feeding the sick child

When kids are sick, all bets are off, especially with infants and preverbal kiddos– appetite, hunger signals– it's just hard. Are they crying because their ears or throat hurt or are they hungry?

A client called the other day, worried that his baby boy was eating less again. They had made major gains with some feeding problems, and this illness was just plain scary. Dad was resorting to some feeding practices that hadn't been helpful earlier on, but he worried about his son's intake.

Taking care of sick kids IS scary and confusing for everyone, but especially for parents who already worry about a child's intake or size.

In general, sick infants and children eat less. When you are cued in to your child's appetite it can be an early sign that something is going on. My own daughter seemed to lose her appetite a few days before the runny nose or diarrhea (yuck) would start.

It can take more than a week for appetite to return to normal, and if your child is on any medicines, particularly antibiotics, that can make it even worse. Antibiotics taste bad and can interfere with normal bacteria in the gut.

Support your child by offering foods and drink often when they are ill. Throw away the usual schedule when your toddler is sick and let them nibble and sip throughout the day. That infant who normally nurses for 20 minutes might only nurse for 5, or bottle intake might drop in terms of quantity too. Instead of waiting 3-4 hours between feeds, try offering the bottle more often and not pressuring when they refuse it.

Kids don't have to eat much when they are ill for a few days. Even a few bites might be all they take. Consider giving popsicles, jello or watered down juice to age appropriate kids when they are sick to boost fluid intake.

Have faith that their appetite will return when they feel better, and see your doctor if it doesn't. Know that the trust model of feeding is flexible and that you can get back to regular feeding and schedules when your child is better. (There might be a little whining for jello, but you'll know how to handle that too!)

If you have any questions or concerns, be sure to see your child's health care provider. If they are listless or acting off, don't hesitate to contact and ask them questions. (Kids can get dehydrated with diarrheal or vomiting illnesses, so be sure to check in with your doc.)

dinner patchwork

As much as I love to cook, it is simply not possible for me to be sane and balanced and make all from-scratch meals every night with several choices of foods. To make family meals work for me, and for many families, I recommend a combination of from-scratch, relying on left-overs, and prepared foods. (Secrets to Feeding a Healthy Family, Ellyn Satter is a great resource.)

The other night, we had a DiGiorno frozen pizza (it was yummy, thin crust...) with leftover home-made butternut squash soup (from the freezer) and a plate of cut up veggies and dip. M ate the soup, veggies and pizza, a pretty well-rounded meal, and it was ready in under 25 minutes!
If you are new to cooking, don't set the bar too high. Start with eating what you eat now at meal times with your family. Maybe add a side of peas or applesauce. If you're going through a crisis with work or at home and you need to rely on take-out or frozen foods for a few weeks, don't feel guilty. Do the best you can, and don't beat yourself up! Get back to it when you feel ready and energized. If you make it too hard, or feel badly about cooking, you are more likely to give up. Good luck!

Squash soup. YUMMY!

1 butternut squash (or acorn)
1 large or 2 small leeks (can use an onion instead)
1 1/2 -2 boxes of chicken or veggie broth (less for thicker soup, more for thinner soup...)
hand immersion blender or regular blender
1-2 Tbspns butter
1 teaspoon fresh grated ginger (optional, or garlic)
parsley optional

preheat oven to 400 degrees, cut squash in half lengthwise and place face down on foiled cookie sheet. Bake for 45-60 minutes, until you can easily pierce squash with fork.
Take out and cool. Scoop out cooked squash into broth and leeks...

Meanwhile remove outer leaves from leek and cut off bottom roots and top darker green leaves. slice the leek in half (white and pale green parts) and get dirct out from between leaves under running water. Slice into 1/2 inch slices.

In large soup pan or dutch overn, melt butter and sautee squash about 10 minutes, don't let butter scorch. Add small amount broth if needed. When done, add the broth and stir. Cook about 10 minutes, add ginger, cook another 5-10 minutes or so. If you have an immersion blender, blend in the pot, if not, let it cool and pour into another pot. Scoop 1-2 cups at a time into blender and transfer back into pot. USE CAUTION if blending hot liquids. Best to wait, cover the top with a tea towel if still hot. May add 1/2 to 1 cup heavy cream for richer, creamier soup, but we like it just as it is... It freezes great! Makes about 6-8 servings depending on how much you eat! This makes a great meal with bread with butter and cheese...
Salt and pepper to taste and add fresh snipped parsley if desired.

calcium strategies and side dish recipe

M is still choosing water over milk most meals, so the easy way of getting plenty of calcium is not happening right now. I continue to not pressure- though it is tempting!

Here are a few ways I'm 0ffering dairy/milk in yummy ways.

•She is eating more cereal with breakfast.

•We enjoy whole wheat crackers like Wheatables or TLC with whipped cream cheese and fruit for snack.

•Oatmeal with milk and a splash of evaporated milk.

•Muffin-tin easy gratins (above right) now easier and more calcium!

More calcium Potato Gratin minis (adapted from Melissa d'Arabian)

prep time 10-15 (with a preschool helper) cooking time 40

Ingredients

* Vegetable spray

* 2 large potatoes or 4-5 smaller ones, roughly peeled and thinly sliced

* 1/2 cup grated cheese (I've done Jarlsberg and cheddar- any mildish cheese should work...)

* 2 green onions, finely chopped (I use the softer parts of a small leek which I usually have in the fridge)

* Salt and freshly ground pepper

* evaporated milk (about half a can)

Directions

Preheat oven to 375 degrees F.

Spray 6 muffin tins with vegetable spray. Layer potato slices, cheese, and onions (leeks) into each muffin cup. (I do potato, leeks, cheese, potato, cheese on top...) Season with salt and pepper and pour enough evaporated milk to fill the muffin tin half way. Cover loosely with foil (I spray foil with veggie oil so the foil doesn't stick and pull off the cheese) and bake for 30 to 40 minutes. Scoop them onto plate and serve. We ALL love these!!!

And today we had a "tea party" with her tea set. (It was given to her at age 2, but she wasn't ready for it so I put it away and she got it again this Christmas...)

We all had tea. M LOVED the ritual of pouring herself a little tea, then a lot of milk and stirring in some sugar. Yes, there is a little caffeine in the tea, but I figure British kids have been doing this for hundreds of years... My brother as a 3-year-old used to have "Kafe" with my mom. A tiny bit of coffee, lots of milk and some sugar. M felt really grown up and enjoyed having tea with us. She drank several milky cups! (Then had fun washing the cups in the sink.)

intake analysis (diet diary)

One tool that is proving so helpful to my clients is the seven day intake analysis. I ask families that I work with to keep track of what their child is offered and what they eat for 7 days. Hydee, FFD's fabulous pediatric nutritionist then works her magic. She breaks down macro and micro-nutrients and then I go over the report with families to review schedules, intake and areas for improvement. My clients LOVE the information because it usually brings peace of mind. This is a case where more information helps them relax and do a better job with feeding.That mom who worries about protein?

Finding out her child is getting plenty allows her to relax and back off the pressure with feeding.

The dad who thinks his daughter is eating too many calories?

Finds out she is getting within the recommended amount. That reassurance allows him to focus on doing his job– providing regular and satisfying meals and snacks and gives him the courage to stop restricting her intake. He can let her do her job- deciding how much to eat.

(Division of Responsibility)

The mom worried about fruits and veggies?

Finds out her three year old is low on fats and Vitamin E. Learns that she's pretty close on fruits and veggies. Adding fats helps those veggies taste better and improves texture and the child enjoys and eats more.

If you would like to explore having an intake analysis and consultation with our team, call 1-888-848-6802 or email katja@familyfeedingdynamics.com

FFD READER CONTEST!

WIN A FREE COPY OF ARTISAN BREAD IN FIVE MINUTES!

CHALLENGE TO READERS:

MAKE MY PINK SAUCE (OR ANY OF MY OTHER RECIPES) AND TELL ME HOW IT WENT. WAS IT FUN TO MAKE? COULD YOUR KIDS HELP? EASY? TASTE GOOD? DID YOUR KIDS EAT IT?

I WILL PUBLISH SOME OF THE COMMENTS (GOOD AND BAD) AND WILL DO A DRAWING FOR THE WINNER AFTER THE NEW YEAR. PLEASE EMAIL YOUR "FFD RECIPE EXPERIENCES" to katja@familyfeedingdynamics.com OR DIRECTLY ON THIS POST. I WILL KEEP COMMENTS ANONYMOUS IF REQUESTED.

There are over 45 recipes at your fingertips. Click on "recipe" on the right of the blog lists.

mac n cheese night

We had swim class last night and then I had a school outing right after dinner, so it was mac n cheese night. This is one of M's favorite meals. Lots of kids eat mac n cheese for dinner. Families tell me the kids eat mac n cheese, mom and dad eat "real food."

Doing mac n cheese, or another quick, kid-friendly meal? Find something the whole family can eat. We had mac n cheese (shells with white cheddar, also comes in whole wheat) with peas. M helped stir the sauce, butter and evaporated milk together. We also had 2 bunches of asparagus with it (cooked about 8 minutes in boiling water) with pink sauce. M also helped whisk and taste the pink sauce.

Asparagus how to. Cut off bottom inch or so. Wash. Boil water in a large deep pan, add asparagus, cook 8 minutes or until desired. I don't like mine too cooked (pale green and mushy) but I also don't like them crunchy which is how most restaurants serve them these days. (I had "blanched" green beans at a fancy restaurant last month and basically had hot, raw green beans. Heck, I could do that at home!) If you've only had canned asparagus, give the fresh a try! On sale at Target right now for $1.99 a pound.

PINK SAUCE

sounds gross but its yummy, a slightly sweet, home-made thousand island-ish

I always make this without a recipe. Some nights I like it a little more tangy (more vinegar...) I take whole cooked asparagus (cut off bottom inch or so) and dip in the sauce (we double dip at home, or give each person their own bowl to double dip...)

Miracle Whip (regular or light) about 1/3 cup

evaporated milk (not sweetened condensed) about 2-3 tablespoons (more for thinner sauce)

white vinegar (I have white balsamic on hand) about 1-2 Tablespoons

ketchup about 1 Tablespoon

let your kids squirt and whisk. Ask him to taste it and see what more might be needed. Start with smaller amounts and have fun!

We all sat down together and ate mac n cheese and asparagus. It was yummy!

Food Cop from an eating disorder perspective

I love this post by author and eating disorder activist, Laura Collins. Here is an excerpt:

"The grocery store is a guided map to "low" "no" "free" consumption that we then drive somewhere to "work" off in measured increments of self-loathing. We eat inside a moral sculpture in the shape of our bodies.

This is the hectoring unpleasantness we call healthy. This is the lifestyle we laud and the new Kool-Aid we give the kids. Do too much of it and you'll be the "Food Police" and do too little and you are part of the Childhood Obesity Crisis. The margin of normal? Vanishingly thin."

I like her passion and her observations. I also bemoan the fact that "normal" eating in our culture is completely abnormal. Having worked in a University Health Clinic, I saw a glimpse of the devastation that an eating disorder can bring on a patient and her/his family.

Thanks for your voice, Laura! Please check out her website FEAST for information for families and parents struggling with this illness.

mindful vs mindless eating

In the book, Mindless Eating, the author comes up with all kinds of ideas to help you lose weight: cut out the handfull of candy at the office, use smaller plates, use less cream in your coffee, switch to diet drinks... The thinking is, that by skipping the soda a day, or using one cream instead of two, you would save 100 calories a day and magically lose 10 pounds a year! This is just not how our bodies work. In fact, if they worked that way, I would have gained alot of weight these last few years.

You see, since having a child and having to learn to eat in a way that is mindful and trusting of my body, I have done lots of little things that in theory would add 100 calories a day. I now eat a small candy bar a few times a week with coffee (occasionally even two.) I eat tortilla chips with lunch a few times a week- full fat! Mostly I drink milk and water, but many weekday lunches, I enjoy mango smoothies or real soda, usually satisfied with a half a can or so. I have stopped eating fat-free yogurt (or fat-free anything for that matter.) I eat more eggs. And recently, I've been baking and eating lots of bread -fresh, crusty bread. Initially I would eat 2 or 3 pieces thinking , "This is so good, I probably shouldn't eat so much, but I'm trying to eat in a way that trusts my body, so I will eat what I have an appetite for." Versus be "good" and eat one piece, then craving and eating way more than I originally would if I just let myself eat enough in the first place! (An example of what I consider mindless eating.) I enjoyed my bread this way for a number of weeks. Nothing changed. My clothes fit the same, I otherwise ate the same way- satisfying meals and snacks. Soon thereafter my appetite for bread lessened. I could eat half a piece and still enjoy and savour it. My body figured it out.

What all the standard mindless eating thinking ignores is that it is more complicated than calories in/calories out. When we try to cognitively control what we eat- by points, plate size, strict portion control- we don't do a very good job at it.

You see, our bodies can compensate. Not maybe every day, but over days and weeks if we eat in a way that is truly tuned in to what our bodies need. Maybe I ate a candy bar's worth of calories less over the next few days? I have weighed within 15 pounds since I was 16. I stayed the same the summers I swam 2 hours a day, or the months when I did no exercise and ate Coke and Doritos at 2 in the morning during residency. (I probably also don't have a genetic predisposition to gain weight easily.)

How can we support eating well and trusting our bodies?

We need to give ourselves permission to eat what tastes good, and enough of it. We need to be disciplined enough to provide regular meals and snacks and to give some thought to nutrition when planning what to eat. We need to tune in to and enjoy food while we are eating it. There is room for the handful of candy at the office or the cream that makes your coffee heavenly. This can be harder for some than others. (See my website for information on the How to Eat series.)

How do we screw up eating well and our body's amazing self-regulation powers?

Diet, overexercise, deprivation, eating cognitively instead of intuitively. Losing weight or eating less calories than your body needs triggers a cascade of hormonal, neural and psychological factors that work really hard to get your body back to it's previous weight, often overshooting the mark and even resetting the weight your body will strive to maintain. Dieiting impairs your body's internal regulation system.

Practice mindful, not mindless eating.

Close your eyes, you might like it...

You'd think I was talking about broccoli, or some other challenging food, but I was talking to my 4 yo about a Snickers bar. Yes, I actually encouraged my kiddo to try a candy bar, and it was for breakfast... For those of you that I haven't totally freaked out, let me explain.

Recently I have been enjoying a fun-size Snickers with my afternoon coffee. I left one on the kitchen table and at breakfast M saw it and said with excietment, "Can I eat this for breakfast" Now usually I would say no and move on, but she's not had candy with breakfast except on one or two occasions and it wasn't one she usually asks for.

Me: "You can chose if you want it with breakfast or with dinner for dessert."

M:"I want it now. It doesn't have nuts in it, does it???" she whined with crinkled nose.

Me: "It does. Maybe if you close your eyes you might like it?"

Wait a minute, what was I doing? I remember my Dad saying that to me very sternly when I was little. "Close your eyes and eat it" if I complained that something looked gross. Was I pressuring?

These are the moments with feeding that I stop and check in with myself. (Something I ask parents to do when things aren't going well or they feel anger or frustration with a feeding situation.) What are my motives? What is my baggage around this issue? Am I pushing? Am I getting push-back? Are we emotionally in a good place? Are we getting upset or are things pretty pleasant and neutral still?

No. It didn't feel like pressure. I casually offered her the option of closing her eyes and mentioned that she might like it. She closed her eyes for the first bite and enjoyed the Snickers bar, somewhat surprised. She drank milk, had half a banana and a clementine and half a piece of buttered whole wheat bread with it. Not too shabby nutritionally, and it was a pleasant breakfast that felt special to her. Will I make a habit of it? No, but part of feeding is to be able to be flexible at times. If she had refused or not wanted to try it, I would have said, "Fine, you can have toast and fruit, and I could also make oatmeal."

Sometimes a gentle suggestion, given with the intention of honoring variety and being open to new tastes, versus pressure or trying to get your kid to eat something can help. When M doesn't want to try something, sometimes just saying, "OK, your napkin is right here in case you want to try it and spit it out." I then move on with my meal, usually eating the food that she refuses to try and most of the time in a minute or two she will be happily eating the offending food. See what works for you. Be careful not to push-you usually just get pushed right back.

Artisan Bread in Five Minutes...

I tried a bread machine for awhile and gave up. I love crusty loaves, but didn't love paying 3-5$ at the grocery store or bakery.

This seems to be one instance where the product lives up to the hype. It IS revolutionizing home baking– at least at our house. A neighbor gave me a business card of a local doc-turned bread cookbook author and I ordered a book. It's called Artisan Bread in Five Minutes a Day. I tried it and fell in love. (Picture is of European peasant loaf with rye and whole wheat flour.)

pluses: quick and easy

•M helps me measure and mix the ingredients (takes about 5 minutes)

•no kneading

•tastes awesome!

•relatively little investment for book and materials

•kid loves it

•home-made bread on a weeknight

negatives:

•the container takes up space in the fridge

•can't do a really high fiber or whole wheat content with this method

•did need an oven thermometer (our over in off by 60 degrees)

•bought a pizza stone

•now that it's colder, I am routinely letting the bread rise twice the recommended time (My FIL left a loaf out overnight and baked it and said it was delicious...)

If you like bread, the book, or a fresh loaf is a great idea for a Holiday gift. Yummy! (We've baked about 3 loaves a week for the last 2 months.) M likes it for breakfast. It's also an easy part oaf a snack. (I put butter on and wrap it up and bring some fruit and water and it's a good snack on the go.) I also recommend visiting their website and watching their video on the technique. It's really helpful.

Next post will be a musing on internal regulation and mindful eating. Long and short is when I first started baking the bread I ate lots of it and enjoyed it. Stay tuned.

Dr. Oz big fat questionable diagnosis

As I was wrapping 24 little advent gifts for our traditional German advent wall-hanging, I was forced to settle for Dr. Oz's medical show. (Again, why a cardiac surgeon is giving general medical advice is beyond me. See an old rant...) A gentleman stood up and asked if his hot flashes and night sweats were normal. With no further questioning, Dr. Oz basically told the man that he had a hormonal imbalance, akin to menopause and he could reduce his circulating estrogen by losing his belly fat. This gentleman was "average" to below average build, don't know if he was fit or had other health factors, but the first thing that jumped to my mind was not that he needed to lose a fairly insignificant amount of belly fat.

Since I've been learning about eating and wellness, I have become much more sensitive to instances of weight bias, which can manifest as a willingness to assign weight as the cause of a condition without any kind of indication it is a factor, and with potential danger in ignoring other possible factors– such as night sweats being a symptom of lymphoma and other serious illness.

Chances are he does not have lymphoma, but was any purpose served by blowing this off as an unlikely hormone imbalance? Will some guy at home who is a little heavy ignore night sweats now as simply another by-product of being big?

FYI, here is an excerpt of possible things that can cause night sweats...

Night sweats are a common outpatient complaint, yet literature on the subject is scarce. Tuberculosis and lymphoma are diseases in which night sweats are a dominant symptom, but these are infrequently found to be the cause of night sweats in modern practice. While these diseases remain important diagnostic considerations in patients with night sweats, other diagnoses to consider include human immunodeficiency virus, gastroesophageal reflux disease, obstructive sleep apnea, hyperthyroidism, hypoglycemia, and several less common diseases. Antihypertensives, antipyretics, other medications, and drugs of abuse such as alcohol and heroin may cause night sweats. Serious causes of night sweats can be excluded with a thorough history, physical examination, and directed laboratory and radiographic studies. If a history and physical do not reveal a possible diagnosis, physicians should consider a purified protein derivative, complete blood count, human immunodeficiency virus test, thyroid-stimulating hormone test, erythrocyte sedimentation rate evaluation, chest radiograph, and possibly chest and abdominal computed tomographic scans and bone marrow biopsy. (Am Fam Physician 2003;67:1019-24. Copyright© 2003 American Academy of Family Physicians.)

Just thought it was interesting. Another example of weight bias: a woman sprains her ankle, her BMI is 26 ("overweight" range.) Though she is an athlete with high muscle mass and her BMI is not indicative of any increased health risks, her physician says she probably sprained her ankle because she is "overweight." (Playing ultimate frisbee on wet grass had nothing to do with it...)

What are your thoughts and experiences?

India House buffet

I must again wax poetic about the benefits of a buffet when eating with children. (Read an old post for lots of restaurant ideas and tips for buffets with kids.)

No waiting for food (how many little toys can you cram into your purse or diaper bag to keep them happy for those interminable 20 minutes while you wait for your food– if you're lucky it's only 20 minutes.)

Variety

Tying new things without a big financial commitment, or too much waste

Not too pricey

We have long loved Indian food, and particularly the buffets. We found a new restaurant to us on Grand Ave in St. Paul. It's called India House and we enjoyed ourselves and the food.

Another bonus when eating with small kids is that they have booths. I am a huge fan. I have a kid who has shunned boosters since getting out of her high chair. She prefers to kneel (even though her feet fall asleep sometimes which is not fun...) and booths are a safe way to sit.

They have options for even the pickiest kids and adults. White rice, Nan bread, cucumbers with ranch, and our favorites are the chiken Tikka with a mild sauce, chick peas and Alu Gobi (curried cauliflower and potatoes.) There are spicy dishes too, but a nice variety.

First time there or eating Indian food? Get a few small plates of the dishes and bring them to the table so the kids can serve themselves family-style. Go in with a positive and curious attitude, don't force anyone to try something they don't want to and enjoy it! Even if they only smell, or lick something new, it's progress and you've had fun. Remember anyone can spit out a food they don't want to swallow, they just have to do it politely.

talking to kids about food

Here's a link to my article on talking to kids about food. Do you think we talk about food and nutrition entirely too much, or not enough? Are we as a culture sending the wrong messages? I think so, read it and tell me what you think!