WEIGHT GAIN FOR WEE ONES (18-24 mos)

amuse-toddlersMany young children ages 18-24 months of age whom I see, need to gain weight. That is these very young children fall off their usual weight percentile by not gaining weight or even losing weight over time. After being evaluated by their MD and other professionals to rule out mechanical or feeding difficulties, medical and metabolic issues the parent is referred to my office to get some ideas to help promote weight gain. From my experience and calculations, this age group needs about 1000-1500 kcals/day for weight gain depending on current weight and gender.
A quick summary shows how these calories may be divided through out the day.

Nutrition Recommendation: 1300-1500 kcals/day for weight gain
50-40% CHO, 20%Protein, 30-40%fat
3 meals and 2 snacks:
Breakfast 300 kcals
Snack 200-300 kcals
Lunch 300 kcals
Snack 200-300 kcals
Dinner 300 kcals
TOTAL 1300-1500 kcals/day

TIPS:
Timed meals every 3-4 hours, no food in between except water
Sit at table for meals as often as possib
2-2.5C whole milk w/ cream, also a ½ C whole juice/day for kcals and fluid
Increase fat calories in starches and whole grains with safflower/canola oil,whole fat dairy, cheeses and stews.
Try soft dried fruits, chopped de-pitted dates, chopped soft apricots for nutrient dense calories for snacks
Have a shake with whole milk or pediatric supplement/yogurt in evening as needed or fruit shake with milk, cream, and frozen berries and banana
Try high fat foods such as avocado, hummus, ground seeds and puddings.

DELETING THE WHEAT

Defatted_Wheat_GermImagine having diarrhea and stomach aches for most of your life, seeing doctors who tell you it’s all in your head and finally at the age of 59 years getting diagnosed with Celiac Disease. That is just one story I heard from a conference attendee Carolyn A. as I promoted Dietz and Watson GF condiments, deli varieties and cheeses at the 39th Annual Celiac Sprue Association Conference in Erie, Pa. Celiac Disease affects 1/133 Americans and is an auto immune disease. It is marked by an intolerance to a wheat protein called gluten. If you have Celiac Disease and eat wheat, rye or barley as well as products containing these foods your gut gets sick, your intestinal villi flatten from inflammation and you cannot absorb nutrients. If you take wheat, rye and barley out of the diet the gut gets healthier. It is one of the only diseases that can be controlled- not cured- by diet alone. This disease has a genetic component, as well as environmental. Both children and adults suffer from Celiac Disease and often have been misdiagnosed with irritable bowel syndrome, nervous stomachs and like Carolyn “it’s all in your head”. As a dietitian it is my job to ask the right questions and to hone in on family and patient diet history, medical history, symptoms and present dietary intake. I help patients coordinate a workup with a Gastroenterologist to find out if they are gluten sensitive. After being diagnosed with Celiac Disease by an MD, I then help patients find gluten free (GF) foods and avoid those foods containing gluten…

Grasses that contain GLUTEN and should be avoided are wheat, spelt, kamut, eincorn, barley, rye, triticale, wheatgrass and bromegrass.

Foods allowed are rice, corn, millet, sorghum, quinoa, ragi, teff. wild rice, rice, oats, indian rice grass and Timothy.

The amount of gluten free products available to the US consumer has gone from $210 in 2001 to $1.7 Billion in 2007. Some of the many gluten free brands found in the supermarket today are: Enjoy Life Foods, Ians, Glutino, dr. Shar, Gluten Free Pantry, Lara bars, Genisoy bars, Rice Crackers, 365 Veggie chips and cheese curls and many many GF flours, pasta’s, cookies, crackers, meals and baking products.
Supermarkets are labeling foods at “GF” now as well as having special gluten free product areas.

COOKING WITH KALE

“What do I do with this Emma?” asked Susan as she stood in the center isle of Gentile’s fruit and veggie market clutching a large bunch of dark green curly leaves. Throw it in a homemade soup with white beans and spicy turkey sausage, I suggested.

Later that afternoon as I washed my bunch of kale by the sink and cut up the broad leaves and thick stems, I decided to learn more about this “ super food”.

Just one cup of boiled kale contains 36 calories and provides over 350% of recommended daily value (RDV) of Vitamin A and 89% RDV of vitamin C is also an excellent source of vitamin K and manganese. It contains 3 grams of fiber and 2 grams of protein and is chock full of cancer fighting chemicals “phytochemicals” such as organosulfur compounds and carotenoids : lutein and zeaxanthin.

Kale is from the Brassica family of vegetables, which include cabbage and Brussels sprouts. It is a winter vegetables best bought as firm dark leaves. Young leaves are more tender and easier to cook by boiling, steaming, stir frying or braising. (Braising is a cooking technique in which the main ingredient is seared, or browned in fat, and then simmered in liquid on low heat in a covered pot.) Mark Bittman in his cookbook How to Cook Everything states kale is stored best loosely wrapped in plastic in the fridge and can be eaten before the leaves turn yellow- within a few days. (I told Susan, kale can last “a couple of weeks”. Maybe due to the fact that most kale lies around in my fridge for a couple of weeks before I figure out what to do with it and it is non edible as over tme it becomes more bitter.)

The leaves as well as the stems can be cooked and eaten. To prepare, it is easiest to roll up the leaves into a cigar shape and chop across in strips. The stems can be cooked first and then the leaves added to cook until wilted (5 minutes).

Braise kale in 1Tbsp extra virgin olive oil or peanut oil, sweet onion and garlic or try kale with bacon/ham and garlic. Another idea is to add 1C chopped seeded tomato and 1C feta cheese to the braised kale.

Here are some other tasty combinations:

MEAL KALE LEGUME GRAIN PROTEIN/VEG
PASTA Kale lentils Whole wheat pasta
PASTA Kale whole wheat pasta feta cheese/pine nuts
SOUP Kale White beans Potato Smoked sausage
SOUP Kale Barley Beef
RICE Kale Red beans Brown rice Red Pepper
STIR FRY Kale Asian noodles Tofu*, Red pepper
Ref: www.whfoods.com/genpage.php?tname=foodspice&dbid=38 *firm tofu

TABLE TALK : THE IMPORTANCE of FAMILY MEALS

Family meals are becoming scarcer. Busy schedules, dual incomes, no time to shop, no time to cook and no time to sit down together. Are family meals important? Do family meals even provide connectedness?

Data supports that teens who eat meals as a family together experience the following positive behaviors:
have less fights
have less thoughts about suicide
are less likely to smoke, drink or use drugs
have better academic performance
have fewer depressive symptoms
have higher fruit, vegetable and dairy intake.
ref: www.childstrensdatabank.org Family Meals

While in Edgartown , MA on Martha’s Vineyard this summer I met Carol McManus. carol is a mother of five, grandmother and owner of Espresso Love Café. Carol brings seasonal, fresh meals to patrons. The Garden at Espresso Love –is a dining experience for the entire family providing delicious salads, soups, and sandwiches to tasty main entrees such as lobster and local seafood.

Carol McManus has a motto: food+ family=love and has even written a cookbook called Table Talk, published by vineyard stories ( www.vineyardstories.com,) 2008 which gives tips, recipes and ideas for family meals . She encourages family meals in even the most hectic times by using simple fresh ingredients in as illustrated in eighty of her best loved recipes.

A fabulous family cook book …she will help you make it easier to give your family some love.

Table Talk by Carol McManus

COOKING AS A SPECTATOR SPORT

Michael Pollan recently wrote an article in The New York Times Magazine , “Out of the Kitchen, onto the Couch, How American Cooking Became a Spectator Sport, and What We Lost Along The Way.” Ironically we are spending 27 minutes a day on food prep and many of us are spending much more time watching food being prepared and cooked on the latest televised cooking shows.

In his article, Pollan asks questions such as: Why has every day cooking declined? Is it that more women are working? Are food companies doing the cooking for us? Does cooking …or not affect our physiological and psychological well being?

David Cutler of Harvard University finds that the less we cook food the more calories we eat. He concludes that obesity rates are inversely related to the amount of time spent cooking. I know that for my family, cooking at home allows me to control ingredients: how much sugar, salt and especially fat goes into the meal. It is more economical, nutritious and tasty to have fresh ingredients prepared and presented to my family.

That does not mean that every night we have a dinner cooked from scratch, what is does mean however is that we eat together as often as possible, assemble a meal on many nights and more importantly connect. There is work involved in cooking- mostly the planning of what to eat and then prep time. Ultimately, cooking results in the gratification of time spent together enjoying a meal and each other.

PARENT POWER and EATING

Working with children and nutrition for the last seven years has brought the realization that it is the family who has a huge impact on the way children prefer different foods and relate to food as a whole. In particular as I work with younger children I see that I as an adult- have a larger impact for change. I am aware that I can help parents and caregivers present healthy foods, have parents become positive role models to the children by eating well themselves and encourage parents to practice routine eating behaviors.

With young children parents and caregivers have a huge impact on a child’s eating habits and with that becomes a big responsibility. As Ellyn Satter states it is the parents/caregivers who shoulder the what, when and where of eating. This is huge. To put it simply- parents are in charge of

what is for dinner such as mashed potatoes, chicken and broccoli, with yogurt and fruit for desert

when is dinner -say 6 pm and

where is –at the kitchen table.

Instead of such a formal venue, parents can also decide to have take-out (what), have it pic-nic style at sports practice (where) at 4pm (when) ! There is room for flexibility but the responsibility (What, when and where) is still there for all meals of the day including snacks.

We know children eat well when the foods are presented in developmentally appealing ways. There is a study which shows that “dinosaur patties” may be more eagerly accepted than a lean hamburger. Don’t’ “magic coins” sound more delectable than cooked carrots?

Until the power of peers and media start to take over at around ages 6 years or so- I challenge all parents and caregivers to “work it”. Shoulder the responsibility of what,when and where and give yourself a deserving pat on the back. If your child decides not to eat this meal…move onto the next meal (I forgot to mention you should have at least one food the child likes to eat at each meal.)!

Ref: www.ellynsatter.com

BOOK TIP! (Ages 4 -8 years)

Charlie and Lola’s I will Never , Not Ever Eat A Tomato by Lauren Childs

Blast off with Calcium!

QUICK TIP FOR THE WEEK OF FEBRUARY 19TH

Children ages 9-18 years need to get 1,300 mg of calcium per day for their growing bones. Click here to see the calcium needs of children ages 1-18 years.

For a calcium-packed breakfast or snack, combine the following ingredients into a blender:

1 cup frozen berries (strawberries or blueberries, raspberries or mixed berries)
½ of a 6-inch banana
½ cup fruit flavored kefir or low fat yogurt
½ cup calcium-fortified vanilla soy milk or skim milk
½ scoop of whey or soy-based protein powder (optional – 7 g protein)

Blend on high in a blender until smooth.

Contains:
250 kcals/serving
414 mg calcium (1/3 of daily intake of 1200 mg/day)
17 g protein