Tips and Tricks on Diet and

Nutrition

CHEO Connects!

February 6, 2012

Tammy Cooper, RD

Objectives

• Explore reasons that may contribute to feeding difficulties

• Review appropriate nutrition for Toddlers and Preschoolers

• How it relates to their developmental stages • Demonstrate portion sizes

• Discuss challenges and strategies for picky eaters• Offer resources and ideas

How Do I Get My Kid to Eat ?

What should our kids be eating, how much, how often? 

What to do about picky eaters?

How do I get my child to stop talking and eat?

Does it really matter if we sit down at the table and eat?        

Feeding Conflict

Chatoor I. Diagnosis and Treatment of Feeding Disorders in Infants, Toddlers, and Young Children. Washington, DC: Zero to Three; 2009.

Parental pressure

to eat

Feeding resistance

Medical Reasons for feeding problems

• Reflux• Undiagnosed Food Allergies• Constipation• Dental Problems• Excessive Juice or milk intake• AutismIf you suspect that your child has any of these, contact

your family physician

5. Excessive Juice or Milk Intake

- Recommended drink for children is water- Recommendations are no more than 250mL (1 cup of

juice) per day - Recommendations for milk are 2 cups (500mL) per

day - Liquids (except water) should only be offered with

meals and snacks after the food has been eaten.

Picky vs. Problem Feeders

• PICKY• Eat fewer than 30 foods• Eat at least one food from

almost all textures• Eat the same food every day

(food jag)• Tolerate new foods on their

plate• Adventurous to taste new foods• Willing to eat new foods after

repeated exposure 15-25 times

• PROBLEM• Eat fewer than 20 different

foods• Restricted range or variety of

foods and textures• Foods lost to food jags are NOT

re-acquired• Cries and “falls apart” when

presented with new foods• Adds new foods in more than 25

times

Selective Eating

• Extreme picky eating can cause growth problems, nutritional deficiencies, severe dental decay, dehydration, and constipation.

• Keep a food diary• Is your child’s diet varied enough?• Try to understand what, where, and how your child

prefers to eat• Don’t label your child as “picky” “problem” or “fussy”

eaters in front of them

1 Year of Age – begins to eat more independently

• Family foods encouraged(may need to be softer in texture depending on the food)

• Encourage small frequent feedings

• Food jags/dislikes: try again later

• Supervise during meals and snacks for safety

• Promote Healthy Eating Habits

.... 2 Years of Age + - definite likes & dislikes, wants to eat only one food, conflict at mealtime

• Develop a sense of taste and an acceptance and enjoyment of different foods

• Give small quantities of new foods

• Portion sizes appropriate for age

• Energy dense, nutrient-rich foods

• Comfortable setting without distractions

Ages 2 Years +

• Appetite is variable with growth

• Increase independence & experimentation with foods

(colour, texture, taste)

• Avoid pressuring child to eat – be a good role model

• Child will determine how much food is enough - listen to cues e.g. turning head away, refusing to eat.

How do I get my kid to eat? Tips and tricks on diet and nutrition.

•    Be a good Role Model•   Get your child to participate in cooking, baking,

shopping etc.•    Give appropriate serving sizes

(many parents give too much)

How do you as a parent ensure your child is getting what they need? 

Follow Canada’s food guide recommendations for all food groups. Smaller children need small portions.

Talk to a health professional if your child:Is missing out on a specific food group (a food diary helps).

Regular visits with your family doctor to check growth.

How to get your fussy eater to eat? 

• Same as getting any kid to eat, ignore negative behaviours at mealtimes and reinforce positive ones.

• Have the same food on your plate

• Make sure they come to the table hungry

(it has been 2 hours since their last meal/snack)

How to get a child to eat more variety?

• Offer a “nibble tray”• Let children cook or help prepare food• Serve new foods over and over again• Prepare new foods in ways your child prefers (same

shape, color, texture)• Set a good example• Ignore “food jags”

....Setting the Stage

New foods are introduced one at a time every 3 to 7 days

• Start with 1 Tbsp of a new food• Introduce it first with foods the child likes• Be positive• Be sure the child has not eaten too close to the

meal

Feeding Strategies

• Feed foods your child likes• Don't force your child to eat foods he/she cannot

tolerate • If a new food causes distress, remove it and try

something more closely resembling a preferred food • Do not push your child to try new foods• Always respect your child's aversions

Mealtime Routines

• Set a schedule (3 meals and 2-3 snacks spaced 2 hours apart)

• Offer solid foods first• Give 30 minutes to complete a meal (including drink)• Give 15 minutes to complete a snack• Ensure child is seated during meal or snack

Nutritional Requirements

• Nutrients are required for maintenance, growth and development

• Amount needed depends on the individual.

• Most reliable guide to energy requirements is regular, frequent measurements of body weight, and monthly measurements of length/height

Macronutrients

• Energy – Needs vary based on age, size, activity, rate of growth, and overall health

• Fat – No need for low fat before age 2

• Fluids – 4-5 cups per day

• Protein -Required for growth, tissue repair, enzymes & antibodies, hormones, etc.

Multivitamins

• Most children who are selective eaters require a daily multivitamin

• Aim for a children’s complete multivitamin with iron, calcium, vitamin D

• If children are getting 3-4 of each food group at a meal and 2-3 of each food group at a snack from Canada’s Food Guide for Healthy Eating they should be meeting their needs

Meat and Alternatives:

1 serving - Cooked fish, shellfish, chicken, turkey, meat (2.5 ounces or ½

cup)- Cooked legumes (lentils, chickpeas, beans) (3/4 cup)- Tofu (3/4 cup)- Eggs (2 eggs)- Peanut or nut butters (2 Tbsp)- Nuts and seeds (1/4 cup)

Milk and Alternatives

2 servings per day- Milk or Powdered Milk (1 cup)- Canned milk (1/2 cup)- Fortified Soy or Rice beverage

(1 cup)- Yogurt (3/4 cup)- Cheese (1.5 ounces)

Vegetables and Fruit

4-5 servings per day- Fresh, frozen, or canned vegetables (1/2 cup)- Leafy vegetables (1/2 cup cooked; 1 cup raw)- Fresh, frozen or canned fruit (1 fruit or ½ cup)- 100% real juice (1/2 cup)

Grain Products

3-4 servings per day- Bread (1 slice)- Bagel (1/2 bagel)- Flat breads (1/2 pita or ½ tortilla)- Cooked rice, bulgur, quinoa (1/2 cup)- Cereal (3/4 cup)- Cooked pasta (1/2 cup)

Simple Steps to a Lifetime of Healthy Eating

• Serve and eat a variety of healthy foods

• Make smaller portions

• What, when and where is Parent’s responsibility

• How much or whether to eat is Kid’s responsibility

Recommended websites

Eat Right Ontario - www.eatrightontario.ca

or call 1-877-510-510-2 to speak to a dietitian

Dietitians of Canada-Healthy Start for Life

www.dietitians.ca/healthystart

Health Canada –Eating Well with Canada’s Food Guide

www.healthcanada.gc.ca/foodguide

Resources

• Nutrition resource centre (www.nutritionrc.ca)

• Ottawa Public Health – Nutrition - Ottawa.ca/nutrition

• Ottawa Public Health (613) 580-6744• Ottawa.ca/health

Recommended Books

• A SMART START for Feeding Your Toddler: A guide for moms, dads and caregivers of families with children aged 1-6 years. (Ottawa Public Health 2008)

• Secrets of Feeding a Healthy Family. (Ellyn Satter. Kelcy Press, 1999).

• Child of Mine (Ellyn Satter, Bull Publishing Company, 2000).

• Better Food for Kids. (Joanne Saab & DainaKalnins. Robert Rose Inc. 2001)

Thank You !

Questions?