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|Nutrition and You: Keeping Young Kids Healthy|
Good nutrition for infants and children is one of a parent’s greatest concerns. Am I providing the right types of foods? Is my child eating correctly? Can we go to a fast food place? Is she or he gaining enough or too much weight? There are so many things to think about.
When you have a child who relies on home enteral or parenteral nutrition (HPEN), the concerns are not really that much different. Here are a few check points for growth and development so you can know how your kids are doing.
GrowthGrowth is a key assessment tool for infants and children. At birth, measurements are made of weight, head circumference, and length. Follow-up measurements tell us how well the child is progressing. As the child grows, height and weight are compared to growth charts indicating growth velocity (the rate at which your child grows).
All children have their own natural growth pattern. For example, if a child’s parents are both very tall, most likely the child will be tall and also track higher on the weight growth chart. Conversely, if the child’s family is shorter, they will likely be closer to the lower percentiles as they grow. The important point is to watch for a sharp upturn or downturn, or for numbers that fly off the chart from either the top or bottom. You can find growth charts online at www.cdc.gov/growthcharts
Children with special needs, like those receiving HPEN, get a break on having to be measured against the reference “standards.” Sometimes we are happy with small increases and sometimes even stability. If your child is receiving HPEN, you probably have a clinician who is charting your child’s status, but you can chart it, too.
Feeding and DevelopmentAnother key point is progress in development. Physical development is tied to the child’s ability to eat certain foods. For instance, first foods and cereals are not typically given to infants until they can sit with help or support and can push up on their arms when lying down on the tummy. This is usually around four to six months of age.
By the time your baby is an independent sitter, she has started to master pulling food in and swallowing, and can go on to slightly thicker baby foods—usually called “stage 2.” Introduce only one new food every few days to make sure there is no allergic reaction. (If there is a family history of allergies, those foods should not be introduced until around age two.)
Even if your baby is on PN, he should be learning to suck on a pacifier or bottle and have the experience of different textures and tastes in and around his mouth. Later on, “mouth feel” becomes important. We all know someone who doesn’t like a certain food because of the way it feels in his mouth. For example, some kids dislike foods with a slimy or pasty-mouth feel, like certain beans and fruits, while others love them. Depending on the underlying medical condition, it may be good to try some different food items that the child can tolerate to help to prevent food aversions. This is part of the development process.
Around twelve months, infants are graduated to “toddler” status and can typically eat small, cut-up, solid foods. The key is to expose your child to a variety of foods. If your child does not accept a food at first, do not remove that food from the menu. Research shows that a child sometimes needs to be exposed to the same food many times before she accepts that food. If you remove foods right away, this can end up creating a limited variety of foods that your child will eat and prefer. Instead, continue to put foods on her plate and eat those same foods with her so she sees that you like them.
Nutrition for our little ones can be complex. Working with a dietitian, along with your physician, nurse, and others, such as the speech therapist, completes the circle of care.
This column has been compiled and reviewed by our guest co-editor, Angela Lemond, RD, CSP Pediatric Dietitian; Carol Ireton-Jones, PhD, RD, LD, CNSD, FACN; Laura Matarese, PhD, RD, LD, FADA, CNSC; Cheryl Thompson, PhD, RD, CNSD; and Marion Winkler, PhD, RD, CNSC.
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