Gluten-Free Foods That Kids Will Enjoy!

I see many children that are newly diagnosed with gluten intolerance or celiac disease, and the normal reaction from parents is feeling overwhelmed. After all, it is an entirely different diet that their kids must follow and many of these kids already have limited preferences. What I do is educate the family on getting their child’s diet and life gluten-free and also monitor growth trends as we make the transition. This diet can also put them at risk for certain nutrient deficiencies, so making sure they are getting what they need is important as well.

Recently, I saw an almost 9 year old boy, Noah, whom his mother, Monica, called a “picky eater.” She was very concerned about how he would transition to totally new food because he loved foods that had gluten. After our initial education, Monica made it her priority to try a large variety of products on Noah and because of her efforts, Noah is still growing normally. She sent me a very detailed e-mail with specific gluten-free products that Noah likes and I thought it would be helpful for other families with children following gluten-free prescriptions. Please note that the following suggestions are not direct suggestions from me, but suggestions from a mother on the front lines of the gluten-free lifestyle. And I think very highly of my moms! Let me tell you, they get all the kudos out there, seen and unseen. As you know, bread products are the most challenging items for this type of diet so they are emphasized here. Add plenty of fruits, vegetables, lean protein and low-fat dairy to round out a well-balanced gluten-free diet.

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Noah with his family in Jamaica.

From mom, Monica: I get all the following gluten-free products at either Walmart (W), Kroger (K), Sprouts (S) or in bulk from Amazon.com (A). I think the most important thing to tell the parents of your future patients is that there are good tasting GF products out there BUT that realistically they will never be able to match the exact texture of regular wheat products because gluten is what gives elasticity to dough, helps it to rise and to keep its shape, and gives the final baked product its chewy texture. Noah has had to work through this aspect of GF foods and is getting much better. Chris and I try every product we buy and the rule is that if we think it's good then he has to try it a few times before he can decide whether he likes it or not. Now don't get me wrong, there are some GF products that are so gross in texture (think sawdust or kitchen sponge - yuk!) that I would never make him eat it and I have had to simply throw them away after a couple of bites. Anyone that knows me knows that I hate to waste food BUT some I couldn't even choke down myself to try and save money and not waste:) The good news is that Noah is a very picky, textural eater and if he has been able to find the items below that he enjoys, everybody should be able to find some items they'll enjoy too.

Breakfast

• Chex cereals have five flavors that are GF - Noah likes the chocolate and cinnamon Chex best. (W, K)

• Post makes GF Fruity Pebbles cereal (W, K)

• Van's makes frozen waffles that are really good in Apple Cinnamon and Blueberry flavors. (S, K)

Bisquick makes an amazing GF pancake and baking mix that can be used to make easy pancakes, waffles, biscuits, pizza crusts, breading for homemade chicken fingers and oven baked fried chicken - yum! (W, K)

• Kinnikinnick makes some good GF Donuts and Blueberry Muffins. Noah's favorite donuts are the Chocolate Glazed (S)

• Betty Lou's makes some great cereal/breakfast bar replacements they call fruit bars. You can buy them individually at Sprouts or buy them in bulk (12) on Amazon. Noah like the Blueberry, Strawberry and Cherry but they also have Apricot and Apple Cinnamon. (S, A)

• Udi's White Sandwich Bread to make toast with jelly or GF french toast. Udi's also makes an excellent cranberry granola mix. (S)

Lunch

As I mentioned above, the Udi's brand makes the absolute BEST GF bread, hot dog and hamburger buns. There isn't an other brand we tried that even comes close to Udi's. The bread is quite a bit smaller than regular sized loaves (Noah called it toy bread at first) and the texture is a little bit different than regular bread (as is the case with all baked GF products) but it isn't too different and the taste is the absolute best with no sour aftertaste (which we found in most the other brands we tried - yuck!) The great thing about Udi's is that it is one of the only brands that is SHELF STABLE meaning that as soon as I buy it from the freezer section at Sprouts I leave it out on my counter to thaw and it lasts for the whole week without spoiling. This IS NOT the case with most other GF bread - you buy them frozen and then you have to keep them frozen or they go bad quickly. I found that if I put two slices in the microwave for 10 seconds on each side before I make his sandwich it helps to improve texture and soften the bread a bit. We make sandwiches, grilled cheeses, PB&J's, hot dogs and hamburgers with the Udi's products. (S,K)

Pamela's Products makes the best GF bread mix to make at home in a bread machine. (S, K) I add two teaspoons of honey to the mix in my bread maker and it makes it taste more like the honey wheat bread Noah used to eat. I also love and highly recommend the West Bend Hi-Rise Bread Maker I bought from Walmart.com. It was only $90 and makes beautiful, perfect horizontal loaves - very important as most other bread makers make weird vertical loaves that when sliced make almost comical-looking, super tall and skinny slices of bread. It also has a setting to mix and knead perfect pizza dough also using the Pamela's Products Mix. But bottom line, if your looking for convenience, Udi's is the way to go.

Dinner

• Annie's makes a great rice pasta & cheddar GF macaroni and cheese (W, K, S)

• Ian's makes the best GF chicken nugget or chicken tenders. (S)

• Heartland makes the best GF corn and rice blend spaghetti noodles. (W) It taste and has the exact texture of regular spaghetti.

Desserts

• Betty Crocker now has four affordable GF mixes that are great. The offer chocolate cake, yellow cake, brownie and chocolate chip cookie. Noah loves the Chocolate Cake and Brownies the best. We use Duncan Hines whipped frostings on the cakes. They are all GF. (W, K)

• Kinnikinnick makes great Oreo cookie replacements called Kini-Toos. (S)

This blog post was specifically for children and adults with gluten intolerance and celiac disease. I do not advocate a gluten free lifestyle for general wellness. Seek the advice of a Registered Dietitian before beginning any new diet to avoid nutrient deficiency. The removal of gluten entails more than just food restrictions, so it is important to seek advice from dietitians who specialize in gluten-free education. Do not simply rely on Internet references including this one to go gluten-free.

More Than a Meal: Benefits of Eating Together

This past weekend, I was honored to speak at the Texas PTA Leadership Conference in Austin, TX on the importance of family mealtimes. The benefits of family meals go far beyond nutrition. Did you know that young people who reported eating dinner with their family 5 or more times per week were much likelier to report receiving either all A’s or mostly A’s and B’s in school? Other key items from research include:

• Mealtime conversations help children acquire and improve the language skills that are critical for school success. Children learn new vocabulary, sentence structure, and how to share their point of view with other people.

The benefits of family meals go beyond nutrition.

• Conversations at the family table taught children more vocabulary than they learned from their parents reading books to them.

• Elementary school children who did well in class and on achievement tests were those who generally spent larger amounts of time eating meals with their families.

• Eating meals with their family was a stronger predictor of academic success than whether they lived with one or both parents.

• The more often families eat together the less likely teens are to smoke cigarettes, use illegal drugs, abuse alcohol, become depressed, develop eating disorders, or get pregnant.

Nutrition Benefits
We can’t deny the family mealtime benefits on your child’s current and future nutrition. They include:

• More likely to have a healthy weight

• Less likely to become or stay overweight

• Less likely to develop an eating disorder

• Family meals during adolescence had a lasting positive influence on the quality of their diets and meal patterns, such as eating breakfast. In other words, having family meals with your teenagers improves their chances of eating right in their 20’s.

• Young people who eat more often with their families have higher intakes of fruits, vegetables, grains, and dairy foods.

• For teens, more regular family meals mean fewer fried foods and soft drinks. These adolescents also have higher intakes of key nutrients like calcium, iron, vitamins A, B6, C, E, and folate, as well as fiber.

Keeping It Simple
The great thing to know is that the meal does not need to be complicated to have all of these great benefits. If you are super strapped for time, these ideas don’t even need a recipe:

• Flank steak with tossed salad and frozen vegetables

• Pasta with frozen or canned shrimp, sautéed in olive oil with onion and garlic

• Cheese omelet with tossed salad

• Tuna salad in a whole wheat wrap made with reduced-fat mayonnaise

• Black beans and brown or wild rice with frozen veggies

• Spinach salad with grilled chicken, mandarin oranges, and slivered almonds

• Peanut butter and banana sandwich on 100% whole-wheat bread

• Hamburgers (made with lean ground beef) on whole-grain buns, with boiled potatoes and frozen vegetables

Add some skim/1% milk as a beverage, add quick veggies as needed and serve fresh fruit as a dessert – and you have a very well-rounded stress-free meal.  Remember, eliminate all distractions and make all mealtime discussions pleasant and friendly.  Involve your kids in the recipe selection, shopping and preparation for maximum impact.  And if you are not eating at least 5 meals as a family, consider adding one per week. Dinner is a great time, but breakfasts and lunches work as well.

Eating together is one of the best things we can do as a family to enrich the quality of our children’s lives. Commit today to make family meals a priority in your home and watch all the great things that will follow.

Sportline Product Giveaway!

Mommy Dietitian Facebook page!  All winners are announced on Facebook.>

Well, you heard my Summer Wellness Confessions: And Plans to Execute. Now I want to hear from you! Together, let's stay active all summer long for our own health's sake, and to model healthy behaviors for our children.  For a bit of incentive, we are giving away a couple great fitness monitors courtesy of Sportline. There will be one winner for each of the following items:



Sportline Women's DUO 1010 Heart Rate Monitor



Sportline Women’s DUO 1010 Heart Rate Monitor ($69.99 value): A heart rate monitor can set the proper pace for any kind of workout by ensuring the user stays within a certain heartbeat per  minute zone to get a more effective workout. This monitor is a works with or without a chest strap. Simple to use, but full of features, the DUO 1010 allows for continuous and on-demand HR monitoring. Activate your heart rate by touching the watch face (no chest strap required), or utilize the included chest strap for continuous measurement. The DUO 1010 provides EKG accurate data and helps the user increase or decrease intensity to get a more effective workout. The DUO 1010 has pre-defined HR zones, audible alerts, numerous heart rate indicators, and tracks calorie burned.

Sportline Qlip Any-Wear Pedometer

Sportline Qlip Any-Wear Pedometer ($34.99 value): Those who walk fewer than 5,000 steps a day are more likely to be overweight…people walking 9,000+ steps daily are more likely to be of normal weight. Pedometers are a great way to get and stay motivated in your walking routine. It’s an advanced digital pedometer that can be worn (clipped) anywhere on the body and provides real-time feedback for individuals pursuing fitness and walking goals, including accurately tracking steps, distance, and calories burned.

I have personally tried both of these items while running and they are quality pieces that provided accurate data for me.

How Does The Giveaway Work? Get one entry for doing any or all of the following:

- Describe at least one thing that you and/or your family has changed to increase your health in 2011 on the Mommy Dietitian Facebook page.

- List out ingredients and directions for a quick, healthy but tasty recipe for a meal or snack on the Mommy Dietitian Facebook page.

- Recommend the Mommy Dietitian Facebook page your family and friends using the “share” button (you can find at the bottom left column of the Mommy Dietitian Facebook page). Make sure to tag us in your status by entering @MommyDietitian in your comment of your post so we count this as an entry.

Please do not include links on your posts on your Mommy Dietitian page comments (any comments with links will not get an entry). This giveaway is not for the purposes of promoting a product or service, but instead providing general ways to include more whole foods and physical activity.

The more entries you have, the better chances of winning! Winners will be selected using randomizer.org. Enter to win through 11:59 PM Friday, July 8th, 2011. Best of luck!!

Special thanks to Nada Shabana, Mommy Dietitian dietetic intern for co-authoring this post, and to Sportline for sponsoring this giveaway.

Summer Wellness Confessions - And Plans to Execute!

As a mother with a school-aged child, I was filled with fear in the pit of my stomach. School was letting out for the summer and I was reminded of the chaos that ensued in the last month of summer last year. I had joined my mother friends in counting the days down until the little “balls of energy” would be back in school. You see, I nicknamed my daughter the “Texas Tornado” very early in her life because she has the capacity to pull out every craft, coloring book and toy in less than 10 minutes flat.  (I am sure you can relate, many of our kids are TTs!) And I have to admit, my private practice was pretty busy at that time and following through on a consistent schedule fell by the wayside. What can I say, I am human just like you. Although I still make a point of staying home 2 days per week to be with my 4 year old son, it takes a conscious effort to keep my work at my office. I guess it’s the struggle of most people that own their own businesses. {sigh}

Well, I have consciously squashed that fear and vow to maximize my time with both my husband and children during the summer months   Join me!  Family time must be kept a priority and when you see other things are taking precedence – re-align those priorities. After all, I love what I do, but what is it all for anyway I can't find time to spend with my own family, and also live out the wellness aspects I educate on?  I had recently done two media interviews – one with My Healthy Steps by Jokari and one with our local NBC Dallas/Fort Worth affiliate on keeping kids eating healthy through the summer months. This started me thinking about my own family challenges - getting the practical logistics down, a plan of family plan of action to staying active together and making family time a priority.   Doesn't it usually boil down to logistics?  Believe me, I can relate.

Our family at the Desert View, Grand Canyon.

I have to admit, we started this summer off very well as a family. My husband and I absolutely love the outdoors and this summer, we chose to explore the New Mexico and Arizona areas with our children. We bravely set out on a road trip with our 4 and 7 year old – and purposely gravitated toward active outdoor activities that the kids would enjoy and be able to do along with us. We visited a still-inhabited American Indian mesa where we got to see how families still live on top of a mountain with no electric or running water. The kids really loved the raft trip we did in Page, Arizona where we went down the smooth part of the Colorado River and learned about the local history. A highlight of the trip was making it out the incredible, breathtaking Grand Canyon where the kids got to work on being junior park rangers, get up and close with some tame wildlife and even do some canyon hikes. But I think my favorite part of the trip, other than the quality time spent as a family, was our 4-wheel jeep experience in Sedona, Arizona. We climbed some crazy, large rocks with an unstoppable Rubicon Jeep! The kids blew us away by climbing up submarine rock like little monkeys! All in all, it was an amazing trip where we got to challenge our bodies physically, enjoy local food flavors and maximize nutrient-rich eating.

Now that we are back from vacation, I am pumped up! Feeling invigorated by time away, morning runs, day hikes and optimized nutrition on the trip, I want to keep the momentum going with the kids. (Not to mention the book on tape my husband I were listening to in the car – A Walk in the Woods: Rediscovering America on the Appalachian Trail by Bill Bryson) As we were making the trek back, I realized that other moms and dads out there are probably wondering – how to keep the family healthy, happy and sane during the summer months. Here is what I came up with for our family during the car ride, and I hope it helps your family.

First of all -- have a plan! Again, it sounds so obvious, but we start the summer off feeling relieved that we don’t have to be crazy busy in the morning by getting the kids to school. So we savor that for a couple weeks. But then we realize that there is no plan and the kids are taking over! It’s better to start with a plan. Here are some things you can consider adding to your own customized family plan.  If there are two working parents, pay special attention to your child's daycare activities and nutrition plan - balance is key.  Plan family activities in the evenings and on the weekends.  Now, let's get that calendar out and start planning.

ACTIVITIES

• Plan in family exercise/active fun. I need to hear 'family' on this myself because I love my early morning runs with my iPod -- alone. Other than sleeping, it’s really the only time I have to myself. But I have decided to let go of that during the week and take the kids out with me (but the weekend runs are still mine!!). There is a small man made lake within walking distance of our home filled with ducks and water fountains. On the days I am home with the kids, I take the kids out there to feed the ducks, play Frisbee and even run a bit with me. There is also a playground down from that lake that I take the kids to while run around the playground block. Yes, it is different than my runs by myself and my husband had to remind me to flex here (thanks, Jeff!). When I flexed, I realized that I opened myself up to some great time with the children and starting their days off active and energy expended (remember, Texas Tornado??). Hannah actually loves to run herself, and can easily make it around the lake at least one time! This running will help keep her in shape for when soccer season starts back up. Other things to consider doing as a family is camping, hiking, walking, biking, running and swimming. Even a sprinkler, water guns and slip n’ slides offer cheap ways to keep the kids outdoors and running around.  Our family looks forward to doing day hikes at local parks on the weekends!  Explore your area this summer.

• Local Communities. Our public library has a family story time 2 days per week from 11:15 – 11:45. We will do our morning outdoor time, get cleaned up and head over to the library for some summer reading. Our city also has tons of outdoor events and activities that the kids and/or the family can take part of all summer long. We have decided to take part in many of them and are on our calendar.  Check your local area for free events that your family can enjoy.

• Co-op. Moms of your children’s friends are looking for things for their children to do just like you. Set-up a schedule with one or two moms where you can take each other’s kids so you can get some grocery shopping done or have some much needed downtime.

• Summer Camps. Hannah and I are actually scheduled to go to our church summer camp in July. I will be her cabin’s camp counselor – and this will allow us to have extra special time together. The camp also has active, outdoor things to do such as zip line, horseback riding, biking and challenge courses. Summer camps fill up fast, so hopefully you have yours booked!

NUTRITION

• Have fun with food. My free resource page on my professional website provides many websites that give great reliable nutrition information, recipes and ideas to make food production and learning fun. Involve your kids in the planning, shopping and preparation process as much as possible. Take a cooking class as a family so kids can have stress-free experiences playing with outside of meal time.

• Gain back home-cooked meal momentum. Even though I am a nutrition educator, our family still falls off the wagon some weeks where we eat out a bit too much. I may have a business deadline to meet, travel to speak or overloaded with patient paperwork so we grab take out for survival. Ironically, I may be speaking on this very subject! The beginning of any season, including summer, is a great time to try new recipes and get your weekly shopping routine going again.

• Keep proper hydration a priority! Kids can get dehydrated fast, so as we encourage outdoor activity, also encourage proper hydration. (see my blog post, "The Must Knows of Outdoor Hydration with Children.")

• Shop Local. Local produce is typically higher in nutrient content because the distance from farm to plate is much shorter. Shop local by visiting your local farmer’s market – seek out local producer sheds. Make it a game with your kids by making a taste test worksheet. List the local produce that is there and have them taste it for the taste test. I’ve done this many times with groups of children, and you wouldn’t believe how much more likely they will try the food when it’s a “taste test.”

• Pantry Clean-out. Aside from nutrition, this must be done for food safety purposes! The last time I went into my pantry, I think there was still some Easter candy lingering in there.  Oops!  What's in your pantry? Do your own assessment on your pantry and fridge – I’d say that at least 90% of foods should be what I can “always” foods – lean protein, whole grains, healthy fats, fruits, vegetables and low-fat dairy. Put the always foods where you can see them and make them convenient for everyone to enjoy.

• Utilize the new MyPlate icon and resources. It is a great visual to start with when loading your family plates. The website still provides personalized plans and tons of resources. Get acquainted with it and then teach those principles to your kids in fun, creative ways (see my post, MyPlate: A Nutrition Educator's Perspective).

Like I always tell people, a healthy lifestyle is not perfectly linear.  It ebbs and flows.  What I love about what I do is that I am constantly reminded of healthy behaviors for my own family, at the same time, share those same practical tips with you. So - the things listed above are our calendar this summer.  How about yours? I would love to hear what your family has planned this summer that will keep everyone active and healthy. My family may take on some of your ideas. Let’s share!

MyPlate: A Nutrition Educator's Perspective

Goodbye, Food Guide Pyramid.  Mr. Pyramid, you've had a good run, but your place is now inside the history books - we appreciate your efforts in keeping Americans healthy.  There's a new graphic in town that's gonna try to improve on your healthy diet messaging.

Well, I'm hear Kingsville, Texas on a very interesting food investigation (future post!) so I was unable to join the news conference yesterday on the unveiling of the new USDA's MyPlate, which is the new icon that replaces the MyPyramid graphic. 

The MyPlate was rolled out with the intention of educating the new 2010 USDA Dietary Guidelines (just like the MyPyramid attempted in the past guidelines). The key messages here are:



Introducing MyPlate - the USDA MyPyramid replacement.


Balancing Calories

• Enjoy your food but eat less.
• Avoid oversized portions

Foods to Increase

• Make half your plate fruits and vegetables
• Make at least half of your grains whole
• Switch to fat-free or low-fat (1% milk)

Foods to Reduce

• Compare sodium in foods like soup, bread, and frozen meals ― and choose the foods with lower numbers.
• Drink water instead of sugary drinks.

PROS: The MyPlate graphic reminds me of the Idaho Plate Method that has been out for years.  In the past, I have used it with my adult weight management patients and it works very well.  In fact, I used to give out compartment plates to them so they could practice loading their plate appropriately.  This visual helped patients not only eat the right types of foods, but give them an idea of portion size for each food group.  So this MyPlate visual is something I really appreciate as a clinician, and one that I believe will translate better to consumers.

I also like how the USDA has produced some printable aids that further allow consumers to understand and put the MyPlate into practice.  Their Let's Eat For the Health of It provides practical tips that families can use.  The 10 Tip Series is an educational set that delves deeper into the key messages of the 2010 Dietary Guidelines.  They can be viewed online or printed for future reference.  I am pleased that the Get a Personalized Plan feature was not pulled off the new website, which is now http://www.choosemyplate.com/.  I used this feature with the old MyPyramid plan and it really helps people see how much of each food group they need for proper nutrition.  This personalized information can be integrated into the new graphic as well.

CONS:  I had hoped that the focus on vegetables would translate into half the visual plate and place the fruit portion on the side like the milk.  Again, this is how the Idaho Plate Method's visual had it and it looks like more food, maximizes vegetable intake and it shows consumers that they could get their sweet treat after a meal using fresh fruit.

Just like the other food guidance graphics, consumers need to know that this guidance is for the average American without special nutritional needs.  It may not be completely appropriate for people with increased calorie needs (athletes, those dealing with injury or disease) or that are on special diets.  The good news is that dietitians can put together custom plans that can assist with special populations.

It will be interesting to see how MyPlate translates to consumers.  I plan to do a little sample study among my own patient population to see if this new graphic really does help them eat better.  What do you think?  I would love to hear your thoughts!

The Mom Chronicles: Mystery Diagnosis

Meet the Berenger family – Greg, Susan and daughter Ashley.

When Greg & Susan had Ashley, she immediately started having health problems. After they took her home from the hospital, they would feed her a bottle and it just appeared as if she couldn’t breathe and drink her bottle at the same time. They brought her into the doctor and she was immediately hospitalized for severe apnea (stopped breathing) and reflux. She actually stopped breathing 60 times in 12 hours! Greg & Susan were so thankful that they got her in. The doctors acknowledged the severity of her apnea, but reassured us that this will be something she will outgrow. In the meantime, she had to be on an apnea monitor for her first year of life. Unfortunately, her apneic episodes and reflux impacted her growth and she had been diagnosed with failure to thrive. One doctor even told them that these babies “don’t typically survive.” They were amazed at the comment, but pressed forward diligently. The reflux and failure to thrive was somewhat relieved by switching to a formula that was easier on her tummy. She gained weight and we just figured we’d have a smaller child. Both the apnea and reflux were pretty much resolved and they went on with our lives.

Flash forward to toddlerhood and Ashley began having chronic respiratory infections. These were not just any typical respiratory infection – they would last 3 weeks long, require intense breathing treatments and they were, at times, back to back. Susan just remembers that time as “survival mode”. Both Greg & Steve suspected that something wasn’t right. But their pediatrician just kept sending them home with medications and assured them that this is also something she will outgrow. Susan recalls some of the things other people would say to her during this time like, “Why don’t you just let Ashley just wear out her illness instead of always putting her on that medication?” Or, “If you just put this “special salve” on her feet and then cover it with socks, she won’t get sick anymore.” Others obviously didn’t understand the severity of Ashley’s respiratory illness!

Finally, when Ashley was 4 years old, she was referred to an allergist where they started investigating. She started receiving allergy shots, but unfortunately, they were never able to get to the maintenance level before she would get sick again.

Diagnosis At Last
Susan was exhausted and ready to get some answers. Her local allergist in their small town ran more tests and a major diagnosis was discovered. Ashley had Common Variable Immune Deficiency, or CVID. CVID is a disorder characterized by low levels of serum immunoglobulins (antibodies) and an increased susceptibility to infections. The exact cause of the low levels of serum immunoglobulins is usually not known. As scary as the diagnosis was at first, at least they could look back and see a common theme and see the connection. Now, Ashley goes to Dr. Richard Wasserman in Dallas – even though the drive is several hours from their small Texas town – Susan believes he is one of the best pediatric immunologists in the area.

Last year, Dr. Wasserman ran some more tests because it appeared that her illnesses continued to get closer and closer together despite managing her asthma and allergies. The tests revealed that her immune system needed help so they began monthly gamma globulin infusions to provide Ashley’s body with the antibodies needed to fend off illness. Although she has been out over 29 days of school for her infusions, no major illnesses have occurred since starting this treatment.

Dietitian Assistance
Ashley was now 12 years old and was still having trouble with weight gain and very low energy. The Berenger’s were referred to a pediatric dietitian, although Susan was not sure what the dietitian could do more than what she had already been doing. To their surprise, targeted food therapy allowed her to double her calories! Some supplements are available for retail sale, but what Susan learned is that dietitians have access to many different types of caloric substances that the public does not and they know how to use them in targeted ways. Within a couple weeks of the high calorie prescription, Ashley was a different person. At her tennis lessons, she used to only have enough energy for half a lesson and she got so tired that Susan had to hold her racquet. One day not long after food therapy started, her tennis coach saw a different girl. She was running around the court – completed her lesson – and was even joking and carrying on with him! Ashley has been making excellent strides in both weight and height since seeing a dietitian.  The hope is that she can have significant catch-up growth as she continues on this food therapy.

Greg and Susan recommend the Immune Deficiency Foundation for reliable information on any suspected or diagnosed immune disorders (be careful to self-diagnose, always refer back to your physician or physician specialist). As for her, she does not prefer community forums because many times she would see horrible cases that made her worry more. She needed to stay positive for Ashley’s sake. What does help her is that she uses an 8 ½ x 11 planner and tracks Ashley’s trends – illnesses, food intake and even weather changes. This really helps her identify problems before they begin.

Susan learned 2 major lessons along the way. Listen to your gut instincts. She knew something was not right with her little girl and she wished she had demanded further investigations sooner (even though surprisingly, only about 20% patients are diagnosed before age 16). And she wished she had dietitian guidance sooner so Ashley could have grown more aggressively despite her illnesses. She wonders now how her lack of nutrition played a role in the frequency of her illnesses.

If you suspect that you or your child has an immune disorder, talk it over with your doctor, or even seek the advice of an immunologist for further testing.
To find a Registered Dietitian in your area that specializes in your or your family’s nutrition needs, go to the American Dietetic Association’s Find a Registered Dietitian link on the top right of the main page.

Names were altered for privacy.

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To all my families that graciously gave of their time to participate in The Mom Chronicles, thank you! We hope that by reading these posts that at least one family dealing with a chronic illness is helped and/or encouraged to demand good medical care, reach out for community support (reputable forums as listed, family/friends and/or faith-based organizations) and seek the guidance of a Registered Dietitian. If you are blessed to have children with good health, may these posts serve as a reminder of how fortunate you are. This post completes our series on The Mom Chronicles.

The Mom Chronicles: VACTERL Syndrome

Here we are with our second installment of The Mom Chronicles.  The format going forward will be a bit different with it being told as a story after interviewing the family versus question and answer format in the first post.  The next couple stories are a powerful account of how the dietetic profession can have such a positive impact on health and it makes me proud of what we do.  Some people think of dietitians as weight management experts, but clinical nutrition is an area that directly shows the influence of food therapy on the body's growth as well as its recovery and management of disease.  Even though the Mommy Dietitian Blog primarily discusses wellness, it happens to be my favorite line of work.

Meet the Duncan family – Jessica, Bill and daughter Ronda.

Jessica and Bill were a newly married couple that had children in their future. As life would have it like many other couples, they unexpectedly got pregnant anyway despite being on birth control. Throughout her 9 months of pregnancy, the couple was told that they were having a healthy baby. But at delivery, they discovered that their precious baby had a rare disorder called VACTERL Syndrome or VACTERL Association. “VACTERL” is an acronym that lists the congenital anomalies that these children can have – most children born with this syndrome have three or more. In their baby, Ronda’s case, that was the case. She had congenital heart defects, her esophagus was unattached to her stomach and she had limb and shoulder disfiguration. Ronda went through dozens of surgeries and was not even fed by mouth until she was 5 months of age. Jessica was extremely thankful that when she was fed, she took the bottle very easily instead of having trouble accepting something in her mouth (which is often the case in late oral feeding). Ronda had clinical failure to thrive from the beginning and it was a constant struggle to keep weight on her.

Jessica says that the one thing that she wishes she had back then was a referral to a Registered Dietitian (RD). Her growth had failed so badly that now she is on growth hormone to assist catch-up growth. You see, Ronda is now 13 years old and was just referred to an RD by her gastroenterologist who regularly refers patients for nutrition guidance. Now that Ronda is being followed by a pediatric dietitian, she is catching up on growth. And more immediate, Jessica saw an obvious change in Ronda’s energy and stamina followed by strength. Ronda’s lingering health issue is mainly her esophageal atresia, which causes a continual narrowing of the esophagus. She needs to get her esophagus dilated every 4 weeks and as that date gets closer each time, Ronda’s ability to swallow certain food items diminish due to the diameter of the opening. For this reason, she is fed at night with a feeding tube. However, their issue was that they were giving her the maximum that her body could take at night and she was still not gaining weight appropriately. The dietitian helped in switching to a formula more dense in calories to double calories in the time infused and she also coached them on maximizing oral calories with special attention to food textures. The ultimate goal is to maximize catch-up growth, wean Ronda off the tube feedings and get her eating 100% by mouth so she can feel like a normal teenager. They now feel like they’re well on their way to achieving these goals. Their challenges are by no means over, but Ronda and her family is seeing life down the road easier to manage. 

What resources would you recommend for any family that has a child with similar issues?

The Vater Connection: a community forum of families that have children born with VACTERL Syndrome. (previously named VATER Syndrome, but later congenital anomalies added to lengthen the acronym)

EA/TEF Child & Family Support Connection: was formed by and for families of children born with (Esophageal Atresia and Tracheoesophageal Fistula) EA/TEF and the medical professionals who treat them dedicated in providing educational resources as well as emotional and practical support to aid in the daily care of our medically fragile children.

To find a Registered Dietitian in your area that specializes in your or your family’s nutrition needs, go to the American Dietetic Association’s Find a Registered Dietitian link on the top right of the main page.

Family names were altered for privacy.