Partnership with Feeding Matters

I had the opportunity to work with Reckitt Mead Johnson and learn more about the Feeding Matters website and the support they provide to families. If you aren’t familiar with them, then make sure you CLICK HERE to check out their website. This group provides support for families who have children with a pediatric feeding disorder. I love their evidence-based approach to getting information to families that is creditable and actually helpful. I was able to work with Reckitt to create a blog post and then do an Instagram live for them. I was paid by Reckitt for my time to write the blog post and do the live discussion. The information provided though is not influenced by one particular formula company. This information is evidence based and is the gold standard recommendations for the CDC, WHO and the AAP. Evidence for the recommendations are all listed at the end of the blog post. You can check out the blog post by CLICKING HERE. Then after publishing the blog post I was able to do an Instagram live with Feeding Matters. We had a great conversation about some myths regarding preparing formula for your child, how to safely handle that preparation and why you would want to be conservative when it comes to following mixing instructions and expiration dates. There is a great handout available from the CDC on how to safely prepare infant formula and it is wonderful resource for caregivers (see that graphic below).

From the CDC

Follow these hand washing techniques when getting ready to prepare your child’s feedings.

Toxic Metals in Baby Foods

This topic has been hitting the news headlines this week and so many parents are freaking out. It is a scary topic and the headlines are enough to really make you nervous and start off some serious mom guilt. I wanted to share some information with you to provide some reassurance and help support you as you look at what you are feeding your child.

News Report published by WebMD - This article like many that were all over websites/social media and the evening news definitely is alarming to parents. This specific article talks about how infant rice cereal is the only baby food that has a legal limit on the amount of arsenic that can be in that product. This is because we have known that arsenic levels are high in rice. That is not new information. Arsenic naturally ends up in the soil/water from minerals in the earth. That is how rice grains get higher levels of arsenic from getting into the roots of these plants and then is stored in the grain (article from No Meat Athlete about this). Now that doesn’t mean you have to stop eating rice. Choose the rice with lower amounts of arsenic like Thai jasmine or Indian basmati. Then you need to wash your rice, prior to cooking until the water runs clear. This can decrease arsenic levels by 25-30% (from this article in the Chicago Tribune). As you can see, when you are aware of this information you can make informed choices.

I think that is one of the most shocking things for families is that no one realized that our food supply isn’t as “clean” as we like to think it is. Lots of our foods have other contaminants in them that we don’t normally think about. This doesn’t lessen the concerning findings brought up by the US House of Representatives. I just wanted to point out, that this isn’t brand new information. We do need to work harder to hold food companies accountable and work to find better alternatives and even ways to process these foods.

The US House of Representatives Staff Report - Came out on 3/4/21 talking about specifically arsenic, lead, cadmium and mercury in baby foods. These are heavy metals and depending on how much you consume of these metals they can be toxic. Baby food brands were named and it covered all the popular brands you will find on store shelves. The recommendations this committee made were to require baby food manufacturers to have products tested for these heavy metals, report those levels on the food label and then work to find substitutes for these tainted ingredients. This committee also asked that the FDA set maximum levels for toxic heavy metals permitted in baby foods. I think that these are great recommendations and should definitely be prioritized.

Have been covering our NICU Follow Up Clinic and I have received several phone calls from parents really concerned about these findings. That is one reason why I wanted to take a moment and share some of this information with you. Plus, I also wanted to highlight another RD who has a great blog post on this topic - Check out Kids Eat in Color and her post on Heavy Metals in Baby Foods.

In the end, if you have fed your child baby food and infant cereal, I wouldn’t freak out. The biggest key and take and away from this is remembering that variety is key. Providing different foods is important to help limit exposure to these potentially contaminated foods.

Toddlers and Meal Times

In our house now we have two toddlers - a 4 year old and a 2 year old. Let me tell ya meal time is NEVER dull. We have all the singing, emotions, story telling, throwing of food at times and even refusing certain food items. The whole gambit can happen at our dinner table.

I wanted to bring up this topic again regarding family meal times, because we all have spent more time at home and are eating together more often as a family. I did another post back in November about family meal times and why they are important - CLICK HERE. For children, sitting down to eat together a great opportunity to learn and get to connect. We always have dinner together and talk about our day. Both of my children eat fairly well, but they also decide at times that certain foods aren’t their favorite.

I love this terminology “that food isn’t my favorite, right now.” This is a great way to phrase something if your child doesn’t want to eat something. As the parent your role, is to prepare the food and put the meal in front of the child. The child’s role is to decide how much they are going to eat. There is nothing worse, as the parent, than slaving away to cook a delish meal and have your child refuse to try it. This can often lead to an escalated and heated situation where everyone gets upset.

So how can you avoid that from happening? Or if it does happen how to do you deal with this situation?

1. Start by making sure you (as the parent) don’t over react. Keep your cool and ask why your child doesn’t want to try their food? Is it too hot? Too cold? Have they touched it? What does it feel like? Do they need help with their utensil? Try to assist them in getting ready to eat that food item.

2. If they are still refusing then ask them to take a bite. You can take a bite of their food and show them that it is good (and describe the taste, smell and texture). Then offer them the utensil and let them try. Explain that we need to try the food that is offered to us to see if we like it. It might not be our favorite food right now and that is ok. Sometimes we all have to eat some foods that aren’t our favorite right now. Even though it isn’t your favorite today, you could still learn to like it more in the future. That is why we always try a bite, to see if we like it today.

3. Having a conversation with your child, helps to reassure them that you are listening to them and hear the fact that they don’t love this food item. That is ok for them to not love something. That reassurance helps to build trust between you and your child.

I promise that if you let your child express to you why they don’t love certain food items right now that will help empower them to try new things, but also be ok with giving their opinion. We always have a bite of the food and then determine how we feel about that food item. One of the RDs I follow on Instagram, calls these “no thank you bites.” She instructs families, to have your child take a bite and then if they don’t want more they can say “no thank you.” I love that approach as well.

Know as a parent, that if you child has tried a bite of the main dish at dinner, told you that isn’t his favorite and doesn’t want any more of that food, that is ok! There will be another meal time and they will have a chance to eat food again. They are the ones that can decide how much they eat! Work to try avoid using the terminology “you don’t like that” or “you are being picky",” because your child will start to believe those things. Our goal should be to encourage and empower your child to decide how much they want to eat. Keep offering those foods that “aren’t their favorite” to them and pair with some preferred foods. You are doing an amazing job as a parent. It can be hard at times, but hopefully these tips are helpful and encouraging for you to keep offering those challenging foods.

Family Meal Time

I have spoke about family meal time before, but I was sitting at our dining room table last night and I was looking around at my wonderful family and thought I should bring up the importance of family meals. Spending this time together as a family is so valuable to the development of our children and fostering positive relationships. I actually wrote up a blog post on this topic in the summer. I was watching my youngest son and his interaction with the rest of the family and it made me realize how important this time together is for all of us. I have spoken about baby led weaning before and I think that this part of family meal times helps SO much with food acceptance.

Family meal times teaches how we as humans sit down and communicate over a meal. My almost 2 year old was watching us talk about our day and wanting to chime in with his own thoughts and noises. We always ask our almost 4 year old how his day was and what he did at daycare. Now our little guy (whose almost 2 years old) is babbling and wanting to chat with us as well. I wanted to share this to encourage you to make sure your kiddos are having that uninterrupted time with you at the dinner table. Our total amount of time eating together maybe lasts 20 minutes at the most, but that is still valuable. Some days I am able to make a delicious homemade meal and other nights it is frozen foods that have been heated up … the main point of dining together is the togetherness, not what is being served.

Another example of that family time helping to teach children how to behave, how to communicate, but always how to try new things. My almost 2 year old was very eager to mimic and try things like his older brother. He would look over and watch his brother and then pick up the same food and try it. This time and ability for him to watch and learn from his brother is important for his development and food acceptance.

In some of my work with outpatient follow up at the hospital, I have chatted with families about how to start solids with their babies. The first thing I emphasize is getting a high chair and having their child at the table for meal time. Give them foods at meal time, when everyone else is at the table. They are part of the family and sitting down together to eat is what your family should do at least once a day.

Hopefully this posts encourages you, whether you have small children or teenagers, to sit down at the table a share a meal together. It could even be enjoying take out from your favorite restaurant, but take a moment and sit together as a family and talk.

Toddler vs. Vegetables

I have done Baby Led Weaning now with both of my children. My oldest was a great eater and loves all food for the most part. He was always willing to try something new and has a great appetite. Of course, as you may guess my second child, had to be different. He was a good eater when he was < 1 year old, but now that he is nearing 2 years old things are changing. My oldest went through this stage, gaining independence, but it has been as bumpy as with baby #2. My 1.5 year old is really not loving vegetables. If you put his fruit, main course and veggies on a plate … he will eat the fruit first, then the main course and if he is still hungry we will try a piece of vegetables. As the weeks have ticked by, he was eating less and less of those vegetables. Then one night we had a massive melt down at the table when I wouldn’t give him his milk and he was not wanting to sit at the table.

So let’s break this down and exactly what happened, because there were lots of things at play here.

1. He wanted his milk. I took his milk away, because he wasn’t eating any of his food. My child is obsessed with milk and would drink it all day everyday if I let him. His reaction to me taking away his milk was to completely melt down (scream, cry, push away from the table and start to throw food on the floor). We had a power struggle on our hands, I said no and he didn’t like that choice I made for him.

2. He ate the carbohydrates for the meal first. Every time he was keeping the vegetables until the end. I am ok with that sometimes, but all the time wasn’t working for us. It was getting to the point that he just wasn’t eating the vegetables.

3. Too many snacks. This one was completely my fault. I was giving him a snack of a piece or two of apple a cheese stick when we got home, but this was filling him up enough that he wasn’t eating much for dinner. That snack was not helping him when it came to eat a wider variety of food items. Instead he was filling up on a cheese stick and a fruit or cracker and that was leading even less vegetable consumption.

4. Not staying at the table. He kept pushing his chair away from the table and not wanting to be present at family meal time. He was throwing food on the floor and not calming down. This was another power struggle issue, because he decided that since he wasn’t getting his way, he wanted to leave the table.

You are probably now wondering what I did in this situation?! Well I kind of lost my cool and felt like a terrible mother for the rest of the evening. This turned into our “come to Jesus moment,” because it was just too much for the whole family at the dinner table. My husband and I decided that we were going to flip things around for the next few weeks and we started offering our toddler vegetables first at lunch and dinner and also for snacks. We basically jumped into the vegetables 100%. We offered that “non-preferred” food first and then offered the “preferred” foods like the main course and maybe a fruit. Then snack was normally a variety of raw veggies and a hummus dip. Over the course of a couple weeks, he started eating the vegetables. We eliminated the evening snack and he got hungry enough that he was eating what was placed in front of him. Now, I am kind of back to offering the veggies and main course at dinner and that is going well. I am still cutting out the evening snack and our daycare provider offers the veggies first at lunch. So in the end, we have a stubborn toddler who prefers other foods over vegetables. I don’t blame him, but I have to help give him those healthy options and limit those other choices (within reason).

I wanted to share this experience with you, because raising adventurous, well rounded eaters is touch. There are a few key points to remember … as the adult you get to decide WHAT is offered and WHEN it is offered. The child gets to choose HOW MUCH they eat of that food item. Especially with toddlers, who are looking to gain independence, it can be hard to navigate family meal times. You are not alone if you have faced some of these struggles. Just remember that you are the parent and you love your child and this too shall pass.

Summer Loving

This summer is obviously different for all of us, than what we originally imagined. I feel like it is turning out to be unique and I am wanting to make the most of it. I want to be able to spend some of this extra time with my children and make some fun memories together. It won’t include a big, summer vacation, but often we will be able to do some fun things together that they will remember and enjoy.

We have moved to a new area of the country and during a pandemic. We are social distancing from family and friends, because we feel that is the best thing we can do. We are getting more time just the four of us and I wanting to do some neat things with my boys to make this summer fun and special.

Creative Summer Activities

• Water Play - We don’t have a fancy pool, but we have been playing outside lots with our water table, kiddo pool and slide and then our sprinkler. I know blow up pools have been a hot commodity recently and if you happened to find one, good for you! I have loved being able to get my boys outside and playing in the water to cool off. This is a great way to run around and burn off energy and stay cool.

• Craft Projects - I am not an extremely crafty person, but I am trying to encourage my kiddos to work on their creative expression. We have played with play dough, colored pictures, mailed our creations to friends and family, worked through alphabet crafts and played with pipe cleaners. I don’t have an abundance of craft supplies, but I have appreciated finding kits on Amazon that have all the things needed for the crafts. That is a huge win for me and plus I know I have ALL the things we need for the activity. I have also looked at Kiwi Co and I am interested in getting a subscription for William to do some projects, but we haven’t ordered that yet.

• Cooking Classes - I have kind of fallen out of the habit of including the boys in cooking. It can be tough to make the time to have them help. William and I have been doing some baking in the afternoons when he wakes up from nap and Samuel is still sleeping. William has had so much fun measuring the ingredients and getting to make yummy treats. I would love to take more time and have him help with meals. So hopefully each week, I can have him help me prepare dinner. Got to set a goal and we will see how it turns out.

• Nature Walks - The saving grace of quarantine has been daily walks, in fact we would normally go on two walks a day. We have loved watching baby ducks, looking at the clouds, talking about tree bark and watching for birds. I really love this time outside, because we get to do a somewhat structured activity outside. We have gotten to see baby ducks grow up and learned about how they nest, what they eat and how their feathers change.

• Summer Reading - The last several years we have done the summer reading program at our local library and also through a friend’s Usborne business. I have been trying to get us set up with library cards and trying to do their summer reading program. It is obviously all a little different this year, but we are still reading our books and loving that quiet time together, sitting the AC at the end of a long day.

What fun things are you trying to do this summer? Are there any types of activities you are excited to do or things you will miss? I am excited to be able to make some special memories and hopefully enjoy some time with our favorite boys.

A Little Acid Base Balance

During this whole coronavirus pandemic, I have tried to brush up on my acid base balance. As an ICU dietitian this is important. If you are reading this and you don’t work in an ICU, this might not mean as much to you. Just know that your body is complicated and is designed to stay in a balance, that when it is thrown off can cause havoc and needs to get rectified for you to survive. When you are healthy your body works to keep your body in homeostasis. Your lungs help to remove unwanted CO2 and then your kidneys work to process bicarbonate. When you are sick or find yourself in an ICU setting this balance either respiratory, metabolic or both gets messed up. So this means your body isn’t able to maintain that balance and your body starts to go acidotic (lower pH) or alkalotic (higher pH). Your body wants to keep your pH around 7.4 and that helps ensure all your organs are able to function appropriately. The pH of your arterial blood is determined by three things: 1) your PaCO2 (that is the pressure of CO2 in your blood), 2) lactic acid which is a by product of anaerobic metabolism, and 3) the buffering capacity of your blood (the amount of bicarbonate that is present.

If there is a problem with your lungs ability to function then you can have respiratory acidosis or alkalosis. This means that your ability to clear that CO2 is altered and your pH will go down (acidosis) or up (alkalosis). If you have an issue with your kidney function then that is termed metabolic acidosis or alkalosis. This means that bicarbonate isn’t able to be processed appropriately.

https://www.medifee.com/blog/acid-base-disorders-a-look-into-balance-and-imbalance/

What does this mean for a dietitian? Being able to have an understanding of how the body reacts to stress and then critical illness impacts how you provide nutrition to help the body get through that event. A patient in the ICU with an acid-base imbalance may be on Total Parenteral Nutrition (TPN). Being able to know what time of imbalance the patient is experience (acidosis or alkalosis) and then having a working knowledge of if it is respiratory or metabolic will help in understanding the treatment methods.

Having this understanding of how the body maintains a normal acid-base balance for physiologic homeostasis and growth matters. Becoming familiar with the key components of acid-base status is important and those include PaO2, lactic acid and bicarbonate. Having a basic understanding of how these blood gases are interpreted allows clinicians to figure out what therapies are needed to normalize acid-base balance. This can help save patient’s lives and makes a difference! So whether you are an ICU provider or not, knowing that your body is incredibly complex matters.

Resources:

1. Webinar by Dr Adamkin from Louisville.

2. Book on Acid Base Balance

Donating Breast Milk ... The Second Time Round

I have been so thankful for the opportunity to be a breast milk donor now two times with both of my children. This opportunity was something has meant so much to me. It was a goal that I had each time, I have breast feed my children. I wanted to have enough milk for my child obviously, but also to be able to give some to other children. Being able to help support those babies I work with in the NICU everyday is something that is near and dear to my heart. I do understand for lots of mamas, this wasn’t a choice for them. They may have wanted to breast feed, but couldn’t sustain their milk supply or maybe didn’t have much of a supply to begin with. I don’t want this post to make any mama feel inadequate, but I just wanted to share this journey in the hopes of inspiring you and having you encourage other mamas out there on their breastfeeding journeys.

So I wanted to talk a bout how and why breast milk donation is important. I wrote up a post about 3 years ago now about the steps to breast milk donation - CLICK HERE. I wanted to share with you more about where this milk goes and why donating to a milk bank is important.

You might have heard about informal milk sharing. That is where one mama gives her breast milk to another mama to feed her child. This is also the idea of wet nursing (and those individuals had been used in years past). For mamas today, I would be very cautious about informal milk sharing. You have no idea what mothers do in terms of medications or drugs taken, alcohol consumed or any other substances. That makes me very apprehensive to tell mothers it is ok to obtain breast milk from informal milk sharing. Some women will say “well I know this person and trust them.” That is ok, and you as the mother have to do what you feel is best for you and your child and make a choice you can live with. I do have an experience with giving some of my milk to a mother (who I didn’t personally know) . I spoke with her ahead of time and told her that I was an approved milk donor, but she never asked me any questions. Honestly, I never gave my milk away again. I didn’t feel comfortable with it and didn’t feel like it was best use of a limited resource.

The process to donate milk to the Milk Bank has a couple of steps - an application, a screening call and blood work. Those things are all done to ensure that the milk is safe for recipients. This milk that is donated, is then pooled together to ensure that the calories and protein are evenly distributed. It is then bottled and then pasteurized for hospitals and the community to purchase. This process is done in a safe and clean milk handling space. The staff that handles and pasteurizes this milk is specially trained to follow safety guidelines and procedures.

I wanted to share this information with you all so you are aware of this amazing resource and if you have extra breast milk and are interested in donating - reach out to The Milk Bank.

I also wanted to share a quick summary about my personal experience with donating milk for a second time. I have admit it was a very different experience. Life with two small children is so much different compared with only having one. The first time, I had LOTS of extra milk and was able to donate quite a bit. I also was limited on freezer space and that is what pushed me donate more sooner, rather than later. This second time around, I have donated less and then getting the blood work done took me forever. It was just hard to fit it in my schedule. I plan to try to donate some more milk one more time, but I have had as much extra as I did the first time round. I share all of my personal experience with you to let you know that each pregnancy, each child and each time you choose to breast feed is different. It never goes the same way twice and that is ok. If you are able to have extra milk to donate, please send it to The Milk Bank and if that’s not possible for you that is ok as well. There are other ways to give and support this non-profit.

Skip the Baby Food, Give the Table Food

If you have been around here for awhile you know that I really love Baby Led Weaning. I have done it for both of my children and I am a strong believer in feeding your baby what you are eating. I had the opportunity to put together a journal club presentation for our local NICU Journal Club on the topic of Baby Led Weaning. I thought it was time to write up another post on the topic and hopefully help to answer some questions you might have or at least alleviate any concerns you might have.

https://images.app.goo.gl/pFeXVG6aDvtV8FiS6

What is traditional baby food feeding method and do I have to do that? I thought it might be easiest to put together some questions and talk about some of the background behind how we feed 6 month old babies into their toddler years. You are probably familiar with traditional baby foods that you purchase at the store or even puree and make yourself. You might have started your child on some type of cereal and then tried vegetables, fruits and even meat purees. The first baby foods were developed in the 1920s and then increased in popularity into the 1930s. Before that there was no commercially available baby foods. With this launch of marketed baby food, parents were instructed that they needed to purchase these items. This has been a rite of passage for most infants, trying cereal and then advancing up through the various stages of packaged baby foods.

What are the pros/cons to traditional baby foods? Obviously purchasing foods that are already “prepared” and ready to feed to your child is extremely convenient. It is also very familiar to families. Most people understand the idea of purchasing baby food. Purchasing these baby food products can be expensive and then there is limited variety of these items. Don’t get me wrong, more blends of foods are made and marketed to families, but it is still limited. Another draw back to this method, is that the child is eating something that is different from the rest of the family. They are missing out on that experience of watching others eat and learning how to do that themselves. They can still work on those skills but it is a lot different when they aren’t able to mimic what is happening around them.

So what is Baby Led Weaning (BLW) and how is it different from using traditional baby foods? The idea of baby led weaning has been around forever and is not a new concept, but the terminology might be a “new” way to describe this method. The main premise of BLW is that the baby sits at the table for meal time with the rest of the family and gets to feed themselves. The food that is offered is the meal that the rest of the family is eating. The food can be modified to make it easier for a 6 month old to eat and hold. For example, the veggies offered would be cooked so they are soft enough to manipulate in the child’s mouth. Plus, those cooked veggies are cut in a way that they are long strips that will stick out from the child’s fist so they can bite it. That is all developmentally appropriate for a 6 month old child. As the child grows and gets closer to 12 month, they have a better pincer grasp and can more easily pick up small food pieces. BLW is appropriate to start with child who are 6 months of age and who are able to sit up, have good head and neck control and who are showing interest in foods (reaching for what you are eating and wanting to be with the family at meal time).

What are the pros/cons to Baby Led Weaning? This method of feeding can be easier on families, because they don’t have purchase baby food and the caregiver only has to make one meal. This family meal time has been shown in research to help children as they grow develop to have good social skills and help build stronger family relationships and positively correlate to better weight control. The foods that the child is exposed to at meal times tends to include a wider variety of foods compared with just traditional packaged baby food items. This can be a very unfamiliar feeding method for families and that can be intimidating. Plus, if there is a daycare provider or someone else helping to care for the child, they might be unfamiliar with BLW and not want to be supportive of the parent’s wishes.

If I am interested in trying baby led weaning, where do I begin? Start by using some of the resources listed below to do some research. Most parents are concerned about choking and giving table foods to babies. Becoming familiar with the difference of coughing and choking is helpful in understand that your child is learning how to manipulate food in his/her mouth versus getting that food in their airway and being unable to breath. If you have questions or concerns, let me know! I would love to chat with you about this feeding method or even work with you to figure out the best way to feed your child.

List of Resources:

• https://www.fortifiedfam.com/

• https://www.feedinglittles.com/

• Rapley, Gill and Murkett, Tracey. Baby-Led Weaning The Essential Guide. 2019.

• Rowan, H and Harris, C. Baby-led weaning and family diet. A pilot study. Appetite 58 (2012) 1046-1049.

• D’Auria, E et al. Baby-led weaning: what a systematic review of the literature adds on. Italian Journal of Pediatrics (2018)44:49.

• Brown, A, Jones S, Rowan, H. Baby-Led Weaning: The Evidance to Date. Curr Nutr Rep (2017) 6:148-156. 

• Helwig, J and Stasenko, N. Baby-Led Feeding. 2018.

What products or things do I need? Well you really don’t NEED anything, but there are some great products out there that you might find helpful. With BLW, the child is getting to decide how much they eat of something and you as the caregiver get to decide what they eat and when they eat. So to help encourage more self feeding some of these products (listed below) are helpful! The goal would be getting a bib to help protect your child’s clothes (whatever one works best for your child), then a plate or bowl that can’t easily be thrown to the floor, an open cup or a sippy cup that your child likes and then some type of small utensil that your child can easily manipulate.

Products to Try:

• A good bib: Bapron

• Plates/bowls that stick to the high chair: EzPz cups and plates

• A cup: EzPz Tiny cup

• Small utensils: Grabease or NumNum GOOtensils

Hopefully this is a helpful tool for you as you learn more about ways to fed your child. It is amazing how fast these little ones learn and how the watch the world around them and mimic what they see. Being able to develop those healthy family relationships with each other and with food is so important!

Iron Rich Foods for Your Baby

This topic has been near and dear to my heart this last week. I am not sure if you are familiar with baby well visits but at your 9 month appointment your pediatrician will check your child’s hemoglobin. Now what is your hemoglobin? Hemoglobin in a protein in red blood cells that carries oxygen around your body. When it is low your oxygen binding capacity is lower and this impacts how well your body functions. When your hemoglobin is low this can make you feel tired, lethargic, you can appear more pale, you may experience shortness or breath or even irregular heart rhythms.

https://images.app.goo.gl/euXvyV7gwgUJmPrh8

So why is this checked in your child at their 9 month appointment? When you are baby, you are born with adequate iron stores, that you acquired from your mother. As time goes on that iron that is stored is used and then the baby needs to make that switch to working to utilize/produce appropriate iron usage/storage independently. This stored supply of iron often starts to trend down around 6 months. Preterm babies may also have lower iron stores, because they were born early and didn’t have as much time to acquire iron stores from their mother. When your infant starts eating solids iron levels in food has a big impact around 6 months of age. As humans we get most of our iron from our diet. There is iron that is absorbed in breast milk and it is very bio-available. If you have a full term, healthy weight infant their odds of becoming iron deficient are low. But if you child was born prematurely (before 37 weeks gestation), was less than 6.5lbs at birth, if you as a mother are a poorly controlled diabetic and for children given cow’s milk before 12 months of age. For these reasons, pediatricians will make sure that they check your baby’s hemoglobin to see how well their body is using/processing iron.

What happens if you learn your baby’s hemoglobin is low? There are a variety of things that can happen. Your pediatrician will most likely have your child go for a full blood draw. The hemoglobin test they do in the office is normally a heel prick and isn’t always the MOST accurate. They will send you for a blood draw and look at those lab values to see what that hemoglobin really is and then decide if your child needs a iron supplement. If your child ends up needing some iron given orally, that is ok. It is an easy supplement to give (just like you would give Vitamin D to a breast feed baby). You would be provided the prescribed amount of ferrous sulfate daily and follow up with your pediatrician or a hematologist.

We have talked about how you get iron from breast milk, formula and from foods. The amount of iron is lower in breast milk compared with formula, but it is more bio-available. When your child is getting breast milk or formula, they are getting a good source of iron, but as they get older, they will need additional sources of iron. That is where table foods/solids comes into play. What are some iron rich foods I can make sure to feed my baby? There are lots of foods that are high in iron and other foods that are fortified with additional iron. Sometimes dietary intake of iron is an issue for families. See the list of iron rich foods below and make sure that you are fitting these foods in your children’s diet on a regular basis.

Iron Rich Foods

• Meat (any type of meat items are iron rich - think ground meats, fish that flakes and serve those meats in a way that is easy for them to manipulate in their mouth without teeth).

  • Organ meats - liver

• Soy - tofu, edamame, tempeh

• Sea vegetables (think of seaweed, algae are rich in iron)

• Beans

• Winter squash/sweet potatoes

• Dark green veggies (spinach, kale, collard greens)

• Grains (cereals, bread, crackers are often fortified with additional iron as well)

• Eggs (yolks)

Hopefully your baby has great iron stores and those are able to be maintained as they head into toddler-hood. If that isn’t the case and your pediatrician finds out that your baby has lower iron levels, that is ok. There are numerous ways to help support you as the parent and get those levels up so your baby is able to grow and develop to the best of their ability.

References:

1. Kelly Mom

2. Handouts

3. Stanford Children’s

4. The Science of Mom

5. Iron Rich Food Sources
   

Say "NO!" to the Pouch

I’m sure you’ve seen fruit/vegetable pouches at the grocery store and have seen kids squeezing some type of puree into their mouths through a little spout. There are pouches with fruit, pouches with vegetables, pouches that contain organic produce and even pouches with beans and avocados in them. There are even re-usable pouches you can buy and make yourself at home. If you ask me, the baby food pouch market is a little ridiculous. Did you know that pouches now account for 25% of the baby food market?! Sure, the idea of getting your kids to eat a wide array of foods is great, but what grown adult eats these food items out of a pouch?!

Now, if you have given your child a fruit/veggie pouch, don’t feel like you have messed up. It is not the end of the world. However, I am here to tell you that your child is in no way, shape or form NEEDS a pouch to eat their fruit and vegetables. This has been on my mind the last several weeks, because I have encountered several parents who were talking about their child eating vegetables and then they followed up by saying '“in a pouch.” That just made my heart hurt, because from a sensory perspective that child is missing out on SO much. Now, if you give your child a pouch of organic, blueberry and acai berry puree on occasion that is fine, but if your child is depending on pouches to “eat” vegetables, we might want to chat offline.

Let’s talk about the pouch phenomenon from a sensory perspective. Let me clarify - I am not an Occupational Therapist, but I have done some sensory food training (the SOS Feeding Method) and I have worked with several OTs over the past eight years. I know just enough to help explain the basics to you. When your child eats food, they are experiencing so much more than it may first appear. They are touching the food and getting to feel it. They are smelling the food and they are looking at the color and texture of the food. They are getting to taste the flavor of the food and they are getting to watch you eat the food as well. There is so much sensory input that is happening when a child eats. When you give that child a pouch of food, they are missing out on ALL of those sensory experiences. They don’t get to touch the food, they don’t get to smell it, they don’t get to see it and the only sense they get to use is their mouth. Can you imagine having to taste something that you can’t smell, see or feel first? That is a rather shocking experience. Add to that the fact that no one else around you is eating out of a pouch. Imagine how you would react.

My main point with this post isn’t to shame you if you give your child food pouches. I simply want to provide you with some reasoning behind why offering your child pouches on a regular basis might not the best idea. If you have a child that is really picky and is struggling with some sensory issues, and therefore, you rely on pouches, consider working with a feeding therapist. I would be happy to work with you and point you in the direction of a great feeding therapist if you need it.

Eating is such a wonderful sensory experience. When we deprive our children of the opportunity to use their senses while eating, we start to see them struggle with eating. So, while you may choose to use pouches on occasion, please don’t rely on them as a normal meal source. The best thing to do is to prepare soft foods for your child and offer them what you’re eating.

Next time you are in the baby aisle, walking by the baby food, keep going and just say “no” to the pouches!

Resources:

• New York Times article - Rethinking Baby Food Pouches

• Baby Pouches Pose Risk for Development

• The Truth about Food Pouches

• The Downside to Baby Food Pouches

Weight Watchers for Children?!

If you haven’t heard already Weight Watchers has launched an app for children. Yep, you read that right, an app targeting 8-13 year olds and focusing on green, yellow and red foods. When I started hearing about this, I was first really surprised. Then that surprise was followed by being slightly upset and then realizing that I shouldn’t be surprised. This “diet culture” that is very pervasive in our world is now reaching our children, who aren’t even in middle school yet.

I can definitely acknowledge that there is an obesity problem facing Americans. From adults to children, as a country we struggle with being healthy, but I strongly believe that an app targeting children and trying to help them “diet” is NOT the answer. This app is called Kurbo. There are lots of articles that are showing up online addressing this app. I am not opposed to the Green, Yellow and Red light method for nutrition education, but it isn’t my favorite. Why? Because children are so literal. If a food is termed as “bad” then they remember that and they don’t want to eat those food items. Children’s processing abilities are very black and white. That is why using the term “good” and “bad” is tough for them. I am in support of the all foods fit method. Focusing on eating more healthy foods, but not overdoing the special, treats.

This picture below is from the Kurbo app and showing how it works. You log your food intake and then the app organizes it into green, yellow and red categories. The part that bothers me is when you consume “too many red foods” then the app will tell you that and “encourage” you to try other “green foods” instead. All of the foods that are listed as “green foods” are fruits and vegetables. That is a great goal, but one can not live on only fruit and vegetables. You need some other forms of protein and fat sources to help your muscles grow appropriately and then a child’s brain develop. Plus, this app is promoting before and after pictures of children who have lost weight. This was extremely upsetting because that is not at all how we want children to gain confidence. Their self worth should not be tied to a picture of themselves.

My point of sharing this with you all is to bring the focus to this “Diet Culture” that is persistent in our environment. This is NOT the message that we should be sharing with our children … that they NEED to lose weight to “make their parents happy.” Children should never be put on a diet, because research shows that is not helpful for their development and leads to a negative relationship with food and often creates more eating issues as they grow. Having a goal to get children to be more active and choose more nutritionally dense foods in their diets are perfect things to focus on as a family. I think the other part of this that really bothers me is the fact that this is suppose to be used by the child and doesn’t include the family. Whenever I counsel a family with a child who is overweight … the goal is lifestyle modification for the family and it is a whole family affair. The child doesn’t go to the store and purchase food … that is the parent’s role so that education needs to include the parent to help provide more nutritionally dense choices and the child can choose how much of those food items to eat.

No child should ever be told that they are fat and they need some app to help them fix some weight problem about themselves. I am not a fan of weight loss apps and I don’t like how people get caught up in “good” and “bad” foods. The goal with weight loss counseling is working to make small life style changes that are sustainable. Using an app can’t really help with that. As a parent be aware that this app is out there. This is dangerous and not at all helpful to building children up and fostering a positive relationship with food/their own body image. Working with a Registered Dietitian Nutritionist can be a helpful tool to make small changes for the entire family. If you have questions about your child’s weight or concerns about making food changes - reach out and let me know. This can be tough, but with the help of trained professionals there is a way to encourage and foster a healthy relationship with food and help children grow and develop in a positive manner.

Baby Led Weaning #2

I wanted to bring up the topic of Baby Led Weaning again, because we are once again in that phase of life. My youngest is now 6 months old and we have started with table foods. This is kind of a big deal and crazy to think that our little man is half way to his first birthday.

If you can remember, back 2 years ago, I started William with Baby Led Weaning. If you want to read about that experience - CLICK HERE. With this second time around, I feel more comfortable introducing my little one to table foods, but has been a different experience. William was already sitting up independently at 6 months. Samuel is not sitting unassisted yet, but doing great at pivoting on his belly and rolling from back to front and front to back. He has been sitting with me at the table when we eat dinner and loves to be at the table. I have now been placing him in his high chair and giving him soft foods that we are eating at dinner. He loves being there with the family and is always so excited. He is grabbing the food and working on getting it to his mouth. The large majority of food falls to the floor or into the chair, but he tries so hard. He is doing a great job and I am working hard to not compare him with his brother.

We have tried a large variety of foods already - Chinese noodles were a big hit, he loved veggie straws, cooked veggies like broccoli was fun to try as well. William loves to try to “help” him eat as well. We are trying to teach William to let Samuel learn on his own.

Key Points with Baby Led Weaning to Remember …

1. Coughing is good. This is one of the biggest initial challenges with baby led weaning. Most parents worry and freak out when their baby coughs, but coughing is a good thing. The baby is working to protect their airway and learning how to properly do that. Remain calm at the table, we often praise the cough and say “good coughing” with a smile.

2. Eating is for practice. As I mentioned above so much of the food that I give Samuel never makes it into his mouth. Instead it is all over the floor, in his chair or on his clothes, but that is fine. The goal is smelling, touching, tasting and some eating at meal time. It is a complete sensory experience and the goal is a positive interaction with food.

3. Keep things positive. Some times the amount of time the baby is in the chair isn’t the entire meal time. There have been a couple of meals, where Samuel was not into eating, was tired and cranky. He sat and tried food for maybe 10 minutes and then when he was obviously done, I asked him “all done?” and then once he was calmer, I took him out of his chair. It isn’t about how long the baby sits in the chair, but instead cultivating a positive eating experience.

4. Variety. The amazing benefit of baby led weaning is the ability to exposure your child to new foods. Work to eat a variety of foods and then give those to your child as well. We always aim for a vegetable, entree/protein and a fruit at dinner. We try to switch things up and then never order kid’s meals at restaurants. We purchase a regular meal and then share it with the child. Normally the kid’s meal is just chicken nuggets, applesauce, more bland foods with limited variety.

5. Family meal time. Working to have that family time and sitting together at the table is important for teaching your little one how to eat and how that social event occurs. Children who have family meals do better in school, feel more supported by their family and tend to eat a wide array of foods. This is a win, win, win for all involved.

If you have any questions about baby led weaning, let me know. Check out some of these pictures of our meal time. If you want some additional resources check out - Fortified Family, Feeding Littles, The Baby Led Weaning Cookbook.

Infant Driven Feeding

I had the opportunity to listen to a CCC-SLP talk about infant driven feeding and working with infants to learn how to eat in a positive manner. I know for most of you this might seem like a simple concept, but for all babies it is an acquired skill.Please recognize that I am not a SLP, but I am a pediatric RD and I have been trained in infant feeding and the SOS feeding method. I am not here to try to diagnose swallow dysfunction, but instead to focus on watching feeding cues and helping to create a positive feeding environment.

A baby in utero starts to suck and swallow as early as 12 weeks gestation. Throughout their time in utero they are sucking in amniotic fluid and then swallowing it and peeing it out. The act of eating is a series of processes - sucking, swallowing and breathing and doing this in a coordinated manner. For those babies born early, they miss out on practicing this skill in utero. We will watch for oral feeding cues around the 32-34 week gestation mark and then often infants will be allowed to start orally feeding ~34 weeks gestation with proper feeding cues.

Well what are feeding cues? Feeding cues include behaviors that a baby is going to show that they are hungry. This could include, waking up, starting to move around/fuss, putting hands in our around their mouth, and rooting whenever anything gets near their mouth. Most of us are familiar with cues to show that a baby might be hungry.

I would say that most adults are less familiar with stress cues. What are stress cues? These are signs that a baby is showing that they don’t want to eat. This would be if they are arching/pulling away from the bottle or breast, if their brow is furrowed, if they are excessively blinking their eyes, crying, trying to not latch onto the bottle or breast, not opening their mouth, putting their tongue to the roof of their mouth or simply not sucking on the bottle or breast. These are all signs that the baby isn’t ready or wanting to orally feed.

For most term infants who are healthy, after the first few days of life they are getting the eating routine down and they learn those skills and take off. With preterm infants, this is a lot harder and they don’t tend to have such positive experiences all the time. Eating is extremely hard work, it is exhausting and if they are sick, have low stores and can easily burn more calories than they are consuming if feedings go longer than 30 minutes. Plus if you are pushing a baby to orally feed, who isn’t ready you can create a feeding problem. That baby can silently choking or aspirate that breast milk or formula and that can lead to an infection, like pneumonia. Unlike older children or adults, babies don’t really cough when they choke. They can still choke on a feeding and you wouldn’t know (we call that silent aspiration).

Why I am going through and sharing this information with you all? Because this has been a topic of discussion in our NICU, because one of the basic things a baby needs to do to go home is eat. So much focus is placed on volume intakes and growth and parents get caught up in volumes and trying to meet numerical goals. Volumes do matter, but honestly for the long term development of a child, volumes don’t matter as much as the quality of the feeding. Is the child calm, able to coordinate sucking, swallowing and breathing and are they able to take an appropriate volume in an appropriate amount of time while keeping their composure. Having well trained RNs who can watch for stress cues and are able to help teach the baby who is eat in a calm way is key to the long term feeding success for that child. Most parents who have term infants, don’t have to stress and worry about feedings in the same way as a parent of a preterm infant. The key is help teach parents how to properly feed their preterm baby so that the baby and the parents are not stressed. Whether you are feeding your preterm or term baby, make sure you watch for any stress cues with PO feedings and then stop a feeding if the baby isn’t able to maintain a calm state. It is not worth force feeding a baby. If you have questions or concern about your child and feeding, reach out to your pediatrician to talk about your concerns and they can help get you in touch with SLP to discuss any oral motor feeding concerns.

Help, My Child is Vegetarian!

It can take you by surprise if you child comes to you and informs you that he/she have decided to become vegetarian. This can be shocking to a parent and very overwhelming. For families who eat a lot of meat this can be very challenging as well. Learning how to work through this dietary choice as a family is important. I have experienced this first hand in my own family and then also worked to counsel families who are going through this experience.

My younger sister decided to become vegetarian when she was in college. She made the choice to stop eating meat and if I remember correctly this happened in the summer immediately prior to a family vacation. It was challenging for my family, because my sister was also restricting her overall caloric intake and then struggling with disordered eating. My sister has continued to be vegetarian for several years, but has thankfully overcome disordered eating and still practices vegetarianism in a healthier way now. This was obviously challenging for family to navigate my sister’s dietary preferences with the rest of the family.

It is important to help remind the parents that their child is making a choice about their diet isn’t a personal reflection of them, but instead an expression of their child’s independence. Talking through why their child is choosing to avoid meat, where is the desire coming from and what prompted that change? How does it make the child feel? How can the parent work to support their child’s independence in a healthy way? If you child is choosing to be vegetarian that is great, but they need to be choosing healthy foods. Being vegetarian doesn’t mean they should be eating crackers all day with PB&J sandwiches for every meal. Being a healthy vegetarian means that they are consuming more fruits and vegetables and finding ways to increase their consumption of plant based proteins (beans, soy, hemp, etc). Also making their that the child’s choice to be vegetarian isn’t an excuse to calorie restrict. Sometimes disordered eating is masked by a dietary preference like avoiding meat, or cutting out a particular food group. That is unhealthy and not safe for a growing child. Working with a Registered Dietitian to help facilitate these discussions can be helpful. It is tough sometimes for a parent and child to have an open and productive discussion without a 3rd party to help mediate. It is easy for emotions to get in the way and then creative a stressful/hostile environment.

1. Discuss this dietary change and what all surrounded this shift in eating. Having this open communication is key to embracing and working through this new behavior in a positive way. This can be where having another person, like a Registered Dietitian, can be helpful to lead this discussion and help both parties (child and the parent) share their feelings in a non-judgmental environment.

2. Talk about what this means in terms of the family dynamics at meal time and in regards to food preparation. This is one of the biggest challenges. For most families, if one child is choosing a different diet/eating habits from the rest of the family that makes meals complicated and can add stress. Talking about how everyone in this family matters and there will need to be some compromise to make this work. There can’t be two separate meals each night for dinner and the vegetarian child can’t be eating “special” foods all the time that will make other siblings jealous. Coming up with recipes and meal ideas where the family can “build” their own dinner plate with meat and non-meat options can be one of the best ways to accommodate special requests. For example, if you are having hamburgers, then have meat burgers and veggie burgers available for the main entree. If you are having a grilled meat item, then make sure there is an acceptable non-meat option (grilled mushroom, tempeh or vegetables kabobs).

3. Brain storm ways for the child to help take ownership over his/her meals (list making, shopping, cooking and cleaning up). Including your child in the meal planning and preparation process is a way to help them assuming responsibility for their meals. If your child is choosing to eat vegetarian then they can help come up with food items they would like include for meals/snacks that are healthy and don’t contain meat. They can also help prepare those items since they are part of the family. I believe that all children need to be involved with the food preparation and these skills help them grow up into independent people.

Talking with your child about healthy eating habits is important. Working to accommodate their dietary preferences/choices is important as well. If you child has chosen to be vegetarian, there has to be some reason behind that change. Maybe is stems from a discussion they had with their peers and it leaves them really be grossed out or concerns about processed meat items. Maybe they are trying to restrict calories and that is presentation of vegetarianism is just a symptom of a deeper issue. As the parent, talking with your child is key to better understand what they are thinking and working with them to make healthy decisions. If you have questions about working with your child and dealing with food choices/dietary changes, let me know and I would love to be able to work with you and your child.

ADHD and Nutrition Intake

I recently had the opportunity to work with a family whose son was diagnosed with ADHD and I started doing some more in depth research on nutritional intake. Just like with anyone, what you eat can have an impact on how you feel and how your body works. As the years have gone by there has gotten to be more research on the topic of nutritional intake and ADHD.

Sometimes children with ADHD are not always interested in eating enough food and sometimes medications they are put on cause a decrease in appetite. Making sure that children with ADHD are eating three meals a day with two snacks is important. So working to optimize the nutritional intake of the meals and snacks will help give you the biggest nutrition bang for your buck. Noting the timing of the medication and then when your child is the least hungry compared with being the most hungry. Trying to time nutrient dense meals/snacks around those optimal eating times can be helpful as well.

There are some key nutrients that have been shown to be low in children with ADHD. It is true that for all of us our food intake plays a big role on our behavior. Often children with ADHD had sub-optimal eating habits and parents tend to feed these children whatever foods they will accept and eat, because meal times are stressful. Learning more about what nutrients can be focused on and then working to offer these children well balanced meals and snacks can have a big impact on how that child feels, how they grow and how well their brain functions. The following is a list of nutrients that have been researched and shown to have some positive impact and correlations with improved ADHD symptoms.

Omega-3 Fatty Acids

• ADHD is a neurodevelopmental disorder and the thought is if we provide a fat supplement this will help with brain neurotransmission and help treat any behavioural dysfunction disorders. Your brain uses fat as fuel and making sure that you are choosing anti-inflammatory unsaturated fats and consuming enough of those has been shown to have a positive impact on behavior outcomes.

• Food sources that contain high amounts of omega-3 fatty acids include: flaxseed, walnuts, chia seeds, cold water fish (salmon, mackerel and trout). Limit consumption of fish in young children to 2-3 servings per week.

• What about a supplement? There is a product that has been researched and has a blend of Eicosapentaenoic acid (EPA), Docosahexaenoic acids (DHA) and Gamma linolenic acid (GLA) and children in this study took this supplement over 12 months and didn’t need to increase their medicine dose and reduced their ADHD symptoms. Equazen is available in pill or gummy form through Amazon.

Iron

• The idea behind making sure your child is consuming enough iron is to help make sure that your child isn’t anemic. If your child doesn’t consume a lot of red meat or protein sources it is easy for your child to be development anemia. In a study of 23 children, those taking an iron supplement showed progressive improvements in ADHD symptoms over the placebo group.

• Food sources for high amounts of iron include: meat/protein (beef, pork, chicken, eggs and beans), dark leafy greens and fruits fruits (raisins and apricots). Pair these foods with a Vitamin C rich food to help optimize the absorption of the iron (orange juice, strawberries, tomatoes).

Zinc

• Zinc is an important factor in the metabolism of neurotransmitters, prostaglandins, and for maintaining brain structure and function. Dopamine is an important factor in the pathophysiology of hyperactivity disorder, and the hormone melatonin has an important role in the regulation of dopamine. Because zinc is necessary in the metabolism of melatonin, it can be assumed that zinc is a very important factor in the treatment of attention deficit and hyperactivity disorder (ADHD).

• When looking to supplement zinc those in studies taking 150mg/day experiences improvements in hyperactivity and impulsivity compared with the placebo group.

• Foods that are zinc rich include: meat (beef, pork, chicken and lamb), wheat germ, yogurt and nuts (cashews and almonds).

Magnesium

• Magnesium is a mineral required for hundreds of the body's biochemical reactions including protein synthesis, muscle and nerve function, blood glucose control, bone development, DNA synthesis, and glutathione synthesis. Magnesium is essential for brain function. The bioavailability of magnesium affects the function and binding of neurotransmitters to their receptors, such as serotonin and dopamine. 

• Foods rich in magnesium include: dark leafy greens, nuts/seedy, bananas and avocados.

Good For Your Greens

Spring is officially here and we have just wrapped up March and now it is April. That means that things will start to turn green soon and people will plant gardens and fresh produce will start to grow. I love it when seasons change and I especially love being able to enjoy fresh produce that I have grown or purchase from the Farmer’s Market. There are so many delicious fresh vegetables to enjoy and one of the first vegetable items that will be available is fresh lettuce.

I am not sure how many of you have children, but it can be a struggle for parents to have their children eat vegetables, let alone green vegetables. Depending on the age of your child, it is normal for them to want to be independent and have their own opinions and often this comes out at the dinner table. I wanted to share with you some tips and tricks to help you get more green veggies into your meals and help your “picky child” eat those vegetables that you have prepared.

Green vegetables are good for you, but why? What makes green vegetables healthy? The color green is made from a compound colored chlorophyll and this pigment absorbs like and is critical to the process of photosynthesis within the plant. That process of photosynthesis is the plant’s way of taking sunlight and processing it into usable energy to grow. Without the chlorophyll, the plant couldn’t collect and process the sunlight.

So plants are green, because they contain chlorophyll, but is that what makes them healthy? Not necessarily, the main reason that green vegetables are healthy is that they contain other vitamins, minerals, fiber and antioxidants that are used and metabolized by our bodies to fight off diseases and help us stay healthy and grow strong. The green color serves as a symbol that there are other vitamins, minerals, fiber and antioxidants in that food item and it is good for us.

Ok, so green vegetables are healthy, but how do I get my picky child to try those foods? It can be tough to have a power struggle at the dinner table over vegetables. Honestly, that is not the ideal situation for yourself or your child. The time to start talking about and teaching about how good and healthy green vegetables are, is earlier. When you are grocery shopping, stop and look at all the green produce and talk about the different types of vegetables (lettuce, broccoli, brussel sprouts, asparagus, green beans, etc). Have your child help pick out a new vegetable to try and take it home. Then include your child in the preparation/cooking process for that food item. If your child choose broccoli, have them help you wash it, cut it up and then cook that vegetable. You can talk about the food item and discuss how it looks like tiny trees and how the top of the broccoli is bumpy and how the stalk is smooth. Then at dinner time have your child help serve the broccoli to everyone at the table (including themselves). Then at dinner, make sure that you eat the broccoli as well and talk about how good it tastes. Encourage your child to try 1 bite. Then praise them for helping to cook the food and taking a bite. Then leave it at that. This takes time and it is a process. Don’t feel like your child is going to eat all the broccoli right away, but keep offering that food item to them and keep including them in the cooking process. It is tough, but you are not in this alone and learning about how good for you green foods are is just the beginning of learning to explore and love food!

Check out the picture below with some other tips on dealing with picky eaters! If you have any other questions, feel free to reach out and I would love to work you and your children on trying new foods and making dinner time a more positive experience.