Tag Archive for: Diet

Ideas for Kid-Friendly Vegetarian Dinners

People choose to have a vegetarian diet for a variety of reasons. There are some nutrition advantages to being a vegetarian, especially when it is done vegi childcorrectly. In other words, when eating as a vegetarian, it is still important to eat quality foods. If abstaining from meat implies consuming more processed carbohydrates and cheese, this is not exactly a healthy trade-off. Fruits and vegetables should be emphasized, of course, but a variety of quality protein sources and healthy fats should be included in a vegetarian diet as well. See my previous blog on protein sources for kids for a list of alternatives to meat.

I believe it is great to include one or two vegetarian meals a week. It introduces variety to your family so that dinners do not always involve a rotation of meat, starch and vegetables. It can also save money to feed your family a vegetarian meal; for example, if you use dried or canned legumes as the main course. Finally, vegetarian dinners tend to be lower in fat and higher in fiber, which are the ingredients to a heart-healthy diet.

Here are three easy recipes for vegetarian dinners that are also kid-friendly:

White Bean and Quinoa Panini-Wraps

1 small onion, chopped
1-2 tablespoons olive oil
1-2 can white beans, drained and rinsed (estimate 1 can for about 4 servings)
2 cups cooked quinoa
1-2 handfuls of baby spinach leaves
½ tablespoon cumin
1 cup shredded mozzarella cheese
½ cup plain yogurt
6 whole wheat tortillas

Heat olive oil in a medium or large pan over medium heat. Saute onions until soft. Add beans, quinoa, spinach and cumin. Continue stirring over medium heat for a few minutes until all ingredients are heated thoroughly and spinach is wilted. Remove from heat and stir in yogurt and cheese. Heat another skillet or griddle over medium heat. Scoop ½ cup of the bean mixture and place into the center of the tortilla. Fold tortilla sides inward. Place wraps on the skillet or griddle, seam side down. Press flat and let toast 3-5 minutes on each side.
Makes 6 servings.

Since this recipe incorporates protein, whole grains and vegetables, the only side you need to add is fruit!

Peanut Butter-Drizzled… Tofu Stir Fry

1 block of organic, extra firm tofu, cubed
1-2 tablespoons olive oil
2 cups of your favorite vegetables, chopped. (Let the kids pick! Or go with colorful bell peppers)
1 cup chopped dark leafy greens (kale, spinach, chard, etc.)

1/4 cup peanut butter or almond butter
2 teaspoons maple syrup
2 tablespoons soy sauce
1 teaspoon grated ginger
1/3 cup water

Saute tofu in olive oil over medium heat until tofu starts to brown (approx 10 minutes). While this is cooking, mix all of the ingredients for the sauce in a small saucepan over low heat. Stir with a whisk frequently until it is smooth and heated thoroughly. In the tofu pan, add vegetables and greens; continue stirring frequently. Let the tofu and vegetables saute until the vegetables are softened and the greens are wilted. Pour sauce over the tofu-vegetable mixture and mix well. Serve with noodles or brown rice and fruit.
Makes approx 4 servings.

Scrambled Egg Burritos

6 eggs
1 tablespoon butter
6 soft corn tortillas
1-2 cups shredded cheddar cheese
Condiments- chopped avocado, cilantro, and salsa or any your family chooses.

Melt butter in pan and cook eggs, scrambled-style. Warm the tortillas so that they are softened prior to assembling the burritos. Place each condiment, including the cheese, in small bowls on the table. Let the kids assemble their own burritos and pick which condiments they would like. Serve with a side of seasoned black beans (can of beans that has been drained, rinsed and heated in a small pot with salt, pepper, cumin and pinch of red pepper) and a side of fruit.

Try creating and serving these recipes once a week with your family. Help them enjoy a new meal by showing your own enthusiasm for it and asking them to help prepare it. Remember to use words to name the meal that they are already familiar with, such as Panini, peanut butter and burrito. This may help them feel more comfortable with the meal rather than saying quinoa and spinach, tofu and vegetables or eggs and beans. Enjoy!


Don’t Let Halloween Spook the Nutrition out of Your Kids!

Halloween and nutrition don’t exactly go together as do witches and brooms. I know, as a parent, I’m wondering how to balance the fun of the holiday halloween candyalong with the health of my young daughter. All foods have some place in our diets. Candy is one that should appear less often than most. Here is my advice regarding how to handle all the candy your kids bring home from Trick or Treating.

Keeping a nutritious mind on Halloween:

  1. Before Trick or Treating, as in the night before so you have their full attention, explain what the ground rules are going to be for the candy. Make sure they know what to expect ahead of time.
  2. Some example ground rules could be:
    1. The kids can pick 5-10 of their favorite candies from trick or treating to eat Halloween night. Save the rest and choose 1-2 candies to have each day from there forward.
    2. Let them keep half the candy, and allow them to eat a few pieces every day until it’s gone. Create a project where they give the other half away in little treat bags to people who might appreciate the thought (i.e., the mailman, the school secretary, grandma and grandpa, etc.)
    3. Pick a handful of candy to eat at designated times. Give the rest of the candy to both parents to take to work.
  3. Remember the ground rules. They may start whining about what their friends get to do and how unfair you are as their parents. You are in charge; you make the rules; therefore, you must enforce the rules.
  4. In addition, remember that a moderate amount of candy in one day is not the end of the world. Eating a little candy every day for a number of days is not all that bad either; however, having no rules relating to eating the candy can result in unnecessary sugar consumption in short periods of time. This will likely result in a huge crash in behaviorIt can start as hyperactivity and quickly escalate to emotional outbursts, anger or aggression and feeling ill. Also, they will probably not have an appetite for other food, making mealtimes a definite struggle.
  5. Be conscious to not use candy as a reward. It sends a message that there is some great value in candy when you use it as the ultimate reinforcer for what you want them to do. This will turn into a continuous battle once you decide that you don’t want to reward them with candy.

I will leave you with a few nutritious, kid-friendly Halloween recipes to balance all the candy:

Edible Eyeballs- carrots, cream cheese, pitted black olives
Slice carrots into 1 inch thick rounds, and top each with a blob of cream cheese and one half of a pitted black olive.
From Familyfun.com 2009

Eerie Eyeballs- apples, apricots, dried cherries or raisins
Slice apples horizontally so that you have ¼ inch flat disks; cut out the core centers. Slice apricots carefully in half (lengthwise) and place sticky side down onto the apple rounds. Do the same with raisins or dried cherries and place stick side down onto the apricots.
From Familyfun.com 2009

Witches Fingers- carrots, block of white cheddar cheese or string cheese, sliced almonds, peanut butter, cream cheese.
Use baby carrots or peeled thin carrots and put a small dab of peanut butter on the top of one end. Place one sliced almond on the peanut butter so that it is held in place. This is the witches fingernail and the carrot is the finger. Do the same with the cheddar or string cheese by slicing it into finger-like shapes and putting the almond on using a dab of cream cheese. Arrange on a plate and be sure to slice in “knuckles”.

Pumpkin Pancakes
Just add a few dollops of canned pumpkin and a little sprinkle of nutmeg and cinnamon to your favorite pancake batter. Try pouring the batter into greased pumpkin-shaped metal cookie cutters on the griddle to make festive shapes.


Weight Issues: What Effects Do Overweight And Obesity Have On Our Kids?

As of 2008, the prevalence rate for childhood obesity was almost 20% in kids 2-19 years old (1). Obesity is diagnosed by a single measure, which is the Obese ChildrenBody Mass Index (BMI) percentile on the growth chart. BMI is calculated as a proportion of weight to height, and reflects how much weight a person carries for their height. BMI is categorized differently for children and adults.

For children, these are the Obesity parameters:

BMI greater than 85th percentile is diagnosed as overweight.
BMI greater than 95th percentile is diagnosed as obese.

Pediatricians or other healthcare professionals should be measuring and plotting BMI for all kids over the age of 2 at regular visits. If a child’s BMI plots higher than the 95th percentile, action needs to be taken. It is the position of the American Academy of Pediatrics as well as the Academy of Nutrition and Dietetics that obese kids need intervention to achieve a healthy weight status. Studies have shown that the most effective treatment is a multi-disciplinary, family based approach with regular, frequent visits.

The reason why it is important to seek help is because obesity is a chronic health problem. There are several comorbitities, or associated health risks, that can develop during childhood as a result of obesity:

  • High blood pressure (hypertension), which is correlated with heart disease and stroke.
  • High cholesterol (hyperlipidemia), which is correlated with heart disease and stroke.
  • Type 2 diabetes, which was previously called “adult-onset diabetes” since it used to only be diagnosed in adults. Type 2 diabetes can lead to other health issues such as heart disease, stroke, neuropathy, kidney problems, and more.
  • Non-alcoholic steatohepatitis (NASH)- the liver is inflamed and has excessive fatty deposits in the tissue, which affects function
  • Gallstones and gallbladder disease.
  • Acanthosis nigricans- darkening of the skin, especially in the back of the neck, hands and knees.
  • Difficulty breathing and asthma- the entire cardio-respiratory system is decompensated due to less ability to do physical activity, and more weight bearing on the heart and lungs.
  • Sleep apnea- Kids (and adults) with sleep apnea have brief periods where they stop breathing several times throughout the night. The excess weight and distribution of fat on the chest and neck contribute to this. These kids to not get the benefits of sleep, and therefore are more fatigued during the day, have more difficulty concentrating in school, and may have mood and behavior disturbances due to lack of sleep.

These comorbidities can last into adulthood and impact quality of life and lifespan. Data from an NHANES follow up survey and the Bogalusa Heart Study show that 50-60% of school-age kids will be obese as adults. But for obese kids, the social issues they face during childhood are even more devastating.

Obese kids are at higher risk for:

  • Low self-esteem, which can lead to poor school performance; higher likelihood to engage in “risky” behaviors; etc
  • Depression
  • Bullying
  • Discrimination

One study asked kids with a variety of serious diagnoses to rate their quality of life. The obese kids reported a lower quality of life than kids with cystic fibrosis, epilepsy, cancer, type 1 diabetes, kidney transplant, irritable bowel disease, and healthy kids (2). This shows how much kids struggling with obesity need our help.

In the presidential race, two hot topics, as always, are healthcare and federal spending. The fact is, as big as these issues are now, they are going to become exponentially bigger as America’s youth carry health issues into tomorrow. That is, unless, we help take away that burden for our kids. At North Shore Pediatric Therapy, we have a multi-disciplinary team of experts who can dedicate time to your family’s health. Call to schedule an appointment today.

1. Ogden CL. JAMA 2006;295:1549-1555, Ogden CL JAMA 2008;299:2401-2405, Ogden
CL. JAMA 2010;303(3):242-249.
2. Ingerski et al J Pediatr 2010;156:639-44.


Swallowing Disorders vs. Feeding Disorders in Children

Swallowing Disorder and Dysphagia are terms that are used often to specifically describe difficulty eating as a result of physiological or anatomical baby eatingissues. These issues result in the inefficiency or inability of a child to safely ingest an age-appropriate diet that meets all nutritional needs. For example, an infant who is unable to coordinate the actions of sucking, swallowing and breathing to nurse may aspirate during meals (when liquid or food enters the windpipe, and may eventually reach the lungs). This could be due to physiological dis-coordination and anatomical weakness. We all have experienced a “Dysphagia moment” before due to this type of dis-coordination which results in “down the wrong pipe” discomfort and, usually, a coughing fit. However, this example is just that- one example of the multitude of ways a child’s swallowing pattern may be negatively altered and result in Dysphagia. It is not always obvious (i.e., silent aspiration will not result in a coughing fit) and has many causes and signs.

What Is A Feeding Disorder?

A feeding disorder is a more broad term that is used to describe the difficulty a child may have accepting a varied and age-appropriate diet. A feeding disorder may best describe a child who shows strict texture and food preferences. A feeding disorder may also describe a child who shows signs of aversion to being fed or feeding themselves. Feeding disorders in children can sometimes develop due to a child’s history of Dysphagia and the uncomfortable eating situations they have experienced. This history will likely impacted their flexibility and acceptance in trying new foods.

How To Identify Swallowing And Feeding Disorders?

A very broad and simplified way to differentiate between these types of feeding difficulties is to consider where the breakdown lies. A child who experiences difficulty getting food from a plate to their mouth for manipulation exhibits a feeding disorder, whereas a child who experiences difficulty getting food safely from their mouth into their digestive system exhibits Dysphagia.

Feeding and swallowing difficulties must be identified and treated as soon as possible for the greatest success of a child. If you have any concerns with your child’s abilities or behavior during meal times, seek out the advice of your pediatrician. An evaluation with a Speech-Language Pathologist, Nutritionist or Occupational Therapist may be warranted to ensure the development of age-appropriate feeding skills and the acceptance of a varied diet.


Snacks for Kids: How Much, When, and What to Give Them

Snacks are an important part of a growing child’s diet. It is important to set boundaries around snacking in the household, as eating too many caloriesfrom snacks can lead to excessive weight gain. Also, “grazing” on small snack foods all day can decrease appetite at mealtimes. Beloware the general “snacking guidelines” by age.

Snack Suggestions for ages 1-2:

Snacks should be offered twice a day, between meals. At this age, they still need somewhat frequent feedings, as eating every few hours supports their growth and energy needs. Make sure that snack times have defined starting and ending times (about 15 minutes), so that the child isn’t grazing all morning or afternoon.

boy and girl with snack

Smart Snack Choices:

  • fresh fruit
  • dried fruit (once they are able to chew it well)
  • pretzels
  • whole grain or rice crackers
  • rice cakes
  • dry whole grain cereal
  • string cheese
  • only offer water to drink between meals

Portion sizes: ½ piece fruit, ¼ cup dried fruit, 1/3 cup pretzels, crackers or cereal, 1 rice cake, 1 piece of string cheese.

Snack Suggestions for ages 2-4:

Growth rates slow quite a bit during these years, compared to the rate of rapid growth in infancy. Hopefully, up to this point, your child has been offered meals and snacks at regular, scheduled times daily. He or she should have a good sense of when mealtimes are coming and what behaviors are expected at meals. At this age, your child may not need snacks between every meal to support growth. This is the age of picky eating, so be sure your kids have a good appetite for meals by not giving them unnecessary snacks.

Smart Snack Choices:

  • fruit or vegetables
  • granola bars
  • yogurt
  • string cheese
  • rice cakes
  • whole grain crackers
  • only offer water to drink between meals

Portion sizes: 1 piece of fruit, 6 mini carrot sticks, 1 granola bar, 4 oz yogurt, 1 string cheese, 6-10 crackers, 1 rice cake.

Snack Suggestions for ages 4-8:

Growth occurs at a somewhat slower rate during these years. However, kids at this age should be very active. Often, kids will say they are hungry after coming home from school. Do not allow them to come home, get a bag of chips, and sit in front of the TV munching. Instead, offer a small snack, a glass of water, and tell them to go play until it’s time for homework or dinner.

Smart Snack Choices:

  • fruit or vegetables
  • granola bars
  • yogurt
  • string cheese
  • rice cakes
  • whole grain crackers
  • only offer water to drink between meals

Portion sizes: Pick one or two of the choices listed above, based on how hungry your child is and how soon the next meal will be.

Snack Suggestions for ages Pre-puberty and Puberty:

Children start puberty at different ages, and this is another time of rapid growth. Kids in or entering puberty often feel hungry all the time, especially if they are very active. Be sure to have quality snacks available to them. Refrain from stocking the house with junk food, because that is exactly what they will go for first.

Smart Snack Choices:

  • peanut butter spread on whole grain bread or fruit
  • trail mix with nuts and dried fruit
  • cheese and whole grain crackers
  • rice cakes or veggies and hummus
  • smoothie with 1 cup yogurt + ½ cup frozen berries + ½ banana + handful baby spinach leaves
  • granola bars
  • hard-boiled eggs

Portion sizes: ½ sandwich, 1 piece of fruit with 1-2 tablespoons peanut butter, ½ cup trail mix, 1 piece of cheese and 6-10 crackers, 1 rice cake with 2 tablespoons hummus, smoothie per recipe above, 1 granola bar such as a Clif Bar or Larabar, 1 hard boiled egg with ½ piece of whole grain toast.

Children at any age who are overweight or obese should choose fresh fruits and vegetables as their snacks. Children who are underweight should always be offered snacks between meals, and the snacks should include a combination of carbohydrates, fat and protein. If you need more guidance on this issue or on meal planning for your family, make an appointment to see a registered dietitian at North Shore Pediatric Therapy.


Is Gluten Bad For You?

Recently a colleague asked me: “is gluten bad for you”? I know this question is stemming from the popularity of gluten-free diets. My guess is that many people do not know what exactly gluten is and when a gluten-free diet is actually appropriate. So to answer the question, no, gluten is not bad for you inherently, although it does make some people sick.

Gluten is a protein fraction found in wheat. Yes, gluten is actually a protein. Gluten itself is not a carb. Gluten is found in a carb, and wheat is a major staple carb source in most Americans’ diets multiple times per day. This is why sometimes people lose weight when they go gluten-free, because they are cutting out lots of starchy calories.

How Gluten May Make People Sick:

As I said, gluten can make some people sick. Gluten is the protein culprit that causes the devastating autoimmune response in the gut for people with Celiac disease. Our gut is lined with tiny villi that look like millions of fingers, and these villi contain important enzymes for digestion and also absorb all of the vital nutrients from food that our body needs to function. When someone with Celiac eats gluten via wheat, the gluten causes an immune reaction where the villi are destroyed. On a biopsy under a microscope, the villi will actually look flat and blunted.

gluten diet

Photo from www.marquettenutrition.com

This causes significant symptoms, which vary by person, but can include nutritional deficiencies such as iron deficiency anemia, weight loss, growth stunting, diarrhea, abdominal pain, and vomiting. Celiac disease is also genetic. Some people live with Celiac disease and the accompanying symptoms for years before getting diagnosed. There is more awareness now of Celiac disease, so more people are getting diagnosed. The gold standard of diagnosing Celiac is with a biopsy of intestinal villi by a gastroenterologist. The treatment is life-long strict avoidance of all gluten, and education is provided by a registered dietitian.

What is a Wheat Allergy:

Wheat allergy is one of the top 8 most common food allergies diagnosed in children. A wheat allergy is different than Celiac in that it is not a genetic, auto-immune mediated response, but rather an immune response where IgE antibodies react to wheat proteins as foreign antigens, and mount a response that produces symptoms. These can include eczema, diarrhea, abdominal pain, vomiting, and more. A registered dietitian can help families navigate the difficult wheat-free diet in this case as well.

Finally, many people try a gluten-free diet because they suspect gluten or wheat intolerance. With a gluten intolerance, the immune system is not involved as with allergies or Celiac. But nevertheless, people find that consuming wheat products makes them sick in one way or another. When they stop eating wheat for a couple weeks, they notice many positive changes in their health and the way they feel. For some people this can mean fewer headaches, or less stomach aches, or more energy, or rashes that disappear, and so on.

To reinforce the point, gluten is not bad for you or your kids to eat, unless one of the above scenarios applies. Wheat should be eaten in moderation however, and I recommend rotating different types of grains into your family’s diet for well-rounded nutrition and to prevent over-exposure to one particular food. Some different grains to experiment with include quinoa, amaranth, rice, buckwheat, and millet.


Arsenic found in over 200 rice products tested, including infant rice cereal!

Recently, Consumer Reports released their findings of arsenic in rice and rice-containing foods that are commonly eaten, including infant rice cereal, Arsenic in Ricerice cakes, white rice, brown rice, organic rice, rice pasta, and more. When I heard about this on the news, I thought about three sectors of the population I work with who would be affected based on their dietary intake of rice: infants who eat rice cereal as a staple in their diet; kids on gluten-free diets who eat rice products as an alternative grain; and ethnic groups who traditionally eat rice daily.

What did the study find?

Click here to see Consumer Reports‘ results table with all the foods tested, including brands, and the level of arsenic found per serving. There are two types of arsenic: inorganic arsenic which is known to cause cancer, and organic arsenic which is also considered toxic. Both types were found in all of the rice products in the study.  The question is what level of arsenic in foods is safe? There are no federal standards set at this point for acceptable levels of arsenic in foods; however, there are arsenic regulations for drinking water.  New Jersey has the most conservative allowed amount of arsenic in water which is 5 ppb. In the table of results, Consumer Reports used 5 ppb as a standard of comparison, and found that many rice foods had levels >5 ppb of inorganic arsenic per serving and many foods having total arsenic levels in the hundreds ppb. Brown rice was found to have more arsenic than white rice, which is because white rice has had the outer layers stripped in processing, thus stripping some of the absorbed arsenic.

What does this mean for your family?

It is important to consider how much rice you or your child is eating. If it’s daily, you should consider decreasing that intake to weekly instead, until the FDA responds with regulations for arsenic in foods. In the case of infant rice cereal, switch to baby oatmeal cereal or make your own infant cereal by grinding whole, dry quinoa, millet or amaranth in a coffee grinder, then cook with water per the directions. Once cooled, stir in breastmilk or formula to desired consistency. Talk to your pediatrician or registered dietitian about more sources of iron in your child’s diet if taking out iron-fortified rice cereal is a concern. On another note, although brown rice was found to have higher arsenic levels than white rice, brown rice is better nutritionally than white rice because it has more fiber, naturally occurring vitamins and minerals, and small amounts of healthy fats.

How does this affect children?

As I mentioned, inorganic arsenic is a known carcinogen. Children and especially infants have immature organs and detoxification processes compared to adults, so exposure to toxins like arsenic can be more harmful for the very young. At any age, eating a variety of grains is healthy and based on the study results, decreasing rice intake and replacing with other grains would be advisable.

Here is a list of different types of grains that could substitute for rice:

  • quinoa
  • amaranth
  • millet
  • oatmeal
  • buckwheat
  • corn or grits

This study demonstrates the need for regulations on allowable levels of these kinds of toxins in our food supply. This would need to include regulations on arsenic and other potentially harmful toxins in pesticides, fertilizers, as well as drugs and feed given to animals. To find out more about what is being done and how you can get involved, go to ConsumersUnion.org/arsenic. We all need to have a better awareness of what is in the foods we eat and feed to our kids, even beyond the major nutrients and ingredients. For nutrition counseling to evaluate and improve your family’s diet, contact North Shore Pediatric Therapy for an appointment with one of our registered dietitians.

Food Allergies in Children

This week is Food Allergy Awareness week (May 13-19). For many of us adults, it is surprising how many children these days have food allergies. We peanut butter allergyremember bringing birthday treats to school, and all eating at the same table in the school lunchroom. Today, many schools have banned edible birthday treats altogether, and have designated “allergen free” tables at lunchtime. The grade school my mom teaches at has signs posted on the classroom doors that read “Nut-Free Classroom.”

The answer to the question “why have food allergies become more prevalent?” is still being investigated. A food allergy involves an IgE-mediated immune response in which the immune system reacts to protein fractions in foods, producing a variety of symptoms for different people. A food intolerance does not actually involve the IgE immune response, but still produces symptoms. In either case, strictly avoiding the particular food is the best treatment.

There are eight common food allergens, which the Food Allergy and Anaphylaxis Network estimates account for 90% of all food-allergic reactions:

8 Common Food Allergies:

  1. Wheat
  2. Soy
  3. Dairy
  4. Eggs
  5. Peanuts
  6. Treenuts
  7. Fish
  8. Shellfish

Diagnosing Food Allergies:

Diagnosing food allergies can be somewhat tricky, as blood tests that look for elevated IgE markers in response to certain foods can produce false positives and false negatives. Symptoms present differently depending on the individual, and can be severe as in the case of anaphylaxis. Other signs and symptoms are less obvious, and may be overlooked as a possible food allergy. Some I have seen in the clinical pediatric setting include:

Signs of a Food Allergy:

  • Rhinitis (aka “runny nose”) or general congestion
  • Chronic ear aches (resulting from congestion)
  • “Allergic shiners” which are dark and/or swollen circles under the eyes
  • Asthma
  • Eczema
  • Diarrhea
  • Blood or mucus in the stool
  • Vomiting or reflux
  • Suboptimal growth or a slowing of growth

A definitive way to determine food allergies or intolerances is through an elimination diet. A registered dietitian can educate parents and children on how to do an elimination diet successfully, which can provide clear answers and a path to better health. The elimination diet is also useful for breastfeeding mothers whose infants are showing signs of possible food allergy or intolerance.  A registered dietitian can also provide education and alternatives for infants who are formula fed and not tolerating standard infant formulas.

Once a food allergy or intolerance has been identified, a registered dietitian can also provide education and guidance for families on how to eliminate the food (and all forms of it), as well as alternatives that can be consumed.  At North Shore Pediatric Therapy,  an experienced pediatric registered dietitian can help your child feel the best he or she can, food-allergy free.

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