Feeding Kids Healthy series – Eating a Balanced Diet

Traditionally, parents worry about whether children are eating enough but based on the rise in childhood obesity (currently about 11% in Singapore), parents also have to be mindful of overeating AND eating the wrong types of foods.

Anna Jacob Abbott Interview with EczemaBluesFor this 2-part series focused on feeding kids healthy, Abbott facilitated the interviews with nutrition experts. Last week, we covered what and how much a child should eat. This week, we will focus on how we can get the child to eat a healthy and balanced diet. We have Anna Jacob, Director of Nutrition from Abbott. More on Ms Anna here.

MarcieMom: Thank you Anna for helping us figure out how we can actually get our kids to eat the healthy meal we’ve prepared. We assume that parents have the knowledge to serve a healthy meal of half plate fruits and vegetables (the more colour, the better), a quarter of protein and a quarter of whole grains. Let’s overcome the potential obstacles in each food group!

For fruits, the common ones in Singapore are apples, oranges, pears, grapes, strawberries and mangoes. Within these fruits, we have red, orange, green, purple and yellow! Would you reckon it is more attractive to kids to be served a variety of colours within a meal or rotating each fruit? What is the serving size in each case? Must they be organic?

Anna Jacob: Fruits are rich in many vitamins, some minerals and dietary fibre. Brightly colored fruits also have many natural plant compounds that are now known to be beneficial to health. For example, beta-carotene in yellow-orange fruits supports healthy skin and anthocyanins in red fruit may benefit heart health.

There are basically five colored types of fruit:

  • Green:  Green apples, pears, kiwi, honeydew
  • White: Bananas, lychees, longans, mangosteens
  • Yellow and Orange: Oranges, papaya, cantaloupe, mango
  • Red: Cherries, watermelon, red apples
  • Blue and Purple: Blueberries, purple grapes

Parents can add color to their children’s meals with a variety of fruits, making recipes more attractive and nutritious.  However, we do not have to serve up all the colored fruits on one plate all the time. Incorporating them through different meals and snacks will help your child appreciate and eat them too.

Dietary guidelines from around the world recommend that fruit should be part of a child’s diet – starting with just half a serving after 6 months and progressing to 2 servings by 7 years.  Examples of a serving of fruit, as defined by Singapore’s Health Promotion Board, is 1 medium banana, 1 medium apple, pear or orange, 1 wedge of watermelon, papaya or melon or 10 grapes or longans.

Fruits in Singapore are safe and rinsing the fruit in clean running water before cutting and eating it is sufficient. Therefore, it is not necessary for parents to buy only organic fruit for their children. But for those who want it and can afford it, organic fruit – free of synthetic fertilizers and pesticides – may provide peace of mind.

MarcieMom: For vegetables, the leafy green ones, cruciferous (broccoli, cauliflower and Brussel sprouts) are packed with nutrients. What is the best method of preparation that retains the nutrients yet appealing to kids? Do you recommend hiding vegetables?

Anna Jacob: Indeed, green leafy vegetables are rich in many nutrients including iron, vitamin C, folate, calcium and fibre.  However, many vitamins are sensitive to light and exposure to air. In addition, the water soluble vitamins and many minerals are soluble in water.

Vegetables retain their nutrients best when they are eaten fresh and not processed. To preserve the nutrients in fresh vegetables, prepare them just before eating; do not soak or cook them in water for too long, prepare just before eating, cut into larger pieces and do not overcook vegetables.

Cooking destroys some nutrients, especially the fragile, water soluble ones.  However, many children eat more vegetables when they are served up cooked. Of the many cooking methods commonly used to prepare vegetables, microwaving and steaming conserve nutrients best.  On the other hand, some nutrients in vegetables are better absorbed when prepared with some fat.  For example, tomatoes cooked in oil make lycopene (the natural red pigment) more available to the body. Cooking also makes many otherwise inedible vegetables suitable for a child’s diet – think potatoes, yam, beets and more.

So, use several cooking methods to prepare vegetables to increase your child’s exposure to a variety.  Aim to provide ½ serving of vegetables a day to a child over 6 months and, gradually progress this to 2 servings by the time he / she enters school.  A serving is defined as ¾ of a 250-ml mug of cooked or non-leafy vegetable, 150 g of raw leafy vegetables and 100 g of non-leafy vegetable.

Ideally, children should accept all food including vegetables. However, some reject vegetables due to color, taste, texture. Some scientists also suggest that a few kids are ‘super-tasters’ and may be more sensitive to the bitter notes of leafy green and cruciferous (broccoli, cauliflower and Brussel sprouts) vegetables – causing rejection of these nutrient-dense foods.

Patience is the key when you want to inculcate healthy habits – offer the same vegetable over and over again, without forcing, so that the vegetable becomes familiar. Model eating the same food item at family meal times and, vary the presentation, cooking method and flavoring.  If and when all these suggestions for introducing vegetable fail or take time to achieve, parents may have to be creative and incorporate vegetables in foods. So, ‘hiding’ vegetables is a last resort and not the best option.  But, it is still a valid option and, so, do not feel guilty if you are doing it. Just keep working on all the suggestions listed above, and, soon over time, you will succeed – at least to some degree.

MarcieMom: For grains, whole grains like whole wheat, brown rice, quinoa are better than white rice. As there is less natural sugar in these than white rice, how should they be prepared to be appealing?

Anna Jacob: Natural grain foods – whole grain and polished – do not contain natural or added sugars. All carbohydrates in grain foods, after digestion are absorbed into the blood stream as simple sugars. This is unavoidable as it is the way the body handles carbohydrates. Sugars and starches are not all bad – they do help provide energy to keep children active. In the right proportion, they ensure that children get the energy they need to grow and be active. One advantage of whole grains is that it has more fibre, vitamins, minerals and natural plant components than refined grains. So, definitely, whole grains are more nutritious and therefore, the healthier choice. Here are some tips on how to cook them:

  • Brown rice can be steamed or boiled. However, you need to adjust cooking time and added water volume to achieve a soft and edible grain suitable for your child’s eating ability.
  • Whole wheat grains can be boiled to prepare porridge or milled to make whole meal flour. The flour is versatile and you can make a variety of breads and biscuits with it.
  • Quinoa, usually prepared by the absorption method, requires two-times the volume of water as quinoa and cooks in 10 – 15 minutes.

As these are staple foods and, we eat a good portion of them at each meal, so, it is best to prepare them simply with less fat, salt or sugar. They can be eaten with vegetables and lean proteins as side dishes.  In addition, for variety, you can toss whole grains with fresh or cooked vegetables, nuts, lean meat and some natural seasonings to prepare delicious one-dish meals or snacks.

MarcieMom: Apart from the food preparation, can you share your top 5 tips for getting children to experiment different foods and eat the foods served to them? What are the top 3 pitfalls to avoid when getting a child to eat his/her meal?

Anna Jacob: 5 tips to get children to experiment eating different foods 

5 Tips to Get your kid to experiment

  1. Involve your child in food preparation. From gardening to shopping and cooking, involving your child will help him/her learn about food, become familiar with it and, even develop a sense of pride and ownership. Time spent together over these activities will offer you many opportunities to teach your child about the nutrient-goodness of food as well.
  2. Eat with your child. Children learn about nutrition best by modeling healthy eating behaviors. As you eat a wide variety of food, your child will learn to do so too. You can use these special moments to teach table manners and to bond.
  3. Offer healthy foods. As a parent, you need to ensure age-appropriate and healthy foods are available at regular meal and snack times. However, you need to allow your child to select the portion he wants to eat. Encourage independent eating too. Over time, your child will develop a healthy attitude towards food and eating.
  4. Be creative but do not become a short-order cook. Offer your child a variety of food items, cooked in various styles. You can do this by becoming a creative cook or introducing your child to various food choices out of home. But, once the menu is set, and the food is on the table, do not entertain preparation of special dishes for your child.
  5. Allow your child to occasionally eat with peers. Kids also learn fast by watching their friends. Eating a meal or two with peers helps your child pick up skills he never had.

3 pitfalls to avoid when getting a child to eat his/her meal

  1. Do not abdicate responsibility for your child’s nutrition. Many working parents do not have the luxury to be at home with their child at every meal time. But, set the menu. Know what is served and what is eaten. Talk to your child’s caregivers and, tell them what you would like your child to eat so that they can work with you to ensure good nutrition.
  2. Do not force feed. While you decide when, where and what your child eats, please give your little one the right to select how much he wants to eat. Force feeding is counterproductive as it stresses the caregiver and, scares the child or causes defiance.
  3. Do not distract your child while eating. It is another common practice to let children watch television or play computer games during meals while the caregiver feeds the child. This feeding style does not develop a child’s self-feeding ability – to know and appreciate what is served and learn to be conscious of how much he is eating.

While you should encourage healthy and appropriate eating, this takes time and much effort, you should track growth with your child’s physician at regular visits; and, in the interim you may provide a complete and balanced supplement to fill nutrient gaps, if any – to achieve optimal growth during the critical periods of life.

Thank you so much to Anna Jacob for sharing these tips. Even for families who are already eating healthy, it is a good reminder to keep up the effort, try new foods and enjoy a healthy life!

Pediasure Giveaway

There is also a giveaway sponsored by Abbott and do visit their free Pediasure-Nutritrac tool.

PediaSure goodie bag

The goodie bag contains:

  • 1 x PediaSure purple tote bag
  • 1 x Food cutter set
  • 1 x Lunch box
  • 1 x PediaSure RTD Chocolate flavor
  • 1 x PediaSure RTD Vanilla flavor
  • 1 x $3 PediaSure voucher
  • 1 x $5 PediaSure voucher

Giveaway rules:

Comment in this post or email [email protected] your reply to “How do you get your child to eat more vegetables?” by 27 February 2015

3 winners will be selected, with each receiving the goodie bag above.

If you’re selected as a winner, you have to provide your Singapore address for the goodie bag to be sent to you.

Have fun with the giveaway! You can include pictures of a healthy meal with veges too!

Feeding Kids Healthy series – What and How Much is Right?

Traditionally, parents worry about whether children are eating enough but based on the rise in childhood obesity (currently about 11% in Singapore), parents also have to be mindful of overeating AND eating the wrong types of foods.

Dr Chu pediatrician Singapore Interview on EczemaBluesFor this 2-part series focused on feeding kids healthy, Abbott facilitated the interviews with nutrition experts. Today, we have Dr Chu Hui Ping, Paediatrician from Raffles Children’s Centre with a clinical interest in pediatric gastroenterology. More on her profile here.

So let’s start with understanding how much a child should eat!

MarcieMom: Thank you Dr Chu for helping us in this series to clarify for parents how to feed our children. Firstly, in Singapore, we are familiar with the growth charts included in our child’s health booklet. Parents can work out the weight and height percentile of their child against the right chart for their age and gender.

Should growth charts be used as a gauge of how much to feed a child? For instance, being above 95% percentile for weight means that the child should cut back and below 5% means parents should feed more?

Dr Chu: It’s probably not that simple and straight-forward just to use the growth percentile to decide on how much the child should be eating. Generally we don’t only look at the percentile for weight; we also consider the height percentile, i.e. whether the child is proportionate for weight and height, as well as the growth of the child over the last few months or a year.

Some children are genetically bigger in size, for instance they are already born bigger and have always been growing along the 95th percentile for their weight and height. So it will not be appropriate to put these kids on a diet. It is more important to ensure that children who are at above 95th percentile and who are at less than 5th percentile for weight are being assessed by their doctors or paediatricians to exclude any medical conditions which make them gain or lose weight respectively. Even if there aren’t any underlying medical conditions, it is also essential to review the various components of their diets and ensure that the diet is well-balanced and consists of the essential nutrients rather than just cutting down or feeding more.

MarcieMom: Growth charts don’t take into account the fats a child has (since obesity is defined as excess fats) nor do growth charts take into account physical activity levels. How should parent figure out if their child should be eating more or less based on the amount of exercise they have?

Dr Chu: The child should be able to regulate his intake of food depending on the amount of exercise he has. Generally if the child is active, i.e. participates in active play or exercise for 60 minutes in a day, he will feel hungry and ask for food if his current diet is insufficient to meet his activity level. It is more common for parents to give too much food in proportion to the amount of exercise that the child has, resulting in the child being overweight due to the excess unutilized calories. If the parent feels that the child is not eating sufficient for the amount of physical activity he has, he can increase the proportion of complex carbohydrates or whole grains which can help to release energy in a slow manner, as well as proteins in the form of lean meat for muscle growth.

MarcieMom: How much to eat is only one part of the equation. What about the type of foods? While we know that excess sugar, trans-fat and processed foods are bad for health, what can parents do to ensure that their child have an optimal diet? Do share your top 5 tips on eating healthy for the child (and family)!

Dr Chu: My 5 tips for healthy eating for anyone, child or adult, are as follows:

Kids Healthy Diet

  1. Eat fresh –try to avoid processed foods and to prepare your meals using fresh ingredients.
  2. Ensure that half of your meal should be consisting of vegetables and fruits.
  3. Choose wholesome foods such as brown rice and wholemeal bread.
  4. Reduce unhealthy fats/oils by cooking in a more healthy manner – steaming, boiling, stewing etc.
  5. Drink water for hydration instead of sweetened juices and soft drinks.

MarcieMom: In Singapore, there are many food courts and coffee shops but these usually don’t meet the healthy plate guideline of half a plate of fruits and vegetables. Which 5 common dishes found in coffee shops would you recommend and which 5 dishes would you discourage for children?

Dr Chu: Choosing health food options in food courts and coffee shops may be tough but not impossible. I would recommend these food choices:

  1. Rice with mixed dishes (choosing at least 1 vegetable and 1 lean meat)
  2. Fish soup with additional vegetables, soup noodles with additional vegetables
  3. Grilled fish or chicken with salad and mashed potato (instead of French fries)
  4. Freshly cut fruit platter

I would discourage these food options for children:

  1. Chicken rice (because too oily and little vegetables)
  2. Char kway teow (because too oily and too much salt)
  3. Fried economic beehoon with luncheon meat (because too oily and lots of MSG in the processed meat)
  4. Laksa (because high saturated fats from the coconut milk)
  5. Black fried carrot cake (because too much salt and sugar from the black sauce used)

Thank you Dr Chu for enlightening us on the types of foods beneficial for our child’s growth. Next week, we will check back on how to actually get our child to eat them!

Pediasure Giveaway

There is also a giveaway sponsored by Abbott and do visit their free Pediasure-Nutritrac tool.

PediaSure goodie bag

The goodie bag contains:

  • 1 x PediaSure purple tote bag
  • 1 x Food cutter set
  • 1 x Lunch box
  • 1 x PediaSure RTD Chocolate flavor
  • 1 x PediaSure RTD Vanilla flavor
  • 1 x $3 PediaSure voucher
  • 1 x $5 PediaSure voucher

Giveaway rules:

Comment in this post or email [email protected] your reply to “How do you get your child to eat more vegetables?” by 27 February 2015

3 winners will be selected, with each receiving the goodie bag above.

If you’re selected as a winner, you have to provide your Singapore address for the goodie bag to be sent to you.

Have fun with the giveaway! You can include pictures of a healthy meal with veges too!

(Video) Family Mealtime should look like this!

For parents of picky eaters, the last date to sign up for the Picky Toddler Solution is on 16 October. Dietitian moms behind this course has prized it to be cheaper than private sessions with pediatric dietitian.

For parents of picky eaters, the last date to sign up for the Picky Toddler Solution is on 16 October. Dietitian moms behind this course has priced it to be cheaper than private sessions with pediatric dietitian.

This is the last of the short video series by two Mom Dietitians, previous videos were on Magic Phrase to end feeding battles and Mom’s Role in Feeding Kids. Today, it’s another short video on what Happy and Healthy Family Mealtimes should be. Dietitian Natalia Stasenko, RD is no stranger to this blog as she had provided valuable information on a Toddler Nutrition series covering

How Much to Eat
What to Eat
What Not to Eat

In this video (click link here then input your email to view the 2nd and 3rd video), the following tips are shared:

  1. Picky eating typically starts at around 2 year old.
  2. Either of the extreme approaches are wrong, either (i) Give up serving healthy selection  of food (Mom’s Job!) and cater to what the child wants and when he/she wants it! OR (ii) Controlling and turn meal time to be a battle session.
  3. A Happy and Healthy Mealtime should incorporate selection of foods, including healthy options and what your child normally likes to eat. The whole family sits together and each pick their own foods from the serving.
  4. It is not advisable to have a separate meal time for the child = Sending message that he/she is not expected to eat what the family eats.
  5. Inculcate a positive attitude to eating, valuing family meal time and trusting the child to feed himself/herself (the child’s job!

P.S. I’VE SIGNED UP AS AFFILIATE FOR THIS PICKY EATER CLASS, BUT MORE SO AS I’VE WORKED WITH NATALIA BEFORE AND SHE’S VERY PASSIONATE ABOUT KIDS NUTRITION.

(Video) Mom’s Role in Feeding Kids

Nuts with Toddler Feeding

FeedingBytes Kids Diet VideoLast week, I’ve shared a short video on Magic Phrase to end feeding battles. Today, it’s another short video by two Mom Dietitians that clarify’s the Mom’s Role in Feeding Kids. Dietitian Natalia Stasenko, RD is no stranger to this blog as she had provided valuable information on a Toddler Nutrition series covering

  • How Much to Eat
  • What to Eat
  • What Not to Eat

In this video (click link here then input your email to view the 2nd video), the mom’s role in feeding our kids is clarified:

  1. Selecting a healthy variety of foods
  2. Structuring meal and snack times

Kids’ stomachs are smaller and their attention spans shorter, as much they may eat more frequently, of smaller portions compared to adults. The parents’ role is to ensure healthy foods are served, i.e colorful fruits and vegetables, grains, proteins AND to plan meal times, rather than allow the child to eat anytime all day long.

It is OK if the child rejects certain foods, eats small portions of some or generous portions of others OR even vary on different days. Face it, even adults can’t have the same appetite daily.

It is not OK if the child eats junk all day, or start to link food with emotions (“emotional eating”). Here’s where the dietitians recommend structuring meal and snack times and when it’s not the scheduled time, to offer water instead.

Child’s Feeding Job

The child’s job is to decide what and how much to eat, otherwise, he/she will lose the ability to self-regulate eating and instead eating becomes a power struggle or easily turn into emotional eating.

All parents worry about the child’s growth and whether eating enough. However, it should be more focused on healthy selection of food, right attitude towards eating and enjoying family meal times!

P.S. I’VE SIGNED UP AS AFFILIATE FOR THIS PICKY EATER CLASS, BUT MORE SO AS I’VE WORKED WITH NATALIA BEFORE AND SHE’S VERY PASSIONATE ABOUT KIDS NUTRITION.

(Video) Picky Toddler – Feeding Battles Magic Phrase

Kids Nutrition Video Picky Eater

Watch two dietitians share tips on feeding picky toddlers

Two Mom Dietitians had teamed up to present an online training class for feeding picky toddlers. I’ve interviewed one of them, Natalia Stasenko, RD before on a Toddler Nutrition series covering

How Much to Eat

What to Eat

What Not to Eat

In the video above (click link here), the dietitians shared about a magic phrase to end feeding battles

Toddler Nutrition

You Don’t Have to Eat

Generally, for picky eaters, the parents find themselves pleading, tempting or rewarding for eating food. However, the more pressure placed on the child to eat, the more likelihood that child will resist and not eat. On the other hand, children are more likely to consider trying foods when there’s less pressure to eat.

However, what if the child really doesn’t eat? Both dietitians shared that it’s unlikely that children will not eat meal after meal. To gain some insight as to why a child may not want to eat then, parents have to look at the eating pattern of the child and the existing circumstance. For instance, if the child has been grazing the whole day (i.e. eating small amounts of food throughout the day), he/she is unlikely to feel the need/drive to eat a proper meal. Also, the child can be tired, or feel more like playing or doing other activities to ‘release steam’ rather than eat.

There will be a next video on parents’ role in feeding and a clue is that it is not our job to get the child to eat – yes, we prepare and present the food but eating should come from appropriate inner drive from the child. Watch this video here!

p.s. I’ve signed up as affiliate for this picky eater class, but more so as I’ve worked with Natalia before and she’s very passionate about kids nutrition.

Toddler Nutrition series with Natalia Stasenko – What NOT to Eat (Part II)

Toddler Nutrition series with nutritionist on Eczema Blues

Learn more about supplements in this interview with nutritionist Natalia

This is a 3-topic series focused on nutrition for toddlers, in particular dealing with picky eaters or children who cannot eat certain foods. I’m glad to know a friend, Natalia Stasenko, a registered dietitian, whose passion is pediatric nutrition and shares nutrition tips on her website, online classes and of course, with all of us here in this series!

More on Natalia, RD – Natalia has a Master of Science in Nutrition Education from Columbia University. She founded her private practice Tribeca Nutrition and online nutrition class for parents of babies and young children at Feeding Bytes.
For further information on her latest online course on feeding toddlers, do check out this link.

My Child Can’t Eat That!
This final topic of the Toddler Nutrition series is an extension from last week, focusing on what a child cannot eat simply because they shouldn’t! If you missed the first two parts on How Much to Eat and What to Eat, do click on the links and catch up!

MarcieMom: Thanks Natalia, let’s zoom right in to What are the top 5 foods that you think under no circumstance a child should be given, or as infrequent as once a month?

Natalia: It is hard to ban certain foods from a child’s diet, especially as they become more independent in obtaining their food when they grow up. To avoid vilifying certain foods, that may only increase their appeal in children’s eyes, I prefer to focus on staying away from certain ingredients and buy or make a better version of children’s favorites most
of the time. My top 5 food additives to avoid are artificial dyes, artificial sweeteners, sodium nitrate, certain preservatives (BHA and BHT) and trans fats. The good news is that by preparing most of the food at home and reading food labels a family can easily cut on their consumption of these foods.

I also believe in watching sugar in kids’ diets because too many sugary foods not only leave less space in small tummies for more nutritious foods but also create real health risks in the future. American Heart Association recommends only 4-5 teaspoons of added sugar per day for children, while most children get 3-4 times the amount. To calculate the amount of sugar in a serving of food, divide the number of grams of sugar on the label into 4, it will give you the number of teaspoons of sugar the food contains.

MarcieMom: I’m giving my child supplements – she eats a balanced meal but I think 1. Probiotics, 2. Omega-3 and 3.Multi-vitamins (in doses below 100% of daily requirement) could strengthen her immune system. Is that the right thinking/approach or should I throw these out of the window? 

Natalia:When it comes to supplements, it helps to remember that it is a very loosely regulated market. FDA controls (somewhat) their safety, not efficacy. In our class we talk about consumer organizations that test and review supplements and I use their input in my work and personal life all the time. I see a lot of multivitamins of supermarket shelves that are mostly sugar and food coloring, missing the nutrients children are most likely to fall short on. So I think it is important to work with a dietitian to choose the supplements your child may truly need.

For example, many toddlers do not get enough iron in their diets and at the same time it is missing from most multivitamins. The good news is that there are specific additive and allergen-free comprehensive multivitamin formulas I recommend to parents of picky toddlers but they are not typically sitting on the eye level in supermarket shelves and some may only be purchased online.

Back to your question: providing your child with multivitamins, probiotics and DHA may be a good strategy to help close the potential nutrient gaps if your child does not eat many fruit and vegetables, eats no fermented foods and oily fish. But we know that nutrients are best absorbed when they come in the whole package, in foods. So I would still focus on exposing children to the nutritious foods that they are still learning to like, which I feel
you are already doing wonderfully!

Thank you so much Natalia for being with us and sharing so much tips for the past 3 weeks. I’m most happy to see that parents who sign up for your online course for toddlers will really get their money worth with your practical approach to improving nutrition!

Toddler Nutrition series with Natalia Stasenko – What NOT to Eat

Toddler Nutrition on Eczema Blues with nutritonist Natalia Stasensko

Don’t forget to get 30% off Natalia’s toddler nutrition class with code EcBlues30

This is a 3-topic series focused on nutrition for toddlers, in particular dealing with picky eaters or children who cannot eat certain foods. I’m glad to know a friend, Natalia Stasenko, a registered dietitian, whose passion is pediatric nutrition and shares nutrition tips on her website, online classes and of course, with all of us here in this series!

More on Natalia, RD – Natalia has a Master of Science in Nutrition Education from Columbia University. She founded her private practice Tribeca Nutrition and online nutrition class for parents of babies and young children at Feeding Bytes.
For further information on her latest online course on feeding toddlers, do check out this link. Natalia is also offering 30% to readers of Eczema Blues with the code EcBlues30.

My Child Can’t Eat That!
This final part of the Toddler Nutrition series with Natalia is going to be fun. If you missed the first two parts on How Much to Eat and What to Eat, do click on the links and catch up!

Today we will explore two scenarios:
i. What a Child Cannot Eat due to Allergy, Food Sensitivity or Intolerance, and
ii. What a Child Cannot Eat because he/she just shouldn’t!

MarcieMom: Hi Natalia, so good to have you back! Let’s go straight into the situation when a child cannot eat certain foods. Instead of focusing on each condition, could you offer quick insights into
i. When a parent should suspect there’s a problem with the child after eating the food?
ii. When should a parent bring a child in for test/ examination?

Natalia:In case with allergic reactions, the typical symptoms to look out for are hives, swelling of the face and mucous membranes found in the nose, ears, lungs and throat, nasal congestion and sneezing, intestinal cramps, vomiting and diarrhea. With smaller kids who cannot talk yet, general discomfort and crying after eating a specific food may also indicate an allergic reaction to food. If your child has any of these symptoms after trying a certain food for the first time, food allergy may be suspected. It is a good idea to call your doctor who will probably refer you to an allergist for a testing.

Food allergy is often diagnosed by one of the widely available tests: skin prick test and blood test for antibodies, neither of which gives a 100% guarantee of true clinical reactivity. These tests may be helpful to assist in diagnosing food allergy when the patient history indicates that a specific food may be a problem. A double blind placebo controlled food challenge is considered by this and other reports as a diagnostic “gold standard”. This basically means that a person is given the suspected food once and a placebo another time, without knowing what is what.
The challenges are provided in gradually increasing doses and neither the patient nor the practitioner knows in which order they follow, thus patient and clinician biases are removed.

Once the offering food is identified, the doctor will likely recommend to remove it from a diet.Children with food allergies may be at a high risk for nutritional deficiencies if important foods like dairy, eggs, or wheat are not replaced by nutritionally optimal alternatives. For example: calorie, protein and fat contents of cow’s milk are much higher than those in most milk substitutes, including almond and rice milk. A child who drinks rice milk instead of cow’s milk may not be growing properly because he or she will not be getting enough nutrients in the diet. Soy milk, on the other hand, is closer in calories, fat and protein to cow’s milk and could be considered a good alternative. The US Food Allergy guidelines recommend nutrition counseling and close growth monitoring for all children with food allergies in order to ensure proper growth and development.

MarcieMom: We know that there are certain foods that are the more common food allergens of children, while others are likely to cause intolerance. Given that a food (say fish) has more than one nutrients, how should a parent know what is a suitable replacement food i.e. as long as replacing the main nutrition, say is a protein or replacing the more beneficial nutrients, the omega-3 or finding a food that is as close to fish as possible (but that may trigger the same allergy?).

Natalia: It is a great question and I would like to provide some background information. Food allergy is an adverse reaction to protein in food. So every time the allergen is eaten, the immune system starts fighting it using the whole arsenal of chemicals causing the potentially life-threatening symptoms. Food allergy is often confused with food intolerance, which is caused by lack of digestive enzymes, such as lactase in case with milk intolerance. However, food intolerance does not involve immune system.

Food allergy can be IgE-mediated and/or non-IgE mediated. IgE-mediated basically means that when the allergen is ingested, the body produces Immunoglobulin E antibodies, which attack the allergen causing the release of histamine and other potent mediators that cause the symptoms of a food allergic reaction. Non-IgE mediated reactions primarily affects the gastrointestinal tract lining and causes allergic disorders such as protocolitis and
entrocolitis. To complicate matters further, a bunch of adverse food reactions can be both IgE and non-IgE mediated.

As you see, there are many different ways we can react to certain foods. To answer your questions, in the case with fish allergy it is more likely to the protein the child is reacting to so the health care provider will probably recommend stay away from all fish and seafood and take a DHA supplement instead.

In case of milk intolerance, switching to lactose-free milk will help to avoid the symptoms but if your child. has food allergy to milk i.e. reacting to milk protein, all dairy products lactose free or not, should be avoided. In my private practice I worked with many kids with food allergies who needed a safe and balanced diet to meet their nutrient needs after removing the allergens. In most cases I needed to collaborate with their allergists and pediatricians to create a plan that works for a specific family.

Thanks so much Natalia, we are taking a pause till next week where I’d publish Natalia’s reply to part (ii) of this post on what foods kids simply should not be eating. This is to give some time for parents to digest the tips from Natalia – as you can see, she is thorough in her explanation, so imagine how much more you’d learn from her online class. Do sign up and don’t forget to use EcBlues30 for that 30% off.

Toddler Nutrition series with Natalia Stasenko – What to Eat

Toddler Nutrition series on Eczema Blues

Don’t forget to get 30% off Natalia’s toddler nutrition class with code EcBlues30

This is a 3-topic series focused on nutrition for toddlers, in particular dealing with picky eaters or children who cannot eat certain foods. I’m glad to know a friend, Natalia Stasenko, a registered dietitian, whose passion is pediatric nutrition and shares nutrition tips on her website, online classes and of course, with all of us here in this series!

More on Natalia, RD – Natalia has a Master of Science in Nutrition Education from Columbia University. She founded her private practice Tribeca Nutrition and online nutrition class for parents of babies and young children at Feeding Bytes.
For further information on her latest online course on feeding toddlers, do check out this link. Natalia is also offering 30% to readers of Eczema Blues with the code EcBlues30.

Who is Picking the Food?
Come to think of it, the willingness to open one’s mouth, put food in, chew and swallow can’t be forced. So seen in that light, your toddler is the one choosing the food. The problem steps in when he/she is choosing so much, the term ‘picky eater’ soon becomes how you see your child. Natalia has a special interest with helping parents feed picky
eaters, given her own parenting experience, let’s find out more from her in today’s interview!

MarcieMom: Natalia, thank you for joining me again in this series. The one last week on how much to eat was really insightful. Before, children can ‘pick’ the foods, parents must first put the food before them. What are your top 3 must eat foods that are essential for toddlers, on-top of the standard fruits and vegetables, protein source and carbohydrates?

Natalia: I would change the term Must-eat to Must-served. I feel like when parents are under pressure that their child must eat a particular food, children sense it and are more likely to reject it.This is a very small part of the nutrition talk we share in our upcoming online class where we discuss food alternatives and supplements if the child does not eat (yet) nutrient rich foods.

The Must-serve foods are:

Orange and dark green rich fruit and vegetables, due to Vitamin A, important for eye health and immune system

Oily fish such as salmon and tuna, due to DHA, important for retinal and brain development

Red meat, fortified cereal, beans, due to Iron, important for oxygen transportation and storing it in cells. Most common nutrient deficiency in small children is iron deficiency

MarcieMom: Assume that the child is refusing to eat the healthier butternut squash, broccoli and fish. What would you recommend a parent to do?
i. Forget about these foods, try new ones
ii. Stick to these foods, try new way of cooking
iii. Keep cooking these foods and let the child ‘starve’ if not eating
iv. Keep cooking these foods and more, just in case
In the option(s) you choose or maybe another option or a combination, how long should a parent try a certain tactic?
(It’s already starting to sound laborious to me, lucky for me, my child happen to love superfoods!)

Natalia: I would suggest to keep serving these foods, in the context of family meals, alongside the foods your child has already warmed up to. The biggest mistake parents make is creating pressure at mealtimes in an attempt to get their children to eat particular foods. This does not work. Catering, i.e. giving only the foods that your child likes, also backfires. Non-pressure, pleasant mealtimes, role modeling and plenty of exposure help kids push themselves to learn to like the foods the rest of the family is enjoying. Exposure to less liked foods outside of mealtime through shopping, cooking and taste-testing also works.

New ways of cooking may also help. For example, many toddlers dislike texture of meat so in the class we will share a recipe of meatballs cooked in broth that are literally melting in the mouth. When it comes to vegetables, even the simplest of them can be prepared in a variety of ways. For example, you can grate a carrot, cut it into matchsticks, make it into ribbons, steam it, roast it or pan fry it with some butter.

We definitely do not suggest starving your child till he eats certain foods. After years of working with children with feeding problems, I know that some of them would rather starve than eat something that is not acceptable to them. Besides, it creates a very negative mealtime dynamics that leads to smaller appetites and ultimately less variety in diet. Since our class is for parents of picky toddlers, we talk about specific strategies that help streamline meal planning to include the challenging foods and let everyone enjoy the meal in a pleasant environment.

MarcieMom: Various nutritionists have shared on this blog about inflammatory foods. Would you think this is of concern to young children as well? If so, which are the top inflammatory foods that you see commonly given to children and should be avoided?

Natalia: While we are still learning more from research what exact benefits anti-inflammatory diet brings to adults and children, it is clear that reducing processed foods and boosting fruits, vegetables, lean protein, oily fish and whole grains is a path to good health for both kids and grown ups. However, research shows that an overall dietary pattern seems to be more important than adding or removing specific foods from diet. I often use 80 to 20 ratio in my talks and classes, where 80 percent of food in kids’ diet are minimally processed from the list above and 20 percent are fun foods including treats. That said, I do not think that hydrogenated fats and artificial colors have a place in children’s diet. Of course, eating a blue lollipop or commercially prepared french fries from time to time is not likely to have a big health effect but if parents have an opportunity to choose candy with natural colors or bake french fries at home in the oven, it is great.

MarcieMom: A final question, how would you grade my ‘food grading’ chart that I use to educate my child? Feel free to shift items around!

ood Grading for Eczema ChildNatalia: I think it definitely helps to create a balance in the diet, with the focus on more nutritious foods. I think that following a chart like this can help lay down very good foundation for healthy eating habits in the future. However I must say though that as kids are growing up and have more outside influence on their diet from the peers, I had to adjust my feeding strategy to occasionally include “forbidden” foods like soda and cookies. Research shows that kids who are restricted tend to over indulge when they are given access to foods that are forbidden at home. Again, serving the foods you want your child to eat all the time is the key to get them learn to enjoy their flavor, which is the best nutrition education parents can provide.

Thanks so much Natalia, I can’t wait for next week’s interview on What Not to Eat!

Toddler Nutrition series with Natalia Stasenko – How Much to Eat

Toddler Nutrition series on EczemaBlues.com with nutritionist Natalia Stasenko

Learn from Nutritionist Natalia Stasenko on how to feed your toddler

This is a 3-topic series focused on nutrition for toddlers, in particular dealing with picky eaters or children who cannot eat certain foods. I’m glad to know a friend, Natalia Stasenko, a registered dietitian, whose passion is pediatric nutrition and shares nutrition tips on her website, online classes and of course, with all of us here in this series!
More on Natalia, RD – Natalia has a Master of Science in Nutrition Education from Columbia University. She founded her private practice Tribeca Nutrition and online nutrition class for parents of babies and young children at Feeding Bytes.
For further information on her latest online course on feeding toddlers, do check out this link. Natalia is also offering 30% to readers of Eczema Blues with the code EcBlues30.

Starting Solids
It is recommended by the American Academy of Pediatrics to start solids at 6-month old. During the first year, the primary nutrition should still come from milk, preferably breast milk as this is still the best nutrition for infants. Before we get into what to eat, let’s first start with the basic of how much to eat.

MarcieMom: Hi Natalia, thanks so much for collaborating on this series and congrats to the launch of your new online toddler nutrition class with Adina Pearson, RD. Given the small tummies of young children and that solids have a different place in their nutrition at various stages, would you summarize for busy moms and dads what portion sizes their children should be eating?

Natalia: This is a great question and I get it a lot at my workshops and online classes. Generally speaking, babies start with a very small amount of solids and gradually progress to more solid foods in their diet by the time they turn 12 months. At around 9-10 months many babies go through the “big switch”, as I call it. At this point, more calories and nutrition start coming from solid foods than from formula or breastmilk and many babies want bigger portions of solids and also start snacking on solid food rather than drinking milk or formula for snacks. It is important to remember that any guidance on portion sizes for babies can be interpreted only as an estimation, as babies’ appetites vary greatly.

Toddler Nutrition portion What I provide in this chart is more of a “starter” for portions. Some babies need more and some babies need less food. With this in mind, babies should never be pressured to finish a portion of food or be restricted in the amount they are hungry for. Here is a link to the article I wrote on why it is important to trust babies’ appetites.

MarcieMom: With regard to picky eaters, I’ve attended a talk by Dr Sears who suggested ‘grazing’, eating small-size food portions throughout the day. Since then, I’ve seen increasing number of articles that recommended it. Would you recommend the same, and if yes, why and for which groups of children would ‘grazing’ work best?

Natalia: Toddlers need to eat more frequently than older kids – every 2 to 3 hours. And serving them snacks in a muffin tray is a great idea! I did it for my own kids and always recommend it in my classes. But I think that the word “grazing” is a little confusing here. Grazing suggests eating small portions throughout the day without any mealtime structure. Dr Sears suggests serving the tray mid-morning and mid-afternoon and I think these are great times for a scheduled snack.

Some parents may leave the tray out all day in a hope to get a few extra bites into their toddler. This will most likely result in eating out of boredom and/or no appetite for dinner. Structure in meals and snacks help kids of any ages to eat better at meals and stay attuned to their hunger and fullness signals. In the class we are providing our participants with meal plans that help them to schedule meals and snacks to provide maximum nutrition and ensure good appetites for meals!

MarcieMom: Obesity is a rising problem among kids, actually not just in US but in Singapore as well. I’m thinking that the main meals or snacks which are planned and prepared ahead by parents and caregivers are likely to be ‘correct’. However, some parents (me included!) may slip and offer ice-cream, ice milo, juice (even diluted) and grandparents may offer chocolate-coated snacks (who can resist?!). What is the practical way to look at and control these ‘extras’? 

Natalia: Those delicious extras can be a legitimate part of your child’s diet. In fact, research shows that it is important to serve your child’s favorites from time to time because kids tend to value restricted foods even more. It is up to parents, of course, to decide how many treats their child will get per day or per week. A good rule of thumb I use with my kids and clients is that anything marketed to children or with added sugar is a treat. To help kids feel in control around “forbidden foods”, we recommend serving them in unlimited amount from time to time (an example will be a glass of milk and a plate of cookies for snack once a month). If served for dessert, the treats should be smaller (think of a size of an oreo cookie) but they should never be served as a reward for eating dinner. Instead, try to serve a small dessert alongside the meal, to “neutralize” it as much as possible. And do not forget that a bowl of fruit with plain yogurt also makes a great dessert!

MarcieMom: A final question on how much to eat – is the BMI-chart for kids accurate or should looking at a kid and assessing whether he/she is all chubby/flabby or look firm and fit be a better gauge? !

Natalia: The most important information we can derive from growth chart is if the child is growing consistently. Some health professionals call it “following the curve”. We aim for comparing the child to himself, not to other children. Some children are consistently on the 90th percentile and completely healthy while others thrive on the 5th percentile. If the child suddenly starts “dropping” or “climbing” percentiles on a growth chart, on the other hand, it may indicate a medical or feeding problem. For the most accurate results, it is also important to pick the right chart. BMI chart is available for kids only 2 years and older and breastfed babies are best assessed on the World Health Organization charts, not the CDC ones. You can read more on growth charts in this post.

Thanks so much Natalia, it was great fun to learn these tips and particularly, having a practical angle to it rather than theoretical and hard to implement. Am sure many of the parents reading this will be grateful! Next week, will be on What to Eat.

Soda and Child series : Impact on Eczema, Allergy

Soda Eczema Allergy

For the past two weeks (here and here), we have explored the Top 10 Bads of Soda for our children. Today, we’d be going into whether soda leads to allergic conditions.

There is actually very little written on this, and I’ve scoured both the web and Pubmed. Thus far, the biggest culprit ingredient linked to eczema, asthma and allergies is Sodium benzoate. This has been covered last week where sodium benzoate is a preservative found in soft drinks, and linked to allergy and behavourial issues.

I only found one study on Pubmed, where 62 children from age 12 months to 13 years were observed for whether restriction in their diet led to an improvement in eczema. Among the restricted foods, soda (11.9%) was the highest, followed in decreasing order by food additives (9.2%), walnut (7.0%), peanut (7.0%), and other nuts (5.9%). When foods were grouped, the crustacean group was the most frequently restricted group, followed by processed foods, nuts, milk & dairy products, and meats.

The observation from the study was that atopic dermatitis/eczema improved for those children which had restricted 1 to 3 food groups, and those that avoided more than 3 groups didn’t showed significant improvement. There may therefore be some impact on restricting foods, but it is not clear nor a causal link directly established through this study.

There are many websites though, through personal testimonies, where various individuals found that removing sugar, caffeine, preservatives and artificial sweeteners from their diets helped. In this case, as there is little nutritional benefit of such ingredients for our children, restricting these ingredients from their diet should be a plus (if not for eczema, for healthy living!).

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