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Title to Go Here NOURISHED A New Model for Childhood Nutrition Nebraska Academy of Nutrition & Dietetics April 24, 2020 © 2018 Jill Castle, MS, RDN Disclosure Beef Checkoff Speaker’s Bureau New England Dairy & Food Council Blogger Network Nutrition Advisor Once Upon a Farm, LLC Brainiac Kids Needed Parents Magazine Creator The Nourished Child Project Eat Like a Champion The ADHD Diet for Kids Author, Fearless Feeding, Eat Like a Champion, Try New Food, The Smart Mom’s Guide to Starting Solids Objectives 1. Facilitate nutrition interventions by using a holistic approach, including food and nutrients, positive feeding strategies, and child developmental considerations. 2. Strategize fresh approaches highlighting nutritious food, positive feeding, and autonomy with developmentally-sensitive instruction around nutrition at different ages and stages. 3. Utilize modern, evidence-based, commonsense techniques to help families raise healthy kids, inside and out. The State of Child Nutrition Today 18.5% of children & teens struggle with overweight & obesity1 Eating disorders are increasing (boys; <12 years)2 Picky eating lasts longer (> 6 years) ARFID2 1 in 13 children food allergy3 Up to 11% children ADHD4 Rickets is making a comeback5 Iron status increasingly at risk6,7,8 Healthy Food Healthy Child Exercise JILL CASTLE NUTRITION LLC © 2019 | THE NOURISHED CHILD® Self- Sleep esteem Exercise Body Image Media JILL CASTLE NUTRITION LLC © 2019 | THE NOURISHED CHILD® Food & Nutrients JILL CASTLE NUTRITION LLC © 2019 | THE NOURISHED CHILD® Growth & Nutrient Needs Key Concepts Food Balance (All Foods Fit) Starter Portions & Goals Meaning in Meals JILL CASTLE NUTRITION LLC © 2019 | THE NOURISHED CHILD® 5 Guiding Nutrients6 INFANT TODDLER/PRESCHOOLER Total Fat Calcium Iron Brain Vitamin D Bones Bones Brain Zinc Growth Vitamin E Blood Vitamin D Potassium DHA Iron CHILDREN TEENS Fiber Bones Calcium Bones Potassium Blood Vitamin D Brain Iron Gut Magnesium Blood Calcium Vitamin E Vitamin D Iron JILL CASTLE NUTRITION LLC © 2019 | THE NOURISHED CHILD® Deficiencies In Children IRON anemia ZINC poor growth, low appetite CALCIUM osteopenia, rickets VITAMIN D rickets, poor immunity DHA vision, brain development POTASSIUM muscle cramps, weakness FIBER constipation Common Nutrient Deficits – Young Children Iron: 18% of older infants have intakes below EAR7 In animals, iron is conserved for blood at expense of brain May cause permanent change to structure and function of brain Total Fat: 31-33% of 12 m – 4 years had low intake Vitamin D: Only 25% of infants are meeting recommendations9 Vitamin E: 52% are meeting less than EAR10 Fiber: below the AI of 19 gm/day in children over age 1 JILL CASTLE NUTRITION LLC © 2019 | THE NOURISHED CHILD® Food Choice Matters – Young Children PROTEIN IRON ZINC Beef, chicken, pork Beef Beef Cottage cheese Chicken Baked beans Tofu Turkey, dark meat Fortified breakfast cereal Yogurt Tuna, light Pork Cow’s milk Pork loin Chicken, dark meat Soymilk ******************** Yogurt, fruited Peanut butter Ready-to-eat cereal Cashews Beans Instant oatmeal Chickpeas Egg Soybeans Cheese Cheese Lentils Milk Nuts Beans Almonds *6-12 m: 2 Tofu servings of iron- Spinach rich foods/day8 Raisins *12-24 m: 1-2 Bread iron-rich foods/day *Optimize non-heme iron absorption with vitamin C rich foods; phytates in legumes, nuts, seeds and grains may inhibit absorption of minerals such as iron and zinc. JILL CASTLE NUTRITION LLC © 2019 | THE NOURISHED CHILD® Beef as a First Food ESPGHN Committee on Nutrition “Regardless of timing, it is important the first CF given to infants… should provide a good source of iron” “Meat is a good source of iron and zinc, but also arachidonic acid, which is important in brain development” AAP Committee on Nutrition “The recommendations for protein intake assume that the sources of protein are highly digestible (>95%) and that the indispensable amino acid composition closely meets human needs” “The AAP recommends iron-fortified infant cereals and pureed meats as good first foods because they contain ample protein, iron, and zinc” Robert Wood Johnson Expert Panel “Iron/zinc fortified baby cereals or pureed/mashed meats are recommended as first solid foods…” Health Canada Guidelines “First complimentary foods should be iron-rich meat, meat alternatives, and iron-fortified RDN MS, Castle, 2019Jill cereal.” JILL CASTLE NUTRITION LLC © 2019 | THE NOURISHED CHILD® Foods that Fill the Gaps Nutrient Foods How Much? Calcium Milk, yogurt, cheese, cottage 3 servings of dairy or other high cheese, dark green vegetables, calcium foods fortified bread & cereals Vitamin D Vitamin D-fortified milk, salmon, 3 servings of dairy, 8 oz fatty fish tuna, mushrooms, fortified OJ, eggs per week Iron Beef, beans, crab, fortified breakfast 4-6 ounces per day cereal, pork Fiber Whole grains, fruit, vegetables, nuts 5 servings fruits and veggies per day and seeds, beans + one to two servings of beans or whole grains Potassium Leafy greens, fruit, root vegetables, 5 servings of fruit and veggies per citrus fruits day Omega-3 DHA, EPA Salmon, tuna, sardines, fortified 8 oz seafood per week eggs, milk and yogurt JILL CASTLE NUTRITION LLC © 2019 | THE NOURISHED CHILD® Food Balance Healthy Sweets Fats & Treats JILL CASTLE NUTRITION LLC © 2019 | THE NOURISHED CHILD® 90-10 Rule 90% Nourishing Foods Avg. added sugar Food Groups intake is 5.5 – 7 tsp in children 1-2 years and 14% of calories 10% Fun Foods in children.11 Added sugar Sweets & Treats intake is 14% of calories in children and 16% in teens.10 JILL CASTLE NUTRITION LLC © 2019 | THE NOURISHED CHILD® Right Size Portions12 1. Start with age-appropriate portions 2. Allow appetite to gauge additional servings Portion Control vs. Portion Awareness JILL CASTLE NUTRITION LLC © 2019 | THE NOURISHED CHILD® Meaning in Meals Connection Role Model Meals together are down 33% in Food Learning the past 20 years. Families spend less than 12 Manners Practice minutes eating dinner together.13 JILL CASTLE NUTRITION LLC © 2019 | THE NOURISHED CHILD® Feeding JILL CASTLE NUTRITION LLC © 2019 | THE NOURISHED CHILD® Responsiveness Key Concepts Avoid Negative Feeding Adopt Diplomatic Feeding & Goals Self-Regulation Healthy Relationship JILL CASTLE NUTRITION LLC © 2019 | THE NOURISHED CHILD® Responsive Feeding Division of Responsibility Diplomatic Feeding JILL CASTLE NUTRITION LLC © 2019 | THE NOURISHED CHILD® Feeding Styles & Controlling 14-17 Indulgent Practices Uninvolved Diplomatic Controlling Feeding Style Low sensitivity to hunger, fullness & food preferences Demanding “Clean your plate” High structure, rule-based Poor Food Regulation Out of touch with hunger/fullness Correlation with overweight/obesity Reduced fruit/veggie intake JILL CASTLE NUTRITION LLC © 2019 | THE NOURISHED CHILD® Indulgent Feeding Style Highly responsive to appetite Low demands, low monitoring Child leads food choice Lax structure Poor Food Selection Increased intake of high fat foods & sweets Higher BMI (preschoolers) Associated with overweight in certain populations JILL CASTLE NUTRITION LLC © 2019 | THE NOURISHED CHILD® Diplomatic Feeding Style15 Highly responsive & High demands Love with Limits Responds to hunger, fullness, food preferences Healthy Eaters/Kids Leaner Eat more fruits, veggies, dairy More active Protect against emotional eating JILL CASTLE NUTRITION LLC © 2019 | THE NOURISHED CHILD® Feeding Styles -> Practices18-21 Controlling Indulgent Diplomatic Food Catering Structure Restriction Pressure to Constant Boundaries Eat Feeding Food Autonomy Rewards JILL CASTLE NUTRITION LLC © 2019 | THE NOURISHED CHILD® NEGATIVE PRACTICE CHARACTERISTICS POTENTIAL OUTCOMES Restriction Limiting access to certain foods, Overly focused on restricted food, portions overeats when available Pressure to Eat Nagging to eat more; pressure to try or Disinterest in food; early satiety; poor take bites; reminding child to eat weight gain; worsens picky eating; OR weight gain; overeating; ignoring fullness Food Rewards Use of sweets/desserts to get child to Values reward food over healthy food; eat; manipulating with rewards for eats to please; poor self-regulation; eating performance relies on external indicators Catering Allowing child to make most food Limited diet; nutrient inadequacies; choices; makes a rescue meal or snack child in charge; less likely to try new foods Constant Feeding Grazing; always hungry; lack of Constant eating; overeating; unable to structure ID true hunger; may not expand food repertoire JILL CASTLE NUTRITION LLC © 2019 | THE NOURISHED CHILD® Reciprocity in Feeding20,21 Picky eater or Underweight Pushing, Catering, Rewarding Big eater, Heavy child, Food-focused Restricting, Controlling Perceived “normal eater” or normal weight Relaxed, Diplomatic Parent Child JILL CASTLE NUTRITION LLC © 2019 | THE NOURISHED CHILD® The Gold Standard: Diplomatic Feeding15 Warm, involved, sensitive Encourages maturity & self-control Promotes autonomy Anchored in trust Maternal monitoring Leaner, active kids who eat healthier JILL CASTLE NUTRITION LLC © 2019 | THE NOURISHED CHILD® Structure Schedule: Regular timing of meals & snacks Q 2-3 hours for infants/toddlers (3+3) Q 3-4 hours for preschoolers (3+2-3) Q 4-5 hours for teens (3 + 1-2) Location The Menu/Food Balance (90/10 Rule) Dining out, extra treats, etc JILL CASTLE NUTRITION LLC © 2019 | THE NOURISHED CHILD® JILL CASTLE NUTRITION LLC © 2019 | THE NOURISHED CHILD® Child Development JILL CASTLE NUTRITION LLC © 2019 | THE NOURISHED CHILD® Cognitive, Social & Emotional Key Concepts
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