Children, Follow My (Eating) Cues

Feeding behaviors are solidified early in life. In general, children are wonderful examples of listening to their hunger and satiety cues. Both of my children are great examples. My son is a really big eater in the morning and into lunch time and then has a tendency to pick the rest of the day. While other days, he eats very little. My daughter, on the other hand, eats a small amount at breakfast and then slowly picks up throughout the day.  Some days, she seems to eat the amount a grown woman would eat!  But I trust she is accurately listening to her own body as remains active and her weight is following a healthy growth curve. Unfortunately, many parents confuse children when they tell them to eat because it is meal time. Parents think, “Surely they should be hungry because they haven’t eaten in several hours.” And not only do some parents make children eat, some make them clean their plates. I recently wrote a letter to a well-known, elite school here in Dallas when one of my pediatric patient’s mother (who happens to be a physician) told me they still practice the clean plate club at their school. Really?! I thought everyone has figured out by now that this is not a good thing to do. The clean plate club trains the body “untrust” its physiological signals to eat or not to eat. This approach may have started back in the Depression when food was scarce, but I see many adult patients that are still trying to unlearn what they were taught by their parents. “Do not get up from this table until your plate is clean.” Or, “If you want that dessert, you better eat everything on that plate.” Dietitians cringe at the thought, although I truly believe parents are very well-intentioned. 

One of the best food behavior gifts we can give our children is the gift of trusting in their own hunger and fullness cues. I credit my own mother for allowing me and my siblings to make our own decisions to eat or not, and I firmly believe this has been one of the foundations to my healthy relationship with food. We ate as a family at the table without distractions (this is key), which helped us in listening to our individual cues. Because of mom, I can have my favorite food under my nose and if I am not hungry, I have no desire to eat it.

Hunger Scale by Paula Ryan, MS, of
Healthiest Regards Blog.
(Click to enlarge)

Paula Ryan, MS, author of the Healthiest Regards Blog, posted a great hunger and satiety scale that I wanted to share with Mommy Dietitian readers. It’s one of the best I have seen because it also lists the consequences of waiting too long eat, or not stopping when the body says it has had enough. If you find yourself eating in the absence of hunger or waiting way too long to eat, consider printing this scale off and going back to the basics. Many people eat for reasons other than hungers like when they are stressed, mad or sad. Deal with those issues directly instead of turning to food. It may be easier said than done for some, but this can be a start to a healthier YOU in 2011. And a healthier you means a healthier family because the children are watching – and doing what you do.

Nutrition For The Sick

Nutrition can play a key role in the recovery of an illness.

It’s that time of year again where all the nasty viruses and infections bring us and our loved ones down for a bit. Proper nutrition can be a major key to recovery. Even still, there are some among us dealing with more serious illnesses where optimal nutrition is even more crucial to the healing process. Our family is still trying to cope with the immense loss of a loved one last month, that despite all nutrition interventions I tried with her, our loved one did not survive her aggressive, brief bout with cancer (see dedication at the end). So yes, I have seen personally that there are times when nutrition is not enough.  While in other instances, medical nutrition therapy is a vital component of a patient’s care, prevention of complications and ultimate recovery. Although this is a subject that could be discussed for days, this post very briefly covers the role of food and nutrition for those who are sick with minor, major and terminal illness.

Minor Illnesses
Most of us will only deal with minor illnesses that pass in a matter of days. My 3 year old son recently came down with strep throat and it was no fun watching him be so uncomfortable in his own body. He ran a high fever for 3 days and during that time, he did not eat one calorie. Ack!  Don't you know, I hated it.  Even when we gave him a fever reducer medicine, he would not eat. Luckily, we were able to get an electrolyte replacement fluid in him throughout the days. If you are your child is sick and unable to eat, make sure fluids are still being taken in. For high fevers or those that are vomiting or have chronic diarrhea, an electrolyte beverage such as Pedialyte, Gatorade or CeraLyte are important to drink over water. When dehydrated, water can actually further the dehydration process since dehydration is not just about fluid loss, but loss of electrolytes as well. Do not worry too much when there is little to no food intake during these brief illnesses because any weight loss can be re-gained after getting better. My son little body lost 2 ½ pounds during strep throat, but luckily he has completed his 10-day regimen of antibiotics and is eating well again. I expect him to re-gain any lost weight.  During any minor illness, consider eating small, bland meals that are easy to digest until you are feeling better.

Major Illnesses
Major illness are what I would consider any illness lasting greater than 2 weeks or are chronic in nature. I work with many children and adults that are chronically ill and adequate calorie intake is my most important goal for them. For children, long term weight loss or failure to gain will result in loss of length/height growth. We have a window of opportunity to grow these children optimally so we must do all means necessary to get adequate total calories in them. With adults, a loss of 10% or greater over 3 months or less can cause the immune system to be compromised. Even if they were overweight to begin with, drastic rapid weight loss is not a good thing during major illnesses. Quality nutrition - high produce and antioxidant foods - would be great in a major illness, but many times sick people are very tired and eating is a challenging chore. Adequate calories is the ultimate goal with quality nutrition coming in as a close second.  On my website, I have a free resource page that includes an educational sheet that assists with healthy weight gain/weight stabilization and I also have a sheet on a high calorie liquid diet including smoothies and supplement ideas to maximize calories. In major illnesses, I highly recommend a visit with your local Registered Dietitian to do a full and complete nutrition assessment that will come with a customized medical nutrition therapy plan.  You can find one in your area by going to ADA's Find a Registered Dietitan page.

End of Life Nutrition
End of life and hospice nutrition really is a different issue altogether. All medical efforts have been exhausted and the person is still dying. I have had the honor of working with some of these patients in their homes and what their loved ones need to know is that under nutrition can actually act as an anesthetic. It can dull the senses which can assist with some pain control. In some cases, feeding can actually cause pain if their intestines or complementary organs are not working correctly.  The biggest goal in hospice/end of life nutrition is to comfort the patient. After all, a patient that is dying does not have many decisions they can make so deciding to eat or not to eat should be theirs and theirs only (if conscious). As a dietitian that works in hospice care, we educate on the risks associated with eating certain foods so the patient and their family can make an informed decision. Many of these people are at risk for aspirating food into their lungs, which could put them at risk for pneumonia. If this patient still had a shot at getting better, we would not allow them to eat certain textures. But in hospice care, we allow the patient and/or their families make that decision.

Whatever the illness may be in your or your loved one’s life, know the important use of food and nutrition. It has the power to recover and stabilize in many instances. But in others, allow food and nutrition be an individual’s choice.  In both instances, food can provide nourishment to the soul and that is a good thing.

Stay Healthy/Preventing Illness Resources:
Eat For Immunity using American Dietetic Association’s Public Resources
CDC’s Family Health Page

Kid’s Health From Nemours: Keeping Your Children Healthy
----------------
End of Life Nutrition:

Hospice Foundation of America on Nutrition & Hydration


This blog post is dedicated to what I believe was the best mother-in-law in the world. Oh, I so miss our conversations and special times we had together. You were such a beautiful woman inside and out. It was truly inspiring how you loved your family and how you empowered those around you to be better people. Thank you for being a Mommy Dietitian blog follower and one of my biggest cheerleaders for my nutrition consulting practice.  I am a better wife, mother, woman and entrepreneur from learning by your incredible example.  I will be forever grateful for how you raised your son, my husband, to be one of the greatest men I have ever known.  Your grandchildren miss their Nanny, and are sad you left this world so soon and so suddenly. But we find comfort in knowing that we will see you again someday. We love you, Beverly.

Do Not Fear The Pomegranate

If you have been to the grocery store in the last month, you’ve probably seen the pomegranate displays.  Did you just walk by? It’s that time of year when pomegranates are at their peak season, but the majority of people don’t know what to do with them so they don't even try them. Or, they are stumped on how to cut the seedy, red-staining fruit up without causing a big mess. I recently received some pomegranate in my produce co-op share and I was looking for new ways to eat this seasonal treat. So, let’s explore pomegranates together.

The word pomegranate is French derived from pomme garnete, which literally means “seeded apple.” Favored by the gods in ancient mythology, considered as a symbol for fertility in many cultures, prosperity among Jews and hope among Christians, this unique fruit has only positive origins and references. Nutritionally, it is a rich source of fiber, postassium, Vitamins C, K, B6 and Pantothenic Acid. Pomegranate contains antioxidants like polyphenols, tannins and anthocyannins which effects in removal of free radicals from our body cells. It also helps in repair of cells and boosts the immune system. Pomegranate juice is known to be among the super healthy drinks of today. It is helpful in osteoarthritis and keeping the skin and heart healthy.

Interested yet?  If I have now piqued your interest about pomegranates, you may consider eating one if you gained confidence in cutting one up. The California Pomegranate Council says that there is an easy 3-step process in cutting and de-seeding pomegranates:

1. Cut off the crown, and cut the pomegranate into sections.

2. Place the sections in a bowl of water and then roll out the arils (juice sacs) with your fingers. Discard everything else.

3. Strain out the water, then eat the arils whole, seeds and all.

You can blendarize the arils and seeds to make juice, or use the nutritious seeds as a topping to oatmeal, yogurt or salads. For recipe reference, one medium pomegranate yields about a ¾ cup of seeds and ½ cup juice.

If you want to start slow, try this wonderful nutritient-rich recipe that mildly uses the sweetness of just one pomegranate, but mixes it with bolder flavors of lime, jalapeno and salmon.  As a proud Texan, this is my kinda flavor!

Roasted Salmon with Pomegranate and Avocado Salsa

Roasted Salmon with Pomegranate and Avocado Salsa

 

2 teaspoons ground coriande
2 teaspoons sugar

Salt, as needed

1 pomegranate, seeded (see above for process)

1/2 cup thinly sliced green onion

3 tablespoons fresh lime juice

2 teaspoons finely chopped jalapeno pepper or to taste
1 large clove garlic, chopped finely
2 avocados, preferably Hass, cut in 1/2-inch dice
1 head hearts of Romaine, about 7 ounces
4 center-cut Salmon fillets the same thickness, 6 to 7 ounces each
1 lime, cut in eighths for garnish

Mix coriander, sugar, and 1 teaspoon salt; reserve. Up to 4 hours before serving, mix pomegranate seeds, onion, lime juice, jalapeno, and garlic; gently fold in avocado. If holding more than 30 minutes, put plastic wrap against the surface of the salsa, then tightly cover; store in the refrigerator. Remove about 30 minutes before serving. Separate the romaine leaves; wash, then dry thoroughly. Reserve 4 of the most attractive leaves for garnish. Slice the remaining leaves crosswise in thin shreds; reserve.

To prepare the salmon, rub a generous teaspoon of the reserved seasoning mixture over each piece. Arrange the salmon on a baking sheet, skin-side down. Roast at 500˚ F about 11 minutes for medium rare (salmon should be spongy when pressed with a finger at its thickest part.) and 13 minutes for medium-well (salmon should be just firm when pressed with a finger at its thickest part.).

Do you have a favorite recipe that uses pomegranates?  If so, I would love to hear from you!
 
Some information provided in this post came from the California Pomegranate Council website.

Operation Halloween Candy: Party's Over!

If the leftover Halloween candy is causing a struggle in your
home, consider teaching a valuable community service
lesson to your children by donating it.

Our family has way too much candy leftover from Halloween.  We didn't get as many trick or treaters this year so we have bags of chocolate bars.  Plus, my kids received tons of candy that has been taunting them daily.  Is it the same scenario at your house?  Although I encourage each of us to continue teaching our children about the proper behaviors around candy, we also must consider environmental triggers.  I think candy donations to our military troops can be a great way to teach our children about community service and giving to others while also eliminating candy overconsumption in the household.  At our house, we are putting together a care package that includes our candy along with handmade cards from our children thanking the troops for how they protect our country.  Of course, we will be sure to include a message that encourages the troops to enjoy their candy in moderation so they can maintain a healthy lifestyle!  My brother served two tours in Iraq and he said that it was wonderful to get candy in the mail because it was not available where he was stationed.  Apparently, this is the case in many places soldiers are stationed in different parts of the world.  Although I am not a fan of candy (I'm a salt vs. sweet kinda gal), I understand that others like it and would appreciate having some sent over for an occasional treat.

If you want to donate your candy, here are a couple places:

Operation Gratitude
Operation Shoebox

Halloween is fun because it comes once a year and then it's over.  So don't let Halloween candy eating continue on and on to where the treats do a "trick" on your healthy lifestyle.  Donate your candy this year!  If you have any other great ideas on what to do with Halloween candy other than eating it all until it's gone, I would love to hear about them.

Trick or Treat -- Candy, Please!

Yep! Candy is mostly sugar.  Good thing
Halloween only occurs once a year.

The reality is that the Halloween tradition is about children receiving candy as they go door to door in their Halloween costumes.  Halloween only occurs once a year, so I say, let the children enjoy some candy.   Don't get me wrong.  I love the healthier ideas out there, especially the toy and sticker alternative.  But remember, candy is not the root of all evil – it is the frequency in which it is consumed that could pose a problem.  We live in a world where our children are already around lots of candy, so we must teach them proper behaviors around eating it.  I see Halloween as a wonderful training opportunity on proper eating behaviors.  So let the kids enjoy their Halloween candy, but don’t let it be consumed endlessly after the holiday.  I allow my children to have more candy than usual on Halloween.  In fact, I let them have all the candy they want this one night per year.  My daughter has already learned firsthand that too much candy will give her a tummy ache.  We had a great discussion when she was feeling sick after eating too much icing one time that too much candy will make her body feel bad.  After Halloween comes and goes this weekend, the frequency of candy consumption will go back to how it normally is at our home – a maximum of once or twice per week.  So, my take on Halloween?  Let the kids have their candy.  And remember to use this time to teach them about the place that candy should have in their lives every other day of the year – as an occasional treat. 

Haunting Tales....From The Buffet Line

Don't let amazing buffet designs divert your attention
from the temperature your food should be served to you!
(cool watermelon design on one of the cruise buffets)

Thanks to my food microbiology class several years ago, buffets scare me like a teenage girl going through a haunted house. It may also be because I have had food poisoning on more than one occasion and it is no fun. I can look at blood and guts all day long, but seeing food with mold on it makes me want to shriek! It’s all about bacteria overgrowth here. Now that you know my phobia, you will giggle to learn that I just got off a cruise ship filled with buffets! There was so much food the entire week and much of it was indeed served buffet-style. My first shot at the buffet line, I said to myself, “OK, you can do this, Angela. All those stories you hear about foodborne illnesses on ships – it’s the exception to the rule.” So I boldly fill my plate with all kinds of food, including some grilled fish. I sat down at the table and began to eat. All the food was lukewarm at best. The grilled fish was cold! That’s it, I’m done. Stick a fork in me.


My food bacteria fear will one day cause me to bring a food thermometer with me to buffet lines – I can feel it coming. After all, the temperature danger zone (TDZ) is between 40-140 degrees, because this is the range in which most common bacteria love to grow. If you arrive at your holiday party without your handy temperature gauge (as most of us do!), make sure the foods that are normally in the refrigerator are actually cold and the foods that are supposed to be served hot, actually are hot. A good rule of thumb is to stay clear of any hot or cold food that has been sitting out longer than 2 hours. If you are entertaining this holiday season, do us bacteria phobes a favor and review the safe guidelines provided by the USDA.  The USDA provides an entire website devoted to food safety, so keep your family safe this year by reviewing their guidelines and techniques.

You may wonder how I survived my 5-day cruise. Well, I am happy to report that I survived all the buffets. If only I hadn’t eaten at the authentic Mexican restaurant in Veracruz! All of us got sick on that one. Thanks a bunch, Montezuma. Grrr.

Fall Fun With Pumpkins

Halloween is a great time to encourage family fun
with food - by playing and eating pumpkins!

With the Fall season in full swing, we are approaching the fun times of pumpkin patches and pumpkin carving - such great activities for families with small children.  What a wonderful time to allow your kids to learn about and play with pumpkins.  Afer all, the more comfortable and interested they are in this nutrient-packed gourd, the more likely they are to eat it in varying forms.  Pumpkins are thought to have originated in North America.  The word pumpkin comes from the Greek word "pepon" which means "large melon."  Pumpkins are packed with great nutrition to fuel our child's growing bodies.  They contain carotenoids, lutein, and zeaxanthin, which are all antioxidants or anti-cancer properties.  Pumpkins also contain iron, zinc and fiber.  Talk to your children about these interesting facts and more as you have fun picking and carving your pumpkins.

I love those farms that allow you to pick pumpkins right off the vine, although they are harder to find these days.  Many of the pumpkin farms have them already sorted by size and price.  Allow each of your children to have their own pumpkin, if possible, so they can design their own.  Give your child an ice cream scoop or large spoon so they can be part of the messy fun after they draw their own whimsical faces and designs.  I personally like the ideas on Kaboose's pumpkin craft page.

After you have carved your pumpkins, what to do with the pumpkin "guts?"  Don't throw that wonderful nutrition in the trash!  No, continue the fun by baking or cooking a recipe with your children.  You can substitute canned pumpkin in any recipe for fresh pumpkin.  Simly remove the pumpkin seeds and set aside (to lightly salt and roast for their own separate treat later).  Steam the pumpkin pieces and pulp with a bit of water in a pressure cooker, or in a pot using a steaming basket.  When it's done, blendarize your pumpkin and it's ready to be added to your recipe.  These are the recipes that look interesting to me this Halloween:

Eating Well's Pumpkin Cookies or Pumpkin Apple Soup

Taste of Home's Pilgrim Pudding

All Recipe's Pumpkin Bread

Family Oven's Pumpkin Breads & Muffins

What is your family's favorite pumpkin recipe?  I would love to hear from you.  This season, make time to have some family fun with pumpkins!

School Lunch vs. Brown Bag: Obvious Choice?

Many people believe that sending a school lunch is always the healthier alternative. Is it? School lunch has been under heavy scrutiny for good reason. However, I have done many diet recalls on children and have seen my share of issues with lunches brought from home as well. Therefore, I put a chart together that gets you to think objectively about your child buying vs. bringing a lunch to school.



(If you are having trouble reading this table,
let me know and I will happily send it to you directly!)

 Addressing The Issues: Brown Bag & School Lunch

If your child is brown bagging:
- Commit to providing food variety for your child. Even if you believe the same lunch you make is considered healthy, don’t make that same lunch every day. Sit down with your child and discuss menu options that they can get excited about eating.  When kids are invited to be part of the planning process, they will feel more inclined to eat the foods you provide.  I absolutely love Catherine McCord's super creative lunch ideas that also make healthy foods fun to eat.  Check out her quick video to inspire you on Weelicious. 
- Include a fruit and veggie in your child’s lunch every day. And for vegetables, branch out from carrots! Make a side salad, veggie kabob or even make fun faces out of veggies and provide a nice dip such as hummus for dipping.
- Concentrate on quality carbohydrates such as whole grain breads, rices and noodles. Low-fat chips are fine sometimes, but try not to use that as the staple carbohydrate in your child’s lunch.
- Make sure portions are right for your child. Some healthy bagged lunches do not provide enough calories to get your child through the day. On the other hand, too many “healthy” sweets might push your child over the calorie limit recommended for a child’s lunch.
- Include a low-fat dairy everyday – either a low-fat yogurt, milk or cheese. For those with milk allergy (rare), consider soy products as a good alternative.

If your child is buying a school lunch:
- Review the school menus with your child. Empower them to make healthy choices on their own. That includes, for example, making the choice not to have ice cream every day.  Allow the cafeteria experience to be part of the education experience!
- Encourage your child to eat the healthier meal items first to maximize their nutritional intake. Remind them that there is a limited amount of time to eat, and that their lunch will help them power out the rest of their day.
- Become involved in your child’s school lunch menu. Contact their school nutrition department and discuss any concerns you have with them directly.

The biggest thing I want to highlight is to get involved in the changes happening with school lunches everywhere. Schools get so many negative comments about their food, so when you see an improvement, let them know. Positive changes are slowly occuring, which is certainly something to be celebrated.  I am inspired by the changes being made in my city - Dallas, Texas. They have taken out many high calorie/low nutrient foods out and have added quality foods in their place. And now, a new initiative is on the horizon where Dallas Independent School District will be collaborating with Registered Dietitians from the Dallas Dietetic Association to educate freshman students on nutrition. These are the wonderfully positive things that are happening in my area. What about yours? Encourage positive change by recommending practical solutions that your school district can implement. Help to be part of the solution – for the sake of our children!

Parenting Styles and Child Feeding: What Does It Mean?

Health professionals were reminded in a great study that came out in the Journal of the American Dietetic Association back in 2008 that we must address parenting styles and family dynamics if we want to be successful in implementing dietary change in families. This study is consistent with many others published.  So with that, what is your parenting style? (If you haven’t yet, take the quiz in my previous post: Parenting Styles & Family Feeding: Take the Quiz!)

The good work started by psychologist researcher, Diana Baumrind, in the 1960’s helped us identify these 3 types of parenting styles – authoritarian, authoritative and permissive parenting. Now there are psychologists adding other styles, but we will zero in on the original three. The research I have done along with my own experiences with many family interventions reveal that authoritative parenting correlates to the best family feeding practices and lowest incidence of childhood overweight. Why? Because authoritative parents have a tendency to do the things pediatric dietitians and feeding experts recommend: monitor unhealthful child behaviors such as sugar and fat consumption; positively monitor, and take responsibility to promote child health and well-being through limit setting. They also have a tendency to model healthful lifestyles, which is a key component in your child’s learning process. On the other hand, authoritarian parents tend to food restrict and/or pressure children to eat regardless of the child’s desires. Permissive parents have a tendency toward poor healthy lifestyle modeling.  Therefore, it is not surprising that authoritarian and permissive homes produce the most overweight children.

The right parenting style may make your meal
times even more enjoyable.

So what’s the take home? It is clear that children need structure and clear guidelines when it comes to all kinds of behavior. But they also need and desire to have choice in matters. So, combine clear limits with the allowance of your child to make their own choice within those guidelines. Many child feeding specialists believe that regular and consistent times for meals and snacks promote feeding confidence in a child. The choices you give your child need to be age-appropriate as well. As an example, I allow my 6 year-old daughter to choose from a large selection of healthy snacks in our refrigerator and/or pantry during snack time. They are all there for her choosing. She feels empowered to make her own choice within the acceptable selection, and I am pleased that she is having a healthy choice.

If you took the quiz and found that you lean more towards a parenting style other than authoritative, don’t be upset. Many times our parenting styles fluctuate between the three styles. For instance, I notice that I sometimes deviate towards permissiveness when I am really tired, or more authoritarian-like when I am angry. So, take heart and know that knowledge is power. This information is designed to remind all of us as parents to be invested, consistent and clear about parenting for the sake of our home atmosphere as well as for the future of our children – in all areas, including feeding. If you want to read more about Diana Baumrind’s work on parenting styles, go to UC Berkeley's Institute for Human Development page.

More Reading:

Kyung E. Rhee, Julie C. Lumeng, Danielle P. Appugliese, Niko Kaciroti and Robert H. Bradley. Parenting Styles and Overweight Status in First Grade. Pediatrics 2006;117;2047-2054.

Hubbs-Tait L, Kennedy TS, Page MC, Topham GL, Harrist AW. Parental feeding practices predict authoritative, authoritarian, and permissive parenting styles. J Am Diet Assoc. 2008 Jul;108(7):1154-61.

Wake M, Nicholson JM, Hardy P, Smith K. Preschooler obesity and parenting styles of mothers and fathers: Australian national population study. Pediatrics. 2007 Dec;120(6):e1520-7.

Kyung Rhee. Parenting Style, and Family Functioning. The ANNALS of the American Academy of Political and Social Science 2008 615: 11

Parenting Styles and Child Feeding: Take the Quiz!

In my practice having counseled many families on food and nutrition, I have come to learn that parenting styles dictate the feeding style in the home. What is your parenting style? Take this quiz and get your score at the bottom. Next week I will discuss how these parenting styles positively or negatively impact the way you feed and expose your child to food. Remember, information is power. This is not meant to make you feel bad if the result is not what you desired, but instead give you insight into how to maximize your child’s experience with food. Try and answer the questions on how you really handle things instead of how you think you “should” react. OK, here we go…are you ready?


1. Your pre-teen son is watching a show and as you walk through the room, you notice that the show has questionable content that may not be appropriate for teens. What would you do?

a. Get mad, telling him that he can't watch the show.

b. Go ahead and let him watch it anyway.

c. Tell him that he’s gonna have to change the channel, but you could help her find a more appropriate show.


2. If your daughter hits another girl at school, what would you do?

a. Get mad at your daughter’s actions, and tell the other child to hit him back.

b. Ignore the kids and let them handle it.

c. Tell him not to hit other people, make her apologize, and if this is a second offense, take away one of her privileges.


3. Your son wants to go play basketball with his friends, but you know he hasn’t finished his homework.

a. Yell at him saying he should know better than to ask you.

b. Go ahead and let him go play with hopes he’ll do it later.

c. Help him with his homework to get it done faster so he can enjoy his friends.


4. What do you do if you kids don't listen you?

a. Yell often out of frustration.

b. Shake your head and let it go because you are exhausted.

c. Remind them that they need to do and follow through with having them meet those expectations.


5. You daughter is procrastinating her bedtime by saying that she would like something to eat. What would you do?

a. Make her go to bed hungry because it's her bedtime.

b. Go ahead and let her eat a snack before bed.

c. Give her a healthy snack, but tell her it's the last time she gets a late night snack because she'll need to start eating more at dinner.


6. Your children come along with you to the grocery store and are pointing to everything at the toy area close to the cash register. What do you do?

a. Flat out tell them no that they cannot have anything – this trip is not for them.

b. Buy them one or more items just to prevent a potential scene.

c. Tell them no, but explain that when they save up their money, you'll take them back so that they can purchase whatever they want.


7. What do you do when your child has a tantrum or emotional breakdown?

a. Send him to his room.

b. Give in because you’re tired and you just want him to stop.

c. Wait until he's done with his tantrum and explain to him there are better ways to express his frustration.


8. What do you do if your preschool child wakes up in the middle of the night from a bad dream?

a. Get mad because she woke up and tell her to just go back to bed.

b. Just grab her and pull her into bed with you so you can get back to sleep.

c. Comfort her and try to help her back to sleep into her own bed once she's calmed down.


9. If your child gets breaks a clear rule, what do you do?
a. Yell or spank the child and say nothing because they should know – they broke a well-established rule.

b. Don't do anything.

c. Discipline the child and then explain that there are better choices to make.


10. What do you think the main goal is for parenting and discipline?
a. To get your child to submit and follow rules laid out by you.

b. To keep the peace in the family.

c. To teach your children why rules are important and to help them learn how to make good choices.



Answers & Explanations

Count up your A's, B's, and C's.

If you had more 'A' answers, you are more of an authoritarian parent, which means you attempt to control your children's behaviors. You stress the importance of obedience in regards to authority. Most authoritarian parents rely on punishment.

If you had more 'B' answers, you are more of a permissive parent, which means that you have very little if any control. You let your kids set their own schedules. Most permissive parents do not demand the same type of behavior as the other to parenting types.

If you had more 'C' answers, you are more of an authoritative parent, which means that you believe that both the parent and child have certain rights that are both of equal importance. You tend to set rules and explain them to your children.

Wellness Lock-In: A 'Must Do' For All Families

I had an epiphany this past weekend. What if families scheduled random "wellness lock-ins" every 3 months or so where they purposely worked on healthy family lifestyle components? You know, things such as:

- Emphasized family time
- Family-wide random activities such as going to the park, riding bikes, painting, cooking (at least one physical activity)
- Meals together the entire weekend, emphasis on nutrient-rich/healthy cuisine
- Read stories together
- Plenty of sleep with naps an option any or all of the days
- Reflect on old pictures, tell family stories, things that remind your children of their preciousness & uniqueness
- Minimize computer and television time to 2 hours daily (or none at all)

These types of weekends should be sacred, so that would mean no other obligations other than family time. Day after day, I meet families that say they are too busy to do many of the things that I suggest in my private nutrition consulting practice. But if you scheduled an entire weekend devoted to doing just these things, I believe that it would set the pace for a new emphasis and outlook. We all have Blackberry’s, iPhones and/or other devices that dictate where we will be at any given moment, so why not schedule sacred family time and decline other things that may come up during that time? Let our calendars work in our favor for once!

I have to admit, my last minute trip to the northeast was cancelled. Since nothing else was planned, I was able to have uninterrupted time with my precious family. There was nothing on our social calendar, so we did all these things mentioned above. It was such a gloriously enriching weekend that made me think about all the other families out there that need to do the same thing. This just happened for us this weekend, but I can assure you that we will have these planned out in the future.  You see, we should never be too busy to make time for the most important people in our lives but sadly, so often we are. If we don’t have our priorities straight, we cannot live out and model the healthy lifestyle we so badly want for our own children.

I want to issue a challenge to your family. Take the Wellness Lock-In Challenge at least one time between now and the end of the year by blacking out an entire weekend just to hang out with your family. If you decide to do this, do not make a bunch of set plans (i.e., (9-10am bike ride, 10-10:30 reading, etc. No!). Instead, just keep it open and allow the love you share take the lead. I promise you that it will be the most nourishing thing you and your family can do on so many levels.  Set aside the weekend, and take the challenge!

Our "Wellness Lock-In" consisted of empowering the kids
to have fun with food and assist with meal preparation!
What will yours entail?

Snacking Tray for Kids

A fellow mom friend of mine, Julia Shelton of My Blue Canoe blog, shared a way she encourages her children to choose healthy snacks. It's what she calls their "snacking tray." She fills it up with a colorful variety of healthy snacks and her children make the choice of what they would like to have each time. All the choices are pre-prepared in advance for ease of execution, appropriately portioned out and all of them are nutrient-rich that help maximize their nutrition with each choice. What's also great about this idea is that it empowers children to make their own choice, which is really the key for your child's lifetime nutrition status.  Put your snacking tray in an easily-accessible place in your refrigerator so your kids can just grab and enjoy.

I absolutely love grassroots ideas like this one, mostly because they have been formulated in the homes of real-life families.  Let's continue to share with each other so we can invest in the health of all families by doing just that.  If you would like to share creative ways you encourage healthy eating and snacking in your own home, I would love to hear about them!

Julia Shelton is a wife, mother of two precious girls.  On her My Blue Canoe blog, she shares her family adventures and tries to focus on the beauty we happen upon in this journey of mindful mothering, intentional living, and plain 'ole having fun. 

Top 5 Nutrition Tips for Family Vacationing

Our family spent a very fun, active 9-day vacation in Disneyworld down in Orlando this month right before school started.  Parents often ask me how to do a vacation without destroying all the healthy habits you worked so hard on at home. My answer? Vacations occur in brief timeframes so they should not completely de-rail any efforts made. However, there are 5 things you can do to make your next vacation as healthy as possible:

Remain strong like The Incredibles
on your family vacation by practicing
food and activity balance.  Here, my
family poses with the crew that are
surely eating their vegetables!

1. Rental with a kitchen. Not only is this choice more economical, it enables you to have your own food choices that can continue some normalcy for your family. The same day we checked into our condo, we headed up to the local grocery store and stocked our kitchen with nutrient-rich foods. Each morning, we got up and had our family breakfast and then packed snacks and waters into our backpack for the long day at the park. We were thankful to know that Disney allows you to bring food and drinks into the park, so you could even pack your lunches for the day.

2. Seek out healthier options.  Yes, there was plenty of what Americans call “kid food” at the park (chicken nuggets, macaroni and cheese, French fries, etc.), but there were also healthier options at many of the eating establishments.  Kudos to Disneyworld!  They have publicly committed to doing their part to make children in the U.S. healthier through the Let’s Move Initiative started by First Lady Michelle Obama. Allow yourself and your children to enjoy higher calorie faire in moderation, especially if you are remaining active throughout your vacation. Take advantage of those times when you can order healthier foods. At Hollywood Studios, we enjoyed a lunch at a diner with Handy Manny & Little Einstein characters that had a wonderful buffet with lots of fruits, vegetables, grilled meats and whole grains. At Epcot, we enjoyed other fresh options such as teriyaki stir fry and fish with steamed carrots at a cafeteria. Many times, the options are there and you just need to search them out.

3. Make your vacation active. Believe me, I am all about some down time! As a mother of 2 very active young children, there must be some time to just relax and unwind. But do make time to continue your physical activity. My husband and I estimated that we walked about 100 miles altogether on this Disney trip, which equates to over 6000 calories for a woman of my size (I am very thankful for the double stroller rentals at the Disney parks!). As you can see, if you make your vacation active then you can experiment with a variety of cuisines and flavors that might be a little higher calorie and you will still not destroy your healthy lifestyle efforts. Balance can take its course naturally.

4. Teach your children along the way. We did eat out much more than when we are at home, so I took the opportunity to empower our children to be satisfied with healthier foods that were being served. Although our 3 year old is a bit young to fully grasp this concept, our 6 year old understood that long park days required extra “super powers” to be able to have energy and stay happy while having lots of fun. She was happy to get a salad or mixed vegetables with her meals. Besides, she wants to have “princess” skin and she knows that healthy foods assist in this goal! We saw lots of Disney princesses on this trip so our home discussions about this really helped seal the lesson further.

5. Seek out nutrition education. Visiting a rural destination? Make a point to stop at a local farm that might be offering a tour. Going into a city? Try and visit a food manufacturing plant that might produce certain types of foods. Go shopping at one of the destination’s local farmers markets and show your children what the local people eat. At Disney’s Epcot, they have an amazing riding tour that I highly recommend called, Living With the Land. It is a family-friendly informative ride that discusses unique and sustainable ways food is being produced all over the world. Both our children loved picking out the food plants that they recognized. It was fun to see the 9 pound lemon that can produce a gallon of lemonade! If the this tour interests your family, you could go on an additional Behind The Seeds tour that provides further detail into the nutrient film, hydroponic and waterponic growing techniques. Fascinating! I included a video that I found of the entire Living with the Land tour (the greenhouse portion begins after about 5 minutes).



Just as in your everyday life, take some time to plan out ways to keep your vacation healthy and balanced. That way, you can have fun knowing that you will coming back home feeling great and energized, which complements the great vacation memories to fuel your busy lives. Although our vacation was extremely busy, we are still relishing in all the sites, sounds and experiences we were so fortunate to be a part of at Disneyworld. 

Wisdom From a Foodie Dietitian

In my industry, there are different types of dietitians.  My claim is clinical dietetics and practical wellness nutrition.  Dietitians that specialize in the culinary end of eating are usually nicknamed "foodie dietitians."  Since I consider myself more of a foodie wanna be,   I recently caught up with one of my favorite true blue foodies, Robin Plotkin, RD, LD, to get her perspective on family feeding for Mommy Dietitian readers.

Robin Plotkin, RD, LD and her son having some
fun with food.

Q: What are 3 top things that families can begin doing today that would help them pull healthy dinners together faster/more efficiently?

A:
1. Make a meal plan! We make plans for our after school actives, our workouts, our social lives....it’s critical to make plans for dinner. I encourage people to start slowly-just plan for 3 nights worth of healthy dinners at home and go from there. That way, you know you have at least 3 meals covered for the week. There are great resources out there for meal planning if you are someone who struggles with this-I love http://www.sixoclockscramble.com/, http://www.mealmakeovermoms.com/ and http://www.myfridgefood.com/ are a few websites I routinely recommend.

2. Gather the groceries! Once you have the meal plans in place, having the food handy seals the deal. Take your plan, make your list and off you go! It can be on a sticky note or an Excel spreadsheet-whatever works for you. If you are a beginner at meal planning, I recommend taking recipe ingredients word for word-as you hone your skills, you will be able to mix and match ingredients and find different uses for them as you go along.

3. Relax! Kids take their cues from the parents. If you enjoy preparing healthy meals for the family and look forward to spending time around the table, the kids will, too. If you are stressed, frustrated or would rather have a root canal instead of making dinner for the family, they will know and will feed off of the negative energy that you may be inadvertently sharing with them when it comes to food.

Q: From a culinary perspective, how important do you think exposure to a variety of foods impacts a child's palate long term? Please explain.

A: Reports are showing that kids are more adventurous with their food choices these days. The traditional PB &J is giving way to more organic, healthful and locally made. In addition, kids lunchboxes are filled with more ethnic foods which shows the diversity of the foods available in terms of takeout menus. Parents want to share their excitement of their new finds with their children. Speaking from the culinary side, kids are developing more distinguished palates at an earlier age which allows more creativity and acceptance long term when it comes to food.

Q: What are some techniques that you recommend to increase food acceptance in children?

A: You’ve heard it before and you’ll hear it again-get kids involved! I’ve taught kids cooking classes for twelve years and there is a world of difference between a hands on cooking class vs. a demonstration only. When kids are encouraged to take part in the process, the sense of empowerment, self sufficiency and acceptability of the food itself skyrockets. And, the pride they feel after making something on their own to feed themselves and their family is indescribable.

Got tools? Get Cooking! At any age, kids should be allowed into the kitchen. Give them their own age appropriate tools-cutting boards, measuring cups and spoons, whisks, etc. Assign age appropriate tasks as well. Smaller kids can stir or pour, older kids can chop softer foods (i.e. Kiwi, banana, pasta) with child safe knives, and preteens and teens can take on complete recipes-start easy-scrambled eggs with cheese, guacamole, etc. Of course, adult supervision is necessary as are proper food safety and sanitation.

I also love to give fun tools and resources for parents as gifts. For example, http://www.fredandfriends.com/ has great plates, utensils, and other creative and fun tools just for kids. Ellyn Satter, RD books are terrific http://www.ellynsatter.com/ for introductions on how to feed your baby well. Cooking school gift certificates are unique gifts for kids adults alike-they allow the individual to gain confidence in the kitchen and are a lot of fun!. Finally, subscriptions to kids cooking magazines like Chop Chop (http://www.chopchop.com/) or Relish Kids (http://www.relish.com/) are gifts to encourage and inspire-all year long.

Q: Care to share one of your favorite, quick and healthy recipes that you make for your family?

A:
Easy Turkey Meat Sauce with Whole Wheat Pasta

Ingredients:2 T olive oil
1 onion, diced
1 pound lean ground turkey breast
1 jar of your favorite spaghetti sauce
Frozen broccoli, thawed (as much as you’d like)
Fresh spinach (as much as you’d like)
Oregano (to taste)
Basil (to taste)
Pepper (to taste)
Whole wheat pasta-cooked according to directions
Mozzarella cheese, grated

Directions:
Heat a large sauté pan over medium high heat. Add olive oil. Add diced onion and cook for approximately 5 minutes, or until onion becomes translucent. Add turkey and quickly break into small pieces. Once cooked through, add spaghetti sauce and allow to simmer for 5-8 minutes. Add broccoli and allow to heat through. Season with oregano, basil and pepper. Stir. Add spinach and stir, allowing it to wilt slightly. Remove from heat. Serve pasta in bowls and spoon sauce over the top. Add cheese. Enjoy!

Use the leftover sauce for Turkey Sloppy Joes, as a sauce for pizza, as filling for tacos, enchiladas or any other place you would substitute traditional meat sauce.

Robin Plotkin, RD, LD is a culinary and nutrition expert based in Dallas, Texas. She blogs, tweets, teaches, talks and tastes food for a living and wouldn’t be happier doing anything else. For more information, visit http://www.robinplotkin.com/ or her Robinsbite blog at http://www.robinplotkin.blogspot.com/.

Pregnancy Nutrition: Managing Nausea

As moms, we all know how exciting of a time it is to be pregnant. But this time can bring on some challenges related to the surge of hormonal changes going on throughout the gestation period. Some fair these changes with little difficulty while others have problems. With my second child, I struggled much more than my first with both food aversions and nausea. I had cravings for processed foods, especially processed meats – hot dogs, deli meat, and fried chicken – which are fairly unusual for me. We went to the Texas State Fair the year I was pregnant and I had an extreme craving for their world famous corny dogs. I told my husband about my primal anticipation, and he looked at me very strangely and said, “Who are you and what did you do with my wife?” But the funniest part of the story was that when I finally got a hold of the corny dog, I began scarfing it down like I hadn’t eaten in a month. I was half way finished with it when my love for the dog turned to hate. How could a food taste so incredible one minute and then taste like rot the next? Yuck! I had to get it away as fast as possible. The smell, the flavor – everything about it was hideous. So I know firsthand that yes, hormones are a crazy thing in pregnancy!

The term "morning sickness" does not give nausea
in pregnancy justice because it can certainly strike
anytime.  Take basic steps so you are well prepared.

It is very common to have food aversions and nausea in pregnancy, particularly in the first trimester. But in the most extreme cases, hormonal illness in pregnancy can cause continuous vomiting and the inability to keep food down. It can get so bad that intravenous feeding is necessary. Of course that is an extreme and rare situation, but it can happen. Here is a quick reference chart that can help you deal with your nausea in pregnancy.

CONSUME

Bland foods. [During extreme nausea and recovering from vomiting] These include white breads and pastas, applesauce, bananas, eggs and lean meats with minimal seasonings. They are easy to digest, soothe your stomach while providing much needed calories and nutrition.

Focus on nourishing foods. [Light to no nausea] Foods that nourish the body the best are the ones that contain the most nutrients. Lean meats, fish, beans, low-fat dairy, fruits, vegetables and healthy fats all supply the vitamins and minerals moms and babies need.

Peppermint or ginger. Both are safe in pregnancy and have been shown to decrease and treat pregnancy nausea. Make sure that you get real peppermint and real ginger foods and drinks. Things like commercial ginger ale do not contain the real thing.   Make your own fresh ginger tea by mincing some ginger with 4 cups of water in a tea pot.  Bring to a boil and then pour it over a 2 inch piece of fresh ginger in a coffee cup.  Add some honey and lemon for a nice, refreshing taste.  Allow the tea to cool until it is lukewarm for the most soothing effect.

Salty crackers. You read it everywhere and it’s true. They really help. And normally I would say go for the whole grain ones, but in the case of pregnancy nausea, it’s probably best to go for the old saltine-type crackers that get into your system faster.

Food with medication and vitamins. Both increase stomach acid in general, so make sure you take them with food unless instructed otherwise. Do not take any medication, vitamins or herbal supplements without telling your doctor first. Strong smells. As you are probably aware, your senses are heightened during pregnancy and that includes your sense of smell.

Enjoy decadent food cravings in moderation. We still need to exhibit self-control in pregnancy because the reality is that we are not eating for an equivalent of 2 people. More than ever, women are exceeding the weight gain goals for pregnancy and that its implications on both mom and baby. But allowing yourself to eat some of your decadent food cravings will make you feel more satisfied during pregnancy. Most decadent foods may fall into the “avoid” category, so consume only if they do not contribute to feeling ill.

AVOID

Strong smells. As you are probably aware, your senses are heightened during pregnancy and that includes your sense of smell.  An intense smelling food can trigger nausea in the blink of the eye, so be congnicent to those most offending aroma.

Skipping meals. Just as a stomach that is too full can cause nausea, the same is true with an empty stomach. The best way to eat during pregnancy is small, frequent meals.  Keep snacks in your purse and in your car so you can put something in your stomach when hunger strikes without any lapse in time.

Foods that cause reflux. Acidic foods, high fat foods, chocolate and large meals tend to produce more stomach acid. This can exacerbate nausea and also contribute to reflux (reflux also increases as the belly gets bigger due to anatomical pressure).

Drinks with meals. If you really need something to wash your food down, sip on water that is room temperature. Drinking warm, cold or too much fluid can expand your stomach to the point of causing nausea and exacerbating reflux.

Strong smells. As you are probably aware, your senses are heightened during pregnancy and that includes your sense of smell.

All personal food aversions. Each of our pregnancy experiences vary and that is also the case when it comes to the foods that we crave and dislike. Listen to those cues of aversions to avoid an unnecessary illness. If that aversion is high in nutritive value, try a similar alternative, or seek advice from a Registered Dietitian.

If you cannot keep food and/or liquid down without vomiting, contact your doctor. He may prescribe some medication that will assist you during this period. Know the signs and symptoms of dehydration which include dizziness, weakness, decreased urination, dry eyes, headache and dry mouth or eyes. Discuss your weight gain with your doctor. If either you or your doctor do not think you are gaining weight or are not getting the food variety suggested in pregnancy (see Pregnancy Nutrition: The Basics), it is best to turn to a Registered Dietitian in your area. They can work with you on an individual basis to maximize your nutrition status – for you and your baby’s sake. One day, like me, you can share giggles with others about your food issues during pregnancy. Know that this is a phase – and this phase will certainly pass!

Pregnancy Nutrition: Foods to Avoid

As dietitians, we generally do not like to say “don’t eat this” or “don’t eat that.” We believe that most foods fit into a healthy diet. However, pregnancy is a little different. It is important that you stay away from foods that might cause undue illness or even have bad effects on your developing baby. So, err on the safe side and avoid these risky foods and drinks.

Don't let grocery shopping be intimidating during
pregnancy.  Follow these basic guidelines so you
can shop stress-free.

Foods Fostering Excessive Bacteria. Since our bodies are hyper focused on growing a human body (or more with multiples), pregnancy is a time when a woman is more vulnerable to illness. So when you are thinking about consumption of foods, you want to think bacteria minimization. I am not suggesting that you become obsessive, but I am recommending some caution. Any foods that might have more opportunities for bacterial growth are best to be avoided. These include undercooked meats and seafood; underpasteurized milks, juices and cheeses; and sprouted raw vegetables (radishes, bean sprouts, alfalfa).

Alcohol. It is unknown how much alcohol causes fetal alcohol syndrome. Most experts agree that it is recommended to abstain from all alcohol in pregnancy.

Oversupplementation. While a basic prenatal vitamin is recommended to ensure adequacy of vital nutrients, oversupplementation can have equally dangerous effects. Do not believe more is better in pregnancy. Avoid any megadosing on vitamins, herbal supplementation or any other alternative supplements unless you first get approval from your physician or dietitian.

Seafood High in Mercury. The FDA says that it is safe for pregnant women to consume up to 12 ounces of low mercury fish each week.  Shark, tilefish, king mackerel and swordfish generally have higher amounts of mercury while wild salmon, shrimp, canned white tuna, catfish and tilapia have lower amounts. Fish actually contain great amounts of protein and omega-3 fats that may assist in cognitive and brain development for your baby.  There has been so much discussion about mercury intake in pregnancy that I wonder how many pregnant women are avoiding fish altogether.  I encourage pregnant women to eat fish regularly during pregnancy, staying within the FDA guidelines.

Caffeine. Caffeine levels over 200mg per day have been shown to increase a woman’s risk for miscarriage – particularly in the first trimester. A typical 8-ounce cup of home brewed coffee contains anywhere from 95-200mg. Dark caffeinated colas contain 25-44mg per 12-ounce can. The best rule of thumb is to minimize caffeine during pregnancy for optimal outcome. If you are currently drinking large quantities of caffeine, wean off slowly to avoid uncomfortable withdrawal symptoms.

Allergy Foods. Foods that are highly allergenic should only be avoided if you have a family history of a certain allergy. There is some evidence that shows avoidance during pregnancy can help lower your baby’s chances of having that allergy. High allergenic foods include peanuts, shellfish and eggs to name a few. If there is no history, allergenic foods do not need to be avoided.

Stay tuned for the last blog post on pregnancy nutrition where we discuss nausea and illness associated with hormonal changes.  I have a pretty funny story of my own that I look forward to sharing with you!

Pregnancy Nutrition: The Basics

I was honored to have written a 3-part series on pregnancy nutrition for a great product for expectant moms.  The product is called Ritmo™ which is a sound system belt that transmits songs and stories to your baby.  I wanted to share these articles with Mommy Dietitian readers, and with the posting here, you get a bonus healthy weight gain section.  Feel free to pass them along to anyone you know that is pregnant or even thinking about becoming pregnant.

Pregnancy Nutrition: THE BASICS

Congratulations on your pregnancy! Whether it is your first child or you have been pregnant before, it is thrilling news to find out you are having a baby. As a mother of a 3 year old and a 6 year old, I can attest to the road you are on this very minute. I remember the excitement and joy, but also remember the fear of the unknown. Relax! Any new adventure naturally comes with it some fear. It is very normal. The great news is that your body knows exactly what to do in order to grow this baby. My advice is follow some basic guidelines in nutrition so you can provide the fuel required to start this baby’s life off on the right foot.

Pregnancy is certainly a great motivator to eat smart. Balanced nutrition will yield a healthy body weight and will also help you achieve the vital nutrients you and your baby need during this incredible time of growth. It amazes me to know that the blood volume in our bodies increase 45-50% in pregnancy! This increase is needed for extra blood flow to the uterus, higher metabolic needs of the fetus, and increased perfusion of other organs, especially your kidneys. All of this requires proper nutrition. We will touch on the basics of pregnancy nutrition in this article so you can hit the ground running in the right direction.

Proper Weight Gain. Studies show that gaining the right amount of weight really helps your baby in being born a normal weight. Low weight gains, especially in underweight women, are associated with increased risk of perinatal mortality and low birth weights. High weight gains, particularly in obese women, are associated with increased risk of birth weight , longer labor times, complicated deliveries and birth traumas. The first thing you want to do is figure out what your body mass index (BMI) was before getting pregnant. Once you get that BMI number, look at the table below to establish what the weight gain recommendations are for you. Your obstetrician will weigh you periodically to make sure you are on the right track.

Step 1: Figure Out Your Pre-Pregnancy Body Mass Index (BMI)
http://www.nhlbi.nih.gov/guidelines/obesity/bmi_tbl.pdf

Step 2: Follow Recommendations for Total and Rate of Weight Gain During Pregnancy, by Prepregnancy BMI















5 Key Nutrients during Pregnancy. Nutrition needs increase during pregnancy due to rapid fetal growth, and there are some key nutrients that you should focus on while you are pregnant.

Folic Acid. Folic acid, folate or less known as vitamin B9, is critical in pregnancy nutrition. Folic acid supports reactions required for rapid cell division, carbon transfers and maintenance of red blood cells during the fetal growth process. Normal female needs are 400mcg, but daily pregnancy needs are 600mcg. Due to the critical nature of this nutrient during pregnancy, it is recommended that all pregnant women take 400mcg of a folic acid supplement to ensure adequacy (if taking a prenatal vitamin, the folic acid requirements should be included). However, foods that are high in folic acid include fruits and vegetables (especially leafy greens), whole grains and fortified cereals.

Iron. Due to the increase in blood volume as mentioned above, iron needs increase during pregnancy from 18mg to 27mg for most pregnant women.* As you progress in your pregnancy, you are at higher risk of becoming anemic due to the increased growth of the baby. Your doctor will do hematocrit finger pricks to check iron status. It is good to be mindful of foods that are naturally high in iron – such as beans, lentils, cooked spinach, fish, nuts, dried fruits, beef and other meats. There is an increase in high iron foods such as tofu of which ½ cup provides 13.2mg. Non-animal sources contain a type of iron that requires Vitamin C for absorption. Iron and calcium fight for absorption so as able, separate high iron foods from foods that are high in calcium.

Zinc. Zinc plays a vital role in protein synthesis, cell division, hormone metabolism and immune function. These bodily functions are highly utilized during pregnancy. Therefore, needs go up from 8mg to 11mg per day.* Vegetarians, depending how restrictive, may need to consider supplementation. Foods high in zinc that are recommended for pregnant women are red meat, poultry, eggs, pork, nuts, pumpkin seeds, summer squash, asparagus, chard, collard greens and broccoli.

Calcium & Vitamin D. Although needs do not increase during pregnancy, calcium (1000mg per day) and vitamin D (200-400mg per day, but amounts currently under review) are essential to bone mineralization and metabolism. Unfortunately, many women do not get adequate levels so purposeful intake is advised. Foods high in calcium are dairy foods, spinach, collard greens, soy, rhubarb and fortified cereals. Vitamin D is mostly found in dairy foods, fatty fish such as salmon and tuna; fortified foods, mushrooms and animal fat such as butter. Sunshine is an excellent source of vitamin D, so consider 15-20 minutes of daily sunshine to help achieve minimum levels.

Making a pregnancy meal plan. In general, a typical pattern should include 3 meals and 2-3 snacks each day to keep your body running well. The amounts of each type of food really depend based on your individual calorie and nutrient needs. If you are feeling nauseous, try and focus on foods that have more mild smells, spices and flavors. With my daughter, all I felt was a little nausea in the first trimester. With my son, I was very sensitive to smells and even remember changing my mind about foods mid-meal. Yuck! No worries, just make some adjustments if this happens to you. Plan around your aversions as much as you can. Overall, it is good to think this way for each meal and snack:

Breakfast: Dairy, protein, fruit, grain, healthy fat
Lunch & Dinner: Protein, vegetable, fruit, grains, dairy, healthy fat
Snacks (2-3): Protein, grains, fruit or vegetable, healthy fat

Balanced nutrition in pregnancy allows moms to
enjoy decadent treats. Here I am, pregnant with my son,
Evan, pretty excited about my baby shower cake.

Although the MyPyramid website is dynamic, a great way to get a plan that is perfect for you is to consult with a local Registered Dietitian (RD) that specializes in pregnancy nutrition. This is especially important if you have pre-existing health conditions, are having trouble getting nutrients in due to hormonal illness or have special dietary needs.

With a little proper planning and considering, you and your baby will be off on a healthy, exciting adventure. Be sure to cherish these days, write thoughts and feelings down – and above all, enjoy and appreciate this great miracle that is occurring inside your body right now. Blessings of good health to you and baby!

Linked Resources:
*Complete list of the Dietary Reference Intakes (DRIs) in Pregnancy

MyPyramid Plan for Moms

Expect the Best with Elizabeth Ward, MS, RD

Produce Variety Assurance (PVA)

Does your family have produce variety assurance (PVA)? Don’t worry. It’s a new term that I just randomly coined, but involves an important consideration. We often talk about the importance of produce and even variety within that produce, but are we really living this out in our daily lives? I recently had to ask myself that very question for my own family. Do we regularly consume fruits and vegetables? I am happy to report -yes! Do we alternate the varieties of differing kinds of produce? Hmm. Not always. We adore fresh produce and eat them regularly, but we’re like most people. We are creatures of habit! We still have that tendency to flock to our family favorites. I like to pick up some different stuff here and there, but then I slowly start going back to my habitual varieties. That’s when one of my patient’s mothers told me about a thriving local produce co-op here in the area. I immediately joined because I knew this was our family’s answer to PVA.


I just love the concept of produce-co-ops and community supported agriculture (CSA) groups for so many reasons. They bring local families together in mutual admiration for fresh foods and they promote grassroot efforts to support farmers and agriculture. Today I get to pick up my “share” of produce – whatever that may be- which will dictate our family’s menu over the next 2 weeks. What a great way to keep our experiences with food new, interesting and rich in all kinds of colorful varieties.

Our 1/2 share of  of produce via Your Health Source  food co-op.
This delivery, we opted for a full share of produce, which will be
double content.  We look forward to what we'll get this time!

Your Health Source is a family-run food co-op that coordinates the delivery of USDA certified and if possible, local produce for a variety of areas in Texas, into Oklahoma and Colorado. You can also order fresh grains, meats and other foods - and have access to health communities and recipes through e-mail distribution. I recently caught up with Monica Brown to find more information about Your Health Source. They started the co-op 9 years ago when she moved away from what she calls the “standard American diet”. The increase of fruits and vegetables in her family yielded life-changing health benefits for each family member, including helping one of her son’s behavioral problems and solving her own digestion issues. Aside from the nutritional benefits, Monica admits that one of the best benefits to her family has been the new friendships they have formed. “I know people today that I would have never known if it weren’t for the co-op. I rarely make a friend at the grocery store – but at co-op, I have friends for a lifetime now.” Monica is also appreciative that her children have had the benefit of witnessing so many families striving to make healthy choices. Her and her husband see their co-op as a way to serve families everywhere that yield the highest of health benefits. It is families like the Brown’s that inspire us all to make health investments in our local communities. After all, it is one of the many things First Lady Michelle Obama encourages in the Let’s Move initiative to fight childhood obesity.

If you want to promote PVA in your family, consider joining a produce co-op, community supported agriculture (CSA) group, schedule regular visits at your local farmer’s market or just reach out to a local farmer. What a great way to expose your children and family to the colors of the produce rainbow! If you have anything to share on the subject, I would love to hear from you.

For more information on The Brown Family’s co-op, go to their website below. A special thanks to my friend and dietitian colleague, Robin Plotkin, for giving me the Edible Communities websites below. What a wonderful resource for us all.

Online Resources for Produce Co-ops, CSAs, Organic and Local Foods

Your Health Source Co-Op: http://www.yourhealthsource.org/
Local Harvest: http://www.localharvest.org/
USDA's Farmer's Market search: http://apps.ams.usda.gov/FarmersMarkets/
Pick Texas: http://www.picktexas.com/
Edible DFW (for the Dallas/Fort Worth area): http://www.ediblecommunities.com/dallasfortworth/
Edible Communities (for all areas throughout the U.S.): http://www.editblecommunities.com/
USDA’s Fruits & Veggies More Matters (includes recipes by produce type): http://www.fruitsandveggiesmorematters.org/