Tag Archive for: Feeding

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.


What is GERD and how does it affect babies’ eating habits?

Gastroesophageal reflux disease, or GERD, is a fairly common condition in infants. To be clear, almost all babies will have typical infant reflux, or Acid Reflux Baby“spitting up” to some degree, because their gastroesophageal sphincter muscles are still developing. More severe infant reflux will be painful, causing fussiness and sometimes interfering with successful feeding and weight gain.

Signs that an infant has more serious reflux issues are:

  • Frequent spit ups, with crying and fussiness before, during and after spitting up
  • Back arching during feeds
  • Eyes watering during feeds
  • Face turning red, along with grimacing and signs of pain during and after feeds and/or spit-up episodes
  • Frequent hiccups
  • Fussiness when lying down that improves when upright
  • Baby refusing breast or bottle feeds
  • Infant not meeting weight gain or growth goals at pediatrician visits

Most of the above symptoms are a direct response to the burning pain the baby feels when acidic stomach contents are refluxing up into the esophagus. In severe cases of reflux, the infant begins to develop a strong negative association of pain with breast or bottle-feeding. The infant will begin to refuse feeds in order to avoid this pain. This response becomes a learned habit, and over time, results in lower intake, slower weight gain, and dehydration in extreme cases. A baby who is refusing feeds can cause alarm for parents, who then might try forcing feeds in desperation, which can be distressing to the infant and cause further negative association with feeding. Parents should be aware of these signs of GERD and contact the pediatrician right away.

Diagnosis and Treatment of GERD:

Reflux is more common in premature infants since their gastrointestinal tracts are immature compared to term infants. It can also be a symptom of food allergies, in which case the infant may be allergic to the milk proteins in formula, or proteins from foods passing through mother’s breastmilk. In any case, a pediatrician can discern symptoms and diagnose GERD. Treatment protocols for infant GERD usually include a medication, such as ranitidine (also known as Zantac) or lansoprazole (also known as Prevacid). In some cases, the infant needs a special formula or mom may need to eliminate food allergens from her diet. A registered dietitian can help moms navigate special diet needs related to GERD, as well as ensure proper growth and transition to solids if these areas have been affected. Also, the pediatrician can educate parents on “reflux precautions”, which include feeding the baby at a more upright angle, not lying baby flat on their back after feeds, burping baby well, etc.

Sometimes the painful association of GERD creates long-term feeding issues with infants and kids. In these cases, children will continue to have “oral aversion” to eating. Signs of oral aversion stemming from reflux include difficulty transitioning to solids, very picky eating, refusal to put objects in their mouths in general, etc. If your child has signs of feeding difficulties, or if his or her growth has been impacted by GERD, contact North Shore Pediatric Therapy. A multi-disciplinary team including registered dietitians and speech therapists can work with your child to ensure adequate nutrition, growth, and development related to feeding skills.


Feeding Difficulty in Children- How Common Is It?

It is often assumed that eating is a natural instinct children are born with and that difficulties in this area are rare. Not so. Various studies into boy wont eat his vegetablesfeeding disorders have identified a wide variety of prevalence statistics. It is known that some children are at an increased risk for feeding difficulty; those who are born prematurely, experience early medical complications, or children with neurological disorders. But even for children without any medical or developmental diagnoses, feeding may be a very tricky skill to acquire.

Currently available data suggests the incidence of children who experience feeding difficulty is as follows:

  • Manikam & Perman, 2000: Pediatric feeding disorders are common. 25% of children are reported to present with some form of feeding disorder. This number increases to 80% in developmentally delayed children.
  • Lewinsohn et al 2005: up to 45% of children at 36 months of age exhibit some “picky eating” as defined by food refusal, or accepting food one day and denying it another.
  • Emond, Emmett, Steer, & Golding, 2010: This study compared the eating habits of children diagnosed with Autism to a sample of typically developing children at multiple ages. Children with ASD experienced feeding difficulty much more frequently and to a greater degree. Using a parent-completed questionnaire, typically developing children were identified as “very choosy” eaters as follows:
    • o 15 months: 5.4%
    • 24 months: 9.5%
    • 38 months: 15.5%
    • 54 months: 13.9%

Parents of picky eaters, the underlying message here is: you are not alone. If your child is experiencing feeding difficulty, seek out the advice of a professional- your pediatrician, an occupational therapist, speech-language pathologist, and nutritionist are among the qualified individuals who can help you to better understand and navigate the factors that impact your child’s feeding abilities.


Emond, A., Emmett, P., Steer, C., & Golding, J. (2010). Feeding symptoms, dietary patterns, and growth in young children with autism spectrum disorders. Pediatrics, 26, 337-342.

Lewinsohn et al. (2005). Prblematic eating and feeding behaviors of 36-month-old children. International Journal of Eating Disorders, 38, 208-219.

Manikam, R., & Perman, J. (2000). Pediatric feeding disorders. Journal of Clinical Gastroenterology, 30, 34-46.

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Making Mealtime Fun

Eating is supposed to be an enjoyable and social experience. For children with feeding disorders, the opposite may be true. In fact, children with sensory-based feeding disorders often find mealtimes to be stressful and anxiety-provoking. This might feel mom and child baking togetherdiscouraging to parents, who feel helpless as they worry about their child’s nutrition, growth and well-being. Not to mention that it’s wearing when mealtimes frequently result in meltdowns.

When working with children with feeding difficulties, an important goal is to foster positive experiences with food. Children with feeding disorders often have strong negative associations towards foods, whether from related pain, discomfort, sensory-aversions, or past negative experiences. To break these associations, mealtimes must be strategically planned to ensure positive experiences and a new relationship with food.

8 fun ways to revamp mealtime:

1. Make a placemat with your child. Help your child decorate a construction-paper placemat. Let them choose favorite movie characters, stickers, or pictures to fill their placemat. Laminate your child’s placemat to use at mealtime.

2. Let your child help with cooking. Give your child special jobs to help prepare meals, weather its helping mix foods, scooping foods onto plates, or adding ingredients.

3. Explore food during non-mealtimes. Plan fun activities to explore foods during non-mealtimes, when there’s no pressure to eat. You might make a craft out of foods (e.g. potato stamps), or finger paint with different sauces.

4. Make fun food shapes. Incorporate cookie-cutters into meal preparations. Have your child choose a fun shape, whether it be a racecar, an animal or a favorite shape. You might make heart-shaped pancakes, star-shaped sandwiches, or triangle potato slices.

5. Forget the manners. Let your child get messy while they explore their food. Touching and playing with food in a fun context will help young children reduce textural sensitivities. If you’re worried about messy eating occurring in public, then set parameters ahead of time. For example, you might make “silly rules” for Friday night dinners at home.

6. Make an edible craft. Plan a fun edible craft to create with your child. Instead of focusing on eating the craft, focus on making it. Enjoy planning the ingredients, grocery shopping, and putting it all together. For fun edible craft ideas, visit this previous blog.

7. Make a food face. Use a round plate, or draw a circle on a big piece of paper. Encourage you child to add different parts to the face. You might make spaghetti hair, grape eyes, and an apple smile. Experiencing food in a playful context will create a positive experience with food.

8. Make it social. Eating is a social experience, so be sure to participate with your child. Children learn by watching, so model positive interactions with food. Enjoy laughing and being silly while you experience new foods with your child.

If you suspect that your child has atypical feeding habits, seek help from a licensed therapist right away. These suggestions are not a replacement for feeding therapy, but are a supplement to recommendations by a trained therapist. A therapist trained in treating feeding disorders will help identify the underlying problem, determine whether your child is able to chew and swallow safely, and develop a specific plan to intervene.

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5 Ways to Know Your Baby is Ready for Solid Food

Since the holidays are just around the corner, you may be wondering if your child is ready to grab a plate and join you at the buffet! While there is no clear-cut age to start introducing solid foods, most young children independently begin to show signs that they’re ready to move past their typical pureed diet around the same time. You may receive the green light from your pediatrician to begin introducing solids, but also but watch for these signs, as these may indicate that your child is ready to move on.

Signs Your Baby Is Ready To Eat Solids:

1. Your child is gaining more gross motor control. When your child is able to demonstrate adequate head baby eating solidscontrol as well as stabilize their trunk when sitting, they are typically ready to tolerate a more complex repertoire of foods. While your child does not have to independently be able to sit on their own, they should be able to maintain an upright position when placed in a highchair without slouching or falling over.

2. Your child begins to show interest in what you are eating. Many young children may begin to watch others intently during meal times, any they may even attempt to grab items off of your plate! Young children may also become more interested in self-feeding, and your child may start to reach for the spoon when hungry, attempt to drink from your cup, bring a cracker or
cookie to their mouth, or place their hands on the bottle when feeding.

3. Your child demonstrates more oral-motor control. The most apparent sign that your child is ready for foods is when they lose the tongue thrust reflex. Rather than immediately pushing foods out of their mouth with their tongue, your child should be better able to manage the foods inside their mouth. Also, when your child begins to present with more tongue movement, such as back-and-forth and up-and-down when a spoon is introduced, they are indicating that they are also ready to move on.

4. Your child is on track for meeting feeding milestones. Observe your child’s behavior at play, as there are many signs to indicate that they are ready for a change in their diet. Some of these behaviors may include: an increase in hand-to-mouth play as demonstrated by orally exploring with objects, anticipation of spoon feedings, the transferring toys from one hand to another, the ability to “rake” toys and foods towards themselves, and the emergence of the pincer grasp.

5. Your child starts to not appear “satisfied” after breast or bottle feeds. During certain ages, children may insist on eating more than they typically would, but note that significant changes in their feeding patterns could also be related to a growth spurt. Some pediatricians will indicate that once children have doubled their birth weight, most children are ready to be introduced to solids.

Even though your child may present with many of the signs, they may still not be ready to tolerate the transition. Just remember to be patient, and speak with your pediatrician about any concerns you may have about moving to solid foods.

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Oral-Motor and Feeding Difficulties in Young Children

All children are born hard-wired to eat. However, some children with poor oral motor skills may present with many challenges while feeding. Some children may appear to be “messy eaters”, but in reality, they may not have the strength to successfully close their lips around a spoon. Other kids may tend to rush through meals, however their oral awareness may actually be reduced and they may not even be aware of how much food is actually in their mouths. Therefore mealtimes may Young Girls Is A Messy Eaterprove to be difficult and frustrating for children, and equally as stressful for mom and dad.

Oral Motor And Feeding Red Flags

  • Lack of oral-exploration with non-food items as an infant
  • Difficulties transitioning between different textures of foods
  • Weaknesses sucking, chewing, and swallowing
  • Frequent coughing and/or gagging when eating
  • Vomiting during or after meals
  • Refusal to eat certain textures of foods
  • Rigidity with diet
  • Avoidance of touch on face and around mouth
  • Loss of food and liquids when eating
  • Obvious preference for certain textures or flavors of foods
  • Increased congestion during and after meals
  • Grimacing/odd facial expressions when eating
  • Consistent wiping of hands and face during meals
  • Pocketing of food in cheeks, or residue observed after swallow
  • Irritability and anxiety during mealtime
  • Excessive drooling and lack of saliva management
  • Sudden refusal to eat previously tolerated foods
  • Excessive weight gain or loss

Oral-Motor Skill Improvement

Fortunately, there are also many activities you can easily incorporate at home to facilitate improvements with oral-motor skills.

  • Blowing activities (blow-pens, instruments, whistles, etc.) help to improve posture, breath control, lip rounding, and motor-planning skills.
  • Infant massage may also help to increase oral-awareness and facial tone.
  • Straws, sour candies, and bubbles may help with drooling.
  • Constantly exposing your child to a variety of new foods will help to avoid food jags, and increase their tolerance to different textures and tastes.

If you notice that your child presents with some of the above-mentioned characteristics and does not seem to be improving, it would be advantageous to speak with a Speech-Language Pathologist about your concerns.


Top 5 Healthy Halloween Treats for Your Toddler

Halloween PizzaLadies and gentlemen, ghosts and goblins…the darkest, spookiest, goose-bumpin’ season has finally arrived! During Halloween season, there’s nothing scarier than the sight of your adorable toddler in his or her costume, running around with buckets full of candy. Lucky for you, they are still at an age where you can instill healthy eating habits in their little bodies without letting go of the Halloween spirit! Below is a list of some of my favorite healthy treats for Halloween which won’t lead to cavities and constant cravings for sweets.

 Top 5 Healthy Halloween Treats for Your Toddler 


  • Spooky Jell-O:  Make a package of orange Jell-O and use Halloween cookie cutters to make spooky creatures. Top it off with creepy crawlers and you’ve got yourself a non-fat treat. 
  •  Trick or Treat Alternatives: This year, take initiative in your neighborhood by giving healthier candy alternatives like animal crackers, single serve boxes of cereal, or individual 100 percent juice drinks. The more your toddler is exposed to it, the more likely they’ll choose it over candy! To top it off, you’ll make other parents very happy.  Read more

5 Ways to Get Your Picky Toddler to Eat 

toddler not eating dinner

Struggling to get your toddler to eat a variety of foods? Tired of watching them eat the same foods from the same food group over and over again? Have no fear! NSPT’s very own dietitian is here! 🙂

First and foremost, is your child a picky eater? Do they refuse to eat any of the healthy foods that you offer? Have you tried unsuccessfully to get them to eat different healthy foods? Is the number of foods they are willing to eat so limited it concerns you? If you’ve answered ‘yes’ to any of those questions, your child may be a selective eater. However, in many cases, picky eating has nothing to do with food and has more to do with control.

5 Tips for a Picky Eater

1. Set a schedule. Children tend to respond well to routine, so try to schedule a set time for breakfast, lunch, dinner and at least two small snacks. The more consistent the timing, the more your child will get accustomed to eating every two to three hours.

2. Take advantage of food jags. Does your toddler only eat plain macaroni orr pieces of cheese? Have no fear – the good news is that they’re eating! It’s safe to assume that eventually they will get over these “food jags”, and now is the time to experiment with healthier alternatives without taking away their favorite food. For example, try pasta with added fiber or cheese made with two percent milk for healthier alternatives.

3. Don’t give up. When it comes to getting your picky eater to try new foods, be patient. Studies show that it can take up to 15 to 20 consistent tries in a period of one to two months for a child to even consider trying a new food. If your child doesn’t want to eat chicken on Monday, try again on Friday or the following week.

4. Participation is key. Try to get your child involved with grocery shopping and meal preparation. Let them pick out fruits and vegetables at the local farmers’ market and get them involved in the kitchen. The more you get them involved with what they can eat, the more likely they’ll be to try it.

5. Remember the rule of thumb: your child will decide what he or she will eat, but you as a parent decide what foods and how often. Especially during the ages of two to five, children try to gain their independence with their eating behavior. The less you try to force them to eat, the more likely your child will be able to control their own food intake.

What is your secret to get your picky eater to eat? What has worked for you? Do share!

4 Ways to “Trick” Your Child to Eat Healthy Foods

 Child wont eat healthyTrying to get your kids to eat healthy could be one of the biggest challenges you’ll ever face. Their love for chicken nuggets, French fries, macaroni and cheese and pizza is likely so intense that they’re practically inseparable! But don’t fret – there are ways to try to “trick” your child to eat those healthy foods you’ve been trying to introduce since they were babies. 

1. Puree Away.

 That’s right – it’s time to bust out that food processor that’s been hiding in your cupboards. One of the best ways to try to get your child to eat fruits and vegetables is by pureeing them! Try throwing in cooked cauliflower and a little olive oil in a food processor, then mix it in a bowl of mashed potatoes.

2. Send to blender!

A great way to incorporate fruits into your child’s diet is by sending them to the blender! Try blending in half of a frozen banana in their chocolate shake, or throw a handful of baby spinach into their fruit smoothie.

3. Oven-baked fries:

Is your child a huge fan of French fries? Instead of stopping by the nearest fast food restaurant for an order, try baking your own! Slice a potato into wedges, drizzle a little olive oil on top, add salt and pepper, and bake in the oven at 375 degrees Fahrenheit. It satisfies your kids’ craving without all of the excess fat, and it’s a great way to get them involved in the kitchen!

4. Fake it ‘til they make it.

If you don’t eat as many fruits and vegetables as you should, increasing your intake will likely increase your child’s chances of eating and enjoying them, too. So go ahead – pick up that bunch of kale from the grocery store and make a batch of kale chips. You just might fall in love with it!

 What are your secrets in trying to get your child to eat healthy? Tried any of the above with success? Please share! 

Picky Eating: How Common Is It, And Is It More Prevalent in Children With Autism?

A recent study from The Journal of Pediatrics discovered that children with Autism Spectrum Disorders are more likely to be picky eaters and may be at risk for suboptimal nutrition¹.   Children with Autism Spectrum Disorders were found to have increased occurrences of food refusal and more limited food repertoires.  Other research has estimated that one third of mothers felt their infant had feeding difficulties in the first four months of life and one in four mothers at routine pediatrician visits expressed concerns with their child’s feeding skills².  The statistics show nearly 25% of typically developing children and 80% of developmentally delayed children will demonstrate characteristics of a feeding disorder³.  Read more