds extra iron to your daily foods, soups or drinks. It is an affordable solution, especially for those with iron deficiency anemia.
  6. Cook with garlic or onion. Preparing meals with allium-containing ingredients (such as garlic and onions) can help increase iron absorption.

BOTTOM LINE 

Regardless of which feeding approach you choose, it is recommended to introduce iron-rich foods at around 6 months of age depending on their developmental readiness for trying solid foods.
A baby following the baby led weaning approach can indeed obtain sufficient iron intake, by offering a variety of iron-rich food sources.

For more help with baby led weaning and how to help you baby succeed with eating, be sure to check out my 3 months TRANSFORM program. 

Know the Difference between Gagging and Choking When Starting Solids

Know The Difference Between Gagging and Choking When Starting Solids

by with No Comment Baby Led WeaningInfant Nutrition

Many parents are terrified of feeding their baby beyond purees or finger foods.

“Is there a risk of my baby choking if I introduce finger food?”

“What is the difference between gagging and choking?”

“How to prevent my child from choking?”

“What should I do if my baby starts choking or gagging?”

“How can I overcome my intense fear of choking when feeding my baby?”

DOES BLW INCREASE THE RISK OF CHOKING? (WHAT THE RESEARCH SAY)

A 2021 review study quoted: “Fear of choking was an important factor in parents’ decision not to implement BLW; however, this fear was not supported by the literature.”

Today, I will provide a breakdown of two studies that have examined the risk of choking associated with Baby Led Weaning as a method for introducing solids.

THE BLISS STUDY

BLISS stands for “Baby-Led Introduction to Starting Solids”. This clinical trial on choking was published in the “Pediatrics” journal and titled “A Baby-led Approach to Eating Solids and Risk of Choking” This study included 206 families.

During the study, parents completed questionnaires at 6, 7, 8, 9, and 12 months of age regarding their baby’s choking and gagging experiences. Additional follow-up questions were asked to parents who reported incidents of choking to gather information about the type of food consumed and how the choking was resolved.

The findings revealed that approximately 35% of babies experienced at least one episode of choking between the ages of 6 and 8 months. There was no significant difference in the incidence of choking between the two groups at any of the assessed time periods.

However, it was observed that babies who started with Baby Led Weaning initially experienced more frequent gagging at 6 months, which decreased by the time they reached 8 months. On the other hand, babies in the puree group exhibited an increase in gagging incidents by 8 months, likely due to their progression to consuming finger foods. It is important to note that the gagging stage is a normal part of learning to eat and cannot be entirely avoided.

Regarding cases where medical assistance was required due to choking, two babies choked on milk, while one choked on food that was placed in their mouth by a caregiver (it is not recommended with Baby Led Weaning). This highlights the fact that choking can occur with any type of food or substance.

Furthermore, the researchers discovered that both groups frequently offered choking hazards to their babies, and not all parents closely supervised their babies during feeding.

ANOTHER STUDY PUBLISHED BY Dr. Amy Brown

This observational study was titled “No difference in self-reported frequency of choking between infants introduced to solid foods using a baby-led weaning or traditional spoon-feeding approach. “

The survey also inquired about instances of choking experienced by the babies, including the frequency and the type of food involved (smooth puree, lumpy puree, or finger food).

The results indicated that 13.6% of the babies (155 out of the 1151) had experienced choking incidents. However, no significant correlation was found between the chosen method of introduction (BLW or traditional) or the frequency of spoon-feeding purees and the occurrence of choking.

It is noteworthy that among the babies who experienced choking, those following a traditional weaning approach had a higher number of choking episodes associated with finger foods and lumpy purees compared to babies following either strict or loose BLW.

This observation raises potential hypotheses: BLW mothers might exhibit lower anxiety levels, leading to less overinterpretation of choking incidents or excessive assistance during feeding, which can pose risks. Alternatively, the higher incidents of choking among traditional weaning babies could be attributed to their lower exposure to finger foods in the early stages, resulting in less practice when the gag reflex is more sensitive. This finding emphasizes the importance of introducing finger foods from the beginning, regardless of whether purees are included in the feeding approach.

Overall, based on the research, it suggests that the potential risk associated with BLW is not significantly higher compared to a traditional approach when initiating solid foods.

IS MIXED FEEDING SAFE?

Both Health Canada and the National Health Services (NHS) in the UK actually recommend a combination approach when introducing solids, which includes offering both finger foods and purees right from the start.

Despite some adamant claims made by Baby-led Weaning Facebook groups suggesting that this method increases the risk of choking, both research findings and personal experiences from my clients and my own child have not supported this belief.

Therefore, if you choose to incorporate both pureed foods and finger foods into your baby’s diet, there is no need to strictly adhere to the label of “Baby-led Weaning.” The important thing is to follow responsive feeding practices when spoon-feeding purees, being attentive to your baby’s hunger and fullness cues to avoid overfeeding. Additionally, make sure to offer finger foods during each meal to provide opportunities for your baby to practice self-feeding.

Ultimately, what matters most is following a feeding approach that suits your baby’s needs and abilities, regardless of the specific labels or guidelines, while prioritizing their safety and nutritional needs.

GAGGING

WHAT IS GAGGING?

Gagging is a natural reflex that helps prevent choking by stopping us from swallowing. It’s a normal and important part of learning to eat solid foods for babies. Gagging brings the food up to chew more before it goes back down, ensuring that only well-chewed food reaches the back of the throat to be swallowed.

Gag reflex effectively keeps larger food pieces near the front of the mouth, only allowing very well-chewed foods to the back to be swallowed.

During the initial stages of introducing solid foods, your baby’s gag reflex is positioned at the front one-third of their tongue. However, as they gain experience and exposure to different solid foods, the reflex gradually shifts further back. Eventually, it settles at the top of the throat, where the gag reflex is typically located in most adults.

WHAT TO DO IF YOUR BABY IS GAGGING

If your baby is gagging, avoid patting their back or attempting to stick your fingers in your baby’s mouth to remove the food, as this could cause the food to move deeper and potentially result in choking. Instead, demonstrate coughing the food up and spitting it out. Remember to stay calm and relaxed, as your reaction can influence your baby’s response to gagging and make the eating experience less enjoyable for them.

Never interfere! Allowing your baby to stay in control and figure it out on his own.

HOW TO PREVENT GAGGING

To help prevent gagging, there isn’t much you can do during your baby’s mealtime. However, you can start preparing them for learning how to eat by bringing them to the table around 5 months of age. Offer them a “hard munchable” item to chew on, such as a rib bone, celery, or a raw carrot. Although they won’t actually consume it, this will make your baby feel included in the family meal and increase their awareness of their mouth and how it functions. It can also strengthen their mouth muscles and potentially reduce a highly sensitive gag reflex.

WHEN TO GET HELP FOR GAGGING

If your baby continues to gag with every bite after a few weeks of introducing solid foods, it may be necessary to seek assistance from an Occupational Therapist or Speech-Language Pathologist.

Occasionally, babies may gag to the point of vomiting, which is also relatively common. To minimize this, try spacing out milk feedings from solids to ensure their stomach is not overly full during mealtime. This can reduce the likelihood of vomiting and prevent significant calorie loss.

If your baby consistently gags and vomits when eating solids exclusively, it might be beneficial to take a break from introducing solids for now. Your baby may not be quite ready, so waiting until they reach six months of age and then trying again could be a good approach.

For babies older than six months, consider offering purees for a week or two before reintroducing finger foods. While babies can still gag on purees, it might be easier for them to manage initially. Remember, it’s important to follow a baby-led approach if it aligns with your preferences and situation.

CHOKING

WHAT IS CHOKING?

Choking occurs when food accidentally enters the airway instead of the esophagus (food pipe).

During choking, a baby will not make much noise or may be completely silent as their air pipe becomes blocked. It is important to remember that loud gagging noises can be a positive sign in such situations.

When a baby is unable to obtain oxygen due to choking, their breathing is compromised, and their lips and face may turn blue.

IS CHOKING NORMAL FOR BABY LED WEANING

Fortunately, choking is significantly less common than gagging.

When reviewing the research, it is worth noting that approximately 13%-35% of babies in these studies were reported to have experienced choking at least once. Personally, I consider myself fortunate as I never had this experience with any of my children.

WHAT TO DO IF BABY CHOKES?

Choking is much more serious than gagging, and requires immediate intervention.

If there is another adult or older child present, quickly shout for their help and instruct them to call ambulance. In the absence of someone else, immediately make the call yourself while initiating infant CPR. Taking an infant first aid course can provide you with the knowledge and skills to handle such situations with confidence, even though the chances of it happening are unlikely.

KNOW THE DIFFERENCE BETWEEN CHOKING AND GAGGING

GAGGING 

Loud and red = gagging, let baby work it out

  • Face may turn bright red
  • Tongue will thrust forward
  • Making gagging noises
  • Sputtering coughing
  • No life threatening

It is advisable to avoid overreacting when your baby experiences gagging during mealtimes, as this may create fear and increase stress for both you and your baby. It is recommended to allow your baby a moment to handle the gag reflex independently without any intervention from you.

CHOKING

Silent and blue = choking, baby needs your help immediately

  • Face will start to go blue
  • Unable to make noise
  • May attempt to cough
  • Loss of consciousness
  • Can be life threatening

Choking occurs when food passes beyond the gag reflex and obstructs your baby’s airway, leading to either partial or complete blockage. This can result in a significant reduction or complete cessation of oxygen reaching the lungs, making it difficult for your baby to breathe. Choking is a severe situation that demands IMMEDIATE intervention, and if your baby is choking, it is crucial to promptly initiate infant CPR.

CHOKING HAZARDS 

It is important to note that BLW does carry a potential risk of choking compared to offering purees, especially when certain types of foods are introduced. Choking incidents occur when the airway becomes obstructed, which can happen if a baby bites off a piece of hard food that perfectly blocks the air passage. Therefore, careful attention must be given to the size and texture of foods offered during BLW. It is crucial to closely supervise your baby during mealtime and consider taking an infant CPR course as a precautionary measure.

HERE’S A FULL LIST OF POTENTIAL CHOKING HAZARDS

  • Raw hard vegetables (carrots or beets)
  • Raw leafy greens
  • Fibrous and stringy foods (celery, pineapple, or asparagus)
  • Firm fruit with and without peels (apples)

  • Fruits with pits or seeds, that haven’t been removed (whole plum or peach)
  • Whole grapes
  • Whole blueberries
  • Whole cherry tomatoes
  • Dried fruits (raisins, dried apricots)
  • Chunks of firm meat (steak)
  • Fish with bones

  • Whole hotdogs or sausages
  • Cheese sticks

  • Whole nuts and seeds
  • Think globs of nut butter

  • Hard candies, mints, or cough drops
  • Gummy bears
  • Popcorn
  • Marshmallows
  • Hard chips or nachos
  • Chewing gum
  • Snacks with toothpicks or skewers

ALTERNATIVE WAYS OF SERVING:

  • Steam vegetables and fruit.
  • Peel and grate hard vegetables and fruit like carrots, apples, and zucchini.
  • Grate cheese.
  • Always remove pits and seeds from fruit.
  • Slice small and round foods into quarter lengthwise.
  • Thinly spread any nut or seed butter on toast.
  • Remove bones from fish or meat.
  • Serve fresh, frozen, or canned (rinsed) corn instead of popcorn.

Well it’s possible for your baby to choke on food (or toys/coins/may other objects), there is a lot you can do to prevent choking.

TIPS TO PREVENT CHOKING WITH BLW

  1. Ensure that your baby is developmentally ready for solids.
  2. Positioning: Make sure your baby is sitting upright during mealtime and avoid a reclining position. Provide proper support by using a high chair that keeps your baby well-supported. Using rolled-up towels if needed to ensure proper positioning, with the tray (or table) positioned between their nipples and belly button.
  3. Minimize distractions: Avoid having toys or the TV on during meals as it may distract your baby and increase the risk of choking. Also, discourage running around with food once baby starts walking.
  4. Supervise mealtime: Always watch your baby while they eat and avoid sitting them on your lap during meals. It is important to have a clear view of your baby’s face while they are eating to ensure their safety.
  5. Let them self-feed: Never put a piece of food into your baby’s mouth. If you put food into their mouth, it may immediately fall to the back, without baby having a chance to control it with their tounge and chew it. Let them feed themselves. Also, never attempt to fish food out of their mouth.
  6. Offer safe size of food: Avoid round items like raw hard pieces of vegetables and fruit. Instead, either grate them or slice them thinly. Whole grapes, blueberries, or cherry tomatoes should also be sliced lengthwise into quarters, so they are not a round shape.
  7. Offer soft foods: Test the foods to make sure you can mash them with gentle pressure from your thumb and forefinger. This is called the “squish test“. If the food is harder, make sure it’s in a safe shape (ex: grated or sliced thinly)
  8. Take an infant CPR course.

BOTTOM LINE

It’s very important for parents to recognise the difference between gagging and choking and the different ways each scenario should be treated.

Remember that gagging is a normal reaction that weaning babies have as their gag reflex is triggered while learning to eat. Choking is when their airway gets blocked, and requires immediate first aid and medical attention.

Hope this was helpful. Please check out more about food textures, finger foods and choking on my IG highlights.

Did you know that we offer personalized nutrition counselling for kids and families? If this is something you’d like to learn more about, please visit here. 

How to Feed Your Children When They Are Sick

How To Feed Your Children When They’re Sick

by with No Comment Child & Family NutritionInfant NutritionToddler Nutrition

HIt seems like everyone is sick recently. COVID-19 is still circulating like crazy, but children are also getting hit with Respiratory Syncytial Virus (RSV), strep throat, stomach bugs, HFMD, the flu and other seasonal viruses. As disruptive as illness can be for work, school, and your family’s plans, it can also impact how you and your child eat. How can we feed our children who are sick so they’ll get better faster?

LOWER YOUR EXPECTATIONS

In most cases, when children are sick, it is very normal to see them have very little appetite, no interest in eating, and may even refuse food they usually eat. Even as adults, when we’re not feeling well, we tend to prefer bland, plain foods that are easy to eat as well our favourite comfort meals. We don’t usually fancy a huge variety of exciting foods when we’re not feeling well.

However, it doesn’t mean that you have to ONLY offer bland or favourite snacks to your children. The best thing to do during sick days is to keep your normal feeding routine as much as possible and rely on your child’s internal body signals. Because it’s important to help them keep their energy up and prevent pickiness after illness, and we know it’s usually only for a short period of time and it’s not going to undo any of the work that you’ve done in encouraging them to enjoy a variety of foods.

Responding to their appetite

You can continue to serve other foods alongside to keep up the variety that they are actually familiar with, but don’t be surprised if they’re not touched, or even expect them to try new foods, or foods that they’re less keen on at this time. Their appetites are likely to be all over the place, it can be hard to predict. Therefore, offering foods at set schedule whether they ask for it or not, and trust their body instincts to do the rest in terms of whether food is accepted or how much is accepted.

If they ask for food outside of mealtimes or seem hungry, that’s perfectly fine to give it to them, especially if you’re finding that there have been a few days where not much at all has been eaten. So let them follow their appetite and give them the chance to eat if they show interest. REMEMBER, it’s ok for the routine to slip as it is only for a short period of time. However, once they start to feel a little better, it’s helpful to start to build in some more structure to get things back on track.

FEED YOUR CHILDREN WHEN THEY’RE SICK WITH

i) a cold and respiratory illness

When your child has a cold or respiratory illness, it may affect their appetite and drive to eat. Between coughing, fatigue, a runny nose and sore throat, they might not want to eat or drink like they usually do. They might be tired or uncomfortable, or maybe they’re unable to smell or taste food appropriately.

The biggest concern during illness is keep the body well-hydrated to prevent dehydration. While a child might not eat as much as usual, as long as they’re drinking adequately they should be okay in the short-term.

Babies:

For babies under 12 months, getting enough milk to stay hydrated is most important during illness. Babies will likely prefer sticking to breastmilk or formula, and that’s OK. If your baby has really bad congestion, the use of a bulb suction or Nasal Spray to clear up the congestion might make eating and drinking easier. Focus on regular breastfeeds or bottle feeds and watch for 5-6+ wet diapers per day. If your baby is eating solids (6+ months), offer solid meals like usual but don’t be surprised if your baby isn’t interested. Stay consistent and continue to include your baby in family meals, as long as they’re not upset when they sit in their high chair.

Toddlers ++: 

Continue to offer the regular food/meals you normally would at regular times but trust their hunger and fullness cues. Focus on lots of veggies, fruits, protein foods, whole grains and fats. Do not force or pressure them to eat. Nutrition is important during illness, but their appetite and food preferences almost definitely change. You may find your child gravitating toward certain foods or surviving on familiar beige foods like bread and crackers – this is OK. You might want to just feed them whatever sounds good for a while until they feel better. As best you can, try to offer some variety in the food groups you serve, too. They might surprise you when they are suddenly interested in something again.

Sometimes it helps to integrate warm foods into their diet, like clear soup, porridge, mee sua soup or oatmeal. The steam from these foods can help loosen mucus and provide relief from nasal congestion.

The pain of a sore throat can make swallowing food and liquids uncomfortable, which may make your toddler eat less even if they feel hungry. Acidic foods can irritate an already inflamed sore throat.

Avoid acidic foods until your toddler’s sore throat has healed:

  • orange and orange juice
  • pineapple juice
  • tomato soup

Offering extra-cold and smooth foods may help soothe a sore throat:

  • smoothies blended with frozen fruits
  • frozen yogurt barks,
  • popsicles
  • frozen fruits

Since many cough suppressant medications are not approved for use in young children, it’s hard to know what to do with the coughing child, especially for those night time coughing. Some evidences (here, here, here, here, here) suggest that a spoonful of 100% pure honey can work as a good cough remedy for children over the age of one.

(ii) hand, foot and mouth disease

Hand, foot and mouth disease can be particularly difficult for children and mealtimes. Their mouths can get SO sore, which obviously makes it uncomfortable for them to eat. It’s especially tough as they may actually WANT to eat, they just can’t because it makes the pain so much worse.

Foods for children with hand, foot and mouth disease:

  • SOFT foods such as yogurt, porridge, cereal or oatmeal are likely to go down well as they are easy to eat and shouldn’t cause too much pain to sore mouths
  • Scrambled eggs, muffins or pancakes
  • Soft toast fingers with toppings like avocado, cream cheese, butter or nut butter
  • AVOID acidic foods such as tomato, citrus fruits or fruit juice

(iii) stomach flu (diarrhea/vomiting)

Stomach bugs or acute gastroenteritis will almost certainly affect the amount and types of food your children eats.

Babies:

Just like with respiratory illnesses, hydration is most important when babies are sick with GI bugs. Dehydration is especially dangerous with stomach bugs because babies can quickly lose fluids from vomiting and diarrhea. Continue to offer regular breastfeeds and bottle feeds and watch for 5-6+ wet diapers per day. If your baby is continually vomiting or has profuse diarrhea and you’re worried about their hydration status, speak with your doctor right away. Make sure your baby can tolerate breast milk or formula before offering bland foods like banana or crackers, then offer a regular diet if bland foods are tolerated.

Toddlers++:

Some simple guidelines to remember when our children are vomiting or have diarrhea:

  • Start with small amounts of liquids to prevent dehydration.
  • If those are tolerated, move onto a bland foods like toast, soup/broth, porridge, crackers, oatmeal, eggs (steam) or certain fruits (applesauce, banana, avocado, berries).
  • Once bland foods are tolerated, move onto a regular, varied diet including complex carbohydrates, lean meats, dairy, fruits and vegetables. Just avoid super heavy and greasy foods like fried or fried chicken, pizzas. The BRAT (banana, rice, applesauce, toast) diet is no longer recommended by the American Academy of Pediatrics. The reason is this diet is low in calories, protein, fat, fiber and other nutrients, also it makes diarrhea last longer. Current research show that children who eat a balanced diet recover quicker from stomach flu.
  • Juice is generally not recommended during stomach flu because it contains a lot of fructose and sorbitol, which can actually worsen diarrhea. If juice is all your children will drink, make sure to dilute it.

Sometimes water isn’t sufficient to rehydrate children when they’re losing fluid quickly from profuse vomiting or diarrhea. Oral Rehydration Therapy (ORT), means to drink solutions that are made with an appropriate amount of salt, sugar and fluid to help your child’s body absorb lost electrolytes appropriately. Sugar is essential in Oral Rehydration Solutions (ORS) because it helps to get the electrolytes through the bloodstream quicker and to rehydrate your children faster.

Some families make their own inexpensive ORT at home using the World Health Organization recipe. It is just as effective as expensive rehydration drinks and doesn’t contain any harmful ingredients and no dyes.

  • 1/2 tsp salt
  • 6 tsp sugar
  • 1L water

HYDRATION IS REALLY IMPORTANT WHEN CHILDREN ARE SICK!!!

During periods of illness, the number one concern is DEHYDRATION.

Babies:

Under 12 months, babies should still be consuming at least 20-24 ounces of breast milk or formula.

Toddlers ++:

Toddlers and older children need to drink lots of water to stay hydrated and get better. Estimated fluid needs per the American Academy of Pediatrics are as follows:

  • 1-3 years: 4 cups (32 ounces or ~1 L)
  • 4-8 years: 5 cups (40 ounces or ~1.2 L)
  • 9-13 years: 7-8 cups (56-64 ounces or ~1.7-1.9 L)

Fever, diarrhea, vomiting, or just refusing liquids for a prolonged period of time can put your toddler at serious risk for dehydration.

How to prevent dehydration

The best way to prevent dehydration and replace fluids lost through vomit, diarrhea, or sweat is to keep a cup full and encourage your child to sip from it all day long. Using a favorite cup, or straw cup to spark a toddler’s interest in drinking more.

Water is the best choice, of course, but if you’re finding it a struggle to get your child to drink it, here are some other drink ideas:

  • Water or infused water
  • Honey lemon water (except children under the age of 1 can’t have honey due to the risk of botulism)
  • Breastmilk
  • Fresh cow’s milk/plain kefir
  • Plant-based milk (ex: soy, almond, oat)
  • Popsicles or freezies
  • Smoothies (If your child can tolerate some heavier textures, then a smoothie is a great way to boost nutrition along with fluids)
  • Bone broth (homemade bone broth has the benefit of protein and additional vitamins and minerals)
  • Coconut water (diluted 1:1 ratio with water) (offered occasionally, it can be a good substitute if your child likes the flavor, but it’s much lower in potassium than ORT and may not rehydrate as effectively).
  • Fruit juice (diluted 1:1 ratio with water) (offered occasionally, DON’T offer if experiencing diarrhea. The risk of dehydration FAR outweighs the risk of added sugars in a juice box)
  • Non-caffeinated tea in small amounts (¼ cup offered occasionally) like Chrysanthemum tea, barley tea, Luohanguo tea 罗汉果

In addition to offering more beverages, if they can still eat, make sure to offer lots of Hydrating Foods (foods with high water content) throughout the day.

Instead of worrying about how much they are actually drinking, watch your child. Make sure they’re urinating regularly and don’t show signs of dehydration.

WHAT ARE THE SIGNS OF DEHYDRATION

Dehydration can be dangerous for a child and severe cases may require hospitalization. If you suspect your child might be showing signs of dehydration, it’s best to call your doctor right away so they can guide you on what’s best to do. According to the American Academy of Pediatrics, the following are signs of dehydration:

Mild to moderate dehydration:

  • Less activity than usual
  • Less than six wet diapers a day
  • Less saliva or cracked lips
  • Fewer tears when crying
  • Sunken soft spot on the head

Severe dehydration (all the symptoms listed above, plus):

  • Very fussy or overly sleepy
  • Sunken eyes
  • Cool, discolored hands and feet
  • Wrinkled skin
  • Only 1 or 2 wet diapers in 24 hours
  • Dry tongue and mouth
  • No tears when crying

GAIN BACK APPETITE AFTER ILLNESS

Appetite after Illness

Ever notice that it takes a few days to even weeks for your children’s appetite to return after they have been sick? Try not to panic that they’ll never eat a variety again. During illness, this is not a good time to force them to eat anything or to buy them French fries, just to get them to eat.

Another thing to remember is after an illness, your child’s taste buds may be dampened. Viruses can inhibit taste and smell function, and sometimes congestion prevents them from smelling (and thus tasting) appropriately. You may experience this as an adult, too. Adding highly flavorful food to their regular meals can help “wake up” their tastebuds and get them back to eating like normal again!

One strategy I love to use is to offer a highly flavorful, crunchy, sour or salty food once or twice a day to help “wake up” their taste buds. I found that children who have been sick sometimes seek out these flavors so they can taste again. Try foods like:

  • Freeze-dried fruit (mango, strawberries, raspberries)
  • Cucumber or tomato paired with a strongly flavored dip like hummus or guacamole
  • Olives (remember to remove pits and quarter lengthwise for kiddos under 4 years old)
  • Ground meat seasoned with cumin and garlic
  • Cooking with flavorful spices like cinnamon, ginger and paprika

You can also try lemon, lime or spicy food (if your children usually enjoys and tolerates it).

Don’t be surprised if your child’s appetite takes a while to return to normal when they have been sick. If they seem to be losing weight or not improving over time, consult a dietitian.

DOES VITAMIN C HELP WITH ILLNESS?

There may be NO STRONG evidence to suggest vitamin C will cure a cold. While some studies have suggested that vitamin C may shorten the duration of illness, other research does not support this theory. Plus, giving your children high vitamin C doses can cause diarrhea and stomach upset.

According to the NIH, here are vitamin C needs based on age (daily):

  • 7-12 months: 50 mg (Adequate Intake)
  • 1-3 year-olds: 15 mg
  • 4-8 year-olds: 25 mg
  • 9-13 year-olds: 45 mg

In general, unless your child has an extremely limited diet or malabsorption issues, they likely don’t need a vitamin C supplement.

FOODS HIGH IN VITAMIN C

Since vitamin C can’t cure a cold, but it can support the immune system. Oranges are not the only way to get your daily dose of vitamin C! Many fruits and veggies – yes, even bell pepper – can fulfill a great percentage of your child’s daily needs. Below are some kid-favorite foods that are high in vitamin C:

  • Potato (medium, cooked) – 15 mg
  • Tomato (medium, raw) – 16 mg
  • Mango (1 cup)  – 45 mg
  • Broccoli (1/2 cup) – 61 mg
  • Orange (medium) – 70 mg
  • Kiwi (medium)– 75 mg
  • Strawberry (1cup) – 95 mg
  • Red bell pepper (1 whole, raw) – 312 mg

Breast milk and formula are great sources of vitamin C, too! In fact, babies’ vitamin C needs are met by their milk alone.

Interestingly, vitamin C also helps our bodies absorb iron, so pairing a high vitamin C food with high iron foods like meats, poultry, fish, lentils, beans and nut butters can help your child’s body absorb iron, a critical nutrient in childhood.

SHOULD MY SICK CHILD AVOID MILK AND DAIRY?

There have been many studies that have looked at the relationship between drinking milk and how it affects mucus production but there is NO scientific evidence to suggest that there is any relationship. However, if you notice your child’s symptoms seem to worsen after a cup of milk or yogurt, you can go ahead and remove it from their diet until they are healthy again.

If your toddler is having a stomach flu, serving dairy can be iffy. It is because sensitive stomach may have a hard time digesting dairy. Again, if you notice any changes or are worried dairy could potentially worsen their symptoms, it’s best to skip it for couple days.

HOW TO GET YOUR CHILDREN TO TAKE MEDICINE?

There’s nothing worse than a sick child who would feel much better if they just took their medicine. If your children refuses prescribed meds, here is an amazing blog post from physician Steve Silvestro, MD on various ways to make taking meds a little easier on everyone.

BOTTOM LINE

Caring for sick children is hard! Be sure to reach out for help and call on your support network for meals or runs to the pharmacy when needed! I hope this article helped to answer your question. For more support feeding children, be sure to check out my 3 months TRANSFORM program.

Note: This information does not replace medical advice. If you have any concerns about your little one’s symptoms, appetite or growth, please do speak to a pediatrician and follow their advice.

sensory-fun-food-play-photo

What You Should Know About Sensory Food Play

by with One Comment Baby Led WeaningChild & Family NutritionInfant NutritionToddler Nutrition

Sensory food play is an extremely hands-on activity, which lets children engage with their senses through the exploration of different foods and textures through play. When sensory play is focused on food, it becomes even more stimulating   a b   se food is the ultimate sensory experience.

I know FOOD PLAY is usually not considered a good thing by parents as it is messy, but it is important for them to explore the foods through play.

Sensory food play is not just about playing foods      

WHY?

In a study published in Public Health Nutrition, researchers from Finland describe “sensory-based food education” programs that are common in preschools there. The programs include activities like preparing salads, growing vegetables in a garden or on a windowsill, taking field trips to pick berries, and participating in “sensory sessions” where children touch, listen, taste, and smell different kinds of foods—then share observations with each other.

They found that preschoolers who participated in this food education chose more fruits and vegetables from a buffet compared to those who didn’t receive it. Researchers say this sensory-based education helps children explore food with all five senses and instills a joy of eating. They also note that the findings held true even if there was a high level of pickiness in the group—which shows that “positive peer modeling” can also encourage children to try new foods.

  • Explore: When we let children explore and play with food, it gives them an opportunity to get to know their food and become comfortable with how it will eventually feel in their mouths.
  • Stress-free: Some children are anxious about unfamiliar foods, and Sensory Food Play provides them with some much-needed relaxation when faced with the overwhelming sensory experience of a new food. Smashing, squishing, poking, rolling, pouring, and dumping the food can provide stress relief as well as teach them how that food might feel in their mouth (and they just might try it!).
  • Build Trust: The use of Sensory Food Play can assist the child with touching, smelling and playing with the texture in an environment with little expectation. As the child develops trust and understanding of this texture it helps build positive pathways in the brain to say it is safe to engage with this food.

SENSORY FOOD PLAY RULES:

You can set a time and place for playing with food. You can also set the rules and boundaries for this exploration process. If you are worried about the mess or expense,  make a rule about that.

  • Mess: You can help your children manage their mess with consistent directions and rules. Before you get started, make sure that you have decided where your children are going to be playing. If it is going to be on the floor, put down a splash mat, old shower curtain or blanket. You could also play in the car porch to avoid lots of mess (handy for a rinse over afterwards!). I love to put the infant (6 months+, support with cushion) in highchair and put the messy/food play activity on highchair table. Just remember, the goal is for your children to develop positive feelings and connections with their food, so let them have a little fun with it.
  • Clean up: Have a clean up bin ready, such as baby wipes, apron, sponge, paper towels, cleaning spray.
  • Expense: Most of my sensory food play items I buy in bulk (e.g., rice, pasta, beans, cereal, oatmeal, yogurt, food coloring, toothpicks, etc.), which saves money in the long run. I often buy canned food items (peas, pears, fruit cups, etc.) or use leftovers. Also, I use items I receive for free at fast food restaurants (ketchup packets, straws, and other dipping containers).

Sensory food play is so important and beneficial for babies and younger children.  Not only is it lots of fun, but there is a lot of learning going on when they are playing that you might not realise. I am going to should you some benefits when a child engages in sensory food play.

SENSORY FOOD PLAY SKILLS:

  • Sensory system (learning and developing new tastes, textures and smells)
  • Gross motor skills (body balancing)
  • Fine motor skills (scooping, pincer grasp, writing, dipping)
  • Mealtime skills (pouring, tasting)
  • Language skills (maths, food vocabulary , following directions)
  • Play skills (imaginary play, solitary play)
  • Social skills (turn taking, manners) with other children
  • Problem solving skills (How to..)
  • Brain development (enhancing memory, ability to complete more complex learning tasks)
  • Learning cause and effect (what happen after squishing blueberries)
  • Growing independence through play
  • Creativity and FUN
  • Exploring shapes and colours

Here are some fantastic ideas and activities for sensory food play:

Digging in Beans – Get ready to dig, lift, dump, and pour. Fill a pan with dried beans, noodles, or rice and get little trucks or cars out. My son was crazy about this one.

Yogurt Paint – Paint  with yogurt. Get your little one touch new veggies while making beautiful art.

Shape Matching – Simple, quick and easy.

Learning Letters – use yogurt to make a letter, and trace the letter with berries or pomegranates.

Stacking – make a tower or building.

Rainbow Toast – Painting on food you can eat!

Counting Game – an easy educational game you can create for your little one.

Food Ribbons – use a peeler to turn a fruit or vegetable into ribbons.

I recommend Sensory Food Play at least once a week at home for picky eaters or problem eaters. Playing with food away from table (without pressure to eat or eat it now) offers your child the opportunity to look at, touch, smell and hopefully tasting the foods.

Sensory food play is vital for a child’s development and learning process! After you discover the key benefits of sensory food play for children in my article today, you may want to initiate sensory food play at home.

DON’T KNOW HOW

If you have no idea, you can check out this SENSORY FUN FOOD PLAY GUIDE. This guide takes you step by step through how to set up food play at home and get your children engaged in more than 100 sensory food play activities. Don’t be afraid to be silly and creative!

Happy Playing!

CHECK OUT NOW

Salt:Sodium for Babies and Toddlers

Salt/Sodium for Babies and Toddlers

by with No Comment Baby Led WeaningChild & Family NutritionInfant NutritionToddler Nutrition

I feel like a lot of us, parents, are pretty conscious of how much sugar we’re giving to our little ones, but what about their salt intake, especially if you are doing mixed approach.

HOW MUCH SALT?

Due to insufficient data for babies, an AI (Adequate Intake) for sodium has been established.

  • For infants 6 months and younger, the AI for sodium is 110 milligrams per day (here).
  • Babies between the ages of 7 and 12 months have an AI of 370 milligrams per day (here).

So, up to 12 months of age, the recommended amount of sodium per day is less than 400 mg sodium. This includes salt found in breastmilk/formula AND solid foods. So, considering that breastmilk and formula have about 200 mg of sodium per 24 oz., this means that babies should only be consuming about 200 mg of sodium via solid food daily.

The reason for this recommended intake level is that we assume that babies’ kidneys are still very immature and won’t be able to process large amounts of salt properly. So far, we don’t have enough research yet to say that this is 100% the upper limit for salt for babies under 1 year old. They may be able to handle more, but without enough research indicating the highest level actually determined safe before developing any risk of poor health effects, sticking to this limit is advised.

SALT VS. SODIUM

Salt and sodium are often used interchangeably and you may see both on food labels. Table salt that we eat is actually made up of sodium (40%) and chloride (60%).

1 tsp salt = 2300 mg sodium 

1 g sodium = 2.5 g salt 

We definitely need both of these electrolytes (as well as potassium) as they help send messages along the nerves, enable muscles to contract,  balance the amount of fluids in the body, enhance nutrient absorption, regulate acid-base balance, absorb potassium, and control the level of bacteria present in the stomach.

SALT IN FOODS

Salt in pretty much everything store-bought, processed or packaged. It’s a preservative and it makes food taste amazing, so naturally food manufactures will put it in deliberately. Salt can be found in:

  • Processed meats like deli meats, bacon, hotdogs, ham and sausages.
  • Frozen foods like fish sticks, chicken nuggets, frozen meals.
  • Potato chips
  • Crackers
  • Canned soups
  • Gravy
  • Broths (vegetables, chicken, beef)
  • Olives, pickles, pickled vegetables (Kimchi)
  • Soy sauce

Other foods that you may not be aware as they don’t taste very salty but are very high in sodium:

  • Cheese and other dairy products like yogurt and milk
  • Bread, bagels, English muffins, tortillas, and other bread products
  • Canned tomato and pasta sauce
  • Canned vegetables
  • Canned beans
  • Box cereal

*Fresh Milk  – 100 mg sodium in 1 cup. The high sodium content is one of the many reasons milk is not recommended as a main drink until your baby turns one. A little milk in cereal or baked goods is ok, so no need to cut it out completely.

WHAT SHOULD YOU DO?

As you can see in the picture above, sodium is found naturally in foods as well as added to processed foods. It’s practically in every food. So do we need to completely eliminate salt from baby’s solid foods?

AT HOME

If you are cooking meals for your family, you can always hold off on adding salt until after you have taken out your baby’s portion. For example, when making a stir-fry, put a small portion aside before adding soy sauce to the pan.

It is important not to add salt to anything you cook from scratch, even if you think it tastes bland, taste can be different experience for your baby than it is for you. You can use herbs and spices as flavour enhancers.

During the first few months of eating, it is very unlikely that a baby will consume a large amount of sodium. Especially if you are being mindful in the purchased foods you provide. When baby’s don’t eat that much, it is just a hard proposition for them to get in a lot of sodium. And if a baby is self-feeding, it does take a while for them to start to ingest a decent amount of food!

For older baby, if we are sharing meals and eating more family-style meals, it is likely that you will need to pay a little closer attention to their foods as hidden sodium can be found in so many foods!

AT RESTAURANT

Restaurant foods tend to be much saltier than what you would make at home. It is also very hard to determine how much sodium is actually in a dish. Even if the nutritional information is published, many chefs will add salt as they see fit, regardless of the recipe. There are a couple of ways you can approach this. My general recommendation is not to worry too much. As long as you aren’t eating at a restaurant daily, or multiple times a day, it will all even out. Try to order something that would normally be cooked with less salt. You can even ask the waiter’s or chef’s suggestion.

If you have a baby that doesn’t eat that much yet, or in general, then you should be fine. If your baby usually eats a lot, there is always the option of bringing along some food for them that you know is low in sodium. I generally find that I can make do at restaurants with the food on the menu. I also want my child to experience the different flavors available. But if you’re unsure what is there, it never hurts to bring your own food along.

The key is being mindful and seeing how you can balance things in the next few days. Maybe one day they eat a good amount of cheese and bread, so the next day you are very conscious of only offering low or no sodium foods. Maybe one meal they eat at restaurant and the next meal you focus on fruit and a homemade muffin for snack. Pick and choose your battles and do what you can to make smart decisions wherever possible.

If it’s really only once or twice a week that you have restaurant meals, then just be sure to note that and adjust the food choices for the rest of the week! Keep it truly balanced while continually striving to plan ahead.

BOTTOM LINE

The idea is to do your best, serve homemade meals as much as possible. Read labels and practice mindfulness around what you’re eating and feeding your baby. This is a good practice to get into for the whole family.

What you feed your child today lays the foundation for taste preferences for tomorrow. 

adding-herbs-and-spices-to-baby-foods-photo

Adding Herbs and Spices to Baby Foods

by with No Comment Baby Led WeaningChild & Family NutritionInfant NutritionPicky EatingToddler Nutrition

Herbs and spices provide our foods with a multitude of flavours, fragrances, and colours. However, many parents worry about adding flavour this way to their babies’ food, believing that spices are hot and not suitable for little ones’ taste buds.

Baby food doesn’t have to be bland!

There is a big difference between hot spices and aromatic ones. Aromatic spices, such as turmeric, garlic, ginger, dill, cumin, nutmeg, garlic, dill, and cinnamon, are perfectly fine to introduce to baby after 6 months.

This guide explains why I recommend parents adding herbs and spices to baby’s food, the benefits of adding them and gives some ideas on how to start introducing them to your baby.

WHY YOU SHOULD INTRODUCE HERBS AND SPICES TO BABIES

If your baby doesn’t have any digestive problems, I always encourage parents who are just starting weaning their babies, either by purees or baby led weaning (around 6 months of age), to experiment with herbs and spices from the beginning. The more you expose your baby to a variety of tastes and flavours, between 6-12 months, the more likely it is that they’ll accept a variety of food later on in life! This means adding herbs and spices right from the beginning helps reduce the chances of pickiness.

In fact, breastfed babies are often introduced to a variety of spices even before starting solids. Breast milk can change its flavour, depending on a mum’s diet. If mum enjoys spicy and flavoursome food, then her baby will be exposed to this through her milk, helping create and develop a taste for flavoured foods. Therefore, by flavouring food with a variety of herbs and spices, you’ll continue the benefits of flavour exposure found in breastmilk.

What about exclusively formula fed babies? We know that babies are made to handle various flavours from the first day of their life, they were capable of experiencing various spices without any issues. So bland food is actually not a requirement for them and it’s natural for them to experience different flavours. If your baby is exclusively formula fed, then they wouldn’t have that exposure, and so beginning with some herbs and spices when they start solids is a great way to get those taste buds primed for new flavours.

As salt and sugar should be limited in baby food, spices and herbs are a great way to flavour food.

BENEFITS OF INTRODUCING HERBS AND SPICES AT AN EARLY AGE 

  • Trains the baby’s taste buds to enjoy variety flavors and will set the foundation for healthy eating habits.
  • Teaches the baby to expect change with food. Offering a plain mashed banana one day and a mashed banana with a dash of cinnamon the next can have a valuable influence on the child’s evolving palate.
  • Fresh herbs are packed with antioxidants, vitamins and minerals.
  • Herbs and spices are great flavour enhancers without adding unnecessary sugar and salt.
  • Helps babies transition to family food, as your baby will be familiar with those tastes and more likely to accept them.

WHAT ABOUT HOT SPICY FOODS?

Hot spicy foods (cayenne pepper or jalapeño) can hold off for a while. But, it is recommended to use aromatic spice first, such as curry, cumin, oregano, turmeric, cinnamon, mint, basil, allow them to experience those flavours first, before adding small amounts of hot spices. We live in Malaysia, the 3 major cultures that have influenced Malaysian food are Malay, Chinese and Indian. A lot of Malaysian dishes can be classified under the hot and spicy category. So, once you start, use mild spices in small dosages, therefore, you can cook a dish that the whole family can enjoy.

POPULAR FLAVOUR COMBINATIONS 

Here is a list of baby friendly herbs, spices and natural flavor enhancers and the foods that pair well with them:

Vegetables 

  • Asparagus: Parmesan cheese
  • Banana: rolled in unsweetened coconut
  • Broccoli: nutritional yeast
  • Butternut squash: cinnamon, nutmeg, allspice or ginger
  • Carrots: basil and garlic; or cinnamon
  • Cauliflower: curry powder
  • Green beans: garlic powder
  • Mashed potatoes: dill or garlic
  • Pumpkin: cinnamon, nutmeg, or ginger
  • Sweet potato: cardamom, cinnamon, cajun spice or nutmeg

Fruits 

  • Applesauce: cinnamon, nutmeg, allspice, or ginger
  • Avocado: cilantro or parsley
  • Bananas: cinnamon or allspice
  • Pears: ginger or cinnamon

Grains/Cereals

  • Oatmeal: cinnamon and nutmeg
  • Pasta: basil, oregano, or garlic
  • Rice: cinnamon, nutmeg, cardamom, or ginger
  • Quinoa (sweet): cinnamon, nutmeg, cardamon, or ginger
  • Quinoa (savory): garlic powder, pepper, onion powder, basil, or oregano

Dairy

  • Plain yogurt: cinnamon or mint

Meat 

  • Chicken: ginger; rosemary, sage and thyme; lemon zest and pepper; or basil and oregano; paprika
  • Beef: garlic and pepper; or onion powder and pepper
  • Salmon: dill, lime or lemon

TIPS TO ADD SPICES & HERBS TO BABY FOOD

When adding herbs and spices, make sure to start simple and try not to add too much so as to overpower the food. Start out by adding one herb or spice to your baby’s food and then building it up from there by mixing with other flavours.

  • Storage: Store spices in airtight containers away from light and heat. Whole spices will keep for around 1-2 years but after around six months, ground spices will start to lose their aroma and flavour. So buy in small amounts and use often!
  • Pre-mix spice blends: Always read the packaging when using pre-mix spice blends (as they often have added sugar and salt), try making your own blends.
  • Start slowly: Start with plain foods so baby can try the taste of the food on its own.
  • Use small amounts: Once baby has tasted the food plain, you can gradually add spices and herbs you use when cooking for the rest of the family. Use small amounts to start with to allow your baby to get used to different flavours. You don’t want to overpower the food. Start out by adding just a pinch.
  • Prepare fresh leafy herbs properly: Wash fresh herbs and then puree or finely mince before adding to baby food. Large leaves can be a choking hazard
  • Don’t give up: If your baby rejects the flavour of the spices/herbs just remember that it can take up to 10-20 exposures for a new flavour to be accepted.

Let’s give our babies something other than tasteless mush or finger foods to eat!  I’m a firm believer that babies deserve the tasty goodness we feed ourselves. When you implement these tips, you will create a change in taste and expectation for your baby. When babies learn to accept change with food, they become less likely to get stuck in food ruts.

If you’ve added herbs and spices to your baby food, what’s your little one’s favourite combinations?

why-shouldnt-babies-eat-honey-photo

Why Shouldn’t Babies Eat Honey?

by with No Comment Baby Led WeaningChild & Family NutritionInfant Nutrition

The American Academy of Pediatrics (news) and the World Health Organization advises that honey should not be added to food, water, or formula that is fed to infants younger than 12 months of age. This technically, applies to raw and unpasteurized honey, local honey; even applies to all foods and baked goods containing honey.

Honey can contain spores of bacterium called Clostridium Botulinum, which can germinate in a baby’s immature digestive system and release the toxin that causes Infant Botulism – a potentially fatal illness.

Honey should never be given to a child under the age of 12 months old.

SIGNS AND SYMPTOMS OF INFANT WITH BOTULISM 

Symptoms typically appear within 12-36 hours after eating contaminated food, but may occur as early as a few hours and as late as 10 days.

  • muscle weakness
  • flat facial expression 
  • decreased movement 
  • lethargy in feeding or weak sucking
  • weak cry
  • constipation 

These are all a result of the muscle paralysis caused by bacterial toxin. If your infant has signs of botulism, it is recommended you visit the emergency room immediately as this is a life-threatening illness.  Be sure to keep samples of the potentially contaminated food for testing.

IS HONEY SAFE FOR TODDLERS, OLDER CHILDREN AND ADULTS? 

These spores are usually harmless to adults and children over age one. In adults, the amount of botulism spores ingested (if any) from honey is really quite negligible because we have mature intestines. The intestines of an adult contain enough acids to counteract the production of toxins the botulism bacteria produce. Once an infant reaches the age of 1 year or older, their immune system is well developed and intestines have a balance of acids that help destroy and fight off any toxins that the botulism bacteria produce. 

WHAT ABOUT FOODS CONTAINING HONEY?

Children under age 1 should not be offered any foods with honey, including yogurt with honey and cereals and crackers with honey, such as honey graham crackers, honey nut cheerios, honey wheat bread. Cooking and baking do not reach temperatures high enough to kill or destroy the botulism spores. 

Honey is unsafe in any form under one.

BOTTOM LINE

Honey contains modest amounts of B vitamins and vitamin C, it can be a nice addition to your baby’s diet, but it’s important to wait until after 12 months of age. Remember, honey, a sweetener, does have a lot of calories, just like other natural sugars. Read labels carefully to see if processed foods contain honey.

Did you know that I provide personalized nutrition consultation service for families? If this is something you’d like to learn more about, check out here. 

how-to-help-your-child-to-gain-weight-photo

How to Help Your Child to Gain Weight

by with No Comment Child & Family NutritionInfant NutritionToddler NutritionWeight Management

So often in the media we hear about the obesity epidemic and how too many children are overweight or obese. But what about those on the flip side of the coin? The ones that may not eat much, may be very selective with their food choice, may have an aversion to food, or may have other underlying medical concerns that it is hard for them to keep weight on?

Being underweight is not the same as being thin or slender. Some children have a naturally slight build and maintain it with a well-balanced diet and physical activity.

The child’s weight can cause great worry to the parents.

THIN OR UNDERWEIGHT? CHECK THE GROWTH CHART 

Children show us they are thriving through their normal growth and development as demonstrated on the Growth Chart. Your public health nurses or paediatrician plots your child’s weight and length/height routinely at well-visits and check-ups.

There are 4 nutrition indices to define nutritional status of children as measure through anthropometric measurements – body weight and height.

  1. weight-for-age (risk for underweight)
  2. height-for-age (risk for stunting)
  3. body mass index (BMI)-for-age (risk for overweight)
  4. weight-for-height (risk for wasting)

Percentiles (from 3 to 97) represent the normal window of growth we can expect for children.

The 50th percentile shows the average. This is where most children are.

It means that below 50th percentile is lower than the average, but still normal. Above 50th percentile is above the average, but still normal too!

Here’s what the percentile values on a growth chart do mean:⠀

A 2 year old boy who places on the 48th percentile on the weight-for-age growth chart means that 52% of all the boys (same age) out there weigh more than him and 48% weigh less than him.⠀

OR

Even if your child is at the 8th percentile for his weight, meaning that 92% of kids his age weigh more than he does, if he has always been at the 8th percentile, then he is likely growing normally. It would be concerning and it might mean there was a problem with his growth if he had previously been at the 50th or 75th percentile and had now fallen down to the 8th percentile

What you should actually look at is how they progress over time on the growth chart and whether or not they’re staying on THEIR particular curve. Children who are growing normally will track their growth predictably on their own personal growth curve. Whether 48th percentile or 8th percentile, it doesn’t mean that his particular weight is good, bad, right or wrong. There is no “goal” to reach here. It just shows that body come in all shapes and forms. Some children are meant to be more petite or smaller, some are meant to be more largely built or much taller. Just look at their parents and family history as a good indicator! Genetics will win!

If time passes and you notice they’ve dropped from the 48th to the 15th percentile, that’s more of a concern! Same thing goes when it’s a big jump from the 60th percentile to the 85th percentile. That’s more of what we would call “falling off the growth curve”. It could be, of course, due to over/under-eating, malabsorption issues or some other underlying medical issue or it could be something as simple as a growth spurt.⠀

The key message here is that there’s no right or wrong percentile for your toddler! Every child has their own established growth curve. Where another child has nothing to do with where your child should be. Having a chubby or a skinny toddler does not mean they are healthy or not healthy. And trying to actively change their natural curve does a lot more harm than good.⠀

Last, the growth chart is a good indicator of your child’s overall nutritional status.  If your child appears to be maintaining a usual and predictable pattern on the curve, you can rest assured that your child is getting adequate calories for normal growth.

It is not just about extra calories.

START WITH HEALTHY MEALTIMES

Sometimes, parents use ineffective strategies to get their child to gain weight and grow, including negative feeding practices, in an attempt to feed them high calorie foods to boost their weight.

First, building a healthy food relationship (not just calories) is more important.

Understand the Feeding Relationship 

A parent’s role is to choose what foods to offer, when, and where. Parents should provide healthy foods and offer regular meals and snacks.

A child’s role is to decide how much to eat and whether or not to eat at each meal.

Zero Pressure

Sometimes your child may refuse meals or snacks. Don’t beg, bribe or threaten your child to eat certain kinds or amounts of food.

Pressuring a child to eat can make them eat less. 

Away from Distraction 

Families should enjoy healthy eating together. Your child shouldn’t be singled out from the rest of the family. Everybody eats at the table together. Your child will focus on eating with fewer distractions. Turn off the TV, computer, IPad, and put toys aside around feeding time.

Stick to Mealtime Schedule

Regular meals and snacks will help your child eat enough food to grow well and be healthy. Offer food every 2-3 hours at planned times.

Offer 3 meals and 2-3 snacks each day. 

Watch Empty Calories

Limit foods like sugary drinks, candies, potato chips and donuts. These foods don’t help children grow well.

Set Mealtime Boundaries

Set some table rules at meal times such as “everyone stays at the table until dad/mum’s finished”, even if your child doesn’t want to eat what you’ve served. Because they are sitting with food in front of them, they may end up picking at it! This is useful if your child wants to rush off and play rather than eat. But don’t force or nag them to eat. You’re just asking them to stay at the table. You don’t want to turn meal times into a battle.

Avoid Filling Up on Fluids 

Drinking too many fluids like milk and juice may make a child less hungry for meals and snacks.

Serve no more than 2-3 cups of milk each day. Limit fruit juice to 0-1/2 cup each day.  

Read Label

Limit foods and drinks labelled “light”, “low fat”, “fat-free”, “low calorie” or “sugar-free”.

Watch Your Languages 

Watch your language and conversation around body size and shapes. If you talk about people being fat, on a diet, over-eating, or you are watching your own weight by counting calories or you obsess over food labels and your own body shape, then a child picks up on this quickly. Children mirror a parent’s pattern and chatter. Catch yourself out and avoid this kind of chatter, especially if your child has suddenly started eating less and is starting to lose weight, they may have started dieting because of this unhealthy conversation.

FOODS TO GAIN WEIGHT 

Every Bite Count 

Every bite of food and every gulp of liquid can make a contribution to your child’s ability to gain weight and grow. Offer foods high in calories and rich in nutrients at every meal and snack.

Make some simple switches to double up their energy intake without making them eat more. 

Parents with an underweight child are usually struggling with knowing which foods to feed their child to help them gain weight.

If your child is thin or underweight and you are worried about whether he or she is getting enough nutrition, here are some ideas to help calm your fears and feed your child:

  • Vegetables and Fruit
    • Cooked vegetables with cheese sauce or grated cheese
    • Fruit with yogurt or peanut butter
    • Avocado as a spread, in smoothie, or as a dip (guacamole)
    • Potatoes, sweet potatoes, squash (butternut squash or spaghetti squash), or turnips mashed with milk and butter (or non-hydrogenated margarine)
    • Dried fruit (apple, prunes, apricots, raisins, cranberries) added to baked goods
  • Grain Products
    • Bread, crackers, muffins with cheese, cream cheese, hummus, nut butter
    • French toast, pancakes, waffles made with eggs, oil, milk. Serve with syrup, fruit, yogurt on top
    • Hot or cold cereal with milk, nuts and fruit
    • Granola or muesli with yogurt and fruit (recipe here and here)
    • Wheat germ added to baked goods
    • Meat (fried in oil) with vegetables and rice
  • Milk and Alternatives
    • Choose whole or full fat milk. Offer as a drink or use it in place of milk in recipes
    • Cream soup or sauce made with whole milk
    • All types of cheese. Sliced or grated onto foods
    • Yogurt as a dip, mixed with fruit, or added to smoothie
    • Fortified soy beverages can be use as a drink or in recipes
    • Plant-based milk are often lower in calories and protein. Not recommended !!
  • Meat and Alternatives
    • Meat with gravy or other sauces (curry or sweet and sour sauce)
    • Scrambled egg with cheese
    • Egg salad sandwich
    • Omelette with cheese, ham, tomato, peppers
    • Quiches
    • Hummus with crackers or pita bread
    • Fish cake (recipe: Easy Salmon Cake)
    • Nut butter spread on bread, or added to smoothie or muffins
    • Tofu
    • Nuts or seeds offered as snacks or add to baked goods, granola, or muesli

I’ve also got another free FOODS TO GAIN WEIGHT guide you can use for your children to get you started so you can start feeling better about every bite your child takes.

ACTIVE LIFE 

Give your child more time to be active. Being active can make children hungrier for meals and snacks. Limit screen time, like watching TV and using other electronics. Read this post to learn how to increase physical activity level of your child.

BOTTOM LINE 

If you’re a parent struggling to put weight on your child, remember that at the end of the day, you want a healthy, happy and confident child. So, yes while it is important for your child to eat, do not make it a battle or power struggle. If you’re concerned about their growth, be sure to talk to your doctor, dietitian, or public health nurses.

Are you worried about your thin child? Are you thinking that you might want some one-on-one nutrition counselling, either for you, or your baby or child? Check out my one-on-one nutrition counselling services here. 

understanding-lactose-intolerance-photo

Understanding Lactose Intolerance

by with No Comment Child & Family NutritionDigestive HealthInfant NutritionToddler Nutrition

WHAT IS LACTOSE? 

Lactose is is a naturally occurring sugar found in milk and other dairy products (yogurt, cheese and ice cream). When you consume food or drinks containing lactose, an enzyme named lactase in the small bowel will break down lactose into two simple sugars: glucose and galactose. These nutrients are then absorbed in the small intestine.

Image source: http://www.evo-ed.org/Pages/Lactase/cellbio.html

WHAT IS LACTOSE INTOLERANCE? 

However, some people might produce less lactase than the others. If the small bowel has insufficient lactase, the lactose consumed will not be digested properly and will continue through to the large bowel. Lactose in the large bowel will be fermented by the gut bacteria, which produces gases including hydrogen, carbon dioxide and methane. This gas production not only can lead to unpleasant gastro-intestinal symptoms such as distention, bloating, flatulence and constipation but can also draw water into the large bowel resulting in loose stools or diarrhea.

Some people may have a temporary lactose intolerance due to  viral infection like the stomach bug, while others can experience it when they have a digestive disorder like celiac disease. Still others may experience lactose intolerance their entire lives.

SYMPTOMS  

  • bloating
  • abdominal pain due to gas
  • tummy cramps
  • nausea
  • loose stool or diarrhea

If you are lactose intolerant, the symptoms may vary and are dose-dependent. That is, the more lactose you consume, the worse the symptoms become. Symptoms may occur immediately after drinking milk or eating dairy products, or they may be delayed for hours.

Lactose intolerance is NOT an allergy to milk. 

DIAGNOSIS 

To diagnose lactose intolerance, the hydrogen breath test is a simple, non-invasive and reliable investigation test. Lactose intolerance is indicated when hydrogen and methane levels of breath meet a certain criteria following the oral consumption of standard dose of lactose.

Another simple way to diagnose lactose intolerance is an elimination diet which involves removing lactose in the diet and assessing whether symptoms improve, followed by a re-introduction of lactose in the diet to assess whether symptoms return.

WHAT FOODS CONTAIN LACTOSE? 

Read the ingredient list on product labels to find out if the product contains a lactose-cotaining food. Food items to look out for include: milk, milk solids, malted milk, buttermilk, curds, cheese flavours, non-fat milk powder, non-fat milk solids, sweet or sour cream, lactose, whey and yogurt.

Note: 1) the cultures in yogurt help to digest lactose 2)Products that contain lactic acid, lactalbumin, lactate and casein do not contain lactose. 

IF YOU ARE LACTOSE INTOLERANT, SHOULD ALL DAIRY PRODUCTS BE AVOIDED? 

Yes, you will need to modify the diet in order to alleviate the discomfort and symptoms at the beginning. The first step is to remove all sources of lactose in the diet that can cause problematic symptoms, including milk and dairy products.

The second step is to find nutritious substitutions for those items you’re removing:

Note: 1)”Lactose free” means that there is no detectable lactose in the food. 2)”Lactose-reduced” means that at least 25% of the lactose in the product has been removed.

Recent research has suggested that most people with lactose intolerance can consume up to 12 to 15g of lactose without any symptoms. You can still tolerate some foods that contain lactose like yogurt or cheese, even if you are lactose intolerant.

OTHER TIPS ABOUT INCLUDING LACTOSE IN YOU AND YOUR CHILD’S DIET: 

  • Drink milk in smaller quantities. Most people with lactose intolerance can tolerate 1/2 cup milk at a time.
  • Eat small amounts of lactose-containing foods spaced throughout the day.
  • Eat with other solid foods may delay digestion, offering more time for the lactase enzyme to break down lactose.
  • Yogurt may also be tolerated (plain better than flavoured), because the live bacteria in the yogurt partially digests the lactose before consumption. Yogurt is also a semisolid, which moves slowly through the digestive tract.
  • Aged cheese tend to have lower lactose content.
  • Try lactase enzyme drops or tablets from the pharmacy. Tablets are taken before eating foods that have lactose. Enzyme drops can be added to milk before drinking.
  • Soy products do not contain any lactose and can be a suitable substitute for dairy products, providing they have calcium added.

Do you have a child with lactose intolerance? How are you managing? Did you know that I provide one-on-one nutrition counselling service for children and families? If you are diagnosed with lactose intolerance, I can help to ensure you are not missing out on important nutrients such as Calcium. This is particularly important for children. If this is something you’d like to learn more about, check out here.