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Nutrition

Children's, Nutrition

Nutrition for Picky Eaters

By: Rainie Robinson, MS, RD, LD, CDE

Looking for a simple way to make sure your child’s plate is balanced? Try filling half of their plate with non-starchy vegetables like cucumbers, broccoli and green beans. Use your child’s fist to help measure a starch like mashed potatoes or pasta. Their fist is also a good measure for protein portion size. Protein can be a tricky addition, especially for younger kids who tend to be a little pickier. Some outside of the box protein ideas are  frozen Greek yogurt, trail mix with almonds or peanuts, string cheese or cubed cheese, or even use hummus for dip. Consider plating your child’s meal on a colorful plate with dividers, or cutting vegetables into interesting shapes to make meal time more fun.

MyPlateA great way to encourage children to make healthier choices is to incorporate a family dinner time. Studies have shown that kids who eat with their parents tend to make better grades, have a lower risk for becoming overweight, usually make healthier food choices, and typically engage in fewer risky behaviors as they grow older. If you’re feeling crunched for time, try starting with one family meal per week.

Children’s of Alabama has 24 registered dietitians ready to help your child thrive. March is National Nutrition Month and a great time to learn more about how dietitians can help your family. We are here to help guide your child as they continue to grow and develop. From the NICU through adulthood, each specialty service has its own dietitian that has become an expert in what your child needs. Our goal is to provide you with the nutrition education and tools you need to help your family live well.

NutritionStaff2019

For more information on National Nutrition Month, healthy eating tips, and resources, visit https://www.childrensal.org/clinical-nutrition.

Nutrition

8 Tips for Packing Healthy School Lunches that Your Child Will Love

Back to school season is stressful for children and parents alike, and parents are concerned about ensuring that their child eats a nourishing lunch to power through the school day. The situation can prove to be frustrating when the lunches come back home uneaten. Rainie Carter, a pediatric dietitian at Children’s of Alabama, offers tips for packing a lunch that will please both kids and parents.

Cover the Nutritional Bases

  • Include protein to help keep them full through the afternoon with items like string cheese, yogurt, meat, or nuts (if the school guidelines allow them). Carter’s favorite tips are to use a whole wheat tortilla to make pinwheels with lunch meat or freezing yogurt the night before for a creamy treat.
  • Fruits and vegetables are important for your child’s fiber intake. “Kids love to dip and scoop so you can pack a little bit of ranch dressing or hummus with vegetables,” Carter advises. For produce that turns brown when cut, like apples, Carter suggests squeezing a little bit of lemon juice over the chunks to placate picky kids.
  • Stick with whole grain for items like bread or crackers, and stay away from concentrated sweets like candy or gummy snacks as these can lead to an energy crash later in the day. “Also, avoid sugary drinks like soda or juice. Make sure that they have plenty of water, and a frozen water bottle will work as an ice pack too.”

Involve Them in the Process

  • Plan as a family for the week’s lunches. “Spend a little time pre-chopping veggies and fruit, and let your child put portions into bags or containers. If they’re old enough, let them do the cutting too. They are more likely to eat something if they remember helping with it,” Carter said.
  • Giving your child options can be a great way to gain their interest. “Let them pick within your constraints,” Carter suggests. “For instance, show them two choices for a fruit and say, ‘Do you want apples or grapes today?” Parents can also do this in the store to make sure they buy what the child wants to eat. She says to stick to the outskirts of the store for fresh produce and whole grains, avoiding the packaged foods in the aisles.

Have a Little Fun

  • Pack a variety of snacks to keep them interested and sneak in more nutrient-rich foods. “Lunch does not have to be a sandwich and a piece of fruit. Kids enjoy finger foods so bento boxes are popular to portion out a few snacks instead of one big lunch item,” Carter said.
  • Get creative if your child tires of the same lunch items. “Some parents will use a cookie cutter to remove the sandwich crust and make a fun shape. If the school allows it, try putting things on sticks like a fruit kabob. Kids love colorful lunches too, so find ways to incorporate that,” Carter recommends.
  • Try making trail mix with your child, letting them fill their own bags. Carter’s suggested ingredients are dried fruit, granola, nuts or chocolate chips.

For more healthy eating tips and recipe ideas, visit https://www.childrensal.org/snacks-and-recipes.

Children's, Nutrition

How Much Caffeine is Too Much?

The consumption of caffeine has become prevalent in adults, teens and children across the country. It is found in soda, coffee, tea, chocolate, energy drinks and several other products we consume every day. Caffeine is defined as a drug because it acts as a stimulant for the central nervous system.

The American Academy of Pediatrics recommends that children should not consume caffeine. If adolescents do drink caffeine, it is recommended that they intake no more than 100 milligrams (mg) per day. Higher doses can cause adverse reactions.

  • 12 oz can of Coca-Cola® = 46 mg
  • 5 oz cup of coffee = 60-180 mg
  • 12 oz glass of iced tea = 67-76 mg

In adults, low doses of caffeine can be used to enhance one’s ability to focus, but any amount over 100 mg actually creates the opposite effect.

Some adverse reactions to caffeine are:

  • Jitters
  • Anxiety
  • Nausea
  • Increased urination (over 500 mg of caffeine)
  • Headaches
  • Insomnia
  • Increased heart rate
  • Tremors
  • Seizures (over 1 gram of caffeine)

“In 2015-2016, the Regional Poison Control Center (RPCC) at Children’s of Alabama received an average of 110 calls per year regarding adverse reactions to caffeine,” said Becky Rozier, MSN, RN, CSPI, RPCC educator. “The highest number of caffeine calls came from parents of 1- to 2-year-olds who had unintentionally consumed caffeine. The second highest came from 13- to 19-year-olds and the third highest came from 6- to 12-year-olds. Both of these groups had intentionally consumed the caffeine.”

Food and Drug Administration regulation:

  • Limits sodas to 71 mg per 12 oz
  • Limits caffeine tablets to 200 mg per tablet
  • Does not regulate energy drinks

“There are true dangers to caffeine,” said Ann Slattery, DrPH, RN, RPh, CSPI, DABAT, RPCC managing director. “Educate your children and teens to closely look at the amount of caffeine listed on the labeling. For example, some energy drinks include herbals that contain caffeine (guarana, kola nut and yerba mate), but are not included in the amount of caffeine listed.”

If your child is experiencing adverse reactions to caffeine or you have a question about toxicity, call the RPCC at 1-800-222-1222. A specialist will calculate the amount of caffeine ingested versus the body weight of the individual. The RPCC is available for all ages, 24/7/365.

Children's, Nutrition

Nutrition Tips for Kids with Diabetes

Eating right is important for everyone, especially children with diabetes. Maintaining healthy blood sugar levels is essential and can prevent hypoglycemia and growth problems. When a child is diagnosed with diabetes, parents often have a multitude of questions and are overwhelmed with so much new information at once.

Let’s start by looking at the basic overview of the two types of diabetes.

Type 1

With type 1 diabetes, the pancreas generates little to no insulin. Insulin is important because it helps transport sugar within the body to create energy. Roughly 5 percent of people with diabetes have type 1. “Children’s of Alabama treats around 2,000 type 1 patients every year,” said Rainie Carter, pediatric dietitian at Children’s of Alabama.

Type 2

More common in adults, type 2 diabetes occurs when the body either can’t make enough insulin, or rejects insulin, causing sugar to build up in the body’s bloodstream. Around 90-95 percent of people with diabetes have type 2. Meal preparation is especially important for type
2 patients.

Meals

When preparing a meal, try using smaller plates. Research shows that eating off a smaller plate can reduce overeating. This tip is especially useful for children with type 2 diabetes. Try to fill the plate with vegetables, grains, protein and fruit.

“Children with both type 1 and 2 diabetes need good fat from unsaturated sources. Foods like avocados, nuts, peanut butter and fish provide this,” said Carter.

It is also important to be aware of carbohydrates when preparing meals or choosing snacks. Carbs breakdown in the body and turn into sugar. Simple carbs such as sugary foods and white breads are broken down quickly, creating a sugar increase within the body. This can lead to high blood sugar levels. On the other hand, complex carbs such as beans, pasta and fiber-rich foods, break down more slowly, producing less of a sugar surge. “Complex carbs won’t raise blood sugar as quickly and also keep children full longer,” Carter said.

Snacks

While meals are crucial, snacks also play a big role in your child’s diet. Choosing snacks that have around 15 grams of carbs is a healthy option for diabetic children.

“String cheese, nuts, peanut butter and flavored almonds are good free food options and help children feel full,” Carter said. “Measure portions to more accurately count carbs. There are also apps available, such as CalorieKing.” It is also recommended that children with diabetes avoid sugary drinks and limit fried foods.

Grocery Shopping

Serving sizes are especially important to notice when buying food for your child. Be aware of portion sizes, carbs and fiber. “Notice the amount of fiber, and try to buy foods with a higher content of it,” Carter suggested. Insoluble fiber promotes a healthy digestive tract, while larger amounts of soluble fiber can lower cholesterol levels and boost blood glucose control. Fiber is especially helpful in keeping children full.

For more healthy eating tips, visit https://www.childrensal.org/snacks-and-recipes

Children's, Nutrition

Holiday Nutrition

One of life’s enjoyments during the holiday season is all of the delicious treats and special meals we can enjoy, so it’s no wonder the holidays are never an ideal time to diet.

Rainie Carter is a Clinical Nutritionist at Children’s of Alabama. She says it’s best for parents to focus on weight management and healthy choices for their children and themselves during the holidays. “It’s easy to add five extra pounds of weight during the holiday season. But the concern is that over the holidays, from October through January, we can put on five pounds of fat, but keep in mind it can take five months to lose it!” She says that can add up. “If you don’t lose it, you are ultimately adding 10 pounds in two years, 15 pounds in three years of holiday eating,” she says.

One tip she offers is to use smaller plates. She serves her meals on salad plates instead of dinner plates. “The difference is huge portion sizes. If you add the same amount of food portions to a dinner plate versus a salad plate, the larger plate doesn’t look as filling so you end up adding more or going back for seconds,” she says. “You need to trick your brain into being fuller by putting it on a smaller plate.”

Carter says it’s not necessary to deprive children treats during the holidays. But if you do indulge, be sure to pay attention to portion sizes. “Just think portion control,” she says. “Be sure to look at the ingredients, including calories, grams of fat and sugar and stick to portions rather than overeating.” She also recommends children stay full on healthy food so they don’t get as many sugar cravings.

Carter says a lot of holiday treats can be made using healthy substitutions like apple sauce and pumpkin instead of oils and fats. But if a true dessert is on the menu, a good rule of thumb is to consider portions again. A fist or palm of the hand is a good guide for a single portion.

The main goal during the holidays is weight maintenance. Children and adults can enjoy a few holiday indulgences without compromising their weight or overall health.

Children's, Nutrition

New Intensive Feeding Program at Children’s

Dr. Michelle Mastin

Dr. Michelle Mastin

Dr. Michelle Mastin is a clinical psychologist and head of the new Intensive Feeding Program at Children’s of Alabama.

A new Intensive Feeding Program at Children’s of Alabama helps infants, toddlers and adolescents overcome problems feeding and drinking often associated with developmental delays or serious illness. It is the first and only program of its kind in Alabama and one of only a handful of similar programs in the U.S.

The program incorporates pediatric subspecialists, technologies and behavioral psychology into a unique and effective system for teaching both parents and children how to deal with these difficult issues. The program at Children’s is designed in a similar fashion to the one developed at Helen DeVos Children’s Hospital in Grand Rapids, Mich.

The program at Children’s of Alabama is the behavioral psychology component of the new Aerodigestive Program, which encompasses a larger mission of managing complex airway, feeding or nutritional issues. Program specialists evaluate children, develop treatment plans and provide care for a wide variety of conditions using proven, behavior modification techniques coupled with the insight and interventions of speech and language pathologists and occupational therapists.

About half of the program’s patients are expected to be feeding-tube dependent, and in many cases the team will work to normalize the child’s eating and drinking abilities. The Intensive Feeding Program is also capable of dealing with:

  • Food refusal
  • Oral aversion
  • Inability to consume adequate volumes of food and liquid
  • Transitioning to age-appropriate textures, consistencies or utensils
  • Recurrent vomiting
  • Restricted eating patterns

Patients should be referred to the program at Children’s after going through previous attempts to improve their feeding and drinking behaviors. The program is set up to handle tougher, more persistent cases that require multi-disciplined interventions and are often associated with conditions such as gastric esophageal reflux disease, failure to thrive, dysphagia, gastrointestinal problems, developmental disorders, including those on the autism spectrum and behavioral difficulties.

This is an intensive, outpatient program lasting six to eight weeks, five days a week, from 8 a.m. until 5 p.m. Generally, experts will spend about four weeks feeding a child all meals during the week in order to approach identified goals. Care is provided in a room equipped for unobtrusive observation by parents, other caregivers or health professionals.

After that, parents or caregivers will be provided with a small earphone and sent into the treatment room to take over the feeding and drinking interventions. Initially they will be working with their child with the help of therapists. As the caregivers progress and the child demonstrates consistent success, therapists will transition to the observation rooms where they can continue to coach caregivers. It is an effective way to improve the interaction between parents and children at mealtimes.

The results are often impressive. For example, the program at Children’s had its first graduate of the day treatment program in November 2014. This patient was born with significant complex medical challenges, including significant prematurity (born at 22 weeks gestation). The patient came into the program 100 percent dependent upon a feeding tube for nutrition, but was discharged 8 weeks later without the need for G-tube feedings.

Similar programs have been studied and found to be effective. This is a precisely targeted therapy that often succeeds in improving the quality of life for both the child and family. Children’s program is currently evaluating patients weekly and is currently admitting two patients at a time into day treatment. The goal is to expand the program to be able to treat three patients at a time in the second year of the program and four patients at a time in the third year. Referrals forms for evaluation can be found on the Children’s website at www.childrensal.org or by calling 205-638-7590.

Children's, Nutrition

Merry Moderation

Jordan-iceCreamThe holidays don’t always feel like holidays without favorite foods, which can make them especially difficult for diabetic kids and their families. If your family’s traditional favorites seem like a recipe for disaster, Children’s nutritionist Rainie Carter has three simple tips to keep your celebrations healthy and fun:

1) Keep track of carbs (carbohydrates)

You’ll want to help your child make lower fat choices to stay healthy on a daily basis. But on a holiday, Carter says, “We’re really just focused on the carbs.”

Accurately counting carbs is one of the things families struggle with around the holidays, Carter explains, but online and smartphone resources to make it easier than ever. Sites like calorieking.com and gomeals.com help identify the carbohydrate counts in common foods, and both sites offer free smartphone apps for quick reference on the go. Gomeals.com was created with diabetics in mind, and it offers extra resources like blood sugar tracking.

For multi-ingredient dishes prepared at home, sparkrecipes.com has a handy recipe calculator that does the counting for you. Keep in mind that these counts depend on accurate serving measures, so you’ll have to be aware when dishing out servings.

Some holiday foods are surprisingly easy to adjust for a lower carbohydrate load. “You can make a lot of the pies a lot more diabetes-friendly by just using a sugar substitute,” Carter notes. “If you use sucralose (Splenda®) it doesn’t really change the consistency or alter the baking in any way.” Making your pie crust-less can save even more carbs.

2) Enjoy some favorites

Remember that the holidays should feel special and it’s okay to indulge a little. Carter recommends that kids stick to three or four of their favorite items in the main meal and one or twosmall desserts. Fill half the plate with non-starchy vegetables and lean protein to fill up on lower carb options. A half-cup serving is a good limit for higher calorie items. (But don’t worry about bringing a measuring cup to holiday dinners: A half-cup serving is roughly the size of a fist.)

Some holiday favorites actually have reasonable carb counts in small servings. Mashed potatoes, for instance, have so much milk and butter that the carb load is only around 15 grams of carbohydrates per half cup. Green bean casserole is another decent option at roughly 12 grams of carbs per half cup. (Macaroni and cheese and cornbread dressing have higher amounts of carbs and should be eaten in moderation, since a one cup serving can add up to more than 50 grams of carbohydrates.) Continue Reading

Children's, Nutrition

Healthy School Lunches: Tips and Tricks to Get Your Children Excited About Eating Right

By Sue Teske, MS, RD, CNSC; Clinical Nutrition Director at Children’s of Alabama

Getting your child to eat healthy is not always an easy task. As the Clinical Nutrition Director at Children’s, I am often asked how to get children to eat healthy. In a world full of readily available fast food, pre-packagedand processed junk foods; it can be challenging to get kids to eat the foods that are good for them. Food manufacturers use blatant and subtle marketing techniques directed to children on television, in magazines and in grocery stores.  Friends and other kids at school who do not have healthy eating habits may influence your child. As a Registered Dietitian let me make a few suggestions to get your kids involved and learn about nutrition and healthy eating.

Involve your child in planning lunches and making healthy choices. Kids love hands-on activities. Making school lunches together is the perfect way to get your kids involved in the healthy eating process and helping out. It also opens the door for conversations about different food groups, how food is fuel, regular physical activity and many other healthy habit topics. Give your kids choices between different healthy options. Ask if they would rather have an apple or a banana as their fruit or celery or carrots as their vegetable. Variety will keep your kids interested in healthy eating while teaching them how to make healthy decisions for themselves.

Make healthy lunches fun! Use cookie cutters to make shapes out of sandwiches. Buy your child a lunchbox with his or her favorite character on it. Write notes on your child’s napkin. Make creative side items at home together and let your kids come up with a special name. Have you ever heard of ants on a log (celery sticks, filled with peanut butter and topped with raisins)? What about a pasta salad made with colorful veggie bow tie pasta? Make a mini lunch – two turkey and cheese mini bagels, cherry tomatoes and mini pretzels.  Have a weekly lunch theme – on Hawaiian week, swap their usual drink for sugar-free, coconut-flavored water. Let your child decorate their brown paper bag. Don’t be afraid to get creative! Continue Reading